The Impact of Posttraumatic Stress Disorder on Blood Pressure and Heart Rate in a Veteran Population

Hyperarousal is a hallmark of posttraumatic stress disorder (PTSD). PTSD has been associated with increased blood pressure (BP) and heart rate (HR) in veteran populations. We retrospectively identified male patients consulted to outpatient psychiatry at the Iowa City Veterans Affairs Healthcare System. Patients were divided into PTSD (n = 88) and non‐PTSD (n = 98) groups. All PTSD patients and a subset of non‐PTSD patients had documented blast exposure during service. The study investigated whether patients with PTSD had higher systolic blood pressure (SBP), diastolic blood pressure (DBP), and heart rate (HR) than patients without PTSD. The effect of trauma exposure on BP was also examined. Mean SBP (133.8 vs. 122.3 mm Hg; p < .001), DBP (87.6 vs. 78.6 mm Hg; p < .001), and HR (78.9 vs. 73.1 bpm; p < .001) were all significantly higher in the PTSD group. Trauma‐exposed patients without PTSD had significantly higher BP than nonexposed patients. The prevalence of hypertension (HTN) was 34.1% (diagnosed and undiagnosed) among PTSD patients. Patients with PTSD had higher BP and HR compared to patients without PTSD. Trauma exposure may increase BP in this population. These findings will increase awareness about the cardiovascular implications of PTSD.     

Donor Factors Predicting Recipient Survival After Liver Retransplantation: The Retransplant Donor Risk Index

The use of extended criteria liver donors (ECD) is controversial, especially in the setting of retransplantation. The aims of this study are to investigate the effects of ECD grafts on retransplantation and to develop a predictive mortality index in liver retransplantation based on the previously established donor risk index. The United Network for Organ Sharing (UNOS) liver transplant dataset was analyzed for all adult, non-status 1, liver retransplantations occurring in the United States since February 2002. All donors were categorized for multiple characteristics of ECD, and using multivariate survival models a retransplant donor risk index (ReTxDRI) was developed. A total of 1327 retransplants were analyzed. There were 611 (46%) recipients who received livers with at least one ECD criterion. The use of ECD grafts in recipients with HCV did not incur worse survival than the non-ECD grafts. The addition of the cause of recipient graft failure to the donor risk index formed the ReTxDRI. After adjusting for multiple recipient factors, the ReTxDRI was predictive of overall recipient survival and was a strongly independent predictor of death after retransplantation (HR 2.49, 95% CI 1.89–3.27, p < 0.0001). The use of the ReTxDRI can improve recipient and donor matching and help to optimize posttransplant survival in liver retransplantation.     

Voluntary ingestion of wood shavings by obese horses under dietary restriction

Dietary restriction for the weight-loss management of obese horses limits the natural trickle-feeding behaviour. During feed restriction, wood shavings are often advised as bedding to prevent dietary supplementation from non-feed sources. Data from twelve overweight/obese horses and ponies of mixed breed and sex, bedded on wood shavings during 16 weeks of feed restriction, were retrospectively evaluated. DM intake (DMI) was restricted to 1.25 % of body mass (BM) daily. Animals were randomly assigned to one of two diets (hay/chaff, n 6; hay/balancer meal, n 6). BM was recorded weekly. Feeding behaviour was recorded by continual observation over 24 h during week 15. The apparent digestibility (gross energy (GE), acid-detergent fibre (ADF) and DM) of feed was determined for all animals by total faecal collection (72 h, week 16). Rates of weight loss were independent of diet type, DM (R(2) 0.15), GE (R(2) 0.20) and ADF digestibilities (R(2) 0.18). Despite similar DMI, faecal DM ranged between 0.52 and 1.16 % of BM daily and was associated with wide ranges in apparent digestibility (GE--11.34 to 53.08 %; ADF--50.37 to 42.83 % and DM 2.14 to 57.32 %), which were improbably low for some animals. Apparent digestibilities were associated with DM output (GE R2 0.96; ADF R(2) 0.99 and DM R(2) 0.99) and time spent feeding (GE R(2) 0.62; DM R(2) 0.61 and ADF R(2) 0.59), indicating that feed intake was supplemented with wood shavings in at least five of the twelve animals. Quantities of wood shavings ingested (negligible to >3.0 kg/d) were back-calculated from predicted feed digestibilities. All animals remained healthy. Implications of 'feed-bulking/energy dilution' for feed-restricted animals need further consideration.     

Liver allografts from hepatitis C positive donors can offer good outcomes in hepatitis C positive recipients: a US National Transplant Registry analysis

Organ donors are screened for the hepatitis C antibody (anti‐HCV) and those with positive tests can be used under extended criteria donation. However, there is still a question of long‐term organ viability. The aim of this study was to assess the long‐term outcomes of anti‐HCV positive (HCV+) liver grafts. The US Organ Procurement and Transplantation Network Scientific Registry was reviewed for the period from April 1994 to February 6, 2008 and 56 275 liver transplantations were analyzed. In total, there were 19 496 HCV+ recipients and 934 HCV+ donors. Patient and graft survival were assessed accounting for both donor and recipient anti‐HCV status. Multivariable proportional hazards survival models were developed to adjust for factors known to affect post‐transplant survival. With anti‐HCV negative (HCV?) recipient/HCV? donor as the reference, the adjusted hazard ratio for death was similar for HCV+ recipient/HCV? donor compared with HCV+ recipient/HCV+ donor (1.176 vs. 1.165, P = 0.91). Our results suggest that HCV+ liver donors do not subject the HCV+ recipient to an increased risk for death over the HCV? donor, keeping in mind that careful donor and recipient selection is critical for the proper use of these extended criteria donors.     

Do Pedometers Increase Physical Activity in Sedentary Older Women? A Randomized Controlled Trial

OBJECTIVES: To determine the effectiveness of a behavior change intervention (BCI) with or without a pedometer in increasing physical activity in sedentary older women. DESIGN: Prospective randomized controlled trial. SETTING: Primary care, City of Dundee, Scotland. PARTICIPANTS: Two hundred four sedentary women aged 70 and older. INTERVENTIONS: Six months of BCI, BCI plus pedometer (pedometer plus), or usual care. MEASUREMENTS: Primary outcome: change in daily activity counts measured by accelerometry. Secondary outcomes: Short Physical Performance Battery, health‐related quality of life, depression and anxiety, falls, and National Health Service resource use. RESULTS: One hundred seventy‐nine of 204 (88%) women completed the 6‐month trial. Withdrawals were highest from the BCI group (15/68) followed by the pedometer plus group (8/68) and then the control group (2/64). After adjustment for baseline differences, accelerometry counts increased significantly more in the BCI group at 3 months than in the control group (P=.002) and the pedometer plus group (P=.04). By 6 months, accelerometry counts in both intervention groups had fallen to levels that were no longer statistically significantly different from baseline. There were no significant changes in the secondary outcomes. CONCLUSION: The BCI was effective in objectively increasing physical activity in sedentary older women. Provision of a pedometer yielded no additional benefit in physical activity, but may have motivated participants to remain in the trial. Trial registration: ISRCTN26786857     

Distribution and determinants of house dust mite allergens in Europe: the European Community Respiratory Health Survey II

BACKGROUND: Several studies in European homes have described allergen levels from the house dust mite species Dermatophagoides pteronyssinus and to a lesser extent Dermatophagoides farinae, but geographic comparisons of exposure levels and risk factors have been hampered by a lack of standardized methods. OBJECTIVE: To study the distribution and determinants of the major house dust mite allergens Der p 1 and Der f 1 in 10 European countries using a common protocol. METHODS: During home visits with 3580 participants of the European Community Respiratory Health Survey II from 22 study centers, mattress dust was sampled and analyzed for Der p 1, Der f 1, and Der 2 allergen. Information on housing characteristics was obtained by both observations and interview. RESULTS: Der 1 and Der 2 allergens were detectable (>/=0.1 mug/g) in 68% and 53% of the samples, respectively. Large differences in allergen levels between study centers were observed, and geographic patterns for Der p 1 and Der f 1 were different. Low winter temperatures reduced Der p 1 rather than Der f 1. Important risk factors for high allergen levels included an older mattress, a lower floor level of the bedroom, limited ventilation of the bedroom, and dampness for Der p 1 but not for Der f 1. CONCLUSION: There are large qualitative and quantitative differences of house dust mite allergen levels in Europe, which can partly be explained by geographic and housing characteristics. CLINICAL IMPLICATIONS: Mite allergen exposure may be reduced by replacing the mattress regularly and increasing ventilation of the bedroom, particularly in winter.