Lack of influence of body mass index on the efficacy of the ketogenic diet

The ketogenic diet is carefully calculated by dietitians in an effort to achieve the child's ideal body weight, theoretically to improve seizure control. This study researched whether achieving a stable body mass index or ideal body mass index-for-age correlates with efficacy with the traditional ketogenic diet. The outcomes of 123 children started on the ketogenic diet were analyzed at clinic visits 3, 6, 9, and 12 months after diet onset. Children who were at 40% to 59% body mass index-for-age did not have higher efficacy than those at a higher or lower body mass index-for-age, except at the 12-month clinic visit (81% versus 48%; P = .02). No clear link was demonstrated between either an ideal body mass index or changes in the body mass index and seizure control in the management of children receiving a ketogenic diet. Attributing changes in seizure control to a rapid weight gain or loss may be unjustified.     

Impact of Women’s Experiences During Mammography on Adherence to Rescreening (United States)

Objective To examine the relationship between womens’ experiences during mammography and their likelihood of being rescreened after receiving a negative or benign mammogram. Methods Telephone interview and medical record data were collected from a random sample of enrollees from four states in a national screening program targeting uninsured and underinsured women at least 30 months after they had undergone an index mammogram in 1997. We calculated 30-month rescreening rates by prior mammography characteristics including pain and embarrassment, worry, convenience of appointment time, treatment by staff, and financial considerations. Results Of the 2,000 women in the sampling frame, 1,895 (93.6%) were located, 1,685 (88.6%) were interviewed and 1,680 provided data required for our analysis. Overall, 81.5% of the women had undergone rescreening. More than 90% of the women reported being ‘satisfied’ or ‘very satisfied’ with treatment by facility staff, facility location and wait time during the appointment. Statistically significant decreased rescreening rates were seen for women who reported feeling embarrassed and for women reporting dissatisfaction with ability to schedule a convenient appointment time. Conclusion These results suggest that providing additional reassurance and privacy may increase rescreening rates. The findings and conclusions in this report are those of the authors and do not necessarily represent the views of the Centers for Disease Control and Prevention.     

Electrical impedance scanning for the early detection of breast cancer in young women: preliminary results of a multicenter prospective clinical trial.

PURPOSE: To evaluate the feasibility and patient satisfaction with electrical impedance scanning (EIS) for early detection of breast cancer in young women. METHODS: Women undergoing screening clinical breast examination, imaging, or biopsy were eligible for EIS examination with T-Scan 2000ED (Mirabel Medical Systems, Austin, TX). Multiple logistic regression analysis evaluated the association between clinical variables and EIS performance. Patients completed a screening EIS satisfaction questionnaire (1 = least satisfied to 5 = most satisfied). RESULTS: Twenty-nine cancers were identified among 1,103 women. Sixty-six percent (19 of 29) of cancers were nonpalpable and 55% (16 of 29) were in women age < or = 50 years. EIS sensitivity and specificity in women younger than 40 years was 50% and 90%, respectively. Exogenous estrogen use (P < .001) and menopausal status (P = .007) correlated significantly with EIS performance. False-positive rates were increased in postmenopausal women and those taking exogenous hormones. No correlation was evident between EIS performance and family history, prior breast cancer, breast density, or palpability. EIS-positive women younger than age 40 were 4.5 times more likely to have breast carcinoma than were women randomly selected from the general population. Patients were highly satisfied with the comfort, speed, and reporting of EIS screening (mean score, 4.8). CONCLUSION: EIS seems promising for early detection of breast cancer, and identification of young women at increased risk for having the disease at time of screening. Positive EIS-associated breast cancer risk compares favorably with relative risks of conditions commonly used to justify early breast cancer screening. Patients are satisfied with a screening paradigm involving breast EIS.     

Asymmetric crying facies and associated congenital anomalies: prospective study and review of the literature

Congenital asymmetric crying facies, a minor congenital anomaly due to absence or hypoplasia of the depressor anguli oris muscle on one side of the mouth, is associated at times with major congenital anomalies, most commonly in the cardiovascular system. In a prospective study of 5532 infants born at the Assaf Harofeh Medical Center, Israel, during 12 months (January to December 1998), 17 infants (an incidence of 0.31%) had asymmetric crying facies. One of the affected infants had ventricular septal defect and another infant had VATER (vertebral defects, imperforate anus, tracheoesophageal fistula, and radial and renal dysplasia) syndrome. No noxious obstetric perinatal factors could be identified. Family history was unremarkable in all cases. Diagnostic work-up performed in all of the affected infants failed to reveal an additional congenital malformation. Asymmetric crying facies is a minor isolated finding in most of the cases; however, a thorough search for other congenital malformations, especially of the cardiovascular system, should be performed.     

Repressive coping style,acute stress disorder,and posttraumatic stress disorder after myocardial infarction

OBJECTIVE: The study examined the associations between repressive coping style, acute stress disorder (ASD) and subsequent posttraumatic stress disorder (PTSD) after myocardial infarction (MI) to ascertain the efficacy of repressive coping style in immediate and long-term adjustment to stress. METHODS: A total of 116 MI patients were examined twice: within a week of their MI (time 1) and 7 months later (time 2). At time 1, repressive coping style, perceived threat, and ASD were measured by self-report questionnaires. In addition, medical measures indicative of the severity of the MI were obtained from patients' hospital records. At time 2, PTSD was assessed. The distribution of the repressive coping style was compared with that of 72 matched control subjects. RESULTS: Findings revealed the adaptiveness of repressive coping style both in the immediate and longer-term aftermath of MI: repressors endorsed less ASD and PTSD than nonrepressors. In addition, the contribution of repressive coping style to PTSD was unique and beyond the implications of severity of MI, perceived threat, and immediate ASD. CONCLUSIONS: The findings support the role of repressive coping style as a stress-buffer; several mechanisms that explain this role are suggested.     

The role of parental negative world assumptions in the intergenerational transmission of war trauma

Social Psychiatry and Psychiatric Epidemiology - Among the most prevalent and adverse sequalae of traumatic experiences are negative world assumptions (WAs), which describe trauma-related negative...     

Negative psychometric outcomes: Self-report measures and a follow-up telephone survey

To assess the effectiveness of the Koach project, two groups of subjects, comprising the 40 Koach participants and 40 PTSD veterans who served as controls, were examined 1 year before Koach and 9 months afterwards. In addition, the Koach participants were also assessed immediately before and immediately following the project. The self-report measures focused on PTSD symptomatology, post-traumatic intrusion and avoidance, general psychiatric symptomatology, social functioning and perceived self-efficacy in combat. Participation in Koach led to improvement in one area only: perceived self-efficacy in combat. The measures of emotional distress and psychiatric symptomatology indicated that patients treated in Koach fared worse than untreated PTSD controls. In addition, in order to assess the long-term impact of the program, 36 Koach participants were surveyed by phone approximately 2 years after the residential stage of the project. Military functioning, family life, work, and psychiatric symptomatology were assessed. Findings indicate that most of the participants had not returned to their prewar level of functioning.     

Vitiligo,Rheumatoid Arthritis and Pernicious Anemia

A patient with a 46-year history of vitiligo who also presented rheumatoid arthritis and pernicious anemia is described. Meticulous physical examination excluded further systemic or cutaneous involvement. The immunological workup revealed a low CD₄ cell percentage with T cells mostly composed of CD₈ cells, a discrepancy between the high percentage of cumulative CD₄ + CD₈ cells and the measured CD₃ proportions, very low NK cytotoxicity toward K₅₆₂ cells, and almost negligible responses to PHA, Con A and PWM mitogens. The results point to severe T and NK cell functional defects. The pathogenetic significance of these data is discussed.     

Posttraumatic stress symptoms and fear of intimacy among treated and non-treated survivors who were children during the Holocaust

BACKGROUND: This study examines the longterm consequences of the Holocaust on child survivors as implicated in PTSD residues and fears of intimacy. METHOD: Participants were 43 Holocaust child survivors who received psychotherapy, 48 participants who also went through the Holocaust as children, but did not receive psychotherapy, and 43 Israeli-born participants who did not directly experience the Holocaust. Data regarding PTSD, fear of intimacy, and exposure-related variables were gathered via standardized self-report questionnaires. RESULTS: The findings show that both treated and non-treated survivors reported significantly higher levels of post-traumatic residues than the non-Holocaust controls, while the treated survivors reported higher levels than the non-treated ones. Treated survivors also differed from the other two groups in their levels of fear of intimacy. In addition, survivors who had been in concentration camps reported significantly more PTSD symptoms than survivors who had been in hiding. Two alternative interpretations are offered. No differences were found in the fear of intimacy of those who survived in the different settings. CONCLUSIONS: The findings point to the long-lasting impact of the Holocaust experience on child survivors, although they also demonstrate wide variability in survivors' long-term adjustment that should be further explored.