Chronic fatigue and indicators of long-term employment disability in psychosomatic inpatients

The major goal of this study was to determine indictors of long-term disability for psychosomatic inpatients with chronic fatigue syndrome. To this end, a cross-sectional study was performed with a random sample of patients (n=1000, response rate: 83.9%) at a psychosomatic inpatient clinic. 51.1% of the patients (n=429) reported intensely persistent exhaustion that had no logical relation to actual exertion. 159 (37.1%) patients in this group were disabled from working and these comprised the main target group of this study. Significantly more patients in the target group worked part time, were disabled for a disproportionately long period of time (50.9% of all were disabled for more than 6 months in the previous year), and felt stressed because of conflicts with their superiors and/or colleagues (in each case, P<0.01). While more frequent psychological comorbidity was not found, they reported physical complaints more often. It was not the patients fit for work who felt more burdened with chronic fatigue, but rather the employment-disabled, who were actually exposed to fewer demands. These patients had, in comparison with those fit to work, a stronger fixation on somatic complaints, inadequate perception of physical and psychic sensations, difficulties getting along with other people and in coping with a regular job (in each case, P<0.01). Prospective examination of these indicators could help detect predictor variables for long-term disability in chronic fatigue. Such predictors could contribute to timely social-medical assessment and treatment.     

Quantitative imaging of intrinsic magnetic tissue properties using MRI signal phase: an approach to in vivo brain iron metabolism?

Quantitative susceptibility mapping (QSM) based on gradient echo (GRE) magnetic resonance phase data is a novel technique for non-invasive assessment of magnetic tissue susceptibility differences. The method is expected to be an important means to determine iron distributions in vivo and may, thus, be instrumental for elucidating the physiological role of iron and disease-related iron concentration changes associated with various neurological and psychiatric disorders. This study introduces a framework for QSM and demonstrates calculation of reproducible and orientation-independent susceptibility maps from GRE data acquired at 3T. The potential of these susceptibility maps to perform anatomical imaging is investigated, as well as the ability to measure the venous blood oxygen saturation level in large vessels, and to assess the local tissue iron concentration. In order to take into account diamagnetic susceptibility contributions induced by myelin, a correction scheme for susceptibility based iron estimation is demonstrated. The findings suggest that susceptibility contrast, and therewith also phase contrast, are not only linked to the storage iron concentration but are also significantly influenced by other sources such as myelin. After myelin correction the linear dependence between magnetic susceptibilities and previously published iron concentrations from post mortem studies was significantly improved. Finally, a comparison between susceptibility maps and processed phase images indicated that caution should be exercised when drawing conclusions about iron concentrations when directly assessing processed phase information.     

An evolving integrative treatment program for military sexual trauma (MST) and one veteran's experience

Military sexual trauma (MST) increases the risk for Posttraumatic Stress Disorder (PTSD) and multiple other comorbidities, presenting substantial challenges for nurses and psychiatric and medical clinicians. A specialized VA Medical Center outpatient program is patterned after Herman's three-phased, empirically-supported, recovery treatments. We use a case example of a female veteran MST survivor to illustrate our treatment model. She presented to our program meeting diagnostic criteria for PTSD, Major Depressive Disorder, and a history of substance abuse. Post-treatment she demonstrated improved scores on measures of PTSD, quality of life, and socialization. This model shows promise for treatment of MST survivors with PTSD.     

Nevirapine plasma concentrations and concomitant use of rifampin in patients coinfected with HIV-1 and tuberculosis

OBJECTIVES: In countries with high numbers of HIV/tuberculosis coinfection nevirapine and rifampin are used extensively. However, limited data are available about whether or not nevirapine and rifampin can be safely coadministered without the plasma concentration of nevirapine falling below therapeutic levels. METHODS: Blood samples for determination of nevirapine plasma concentrations were collected from patients using nevirapine 200 mg twice daily with or without concomitant rifampin. Bivariate and multivariate linear regression models were used to investigate factors possibly related to nevirapine concentrations. RESULTS: We received 74 blood samples from patients using nevirapine plus rifampin, and collected blood samples from an equal number of controls using nevirapine only. Groups were similar for age, gender, weight, height and body mass index (BMI). In the rifampin group the mean nevirapine concentration was 5.47 +/- 2.66 mg/l, whereas in the control group the mean nevirapine concentration was 8.72 +/- 3.98 mg/l. In the rifampin group seven nevirapine trough concentrations were low (< 3.1 mg/l), while in the control group two patients had low nevirapine trough concentrations (P = 0.164). In the multivariate linear regression analysis, corrected for time after drug intake, the use of rifampin was significantly (P < 0.001) associated with lower nevirapine plasma concentrations, whereas higher BMI reached borderline significance (P = 0.065). CONCLUSION: Although nevirapine plasma concentrations were 3.3 mg/l lower when co-administered with rifampin, still more than 86% of these patients had nevirapine plasma concentrations > 3.1 mg/l. Our results suggest that from a pharmacological point of view the majority of Thai coinfected patients, who have low BMIs, reach nevirapine plasma concentrations that are adequate for treatment of HIV. However this can only be undertaken if nevirapine plasma concentration monitoring is available and can be closely followed.     

Development and validation of an imaging and clinical scoring system to predict early mortality in spontaneous ruptured hepatocellular carcinoma treated with transarterial embolization

Abdominal Radiology - To develop and validate a scoring system using a combination of imaging and clinical parameters to predict 30-day mortality in ruptured HCC (rHCC) patients after transarterial...     

Iron deficiency and anemia predict mortality in patients with tuberculosis

Many studies have documented a high prevalence of anemia among tuberculosis (TB) patients and anemia at TB diagnosis has been associated with an increased risk of death. However, little is known about the factors contributing to the development of TB-associated anemia and their importance in TB disease progression. Data from a randomized clinical trial of micronutrient supplementation in patients with pulmonary TB in Tanzania were analyzed. Repeated measures of anemia with iron deficiency, anemia without iron deficiency, and iron deficiency without anemia were assessed as risk factors for treatment failure, TB recurrence, and mortality. The prevalence of anemia (hemoglobin < 110 g/L) at baseline was 64%, more than one-half of which was related to iron deficiency (mean corpuscular volume , 80 fL). We found no evidence of an association between anemia (with or without iron deficiency) or iron deficiency without anemia at baseline and the risk of treatment failure at 1 mo after initiation. Anemia without iron deficiency was associated with an independent, 4-fold increased risk of TB recurrence [adjusted RR = 4.10 (95% CI = 1.88, 8.91); P < 0.001]. Iron deficiency and anemia (with and without iron deficiency) were associated with a 2- to nearly 3-fold independent increase in the risk of death [adjusted RR for iron deficiency without anemia = 2.89 (95% CI = 1.53, 5.47); P = 0.001; anemia without iron deficiency = 2.72 (95% CI = 1.50, 4.93); P = 0.001; iron deficiency anemia = 2.13 (95% CI = 1.10, 4.11); P = 0.02]. Efforts to identify and address the conditions contributing to TB-associated anemia, including iron deficiency, could play an important role in reducing morbidity and mortality in areas heavily affected by TB.     

The Relationship Between Built Environments and Physical Activity: A Systematic Review

Objectives. We conducted a systematic review of the literature examining the relationship between built environments (e.g., parks, trails, sidewalks) and physical activity (PA) or obesity rates.Methods. We performed a 2-step inclusion protocol to identify empirical articles examining any form of built environment and any form of PA (or obesity rate) as the outcome. We extracted data from included abstracts for analysis by using a standard code sheet developed for this study.Results. Of 169 included articles, 89.2% reported beneficial relationships—but virtually all articles utilized simple observational study designs not suited for determining causality. Studies utilizing objective PA measures (e.g., pedometer) were 18% less likely to identify a beneficial relationship. Articles focusing on children in community settings (–14.2%), those examining direct measures of obesity (–6.2%), or those with an academic first author (–3.4%) were less likely to find a beneficial relationship.Conclusions. Policymakers at federal and local levels should encourage more rigorous scientific research to determine whether altered built environments will result in increased PA and decreased obesity rates.Obesity rates have risen dramatically in the United States over the past few decades among both adults1 and children.2 Although obesity prevalence has increased in all parts of the country and for all demographic groups, the prevalence of obesity is higher in the US South3–7 and among African Americans, Hispanics, and the educationally and economically disadvantaged.2,3,8,9 Obesity and sedentary lifestyles are estimated to result in more than 300 000 premature deaths per year in the United States.10,11 The obesity epidemic is regarded as one of the leading health problems facing the country and several federal initiatives such as the Centers for Disease Control and Prevention’s “Communities Putting Prevention to Work” or the First Lady’s “Let’s Move” campaign aim to reverse childhood obesity.Ultimately, obesity is a result of imbalance between energy intake and energy expenditure.12 Physical activity (PA) provides one of the main sources of energy expenditure.13 In fact, the rising prevalence of obesity in the United States has occurred concurrently with general declines in the rates of PA associated with a decrease in such factors as active transportation (e.g., walking to work or school) and an increase in sedentary leisure-time activities such as television watching6 and video game playing,14,15 and a decrease in physical activity in schools.16 Overall, it is estimated that more than 50% of US adults fail to meet the recommended levels of overall PA, with higher prevalence of inadequate PA in the South.7 Evidence of inadequacy in PA among children is also well documented.17–20It is generally believed that PA is not just a matter of personal choice, but also a function of the built environment21–23—which refers broadly to the collective availability of sidewalks, parks, trails, recreational facilities, traffic safety, and other neighborhood characteristics that promote recreational PA as well as active transport to work, school, or errands.24–29 There is also evidence that low-income neighborhoods and minority communities have less access to recreational facilities30 and the existing facilities available to them are of a poorer quality.31 Thus, modifying built environments to make them more PA-friendly is widely advocated as a way to create healthier and less obese communities.32 Concurrently there has been a growing body of scientific research on how various facets of the built environment are associated with changes in PA or obesity rates.33–39 However, because of the wide range of scientific journals in which such studies are published, the heterogeneity in types of built environments considered, the different ways in which PA is defined or measured, and the varying study populations examined, it is increasingly difficult for policymakers and other stakeholders to keep abreast of current findings.The purpose of this study was to systematically review the literature examining the relationship between built environments and PA or obesity rates. We were interested in any articles that focused on any aspect of the built environment that also examined any form of PA or direct measures of obesity. Our work supplements previous reviews of the literature that focused narrowly on body weight only,39 a limited population (e.g., African Americans)37 or other disadvantaged groups,38 or literature (e.g., epidemiology only33), and those that were concerned entirely with how to best measure built environments.35 In addition, previous authors have examined how PA and obesity are related to macro, political, economic, and micro environments36 or the concept of “smart growth” in the context of urban planning.34 In our study, we were interested broadly in determining whether built environment characteristics are associated with decreases in obesity or increases in various types of PA. Moreover, we were interested in quantifying the proportion of existing studies that focus on Southern states, on children, or other vulnerable populations, and determining whether such studies differ with respect to identifying a benefit from built environments. Lastly, we were interested in identifying any specific study characteristics that are associated with finding results that show improvements in PA or obesity rates. Overall, our study helps identify gaps in the literature and provides a useful synthesis for policymakers, urban planners, public health professionals, and other stakeholders concerned with maximizing the benefits of built environments for the health of their communities.     

Hyperbaric hyperoxia induces a neuromuscular hyperexcitability: assessment of a reduced response in elite oxygen divers

We compared the changes in compound muscle mass action potential (M-wave) recorded in vastus lateralis in response to hyperbaric hyperoxia (HBO) in nine combat divers who dived daily while breathing 100% O2 or O2-enriched mixture (O2 divers) to those measured in eight recreational divers who dived occasionally using compressed air/21% O2 (air divers). The O2 divers completed a 6-h HBO exposure in which the inspired oxygen pressure (PiO2) varied from 1.15 to 2.7 absolute atmospheres (ATA), PiO2 being maintained at 1.15 ATA throughout the first 2-h period, whereas the air divers only completed a 2-h HBO exposure with PiO2 constant at 1.15 ATA. Before HBO exposure, there were no intergroup differences between baseline M-wave characteristics (amplitude and duration), but the conduction time was significantly shorter in O2 divers compared with air divers. After 90 min of HBO (1.15 ATA) the air divers demonstrated neuromuscular hyperexcitability, as evidenced by an increased M-wave amplitude (13%, P<0.01 versus baseline), shortened M-wave duration (5%, P<0.05 versus baseline), and reduced conduction time (5%, P<0.01 versus baseline). In O2 divers, similar HBO-induced M-wave changes were only observed when PiO2 was greater than 1.50 ATA. We conclude that HBO elicites neuromuscular hyperexcitability, attenuated in elite O2 divers.