In this article, we address the initial aspects of the management of critically ill patients—namely, resuscitation, stabilization, monitoring, and disposition. Because dysrhythmias, airway management, shock, and mechanical ventilation are covered in detail as future topics in this series and because the background of our expected readers may vary substantially, we provide a general framework to or from which readers may add or subtract their own experiences. For this discussion, we assume that a clinician is called to a “code” situation. Resuscitation issues have been addressed, and the patient desires all life-sustaining treatments.
{"title":"An approach to critically ill patients.","authors":"R. Rodriguez, H. Hern","doi":"10.1136/EWJM.175.6.392","DOIUrl":"https://doi.org/10.1136/EWJM.175.6.392","url":null,"abstract":"In this article, we address the initial aspects of the management of critically ill patients—namely, resuscitation, stabilization, monitoring, and disposition. Because dysrhythmias, airway management, shock, and mechanical ventilation are covered in detail as future topics in this series and because the background of our expected readers may vary substantially, we provide a general framework to or from which readers may add or subtract their own experiences. For this discussion, we assume that a clinician is called to a “code” situation. Resuscitation issues have been addressed, and the patient desires all life-sustaining treatments.","PeriodicalId":22925,"journal":{"name":"The Western journal of medicine","volume":"24 1","pages":"392-5"},"PeriodicalIF":0.0,"publicationDate":"2001-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86539342","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
OBJECTIVE To assess how local television news programs' reporting of injuries and deaths from traumatic causes compares with coroners' records of deaths and the estimated incidence of injuries in the same geographic area during the same time. METHODS Using epidemiologic methods, we identified the underlying cause of death or injury in each of 828 local television news stories broadcast in Los Angeles during late 1996 or early 1997 that concerned recent (<3 days) traumatic injuries or deaths in Los Angeles County. Odds ratios were computed using deaths by homicide or injuries sustained in assaults as the referent group. RESULTS The number of persons depicted as dead amounted to 47.8% of the actual total number of traumatic deaths occurring in Los Angeles County during the study period. In contrast, the number depicted as injured represented only 3.4% of injuries due to traumatic causes. Both injuries and deaths due to fires, homicides, and legal interventions were proportionally well represented. However, injuries and deaths from accidental poisoning, falls, and suicide were significantly underrepresented. CONCLUSIONS Some types of events receive disproportionately more news coverage than others. Local television news tends strongly to present only those events concerned with death or injury that are visually compelling. We discuss reasons for concern about the effect that this form of information bias has on public understanding of health issues and possible counteractions that physicians can take.
{"title":"Local television news coverage of traumatic deaths and injuries.","authors":"D. McArthur, D. Magana, C. Peek-Asa, J. Kraus","doi":"10.1136/EWJM.175.6.380","DOIUrl":"https://doi.org/10.1136/EWJM.175.6.380","url":null,"abstract":"OBJECTIVE\u0000To assess how local television news programs' reporting of injuries and deaths from traumatic causes compares with coroners' records of deaths and the estimated incidence of injuries in the same geographic area during the same time.\u0000\u0000\u0000METHODS\u0000Using epidemiologic methods, we identified the underlying cause of death or injury in each of 828 local television news stories broadcast in Los Angeles during late 1996 or early 1997 that concerned recent (<3 days) traumatic injuries or deaths in Los Angeles County. Odds ratios were computed using deaths by homicide or injuries sustained in assaults as the referent group.\u0000\u0000\u0000RESULTS\u0000The number of persons depicted as dead amounted to 47.8% of the actual total number of traumatic deaths occurring in Los Angeles County during the study period. In contrast, the number depicted as injured represented only 3.4% of injuries due to traumatic causes. Both injuries and deaths due to fires, homicides, and legal interventions were proportionally well represented. However, injuries and deaths from accidental poisoning, falls, and suicide were significantly underrepresented.\u0000\u0000\u0000CONCLUSIONS\u0000Some types of events receive disproportionately more news coverage than others. Local television news tends strongly to present only those events concerned with death or injury that are visually compelling. We discuss reasons for concern about the effect that this form of information bias has on public understanding of health issues and possible counteractions that physicians can take.","PeriodicalId":22925,"journal":{"name":"The Western journal of medicine","volume":"21 1","pages":"380-4; discussion 384"},"PeriodicalIF":0.0,"publicationDate":"2001-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90201260","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
To the editor, Adams does an excellent job of discussing the dangers of the exogenous augmentation of insulin-like growth factor-I (IGF-I) and properly cautions against its use, citing both lack of efficacy and potential adverse effects, such as disruption of the insulin system and carcinogenesis.1 However, many people in the United States are consuming higher levels of IGF-I than they realize and may face the same elevated risks because milk from cows treated with recombinant bovine growth hormone (rBGH) has significantly elevated IGF-I levels. Measuring these levels has even been proposed as a basis by which to test for the use of rBGH.2 In addition, the IGF-I in the milk of rBGH-treated cows is potentially more bioactive than the naturally occurring form, and this bioactivity may be increased further by pasteurization.3 Adams notes the lack of significant effects of IGF-I administration in the elderly, but this does not necessarily hold true for children, who may be at an increased risk of adverse effects. Children's rapid growth may make them more susceptible to IGF-I. In addition, children's intestines, particularly those of infants, are naturally more permeable than those in adults, which could allow greater absorption of the large IGF-I peptide. Despite the common assumption that IGF-I cannot be significantly absorbed when taken orally, several studies have shown that this is not the case. Premature babies given breast milk in addition to formula had almost twice the serum IGF-I levels of those receiving formula alone.4 This finding is not surprising because breast milk contains IGF-I and formula does not, but it does strongly suggest intestinal absorption. Furthermore, people who consumed 3 servings of milk daily had a 10% higher level of serum IGF-I and almost a 10% lower level of IGF binding protein-4 than people who drank less than 1.5 servings.5 Although healthy people may absorb only limited quantities of IGF-I, the situation is likely different for people with conditions that can cause increased intestinal permeability, such as celiac disease, Crohn's disease, autism, cirrhosis, and cow's milk allergy. The use of various medications, such as aspirin and other nonsteroidal anti-inflammatory drugs, can also increase intestinal permeability. In addition, an estimated 10% to 20% of the general “healthy” population unknowingly suffers from this condition.6 It is not enough to look at healthy adults and say that the intestinal absorption of IGF-I is negligible. Rather, the vulnerable in society need to be protected. Adams eloquently points out that the use of IGF-I for enhancing athletic performance “ignore[s] our understanding of the integrated nature of physiologic systems.”1 However, this same ignorance was used when the Food and Drug Adminstration chose to approve the use of rBGH. Let's not put corporate profits ahead of children's health. The use of growth hormones in livestock has certainly not be
{"title":"Many people are taking insulin-like growth factor-I without even knowing it.","authors":"J. Mercola, C. Mermer","doi":"10.1136/EWJM.175.6.378","DOIUrl":"https://doi.org/10.1136/EWJM.175.6.378","url":null,"abstract":"To the editor, \u0000 \u0000Adams does an excellent job of discussing the dangers of the exogenous augmentation of insulin-like growth factor-I (IGF-I) and properly cautions against its use, citing both lack of efficacy and potential adverse effects, such as disruption of the insulin system and carcinogenesis.1 \u0000 \u0000However, many people in the United States are consuming higher levels of IGF-I than they realize and may face the same elevated risks because milk from cows treated with recombinant bovine growth hormone (rBGH) has significantly elevated IGF-I levels. Measuring these levels has even been proposed as a basis by which to test for the use of rBGH.2 \u0000 \u0000In addition, the IGF-I in the milk of rBGH-treated cows is potentially more bioactive than the naturally occurring form, and this bioactivity may be increased further by pasteurization.3 \u0000 \u0000Adams notes the lack of significant effects of IGF-I administration in the elderly, but this does not necessarily hold true for children, who may be at an increased risk of adverse effects. Children's rapid growth may make them more susceptible to IGF-I. In addition, children's intestines, particularly those of infants, are naturally more permeable than those in adults, which could allow greater absorption of the large IGF-I peptide. \u0000 \u0000Despite the common assumption that IGF-I cannot be significantly absorbed when taken orally, several studies have shown that this is not the case. \u0000 \u0000Premature babies given breast milk in addition to formula had almost twice the serum IGF-I levels of those receiving formula alone.4 This finding is not surprising because breast milk contains IGF-I and formula does not, but it does strongly suggest intestinal absorption. \u0000 \u0000Furthermore, people who consumed 3 servings of milk daily had a 10% higher level of serum IGF-I and almost a 10% lower level of IGF binding protein-4 than people who drank less than 1.5 servings.5 \u0000 \u0000Although healthy people may absorb only limited quantities of IGF-I, the situation is likely different for people with conditions that can cause increased intestinal permeability, such as celiac disease, Crohn's disease, autism, cirrhosis, and cow's milk allergy. \u0000 \u0000The use of various medications, such as aspirin and other nonsteroidal anti-inflammatory drugs, can also increase intestinal permeability. In addition, an estimated 10% to 20% of the general “healthy” population unknowingly suffers from this condition.6 \u0000 \u0000It is not enough to look at healthy adults and say that the intestinal absorption of IGF-I is negligible. Rather, the vulnerable in society need to be protected. \u0000 \u0000Adams eloquently points out that the use of IGF-I for enhancing athletic performance “ignore[s] our understanding of the integrated nature of physiologic systems.”1 However, this same ignorance was used when the Food and Drug Adminstration chose to approve the use of rBGH. \u0000 \u0000Let's not put corporate profits ahead of children's health. The use of growth hormones in livestock has certainly not be","PeriodicalId":22925,"journal":{"name":"The Western journal of medicine","volume":"18 1","pages":"378-9"},"PeriodicalIF":0.0,"publicationDate":"2001-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84782176","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
To the editor, We are writing to respond to the commentary written by Professor Parducci that accompanied our recently published article.1, 2 We would like to clarify a few points.
致编辑:我们写信是为了回应Parducci教授在我们最近发表的文章中所写的评论。我们想澄清几点。
{"title":"More on patients' preferences in treating atrial fibrillation.","authors":"A. Montgomery, T. Fahey, J. Protheroe, T. Peters","doi":"10.1136/EWJM.175.6.379","DOIUrl":"https://doi.org/10.1136/EWJM.175.6.379","url":null,"abstract":"To the editor, \u0000 \u0000We are writing to respond to the commentary written by Professor Parducci that accompanied our recently published article.1, 2 We would like to clarify a few points.","PeriodicalId":22925,"journal":{"name":"The Western journal of medicine","volume":"14 1","pages":"379"},"PeriodicalIF":0.0,"publicationDate":"2001-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74774034","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"A heartbreaking story that misses the point.","authors":"B. Sibbald","doi":"10.1136/ewjm.175.6.370","DOIUrl":"https://doi.org/10.1136/ewjm.175.6.370","url":null,"abstract":"","PeriodicalId":22925,"journal":{"name":"The Western journal of medicine","volume":"8 1","pages":"370-1"},"PeriodicalIF":0.0,"publicationDate":"2001-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87214327","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The US News and World Report cover story, “How Shy Is Too Shy?” captured the debate about the pharmaceutical industry's role in bringing social anxiety disorder to the forefront of public awareness. Drug companies have been accused of fabricating this disorder to boost sales of selective serotonin reuptake inhibitors (SSRIs). This is untrue and does a great disservice to patients. In fact, the pharmaceutical industry was a reluctant participant in this area, funding studies in the mid-1990s only on the repeated urging of the academic research community. Social anxiety disorder is a chronic, debilitating condition that has long been trivialized and even ignored. The high prevalence of social anxiety disorder became apparent after publication of the National Comorbidity Survey (NCS) data in 1994.1 This congressionally mandated survey measured the presence of psychiatric diagnoses in more than 8,000 randomly selected American adults living in the community. As a result of this landmark study, social anxiety disorder was recognized as a condition to be taken seriously. The NCS study found that social anxiety disorder has a lifetime prevalence of 13.3%. It is the third most common disabling psychiatric disorder, after major depression (17.1%) and alcohol dependence (14.1%), and is the single most common disabling anxiety disorder in the United States. Persons with social anxiety disorder dread scrutiny and embarrassment in social and performance situations. Symptoms are often so severe that they either avoid interpersonal interactions or endure them with dread. This leads to academic underachievement, poor performance at work, and isolated, lonely living. Social anxiety disorder is a persistent, lifelong condition with an insidious onset in childhood or adolescence. The development of social anxiety disorder in a child or teenager is a harbinger of a lifetime of suffering and comorbidity. Most persons with social anxiety disorder later develop major depression, and many will abuse or become dependent on alcohol. The combination of social anxiety disorder and depression is particularly deadly and is associated with a 6-fold greater risk of suicide attempts.2 Dysfunction and missed opportunities are hallmark sequelae of social anxiety disorder. Compared with control subjects, individuals with social anxiety disorder are 8.4% less likely to graduate from college, 14.5% less likely to secure a professional, technical, or managerial job, and will earn wages that are 14% lower.3 The good news is that social anxiety disorder is treatable. Monoamine oxidase inhibitors are effective,4 but concerns about adverse effects limit their use. It was not until late in the past decade that the SSRIs were shown to be a safe and effective treatment.5 The need for early recognition and intervention is clear and compelling. Yet, why is this condition so overlooked and undertreated? There are numerous barriers to care. Social anxiety disorder, by definition,
{"title":"Have drug companies hyped social anxiety disorder to increase sales. No: Efforts to relieve human suffering deserve rewards.","authors":"D. Sheehan","doi":"10.1136/EWJM.175.6.365","DOIUrl":"https://doi.org/10.1136/EWJM.175.6.365","url":null,"abstract":"The US News and World Report cover story, “How Shy Is Too Shy?” captured the debate about the pharmaceutical industry's role in bringing social anxiety disorder to the forefront of public awareness. Drug companies have been accused of fabricating this disorder to boost sales of selective serotonin reuptake inhibitors (SSRIs). This is untrue and does a great disservice to patients. In fact, the pharmaceutical industry was a reluctant participant in this area, funding studies in the mid-1990s only on the repeated urging of the academic research community. \u0000 \u0000Social anxiety disorder is a chronic, debilitating condition that has long been trivialized and even ignored. The high prevalence of social anxiety disorder became apparent after publication of the National Comorbidity Survey (NCS) data in 1994.1 This congressionally mandated survey measured the presence of psychiatric diagnoses in more than 8,000 randomly selected American adults living in the community. As a result of this landmark study, social anxiety disorder was recognized as a condition to be taken seriously. The NCS study found that social anxiety disorder has a lifetime prevalence of 13.3%. It is the third most common disabling psychiatric disorder, after major depression (17.1%) and alcohol dependence (14.1%), and is the single most common disabling anxiety disorder in the United States. \u0000 \u0000Persons with social anxiety disorder dread scrutiny and embarrassment in social and performance situations. Symptoms are often so severe that they either avoid interpersonal interactions or endure them with dread. This leads to academic underachievement, poor performance at work, and isolated, lonely living. Social anxiety disorder is a persistent, lifelong condition with an insidious onset in childhood or adolescence. The development of social anxiety disorder in a child or teenager is a harbinger of a lifetime of suffering and comorbidity. Most persons with social anxiety disorder later develop major depression, and many will abuse or become dependent on alcohol. The combination of social anxiety disorder and depression is particularly deadly and is associated with a 6-fold greater risk of suicide attempts.2 Dysfunction and missed opportunities are hallmark sequelae of social anxiety disorder. Compared with control subjects, individuals with social anxiety disorder are 8.4% less likely to graduate from college, 14.5% less likely to secure a professional, technical, or managerial job, and will earn wages that are 14% lower.3 \u0000 \u0000The good news is that social anxiety disorder is treatable. Monoamine oxidase inhibitors are effective,4 but concerns about adverse effects limit their use. It was not until late in the past decade that the SSRIs were shown to be a safe and effective treatment.5 \u0000 \u0000The need for early recognition and intervention is clear and compelling. Yet, why is this condition so overlooked and undertreated? \u0000 \u0000There are numerous barriers to care. Social anxiety disorder, by definition, ","PeriodicalId":22925,"journal":{"name":"The Western journal of medicine","volume":"11 11 1","pages":"365"},"PeriodicalIF":0.0,"publicationDate":"2001-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87901405","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
see also p 332 Recognition and treatment are crucial; depression worsens the course of a chronic illness Chronic medical illness is consistently associated with an increased prevalence of depressive symptoms and disorders.1,2 In some cases, depression appears to result from specific biologic effects of chronic medical illness. Examples of this relationship include central nervous system disorders—such as Parkinson's disease, cerebrovascular disease, or multiple sclerosis—as well as endocrine disorders—such as hypothyroidism. In other cases, the association between depression and chronic medical illness appears to be mediated by behavioral mechanisms; the limitations on activity imposed by the illness lead to gradual withdrawal from rewarding activities.3 Why should primary care physicians be alert to the possibility of depression in their patients with chronic disease? Why do they sometimes miss it? And what can they do to manage this distressing mental health problem? Depression significantly increases the overall burden of illness in patients with chronic medical conditions. Compared with those without depression, medical outpatients with depressive symptoms or disorders experienced decrements in quality of life4 and had almost twice as many days of restricted activity or missed work because of illness.5 Similarly, depression is associated with a 50% to 100% increase in health services use and costs.6 Depression has also been linked to increased disease-related morbidity and mortality. Results of population-based studies have shown a modest association between depression and all-cause mortality and a stronger association between depression and mortality resulting from cardiovascular disease.7 Depression is clearly associated with a poorer prognosis and more rapid progression of chronic illnesses, including ischemic heart disease8 and diabetes.9 Here as well, the interaction between depression and chronic medical illness may be mediated by either biologic or behavioral mechanisms. For example, depression may affect the course of ischemic heart disease through increased platelet activation or of diabetes through decreased glucose tolerance. It may also affect these diseases by decreasing treatment adherence and physical activity and by increasing tobacco and alcohol use.10 The presence of a chronic medical illness may reduce the likelihood that physicians or other health care providers recognize or treat depression. The demands of chronic illness management may crowd concerns of depression out of the visit agenda. Providers may also not look beyond a chronic medical illness to explain nonspecific symptoms, such as fatigue or poor concentration. Even when they recognize symptoms of depression, they may defer treatment, believing that “anyone would be depressed” in such a situation. Yet, somatic symptoms often reflect a combination of medical and psychological factors, and the presence of a clear medical explanation for th
鉴于识别和治疗抑郁症的明显好处，所有照顾慢性疾病患者的人都应该把识别和治疗抑郁症作为临床重点。
{"title":"Treating depression in patients with chronic disease: recognition and treatment are crucial; depression worsens the course of a chronic illness.","authors":"G. Simon","doi":"10.1136/EWJM.175.5.292","DOIUrl":"https://doi.org/10.1136/EWJM.175.5.292","url":null,"abstract":"see also p 332 \u0000 \u0000 \u0000 \u0000Recognition and treatment are crucial; depression worsens the course of a chronic illness \u0000 \u0000 \u0000 \u0000Chronic medical illness is consistently associated with an increased prevalence of depressive symptoms and disorders.1,2 In some cases, depression appears to result from specific biologic effects of chronic medical illness. Examples of this relationship include central nervous system disorders—such as Parkinson's disease, cerebrovascular disease, or multiple sclerosis—as well as endocrine disorders—such as hypothyroidism. In other cases, the association between depression and chronic medical illness appears to be mediated by behavioral mechanisms; the limitations on activity imposed by the illness lead to gradual withdrawal from rewarding activities.3 Why should primary care physicians be alert to the possibility of depression in their patients with chronic disease? Why do they sometimes miss it? And what can they do to manage this distressing mental health problem? \u0000 \u0000Depression significantly increases the overall burden of illness in patients with chronic medical conditions. Compared with those without depression, medical outpatients with depressive symptoms or disorders experienced decrements in quality of life4 and had almost twice as many days of restricted activity or missed work because of illness.5 Similarly, depression is associated with a 50% to 100% increase in health services use and costs.6 \u0000 \u0000Depression has also been linked to increased disease-related morbidity and mortality. Results of population-based studies have shown a modest association between depression and all-cause mortality and a stronger association between depression and mortality resulting from cardiovascular disease.7 Depression is clearly associated with a poorer prognosis and more rapid progression of chronic illnesses, including ischemic heart disease8 and diabetes.9 Here as well, the interaction between depression and chronic medical illness may be mediated by either biologic or behavioral mechanisms. For example, depression may affect the course of ischemic heart disease through increased platelet activation or of diabetes through decreased glucose tolerance. It may also affect these diseases by decreasing treatment adherence and physical activity and by increasing tobacco and alcohol use.10 \u0000 \u0000The presence of a chronic medical illness may reduce the likelihood that physicians or other health care providers recognize or treat depression. The demands of chronic illness management may crowd concerns of depression out of the visit agenda. Providers may also not look beyond a chronic medical illness to explain nonspecific symptoms, such as fatigue or poor concentration. Even when they recognize symptoms of depression, they may defer treatment, believing that “anyone would be depressed” in such a situation. \u0000 \u0000Yet, somatic symptoms often reflect a combination of medical and psychological factors, and the presence of a clear medical explanation for th","PeriodicalId":22925,"journal":{"name":"The Western journal of medicine","volume":"16 1","pages":"292-3"},"PeriodicalIF":0.0,"publicationDate":"2001-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74733694","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Results of most research on the physical health of people with mental illness suggests the morbidity and the mortality from certain physical conditions is high in people with long-term mental illnesses. In this review, I examine the physical health of psychiatric patients, especially those with schizophrenia or depression and some possible explanations for any inequities in their health status. I also discuss the health care that psychiatric patients receive, both in terms of recognition of physical illness and subsequent intervention, with particular reference to cardiovascular disease. Finally, I review potential barriers to effective care and methods for overcoming these.
{"title":"The poor physical health of people with mental illness.","authors":"D. Osborn","doi":"10.1136/EWJM.175.5.329","DOIUrl":"https://doi.org/10.1136/EWJM.175.5.329","url":null,"abstract":"Results of most research on the physical health of people with mental illness suggests the morbidity and the mortality from certain physical conditions is high in people with long-term mental illnesses. In this review, I examine the physical health of psychiatric patients, especially those with schizophrenia or depression and some possible explanations for any inequities in their health status. I also discuss the health care that psychiatric patients receive, both in terms of recognition of physical illness and subsequent intervention, with particular reference to cardiovascular disease. Finally, I review potential barriers to effective care and methods for overcoming these.","PeriodicalId":22925,"journal":{"name":"The Western journal of medicine","volume":"86 1","pages":"329-32"},"PeriodicalIF":0.0,"publicationDate":"2001-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73424351","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
“Your body is like a car, and you need food to make it run. But first, you need to turn on the car with the insulin key,” my doctor explained to me. I was 7 years old, weighed 35 lbs, and had been admitted to the hospital with a random glucose level of 900 mg/dL. At that age, I had a limited understanding of diabetes. I knew I had to learn to give myself shots if I wanted to be able to go to spend-the-night parties and that I had to poke my finger a lot. I knew that when I felt like “the icky ants were crawling in my head,” I had to drink juice. But most of all, I knew that no matter what I had to do, I was not going to let this “diabetes thing” get in my way of being a kid and having fun. Twenty years later, my goals have changed. I am not letting diabetes keep me from achieving my dreams, and I am not letting the stress of medical school get in the way of my self-care. In the process, I have discovered that having diabetes while in medical school can be both challenging and rewarding. The medical school regimen makes it difficult to find time to exercise and eat well. I am constantly adjusting my insulin pump and chasing my blood glucose levels, which change with every rotation schedule. I try to push myself and sometimes I get sick. I spent countless hours on the phone before being allowed to bring glucose tablets into a US Medical Licensing Examination test room in case of a hypoglycemic event. Most people are surprised that a medical licensing board, of all organizations requiring standardized testing, is not more understanding about the needs of a diabetic patient. A resident once confronted me about taking the afternoon off to go to my every 3-month appointment with my endocrinologist. During my surgery rotation, while trying to address the management of a patient with diabetes, I was told that I “talk too much about diabetes.” I know what it is like to be in that bed and to be scared about your health and your future. Diabetes is not solely about islet cell destruction or insulin resistance. Just because someone does a terrible job of managing their diabetes at home, health care providers should not accept out-of-control glucose levels in patients on the wards. Labeling the patients as unmotivated and noncompliant dismisses these people by underestimating the difficulties that come with maintaining glucose levels—the carbohydrate counting, the finger poking, and the injecting. These activities are unpleasant and do little to motivate patients to continue them. Patients may be affected by a host of socio-economic disadvantages that make blood glucose control difficult. People with chronic diseases, such as diabetes, need constant support because a chronic illness is not something that goes to sleep at night, takes the weekend off, or goes away for Spring Break to Fort Lauderdale. It is always there. I am not ashamed of having diabetes. Rather, I am proud that I have this “disability” and have still been able to attend medical s
{"title":"The rewards of chronic illness.","authors":"P. Segall","doi":"10.1136/EWJM.175.5.347","DOIUrl":"https://doi.org/10.1136/EWJM.175.5.347","url":null,"abstract":"“Your body is like a car, and you need food to make it run. But first, you need to turn on the car with the insulin key,” my doctor explained to me. I was 7 years old, weighed 35 lbs, and had been admitted to the hospital with a random glucose level of 900 mg/dL. At that age, I had a limited understanding of diabetes. I knew I had to learn to give myself shots if I wanted to be able to go to spend-the-night parties and that I had to poke my finger a lot. I knew that when I felt like “the icky ants were crawling in my head,” I had to drink juice. But most of all, I knew that no matter what I had to do, I was not going to let this “diabetes thing” get in my way of being a kid and having fun. \u0000 \u0000Twenty years later, my goals have changed. I am not letting diabetes keep me from achieving my dreams, and I am not letting the stress of medical school get in the way of my self-care. In the process, I have discovered that having diabetes while in medical school can be both challenging and rewarding. \u0000 \u0000The medical school regimen makes it difficult to find time to exercise and eat well. I am constantly adjusting my insulin pump and chasing my blood glucose levels, which change with every rotation schedule. I try to push myself and sometimes I get sick. I spent countless hours on the phone before being allowed to bring glucose tablets into a US Medical Licensing Examination test room in case of a hypoglycemic event. Most people are surprised that a medical licensing board, of all organizations requiring standardized testing, is not more understanding about the needs of a diabetic patient. A resident once confronted me about taking the afternoon off to go to my every 3-month appointment with my endocrinologist. During my surgery rotation, while trying to address the management of a patient with diabetes, I was told that I “talk too much about diabetes.” \u0000 \u0000I know what it is like to be in that bed and to be scared about your health and your future. Diabetes is not solely about islet cell destruction or insulin resistance. Just because someone does a terrible job of managing their diabetes at home, health care providers should not accept out-of-control glucose levels in patients on the wards. Labeling the patients as unmotivated and noncompliant dismisses these people by underestimating the difficulties that come with maintaining glucose levels—the carbohydrate counting, the finger poking, and the injecting. These activities are unpleasant and do little to motivate patients to continue them. Patients may be affected by a host of socio-economic disadvantages that make blood glucose control difficult. People with chronic diseases, such as diabetes, need constant support because a chronic illness is not something that goes to sleep at night, takes the weekend off, or goes away for Spring Break to Fort Lauderdale. It is always there. \u0000 \u0000I am not ashamed of having diabetes. Rather, I am proud that I have this “disability” and have still been able to attend medical s","PeriodicalId":22925,"journal":{"name":"The Western journal of medicine","volume":"83 1","pages":"347-8"},"PeriodicalIF":0.0,"publicationDate":"2001-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74550036","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Paganini's creativity may have been influenced by his biochemical makeup. Referred to as the “demon violinist,” Paganini could play his first violin concerto with a swiftness that amazed even his fellow violinists. His numerous compositions are to be played with extraordinary rapidity. Undoubtedly, the musician's virtuosity was possible in part because of his remarkably flexible joints, which may have resulted from a hereditary disease of connective tissue—either Ehlers-Danlos or Marfan's syndrome. Judging from Paganini's physical appearance, the most likely cause of his flexible joints was Ehlers-Danlos syndrome. Although each of the 10 types of this syndrome has characteristics symptoms, experts cannot determine from the composers' physical features alone which type Paganini inherited. Had they been available, modern genetic tests would have aided in making this identification.
{"title":"Creativity and chronic disease. Niccolo Paganini (1782-1840).","authors":"P. Wolf","doi":"10.1136/EWJM.175.5.345","DOIUrl":"https://doi.org/10.1136/EWJM.175.5.345","url":null,"abstract":"Paganini's creativity may have been influenced by his biochemical makeup. Referred to as the “demon violinist,” Paganini could play his first violin concerto with a swiftness that amazed even his fellow violinists. His numerous compositions are to be played with extraordinary rapidity. \u0000 \u0000Undoubtedly, the musician's virtuosity was possible in part because of his remarkably flexible joints, which may have resulted from a hereditary disease of connective tissue—either Ehlers-Danlos or Marfan's syndrome. \u0000 \u0000Judging from Paganini's physical appearance, the most likely cause of his flexible joints was Ehlers-Danlos syndrome. Although each of the 10 types of this syndrome has characteristics symptoms, experts cannot determine from the composers' physical features alone which type Paganini inherited. Had they been available, modern genetic tests would have aided in making this identification.","PeriodicalId":22925,"journal":{"name":"The Western journal of medicine","volume":"9 1","pages":"345"},"PeriodicalIF":0.0,"publicationDate":"2001-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73150909","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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