Premenstrual syndrome: comparison between different methods to diagnose cyclicity using daily symptom ratings.

BACKGROUND: In the diagnosis of premenstrual syndrome (PMS) the technique of daily prospective symptom ratings is often used. Several methods of assessing cyclicity, based on the daily prospective symptom ratings, have been presented in the literature. In this paper we compare four different methods to assess cyclicity. METHODS: Eighty consecutive patients seeking help for PMS at the Department of Gynecology completed daily symptom ratings using a visual analogue scale (VAS) during one menstrual cycle. They also made an Eysenck Personality Inventory (EPI) and a thorough case history was taken regarding earlier psychiatric case history. The methods compared were: a) the nonparametric Mann-Whitney U-test, b) effect size, c) Run-test and d) a 30% change in symptom degree between the follicular and the luteal phase calculated in two different ways. RESULTS: There was good agreement in the number of cyclic and non-cyclic patients between the different diagnostic methods used with exception of the 30% of change methods as the criteria for cyclicity. Here the number of non-cyclic patients became higher and lower, respectively, than with the other methods. The correlation between the number of symptoms for each patient showing cyclicity was high in all tests. When comparing the median neuroticism score of the EPI-N inventory the non-parametric, the Run-test and the effect size showed significant differences between the non-cyclic group and the group of patients with pure PMS, but not the 30%-change methods. Frequency of patients with psychiatric history showed similar results. CONCLUSIONS: Three of the methods used seem to identify the same patients as having or not having cyclical changes and probably also then finding the same biological and/or psychological factor being responsible for the cyclicity. There were, however, some differences in outcome of validity testing and the 30%-change methods seem less valid than the other three methods. Due to its simplicity and theoretical/statistical advances the Run-test seems most preferable.

Experimental evaluation of the effect of filtration of diesel exhaust by biologic exposure indicators.

The airway resistance, compliance of the respiratory system, transfer factor, and alveolar volume of 33 healthy rabbits were studied before and after exposure to diluted diesel exhaust generated in an experimental motor. Three diesel fuels and two particle traps were tested. Subsequent to the post-exposure lung function measurements, the animals were sacrificed and the lungs were processed for morphologic examination. The concentrations of particles, nitrogen dioxide, and formaldehyde were measured. The inflammatory airway changes were most pronounced in animals exposed to exhaust from standard fuel. Small changes were identified in animals exposed to exhaust filtered through the catalytic trap as well or exposed to unfiltered exhaust from fuels intended for densely built-up areas. Increase in compliance of the respiratory system was associated with the concentration of soot particles and formaldehyde. Compliance decreased significantly in animals exposed to exhaust from standard fuel filtered through the particle traps and increased almost significantly in animals exposed to unfiltered exhaust from the same fuel.

Influence of premenstrual syndrome on family, social life, and work performance.

Premenstrual syndrome is characterized by mental and physical symptoms that vary with different phases of the menstrual cycle. Symptoms start shortly after ovulation, increase in severity, and reach a maximum during the last five premenstrual days. After the onset of menstrual bleeding, the symptoms rapidly disappear and are usually gone within three to four days. Diagnostic procedures using prospective daily symptom ratings have recently been developed, allowing a more precise diagnosis of the cyclical mood changes and leading to a clearer picture and definition of the condition. Results from community studies show that the severity of the cyclical mood changes varies within a population of women of fertile age, from those having no cyclical mood changes to those severely handicapped by the symptoms for 14 days of the month. The severity assessment of subjective symptoms is difficult since severity is difficult to compare among individuals. In this article the authors review the different approaches to estimating severity of premenstrual syndrome and compare the different approaches with approaches used for other conditions with subjective symptoms. Two possible approaches are discussed in detail. One measures symptoms by counting the number of days with and without symptoms. The other estimates how much the symptoms affect patients' family life, social life, and work performance. Differences between retrospective and prospective assessments are also discussed.

Temporary health effects from exposure to water-borne paints.

Temporary health effects of exposure to experimental paints were studied. Ten painters feeling nuisance from water-borne paints and eight painters not feeling such nuisance applied eight experimental water-borne paints according to normal work routines. The effects were a decrease in forced vital capacity, forced expiratory volume in 1 s and peak expiratory flow, an increase in urine excretion, and a decrease in urine density. A small, but statistically highly significant, increase in the mean volume of erythrocytes was observed. The effects were similar in the two groups, but the "nuisance group" reacted with a larger urine excretion and a larger increase in the mean volume of erythrocytes. The effects did not influence physical work capacity. The effects on the lungs and urinary excretion were probably not associated with the organic solvents or ammonia in the paints. Instead, they were probably due to derivatives of isothiazolinone. This assumption needs verification.

Signs of alveolar inflammation in non-smoking Swedish wood trimmers.

Wood trimmers are periodically exposed to mould and may develop extrinsic allergic alveolitis (EAA). To investigate if there were any signs of EAA in wood trimmers with low exposure, 19 non-smoking wood trimmers underwent bronchoalveolar lavage (BAL), spirometry, and measurement of diffusion capacity (TLCO). The group was subdivided into those with (n = 9) and without serological antibodies against mould. In 14 workers the TLCO was measured both at the beginning and at the end of a week at work. Twenty five healthy non-smokers served as BAL controls and 19 healthy non-smokers as lung function controls. The median exposure of total dust was well below the Swedish threshold value, and the exposure of mould and bacteria was also low. The cell concentrations and the proportions of the various alveolar cells did not differ between the groups. The concentrations of the soluble components albumin, fibronectin, and hyaluronan were, however, significantly increased (p less than 0.001 for all) in the workers. No difference was found in lung function between the workers and the controls, and the TLCO was not impaired during a week at work. The groups of seropositive and seronegative workers did not differ in any of these parameters. The results are interpreted as a low intensity alveolar inflammation. The presence of precipitating antibodies against mould did not predict any greater risk of developing a more intense inflammation. Analysis of soluble non-cellular BAL components seems to reflect a discrete ongoing alveolar inflammation better than cell counts only.

Lung function and precipitating antibodies in low exposed wood trimmers in Sweden.

Wood trimmers are exposed to molds that periodically grow on timber that may induce alveolitis and obstructive lung disease. We have evaluated respiratory symptoms, bronchial reactivity, and lung function in 28 wood trimmers at a Swedish sawmill and in 19 unexposed office workers. Eleven (sero-positive) of the wood trimmers had precipitating antibodies in peripheral blood against one or several molds. The exposure to dust (median 0.26 mg/m3), viable mold spores (median 2950 cfu/m3), viable bacteria (median 370 cfu/m3), airborne endotoxins (range 0.0015-0.0025 microgram/m3), and terpenes (range 0.4-23 mg/m3) was lower than levels that earlier have been reported to affect lung function. The wood trimmers reported an increased prevalence of cough and breathlessness. They also showed signs of a mild obstructive impairment with a tendency to increase bronchial sensitivity to metacholine and decreased FEV1 after 2 days free from exposure. FEV1 decreased more during the working week in the sero-positive workers than among the sero-negative workers, and for the whole group the decrease in FEV1 and MEF25 was correlated to the degree of mold exposure.

Spontaneous anovulation causing disappearance of cyclical symptoms in women with the premenstrual syndrome.

In the premenstrual syndrome the negative symptoms appear during the luteal phase of the menstrual cycle. Ovulation and the formation of a corpus luteum seem to be of great importance in precipitating the syndrome. In a large group of women with premenstrual syndrome investigated daily with symptom ratings and weekly plasma estradiol and progesterone assays, 8 were found to have one ovulatory and one spontaneously occurring anovulatory menstrual cycle. In both these cycles, the post- and premenstrual phases were compared by testing for recurrence of symptoms. All patients showed a highly significant cyclical worsening of negative premenstrual symptoms during the ovulatory cycles, whereas in the anovulatory cycles the cyclical symptoms disappeared, resulting in relief of the premenstrual syndrome. These results support earlier hypotheses, suggesting that the premenstrual syndrome appears as a result of provoking factors produced by the corpus luteum. This view is in line with earlier therapeutic findings showing that induced anovulation can relieve the premenstrual syndrome.

Impeded lung function in moulders and coremakers handling furan resin sand.

A total of 39 moulders and coremakers exposed to furan resin sand and 27 unexposed local controls were examined by lung-function tests before and after a work shift. In all, 28 of the subjects exposed to furan resin sand and the control group were evaluated by dynamic spirometry and nitrogen washout. The remaining 11 subjects exposed to furan resin sand were studied using both static and dynamic spirometry and the CO single-breath technique. The time-weighted average exposure to furfuryl alcohol was about 7 mg/m3, with peak values exceeding the present Swedish short-term exposure limit (40 mg/m3). The exposure to respirable dust and formaldehyde as time-weighted over the shift was less than 2 mg/m3 and 0.4 mg/m3, respectively, in all groups. During the work shift studied, the 28 exposed subjects had more complaints of airway symptoms than did the controls, showing an average decrease of 0.21 in forced vital capacity but no fall in any other lung-function variable. The remaining 11 exposed subjects demonstrated a post-shift decrease in total lung capacity. The results indicate an acute restrictiveness induced by exposure to furan resin sand, but the underlying mechanism is unclear. Chronic impairment of lung function was not observed.

Pulmonary function in workers exposed to diesel exhausts: the effect of control measures.

To assess the protective effect of exhausts pipe filters or respirators on pulmonary function, 15 workers in a tunnel construction site, truck and loading machine drivers, rock workers, and others were studied. The total and respirable dust, combustible matter in respirable dust, carbon monoxide, nitrogen monoxide and nitrogen dioxide were measured for each subject during entire work shifts. The effect of the exposure on the lung function variables was measured by dynamic spirometry, carbon monoxide single breath technique, and nitrogen single breath wash-out. The exhaust pipe filtering had a protective effect, directly discernible in the drivers on vital capacity and FEV1.0 and for the whole group on FEV% and TLco. The dust respirators had no effect, probably because of the difficulties in correctly using personal protection under the circumstances in the tunnel. In the absence of a true exposure assessment, control measures for diesel exhausts can be tested by medical effect studies. Catalytic particle filters of diesel exhausts are one method of rendering the emissions less irritant, although they will not remove irritant gases. An indicator of diesel exhaust exposure should include the particle fraction of the diesel exhausts, but a discrimination between different sources of organic dust must be possible.