Can olfactory training change the psychosocial aspects of chronic pain?

Pain and smell are the oldest senses for apperceive our environment. It is known that chronic pain and olfaction share common limbic cortical regions which are the main parts of the pain neuromatrix such as the anterior cingulate cortex, amygdala, and orbitofrontal cortex. Also, these regions point out the psychosocial aspects of chronic pain. And currently, the most challenging part of chronic pain management is the psychosocial aspect such as kinesiophobia, catastrophizing, or depression. Thus, the connection between olfaction and pain has promising clues to determining new combined therapies with odor training. According to intriguing brain imaging and genetic studies, we hypothesized that patients with chronic pain may have differentiated olfactory thresholds. Further, the additional odor training to the traditional therapeutic approach could be beneficial regarding the patients’ pain perspective and psychosocial domains.     

Do children from community-based parent training programs have clinically significant behavior problems?

Alternative mental health services for children such as parent training are expanding across the country. Yet the clinical picture of the children served in these programs is incomplete. In two studies we compare scores from standardized behavior problem inventories for groups of children from a parent training class with scores from groups of children from a clinic setting and a nonclinic setting. In study one we used the Eyberg Child Behavior Inventory (ECBI), an instrument that primarily assesses externalizing problems. In study two, we used the Child Behavior Checklist (CBCL), an instrument that assesses both externalizing and internalizing problems. The results from both studies show the scores from the parent training groups were equivalent to scores from the clinic groups and were significantly higher than the scores from the nonclinic groups. These results suggest parent training classes do serve children with clinically significant problems.     

Is lactate a mediator of hypoxia-induced anapyrexia?

Hypoxia causes a regulated decrease in body core temperature ( T(c)), termed anapyrexia, which seems to be a very effective way of preventing hypoxia-associated cell damage. Since during several pathological states the supply of O(2) is a limiting factor, the clinical importance of anapyrexia is evident. However, the mechanisms involved in this response remain unclear. We tested the hypothesis that lactate, a classic companion of hypoxia, is a mediator of hypoxia-induced anapyrexia, using the inhibitor of acid lactic production dichloroacetate (DCA). Each of 28 rats was placed in a chamber ventilated with humidified air at an ambient temperature of 24-26 degrees C. After a control period of 30 min the animals were given saline or 100 mg/kg DCA i.p. Then, 30 min later, the chamber was flushed with a 7% O(2) gas mixture for 2 h. At the end of the experiment, the animals were decapitated and blood samples collected for measurements of plasma lactate. T(c) was measured by biotelemetry. DCA did not affect the T(c) or basal lactate levels of normoxic rats. Hypoxia elicited a significant decrease in T(c) and an increase in plasma lactate levels. Although DCA decreased plasma lactate levels during hypoxia, it caused no change in the course of hypoxia-induced anapyrexia. Correspondingly, no correlation was found between the drop in T(c) and the rise in plasma lactate during hypoxic conditions. These results do not support the hypothesis that lactate is a mediator of hypoxia-induced anapyrexia in rats.     

Do places matter? Socioeconomic disadvantage and behavioral problems of children in Canada

This study evaluated the influence of neighborhoods and socioeconomic disadvantage on behavioral problems rated by parents and teachers in a nationally representative sample of children ages 4 to 11 years living in Canada. Between-neighborhood variation accounted for 7.6% and 6.6% of parent and teacher ratings, respectively. About 25.0% of this neighborhood variation could be explained by socioeconomic variables evenly divided between neighborhood and family-level measures. Family socioeconomic status, lone-parent family status, and percentage of lone parents in neighborhoods were strong, reliable predictors of behavioral problems. Ratings were contextualized: Fewer behavioral problems were assessed in children from well-off families living in disadvantaged neighborhoods, whereas more problems were assessed in children from poor families living in advantaged neighborhoods.     

Is behavioral inhibition a risk factor for depression?

BACKGROUND: Several studies have reported an observed relationship between a behaviorally inhibited temperament early in life and subsequent clinical anxiety, but few have explored the relationship between early inhibition and depression. METHODS: In a cross-sectional survey of non-clinical adults we examined the relationship between retrospectively reported childhood behavioral inhibition and lifetime depression. We then examined the mediating role of social anxiety and childhood relational stress factors. RESULTS: Subjects who qualified for a lifetime episode of depression also reported significantly more childhood inhibition, particularly if they had a juvenile onset depression (i.e., by age 16). Further analyses revealed that social anxiety mediated the link between reported childhood inhibition and later depression, and highlighted the additional meditating effect of parental influences. CONCLUSION: Any relationship between an early inhibited temperament and later depression, may in fact be dependent upon the presence of clinically meaningful social anxiety.     

Is There a Role for Antibiotics in the Treatment of Asthma?

Emerging evidence suggests an association between some asthma and pulmonary infection by the atypical organisms Chlamydia pneumoniae and Mycoplasma pneumoniae, but a causal role for infection remains unproven and controversial. Most acute exacerbations of asthma are triggered by acute infections that are due to viral respiratory pathogens, not to bacteria or atypical organisms. Administration of antibiotics for acute exacerbations of asthma has been shown to be ineffective. Most evidence linking atypical infections to asthma is consistent with a promoting role for chronic infection in producing persistent asthma symptoms. Preliminary studies suggest that prolonged (>/=6 weeks) administration of doxycycline or macrolides may eradicate C. pneumoniae from respiratory secretions and improve long term, not acute, asthma symptoms. Randomised, controlled trials are currently under way to investigate the effectiveness of these prolonged courses of macrolides and azalides (roxithromycin, clarithromycin and azithromycin) in adults with stable persistent asthma. Traditional courses (7 to 10 days) of any antibiotic are incapable of eradicating chronic C. pneumoniae or M. pneumoniae infection; furthermore, beta-lactam and sulphonamide-based antibiotics that are commonly prescribed in acute respiratory syndromes are ineffective against these atypical organisms. Unless the goal is to treat documented sinusitis associated with asthma, it is inappropriate to prescribe traditional courses of any antibiotic for acute asthma exacerbations; whether longer courses of antibiotics should be prescribed to eradicate chronic atypical infections and decrease persistent asthma severity remains to be established.     

Is there a role for palmitoylethanolamide in the treatment of depression?

Depression is a common brain disorder affecting about 350 million people worldwide. Although the pharmacological treatment currently available can produce benefits in the majority of cases, residual depressive symptoms, cognitive deficits, functional impairment, and increase in frequency of relapses are frequently present in unipolar and bipolar depressed patients correctly treated. In the last years, numerous evidences have demonstrated the involvement of endocannabinoid system in the pathophysiology of mood disorders. Considering the recent findings about the antidepressant effect of palmitoylethanolamide in animal model, we have hypothesized the potential antidepressant effect of this fatty acid amide in unipolar and bipolar depressed patients.     

Why mentor? A validation study of the volunteer functions inventory for use in youth mentoring

This study explores the functional motivations of volunteers in youth mentoring programs and tests the validity of the Volunteer Functions Inventory (VFI) for this population. Participants included 473 volunteer mentors matched within a one-to-one mentoring program. The study utilizes a mixed-methods approach to validate the VFI, which was administered before the match. Exploratory and confirmatory factor analyses were employed to test for content validity and determine fit. These were complemented by an emergent theme analysis from a semi-structured interview, which included questions assessing mentor motivations. Findings suggest a five-factor structure model best captures functional motivations. In addition, results from the qualitative analysis suggest there may be previously unexplored domains to consider for contemporary volunteer populations. These include community/civic responsibility, organizational structure and reputation, and self-concept. Future research should seek to refine scales that are uniquely predictive of mentor motivations to expand practical applications for use.     

Is bradykinin a mediator of renal neuropeptide Y effects?

We have previously reported that the bradykinin receptor antagonist icatibant attenuates the neuropeptide-Y-induced diuresis and natriuresis in anaesthetized rats (Am J Physiol 275:F502-F509, 1998). Therefore, we have now determined whether bradykinin mimics tubular responses to neuropeptide Y in acutely pentobarbital-anaesthetized rats. Infusion of the neuropeptide Y receptor agonist peptide YY (2 micrograms kg-1 min-1) enhanced diuresis and natriuresis approximately equal to 2- and 4-fold, respectively, but did not increase urinary bradykinin excretion. Intrarenal infusion of bradykinin (100 ng kg-1 min-1) reduced renal blood flow by approximately equal to 12% and this was abolished by concomitant administration of icatibant (200 ng kg-1 min-1). However, intrarenal bradykinin infusion did not affect creatinine clearance, urine flow rate or sodium excretion (basal values: 0.8 ml min-1, 111 microliters/15 min and 7.7 mumol/15 min, respectively). These data do not support our original hypothesis that bradykinin mediates the renal effects of neuropeptide Y.     

Is there today a place for corticosteroids in the treatment of scleroderma?

In systemic sclerosis (SSc), the use of corticosteroids (CS) is controversial due to their association with scleroderma renal crisis (SRC). However, patients with very early and early disease, characterised by main inflammatory component, may benefit from CS therapy.The aim of this review is to discuss pros and cons of CS treatment in SSc, providing current evidence about the use of CS in SSc. Moreover, we discuss also the underlying pathogenetic mechanisms that may be the background for the potential harms and efficacy of CS in SSc.     

Is there a place for intra-articular hyaluronate in osteoarthritis of the knee?

Viscosupplementation refers to the intra-articular injection of hyaluronic acid (HA) as a hyaluronate to relieve pain and improve function, usually in patients with knee OA. HA is the major constituent of a 1-2-micron layer on the surface of articular cartilage as well as a major constituent of synovial fluid (SF). Solutions of HA can act as lubricants when movements are slow and as shock absorbers when movements are fast. In arthritis, the molecular weight of HA is reduced, and so are its properties. Viscosupplementation has been advocated as a way of reversing this, but intra-articular HA has other properties, such as an anti-inflammatory effect, which may also contribute to any therapeutic effect. There is a large placebo effect from intra-articular injections, and the benefits of intra-articular glucocorticoids may be only slightly better than this effect. In only one randomised, placebo-controlled trial was the difference in response significant. Studies of intra-articular HA also show a marked placebo response (where it has been measured), but some have suggested a measurable benefit, which may be more prolonged that that of glucocorticoids. There is only a single study in which the effects of intra-articular therapy with placebo, glucocorticoids and viscosupplementation can be compared. Here, HA may have had a slightly longer period of benefit than triamcinolone hexacetonide or placebo. The very large placebo response after aspiration of the knee may seriously mislead those engaged in uncontrolled therapeutic evaluation of intra-articular therapy. Current evidence suggests that viscosupplements probably provide a similar level of pain relief to glucocorticoids and do so for several months, but the onset is slower, and there is the potential for local adverse reactions.     

Is the P3 amplitude reduction seen in externalizing psychopathology attributable to stimulus sequence effects?

P3 amplitude reduction (P3-AR) is associated with biological vulnerability to a spectrum of externalizing (EXT) disorders, such as conduct disorder, antisocial behavior, and substance use disorders. P3 amplitude, however, can be affected by the context within which it is measured, for example, by the position of the target in the sequence of stimuli during an oddball task. We hypothesized that EXT-related P3-AR may be due to attention or working memory deficits in EXT that would weaken these stimulus sequence effects. Using a community-based sample of adolescent males, we examined the relationship between P3 and EXT as a function of the number of standards preceding the target. Higher EXT was associated with significantly smaller P3 amplitude, regardless of the number of standards preceding the target. These results suggest that P3-AR in EXT does not vary as a function of stimulus sequence, further supporting P3-AR as an endophenotype for EXT disorders.     

Is Sanfilippo type B in your mind when you see adults with mental retardation and behavioral problems?

Sanfilippo type B is an autosomal recessive mucopolysaccharidosis (MPS IIIB) caused by deficiency of N-acetyl-alpha-D-glucosaminidase, a lysosomal enzyme involved in the degradation of heparan sulfate. It is characterized by neurologic degeneration, behavioral problems, and mental decline. Somatic features are relatively mild and patients with this disorder can reach late adulthood. It is the most common subtype of MPS in the Netherlands and probably underdiagnosed in adult persons with mental retardation (MR). In order to increase knowledge on the adult phenotype and natural history in Sanfilippo type B, we present the clinical data of 20 patients with this disorder. Sixteen of them were followed for one to three decades. Six died between 28 and 69 years of age, mainly from pneumonia and cachexia; the surviving patients were 18-63 years old. Apart from the youngest, they had lost mobility at 36-68 years. Most had developed physical problems, in particular in the 4th-6th decade of life: cardiac disease (cardiomyopathy, atrial fibrillations), arthritis, skin blistering, swallowing difficulties requiring feeding by a gastrostomy tube, and seizures. The course of the disease was dominated in most of them by challenging behavioral problems with restlessness, extreme screaming and hitting, difficult to prevent or to treat pharmaceutically. Even in absence of knowledge of the history of an elderly patient with MR, the presence of behavioral problems should prompt metabolic investigation for MPS.