Group treatment of fibromyalgia: a 6 month outpatient program.

OBJECTIVE: To evaluate the impact of a 6 month group therapy program on the treatment of patients with fibromyalgia (FM). Since FM is a common problem in rheumatology practice, a program was designed to treat patients in a group setting using allied health professionals. METHODS: The FM group (15 to 25 patients) met once a week for 6 months. The average session lasted 90 min and consisted of formal lectures, group sessions emphasizing behavior modification, stress reduction techniques, strategies to improve fitness and flexibility and support sessions for spouses/significant others. The 2 major outcome measures were the fibromyalgia impact questionnaire (FIQ) and the total tender point score. Secondary outcome measures were the quality of life scale, questionnaires to assess coping strategies and attitudes to illness, an index of aerobic conditioning, flexibility, distance walked in 6 min., Beck depression and Beck anxiety questionnaires. Patients were followed 2 years and compared to a group of patients outside the program. RESULTS: Between 1989 and 1993 170 patients were evaluated and 104 patients completed the program. At the end of the 6 months 73 (70%) of patients had <11 tender points and FIQ improved 25%. Having a pain profile on MMPI or having major depression, did not predict poorer outcome. Thirty-three patients followed for 2 years after the program continue to show improvement. A control group of 29 patients who never entered the program showed no significant improvement. CONCLUSION: The group treatment of patients with FM in an outpatient setting shows promise; a more formal controlled study is needed to confirm this impression.

Assessing depression in fibromyalgia patients.

PURPOSE: This study investigated the relationships among four methods of detecting depression in patients with fibromyalgia. METHODS: Data were obtained from 100 women (mean age 43 years) who had been diagnosed with fibromyalgia. Instruments included a computerized Diagnostic Interview Schedule (C-DIS), Beck Depression Inventory (BDI), an adjusted "disease-free" BDI (BDI-A), and Minnesota Multiphasic Personality Inventory depression subscale (MMPI-D). Chance-corrected concordance, sensitivity, specificity, and accuracy among the four methods were calculated. RESULTS: The C-DIS detected 22% and BDI-A 29% with current major depression. The BDI and MMPI-D yielded higher estimates of 55% of the 44%, respectively. Agreement on the diagnosis among the four methods was significantly greater than chance. When compared with the C-DIS, the BDI was the most sensitive instrument and the BDI-A most specific.

Inhibition of serotonin uptake into mouse brain synaptosomes by ionophores and ion-channel agents.

[3H]Serotonin uptake into mouse cerebrocortical synaptosomes was decreased by the K+ ionophore valinomycin, the K+ and Na+ ionophore gramicidin, and the proton ionophore carbonylcyanide m-chlorophenylhydrazone. The Na+/H+ exchanger monensin reduced uptake at non-depolarizing concentrations. Uptake was also decreased by inhibition of the Na+, K(+)-ATPase with ouabain and by tetrodotoxin-sensitive activation of voltage-dependent sodium channels with veratridine, batrachotoxin and scorpion venom. In contrast, the Ca2+ channel agents BAY K8644 and nimodipine were ineffective. The effect of reducing the Na+ gradient depended upon whether the internal Na+ concentration was raised (i.e. by scorpion venom, monensin) or the external Na+ concentration was lowered (37 mM NaCl in the medium).

Role of ions and membrane potential in uptake of serotonin into plasma membrane vesicles from mouse brain.

Plasma membrane vesicle preparations from mouse cerebral cortex actively accumulated [3H]serotonin upon the imposition of a K+ gradient (in greater than out), a Na+ gradient (out greater than in), and the presence of external Cl-. Maximal stimulation of uptake by internal K+ occurred at 15 mM and half-maximal stimulation at 2 mM. Internal K+ did not enhance uptake merely via generation of a membrane potential because simultaneous parallel increases in internal and external K+ concentration also stimulated uptake. External Cl- increased serotonin uptake with a Km of 18 mM and a Hill number of 1.0, suggesting a requirement for one chloride ion for transport. Uptake could not be driven by internal H+ instead of K+. Estimation of the membrane potential by the distribution of triphenylmethylphosphonium ion showed a modest effect of valinomycin (1-20 microM) in increasing the potential from -19 to -31 mV accompanied by an increase in serotonin uptake. Proton ionophores prevented this effect of valinomycin and, by themselves, reduced the potential to -6 mV, but did not affect serotonin transport. A model is proposed for serotonin transport in brain plasma membrane vesicles that is similar to the model for porcine blood platelet vesicles as far as electroneutrality and stimulation by K+, Na+, and Cl- are concerned, but that is different in substitution of internal H+ for K+.

Uptake of [3H]serotonin into plasma membrane vesicles from mouse cerebral cortex.

Preparations of plasma membrane vesicles were used as a tool to study the properties of the serotonin transporter in the central nervous system. The vesicles were obtained after hypotonic shock of synaptosomes purified from mouse cerebral cortex. Uptake of [3H]serotonin had a Na+-dependent and Na+-independent component. The Na+-dependent uptake was inhibited by classical blockers of serotonin uptake and had a Km of 63-180 nM, and a Vmax of 0.1-0.3 pmol mg-1 s-1 at 77 mM Na+. The uptake required the presence of external Na+ and internal K+. It required a Na+ gradient ([Na+]out greater than [Na+]in) and was stimulated by a gradient of K+ ([K+]in greater than [K+]out). Replacement of Cl- by other anions (NO2-, S2O3-(2-)) reduced uptake appreciably. Gramicidin prevented uptake. Although valinomycin increased uptake somewhat, the membrane potential per se could not drive uptake because no uptake was observed when a membrane potential was generated by the SCN- ion in the absence of internal K+ and with equal [Na+] inside and outside. The increase of uptake as a function of [Na+] indicated a Km for Na+ of 118 mM and a Hill number of 2.0, suggesting a requirement of two sodium ions for serotonin transport. The present results are accommodated very well by the model developed for porcine platelet serotonin transport (Nelson, P. J., and Rudnick, G. (1979) J. Biol. Chem. 254, 10084-10089), except for the number of sodium ions that are required for transport.

Immunotoxicologic evaluation of chlorine-based drinking water disinfectants, sodium hypochlorite and monochloramine.

Male Sprague-Dawley rats were exposed to chlorine-based disinfectants in the drinking water from weaning to 12 weeks of age, at which time they were terminated and assessed for immune competence. Chlorine-based drinking water disinfectants used were sodium hypochlorite (5, 15 and 30 ppm) and monochloramine (9, 19 and 38 ppm). Parameters of immunity measured were spleen and thymus weights, antibody production, delayed-type hypersensitivity (DTH) reactions, natural killer cell (NKC) cytotoxicity, oxidative metabolism response (i.e chemiluminescence-CL) and phagocytosis by macrophages, and production of 2 immunoregulatory cytokines, interleukin 2 (IL2) and prostaglandin E2 (PGE2). Significant (P less than or equal to 0.05) reductions of spleen weight, DTH reactions, and oxidative metabolism by macrophages were observed only in groups of rats exposed to high levels (30 ppm) of sodium hypochlorite, while PGE2 production was elevated. Rats exposed to the higher doses of monochloramine had reduced spleen weights (38 ppm), decreased antibody synthesis (9 and 19 ppm) and augmented PGE2 production (19 and 38 ppm). These results extend the earlier observations of others that macrophage function of laboratory rodents may be impaired by exposure to high concentrations of chlorinated drinking water. Furthermore, the function of other major populations of immunocytes and types of immune responses may also be altered following subchronic exposure to high concentrations of chlorinated drinking water. These types of effects on the immune system are a previously unrecognized potential side-effect of the ubiquitous practice of disinfection of water with chlorine compounds. Alteration of immune function of chlorine-based disinfectant-exposed rats in this study was only evident at relatively high doses, and only selected immune responses were altered. It appears, therefore, that these chlorine-based disinfectants are not particularly strong immunodepressants. However, further studies in different species may be warranted in order to better extrapolate to implications to human health following chronic low-level exposure.

Immunotoxicity testing: an economical multiple-assay approach.

A model for assessing immunotoxicologic effects of chemicals and drugs was developed in the Sprague-Dawley rat whereby multiple concomitant immunoassays were performed in a single animal. The multiple parameters of immunity assessed in each rat included T cell-dependent IgG antibody production, delayed hypersensitivity, natural killer cell cytotoxicity, and production of three potent immune regulating immunocytokines: macrophage-derived interleukin 1 and prostaglandin E2, and lymphocyte-derived interleukin 2. Splenocyte and resident peritoneal macrophage numbers were also quantitated and spleen and thymus weights recorded. The sensitivity of this animal model was tested by treating rats with the immune-potentiating drugs, NPT 15392 (erythro-9-[2-hydroxy,3-nonyl]hypoxanthine) and avridine (N,N-dioctadecyl-N',N'-bis-[2-hydroxyethyl]propanediamine, or the immune-suppressive drugs, cyclophosphamide (N,N-bis[2-chloroethyl]tetrahydro-2H-1,3,2-oxazaphosphorin-2-amine -2-oxide) and dexamethasone. Rats treated with NPT 15392 or avridine generally had enhanced immune responses, while those treated with cyclophosphamide or dexamethasone had decreased immune responses. Differential responsiveness of various immunocyte populations within individual rats to different drugs, or to doses of the same drug, indicates the efficacy of measuring multiple responses within the same animal. The multiassay-single animal approach represents an economical, versatile, sensitive, and relatively comprehensive paradigm for assessing immunotoxicologic/pharmacologic properties of chemicals and drugs. The approach is extremely economical since multiple immune responses are evaluated in each animal. The approach is versatile because it is amenable to incorporation of a variety of in vitro and in vivo assays and could be applied to almost any species. The model is relatively comprehensive because major types of immune responses/immunocyte populations and immunoregulatory pathways are tested. Finally, the model is sensitive for detecting immunosuppression as well as immunoenhancement, as validated by the use of known immune response modifiers in this study.

Cyclophosphamide-conditioned suppression of the natural killer cell response in rats.

Injection of rats with cyclophosphamide (CY) after their consumption of a novel saccharin-flavored drinking solution resulted in a conditioned aversion to saccharin and a conditioned suppression of natural killer cell (NKC) cytotoxicity. In this study, male Sprague-Dawley rats were conditioned by pairing saccharin with 50 mg/kg CY, an immunosuppressive drug with noxious gastrointestinal side-effects. Twenty-two and 26 days later, re-exposure of conditioned animals to saccharin alone re-enlisted the immunosuppressive effects of CY when NKC cytotoxicity was measured on day 29. Although CY also suppressed spleen cell number, IgG antibody titers and interleukin 2 (IL2) production, these immune responses did not appear to be affected by the behavioral conditioning paradigm in this experiment. Unique aspects of this study include the ability to measure multiple immune responses in a single rat and the finding that previous reports of behaviorally conditioned immunosuppression can be extended to another parameter, NKC cytotoxicity. These findings could have significant implications to human medicine, especially in the area of autoimmunity and immunodeficiency, and intervention and treatment of cancer.

Collective bargaining by nurses: a comparative analysis of management and employee perceptions.

In collective bargaining, the nurses' definition of a situation might be quite different from that of health service management; thus, their reasons for striking and their assessment of the bargaining issues would not be congruent with those of management.

Changing images of professionalism: the case of public health nurses.

A survey of 89 public health nurses in a California county explored factors that might account for the growing support of unions and subsequent militancy among nurses. As predicted, changes in the backgrounds of public health nurses have occurred over time: 1) older nurses are more likely to have graduated from a diploma program and to have parents of lower educational and occupational attainment than younger nurses; 2) older nurses are more likely to view nursing as a calling and less likely to desire representation in collective bargaining by the union or to believe striking professional; 3) older nurses and those from lower social class backgrounds were less likely to belong to the union and less likely to participate in a county-wide strike. Because age and parental background factors are independently related to our indicators of militancy--union membership and participation in a strike--the results are interpreted as a change in nurses' images of professionalism.

Changing perceptions of organizational communication: can short-term intervention help?

An intervention activity commensurate with specific organizational goals, directed to short-term change efforts to alter employee perceptions about their satisfaction, about such work activitiesas communication, and about opportunities to make job-related innovations was implemented for emergency room personnel in a large West Coast metropolitan hospital. When evaluated, using a research design which reduced validity threats in interpreting results, perceptions about some aspects of work were found to be more susceptible to change through short interventions than were others.