Rheumatic Fever

Background

Acute rheumatic fever (ARF) is an autoimmune inflammatory process that develops as a sequela of streptococcal infection. ARF has extremely variable manifestations and remains a clinical syndrome for which no specific diagnostic test exists. Persons who have experienced an episode of ARF are predisposed to recurrence following subsequent (rheumatogenic) group A streptococcal infections. The most significant complication of ARF is rheumatic heart disease, which usually occurs after repeated bouts of acute illness.

Pathophysiology

ARF is characterized by nonsuppurative inflammatory lesions of the joints, heart, subcutaneous tissue, and central nervous system. An extensive literature search has shown that, at least in developed countries, rheumatic fever follows pharyngeal infection with rheumatogenic group A streptococci. The risk of developing rheumatic fever after an episode of streptococcal pharyngitis has been estimated at 0.3-3%. More recent investigations of rheumatic fever occurring in the aboriginal populations of Australia suggest that streptococcal skin infections might also be associated with the development of rheumatic fever. In Oceania and Hawaii, streptococcal strains that are not typically associated with rheumatic fever have been found to cause the disease.

Molecular mimicry accounts for the tissue injury that occurs in rheumatic fever. Both the humoral and cellular host defenses of a genetically vulnerable host are involved. In this process, the patient’s immune responses (both B- and T-cell mediated) are unable to distinguish between the invading microbe and certain host tissues.The resultant inflammation may persist well beyond the acute infection and produces the protean manifestations of rheumatic fever.

Frequency

United States

The incidence of ARF has declined markedly in the past 50 years in both the United States and Western Europe. Most Western physicians see only the late sequelae of rheumatic heart disease; the diagnosis of an acute case is usually reason enough for a ground rounds presentation. This remarkable decline of rheumatic fever likely reflects improved socioeconomic conditions, as well the decline in prevalence of the classically described rheumatogenic strains of group A streptococci.

Following two decades of almost total absence, a resurgence of ARF occurred in the 1980s among middle-class white children in Salt Lake City, Utah. Clusters were also reported in US Army and Navy training camps during the same period. These limited outbreaks were associated with mucoid rheumatogenic strains that were rarely seen in the preceding 20 years. Today, ARF remains a rarity in most of the United States, although Hawaii and American Samoa continue to see a significant number of cases, many of which are caused by streptococcal strains not usually associated with rheumatic fever in persons of Polynesian descent. Read more »

Medical Alert Companies Comparison – Medical Alert Monitoring Systems

When you compare medical alert companies, you are not comparing companies medical alert device companies but service provider companies. This makes comparison process little tricky. Let me use industry knowledge and experience to act as shopper and market researcher.

Think you are going out to stay at a hotel that you’ve never been to before. We will use this analogy to compare medical alert companies. The hotel may appear clean, have nice surrounding, and great amenities, but the wait staff may not be providing good service you are expecting you may have been better off asking a friend what their experience was like, read reviews by others online, or a review by a local travel critic. That’s where we come in.

Assume the hotel is type of the medical alert monitoring device that you will use. Does it have all of the physical features, functions, or the look and feel that you want?

What kinds of Medical Alert Companies are there?

• Full Service These medical alert companies provide the entire operation from sales, to equipment service, to central station monitoring, all themselves. They do not source-out the operations to any third parties.

• Reseller/Marketing Only These medical alert companies take care of the marketing only of the product and service. In today’s digital age, they typically have a website and place ads in magazines, on television, or through retail displays in their storefronts.

• Partial Service These medical alert companies typically take care of the sales and service, but hire out the central station monitoring to a third party. This is due to the very high costs of opening and maintaining a central monitoring station; especially if it is certified or listed by one or more agencies like Underwriters Laboratories (UL).

• The hostess is like the sales person you’ll be speaking with. Are they able to give you an accurate estimate of how long your wait time may be for a table? If they tell you they can accommodate your group size, or maybe a request for special accommodations for a handicapper or a child playing areas?

• The hotel staff is like the customer service representatives and central dispatch operators. These are the people that you or your loved one will spend the most of your time communicating with and get the most satisfaction from. Are they attentive, knowledgeable, friendly, and patient? Are they maintaining the highest standards available and required to have continual training to be sure they are?

Who are then actual Medical Alert Monitoring Companies?

That can sometimes be very difficult finding out who is really who. The full service companies can be easy as they will usually come right out and tell you! The partial service companies will usually tell you who will monitor your loved one typically after you come right out and ask. Very few are up front about it, but some are.

It is not easy to get correct information from some reseller companies. We try to uncover who these companies are, and let you know who is providing the monitoring services for them, so you can read about the actual medical alert company servicing your loved one.

Why You Should Care about Medical Alert Companies?

The full service medical alert companies have a much larger capital and human investment than the partial and marketing only companies. That gives them a vested interest in the quality and care provided to their customers from end-to-end.

The partial service companies have a much greater investment than the reseller/marketing only companies because they take care of the sales, customer service, equipment service, shipping, etc. themselves. They don’t handle the monitoring, but they do more than just market the service.

It is very important to find-out what type of medical alert company you are dealing with. The more services that are under one roof could mean higher customer satisfaction and better quality control.

If you can get a quality, full service, and highly rated company in the same price range as a marketing only or partial company, would you pick the full service company?