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Some psychological factors associated with illness behavior and selected illnesses

In the expanding field of medical sociology, the frequency of visits to a free medical facility has become an important form of illness behavior. Such behavior not only reflects the individual's physical health, but also his perception of it, and his decision what to do about it. Involved here are also his attitudes toward doctors and medical care, his psychological make-up, and his phenomenological well-being. Various studies have been able to relate the frequency of dispensary visits to such variables as occupational status, self-esteem and self-acceptance, perceived stress, and the readiness to assume the sick role.The present study was concerned with relating the frequency of dispensary visits to the following variables: disturbances of mood (reported well-being) and self-report measures of aggressive tendencies and of control over impulsiveness and over feelings of anger. The same variables were also related to three diagnostic categories: rheumatoid arthritis, hypertension, and ulcer. The major findings, obtained on an industrial population of over 300 male workers, are summarized below: 1. 1. Subjects who obtained high scores on the Mood Scales labeled Aggressive, Jittery, and Depressed had a greater frequency of illness behavior (dispensary visits for illness and illness absences).2. 2. Subjects who scored high on a self-report scale reflecting a tendency to engage in overt aggressive behavior, had a greater frequency of illness behavior.3. 3. The above test and questionnaire data were unrelated to control variables, not indicative of illness behavior: hernia, dispensary visits for injuries, and absences for personal leaves.4. 4. When the measures of control over impulsiveness and over feelings of anger were considered jointly with the other scales, then it was apparent that the amount of control affects the association of illness behavior with mood and overt aggressiveness: strong control reduces the association and weak control enhances it.5. 5. If the scales reflecting tendency to engage in overt aggressive behavior and to control impulsiveness and angry feelings are used to construct a two-dimensional space, then the following placements of the different diagnostic categories are possible: 5.1. (a) Hypertensive men tend to be low on overt aggressiveness and high on control.5.2. (b) Rheumatoid arthritics tend to be high on overt aggressiveness and high on control.5.3. (c) Men with ulcers tend to be low on overt aggressiveness and low on control.5.4. (d) Subjects with a high frequency of illness behavior tend to be high on overt aggressiveness and low on control.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/32133/1/0000186.pd

Prognostic model to predict postoperative acute kidney injury in patients undergoing major gastrointestinal surgery based on a national prospective observational cohort study.

Background: Acute illness, existing co-morbidities and surgical stress response can all contribute to postoperative acute kidney injury (AKI) in patients undergoing major gastrointestinal surgery. The aim of this study was prospectively to develop a pragmatic prognostic model to stratify patients according to risk of developing AKI after major gastrointestinal surgery. Methods: This prospective multicentre cohort study included consecutive adults undergoing elective or emergency gastrointestinal resection, liver resection or stoma reversal in 2-week blocks over a continuous 3-month period. The primary outcome was the rate of AKI within 7 days of surgery. Bootstrap stability was used to select clinically plausible risk factors into the model. Internal model validation was carried out by bootstrap validation. Results: A total of 4544 patients were included across 173 centres in the UK and Ireland. The overall rate of AKI was 14·2 per cent (646 of 4544) and the 30-day mortality rate was 1·8 per cent (84 of 4544). Stage 1 AKI was significantly associated with 30-day mortality (unadjusted odds ratio 7·61, 95 per cent c.i. 4·49 to 12·90; P < 0·001), with increasing odds of death with each AKI stage. Six variables were selected for inclusion in the prognostic model: age, sex, ASA grade, preoperative estimated glomerular filtration rate, planned open surgery and preoperative use of either an angiotensin-converting enzyme inhibitor or an angiotensin receptor blocker. Internal validation demonstrated good model discrimination (c-statistic 0·65). Discussion: Following major gastrointestinal surgery, AKI occurred in one in seven patients. This preoperative prognostic model identified patients at high risk of postoperative AKI. Validation in an independent data set is required to ensure generalizability

Increasing frailty is associated with higher prevalence and reduced recognition of delirium in older hospitalised inpatients: results of a multi-centre study

Purpose: Delirium is a neuropsychiatric disorder delineated by an acute change in cognition, attention, and consciousness. It is common, particularly in older adults, but poorly recognised. Frailty is the accumulation of deficits conferring an increased risk of adverse outcomes. We set out to determine how severity of frailty, as measured using the CFS, affected delirium rates, and recognition in hospitalised older people in the United Kingdom. Methods: Adults over 65 years were included in an observational multi-centre audit across UK hospitals, two prospective rounds, and one retrospective note review. Clinical Frailty Scale (CFS), delirium status, and 30-day outcomes were recorded. Results: The overall prevalence of delirium was 16.3% (483). Patients with delirium were more frail than patients without delirium (median CFS 6 vs 4). The risk of delirium was greater with increasing frailty [OR 2.9 (1.8–4.6) in CFS 4 vs 1–3; OR 12.4 (6.2–24.5) in CFS 8 vs 1–3]. Higher CFS was associated with reduced recognition of delirium (OR of 0.7 (0.3–1.9) in CFS 4 compared to 0.2 (0.1–0.7) in CFS 8). These risks were both independent of age and dementia. Conclusion: We have demonstrated an incremental increase in risk of delirium with increasing frailty. This has important clinical implications, suggesting that frailty may provide a more nuanced measure of vulnerability to delirium and poor outcomes. However, the most frail patients are least likely to have their delirium diagnosed and there is a significant lack of research into the underlying pathophysiology of both of these common geriatric syndromes

Myanmar. Mapas generales. 1857 (1856). 1:3700000

Coordenadas referidas al parecer al meridiano de Londres (E90°50'-E100°30').Relieve representado por normalesNotas manuscritas al parecer de D. Francisco Coell

American impressions,

Mode of access: Internet