Unique barriers and needs in weight management for obese women with fibromyalgia.

RESEARCH QUESTION: The aim of this study was to identify barriers, needs, and preferences of weight management intervention for women with fibromyalgia (FM). THEORETICAL FRAMEWORK: Obesity appears in higher rates in women with fibromyalgia compared to the population at large, and no study to date has taken a qualitative approach to better understand how these women view weight management in relation to their disease and vice versa. METHODOLOGY: We designed a qualitative interview study with women patients with FM and obesity. CONTEXT: Women (N = 15) were recruited by their participation in a fibromyalgia treatment program (FTP) within the year prior. SAMPLE SELECTION: The women approached for the study met the following inclusion criteria: confirmed diagnosis of FM, age between 30 and 60 years (M = 51 ± 6.27), and body mass index (BMI) ≥ 30 (M = 37.88 ± 4.87). DATA COLLECTION: Patients completed questionnaire data prior to their participation in focus groups (N = 3), including weight loss history, physical activity data, the Revised Fibromyalgia Impact Questionnaire (FIQR), and the Patient Health Questionnaire 9-item (PHQ-9). Three focus group interviews were conducted to collect qualitative data. ANALYSIS AND INTERPRETATION: Consistent themes were revealed within and between groups. Patients expressed the complex relationships between FM symptoms, daily responsibilities, and weight management. Weight was viewed as an emotionally laden topic requiring compassionate delivery of programming from an empathetic leader who is knowledgeable about fibromyalgia. Patients view themselves as complex and different, requiring a specifically tailored weight management program for women with FM. MAIN RESULTS: Women with FM identify unique barriers to weight management, including the complex interrelationships between symptoms of FM and health behaviors, such as diet and exercise. They prefer a weight management program for women with FM that consists of an in-person, group-based approach with a leader but are open to a tailored conventional weight management program. Feasibility may be one of the biggest barriers to such a program both from an institutional and individual perspective.

Central hyperadrenergic state after lightning strike.

OBJECTIVE: To describe and review autonomic complications of lightning strike. METHODS: Case report and laboratory data including autonomic function tests in a subject who was struck by lightning. RESULTS: A 24-year-old man was struck by lightning. Following that, he developed dysautonomia, with persistent inappropriate sinus tachycardia and autonomic storms, as well as posttraumatic stress disorder (PTSD) and functional neurologic problems. INTERPRETATION: The combination of persistent sinus tachycardia and episodic exacerbations associated with hypertension, diaphoresis, and agitation was highly suggestive of a central hyperadrenergic state with superimposed autonomic storms. Whether the additional PTSD and functional neurologic deficits were due to a direct effect of the lightning strike on the central nervous system or a secondary response is open to speculation.

Sedentary behavior and food cravings in diverse overweight women: a pilot study.

UNLABELLED: Obesity rates have risen sharply in the United States, with minority women among those most affected. Although a majority of Americans are considered inactive, little attention has been devoted to studying the correlation of sedentary behavior with dietary cravings in adults. OBJECTIVE: The current study used objective and self-report methods to measure sedentary behavior and its relationship to food cravings in a sample of overweight African American and Caucasian women. DESIGN: Thirty-nine adult women (54% African American) with an average body mass index of 33.7 wore accelerometers for one week and completed self-report measures of sedentary behavior, physical activity, and food cravings. RESULTS: Self-reported television viewing time was slightly longer (3.0 versus 2.5 hours), although total sedentary time was shorter (6.7 versus 8.0 hours) on weekends versus weekdays. Weekend but not weekday sedentary time and television viewing were associated with stable aspects of food cravings rather than craving for specific foods. CONCLUSION: In this small sample, only a third of all sedentary time was attributed to viewing television. Assessing whether sedentary behavior occurs by necessity versus choice may be a factor to consider in examining its relationship to food cravings.

Health care utilisation in patients with non-cardiac chest pain: a longitudinal analysis of chest pain, anxiety and interoceptive fear.

Chest pain can be a frightening experience that leads many to seek medical evaluation. The symptom results in costly health care utilisation. Over half of patients referred for cardiac evaluations of chest pain do not obtain definitive medical explanations for their symptoms; these cases are described as non-cardiac chest pain (NCCP). Some patients with NCCP are not reassured after being informed their chest pain is non-cardiac in origin and seek repeated medical evaluation. Co-morbid anxiety and mood disorders often coexist with NCCP and are associated with health care utilisation. The current study examined chest pain, general anxiety, interoceptive fear and health care utilisation in a sample of 196 chest pain patients near the time of cardiac evaluation (Time 1), and 70 of these patients one year later (Time 2). Results indicate that anxiety and interoceptive fear were significantly associated with health care utilisation at Time 1, and only interoceptive fear (at Time 1) predicted health care utilisation at Time 2. This study develops research in this area by examining the relation of anxiety and health care utilisation longitudinally in patients with NCCP.

Anxiety and hypervigilance to cardiopulmonary sensations in non-cardiac chest pain patients with and without psychiatric disorders.

We investigated body vigilance, cardiac anxiety, and the mediating role of interoceptive fear on pain in patients with non-cardiac chest pain (NCCP; a syndrome of chest pain in the absence of identifiable organic etiology). Patients were more attentive to cardiac-congruent sensations than cardiac-incongruent sensations (e.g., gastrointestinal, cognitive dyscontrol; p's < .001). Patients with a DSM-IV Axis I anxiety or mood disorder were more body vigilant compared to patients who did not have a disorder (p's < .05). Patients with anxiety disorders were particularly vigilant to and fearful of cardiac sensations relative to patients without anxiety disorders. Latent variable path models examined the extent that interoceptive fear mediated the association between body vigilance and cardiac anxiety on chest pain. Within each model, diagnostic status, body vigilance, and cardiac anxiety were exogenous and predicted interoceptive fear that in turn predicted pain. Separate models examined body vigilance and cardiac anxiety, and both models fit the data well. Findings showed partial mediation for the body vigilance factor, and full mediation for the cardiac anxiety factor. Interoceptive fear played a mediating role in both models. The syndrome of NCCP may persist partly due to conscious hypervigilance to and fear of cardiac-congruent body sensations, particularly among anxious patients.