Episodes of Breathlessness: Types and Patterns – a Qualitative Study Exploring Experiences of Patients With Advanced Diseases.

Episodes of breathlessness: Types and patterns – a qualitative study exploring experiences of patients with advanced diseases.

Palliat Med. 2013 Mar 13;
Simon ST, Higginson IJ, Benalia H, Gysels M, Murtagh FE, Spicer J, Bausewein C

Background:Despite the high prevalence and impact of episodic breathlessness, information about characteristics and patterns is scarce.Aim:To explore the experience of patients with advanced disease suffering from episodic breathlessness, in order to describe types and patterns.Design and participants:Qualitative design using in-depth interviews with patients suffering from advanced stages of chronic heart failure, chronic obstructive pulmonary disease, lung cancer or motor neurone disease. As part of the interviews, patients were asked to draw a graph to illustrate typical patterns of breathlessness episodes. Interviews were tape-recorded, transcribed verbatim and analysed using Framework Analysis. The graphs were grouped according to their patterns.Results:Fifty-one participants (15 chronic heart failure, 14 chronic obstructive pulmonary disease, 13 lung cancer and 9 motor neurone disease) were included (mean age 68.2 years, 30 of 51 men, mean Karnofsky 63.1, mean breathlessness intensity 3.2 of 10). Five different types of episodic breathlessness were described: triggered with normal level of breathlessness, triggered with predictable response (always related to trigger level, e.g. slight exertion causes severe breathlessness), triggered with unpredictable response (not related to trigger level), non-triggered attack-like (quick onset, often severe) and wave-like (triggered or non-triggered, gradual onset). Four patterns of episodic breathlessness could be identified based on the graphs with differences regarding onset and recovery of episodes. These did not correspond with the types of breathlessness described before.Conclusion:Patients with advanced disease experience clearly distinguishable types and patterns of episodic breathlessness. The understanding of these will help clinicians to tailor specific management strategies for patients who suffer from episodes of breathlessness. HubMed – rehab


Increased childhood incidence of narcolepsy in western Sweden after H1N1 influenza vaccination.

Neurology. 2013 Mar 13;
Szakács A, Darin N, Hallböök T

OBJECTIVES: To assess the incidence of narcolepsy between January 2000 and December 2010 in children in western Sweden and its relationship to the Pandemrix vaccination, and to compare the clinical and laboratory features of these children. METHODS: The children were identified from all local and regional pediatric hospitals, child rehabilitation centers, outpatient pediatric clinics, and regional departments of neurophysiology. Data collection was performed with the aid of a standardized data collection form, from medical records and telephone interviews with patients and parents. The laboratory and investigational data were carefully scrutinized. RESULTS: We identified 37 children with narcolepsy. Nine of them had onset of symptoms before the H1N1 vaccination and 28 had onset of symptoms in relationship to the vaccination. The median age at onset was 10 years. All patients in the postvaccination group were positive for human leukocyte antigen (HLA)-DQB1*0602. Nineteen patients in the postvaccination group, compared with one in the prevaccination group, had a clinical onset that could be dated within 12 weeks. CONCLUSION: Pandemrix vaccination is a precipitating factor for narcolepsy, especially in combination with HLA-DQB1*0602. The incidence of narcolepsy was 25 times higher after the vaccination compared with the time period before. The children in the postvaccination group had a lower age at onset and a more sudden onset than that generally seen. HubMed – rehab


Reducing Juvenile Delinquency With Automated Cell Phone Calls.

Int J Offender Ther Comp Criminol. 2013 Mar 12;
Burraston BO, Bahr SJ, Cherrington DJ

Using a sample of 70 juvenile probationers (39 treatment and 31 controls), we evaluated the effectiveness of a rehabilitation program that combined cognitive-behavioral training and automated phone calls. The cognitive-behavioral training contained six 90-min sessions, one per week, and the phone calls occurred twice per day for the year following treatment. Recidivism was measured by whether they were rearrested and the total number of rearrests during the 1st year. To test the impact of the phone calls, those who received phone calls were divided into high and low groups depending on whether they answered more or less than half of their phone calls. Those who completed the class and answered at least half of their phone calls were less likely to have been arrested and had fewer total arrests. HubMed – rehab


Narratives of Four Maori Ex-Inmates About Their Experiences and Perspectives of Rehabilitation Programmes.

Int J Offender Ther Comp Criminol. 2013 Mar 12;
Nakhid C, Shorter LT

M?ori are overrepresented in the criminal justice system in Aotearoa New Zealand. M?ori offenders comprise 53% of those serving custodial sentences and 48% serving community-based sentences. The majority of M?ori offenders reoffended within 2 years of serving their sentence. A number of programmes aimed at reducing recidivism among M?ori have been implemented, and there is considerable debate around the effectiveness of these programmes. This qualitative study focuses on the narratives of four M?ori male ex-inmates about their reoffending and their experiences of the rehabilitation programmes during their incarceration. Using a narrative approach, the study sought to hear the shared stories from the men and to determine what they believe would have reduced their reoffending. The stories revealed that a lack of financial resources and gang connections influenced reoffending; the value of prison rehabilitation programmes varied depending on their appropriateness to the inmate and to their intended outcomes; and healing programmes incorporating kaupapa M?ori principles and practices assisted the participants in understanding their cultural heritage and communicating with society in more acceptable ways. HubMed – rehab