The Effects of Health Anxiety and Litigation Potential on Symptom Endorsement, Cognitive Performance, and Physiological Functioning in the Context of a Food and Drug Administration Drug Recall Announcement.

Drug recalls and lawsuits against pharmaceutical manufacturers are accompanied by announcements emphasizing harmful drug side-effects. Those with elevated health anxiety may be more reactive to such announcements. We evaluated whether health anxiety and financial incentives affect subjective symptom endorsement, and objective outcomes of cognitive and physiological functioning during a mock drug recall. Hundred and sixty-one participants reported use of over-the-counter pain medications and presented with a fictitious medication recall via a mock Food and Drug Administration (FDA) website. The opportunity to join a class-action lawsuit was manipulated. We assessed health anxiety, recalled drug usage, blood pressure, heart rate, and performance on a computerized Trail Making Test (TMT). Symptom endorsement was strongly predicted by health anxiety. When combined, three health anxiety measures explained 28.5% variance (Cohen's d = 1.26). These effects remain strong after controlling for depression and anxiety. Litigation condition did not predict symptom endorsement. Blood pressure and heart rate were modestly predicted by health anxiety, but not by litigation condition. TMT performance was consistently predicted by health anxiety, with higher scores associated with poorer performance. Although there were no main effects for litigation, interactions consistently emerged for the TMT, with generally poorer performance for those with higher health anxiety in the non-litigation condition; whereas health anxiety was unrelated to performance for the litigation condition. All but one participant joined the litigation when given the opportunity, despite a healthy sample and minimal use of pain medication. Subsequent data from 67 individuals with no mention of the FDA scenario or litigation showed that health anxiety still significantly predicts symptom endorsement (12.6% variance), but the explained variance is less than half that obtained in the FDA scenario. The findings suggest that health anxiety plays a significant role in adverse symptom reporting, beyond anxiety or depression, and this effect is independent of the presence of the FDA recall. The lack of differences for health anxiety and symptom endorsement between litigation and non-litigation conditions rules out malingering. Although it is general practice in drug recalls to list potential adverse side effects caused by medications, this may elicit unintended symptom experiences and health anxious individuals may be more susceptible.

Optometry Australia's chairside reference for the diagnosis and management of age-related macular degeneration.

Age-related macular degeneration (AMD) is the leading cause of irreversible vision loss in people over the age of 50 years in Australia. Optometry Australia has developed this AMD chairside reference in consultation with a member-based working group comprised of experienced practitioners. It provides an evidence-based approach to current best practice in the diagnosis and management of AMD. Optometrists should be competent in assessing patients with or at risk of developing AMD, so that they are able to provide evidence-based management including appropriate communication, diagnosis and referral when indicated. This AMD chairside reference covers risk factors for the development of AMD or progression to late-stage AMD; the current clinical classification of AMD; common signs and symptoms; optometric assessment including ocular imaging and biomarkers; differential diagnoses; and management of early, intermediate and late AMD. Optometry Australia's chairside reference is intended as a general guide for optometrists, and is not a formal management protocol.

Bilateral simultaneous laser in situ keratomileusis with the Aesculap Meditec MEL 60 laser.

PURPOSE: To report the outcome of bilateral simultaneous excimer laser in situ keratomileusis (LASIK) with the Aesculap Meditec MEL 60 laser for the correction of myopia and hyperopia. METHODS: This retrospective study included 338 eyes of 169 patients who had bilateral simultaneous LASIK performed by one surgeon (D.L.V.). RESULTS: Postoperatively, 20/20 or better visual acuity was achieved by 78.5% (186 eyes) in the <-6.00-D group, and 55.6% (54 eyes) in the > or = -6.00-D group. Postoperatively, the mean spherical equivalent refraction was within +/- 0.50 D for 78% (185 eyes) in the <-6.00-D group (range, -2.25 to +1.25 D), 55% (53 eyes) in the > or = -6.00-D group (range, -2.38 to +1.13 D), and one eye in the hyperopic group. Complications at 3 months included regression in five eyes (1.4%), infiltrates in six eyes (1.7%), primary undercorrection in two eyes (0.6%), superficial punctate keratitis in four eyes (1.1%), ten eyes (2.9%) underwent enhancement, two eyes (0.6%) underwent refractive lensectomy, and four eyes (1.1%) underwent astigmatic keratotomy 3 months postoperatively. Two eyes lost two lines of best spectacle-corrected visual acuity. CONCLUSION: Bilateral simultaneous LASIK with the Aesculap Meditec MEL 60 laser was effective and predictable. It was more economical and convenient for the patient than unilateral LASIK and binocular visual rehabilitation was rapidly restored. No sight threatening complications occurred in this group of patients.

Effects of weather on daily body mass regulation in wintering dunlin.

We investigated the influence of changes in weather associated with winter storms on mass balance, activity and food consumption in captive dunlin (Calidris alpina) held in outdoor aviaries, and compared the aviary results with weather-related body mass differences in free-living dunlin collected at Bolinas Lagoon, California. Captive birds fed ad libitum increased their body mass at higher wind speeds and lower temperatures, suggesting regulation of energy stores, whereas free-living birds exhibited patterns suggesting thermoregulatory limits on body mass regulation. Daily energy expenditure in aviary dunlin was 2.85 kJ g d(-1), or 2.8x basal metabolic rate (BMR), with thermostatic costs averaging 59 % of daily expenditure. Slight but significant increases in body mass and energy expenditure in captive birds on rainy days, adjusted for possible external water mass, suggested rainfall as a proximate cue in regulating daily body mass. Body mass changes under artificial rainfall indicated similar results, and field masses suggested that free-living birds have greater body mass on days with measurable rainfall. Increased activity costs under artificial rainfall were associated with an increase in maintenance activities, relative to controls. Whether activity costs increased on days with natural rates of rainfall was unclear. Our results are consistent with current hypotheses regarding the role of body mass regulation in providing insurance against increased starvation risk during deteriorating thermal or foraging conditions, or in reducing the costs of extra mass as conditions improve.

Objective evidence of decreased pain perception in normotensives at risk for hypertension.

Results from laboratory and naturalistic studies have demonstrated decreased subjective pain ratings in hypertensives and individuals at risk for hypertension. Based on previous evidence that the nociceptive withdrawal reflex may provide an objective index of pain threshold in humans, the present study examined the intensity of sural nerve stimulation required to elicit nociceptive withdrawal in offspring of hypertensives and normotensives. Participants included 60 men and 56 women who were normotensive, 18-23 years of age, and predominately Caucasian. To assess the nociceptive withdrawal reflex, ascending and descending intensities of electrical stimulation were applied over the sural nerve while electromyographic activity was recorded from the ipsilateral biceps femoris muscle. Analyses of the intensity of electrical stimulation required to reach the thresholds for nociceptive withdrawal and subjective pain revealed a pattern of hypoalgesia in individuals at risk for hypertension. First, significantly higher intensities were required to elicit nociceptive withdrawal in offspring of hypertensives versus normotensives. Second, offspring of hypertensives endured significantly more intense stimulation before reporting pain. Third, both parental history of hypertension and resting systolic blood pressure were significant independent predictors of stimulation intensity at nociceptive withdrawal reflex and subjective pain thresholds. These results confirm and extend previous observations of an association between risk for hypertension and hypoalgesia, and suggest that hypoalgesia should be examined as a potential predictor of progressive blood pressure increases in individuals at risk for hypertension.