The Situation of Patients and The Medical Health Care in Future

ø

New contributions to the development of health care give a different look to the place of the patient. It appears, that the outcome of medical treatments may depend of the specific medical and physiological condition of the patient and even other kind of conditions outside the patient may contribute to the results of the whole medical treatment. Economical or personal circumstances have their influence on the individual so that the same medical treatment appear with different outcomes. Paying attention to the patient as a unique individual will bring a lot of confidence in the medical relationship. The patient, who has to cope with so much information will be drawn to the right position so that he will follow the medical instructions and will find his way to recovery.

In assisting patients of finding extra medical information or when they need to contact with their care supplier, the use of E-health facilities will help. New entities as effectiveness, participation of the patient, ethics, technics, digitization, multidisciplinary approach of research and consultation, deliver a total different look to the way as to how health care has to be secured. New specializations in medical law, medical management, tend to be developed day by day. Effectively working together by transparency in contact and behaviour will bring health care workers and patients closer to each other. New specializations of medicine will bring more effectiveness in using medical procedures. For example Translational Medicine tends to find the best effective way of setting up new treatments, new scientific investigations.

Scientists and clinical specialists may define Personalized Medicine more especially as directed to the needs of the diseased, as described in individual patient cohorts. Translational Research and Medicine as well as Personalized Medicine make use of clinical data, epidemiological data and available bio sample databases for research and clinics. The study of human disease genetics will bring new insights in the way health systems and organs are connected with one another. When enzymes and proteins may be analysed and compared with genetic findings, the origin of irregularities in metabolism, immunologic mechanism, transport, motion, regulation and storage may be better explored. Moreover the introduction of Personalized, Predictive and Preventive Medicine, the Translational Medicine and Precision Medicine, will enhance the implementation of scientific findings. So, when phenotypic and genotypic features of a patient have been established the therapeutic strategy may be adjusted to the individual patient and more information about the risk of complications of the treatment and the natural tendency for a certain illness would be available.

Big datasets, so called Big Data, have been determined, containing the large information of the genomic analysis of individuals. Molecular profiling tests and DNA sequencing are common practice in these laboratories in the determination of chromosomal abnormalities, responsible for many genetic disorders. Professional genetic counselling brings more insight how to deal with the outcome of the DNA tests for individuals and families. Every contribution in this development has to consider the effect to the final result in the health care system. The importance of the condition of the patient remains always the leading motive. Health care will only be complete with the implementation of the patient’s contribution. In the design of clinical research projects and clinical guidelines patients have already been given the chance to participate. Sharing patient’s opinions about different treatments will help to understand the positive and negative effects of treatments.

Way of living, lifestyle strategies and multifactorial medical management in any family at risk may prevent or delay the onset of complications. To be mentioned are neurologic diseases, diabetes, cancer, anxiety. In these situations a holistic approach of the patient assures a more satisfied condition of the patient and a way to rehabilitation. Viewed in this light any health condition is considered as an individual state of physical, mental, social and spiritual well-being. The main idea of the person-centred medicine is to promote health and, therefore, reduce disease burden with the sick person. Traditional, complementary and alternative medicine may all be of help to achieve this effect.

Integration of bio-informatics into clinical practice asks for the knowledge of how to understand the output of genome analysis and taking decisions from it. In Europe the EU, the European Union, has been developing a big project, called HORIZON EUROPE, which is the name of an enormous subvention program for the years 2021 till 2024. One of the targets of this proposed project is continued training of medical doctors, health care workers, researchers and decision makers in policy, educators and bioinformatics experts. Deans of Medical schools have been informed about the HORIZON EUROPE project.

Now and in the future curricula in universities and medical training schools would be adjusted, so that medical studies, and studies in technics and management will bring the right education with the last developments of knowledge included. Renewed attention will be paid to Integrative Medicine, Palliative Medicine and Stratified Medicine. Rare diseases will equally get more attention as being part of Personalized Medicine. Multidimensional interaction of internal and external risk factors, genetic background, ethics, structure and rules, environmental risk factors, lifestyle, culture and many other relationships are all recognised as contributing to the citizens’ well-being and have been taken in the decision making of the huge HORIZON EUROPE project, proposed.

The actual patient fiends himself confronted with all kinds of specialized health care workers and specialists, who all will have to be adapted to a continuously changing health care system. Students and health care workers will follow adjusted curricula, so that new knowledge of medicine, science, technics, management can be implemented. Therapeutic strategies may be adjusted to the individual patient and the risk of complications of the treatment. E-health information of patients and communication will be optimized.

Later-life Depression and Anxiety Disorders

ø

The elderly population is rapidly increasing. Accurate information on psychiatric problems in this group is needed to make the best use of limited health-care resources. Anxiety disorders in the elderly have gotten far less research than depression or dementia to date. Social isolation, decreased autonomy, financial insecurity, poor health, and imminent death, all of which are associated with ageing, may be expected to increase the prevalence of anxiety in later life.

The elderly population is rapidly increasing. Accurate information on psychiatric problems in this group is needed to make the best use of limited health-care resources. Anxiety disorders in the elderly have gotten far less research than depression or dementia to date. Social isolation, decreased autonomy, financial insecurity, poor health, and imminent death, all of which are associated with ageing, may be expected to increase the prevalence of anxiety in later life. Anxiety disorders, on the other hand, account for just a small percentage of mental hospital admissions among patients over the age of 65, and anxiety disorders are on the decline among senior hospital outpatients. However, it is possible that older people suffering from anxiety do not seek medical help or is misdiagnosed, resulting in concealed morbidity. Community- based epidemiologic surveys are more likely to offer more precise data on the extent of anxiety in the elderly, making treatment planning, service delivery, and possibly prevention easier. As a result, the goal of this paper is to compile and review the existing epidemiologic data on late-life anxiety disorders.

The increased intensity and poorer treatment response in those with comorbid anxiety and depression than in that with either disorder alone is an important therapeutic argument for studying comorbidity of depression and anxiety. There is presently a push to look into the comorbidity of anxiety and depression in older populations. This push is due in part to a growth in the senior population; in the United States, the elderly population (aged 65+) is predicted to double in size over the next 30 years, with a similar increase in the 85+ age category. Another source of motivation is research that shows how psychiatric diseases vary substantially over the age in terms of risk factors, presentation, comorbidity, and illness course. In many cases, late-onset depression, for example, appears to have a cerebrovascular aetiology. This “vascular depression” hypothesis proposes that some cases of late-onset depression are caused by cerebrovascular disease- induced disruptions in mood regulating circuits.

Similarly, the high prevalence of depression in the early stages of Alzheimer’s disease (AD) shows that depressed symptoms in later life could be a sign of a neurodegenerative disease. As a result, the pathophysiology of late-life depression differs significantly from that of young-adult depression. The same is true for late- life anxiety disorders, which appear to be infrequent in the community senior population when examined with standard diagnostic measures designed for adults but are substantially more common when using geriatric-specific assessments. As a result, the comorbidity of depression and anxiety disorders in later life may differ from that of younger persons, necessitating further research.

Despite this rationale, there has been little research on the risk factors, phenomenology, course, or therapy of late-life anxiety disorders, or their comorbidity with late-life depression. Review of the research on the epidemiology, risk factors, cross-sectional presentation, relationships with disability and death, and course of comorbid depression and anxiety (both as a symptom and as a separate diagnosis) in the elderly. We present new evidence that comorbid anxiety disorders are more common in depressed elderly people than previously thought, and that depression with anxiety symptoms or a comorbid anxiety disorder in the elderly is a more severe illness in terms of course and outcome than depression without anxiety. We assess depression with concomitant anxiety and make therapy suggestions. Finally, we urge that clinical research into the comorbidity of late-life depression and anxiety be directed in this area.

Illnesses of Unknown Etiology

ø

A public health event (PHE) is defined as any occurrence that may have negative consequences for human health, including those that have not yet caused disease or illness but that have potential and those that may require a coordinated response . This framework focuses on PHEs of initially unknown etiology, which are PHEs for which the cause has not yet been determined. For such events, the One Health approach is recommended, where the ministry of health works in close collaboration with other ministries and multisectoral partners to enhance teamwork and improve efficiencies in preparedness, response, and monitoring and evaluation (M&E).

Between 2000 and 2012, the ministries of health in the WHO African Region identified a mean of 100 PHEs annually. The majority of those occurred in areas characterized by poverty, armed conflict and/ or suboptimal health care delivery or access. Typically, during its alert management stage, a PHE is initially categorized as being of unknown etiology. Once there is laboratory confirmation of the cause of illness, the PHE can be categorized as infectious or noninfectious, with infectious events further classified as zoonotic or non-zoonotic. presents a map on the distribution of PHEs identified in the WHO African Region during 2012. All the PHEs were initially classified during the alert management stage as being of unknown etiology. Like some non-infectious PHEs, infectious PHEs – which include zoonotic diseases and foodborne or waterborne illnesses such as cholera, shigellosis, salmonellosis and amoebiasis -often traverse geopolitical boundaries. In both 2011 and 2012, aside from Vibrio cholerae, which accounted for approximately 30% of confirmed PHEs, an estimated 24% of confirmed infectious disease outbreaks were zoonotic (see WHO EMS). Other important PHEs related to infectious diseases recently identified in the African Region and reported via ProMED Mail 2 and WHO EMS were due to avian and pandemic influenza, meningococcal meningitis, anthrax, measles, acute poliomyelitis, yellow fever, malaria, dysentery, plague, dengue, or the Ebola, Marburg, Crimean-Congo, Lassa and Rift Valley viral haemorrhagic fevers.

Scientific and public health experts agree that the majority of infectious agents identified as causes of human illness in recent decades originated in domesticated animals or wildlife, such as SARS, the highly pathogenic avian influenza, Ebola and Marburg. The importance of zoonotic diseases in the Region reinforces the logic for using the One Health multisectoral approach to evaluate PHEs. Multisectoral national teams of professionals working together on the diseases involving the animal, human and ecosystem interface can strengthen efficiencies by sharing important and timely health information from their respective surveillance systems and working collaboratively in the field. This type of coordination and teamwork can lead to better understanding of the epidemiology of emerging or re-emerging diseases, as well as identify unknown modes of transmission, elements that will improve the efficiency of disease prevention and control efforts.

The overall aim of this framework is to minimize human morbidity and mortality associated with PHEs by providing the ministries of health in the WHO African Region with technical and managerial guidance for early and effective preparedness for and response to PHEs.

Can cochlear implantation improve neurocognition in the elderly?

ø

Völter Christiane1, Götze Lisa1, Müther Janine, Dazert Stefan1, Thomas Jan Peter1 1
Department of Otorhinolaryngology, Head and Neck Surgery, Ruhr University Bochum,
St. Elisabeth-Hospital, Bleichstr. 15, 44787 Bochum, Germany

The association between cognition and hearing is well known. With regard to the growing number of older persons and the incidence of demential illness the question arises whether hearing rehabilitation might counteract cognitive decline in aging.

Material and Methods:

213 patients aged 67,78 years (mean, SD 9,52) suffering from severe to profound hearing loss and scheduled for cochlear implantation underwent a computer-based evaluation of neurocognitive functions prior to surgery. The visual based test battery (ALAcog) is composed of different subtests covering short- and long-term memory, processing speed, verbal fluency, attention, working memory and inhibition.

Results:

66 patients have been reassessed 6 months and 71 patients 12 months post implantation. Whereas most subtests improved after 6 months, long-term memory did not improve earlier than after 1 year (p = 0,00006). After 12 months neurocognition has significantly increased with regard to attention (p=0,00086), recall (p=0,00041), delayed recall (p =0,00069), inhibition (p = 0,0029), working memory (n-back= 0,023 and OSPAN-test p = 0,00001) as well as verbal fluency (p=0,00006). Executive functions improved the most. In general, improvement was statistically better for subjects with poor baseline results. Patients at the age of > 65 years improved in the same way as younger aged =<65 years. Conclusion: Cochlear implantation has a positive impact on cogni><65 years.

Conclusion:

Cochlear implantation has a positive impact on cognitive abilities, mostly on executive functions even in patients with lower preoperative performance and older age. Further studies have to show, whether hearing restoration has a long-term effect on cognition and might even prevent demential illness.

Mental Health Therapies & Motivational enhancement therapy (MET)

ø

Koziba Sebina
Evolve Syndicate, Botswana

Motivational enhancement therapy (MET) is a directive, person-centered approach to therapy that focuses on improving an individual’s motivation to change. Those who engage in selfdestructive behaviors may often be ambivalent or have little motivation to change such behaviors, despite acknowledging the negative impact of said behaviors on health, family life, or social functioning. The primary goal of MET is to help individuals overcome their ambivalence or resistance to behavior change. MET focuses on increasing intrinsic motivation by raising awareness of a problem, adjusting any self-defeating thoughts regarding the problem, and increasing confidence in one’s ability to change.

Instead of identifying a problem and telling a person in therapy what to do about it, the therapist encourages a person in therapy to make self-motivating statements that display a clear understanding of the problem and a resolve to change. The numerous mental health therapy techniques and therapies available today are used to tackle a wide variety of conditions such as depression, anxiety disorders, eating disorders, and phobias, as well as borderline disorders, multiple personality disorder, and schizophrenia. These conditions can be treated, often successfully, with the help of psychotherapy and, sometimes, supplementary drug therapy.