Shape of the OGTT glucose curve and risk of impaired glucose metabolism in the EGIR-RISC cohort.

OBJECTIVE: To study whether the shape of the oral glucose tolerance test (OGTT)-glucose curve is a stable trait over time; it is associated with differences in insulin sensitivity, ß-cell function and risk of impaired fasting glucose (IFG) and glucose tolerance (IGT) in the Relationship between Insulin Sensitivity and Cardiovascular Disease (RISC) cohort. METHODS: OGTT-glucose curve shape was classified as monophasic, biphasic, triphasic and anomalous in 915 individuals. Oral glucose insulin sensitivity (OGIS), Matsuda insulin sensitivity index (ISI) and ß-cell function were assessed at baseline and 3years apart. RESULTS: The OGTT-glucose curve had the same baseline shape after 3years in 540 people (59%; κ=0.115; p<0.0001). Seventy percent of the participants presented with monophasic OGTT-glucose curve shape at baseline and after 3years (percent positive agreement 0.74). Baseline monophasic shape was associated with significant increased risk of IFG (OR 1.514; 95% CI 1.084-2.116; p=0.015); biphasic shape with reduced risk of IGT (OR 0.539; 95% CI 0.310-0.936) and triphasic shape with reduced risk of IFG (OR 0.493; 95% CI 0.228-1.066; P=0.043) after 3years. Increased risks of IFG (OR 1.509; 95% CI 1.008-2.260; p=0.05) and IGT (OR 1.947; 95% CI 1.085-3.494; p=0.02) were found in people who kept stable monophasic morphology over time and in switchers from biphasic to monophasic shape (OR of IGT=3.085; 95% CI 1.377-6.912; p=0.001). CONCLUSION: After 3years follow-up, the OGTT-glucose shape was stable in 59% of the RISC cohort. Shapes were associated with different OGIS and ß-cell function; persistence over time of the monophasic shape and switch from biphasic to monophasic shape with increased risk of impaired glucose metabolism.

Work-related psychopathology: rates in different work activities and relationship between subjective perception of work distress and psychiatric disturbances.

BACKGROUND: The link between work distress and negative mental health outcome is an emergent topic in the scientific literature. The studies that evaluated the risk of work-related psychopathologies in the different job sectors have obtained so far controversial and inconclusive results. The identification, by means of standardized evaluation tools, of the work activities at higher risk of poor mental health is a relevant target for the occupational psychiatry and medicine. OBJECTIVE: To evaluate the relationship between the psychosocial work conditions and work related psychiatric disturbances and to verify the relationship between the higher pathogenic effect of work and specific job activities. PARTICIPANTS: A six-month diagnostic trial was conducted on 234 patients (35.4% women and 64.6% men). METHODS: Psychiatric diagnoses were according to DSM-IV criteria; anxious and depressive dimensions were studied by means of Hamilton-Anxiety-Scale and Hamilton Scale for Depression; psychosocial work environments and bio-psycho-social features were measured by Naples-Questionnaire of Work Distress. Groups with higher and lower work-related pathogenesis were compared and their distribution among specific job activities was evaluated. RESULTS: Mood disorders were strongly linked to negative work environment. Patients with severe bullying obtained higher scores on Hamilton-Anxiety-Scale and Hamilton Scale for Depression than those with lower work-pathogenesis. The highest scores on Naples-Questionnaire of Work Distress were related to mood disorders, to poorer bio-psycho-social functioning and to higher work etiology. No significant relationship between work activities and work-related psychopathologies was found. CONCLUSION: Workplace bullying is predictive of work-related psychiatric disturbances with more severe clinical features and bio-psycho-social consequences. No significant differences were found about the relationship between work-related psychopathologies and work activities.

[Mobbing, organizational dysfunction and bio-psycho-social effects: an integrated assessment. Preliminary data for the validation of the Questionnaire in the Neapoletan dialect on Distress at Work(Qn-DL)]. / Mobbing, costrittività organizzative ed effetti bio-psico-sociali: una valutazione integrata. Dati preliminari di validazione del Questionario-napoletano sul Disagio Lavorativo (Qn-DL).

The aim of this study is to produce preliminary data about the validation of the "Naples-Questionnaire of Distress at Work" (nQ.DW). This inventory is a new assessment tool in order to evaluate the distress perceived in the working environment by means of the differentiation of the conditions linked to the mobbing from which related to organizational disfunction. The nQ-DW also measures the bio-psycho-social global effects of these two phenomena. The questionnaire has been administered to workers suffering of a psychopathological disturbance related to work distress and to a control group matched for the sociodemographic and working variables. The statistical analysis demonstrated a significant validity and reliability. The degree of internal coherence was satisfactory. The ROC curves allow the determination of a threshold value which allows to separate the workers subjected to mobbing and/or organizational stress from control-workers with an optimal reliability degree. The values of the area under the ROC curves show that the inventory has a high discriminating capacity. Future studies, based on a greater sample size, will be oriented to the analysis of the questionnaire by means of multivariate techniques like the factorial analysis.

Beyond the morphology of the glucose curve following an oral glucose tolerance test in obese youth.

BACKGROUND: To describe the morphology of glucose curve during the oral glucose tolerance test (OGTT) and any association with glucose tolerance, insulin action and secretion in obese youth. STUDY DESIGN: Cross-sectional. METHODS: OGTT data of 553 patients were analysed. Subjects were divided in groups based on the morphology (i.e. monophasic, biphasic, triphasic and upward monotonous) of glucose curve. Insulin action was estimated by the homeostasis model assessment of insulin resistance, the insulin sensitivity, the muscle insulin sensitivity and the hepatic insulin resistance indexes (HIRI), and the oral glucose insulin sensitivity (OGIS). Insulin secretion was estimated by the insulinogenic index (IGI). Disposition index, including the insulin secretion-sensitivity index-2, and areas under glucose (AUC(G)) and insulin (AUC(I)) curves were computed. RESULTS: In patients with normal glucose tolerance (n=522), prevalent morphology of the glucose curve was monophasic (n=285, 54%). Monophasic morphology was associated with the highest concentration of 1 h plasma glucose (P<0.0001) and AUC(G) (P<0.0001); biphasic morphology with better insulin sensitivity as estimated by OGIS (P<0.03) and lower AUC(I) (P<0.0001); triphasic morphology with the highest values of HIRI (P<0.02) and IGI (P<0.007). By combining morphologies of glucose and insulin curves or time of the glucose peak, a deeper characterisation of different phenotypes of glucose metabolism emerged. CONCLUSIONS: Morphologies of the glucose curve seem reflecting different metabolic phenotypes of insulin action and secretion, particularly when combined with morphologies of insulin curve or time of glucose peak. Such findings may deserve validation in cohort study, in which glucose metabolism would be estimated by using gold standard techniques.

Quality of life after stroke in a rehabilitation setting.

The perceived Quality of Life (QOL) was evaluated in one-hundred and eleven participants after a first-ever stroke, who were admitted in a rehabilitation center and completed a 2-month program. The World Health Organization (WHO) QOL-100 was applied. Two domains were correlated with the functional status at discharge, namely, the level of independence and the social relations. The study confirmed the strong correlation between the functional status at admission and at discharge. Other predictive parameters of outcome were age and depression. The functional improvement was highly significant (p < 0.0001) at Wilcoxon test (40 points at functional independence measure (FIM) scale). The gain was gender-independent. Nevertheless, among females, a significant correlation was found between the FIM score at discharge and either distress value at Hospital Anxiety and Depression Scale (HADS) or QOL. In conclusion, the perceived QOL should be considered by a stroke rehabilitative team.

Obsessive-compulsive symptoms in schizophrenia: their relationship with clinical features and pharmacological treatment.

OBJECTIVES: The aim of this study was to evaluate (1) the frequency of obsessive-compulsive symptoms (OCS) in patients with schizophrenia, (2) the impact of OCS on clinical features of schizophrenia, and (3) the association between type of antipsychotic treatment and presence of OCS. METHODS: OCS were evaluated using the Yale-Brown Obsessive Compulsive Scale (Y-BOCS) in 70 patients with schizophrenia. The patients were then divided into two subgroups: those with at least a moderate level of OCS and those with mild or absent OCS. The two subgroups were compared using scores on the Scale for the Assessment of Positive Symptoms (SAPS), the Scale for the Assessment of Negative Symptoms (SANS), and the Global Assessment of Functioning Scale (GAF). RESULTS: Of the 70 patients with schizophrenia who were evaluated, 36 (51.4%) had at least moderate OCS (Y-BOCS score >16). SAPS subscale scores for hallucinations and delusions and GAF scores were found to be significantly higher among patients with at least moderate OCS, compared with those with mild or absent OCS. A significant relationship between at least moderate OCS and treatment with conventional antipsychotics was also observed. CONCLUSIONS: The presence of OCS seems to have the potential to affect clinical outcomes in schizophrenia and treatment with conventional antipsychotics appears to be correlated with the presence of OCS.

Association between bullying at work and mental disorders: gender differences in the Italian people.

BACKGROUND: In the last few years the international literature has shown an increasing attention for the work as life-event stressor, for its organizational characteristics as well as for job insecurity and interpersonal conflicts. METHODS: We have studied 707 subjects who approached the Work Psychopathology Medical Centre of Naples to evaluate the DSM IV diagnoses and the degree of bullying at the workplace according to Leymann's definition. Two groups, with high and with low severity of bullying, were compared, mainly in relation to gender differences. RESULTS: The more frequent diagnoses were anxiety disorders (8.7% of the total), mood disorders (31.5%) and adjustment disorders (58.3%). The patients with higher degree of bullying were 55.7% among the subjects with anxiety disorders, 51.4% among the patients with adjustment disorders and 81.25% in the group with mood disorders. The odds of patients with severe bullying was 1.602 times higher for males than for females. Independently by the gender, the odds of patients being in the group with severe bullying were more than three times higher for subjects with mood disorders than for patients suffering from anxiety and adjustment disorders. DISCUSSION: In the male gender, the psychiatric disturbances are more correlated to bullying at the workplace and this datum is especially linked to the gender differences found in the relationship between severity of bullying and adjustment disorders. Among female employees the psychopathological dimensions could be linked with a more multifactorial genesis in relation to their psychosocial role in the cultural context we examined (Southern Italy).

Prolactin and insulin ultradian secretion and adipose tissue lipoprotein lipase expression in severely obese women after bariatric surgery.

BACKGROUND: Hyperprolactinemia is associated with obesity. Furthermore, in human adipose tissue cultured in vitro, prolactin (PRL) inhibited lipoprotein lipase (LPL) activity via functional PRL receptors. OBJECTIVE: To study PRL and insulin ultradian rhythm and subcutaneous adipose tissue LPL mRNA and protein expressions in severely obese women before and after malabsorptive bariatric surgery. METHODS AND PROCEDURES: Seven severely obese, fertile women were studied twice, once before and the second time 1 year after bilio-pancreatic diversion (BPD), when the weight was stable for at least 3 months. Metabolizable energy intake and 24-h energy expenditure (EE) were measured. Fourier and PULSEFIT analyses were applied to 24-h hormonal time-series to study daily fluctuations and hormonal clearance. Insulin sensitivity was assessed by euglycemic-hyperinsulinemic clamp. Quantitative-competitive reverse transcriptase-PCR and western blot analysis were used to measure LPL gene expression. RESULTS: Spontaneous 24-h PRL secretion was significantly reduced after BPD (mean-daily release, 128.4 +/- 28.1 microg/l vs. 67.2 +/- 9.2 microg/l distribution volume (Vd/l.24 h), P = 0.02); insulin secretion also was significantly reduced (499.9 +/- 204.0 microg/Vd/l.24 h vs. 85.6 +/- 21.0 microg/Vd/l.24 h, P = 0.0001). Metabolizable energy/kg(FFM) did not change significantly after BPD. Twenty-four-hour EE, but not 24-h EE/FFM, was significantly decreased after BPD (P < 0.05). Insulin sensitivity significantly (P < 0.0001) increased after BPD from 21.41 +/- 1.92 to 68.62 +/- 5.03 micromol/kg(FFM)/min. LPL mRNA concentration (from 42.63 +/- 4.21% to 19.00 +/- 2.74% of cyclophilin mRNA, P = 0.001) as well as LPL protein level (from 8.94 +/- 2.73 to 3.16 +/- 1.05 as ratios of protein of interest vs. housekeeping protein, P = 0.038) significantly decreased after BPD. The major determinant of PRL secretion was insulin secretion, whereas the best predictors of LPL expression were insulin and PRL secretion rates. DISCUSSION: The restriction of lipid metabolizable energy rather than weight loss seems to be responsible for both reduction in PRL circulating levels and normalization of its secretion rhythm after bariatric surgery. Furthermore, the reduced adipose tissue LPL expression, being significantly correlated with the decrease in insulin and PRL, suggests a role of hyperinsulinemia and hyperprolactinemia in inducing and sustaining obesity.

A polynomial function of gait performance.

A mathematical data processing method is presented that represents a further step in gait analysis. The proposed polynomial regression analysis is reliable in assessing differences in the same patient and even on the same day. The program also calculates the confidence interval of the whole curve. The procedure was applied to normal subjects in order to collect normative data. When a new subject is tested, the polynomial function obtained is graphically superimposed on control data. Should the new curve fall within the limits described by normative data, it is considered to be equivalent. The procedure can be applied to the same subject, either normal or pathological, for retesting kinematic characteristics. The gait cycle is analyzed as a whole, not point-by-point. Ten normal subjects and two patients, one with recent- and the other with late-onset hemiplegia, were tested. Multiple baseline evaluation is recommended before the start of a rehabilitation program.

Menopause, insulin resistance, and risk factors for cardiovascular disease.

OBJECTIVE: In this retrospective analysis of the European Group for the Study of Insulin Resistance database, a clamp data pooling project, a cardiovascular risk score (CVS) was assessed to verify whether hyperinsulinemia and/or insulin resistance were independent cardiovascular risk factors and to investigate how menopause affected CVS and insulin resistance. DESIGN: Information was obtained on whole-body glucose uptake (M), determined by the euglycemic hyperinsulinemic clamp technique, normalized by fat-free mass (FFM), and insulin concentration (I) at a steady state. Body composition was estimated using a labeled water technique or bioimpedance. Other parameters measured included blood pressure, lipid levels, and waist-to-hip ratio. CVS was computed using a structural equation model that included age, body mass index, blood lipids, and blood pressure. The study population included 523 normal and overweight patients. Women were grouped according to fertility status, and men, according to age (cutoff 50 y). RESULTS: M/kg(FFM)/I significantly decreased after menopause (12.41 +/- 3.40 vs 10.96 +/- 3.68; P < 0.01) and in men 50 years and older (11.39 +/- 3.47 vs 10.32 +/- 3.77 micromol x min(-1) x kg(-1) x microUI/mL; P < 0.02). CVS was lowest in fertile women (-0.414 +/- 0.57 vs 0.107 +/- 0.43; P < 0.0001) and highest in men 50 years and older (0.045 +/- 0.455 vs 0.257 +/- 0.51; P < 0.001). CVS significantly correlated with M/kg(FFM)/I in men 49 years and younger (r(o) = -0.27, P < 0.0001) and 50 years and older (r(o) = -0.38, P < 0.0001) and with fasting insulin in fertile women (r(o) = -0.29, P < 0.01) and in the other groups (r(o) ranging from 0.37 to 0.45, P < 0.0001). CONCLUSIONS: Menopause does not seem to strictly relate to a decrease in insulin sensitivity as postmenopausal women had the same insulin sensitivity as age-matched men. In the population studied, the best predictor of CVS was fasting insulin rather than insulin sensitivity.

Evaluation of sexual changes after stroke.

BACKGROUND: Sexual difficulties may arise after stroke. This study was aimed at evaluating and quantifying sexual changes 1 year after stroke. METHOD: Sixty-eight stroke patients, consecutively admitted to our rehabilitation unit, were enrolled in the study. Sixty-two patients were available for response after 1 year--46 men and 16 women with a mean age of 64 years (SD = 9.2). Time interval between stroke event and admission to rehabilitation unit was 15 days. None of the patients presented with lack of comprehension. Methods of data collection at admission were clinical examination, computed tomographic scan or magnetic resonance imaging, the Cumulative Illness Rating Scale, laboratory data, and data collection on sexual life from patients and, separately, from their partners. After 1 year, they were interviewed again to assess sexual performance; the Center for Epidemiologic Studies-Depression scale, Structured Clinical Interview for DSM-IV, and Functional Independence Measure were also performed. A questionnaire designed for this study was also administered for collecting data on patients' private lives. RESULTS: Sexual decline was common in the post-stroke period. Age (p =.009) and disability (p =.0059) were significant variables. There was no correlation between sexual decline and gender, nor injured hemisphere. There was also no correlation to marriage duration, education duration, or depression. Evaluation and analysis of the questionnaires revealed, however, that patients' partners played a substantial role in the decline of sexual activity. Many partners experienced fear of relapse, anguish, lack of excitation, or even horror, which withheld them from encouraging sexual activities. CONCLUSION: Data from this study demonstrated that sexual decline in the aftermath of stroke is pronounced. Patients suffer from their sexual impairment, but do not conceal that problem. Psychological, rather than medical, aspects account for discontinuity of sexual activity in stroke survivors, and proper counseling is clearly warranted.