Use of personal digital assistants among dietitians and dietetic students in Oklahoma: should programs incorporate PDA training into their curricula?

The objective of this study was to assess the use of personal digital assistants (PDAs) among dietitians and dietetic students in Oklahoma and the desire for training in the use of PDAs. A survey was mailed to 648 dietitians and dietetic students to assess their PDA use and interest in PDA training. Frequency and percentage of responses were determined. A total of 320 usable surveys were returned, for a response rate of 49%. Sixteen percent of responders were dietetic students. The responses of students did not differ from those of dietitians, so all responses were combined. Subjects were primarily female, between 21 and 50 yrs of age, and had practiced for 5 yrs or more, similar to the demographics of dietitians nationally. Twenty-four percent of responders currently use a PDA, primarily as an organizational tool. Twenty-eight percent of the users indicated that they had received training in PDA use. Thirty-seven percent of the users were using a PDA for nutrition assessments, and 28% were using it for nutrition support. Of nonusers, 80% indicated that they would use a PDA if training were available. PDAs were used most often as an organizational tool, seldom for nutrition-specific applications. Dietitians and students expressed an interest in receiving training in PDA use, preferably from state and local dietetic associations. PDA training might also be incorporated into academic dietetic programs, and employers could provide training in the workplace.

Physiologic reactivity despite emotional resilience several years after direct exposure to terrorism.

OBJECTIVE: Six and a half to 7 years after the 1995 terrorist bombing in Oklahoma City, the authors assessed autonomic reactivity to trauma reminders and psychiatric symptoms in adults who had some degree of direct exposure to the blast. METHOD: Sixty survivors who were listed in a state health department registry of persons exposed to the bombing and 60 age- and gender-matched members of the Oklahoma City metropolitan area community were assessed for symptoms of PTSD and depression and for axis I diagnoses. Heart rate and systolic, diastolic, and mean arterial blood pressures were measured before, during, and after bombing-related interviews. The two groups were compared on both psychometric and physiologic assessments. RESULTS: Posttraumatic stress but not depressive symptoms were significantly more prevalent in the survivor group than in the comparison group, although symptoms were below levels considered clinically relevant. Despite apparent emotional resilience or recovery, blast survivors had significantly greater autonomic reactivity to trauma reminders on all measures than comparison subjects. CONCLUSIONS: The results suggest that physiologic assessment may capture long-term effects of terrorism that are not identified by psychometric instruments. The consequences of autonomic reactivity despite emotional resilience years after experiencing trauma are unknown but theoretically could range from facilitating a protective vigilance toward future disasters to more maladaptive avoidance behaviors, somatic symptoms, or medical problems.

Ethnic differences in fasting glucose, insulin resistance and lipid profiles in obese adolescents.

Children and adolescents with obesity are increasingly referred to the pediatric endocrinology clinic at OU Children's Hospital for evaluation and initiation of preventive measures. During the summer of 2004 we conducted a retrospective review of cases to determine the prevalence of fasting insulin resistance and dyslipidemia; to study associations and differences due to ethnic background; and compare values with similar patients seen at four Indian Health Service clinics. We observed the highest prevalence of dyslipidemia in Caucasian youth. The prevalence of high fasting glucose and mean glucose values were higher in the obese Native American youth than in African Americans or Caucasians. The elevated glucose levels in young Native Americans may be associated with their increased risk for type 2 diabetes compared to other races; but Caucasians are more prone to dyslipidemia. Effective methods are needed to detect, prevent and treat diabetes and cardiovascular risk in children and adolescents.

Acanthosis Nigricans, insulin resistance (HOMA) and dyslipidemia among Native American children.

OBJECTIVE: It is controversial whether acanthosis nigricans is an independent marker of insulin resistance. In this study, we evaluated whether insulin resistance (as reflected by HOMA) was associated with acanthosis nigricans, Native American heritage, BMI, fasting insulin, and plasma lipids in Native American children and adolescents. DESIGN/METHODS: Retrospective chart review of Native American children (3.6 to 17.8 yrs) seen in 4 tribal or Indian Health Service clinics after referral for exceptionally high type 2 diabetes risk (family history, extreme obesity, and/or severe acanthosis nigricans). RESULTS: All but 2 had a family history of type 2 diabetes in at least one first or second degree relative, all but 3 had acanthosis nigricans (12 severe and 11 mild/not severe), and all but 2 were obese (BMI Z score of +3 to +8). Those with severe acanthosis nigricans had higher BMI and fasting insulin levels and lower HDL-C (p < 0.05) than those with acanthosis nigricans that was not severe. HDL-C correlated with BMI Z-score (p = 0.046) and approached significance with fasting insulin. HOMA correlated with BMI (p = 0.0005), with 82.4% of males and 33.3% of females having a HOMA greater than the 90th percentile for normal children. A multiple regression model indicated that acanthosis nigricans severity remained a predictor (p = 0.015) of HOMA after association of BMI Z score, Native American blood quantum, and gender were removed. CONCLUSIONS: These data indicate that among Native American children at high risk for developing type 2 diabetes, acanthosis nigricans is an independent marker of insulin resistance (as reflected by HOMA).

Paroxetine treatment of depression with posttraumatic stress disorder: effects on autonomic reactivity and cortisol secretion.

Effects of paroxetine treatment of comorbid depression and posttraumatic stress disorder (PTSD) on subjective symptoms, autonomic reactivity, and diurnal salivary cortisols were assessed prospectively. Cross-sectional baseline psychophysiologic assessments of 22 patients with depression + PTSD, 21 with depression alone, and 20 asymptomatic, previously traumatized controls found that comorbid patients had higher blood pressure and heart rate reactivity to individualized trauma scripts than purely depressed and control groups. On discriminant analyses comparing comorbid patients with each other group, combined autonomic variables correctly classified 55% of comorbid patients (sensitivity) and 75% of traumatized, healthy subjects (specificity) as well as 55% of comorbid patients (sensitivity) and 86% of purely depressed patients (specificity). Although baseline AM and PM salivary cortisol levels were within reference range and did not differ significantly across groups, depression + PTSD patients differed from the other 2 groups in having a flattened diurnal pattern. After 10 weeks of open-label paroxetine, comorbid patients significantly improved in all PTSD symptom evaluations and physiologic reactivity measures but did not change cortisol levels or acquire a robust diurnal cortisol pattern. Ten treated depressed patients did not change in physiologic or cortisol measures. Results demonstrate that sampled comorbid patients had autonomic reactivity patterns similar to PTSD that responded to selective serotonin reuptake inhibitor treatment but had diurnal cortisol secretion patterns different from depression or that expected for PTSD, which did not change with treatment. Results suggest a complexity in the neurobiology of comorbid PTSD and major depression and its response to treatment.

Can physiologic assessment and side effects tease out differences in PTSD trials? A double-blind comparison of citalopram, sertraline, and placebo.

Effects of double-blind treatment of chronic posttraumatic stress disorder (PTSD) with 2 SSRIs and placebo on emotional symptoms and autonomic reactivity were assessed prospectively. PTSD subjects received citalopram (n=25), sertraline (n=23), or placebo (n=10) for 10 weeks, with psychophysiologic assessments performed before and after treatment. Intent-to-treat analysis showed that all treatment groups improved significantly in total symptoms of PTSD (as measured by the Clinician Administered PTSD Scale), all 3 PTSD symptom clusters, and sleep time. However, subtle differences in improvements in PTSD symptom clusters, physiologic reactivity, and reported adverse events were identified. Citalopram treated subjects significantly lowered systolic and diastolic blood pressures, while sertraline and placebo treated patients significantly lowered only systolic blood pressure reactivity to individualized trauma scripts. The sertraline group showed significantly more improvement in avoidance/numbing symptoms than both other groups. Considering side effects, subjects on sertraline reported more gastrointestinal problems, with early terminators having more insomnia. Early terminators on citalopram reported more fatigue and appetite changes than other treatment groups, with completers reporting more sexual dysfunction. Results support a class effect of SSRIs in treating PTSD symptoms, but suggest a possible differential effect of drugs on symptom clusters, physiologic parameters, and side effects that may have clinical relevance. Implications of symptom reduction noted in the smaller placebo group are discussed relative to recent concerns about increasing placebo response in clinical trials.