Comparison of clinic models for patients with work-related asthma.

BACKGROUND: Work-related asthma (WRA) is a prevalent occupational lung disease that is associated with undesirable effects on psychological status, quality of life (QoL), workplace activity and socioeconomic status. Previous studies have also indicated that clinic structure may impact outcomes among patients with asthma. AIMS: To identify the impact of clinic structure on psychological status, QoL, workplace limitations and socioeconomic status of patients with WRA among two different tertiary clinic models. METHODS: We performed a cross-sectional analysis between two tertiary clinics: clinic 1 had a traditional referral base and clinical staffing while clinic 2 entirely comprised Worker's Compensation System referrals and included an occupational hygienist and a return-to-work coordinator. Beck Anxiety and Depression II Inventories (BAI and BDI-II), Marks' Asthma Quality of Life Questionnaire (M-AQLQ) and Work Limitation Questionnaire (WLQ) were used to assess outcomes for patients with WRA. RESULTS: Clinic 2 participants had a better psychological status across the four instruments compared with clinic 1 (for Beck 'Anxiety': P < 0.001 and 'Depression': P < 0.01, 'Mood' domain of M-AQLQ: NS and 'Mental Demands' domain of WLQ: P < 0.01). Clinic 2 had a greater proportion of participants with reduced income. CONCLUSIONS: Our study indicates that clinic structure may play a role in outcomes. Future research should examine this in larger sample sizes.

Comprehensive Self-Management Strategies.

In this article, we provide a review of the literature on self-management interventions and we are giving some thought to how, when, and by whom they should be offered to patients. The present literature based on randomized clinical trials has demonstrated benefits (reduced hospital admissions and improved health status) for chronic obstructive pulmonary disease (COPD) patients undergoing self-management interventions, although there are still problems with the heterogeneity among interventions, study populations, follow-up time, and outcome measures that make generalization difficult in real life. Key to the success, self-management intervention has to target behavior change. Proper self-management support is a basic prerequisite, for example, techniques and skills used by health care providers "case manager" to instrument patients with the knowledge, confidence, and skills required to effectively self-manage their disease. To improve health behaviors and engagement in self-management, self-management interventions need to target enhancing intrinsic motivation to change. This will best be done using client-centered communication (motivational communication) that encourages patients to express what intrinsically motivates them (e.g., consistent with their values or life goals) to adopt certain health behavior, with the goal of helping them overcome their ambivalence about change. Finally, if we want to be able to design and implement self-management interventions that are integrated, coherent, and have a strong likelihood of success, we need to take a more careful look and give more attention at the case manager, the patient (patient evaluation), and the quality assurance.

Differential association of insulin resistance with cognitive and somatic symptoms of depression.

AIM: To examine the associations of depressive symptoms with insulin resistance, evaluating somatic and cognitive depressive symptoms separately. METHODS: A total of 328 individuals (mean age 60 years) referred for exercise stress testing, taking part in the Mechanisms and Outcomes of Silent Myocardial Ischemia study, completed the Beck Depression Inventory II. A fasting venous blood sample was collected for assessments of insulin and glucose level; the HOMA-IR (homeostatic model assessment of insulin resistance) was calculated. In principal component analysis, Beck Depression Inventory II items were forced to load onto two components (somatic and cognitive depressive symptoms). Adjusting for age, sex, BMI, medication use, smoking, physical activity, diabetes and cardiovascular disease, general linear model analyses were conducted to examine the associations between the components and log HOMA-IR . RESULTS: Principal component analysis showed that nine items loaded onto a cognitive depressive symptoms component and 10 items loaded onto a somatic depressive symptoms component. When examined separately, both components were significantly associated with log HOMA-IR however, when including both components simultaneously in the model, only somatic depressive symptoms remained significantly associated with log HOMA-IR. Back-transformed, a one-unit change in somatic depressive symptoms was associated with a 1.07 (95% CI 1.002, 1.14) change in HOMA-IR and a one-unit change in cognitive depressive symptoms was associated with a 1.03 (95% CI 0.97, 1.14) change in HOMA-IR. CONCLUSION: Somatic depressive symptoms seem to be more strongly associated with insulin resistance than do cognitive depressive symptoms. Monitoring somatic depressive symptoms may be more appropriate than monitoring cognitive depressive symptoms among depressed individuals with high insulin resistance.

Assessment of impairment/disability due to occupational asthma through a multidimensional approach.

Subjects with occupational asthma (OA) are often left with permanent sequelae after removal from exposure, and assessing their impairment/disability should utilise various tools. The aim of the present study was to examine whether: 1) assessment of inflammation in induced sputum is relevant to impairment; and 2) use of questionnaires on quality of life and psychological factors can be useful for the evaluation of disability. In total, 40 subjects were prospectively assessed for permanent impairment/disability due to OA 2 yrs after cessation of exposure. Impairment was assessed as follows: 1) need for asthma medication; 2) asthma severity; 3) airway calibre and responsiveness; and 4) degree of inflammation in induced sputum. Disability was assessed according to quality of life and psychological distress. There was a significant improvement in airway responsiveness and inflammation from diagnosis to the present assessment. Sputum eosinophils > or =2% and neutrophils >60% were present in eight (20%) and 12 (30%) out of all subjects, respectively, one or the other feature being the only abnormalities in 15% of subjects. Quality of life was moderately affected and there was a prevalence of depression and anxiety close to 50%. In the assessment of subjects with occupational asthma, information on airway inflammation and psychological impacts are relevant to the assessment of impairment/disability, although these findings need further investigation.

The role of ischaemia and pain in the blood pressure response to exercise stress testing in patients with coronary heart disease.

Silent myocardial ischaemia is a common phenomenon in patients with coronary heart disease. However, very little is known about the underlying mechanisms of silent ischaemia. One potential pathway that may contribute to this absence of pain is increased blood pressure. The main aim of the current study was to assess the associations among blood pressure, pain and ischaemia in patients undergoing a standard exercise stress test. We hypothesized that patients who experienced chest pain during exercise would have lower baseline and peak blood pressures compared to those who did not experience chest pain. A total of 1,355 patients (418 women) who underwent a single-photon emission computed tomography treadmill exercise stress test and had not experienced a cardiac event in the past 2 weeks participated in the current study. Myocardial perfusion defects were assessed at rest and during the stress challenge. Systolic blood pressure (SBP), diastolic blood pressure, heart rate (HR) and rate pressure product (RPP) were assessed during rest and at peak exercise. There were no main effects of either pain or ischaemia on the baseline cardiovascular variables. Peak exercise data revealed main effects of pain on SBP, RPP and HR, and main effects of ischaemia on SBP and RPP, controlling for age, sex, baseline level, medication status and cardiac history. These findings suggest that acute rather than chronic increases in blood pressure may be one mechanism to explain the phenomena of silent myocardial ischaemia in cardiac patients, and may potentially provide a target for future treatment strategies.

Longer VEP latencies and slower reaction times to the onset of second-order motion than to the onset of first-order motion.

We compared visual evoked potentials and psychophysical reaction times to the onset of first- and second-order motion. The stimuli consisted of luminance-modulated (first-order) and contrast-modulated (second-order) 1 cpd vertical sine-wave gratings drifting rightward for 140 ms at a velocity of 6 degrees /s. For each condition, we analysed the latencies and peak-to-baseline amplitudes of the P1 and N2 peaks recorded at Oz. For first-order motion, both P1 and N2 peaks were present at low (3%) contrast (i.e., depth modulations) whereas for second-order motion they appeared only at higher (25%) contrasts. When the two types of motion were equated for visibility, responses were slower for second-order motion than for first-order motion: about 44 ms slower for P1 latencies, 53 ms slower for N2 latencies, and 76 ms slower for reaction times. The longer VEP latencies for second-order motion support models that postulate additional processing steps for the extraction of second-order motion. The slower reaction time to the onset of second-order motion suggests that the longer neurophysiological analysis translates into slower detection.

Impact of temporal lobe epilepsy on phonological processing and reading: a case study of identical twins.

In order to evaluate the possible consequences of temporal lobe epilepsy on reading acquisition, we first compared the reading skills and phonological awareness abilities in a set of 13-year-old identical twins, one of whom is affected by temporal lobe epilepsy (LB). We then compared their performances to those of an age- and IQ-matched control group. Both siblings have an intellectual quotient above average as well as normal memory and linguistic abilities. Results showed that the reading age of LB (assessed by the Lefabvrais French reading test) was more than two years behind expectations whereas that of her sister was above average. Further, in contrast to her sister and healthy control subjects, LB exhibited specific deficits in elaborate metaphonological awareness abilities (non-word repetition, rhyme production, phonemic segmentation and syllabic inversion). These could be linked to temporal lobe dysfunction, thus confirming the important role of the temporal lobes in reading acquisition.

Anger, negative emotions, and cardiovascular reactivity during interpersonal conflict in women.

OBJECTIVE: In order to evaluate the relationship between women's subjective emotional discomfort with anger and cardiovascular responses to stress, cardiovascular and affective responses were examined during two anger-provoking conditions: one in which anger would be in self-defense, and one in which anger would be in defense of a significant other. METHODS: A total of 42 healthy, normotensive women aged 18-35 years recruited a close female friend to participate in the study with them, and were randomly assigned to one of two harassment conditions: (i) Self-Harass, where women were harassed while performing a math task; (ii) Friend-Harass, where women witnessed a close female friend being harassed while their friend performed a math task. RESULTS: Self-Harass and Friend-Harass women reported feeling equally angry, annoyed, and irritated (all P's<.01) during their respective anger-provocation conditions. However, Self-Harass women reported experiencing significantly greater increases in feelings of depression and guilt during anger provocation (P's<.05) relative to Friend-Harass women. Interestingly, it was also the Self-Harass women who exhibited significantly greater elevations in heart rate (HR), cardiac output (CO), systolic blood pressure (SBP), forearm blood flow (FBF), and significant reductions in forearm vascular resistance (FVR; P's<.001) relative to Friend-Harass women during anger provocation. CONCLUSIONS: Results suggest that women may experience other negative emotions (e.g., guilt, depression) when anger is in self-defense relative to when it is in defense of others, and that these emotions may play a more important role than anger in moderating cardiovascular reactivity (CVR) during interpersonal conflict.

Performance of patients with schizophrenia on the Wisconsin Card Sorting Test (WCST).

OBJECTIVE: To directly compare the performance of patients with schizophrenia and control subjects on the Wisconsin Card Sorting Test (WCST). Specifically, we sought to verify if there are significant differences on the "classical" WCST measurements (perseverative errors and number of categories), as well as on more rarely reported scores, and assess the extent to which patients with schizophrenia can improve their performance with card-by-card instructions and continuous verbal reinforcement. DESIGN: Prospective cross-sectional study. SETTING: Psychiatry department in a university-affiliated hospital. PARTICIPANTS: 30 patients with schizophrenia, diagnosed according to DSM-IV criteria, and 30 control subjects, matched to patients according to age and education. INTERVENTION: The WCST was administered according to the criteria of Heaton, and a subgroup of the patients with schizophrenia was given a retest after an explanation of the WCST and verbal reinforcements. RESULTS: Patients with schizophrenia succeeded on fewer categories (t = 23.3, p < 0.001), committed more perseverative errors (t = 15.6, p < 0.001), made more perseverative responses (t = 14.6, p < 0.001), needed more trials to succeed at the first category (t = 9.2, p < 0.003) and gave significantly lower conceptual level responses (t = 14.1, p < 0.001) than the controls. However, on retest, patients with schizophrenia committed significantly fewer perseverative errors (t = 5.1, p < 0.001) and showed higher conceptual level responses (t = -3.45, p < 0.003). CONCLUSION: Consistent with a hypothesis of frontal dysfunction in schizophrenia, patients with schizophrenia tend to show a perseverative deficit; however, some are able to partially overcome this deficit when given verbal reinforcement.

[Schizophrenia and performance on the Wisconsin Card Sorting Test (WCST): deficits and rehabilitation]. / Schizophrénie et performance au Wisconsin Card Sorting Test (WCST): déficits et réadaptation.

In recent years, there has been a sustained interest in the so-called "frontal hypothesis" of schizophrenia: the idea that clinical symptoms and cognitive deficits characteristic of schizophrenia might be explained by defective function of the frontal lobes. Several studies have attempted to test this hypothesis by examining the performance of schizophrenic subjects on the Wisconsin Card Sorting Test (WCST), a neuropsychological evaluation widely believed to reflect the functional capacity of frontal lobes. A typical finding is that schizophrenic patients demonstrate a tendency to perseverate in producing an inappropriate response in spite of negative feedback. This perseverative tendency resembles the perseveration often seen in patients with frontal brain damage. This article proposes a critical examination of the available evidence linking frontal deficits with schizophrenia via the WCST. As we will show, in most of these studies, only a relatively small number of the available measures on the WCST are made, and consequently many interesting cognitive capacities in schizophrenic subjects have not been adequately examined with this test. These "non-classical" measures will be described and critically examined with respect to their pertinence for further work on schizophrenic subjects. Of particular interest are the "failure to maintain set", which measures cognitive instability, "conceptual responses", which can indicate a certain conceptual capacity even in subjects who show perseveration, and "learning to learn", which can demonstrate a capacity to profit from experience on the test. A second objective will be to critically examine the evidence concerning the capacity of schizophrenic patients to improve their performance on the WCST. To the extent that performance on the WCST reflects the functional level of cognitive capacities important for everyday life, any capacity in schizophrenic patients to improve their performance could have important implications for therapeutic intervention and re-education.

Cave biosignature suites: microbes, minerals, and Mars.

Earth's subsurface offers one of the best possible sites to search for microbial life and the characteristic lithologies that life leaves behind. The subterrain may be equally valuable for astrobiology. Where surface conditions are particularly hostile, like on Mars, the subsurface may offer the only habitat for extant lifeforms and access to recognizable biosignatures. We have identified numerous unequivocally biogenic macroscopic, microscopic, and chemical/geochemical cave biosignatures. However, to be especially useful for astrobiology, we are looking for suites of characteristics. Ideally, "biosignature suites" should be both macroscopically and microscopically detectable, independently verifiable by nonmorphological means, and as independent as possible of specific details of life chemistries--demanding (and sometimes conflicting) criteria. Working in fragile, legally protected environments, we developed noninvasive and minimal impact techniques for life and biosignature detection/characterization analogous to Planetary Protection Protocols. Our difficult field conditions have shared limitations common to extraterrestrial robotic and human missions. Thus, the cave/subsurface astrobiology model addresses the most important goals from both scientific and operational points of view. We present details of cave biosignature suites involving manganese and iron oxides, calcite, and sulfur minerals. Suites include morphological fossils, mineral-coated filaments, living microbial mats and preserved biofabrics, 13C and 34S values consistent with microbial metabolism, genetic data, unusual elemental abundances and ratios, and crystallographic mineral forms.

Separation of copurifying GroEL from glutathione-S-transferase fusion proteins.

The purification of overexpressed fusion proteins using bacterial expression systems is a useful tool for the study of many proteins. One problem that can occur is the formation of stable interactions between the expressed fusion protein and certain endogenous bacterial proteins, such as the molecular chaperone GroEL. Such interactions may result in the copurification of contaminating bacterial proteins. Here we describe an efficient and inexpensive method for the removal of contaminating GroEL from a bacterially expressed GST fusion protein. In this method, denatured bacterial proteins are added to the bacterial lysates prior to the addition of glutathione Sepharose resin. The denatured proteins compete for GroEL binding, thereby releasing the GroEL contaminants from the expressed fusion protein.

RGS4 and RGS2 bind coatomer and inhibit COPI association with Golgi membranes and intracellular transport.

COPI, a protein complex consisting of coatomer and the small GTPase ARF1, is an integral component of some intracellular transport carriers. The association of COPI with secretory membranes has been implicated in the maintenance of Golgi integrity and the normal functioning of intracellular transport in eukaryotes. The regulator of G protein signaling, RGS4, interacted with the COPI subunit beta'-COP in a yeast two-hybrid screen. Both recombinant RGS4 and RGS2 bound purified recombinant beta'-COP in vitro. Endogenous cytosolic RGS4 from NG108 cells and RGS2 from HEK293T cells cofractionated with the COPI complex by gel filtration. Binding of beta'-COP to RGS4 occurred through two dilysine motifs in RGS4, similar to those contained in some aminoglycoside antibiotics that are known to bind coatomer. RGS4 inhibited COPI binding to Golgi membranes independently of its GTPase-accelerating activity on G(ialpha). In RGS4-transfected LLC-PK1 cells, the amount of COPI in the Golgi region was considerably reduced compared with that in wild-type cells, but there was no detectable difference in the amount of either Golgi-associated ARF1 or the integral Golgi membrane protein giantin, indicating that Golgi integrity was preserved. In addition, RGS4 expression inhibited trafficking of aquaporin 1 to the plasma membrane in LLC-PK1 cells and impaired secretion of placental alkaline phosphatase from HEK293T cells. The inhibitory effect of RGS4 in these assays was independent of GTPase-accelerating activity but correlated with its ability to bind COPI. Thus, these data support the hypothesis that these RGS proteins sequester coatomer in the cytoplasm and inhibit its recruitment onto Golgi membranes, which may in turn modulate Golgi-plasma membrane or intra-Golgi transport.

Non-fearful panic disorder: a variant of panic in medical patients?

Is it possible to have panic attacks without fear? Beitman et al. reported that 32%-41% of panic disorder (PD) patients seeking treatment for chest pain have non-fearful panic disorder (NFPD). To replicate and extend this work on NFPD, the authors compared NFPD patients (N = 48), PD patients (N = 60), and No-PD patients (N = 333) at the time of an emergency department visit and follow-up approximately 2 years later. The authors compared comorbid Axis I diagnoses, panic attack symptoms, and scores on self-report measures. A significantly greater proportion of PD patients had comorbid generalized anxiety disorder and agoraphobia than NFPD patients. NFPD patients had self-report scores that were between no-PD and PD patients or similar to no-PD patients, with the exception of the Beck Depression Inventory. At follow-up, NFPD patients, like PD patients, were still symptomatic and had either not improved or had worsened according to scores on all self-report measures. NFPD should be recognized as a variant of PD, both because of its high prevalence in medical settings and its poor prognosis.

Is panic disorder associated with coronary artery disease? A critical review of the literature.

OBJECTIVE: To critically review existing literature examining the relationship between panic disorder (PD) and coronary artery disease (CAD). We specifically sought answers to the following questions: (1) What is the prevalence of PD in CAD patients? (2) What is the directionality of the relationship between PD and CAD? (3) What mechanisms may mediate the link between PD and CAD? METHODS: Medline and Psychlit searches were conducted using the following search titles: "panic disorder and coronary artery disease", "panic disorder and coronary heart disease", and "panic disorder and cardiovascular disease" for the years 1980-1998. The above search was also repeated replacing "panic disorder" with "panic attacks" for the same period. RESULTS: The prevalence of PD in both cardiology out-patients and patients with documented CAD ranges from 10% to 50%. The association between PD and CAD appeared strongest in patients with atypical chest pain or symptoms that could not be fully explained by coronary status. There is some evidence linking phobic anxiety but not PD per se to CAD risk, but little evidence linking CAD to PD risk. Studies of the mechanisms linking PD to CAD are still in their infancy, but there is preliminary evidence linking PD to reduced heart rate variability (HRV) and myocardial ischemia, two pathophysiological mechanisms related to CAD. CONCLUSION: PD is prevalent in CAD patients, but it is unclear the extent to which PD confers risk for and/or exacerbates CAD. Prospective research is needed to more firmly establish PD as a distinct risk factor for the development and progression of CAD. However, because many of the symptoms of PD mimic those of CAD, differentiating these disorders and learning how they may influence each other is imperative for clinical practice.

The impact of depression on the course and outcome of coronary artery disease: review for cardiologists.

Epidemiological research over the past decade indicates that major depression and depressive symptomatology are common among patients with coronary artery disease (CAD) and postmyocardial infarction. Major depression is a serious, debilitating comorbid disorder that can significantly increase risk for and complicate recovery from cardiac events (eg, myocardial infarction). Unfortunately, major depression is rarely detected or treated in the cardiology setting. However, it is a disorder that can be successfully and safely treated in the majority of cases. Although the mechanisms that may be mediating the depression-CAD link are less well understood, there are several plausible mechanisms by which depression may influence the course and outcome of CAD. This review examines the literature linking major depression and depressive symptomatology to CAD course and outcome, and makes recommendations for improving assessment and treatment of depression in the cardiology setting.

[Deficit in suppression of interference in visual information processing by schizophrenic subjects]. / Déficit dans la suppression de l'interférence au niveau du traitement de l'information visuelle chez des patients schizophr nes.

Although many studies have indicated information processing deficits in schizophrenic patients, the precise nature and underlying causes of these deficits remain largely uncertain. One prominent hypothesis is that these patients show insufficient attentional inhibition. This deficit to inhibition has been linked to certain cognitive disorders in schizophrenic patients, including attention deficits, as well as to some clinical symptoms, especially those involving delusional thought, hallucinations,and poor contact with reality. The hypothesis of deficient attentional inhibition, although attractive in some ways, is difficult to work with, because it is not easy to directly measure "attentional inhibition". Several studies involving normal subjects have linked attentional inhibition with performance on a task demanding the suppression of distracting information: the presumption is that efficient attentional inhibition will permit rapid responses because the distracting information will be quickly suppressed, allowing undistracted processing of the target information. The present study measures schizophrenic patients' performance on a task demanding suppression of rapidly-presented visual information. An important methodological feature of this study is that performance is measured in terms of "percent correct responses" rather than the reaction time measures typically used in tasks demanding distractor suppression, such as Stroop-like selective attention tasks. Since reaction times are not considered, the results cannot be interpreted in terms of deficient response organization and execution. Schizophrenic (18) and normal (18) subjects underwent trials in which a visual target was the second of two stimuli presented in rapid succession. Interference produced by a non-target significantly impaired perception of the target for schizophrenic patients. This effect persisted longer in the schizophrenic subjects possibly because of deficient attentional inhibition.

Three-dimensional MRI atlas of the human cerebellum in proportional stereotaxic space.

We have prepared an atlas of the human cerebellum using high-resolution magnetic resonance-derived images warped into the proportional stereotaxic space of Talairach and Tournoux. Software that permits simultaneous visualization of the three cardinal planes facilitated the identification of the cerebellar fissures and lobules. A revised version of the Larsell nomenclature facilitated a simple description of the cerebellum. This atlas derived from a single individual was instrumental in addressing longstanding debates about the gross morphologic organization of the cerebellum. It may serve as the template for more precise identification of cerebellar topography in functional imaging studies in normals, for investigating clinical-pathologic correlations in patients, and for the development of future probabilistic maps of the human cerebellum.