The meaning of pain influences its experienced intensity

This experiment tested whether meaning influences the experience of pain. Thirty-one healthy students participated in a study on evaluations of various stimuli placed against the neck. By suggesting that a very cold metal bar was either hot or cold, the potentially tissue-damaging property of the stimulus was experimentally manipulated. A manipulation check revealed that participants believed the experimenter's information, as they rated the bar as more hot in the corresponding condition than in the other condition. Confirming the hypothesis that tissue-damaging meaning influences the experience of pain, participants who were told that the bar was hot rated it as more painful than participants who were told that it was cold. Damage interpretations mediated the effect of information on pain intensity scores, which supported the theory that tissue-damage is a crucial aspect of meaning to influence the subjective intensity of pain.     

The methodology of HIV/AIDS impact studies: a review of current practices

This review of studies on the socio-economic impact of HIV/AIDS shows that diversity in methodological design, which often is a result of practical considerations and resource constraints rather than of poor design, is the norm. This limits the comparability of research findings. More detailed reporting on method, which is not the norm, can go some way towards facilitating such comparison. Furthermore, the review underlines the importance of exploring intervention issues in more detail. Researchers need to employ results in answering specific policy questions. Scope remains for more impact studies to be conducted in developing countries in general and in certain high prevalence countries in specific, i.e. Southern Africa. Studies that explore the urban/rural dynamics of and clients' perceptions and behavior in seeking care and support are necessary to better understand the epidemic. The role of community-based organizations, non-governmental organizations and other stakeholders in studies of this nature can be expanded. Larger studies generally have more statistical power, but smaller, in-depth studies can be equally valuable. A careful stratification of sample populations can enhance the quality of cross-sectional studies. Qualitative methods should be used to complement the current reliance on survey-based methods of data collection. More longitudinal studies are required to explore the long-term impacts of HIV/AIDS. HIV/AIDS training for fieldworkers should be standard in studies of this nature, while cognizance should be taken of the dangers of employing local people as fieldworkers in studies of such sensitive nature. Scope remains for the further empirical analysis of data from impact studies, which requires these data sets being made accessible to more researchers. In the longer term, an attempt at standardizing core modules in impact studies can help to improve our understanding of the impact of HIV/AIDS in different settings.     

Chronic obstructive pulmonary disease patients with invasive pulmonary aspergillosis: benefits of intensive care?

OBJECTIVES: Invasive pulmonary aspergillosis (IPA) is increasingly recognized as a cause of acute respiratory failure in patients with chronic obstructive pulmonary disease (COPD) treated with corticosteroids. For these patients admission in intensive care unit (ICU) is often required for life-support and mechanical ventilation. Whether this approach improves outcome is unknown. DESIGN AND SETTING: Retrospective study in a university hospital intensive care unit. PATIENTS: Between November 1993 and December 1997, 23 COPD patients were admitted in our ICU and received antifungal agents for possible IPA. INTERVENTIONS: None. MEASUREMENTS AND RESULTS: The clinical features and the outcome were reviewed. Diagnosis of IPA was classified as confirmed (positive lung tissue biopsy and/or autopsy) or probable (repeated isolation of Aspergillus from the airways with consistent clinical and radiological findings). Among the 23 patients treated for Aspergillus, 16 fulfilling these criteria for IPA were studied. Steroids had been administered at home to all patients but one and were increased during hospitalization in all. Twelve patients suffered a worsening of their bronchospasm precipitating acute respiratory failure. During ICU stay all patients required mechanical ventilation for acute respiratory failure. Although amphotericin B deoxycholate was started when IPA was suspected (0.5-1.5 mg/kg per day), all patients died in septic shock (n = 5) or in multiple-organ failure. CONCLUSIONS: The poor prognosis of intubated COPD patients with IPA, in spite of antifungal treatment suggests that further studies are required to define the limits and indications for ICU management of these patients.     

Posttraumatic stress disorder after pregnancy loss

This prospective longitudinal study investigated the prevalence of posttraumatic stress disorder (PTSD) in response to pregnancy loss. About 1,370 women were recruited in the early stages of pregnancy and 113 of them had a subsequent pregnancy loss. One and four months after pregnancy loss, they were assessed for PTSD with the Posttraumatic Symptom Scale. Depression was also assessed. The majority had an early loss, i.e., within 20 weeks. At one month, the prevalence of PTSD was 25%, and the symptom-severity was similar to other traumatized populations. Women with PTSD had increased risk of depression: 34% of PTSD cases and 5% of non-cases reported depression. At four months, 7% met the criteria for PTSD, of which half were chronic. In contrast, rates for depression had not declined. The results indicate that pregnancy loss is potentially traumatic, putting women at risk of developing PTSD. In most cases, the disorder is immediate and persists for several months.     

Dislocations and fracture dislocations of the tarsometatarsal joints

Dislocations and fracture-dislocations of the tarsometatarsal joints are potentially disabling injuries that present challenging therapeutic problems. Early recognition is imperative and is based on a familiarity with the important anatomic features of this joint, mechanism of injury, and subtle radiographic changes that often accompany these lesions. Following injury, a precise anatomic reduction of the tarsometatarsal joint is critical if long-term disability is to be avoided. There appears to be a direct correlation between achieving an accurate reduction and a satisfactory clinical result. In our experience, surgical reduction offers the most effective and reliable means of achieving this goal. We have presented an approach for the management of these lesions, which we believe offers advantages over previously described techniques. Our experience has shown that accurate anatomic operative reduction and rigid internal fixation provide an increased assurance of a pain-free, durable, and functional foot in the great majority of cases.     

Der plötzliche Herztod – ein überraschendes Ereignis?

Zusammenfassung Wir untersuchten in einer prospektiven Studie die Randbedingungen des Eintritts des pl?tzlichen Herztodes bei 406 konsekutiven Patienten, bei denen der Notarzt unserer Klinik hinzugezogen wurde. Hierzu wurden die n?heren Umst?nde des Geschehens erfa?t und Augenzeugen unmittelbar an der Einsatzstelle befragt. Das mittlere Alter der Patienten betrug 69,6 Jahre, 60% (n=242) waren m?nnlich. Bei Eintreffen des Rettungsdienstes lag bei 39% (n=159) der Patienten Kammerflimmern vor, bei 42% (n=171) Asystolie, bei 19% (n=76) eine pulslose elektrische Aktivit?t. 100 der 406 Patienten (25%) konnten zun?chst erfolgreich reanimiert werden. Der Kollaps ereignete in 72% (n=294) der F?lle in h?uslicher Umgebung. Augenzeugen waren in 67% (n=272) vorhanden (davon 75% Angeh?rige), in 14% (n=57) wurden ein Laienreanimationsversuch unternommen. Ersthelferreanimation war mit 27% bei Kollaps in der ?ffentlichkeit relativ h?ufiger als bei Ereignis in h?uslicher Umgebung mit 10% (p=0,0002). Bei 323 Patienten konnten Anwesende zum Geschehen befragt werden. Danach hatten 222 Patienten (69%) vor dem Kollaps pr?monitorische Warnsymptome. Am h?ufigsten wurde über Brustschmerz berichtet (40%, n=88), gefolgt von Luftnot (27%, n=61) und Pr?synkopen/Synkopen (10%, n=22) bzw. anderen Symptomen (23%, n=51). Die Warnsymptome dauerten bei 58% (n=128) der Patienten über 30 Minuten an, wobei das charakteristische Symptom „Brustschmerz“ am h?ufigsten l?nger als 30 Minuten toleriert wurde. Eine eindeutig gesicherte – meist koronare – Herzerkrankung lag bei 36% (n=116) der Patienten vor, bei weiteren 39% (n=127) war eine koronare Herzerkrankung sehr wahrscheinlich und/oder sie waren wegen Risikofaktoren in Behandlung. Eine Strategie der Bek?mpfung des pl?tzlichen Herztodes setzt nach unseren Ergebnissen voraus, da? Risikopatienten und Angeh?rige lernen in Notsituationen gezielt zu reagieren. Zum notwendigen Wissen geh?rt offenbar vor allem das Erkennen von Warnsymptomen mit konsekutiver rechtzeitiger Alarmierung des Rettungsdienstes neben Kenntnissen der lebensrettenden Ersthelferreanimation. Eingegangen: 24. Dezember 1998 Akzeptiert: 29. M?rz 1999     

The epidemiology of sudden cardiac death

Summary The variety of existing definitions of sudden cardiac death makes the assessment of trends and the comparison of study results difficult. In 1995/97, the rates of sudden cardiac death were 209 per 100000 for men and 80 per 100000 for women in the age group of 25–74 years according to the data of the WHO MONICA/KORA Augsburg Coronary Event Register in Germany. In the USA, about 225000 sudden cardiac deaths occur per annum. Sudden cardiac death is more likely to occur in older patients and men than in younger patients and women. Similarly to myocardial infarction, a circadian, weekly, and seasonal variation in the incidence of sudden cardiac death can be observed. Triggers of sudden cardiac death include physical activity, emotional stress, and environmental factors. Successful preventive measures combine behaviour modification, pharmacological interventions, and the implanted cardioverter defibrillator in high-risk patients to protect patients during vulnerable periods. Received: 6 April 2001 Accepted: 17 April 2001