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Current Rheumatology Reports Jun 2018While sporadic inclusion body myositis (sIBM) is the most common acquired muscle disease after age 50, the pathogenesis of this disease is still poorly understood. In... (Review)
Review
PURPOSE OF REVIEW
While sporadic inclusion body myositis (sIBM) is the most common acquired muscle disease after age 50, the pathogenesis of this disease is still poorly understood. In this review, we discuss our current state of knowledge in sIBM and provide an update on our current understanding of its pathophysiology and management.
RECENT FINDINGS
Lines of evidence in support of an inflammatory pathogenesis include inflammatory infiltrates in the target organ, NFκB activation, cytokine response, MHC I upregulation, and cN1A antibody. Refractoriness to immunotherapies has led to suggestion of a degenerative pathophysiology. Evidence for impaired protein homeostasis with misfolding burden is coupled with findings of endoplasmic reticulum stress, proteasome dysfunction, and mitochondrial lesion. Recent treatment trials have focused more on correcting the degenerative process or muscle growth rather than controlling the inflammation. There has been growing evidence toward degeneration as the primary process in sIBM. This is consistent with the refractory nature of this disease. Improving our understanding of this disease pathogenesis will propel efforts to find an effective therapy.
Topics: Disease Management; Humans; Immunotherapy; Inflammation; Muscle, Skeletal; Myositis, Inclusion Body
PubMed: 29955981
DOI: 10.1007/s11926-018-0755-z -
Frontiers in Immunology 2020
Topics: Aging; Animals; Disease Management; Disease Susceptibility; Humans; Stress, Physiological; Stress, Psychological; Thymus Gland; Thyroid Diseases
PubMed: 33193434
DOI: 10.3389/fimmu.2020.591936 -
Reproductive Health May 2018A negative experience in childbirth is associated with chronic maternal morbidities. The aim of this systematic review and meta-analysis was to identify currently... (Meta-Analysis)
Meta-Analysis
BACKGROUND
A negative experience in childbirth is associated with chronic maternal morbidities. The aim of this systematic review and meta-analysis was to identify currently available successful interventions to create a positive perception of childbirth experience which can prevent psychological birth trauma.
METHODS
Randomized controlled trials of interventions in pregnancy or labour which aimed to improve childbirth experience versus usual care were identified from 1994 to September 2016. Low risk pregnant or childbearing women were chosen as the study population. PEDRO scale and Cochrane risk of bias tool were used for quality assessment. Pooled effect estimates were calculated when more than two studies had similar intervention. If it was not possible to include a study in the meta-analysis, its data were summarized narratively.
RESULTS
After screening of 7832 titles/abstracts, 20 trials including 22,800 participants from 12 countries were included. Successful strategies to create a positive perception of childbirth experience were supporting women during birth (Risk Ratio = 1.35, 95% Confidence Interval: 1.07 to 1.71), intrapartum care with minimal intervention (Risk Ratio = 1.29, 95% Confidence Interval:1.15 to 1.45) and birth preparedness and readiness for complications (Mean Difference = 3.27, 95% Confidence Interval: 0.66 to 5.88). Most of the relaxation and pain relief strategies were not successful to create a positive birth experience (Mean Difference = - 2.64, 95% Confidence Intervention: - 6.80 to 1.52).
CONCLUSION
The most effective strategies to create a positive birth experience are supporting women during birth, intrapartum care with minimal intervention and birth preparedness. This study might be helpful in clinical approaches and designing future studies about prevention of the negative and traumatic birth experiences.
Topics: Female; Humans; Pregnancy; Labor, Obstetric; Pain Management; Parturition; Patient Satisfaction; Perception; Postpartum Period; Prenatal Care; Stress, Psychological
PubMed: 29720201
DOI: 10.1186/s12978-018-0511-x -
Journal of Behavioral Medicine Feb 2019During the 40 years since the Yale conference on Behavioral Medicine and the founding of the Journal of Behavioral Medicine considerable progress has been made in... (Review)
Review
During the 40 years since the Yale conference on Behavioral Medicine and the founding of the Journal of Behavioral Medicine considerable progress has been made in understanding the role of psychosocial risk and management of physical diseases. We here describe the development of these fundamental concepts from early research on stress through studies of the Type A behavior pattern to more contemporary approaches to the relationship between psychosocial risks and benefits in relation to disease processes. This includes the relationship of psychosocial risk to cancers, cardiovascular diseases (CVD), cardiometabolic disorders, Human Immunodeficiency Virus (HIV)/Acquired Human Immune Deficiency Syndrome. During the past 40 years the effects of prolonged distress responses in the pathogenesis of some cancers and CVD have been well-established and modifiable behavioral, cognitive and social factors have been shown to produce favorable outcome components in the management of such diseases as breast cancer, coronary heart disease and HIV.
Topics: Chronic Disease; Disease Management; Humans; Risk Factors
PubMed: 30632000
DOI: 10.1007/s10865-018-00007-y -
Continuum (Minneapolis, Minn.) Apr 2019This article reviews the management of patients with medically responsive epilepsy, including discussion of factors that may lead to transient breakthrough seizures and... (Review)
Review
PURPOSE OF REVIEW
This article reviews the management of patients with medically responsive epilepsy, including discussion of factors that may lead to transient breakthrough seizures and patient and physician strategies to maintain freedom from seizures.
RECENT FINDINGS
Imperfect adherence, unanticipated changes in ongoing medical therapy, inadvertent use of proconvulsants or concurrent medications that alter epilepsy medication kinetics, and a variety of seizure precipitants such as stress or sleep deprivation may alter long-term seizure control.
SUMMARY
The majority of patients with epilepsy are medically responsive. Many potential factors may lead to breakthrough seizures in these patients. Identification of these factors, patient education, and use of self-management techniques including mindfulness therapy and cognitive-behavioral therapy may play a role in protecting patients with epilepsy against breakthrough seizures.
Topics: Disease Management; Epilepsy; Humans; Seizures
PubMed: 30921013
DOI: 10.1212/CON.0000000000000709 -
Revista de Neurologia Sep 2020The stress that the coronavirus pandemic has produced on the health services and the disruption it has caused in the care of other pathologies and their follow-up in... (Review)
Review
The stress that the coronavirus pandemic has produced on the health services and the disruption it has caused in the care of other pathologies and their follow-up in outpatient visits have led us to promote and incorporate telemedicine in our routine medical practice. Telemedicine refers to remote or non-face-to-face medical attention, a new method of administering medical care by accredited professionals, which optimises resources and increases their scope. One drawback for child teleneurology is that our diagnoses require direct observation of the child and carrying out an examination as though playing a game. Mainly in the youngest stages, a new patient evaluated by telemedicine can be more difficult to diagnose and manage, and therefore some neuropaediatricians have chosen to carry out only follow-up visits, medication management and outcome reviews. Telemedicine, however, also has many benefits, such as the possibility of giving rapid advice, coordination among professionals and reaching the patient where and when it is difficult for classical medicine to do so. The aim of this article is to review the possible indications of telemedicine in child neurology, starting out from the fact that we should never delay the diagnosis of something that can be treated, both at the present time and in an eventual situation of resurgence of the pandemic. The advance of telemedicine will depend on the implementation of technology, on solving legal and security/privacy issues, on its clinical outcomes and on the extent to which patients demand and accept these virtual visits.
Topics: Adolescent; Aftercare; Child; Child, Preschool; Disease Management; Humans; Infant; Interdisciplinary Communication; Length of Stay; Neurology; Neuropsychiatry; Patient Care Team; Patient Education as Topic; Pediatrics; Telemedicine
PubMed: 32729111
DOI: 10.33588/rn.7105.2020304 -
Current Opinion in Psychology Aug 2019Many of today's most common, chronic, and costly diseases-from high blood pressure, to chronic pain-are related to stress. Mindfulness, considered a state, a trait, and... (Review)
Review
Many of today's most common, chronic, and costly diseases-from high blood pressure, to chronic pain-are related to stress. Mindfulness, considered a state, a trait, and a training, might help treat or prevent stress-related physical symptoms. A concise review of current scientific evidence shows that both higher levels of trait mindfulness as well as mindfulness training are associated with better psychological well-being, coping, and quality of life. Effects on objective measures of disease, however, are often non-significant or await replication. Larger trials with active control groups, clear diagnostic criteria, objective outcome measures, and longer-term follow-up are needed to generate better quality evidence. Yet, many studies do support integrating mindfulness into health care as part of self-care and disease management.
Topics: Adaptation, Psychological; Disease Management; Humans; Mindfulness; Noncommunicable Diseases; Personal Satisfaction; Quality of Life; Stress, Psychological
PubMed: 30785067
DOI: 10.1016/j.copsyc.2018.12.014 -
Australian Family Physician Mar 2015The mid-foot bears the unheralded and proud, but potentially onerous, task of converting lower limb, vertically oriented stresses into propulsive horizontal motion with... (Review)
Review
BACKGROUND
The mid-foot bears the unheralded and proud, but potentially onerous, task of converting lower limb, vertically oriented stresses into propulsive horizontal motion with the further challenges of speed and direction change over varying terrains. A complex interaction of bones, joints and connective tissues has been cleverly engineered to accommodate these demands. However, these entrusted tissues will encounter acute traumatic stresses or cumulative micro-stresses, leading to structural and functional deficits.
OBJECTIVE
This article provides guidance in recognising and managing the key red flag conditions affecting the mid-foot region. Recent trends in imaging and medical management will also be outlined.
DISCUSSION
With the exception of tibialis posterior dysfunction in the elderly, midfoot pain may not be a common presentation in general practice. It is important, therefore, to have a scheme of assessment and awareness of possible causes. In particular, the red flags of navicular stress fracture and Lisfranc ligament disruption require careful consideration as delayed care can result in poor outcomes.
Topics: Diagnosis, Differential; Foot Diseases; Humans; Pain; Pain Management; Pain Measurement; Practice Guidelines as Topic
PubMed: 25770574
DOI: No ID Found -
Survey of Ophthalmology 2017The understanding, diagnosis, and treatment of retinopathy of prematurity have changed in the 70 years since the original description of retrolental fibroplasia... (Review)
Review
The understanding, diagnosis, and treatment of retinopathy of prematurity have changed in the 70 years since the original description of retrolental fibroplasia associated with high oxygenation. It is now recognized that retinopathy of prematurity differs in appearance worldwide and as ever smaller and younger premature infants survive. New methods are being evaluated to image the retina, diagnose severe retinopathy of prematurity, and determine windows of time for treatment to save eyes and improve visual and neural outcomes. New treatments to promote physiologic retinal vascular development, vascular repair, and inhibit vasoproliferation by regulating proteins involved in vascular endothelial growth factor, insulin-like growth factor, or erythropoietin signaling. Reducing excessive oxidative/nitrosative stress and understanding progenitor cells and neurovascular and glial vascular interactions are being studied.
Topics: Angiogenesis Inhibitors; Animals; Disease Management; Humans; Laser Coagulation; Retinopathy of Prematurity
PubMed: 28012875
DOI: 10.1016/j.survophthal.2016.12.004 -
The Journal of Allergy and Clinical... Aug 2016Atopic dermatitis (AD) is the most common pediatric skin disease. AD has a significant effect on patient and family quality of life caused by intense pruritus, sleep... (Review)
Review
Atopic dermatitis (AD) is the most common pediatric skin disease. AD has a significant effect on patient and family quality of life caused by intense pruritus, sleep disruption, dietary and nutritional concerns, and psychological stress associated with the disease and its management. Multidisciplinary approaches to AD care have been developed in appreciation of the complex interplay among biological, psychological, behavioral, and dietary factors that affect disease control and the wide range of knowledge, skills, and support that patients and families require to effectively manage and cope with this condition. Common components of multidisciplinary treatment approaches include medical evaluation and management by an AD specialist, education and nursing care, psychological and behavioral support, and nutritional assessment and guidance. Models of care include both clinical programs and structured educational groups provided as adjuncts to standard clinical care. Available evidence suggests beneficial effects of multidisciplinary interventions in improving disease severity and quality of life, particularly for patients with moderate-to-severe disease. Additional research is needed to identify the best candidates for the various multidisciplinary approaches and evaluate the cost-effectiveness of these programs.
Topics: Capital Financing; Cost-Benefit Analysis; Delivery of Health Care; Dermatitis, Atopic; Disease Management; Health Care Reform; Health Personnel; Humans; Intersectoral Collaboration; Patient Care Team
PubMed: 27497275
DOI: 10.1016/j.jaci.2016.04.003