Factors associated with the contemplative stage of readiness to initiate osteoporosis treatment.

We investigated the factors associated with readiness for initiating osteoporosis treatment in women at high risk of fracture. We found that women in the contemplative stage were more likely to report previously being told having osteoporosis or osteopenia, acknowledge concern about osteoporosis, and disclose prior osteoporosis treatment. INTRODUCTION: Understanding factors associated with reaching the contemplative stage of readiness to initiate osteoporosis treatment may inform the design of behavioral interventions to improve osteoporosis treatment uptake in women at high risk for fracture. METHODS: We measured readiness to initiate osteoporosis treatment using a modified form of the Weinstein Precaution Adoption Process Model (PAPM) among 2684 women at high risk of fracture from the Activating Patients at Risk for OsteoPOroSis (APROPOS) clinical trial. Pre-contemplative participants were those who self-classified in the unaware and unengaged stages of PAPM (stages 1 and 2). Contemplative participants were those in the undecided, decided not to act, or decided to act stages of PAPM (stages 3, 4, and 5). Using multivariable logistic regression, we evaluated participant characteristics associated with levels of readiness to initiate osteoporosis treatment. RESULTS: Overall, 24% (N = 412) self-classified in the contemplative stage of readiness to initiate osteoporosis treatment. After adjusting for age, race, education, health literacy, and major osteoporotic fracture in the past 12 months, contemplative women were more likely to report previously being told they had osteoporosis or osteopenia (adjusted odds ratio [aOR] (95% CI) 11.8 (7.8-17.9) and 3.8 (2.5-5.6), respectively), acknowledge concern about osteoporosis (aOR 3.5 (2.5-4.9)), and disclose prior osteoporosis treatment (aOR 4.5 (3.3-6.3)) than women who self-classified as pre-contemplative. CONCLUSIONS: For women at high risk for future fractures, ensuring women's recognition of their diagnosis of osteoporosis/osteopenia and addressing their concerns about osteoporosis are critical components to consider when attempting to influence stage of behavior transitions in osteoporosis treatment.

[Adherence and cognitive performance in schizophrenia]. / Kognitive Leistungen und Adhärenzverhalten bei Patienten mit schizophrenen Psychosen.

BACKGROUND: It is known that many patients with schizophrenia show non-adherence with regard to antipsychotic medication. Furthermore, many studies indicate cognitive deficits in schizophrenic patients. In this review, we compare the results of studies examining the relationship of non-adherence and cognitive performance. METHOD: Based on a systematic literature review, the impact of cognitive performance on the adherence behaviour of patients with schizophrenia was examined. RESULTS: We found 18 studies analysing the impact of cognitive performance on adherence behaviour. Most studies indicated that patients with stronger cognitive impairments show lower adherence behaviour. Possible causal mechanisms are discussed.

Activation of cannabinoid CB1 and CB2 receptors suppresses neuropathic nociception evoked by the chemotherapeutic agent vincristine in rats.

BACKGROUND AND PURPOSE: The ability of cannabinoids to suppress mechanical hypersensitivity (mechanical allodynia) induced by treatment with the chemotherapeutic agent vincristine was evaluated in rats. Sites of action were subsequently identified. EXPERIMENTAL APPROACH: Mechanical hypersensitivity developed over the course of ten daily injections of vincristine relative to groups receiving saline at the same times. Effects of the CB1/CB2 receptor agonist WIN55,212-2, the receptor-inactive enantiomer WIN55,212-3, the CB2-selective agonist (R,S)-AM1241, the opiate agonist morphine and vehicle on chemotherapy-induced neuropathy were evaluated. WIN55,212-2 was administered intrathecally (i.t.) or locally in the hindpaw to identify sites of action. Pharmacological specificity was established using competitive antagonists for CB1 (SR141716) or CB2 receptors (SR144528). KEY RESULTS: Systemic administration of WIN55,212-2, but not WIN55,212-3, suppressed vincristine-evoked mechanical allodynia. A leftward shift in the dose-response curve was observed following WIN55,212-2 relative to morphine treatment. The CB1 (SR141716) and CB2 (SR144528) antagonists blocked the anti-allodynic effects of WIN55,212-2. (R,S)-AM1241 suppressed vincristine-induced mechanical hypersensitivity through a CB2 mechanism. Both cannabinoid agonists suppressed vincristine-induced mechanical hypersensitivity without inducing catalepsy. Spinal sites of action are implicated in cannabinoid modulation of chemotherapy-induced neuropathy. WIN55,212-2, but not WIN55,212-3, administered i.t. suppressed vincristine-evoked mechanical hypersensitivity at doses that were inactive following local hindpaw administration. Spinal coadministration of both the CB1 and CB2 antagonists blocked the anti-allodynic effects of WIN55,212-2. CONCLUSIONS AND IMPLICATIONS: Cannabinoids suppress the maintenance of vincristine-induced mechanical allodynia through activation of CB1 and CB2 receptors. These anti-allodynic effects are mediated, at least in part, at the level of the spinal cord.

Conjunctival flaps.

PURPOSE: The authors reviewed their experience with total conjunctival flaps (TCF) and partial conjunctival flaps (PCF) for the past 5 years in 61 patients. METHODS: Forty-eight patients had TCF and 13 had PCF. Diagnoses for surgery included severe bullous keratopathy for chronic graft failure (not candidates for keratoplasty) (19), herpes zoster ophthalmicus (7), chronic ulcerative keratitis (14), neurotrophic keratitis (2), and herpes simplex keratitis (9). RESULTS: There were seven complications. Four flap retractions occurred in the TCF group, requiring resuturing in two. Three complications occurred in the PCF group. One patient had two flap retractions and recurrent ulceration, requiring tarsorrhaphy. One patient with PCF suffered a perforation after flap retraction, necessitating penetrating keratoplasty. CONCLUSION: The authors believe conjunctival flaps are underused and should be considered seriously for bullous keratopathy, neurotrophic keratitis, recalcitrant keratitis, and persistent nonhealing epithelial defects.

Spontaneous EEG theta activity controls frontal visual evoked potential amplitudes.

Frontal visual evoked potentials (VEPs) were studied in order to extend the application of a recently introduced algorithm for selective averaging of evoked potentials. This algorithm is based on the inverse relationship between amplitudes of alpha or theta components of the spontaneous EEG activity and evoked potential (EP) amplitudes. Stimuli were only applied if the root mean square (RMS) value of the ongoing EEG at the lead F4 was below an individual threshold level ('selective stimulation'). For this comparison, the EEG was filtered in one of the frequency ranges 'alpha', 'theta' and 'alpha and theta', respectively. 'Alpha' and 'alpha-and-theta-dependent' selective stimulation conditions resulted in significant amplitude increases (P < 0.05) at the input reference channel F4 and partly at ipsihemispherical temporal and parietal leads and at Cz. The largest increase of 35% at F4 (P < 0.01) was obtained with visual stimulation during low prestimulus theta activity. We conclude that spontaneous theta activity of the frontal cortex may be a factor influencing the amplitudes of frontal VEPs. A sophisticated analysis of frontal EPs, mainly in the framework of cognitive studies, should consider the theta activity prior to stimulation.

Scombroid poisoning.

Scombroid poisoning is described in the literature as a toxic poisoning caused by ingestion of certain dark meat fish undergoing bacterial decomposition. Poisoning results from the ingestion of a heat-stable toxin. We describe the case of a man who presented to the emergency department several hours after eating tuna steak with evidence of scombroid poisoning that was associated with loss of vision and atrial tachycardia with block. All signs and symptoms resolved after treatment for scombroid poisoning.

[Hospital depression units judged by patients]. / Depressionsstationen im Urteil der Patienten.

The ward atmosphere is an imposant aspect of the clinical treatment. This survey shows the difference in the assessment of the ward atmosphere by patients with major depressive disorders between specialized and non-specialized organisation of the clinical treatment. Measured with a ward atmosphere scale the judgement differs significant in the points involvement and organization between the two groups.

Visually debilitating pterygium: surgical and contact lens treatment.

PURPOSE: We present the management of a patient with large pterygia complicated by irregular astigmatism and corneal opacities. Visual rehabilitation required both surgical excision and contact lens fitting. METHODS: We examined a 30-year-old man with hand motion vision from a large pterygium overgrowing his right cornea. Histopathology was consistent with pterygium. During the first few postoperative weeks, his uncorrected visual acuity improved to 20/60, and manifest refraction yielded no further improvement. In the subsequent months, there were increasing anterior stromal corneal opacities, and the refraction became hyperopic to a variable degree. RESULTS: Best corrected visual acuity was 20/70-20/100. Axial length was 22.64 +/- 0.07 mm. Computerized corneal topography 6 months postoperative was similar to the preoperative topography and revealed irregular and asymmetric astigmatism, with marked variation of the central corneal dioptric power. Slit lamp biomicroscopy suggested that the corneal opacities were responsible for the patient's decreased acuity; however, contact lens fitting provided 20/30 vision with a rigid gas permeable contact lens. CONCLUSIONS: The improved vision with contact lens therapy strongly suggested that the irregular and asymmetric astigmatism were more visually significant than the corneal opacities.

Auditory event-related magnetic fields in a tone-duration discrimination task. Source localization for the mismatch field and for a new component M2".

Auditory event related magnetic fields were measured using an odd-ball paradigm in which the rare event was a tone of short duration, D2, and the frequent one a tone of longer duration, D1. The subjects were required to attend to and count the number of rare stimuli. In the average across target stimuli a mismatch field (MMF) occurs and the dependence of the MMF, especially its latency, on the tone duration D2 is examined in detail. The location of an equivalent current dipole for the MMF-source is found and turns out to be at variance with earlier results. In addition to the MMF we propose a new component, here called M2", which in time overlaps the magnetic equivalent of the P200 signal and which has a source location (equivalent current dipole) lying rather close to the MMF-source. The two sources are, however, active at latencies differing by a time equal to D2. We speculate that M2" indicates the onset of the process: "evaluation of tone-duration" while the MMF indicates the end of this process.

Event-related theta rhythms in cat hippocampus and prefrontal cortex during an omitted stimulus paradigm.

In a recent study on human subjects which performed a time prediction task in an omitted stimulus paradigm we found an increase in the amplitudes of evoked potentials (EPs) for the stimulus preceding the omitted stimuli, probably due to expectancy and focused attention. The amplitude increases were dominant over frontal and parietal association areas and were mainly reflected in enhancements of the theta (3-6 Hz) components. In the present study we analyse the responses of the auditory cortex (GEA, gyrus ectosylvianus anterior), different parts of hippocampus (CA1, CA3), reticular formation (RF), and motor cortex (MC) of the cat brain using a similar paradigm. Similar theta component increases of the EPs were obtained in various parts of the hippocampus, which were dominant in pyramidal cell layers (CA3, CA4), and in motor cortex. The results are interpreted as signs of a diffuse theta response system in the brain including mainly the hippocampus and frontal and parietal association areas. The diffuse theta system is probably involved in general attention and expectancy processes.

Enhancement of visual evoked potentials by stimulation during low prestimulus EEG stages.

A new algorithm for averaging of visual evoked potentials (VEPs) is introduced and compared with the conventional method. The root mean square (RMS) values of the alpha and theta band EEG activities at the vertex 1-s preceding stimulus presentation were computed: stimuli were blocked during phases of high prestimulus activity. Stimulation was applied selectively during periods of low activity. Light stimuli of 1-s duration were given to twelve healthy, voluntary subjects. The main results were: (1) The averaged VEPs at the vertex showed an increase in the N1-P2 amplitude of about 35% in comparison to experiments with conventional stimulation. This increase was in the range of 25-30% when an ISI correction was taken into account. Frontal, temporal and parietal locations showed also increases of the N1-P2 amplitude in evoked potentials. (2) VEPs were also affected qualitatively depending on the frequency content of the prestimulus activity.

Prestimulus EEG-activity strongly influences the auditory evoked vertex response: a new method for selective averaging.

A new algorithm for averaging of evoked potentials (EPs) is introduced and compared with the conventional method. The root mean square (rms) values of the alpha and theta band EEG activities 1-s preceding stimulus presentation were computed: stimuli were blocked during phases of high prestimulus activity, thus evoking auditory responses selectively during periods of low activity. Ten volunteers were stimulated with tone bursts of 2000 Hz, 80 dB and 1-s duration. The main results were: (1) The averaged EPs showed an increase in amplitude of nearly 40% in comparison to experiments with conventional stimulation. This increase was in the range of 30% when an ISI correction was taken into account. (2) Single trials tended to form patterns of damped oscillations of e.g., 7-8 Hz, thus revealing a high correlation to the averaged EP. In alpha or theta band contingent experiments, correlation coefficients between single trials and averaged EPs were significantly higher (p < .01; p < .05).

Human infectious corneal ulcer caused by Pythium insidiosum.

Pythium insidiosum is a fungus-like organism known to infect a variety of animals. In humans, the few known cases involving Pythium have included arterial infections and cellulitis. We present what we believe to be the first case of P. insidiosum recovered from a human corneal ulcer. The organism is difficult to isolate, causing delays in diagnosis. It is also resistant to the usual antifungal medications, making surgical excision the treatment of choice.

Sensory and cognitive components of brain resonance responses. An analysis of responsiveness in human and cat brain upon visual and auditory stimulation.

We performed an analysis of topographic and modality-dependent responsiveness of auditory and visual cortex in 5 cats and of vertex and occipital derivations in 12 human subjects. The evoked potentials were studied in the frequency domain by means of the Fourier transform. Furthermore, digital filtering was applied to confirm and extend the analysis. Preliminary results indicate that resonances were observed mainly in the 5, 10, 20 and 40 Hz frequency bands. The frequency of resonance maxima depended on the sites of measurement electrodes and stimulus modality. It is concluded that the analysis of resonance phenomena in the brain is a useful approach to understanding the relation between evoked potentials, evoked magnetic fields and single-cell recordings.

Symblepharon formation in epidemic keratoconjunctivitis.

Two case reports are presented in which patients with epidemic keratoconjunctivitis (EKC) develop symblepharon during the course of their infection. This report is the initial documentation of symblepharon formation in EKC and the first reported episode of conjunctival membrane formation in association with adenovirus type 2.

The lupus anticoagulant and retinal vaso-occlusive disease.

A patient with a history of hypertension had a combined central retinal artery and vein occlusion in one eye. She had markedly elevated coagulation profiles, especially the partial thromboplastin time, secondary to circulating lupus anticoagulant. Due to the asymmetric involvement, the presence of the anticoagulant, and the lack of any other signs of retinopathy, we believed that the etiology was thrombotic rather than vasculitic. Detection and measurement of the lupus anticoagulant could serve as a marker of disease and in the assessment of disease activity in the follow-up of these patients.

Iritis and papillitis as a primary presentation of Lyme disease.

A 9-year-old boy had iridocyclitis and papillitis. Laboratory evaluation revealed a positive Lyme titer. Institution of therapy with intravenous ceftriaxone resulted in regression of the ocular inflammation. Ophthalmologists should consider Lyme disease in the differential diagnosis of iridocyclitis in conjunction with papillitis.