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The perceived severity of a disease and the impact of the vocabulary used to convey information: using Rasch scaling in a simulated oncological scenario

The perceived severity of a disease and the impact of the vocabulary used to convey information: using Rasch scaling in a simulated oncological scenario

in a cancer scenario depends on the “perceived severity of the disease”, which in turn depends on how the patient has been informed about his/her condition, that is, whether the tumor is malignant or benign or is a benign tumor that could become malignant in the future or increase in size. This may also include advice about the type of treatment (ie, watchful waiting or surgery). The present study investigates more deeply the extent to which the patient perceives the severity of his/her condition. This was done by focusing on a set of information which includes some of the topics con- sidered in Gavaruzzi et al’s study, but further aspects were also investigated relating to the nature of the disease, and the duration and side effects of the treatment and their impact on the patient’s quality of life. In particular, the research focused on three dimensions: the participant’s perception of the condition of his/her health (H), the degree of risk (R), and the degree of commitment relating to the treatment prescribed (T). The relationship among these three ratings was studied, and the effects of modulating the information

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COPD exacerbations by disease severity in England

COPD exacerbations by disease severity in England

Patients in the most severe category (GOLD D) experienced nearly three times the number of exacerbations and COPD- related hospital admissions as those in the least severe cat- egory (GOLD A). In addition to a year over year increase in exacerbations over the study period, GP visits were found to increase substantially with disease severity; however, for higher severity categories, GP visits decreased over time. These findings suggest a possible shift of patient care from primary to secondary care driven by the progressive sever- ity of the disease. Our findings suggest that management of COPD in earlier stages to stabilize disease progression could be beneficial for reducing exacerbation frequency and health care resource utilization.

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Association between LDL, Apolipoprotein B Apolipoprotein A I and Lipoprotein(a) and Severity of Coronary Artery Disease Based on Coronary Angiography

Association between LDL, Apolipoprotein B Apolipoprotein A I and Lipoprotein(a) and Severity of Coronary Artery Disease Based on Coronary Angiography

Atherosclerosis is the most important contributor to increasing burden of coronary artery disease (CAD). Growing evidence suggests that the ratios of Apo B/Apo A-I and Lp(a) are better indexes for risk assessment of CAD. Elevated plasma levels of lipoprotein(a) in humans represent a major in- herited risk factor for atherosclerosis. Thus, a study was performed to determine the association betwwen serum Apo B, Apo A-I, and lipoprotein(a) levels, and severity of CAD in patients with CAD confirmed on coronary angiography findings. An analytical case control study was carried out with 85 patients (58 males and 27 females) 40 - 60 years of age confirmed as having CAD on coronary angiography and 85 age and sex matched healthy volunteers as controls. Serum samples were analyzed for Apo A-1 LDL, Apo B, Apo A-I, and lipoprotein(a) concentration and the severity of CAD was assessed using coronary angiography scoring method. Patients with CAD had significantly high serum LDL-C, Apo B and Lp(a) levels compared to control subjects. However, serum Apo A-I level did not show a significant difference between two groups. Subjects with a positive family history of CAD with increased serum Lp(a) ≥ 17.3 mg/dL have high risk for development of CAD. Present study suggests that serum Lp(a) cut-off value of 17.3 mg/dL may be an important predic- tor in ruling out major vessel disease and luminal narrowing by atheroma.

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Comorbidity in chronic obstructive pulmonary disease. Related to disease severity?

Comorbidity in chronic obstructive pulmonary disease. Related to disease severity?

in our study, the univariate analysis Charlson score increased significantly with increasing disease severity (Table 2), but in the multivariate regression analysis, COPD severity was not significantly associated with Charlson score (Table 5). Both studies have important methodological differences between them. In our study unlike theirs, the measurement of comorbidities in relation to the severity of COPD was the main objective, comorbidities were recorded as a pre- determined list of 24 diseases (Supplementary material) and as a predefined list of diseases used to calculate the Charlson index, participating investigators had full access to the patients’ medical records and patients were recruited from internal medicine departments. For example, in rela- tion with this latest point, in Agusti’s study the prevalence of diabetes mellitus was 10% and heart failure 7%, versus 31% and 23% in ours.

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Human Rhinovirus and Disease Severity in Children

Human Rhinovirus and Disease Severity in Children

Our results showed a high incidence of HRVand RSV in ARIs in young children, and the majority of the HRV infections involved mild symptoms. However, we also found HRV in moderate to severe cases, and this study highlighted the importance of the association of this virus with coinfection with RSV, prematurity, congenital heart disease, or noninfectious respiratory disease in symptom severity. Also, early age as the only factor might not have played a role in more severe disease. These important fi ndings may help chil- dren who are at higher risk of more se- vere respiratory disease.

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Disease Severity and Immune Activity Relate to Distinct Interkingdom Gut Microbiome States in Ethnically Distinct Ulcerative Colitis Patients

Disease Severity and Immune Activity Relate to Distinct Interkingdom Gut Microbiome States in Ethnically Distinct Ulcerative Colitis Patients

MCS-associated luminal products, which include host- and/or microbe-derived immunomodulatory metabolites, provide a multifaceted mechanism by which a pathogenic gut microbiota may influence host physiology and dictate clinical disease severity. Though pathogen-associated molecular patterns (PAMPs) have traditionally been considered paramount to driving host immune responses to microbes, emerging data in the field of immuno- metabolism indicate that microbe-derived metabolites are equally effective in dictating immune cell phenotypes. In addition to the established direct immunomodulatory activity of microbe- derived metabolites such as short-chain fatty acids or p-cresol sul- fate (16, 38), recent studies have demonstrated that the gut microbiota-associated metabolites taurine, histamine, and sper- mine comodulate NLRP6 inflammasome signaling, epithelial IL-18 secretion, and downstream antimicrobial peptide produc- tion (43). Indeed, our data suggest that specific programs of microbe-derived metabolism in combination with an array of PAMPs presented by pathogenic bacteria and fungi in the distal gut of UC patients serve as effective drivers of immune dysfunc- tion related to UC disease severity. Support for this concept comes from our demonstration ex vivo that sterile fecal water from the most severely ill MCS1 patients induced the greatest degree of Th2 skewing in T-cell populations and associated cytokine produc- tion, a feature not observed among the other subgroups with less severe disease. While this observation does not directly implicate the microbiome as a causative agent of UC, it does provide evi- dence of the ability of the microbiome to perpetuate the inflam- mation and symptoms associated with UC in a manner specific to microbiota composition. This finding also indicates that the Th2 skew traditionally considered characteristic of UC patients (26) is not a consistent finding across our cohort and may, in fact, be driven by the most severely ill patients in UC cohorts (i.e., MCS1). Whether or not different inflammatory phenotypes present among UC patients select for phenotype-maintaining microbes or are the result of initial, discrete dysbioses remains to be addressed. Regardless, this raises the possibility that distinct immunological features not examined in this study characterize patients with lower disease activity and distinct gut MCSs. Future larger studies will be important in further characterizing the potential immuno- modulatory contributions of theses MCSs while confirming the observations presented here. Hence, therapies tailored to the spe- cific microbial, metabolic, and immune dysfunctions exhibited by UC patient subgroups may prove a highly efficacious strategy for more effective treatment of this disease.

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Fatigue and multidimensional disease severity in chronic obstructive pulmonary disease

Fatigue and multidimensional disease severity in chronic obstructive pulmonary disease

With use of two multidimensional staging systems, we showed that multidimensional disease severity measured using either the BODE or SAFE indices was associated with the severity and impact of fatigue. In a previous study investigating the factors contributing to the perception of health, Nguyen et al. showed no association between BODE index scores and fatigue. They used a 4-item one-dimen- sional scale [1] reflecting the general intensity and the frequency of fatigue [20]. The use of multi - dimensional scales has been proposed to ensure a complete description of the fatigue experience of patients [21]. Multidimensional fatigue measures seek to explore a wider experience of fatigue with the inclusion of several factors. In our study, the similarity of the correlations between actual and subjective fatigue, which are potentially modifiable factors, and the BODE and SAFE indices suggests that both indices capture the adverse effects induced by fatigue beyond the FEV 1 and that both

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Plasma VCAM1 levels correlate with disease severity in Parkinson’s disease

Plasma VCAM1 levels correlate with disease severity in Parkinson’s disease

in patients with PD relative to age-matched healthy con- trols. Of note, sVCAM1 levels correlated significantly with disease severity (as measured by the Hoehn and Yahr scale and MDS-UPDRS II). In addition to the asso- ciation with motor functionality, we observed a signifi- cant correlation with quality of life (as measured by the PDQ-39) and a trend towards a correlation with non-motor symptoms (as measured by the NMS-Quest). This data supports the hypothesis that peripheral sVCAM1 levels reflect global disease burden in patients with PD, thus indicating the potential for therapeutic targeting of the dysregulated sVCAM1-VLA4 axis.

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Severity of Leukoaraiosis in Large Vessel Atherosclerotic Disease

Severity of Leukoaraiosis in Large Vessel Atherosclerotic Disease

Atherosclerosis of the cerebral vasculature may play an impor- tant role in the severity of WMH among patients with isch- emic stroke and large-artery disease. In our cohort of patients with AIS, age and HTN were the strongest determinants of the WMHV severity; however, future studies are warranted to in- vestigate whether this link has an independent and significant role in the biology of the WMH disease in this patient popu- lation and across various ethnicities.

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COPD disease severity and the risk of venous thromboembolic events: a matched case–control study

COPD disease severity and the risk of venous thromboembolic events: a matched case–control study

The reason for this difference may well be medication- related: it is plausible that some patients with COPD, espe- cially those with more symptomatic and advanced disease are being prescribed medications (for the relief of their COPD symptoms and management of their comorbidities) that carry an inherent risk of clotting and/or arrhythmias, which may in themselves lead to a progressive increased risk of VTE. Alternatively, the difference in the VTE risk relationships might be a reflection of the disconnect between impaired lung function and symptomatic disease; medication-based mea- sures of disease severity will tend to place those with more symptomatic disease (eg, pronounced cough and breathless- ness) in progressively higher disease severity categories as their disease progresses and their symptoms worsen. These highly medicated, symptomatic individuals will probably also have multiple comorbidities and limited exercise capacity, putting them at increased risk of VTE. On the other hand, not all individuals with pronounced lung function impairment will have highly symptomatic disease (lung function and symptoms are not always highly correlated) and may not necessarily be at high risk of VTE.

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Comparison of severity of Phytophthora colocasiae (taro leaf blight) disease on in-vivo and in-vitro Pacific-Caribbean and Kenyan taro (Colocasiae esculenta) grown in Kakamega county (Kenya)

Comparison of severity of Phytophthora colocasiae (taro leaf blight) disease on in-vivo and in-vitro Pacific-Caribbean and Kenyan taro (Colocasiae esculenta) grown in Kakamega county (Kenya)

Taro (Colocasiae esculenta) is an important tuber crop of Kakamega - Kenya. It is nutritionally very rich. Taro leaf blight (TLB) is the most devastating pathogen for its production worldwide and current management strategies are not effective in its control. Studies on TLB disease severity has been done worldwide. However, determining and comparing the disease severity between regions of the world has not been adequately done. Before this study, TLB disease severity on Pacific and Kenyan taro grown in-vivo in Kakamega - Kenya was unknown. Furthermore, knowledge on the differential effect of weather on taro accessions obtained from different regions of the world was scanty. TLB disease severity was assessed on Pacific-Caribbean taro accessions obtained through tissue culture from Pacific- Caribbean. Kenyan taro was obtained from various counties in Kenya. The research aimed at examining and comparing TLB disease severity on Pacific and Kenyan taro. The study was conducted at MMUST University of Science and Technology farm and Maseno university laboratory and greenhouse. All experiments were arranged in a CRD and replicated five times. Data obtained were subjected to ANOVA and the means separated with Least Significant Difference. The results showed that mean disease severity among the Pacific and Kenyan taro varied from 33.2% - 53.5% respectively. TLB disease severity in both in-vivo and in-vitro studies presented higher percentage on Kenyan than Pacific- Caribbean taro. The in- vivo severity range for Kenyan and Pacific taro were; 9.8-28.5% and 4.9-14.8% respectively. Likewise, Kenyan taro maintained higher percentage severity in-vitro, ranging from 20-44% whereas Pacific taro ranged from 9.4-30%. Kenyan Siaya accession KNY/SYA/51 recorded the highest disease severity in-vivo. The lowest disease severity in-vivo was obtained from the Pacific taro CE/IND/06. The study suggested that region of origin of taro, varietal difference and weather would influence TLB severity. This study indicated the need for breeding for resistance to taro leaf blight. Keywords: Phytophthora colocasiae; Colocasiae esculenta; Severity; Accession; Region

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The influence of disease severity and lifestyle factors on the peak annual 25(OH)D value of COPD patients

The influence of disease severity and lifestyle factors on the peak annual 25(OH)D value of COPD patients

studies, this study shows that patients with COPD are more prone to show vitamin D deficiency and important disease characteristics are associated with the 25(OH)D level. Regarding the latter, in this study, those were the scores of CAT and the symptom domain of SGRQ, DOSE index and markers of systemic inflammation, ie, high-sensitivity C-reactive protein and interleukin-6. The study by Persson et al demonstrated significant correlations between 25(OH)D and obesity, current smoking, depression and COPD severity, ie, GOLD stage III–IV. 7 The study by Måhlin et al high-

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Surveillance of the Disease Incidence and Severity of Papaya Ringspot Virus at Four Selected Districts of Bangladesh

Surveillance of the Disease Incidence and Severity of Papaya Ringspot Virus at Four Selected Districts of Bangladesh

Papaya (Carica papaya L.) is a very important fruit all over the world and though its demand is increasing day by day, the production of papaya is not satisfactory. The present experiment was designed to study the surveillance and identification of PRSV disease based on symptomology and to observe the disease incidence and severity of PRSV at eight locations of four districts in Bangladesh. In the survey period among the eight locations, the highest incidence was found at BSMRAU (36.24%) and lowest at Panchari (12.04%). In the case of severity, the maximum severity was found at BSMRAU (11.53%) and minimum was recorded at Panchari (2.50%), BADC (3.057%) and Narayanganj Sadar (3.443%). In the selected locations, the growth parameters were also recorded, including plant height, leaf nu mber, petioles length and leaf blade area. There were significant differences found in different growth parameters at different locations. The highest number of fruit was harvested from BSMRAU campus (6.167) as yield parameters and the lowest number was found at JU and Panchari (4.583). Significant variations also found in percent reduction of growth and yield parameters. From the findings of the study, it may be concluded that the disease incidence and severity and its effects on growth, yield, and yield parameters varied significantly in the surveyed areas by the infection of PRSV in papayas the lowest incidence and severity was found at Panchari (Hill tract area). The farmer may be suggested to cultivate papaya in that region. However, further study need to be continued to have information prissily.

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Impacts of changing air composition on severity of arable crop disease epidemics

Impacts of changing air composition on severity of arable crop disease epidemics

Modelling work to assess impacts of environmental change on severity of crop disease epidemics that com- bines weather-based disease models, crop models and climate scenarios (Luo et al., 1995; Butterworth et al., 2010) is a considerable improvement on the qualitative rule-based methods for predicting impacts of climate change on diseases that were used previously (Coakley et al., 1999; Anderson et al., 2004). Nevertheless, there will inevitably be uncertainty in such projections associ- ated with uncertainty in projections of future weather (Semenov & Stratonovitch, 2010) and uncertainty in the disease and crop models. However, that is no reason not to make projections (Stern, 2007), provided that any assumptions made are clearly stated (Evans et al., 2010), since they provide the best available basis for discussion of current decision making. Since strategies for adapta- tion to climate change, such as breeding new crop culti- vars with resistance that can operate at increased temperatures (Huang et al., 2006) or development of new fungicides, may take 10–15 years, informed comment about what diseases are likely to increase in importance is needed now to guide decision-making by industry and government. Projections in which values of explanatory variables (e.g. temperature, rainfall) remain within the range of those observed when collecting the experimental data must be more secure than those projections which extrapolate beyond this range; hence Evans et al. (2008) projected forward to the 2020s and 2050s, but not the 2080s, which would have taken relationships within the model outside the range of observed data.

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The Effect of Lateral Trunk Motion on the Severity of Knee Osteoarthritis

The Effect of Lateral Trunk Motion on the Severity of Knee Osteoarthritis

is among the essential parameters in the biomechanical discussion of OA patients. The reason lies in the relation of this parameter with the severity of the disease. The impact of trunk lateral motion could be observed in the knee adduction peak. Results indicated that hip abduction torque reduces the abnormal growth of OA. In addition the weakness of hip abductor muscle could rise the drooping in the hip in the swing phase, and cause a change in the center of mass outward its center. This causes load increase to the central part of knee. The amount of two hip adduction torques was reduced with the progress of the disease. Its reason is that the abductor muscle in healthy people has the required strength to tolerate the lateral trunk motion and changes, whereas in OA patients, the strength of this muscle dwindles and consequently the hip and knee adduction torque is higher in the 1 st peak.

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Kawasaki disease in Sicily: clinical description and markers of disease severity

Kawasaki disease in Sicily: clinical description and markers of disease severity

Our center is one of the three major pediatric hospitals in Sicily were children affected by Kawasaki disease are treated. However we have not yet the epidemiological data about the real incidence of Kawasaki disease in our region. A recent study evaluated epidemiology of KD in cen- tral Italy: the peak of incidence was in the second year of life, with a mild prevalence of males. The icidence was 17.6:100.000 children under five years. 5.2 % had one or more cardiac complications, 2.6 % had CAL [27].

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Internet use of parents before attending a general pediatric outpatient clinic: does it change their information level and assessment of acute diseases?

Internet use of parents before attending a general pediatric outpatient clinic: does it change their information level and assessment of acute diseases?

as parents were asked to complete the questionnaires en- tirely on their own and were only given explanations in case of uncertainties. We merely obtained answers from those parents who were willing to complete the question- naires and, therefore, we cannot be sure that our findings are applicable to all parents visiting the FVPMC. The study by definition selected parents who actually visited the outpatient clinic but excluded those who did not. The reasons that keep parents from attending and their poten- tial relation to the internet health seeking behavior there- fore remain unclear. This also applies to IL, DA and CA of parents who did not visit the outpatient clinic and to other factors – besides IUC and OR–with an influence on these variables. We did not ask non-users of CHI resources about their CA. Therefore, we had no control group for users of CHI resources regarding this variable. There was no item gathering the professional involvement or any other previous knowledge of parents in the field of medi- cine, which might have confounded the results regarding IL, DA and CA. We only asked parents if, but not when exactly, they had looked up information regarding the rea- son for consultation, assuming a close temporal relation- ship to the visit at our outpatient clinic. This might also have confounded the results pertaining to IL, DA and CA. The information level of parents was assessed subjectively on the part of parents. Therefore, no conclusions can be drawn on how IUC and the use of OR influence the ob- jective knowledge of parents. Our data provide no evi- dence of actual disease severity, as it would be diagnosed by a pediatrician; and, consequently, no reliable conclu- sions can be drawn from these findings beyond the purely subjective assessment of parents.

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Abstract VĚCHET L. (2006): Reaction of winter wheat cultivars and breeding lines to Blumeria graminis f.sp. tritici

Abstract VĚCHET L. (2006): Reaction of winter wheat cultivars and breeding lines to Blumeria graminis f.sp. tritici

During 4 years, 27 cultivars and breeding lines of winter wheat (Triticum aestivum) were tested in small plot experiments for resistance to powdery mildew fungus. The most resistant were Frimegu, RE9607, Runal, Asset, Folke and Wasmo. The cultivars Asta (Pm2,6) and Vlasta (Pm2,6 and another not determined specific gene or minor genes of resistance) fall into resistant cultivars. It seems that the specific genes of resistance Pm2 and Pm6 are still very effective against the present Czech population of powdery mildew on wheat. Resistance of the cultivars Hereward and Tarso, having the gene of resistance Pm8, can be ascribed to an additional unde- termined gene that is effective only in mature plants. The cultivars Mikon and Ramiro with partial resistance had a higher infection type and disease severity than resistant cultivars, but lower disease severity than the susceptible cultivar Kanzler.

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Obstructive sleep apnea and multimorbidity

Obstructive sleep apnea and multimorbidity

This study has limitations. With a limited response rate of 64%, we were unable to obtain a proportional represen- tation in categories of OSA classification in our sample, and this may have confounded the relationship between the DBMA and OSA. In addition, we had to remove one variable from the analysis (neck circumference) due to a high number of missing values. Another limitation of the study is the use of the DBMA as a measure of multimor- bidity. The DBMA measures self-reported disease burden that correlates well with quality of life outcomes [28]. However, in other multimorbidity measures, disease se- verity is evaluated based on purely clinical criteria assessed by health professionals. The different methods of evaluating disease severity may have an impact on the as- sociation between multimorbidity and OSA.

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The Hand Eczema Trial (HET): design of a randomised clinical trial of the effect of classification and individual counselling versus no intervention among health-care workers with hand eczema

The Hand Eczema Trial (HET): design of a randomised clinical trial of the effect of classification and individual counselling versus no intervention among health-care workers with hand eczema

The questionnaire identified 398 individuals who answered “yes” to the question: “Have you had hand eczema within the past year?”[40]. These individuals will be invited by a personal letter to a clinical examination which will focus on disease severity, self-evaluated dis- ease severity, registration of eruptions through the past quarter, and quality of life. Disease severity will be mea- sured by the use of the HECSI score, which is a vali- dated scoring system including scoring of erythema, infiltration, vesicles, fissures, scaling and oedema [41] as well as scoring of the size of the affected area. The HECSI score ranges from 0 (no HE) to 360 (maximum degree of HE). Self-evaluated disease severity will be reported by the participants by use of a validated photo- graphic guide [42]. Number of eruptions through the past quarter will be reported as the number given by the participant. Quality of life will be registered by use of Dermatology Life Quality Index (DLQI) [43,44], a validated dermatology-specific questionnaire, which has previously proved useful for assessment of quality of life in patients with HE [10,45]. Skin protective behaviour will be studied by specific questions developed from a skin protection programme [46] and through informa- tion withdrawn from the questionnaire about daily handwashing, use of hand disinfectants, protective gloves, and emollients.

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