The effects of acute treatment with escitalopram on the different stages of contextual fear conditioning are reversed by atomoxetine

Rationale  

Although the antidepressant and anxiolytic effects of selective serotonin reuptake inhibitors and serotonin–noradrenaline reuptake inhibitors are well-documented, less is known about their cognitive effects.     

Strategies to promote health behaviors in parents with small children—A systematic review and realist synthesis of behavioral interventions

In this systematic review and realist synthesis, we aimed to identify strategies to improve dietary and physical activity behaviors for parents with small children. A systematic literature search was conducted in MEDLINE, Embase, CINAHL, and PsycINFO in July 2021. Included studies had to: (i) target one or both parents with at least one child (0–3 years), (ii) aim to improve diet and physical activity, and (iii) report on diet and physical activity outcomes. Intervention context, delivery, and outcomes were extracted, and behavior change techniques were coded. A program theory was developed, and context-mechanism-outcome configurations were identified. In total, 17 interventions reported in 28 studies (19 effectiveness studies; nine protocols) were included. Nine interventions showed small improvements: in diet (n = 5), physical activity (n = 2), or both (n = 2) in mothers. The realist synthesis revealed three strategies to improve health behaviors: (1) using knowledge and role modelling to improve family dynamics, (2) providing various home-based activities to change home environment, and (3) offering flexible delivery, for example, phone or website-based to increase social support. Future interventions for parents with small children should consider involving the whole family, focusing on home-based and practical components, and offering various delivery modes. The protocol for the systematic review and realist synthesis was registered in Research Registry (registration ID: reviewregistry860) March 30th, 2020.     

Estimation of individual reference intervals in small sample sizes

In occupational health studies, the study groups most often comprise healthy subjects performing their work. Sampling is often planned in the most practical way, e.g., sampling of blood in the morning at the work site just after the work starts. Optimal use of reference intervals requires that the population, on which the reference interval is based, is representative for the study group in question. The International Federation of Clinical Chemistry and Laboratory Medicine (IFCC) recommends estimating reference interval on at least 120 subjects. It may be costly and difficult to gain group sizes of that order of magnitude for all topics in question. Therefore, new methods to estimate reference intervals for small sample sizes are needed. We present an alternative method based on variance component models. The models are based on data from 37 men and 84 women taking into account biological variation from various variables such as gender, age, BMI, alcohol, smoking, and menopause. The reference intervals were compared to reference intervals calculated using IFCC recommendations. Where comparable, the IFCC calculated reference intervals had a wider range compared to the variance component models presented in this study. The presented method enables occupational health researchers to calculate reference intervals for specific groups, i.e. smokers versus non-smokers, etc. In conclusion, the variance component models provide an appropriate tool to estimate reference intervals based on small sample sizes.     

Adolescents with wheeze have increased risk of additional health problems. The Young-HUNT study, Norway

OBJECTIVE: To explore the hypothesis of an association between current wheeze and other health problems in adolescence and to investigate any sex differences. METHODS: N=8817 adolescents aged 13-19 years completed a self-administered questionnaire including questions on health and lifestyle in Norway (1995-1997). RESULTS: All subjective health problems were significantly more prevalent in current wheezers compared to non-wheezers (frequent headache: girls 18% vs. 9%, boys 8% vs. 3%; frequent neck and shoulder pain: girls 10% vs. 5%, boys 6% vs. 2%; frequent joint and muscle pain: girls 6% vs. 2%, boys 6% vs. 2%; and frequent abdominal pain: girls 10% vs. 3%, boys 3% vs.1%). In both sexes, adjusted for covariates, current wheezers had statistically significant increased risk of reporting frequent headache (girls OR=2.0, boys OR=2.9), frequent neck and shoulder pain (girls OR=1.9, boys OR=3.3), frequent joint and muscle pain (girls OR=2.7, boys OR=3.5) and frequent abdominal pain (girls OR=2.7, boys OR=2.0). CONCLUSIONS: Current adolescent wheezers reported more additional health problems compared to non-wheezers. Even if girls reported more symptoms in general, the associations were stronger in boys. The findings are important for the clinical approach to teenage wheezers and should increase doctors' awareness of coexistence of other health complaints in these patients.     

Linear Lesion Radiofrequency Ablation in Canine Vagal Atrial Fibrillation: Effects of Special Catheters Designed for Efficiency, and the Critical Role of Lesions from the Crista Terminalis to the Superior Vena Cava

Objective: To determine whether specially devised catheters could be used to place radiofrequency (RF) linear lesions quickly and efficiently for termination and/or prevention of atrial fibrillation (AF). Methods: Two versions of 2 different types of ablating catheters were used in 12 canines with AF induced by rapid pacing during vagal stimulation. 1) Modified basket catheters in two versions, one designed to produce caudo-cranial linear lesions through extended bare electrode-splines in contact with the atrial wall; and the other designed to produce horizontal linear lesions by revolving within the atrium. Together these would form longitude and latitude grids in the atrium. 2) The second catheter type was 2 versions of coil electrodes with thermocouples centered under each of the large-area coil electrodes. One version of these deflectable coil electrodes was intended to produce lesions in the tricuspid valve annulus-inferior vena cava (IVC) isthmus; and along the crista terminalis from the superior vena cava (SVC) to the IVC. A different type of deflection angulation on the second version was intended to produce more horizontal lesions from the crista to the tricuspid annulus. Guidance was fluoroscopic, and by electrograms and transesophageal echo. Gross pathologic examinations followed each experiment. Prior to use in canines, all electrode configurations were tested in vitro on fresh bovine preparations suspended in saline at 37[emsp4 ]°C. Results: The bare spline and coil electrode catheter configurations produced discrete non-perforating non-charring lesions in the in vitro preparations. One dog died of exsanginating hemorrhage. Post mortem examination revealed the lesions to be extremely variable, ranging from no evidence of effective RF delivery to deep lesions with perforation. Seven clinical successes were achieved (6 complete), with the coil electrode catheters accounting for 5 of the 7, although the procedure times were shorter with the baskets. Critical lesions were those from the crista to the SVC. Planned trans-isthmus lesions were not done, but may be needed to prevent atrial flutter not seen prior to effective AF ablation. Conclusions: Special basket and coil-electrode catheters may be useful but require refinement. The finding that lesions between the crista terminalis and the SVC were critical to success may be applicable to some cases of AF in humans.     

Management and survival of patients admitted with an exacerbation of COPD: comparison of two Danish patient cohorts

Introduction: The aim of this study was to describe the management and prognosis related to a hospital admission for acute exacerbation of chronic obstructive pulmonary disease and to compare results to an earlier study. Objectives and Methods: This is a retrospective study of 300 consecutively discharged patients admitted in 2006–2007 with an exacerbation of chronic obstructive pulmonary disease from three respiratory departments. Data were collected from patient charts and compared with a replicate study done in 2001. Results: The mean age was 72.1 years; 61.7% were women. Mean forced expiratory volume in 1 s was 37.6% of predicted. On admission, 11.3% were treated with non‐invasive ventilation, and 84.3% were given systemic corticosteroids. In‐hospital mortality was 4.7%. At discharge, treatment with inhaled corticosteroids or at least one long‐acting bronchodilator was given to 86.7% and 89% of patients, respectively, which was significantly higher than for similarly sampled patients in 2001. Mortality in 30 days and 1 year after discharge was 4.5% and 25.5%, respectively, compared with 5.5% and 30.3% in 2001, the 12‐month mortality being significantly lower (P = 0.03). Readmission rate in the 12 months following discharge was 42.3%. Long‐term oxygen treatment, treatment with anti‐dysrhythmic drugs and lack of outpatient follow‐up were independent predictors of 1‐year mortality. Risk of readmission was increased with dependence in self‐care activities, previous admissions and treatment with strong analgesics. Conclusions: Over a period of 6 years, a significantly higher number of patients are being treated according to guidelines. Survival following discharge increased over the same period. Please cite this paper as: Eriksen N and Vestbo J. Management and survival of patients admitted with an exacerbation of COPD: comparison of two Danish patient cohorts. The Clinical Respiratory Journal 2010; 4: 208–214.     

Segmental hypersensitivity and spinothalamic function in spinal cord injury pain

The mechanisms underlying central pain following spinal cord injury (SCI) are unsettled. The purpose of the present study was to examine differences in spinothalamic tract function below injury level and evoked pain in incomplete SCI patients with neuropathic pain below injury level (central pain) versus those without such pain. A clinical examination, quantitative sensory testing and magnetic resonance imaging (MRI) were performed in 10 SCI patients with below-level pain and in 11 SCI patients without neuropathic pain. Patients with and without pain had similar reductions of mechanical and thermal detection thresholds below injury level. SCI patients with central pain had sensory hypersensitivity in dermatomes corresponding to the lesion level more frequently than SCI patients without pain, but this may in part be explained by the exclusion of at-level spontaneous pain in the pain-free group. The rostral-caudal extent of the lesion measured by MRI did not differ between the two patient groups, and there were no statistically significant differences in any of the predefined areas of interest on the axial plane images. This study suggests that neuronal hyperexcitability plays a key role in central SCI pain and furthermore - in contrast to previous findings - that loss of spinothalamic functions does not appear to be a predictor for central neuropathic pain in spinal cord injury.