Evaluation of a self-management plan for chronic obstructive pulmonary disease

We hypothesized that the use of an Action Plan might assist self-management for patients with chronic obstructive pulmonary disease (COPD). A pilot process and randomized, controlled study were undertaken to evaluate an Action Plan that provided advice on management of usual care and exacerbations, together with a booklet on self-management. Fifty six subjects with COPD recruited through general practitioners (GPs) completed the 6 month study, 27 in the control group and 29 in the intervention group. The control group received usual care from their GP, and the intervention group received a booklet and Action Plan from their practice nurse plus a supply of prednisone and antibiotic from their GP. The two groups were demographically similar with a mean age of 68 yrs. The resources were well received by GPs, practice nurses and intervention group subjects. After 6 months, there were no differences in quality of life scores or pulmonary function. There were significant changes in self-management behaviour in the intervention group compared to controls. In response to deteriorating symptoms, 34 versus 7% (p=0.014) initiated prednisone treatment and 44 versus 7% (p=0.002) initiated antibiotics. Subjects in the intervention group readily adopted self-management skills but did not show any difference in quality of life or lung function parameters. A larger, prospective, controlled, clinical trial of this approach is warranted.     

Attributional style and depressive symptoms among children.

The reformulation of helplessness theory proposes that an insidious attributional style accompanies and predisposes depressive symptoms. The present study investigated predictions of the reformulation among 96 8–13 yr olds who completed the Children's Attributional Style Questionnaire (ASQ) and Children's Depression Inventory twice, 6 mo apart. 83 of their parents completed the adult ASQ and the Beck Depression Inventory at their children's 2nd testing. Children who attributed bad events to internal, stable, and global causes were more likely to report depressive symptoms than were children who attributed these events to external, unstable, and specific causes. This depressive attributional style predicted depressive symptoms 6 mo later, suggesting that it may be a risk factor for depression. Children's attributional style for bad events and their depressive symptoms converged with those of their mothers but not their fathers. (15 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Epstein-Barr virus infection in Desert Storm reservists

Approximately 150 U.S. Army reservists from Indiana reported symptoms consistent with chronic fatigue syndrome after returning stateside from the tour of duty in Saudi Arabia. A psychiatric team confirmed the diagnosis, evaluated possible etiology, and treated the service members when appropriate. Those available service members who met the study's diagnostic criteria for chronic fatigue syndrome (n = 37) received an Epstein-Barr virus panel. Seventy-three percent of these selected service members were positive either for an acute or reactivated Epstein-Barr viral infection. These data suggest that service members who suffer from chronic fatigue syndrome may have their symptoms increased and prolonged by secondary viral infections.     

Attributional style as a risk marker of genetic effects for adolescent depressive symptoms.

Genetic effects on adolescent depression have been consistently reported, but little is known about mediating pathways from the distal genotype to resultant behavioral symptoms. Identifying intermediate risk markers may provide clues on these pathways. In the present study, longitudinal twin and sibling data were used to address 3 issues pertaining to attributional style as a putative marker of genetic risk for adolescent depression: state independence by assessing predictive effects between attributional style and depressive symptoms, heritability of attributional style at different time points, and genetic links between attributional style and depressive symptoms characterizing concurrent and longitudinal associations. The authors further examined whether these predictive and genetic links varied across levels of stress, age, and gender. Negative attributions preceded, co-occurred with, and followed symptoms. The predictive association between earlier negative attributions and later depressive symptoms did not differ by stress, age, or gender. Attributional style was moderately heritable at both time points. Genetic links with concurrent and prospective depressive symptoms were larger in individuals reporting higher levels of stress, who were older and female. Implications for attributional style as a marker reflecting genetic risks are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Health status of preweaned dairy heifers in the United States

Chronic fatigue and chronic fatigue syndrome (CFS) have become increasingly recognized as a common clinical problem, yet one that physicians often find difficult to manage. In this review we suggest a practical, pragmatic, evidence-based approach to the assessment and initial management of the patient whose presentation suggests this diagnosis. The basic principles are simple and for each aspect of management we point out both potential pitfalls and strategies to overcome them. The first, and most important task is to develop mutual trust and collaboration. The second is to complete an adequate assessment, the aim of which is either to make a diagnosis of CFS or to identify an alternative cause for the patient's symptoms. The history is most important and should include a detailed account of the symptoms, the associated disability, the choice of coping strategies, and importantly, the patient's own understanding of his/her illness. The assessment of possible comorbid psychiatric disorders such as depression or anxiety is mandatory. When the physician is satisfied that no alternative physical or psychiatric disorder can be found to explain symptoms, we suggest that a firm and positive diagnosis of CFS be made. The treatment of CFS requires that the patient is given a positive explanation of the cause of his symptoms, emphasizing the distinction among factors that may have predisposed them to develop the illness (lifestyle, work stress, personality), triggered the illness (viral infection, life events) and perpetuated the illness (cerebral dysfunction, sleep disorder, depression, inconsistent activity, and misunderstanding of the illness and fear of making it worse). Interventions are then aimed to overcoming these illness-perpetuating factors. The role of antidepressants remains uncertain but may be tried on a pragmatic basis. Other medications should be avoided. The only treatment strategies of proven efficacy are cognitive behavioral ones. The most important starting point is to promote a consistent pattern of activity, rest, and sleep, followed by a gradual return to normal activity; ongoing review of any 'catastrophic' misinterpretation of symptoms and the problem solving of current life difficulties. We regard chronic fatigue syndrome as important not only because it represents potentially treatable disability and suffering but also because it provides an example for the positive management of medically unexplained illness in general.     

Safety and immunogenicity of hepatitis A vaccine in patients with chronic liver disease

Acute hepatitis A superimposed on chronic liver disease (CLD) has been associated with severe or fulminant hepatitis. An open, multicenter study was performed to compare the safety and immunogenicity of an inactivated hepatitis A vaccine in patients with CLD with that in healthy subjects. A secondary objective was to compare the safety of the hepatitis A vaccine with that of a commercial hepatitis B vaccine in subjects with chronic hepatitis C. A total of 475 subjects over the age of 18 years were enrolled into 1 of 5 groups according to history, serological data, and previous diagnosis. Patients in groups 1 (healthy adults), 2 (chronic hepatitis B), 3 (chronic hepatitis C), and 5 (other CLD not caused by viral hepatitis) were vaccinated with two doses of inactivated hepatitis A vaccine, 6 months apart. Patients in group 4 (chronic hepatitis C) received 3 doses of a recombinant hepatitis B vaccine, according to a 0-, 1-, and 6-month schedule. Local injection-site symptoms were the most common reactions reported following vaccination in all groups (35.5% of all doses), with the hepatitis B vaccine eliciting fewer injection-site symptoms than the hepatitis A vaccine (19.8% compared with 37.5%). Although a higher percentage of healthy subjects (93%) seroconverted after a single dose of the hepatitis A vaccine than did subjects with chronic hepatitis C (73.7%) or CLD of nonviral etiologies (83.1%), more than 94% of all vaccinees were seropositive for anti-HAV after the complete vaccination course. At each time point, a lower geometric mean concentration of anti-HAV was observed for each group of CLD patients compared with the healthy control subjects. In conclusion, hepatitis A vaccine was well tolerated and induced a satisfactory immune response in patients with chronic hepatitis B, chronic hepatitis C, and miscellaneous CLD.     

Attributional style and depression in rheumatoid arthritis: The moderating role of perceived illness control.

Examined the moderating influence of perceived daily illness control on the relationship between disease-unrelated causal attributions and Diagnostic and Statistical Manual of Mental Disorders-IV (DSM-IV) depressive symptomatology in a sample of 58 patients (aged 25–75 yrs) with rheumatoid arthritis (RA). Eight of the Ss met DSM-IV criteria for major depression. All Ss completed paper-and-pencil instruments measuring depression, attributional style, arthritis-specific helplessness, disease severity and pain and disability. As predicted, attribution?×? perceived control interactions contributed significant variance to depression, after controlling for disease variables and arthritis helplessness. Specifically, internal and global attributions for negative events were associated with increased levels of depression under conditions of decreased perceived illness control. The findings provide support for examining general attributional style in studies of depression in RA and for cognitive diathesis-stress conceptualizations of adjustment to chronic illness. Clinical implications of the results for cognitive-behavioral treatment approaches in RA are also discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Cognitions and stress: Direct and moderating effects on depressive versus externalizing symptoms during the junior high school transition.

This study examined direct and stress-moderating effects of attributional style and global self-worth on depressive and externalizing symptoms in adolescents. Attributional style, perceived self-worth, depressive symptoms, and externalizing behaviors were assessed in 371 students in the spring of 6th grade. After the transition to 7th grade, they again completed measures of depression and externalizing symptoms as well as measures of negative life events and school hassles. Stressors around the transition predicted both depressive and externalizing behaviors. Perceived self-worth predicted depressive symptoms, but not externalizing behaviors. Attributional style directly and in interaction with stressors predicted depressive symptoms and did not predict externalizing behavior. A 3-way interaction between stress, attributional style, and self-worth suggested that level of perceived self-worth may moderate the effects of attributional style in times of stress. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Phosphate diabetes in patients with chronic fatigue syndrome

Phosphate depletion is associated with neuromuscular dysfunction due to changes in mitochondrial respiration that result in a defect of intracellular oxidative metabolism. Phosphate diabetes causes phosphate depletion due to abnormal renal re-absorption of phosphate be the proximal renal tubule. Most of the symptoms presented by patients with phosphate diabetes such as myalgia, fatigue and mild depression, are also common in patients with chronic fatigue syndrome, but this differential diagnosis has not been considered. We investigated the possible association between chronic fatigue syndrome and phosphate diabetes in 87 patients who fulfilled the criteria for chronic fatigue syndrome. Control subjects were 37 volunteers, who explicitly denied fatigue and chronic illness on a screening questionnaire. Re-absorption of phosphate by the proximal renal tubule, phosphate clearance and renal threshold phosphate concentration were the main outcome measures in both groups. Of the 87 patients with chronic fatigue syndrome, nine also fulfilled the diagnostic criteria for phosphate diabetes. In conclusion, we report a previously undefined relationship between chronic fatigue syndrome and phosphate diabetes. Phosphate diabetes should be considered in differential diagnosis with chronic fatigue syndrome; further studies are needed to investigate the incidence of phosphate diabetes in patients with chronic fatigue syndrome and the possible beneficial effect of vitamin D and oral phosphate supplements.     

Analysis of the terms used by general practitioners to characterize patients considered by them as depressed. A prospective study on 682 patients

The aim of the study was to investigate the terms used by general practitioners (GPs) to describe the patients considered by them to be depressed. 682 patients were diagnosed as depressed by 79 GPs selected at random in four regions of France. The frequency of the diagnosis of depression made by GPs in the total patient population was 3.6-5%. The GPs were asked to describe the main symptoms of these patients on a plain chart. The percentage of use of each term was calculated in each region. In all the regions, the most frequent symptoms were insomnia (31.8%), fatigue (29.9%) and anxiety (24.6%). The results suggest that the three main terms used by GPs to describe depression differ from those used by psychiatrists.     

Attributions and expectations: A confluence of vulnerabilities in mild depression in a college student population.

The reformulated model of learned helplessness assumes that attributional style has its impact on depression in part through the intermediary effect of pessimistic or negative expectations about the occurrence of future outcomes. A possible logical next step in testing the model is to measure jointly attributions and expectations and to examine their combined (interactive) contributions. We used a short-term longitudinal design to examine whether attributional style works in combination with other factors, such as expectations, to predispose individuals to depression. Consistent with the initial theoretical analysis, the interaction of attributional style and expectations predicted depression on the Beck Depression Inventory 6 weeks later. We also found that attributional style predicted depression 6 weeks later in interaction with initial level of depression. These findings support our confluence hypothesis, which assumes that vulnerability factors can combine interactively and qualify the effects of attributional style. These interaction-effect findings have implications for currently popular cognitive theories of depression and for previous research on vulnerability to depression that has examined only the effects of single cognitive variables (such as attributional style) considered alone. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Family physician consultation by patients with rheumatoid arthritis or gonarthrosis/coxarthrosis

OBJECTIVE: To determine how often patients with rheumatic joint disease consult their general practitioner (GP), and if there are disease and patient characteristics that influence GP consultation of gonarthrosis/coxarthrosis patients. DESIGN: Prospective record investigation. SETTING: Seven GP centres in the southeast of the Netherlands. METHOD: All patient contacts were registered prospectively in the seven GP centres: 46 concerned patients with rheumatoid arthritis (RA), 122 patients with gonarthrosis/ coxarthrosis. Patient and disease characteristics were collected on intake sheets. RESULTS: Three-quarters of the RA patients were periodically seen (mostly by a specialist), and 47% of the gonarthrosis/coxarthrosis patients (as often by their GP as by a specialist). Of the RA patients and of the gonarthrosis/coxarthrosis patients 74% and 89% respectively consulted their GPs in one year (the average numbers of contacts were 4.7 and 5.0); 50% and 57% did so because of the chronic joint disease (with 2.2 and 1.6 contacts respectively). No disease characteristics and only a few patient characteristics (arthroplasty, chronic use of medication) of patients with gonarthrosis/coxarthrosis influenced GP consultation. CONCLUSION: Patients with rheumatic joint disease often consult their GP, but not always because of this illness. If they consult their GP, they usually do so more than once a year.     

Negative attributional style as a moderator of the link between perfectionism and depressive symptoms: Preliminary evidence for an integrative model.

An integrative model involving perfectionism and negative attributional style as predictors of depressive symptoms was proposed and tested in 222 college students. Beyond the expected additive influences of the 2 predictors in the prediction of dysphoria, negative attributional style was also hypothesized to moderate the link between perfectionism and depressive symptoms. As theorized, results indicated that dimensions of perfectionism (P. Hewitt & G. Flett, 1991b) predicted depressive symptoms (2 months later) and that a negative attributional style added incremental validity to these predictions. Moreover, consistent with the proposed model, the Perfectionism?×?Negative Attributional Style interaction was found to further augment the prediction of depressive symptoms. These findings are taken to offer preliminary support for the proposed model. Some implications for future studies are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Everyday symptoms in childhood: occurrence and general practitioner consultation rates

BACKGROUND: Fewer than 20% of all illnesses that occur in the home require the attention of a general practitioner (GP). Whether specific illnesses in children are more likely to need the attention of a GP is poorly understood, as is the influence of various other factors. Health diaries are the most suitable method of collecting comprehensive information about children's health problems at home and in general practice simultaneously. AIM: To investigate the occurrence of, and consultation rates for, specific symptoms in childhood in relation to age, sex, birth order, and place of residence of the child, and season of the year. METHOD: The parents of 1805 children kept a health diary over three weeks and recorded symptoms and consultation behaviour. The symptoms were later combined into illness episodes. RESULTS: Over three weeks, colds/flu (157/1000 children) and respiratory symptoms (114/1000 children) occurred most frequently. More young children (0-4 years) suffered from illness generally. Eleven per cent of all illness episodes required the attention of a GP. Consultation rates differed greatly according to symptoms. A GP was consulted most often for ear (36%) and skin (28%) problems, and least often for headaches (2%) and tiredness (1%). Regardless of symptoms, young children (0-4 years) were taken to a GP twice as often as older children (10-14 years). CONCLUSIONS: This study emphasizes the enormous amount of illness that occurs in children and the fact that more than 80% of all illnesses are dealt with by parents without reference to the professional health care system.     

High resolution EEG

Rhinovirus is an important cause of respiratory infection among all age groups, but it is primarily thought of as being responsible for upper respiratory tract infection. Rhinovirus was isolated from the respiratory tract of 48 pediatric patients who were hospitalized (40) or seen in a pediatric emergency room (8) during the period of July, 1985, through December, 1988. Twenty-eight (58%) of the patients presented during the spring and early summer. Forty-one (86%) of the 48 patients were less than 12 months of age. All except four of the patients had viral cultures performed because of respiratory symptoms. Bronchiolitis was the single most frequent clinical diagnosis and was noted in equal proportion among children less than 3 months and 3 to 12 months of age. Nine patients were assigned a diagnosis of suspected sepsis. Rhinovirus infection was a complication of underlying illness for 17 (44%) of the 40 hospitalized patients, and those patients tended to be older than the otherwise healthy hospitalized infants with rhinovirus. Twenty-six patients (54%) were treated with antibacterial agents, although only one patient was documented to have a concomitant bacterial infection (Chlamydia trachomatis). Overall rhinovirus isolation during the study period represented 0.7% of all specimens submitted for viral isolation compared with 8.2% for respiratory syncytial virus. Rhinovirus infection leads to hospitalization less frequently than does respiratory syncytial virus infection, but the severity of illness and clinical presentation in young infants are similar.     

Synergistic effects of curcumin on all-trans retinoic acid- and 1 alpha,25-dihydroxyvitamin D3-induced differentiation in human promyelocytic leukemia HL-60 cells

DEPRESS (Depression Research in European Society) is the first large pan-European survey of depression in the community. A total of 13359 of the 78463 adults who participated in screening interviews across six countries were identified as suffering from depression, a 6-month prevalence of 17%. Major depression accounted for 6.9% of the cases of depression and minor depression for 1.8%. Depressed subjects in both these categories perceived that their working or social lives were substantially impaired by depressive symptoms. The remaining 8.3% of depressed subjects considered that their functional impairment was not substantial. A significant proportion of sufferers from depression (43%) failed to seek treatment for their depressive symptoms. Of those who did seek help (57%), most consulted a primary care physician, the frequency of consultation increasing with the severity of depression. Sufferers from major depression imposed the greatest demand on healthcare resources, making almost three times as many visits to their GP or family doctor as non-sufferers (4.4 vs 1.5 visits over 6 months). More than two-thirds of depressed subjects (69%) were not prescribed any treatment and when drug therapy was prescribed (31%), only 25% of these subjects were given antidepressant drugs. The number of days of work lost due to illness increased with the severity of depression. Major depression had most impact on productive work, with sufferers losing four times as many working days over 6 months as non-sufferers. The results of the DEPRES survey confirm the high prevalence of depression in the community and the burden imposed on the individual sufferer in terms of impaired quality of life and on society in terms of healthcare utilization and lost productivity.     

Thrombotic thrombocytopenic purpura in adult Still''s disease

Chronic fatigue syndrome (CFS) is often preceded by a viral illness and has recurrent "flu-like" symptoms. We compared demographic, clinical, and laboratory features (markers of inflammation and viral infection) among 717 patients with chronic fatigue (CF) with and without a self-reported postinfectious onset to identify associated clinical and biologic findings and to examine the subset of patients with CFS. Only subjective fever, chills, sore throat, lymphadenopathy, poorer functional status, and attribution of illness to a physical condition were significantly associated with a postinfectious onset. The features of patients with CFS were virtually identical to those of the broader category of patients with CF. We conclude that a postinfectious onset was not associated with a pattern of abnormalities across multiple psychosocial and biologic parameters.     

Significance of suspected "chronic aggressive hepatitis" in acute hepatitis

Transition from acute to chronic hepatitis has important prognostic and therapeutic implications. In 17 patients with acute viral hepatitis, observed during a period of 7 years, a liver biopsy showed changes compatible with chronic aggressive hepatitis and superimposed acute hepatitis. Follow-up biopsies showed normal liver in 14 cases, chronic persistent hepatitis in 1, and cirrhosis in 2. In 12 cases the initial biopsy which showed changes suggestive of chronicity was taken 1 month after onset of symptoms of acute hepatitis, or later. Cases developing chronic liver disease showed no characteristic clinical, laboratory, or histological features at the time of the first biopsy. If the diagnosis of chronic active hepatitis is based on histological findings alone in patients with prolonged acute hepatitis, the incidence of this condition will be grossly overestimated. The transition from acute to chronic hepatitis cannot be recognized with any degree of certainty by presently available methods.     

Chronic fatigue--'tired with 23 i's'

Two patients, a woman aged 32 years and a man aged 49, presented with severe chronic fatigue. The woman had chronic fatigue syndrome; she recovered slowly. The man suffered from a pituitary adenoma producing follicle stimulating hormone; he recovered after transsphenoidal hypophysectomy. In patients with chronic fatigue, the history and a thorough physical examination to exclude underlying illness are very important; secondary symptom criteria must not be overemphasized (as is the case with the Holmes and Fukuda criteria), chronic fatigue syndrome should not be diagnosed if the condition has a shorter duration than 6 months, but it should be diagnosed if the clinical picture is compatible. The prognosis is not poor: in patients with a median disease duration of 4.5 years, 20% show significant improvement over an 18-month period.