Transcultural differences in illness behaviour and clinical outcome: an underestimated aspect of general practice?

BACKGROUND: Our aim was to assess international differences in illness behaviour and clinical outcome for patients in Europe with an episode of acute tonsillitis. METHODS: The subjects were 2423 patients from seven countries whose acute tonsillitis was treated with antibiotics. Each country selected at least 10 GPs who filled in a questionnaire for each episode of acute tonsillitis treated during a 3-month period, November 1989-May 1990. The outcome measure was the number of days of illness. Backwards multiple regression analysis with predictors (age, sex, country, initial temperature, days prior to illness) was performed. RESULTS: The number of days of illness of patients with an episode of acute tonsillitis varied between the European countries, from 3 to 10 days. Country was the most important predictor, whereas disease-specific and patients' characteristics were not important predictors. CONCLUSIONS: Duration of illness was primarily influenced by country. The countries in Eastern Europe especially were characterized by a longer duration of illness. Transcultural differences may influence the duration of illness and need more attention in daily practice.      

Generalized and symptom-specific sensitization of chronic itch and pain

Background Physicians are frequently confronted with patients reporting severe itch and pain. Particularly in patients suffering from persistent itch and pain, central and peripheral sensitization processes are assumed to be involved in the long‐term maintenance and aggravation of the symptoms. The present study explores generalized and symptom‐specific sensitization processes in patients suffering from persistent itch and pain. Specifically, it examines whether patients with chronic itch and pain are more sensitive to somatosensory stimuli (generalized sensitization) and simultaneously perceive somatosensory stimuli as a symptom of their main physical complaint, e.g. pain in chronic pain patients (symptom‐specific sensitization). Methods Thresholds for different mechanical and electrical sensory stimuli of Quantitative Sensory Testing were determined in 15 female patients suffering from chronic itch associated with atopic dermatitis, 15 female chronic pain patients diagnosed with fibromyalgia, and 19 female healthy controls. Intensities of itch and pain sensations were rated on a visual analogue scale. Results As expected, the patient groups had significantly lower tolerance thresholds for the somatosensory stimuli applied than the healthy controls, supporting generalized sensitization. Moreover, patients with chronic itch consistently reported more itch, while patients with chronic pain partly reported more pain in response to analogous somatosensory stimuli than the healthy controls and the other patient group, indicating symptom‐specific sensitization. Conclusion The present study provides preliminary support that both generalized and symptom‐specific sensitization processes play a role in the regulation and processing of somatosensory stimulation of patients with chronic itch and pain.     

Psychopathology of white mentally ill immigrants to Jamaica

Object: To test the hypothesis that white immigrants to a predominantly black country have a different pattern of psychopathology from the native population.Method: The psychopathology (DSM IIIR) of white immigrants to Jamaica seen in the author's private practice between 1979 and 1990 was compared with the psychopathology of a control sample of native Jamaicans matched with the immigrant sample for age, sex, and social class.Results: There was no statistical difference in the major diagnoses mood disoder (35%), anxiety states (27%), and schizophrenia (20%) between the immigrant and control groups. White immigrants to this black country did not develop schizophrenia at higher rates than the native born. White mentally ill immigrants to Jamaica move into social class positions at a significantly higher level (p<0.005) than those of their parents with whom they grew up in their home country. This was significantly different (p<0.005) from their Jamaican controls. Two case studies are presented to illustrate these findings.Conclusions: The political/economic situation which exists in black postcolonial countries like Jamaica provides a protective social environment for white immigrants, which buffers them from the etiological conditions that engender schizophrenia in immigrants to other countries with predominantly white populations.     

Malnutrition is independently associated with skin tears in hospital inpatient setting—Findings of a 6‐year point prevalence audit

Skin tears cause pain, increased length of stay, increased costs, and reduced quality of life. Minimal research reports the association between skin tears, and malnutrition using robust measures of nutritional status. This study aimed to articulate the association between malnutrition and skin tears in hospital inpatients using a yearly point prevalence of inpatients included in the Queensland Patient Safety Bedside Audit, malnutrition audits and skin tear audits conducted at a metropolitan tertiary hospital between 2010 and 2015. Patients were excluded if admitted to mental health wards or were <18 years. A total of 2197 inpatients were included, with a median age of 71 years. The overall prevalence of skin tears was 8.1%. Malnutrition prevalence was 33.5%. Univariate analysis demonstrated associations between age (P ˂ .001), body mass index (BMI) (P < .001) and malnutrition (P ˂ .001) but not gender (P = .319). Binomial logistic regression analysis modelling demonstrated that malnutrition diagnosed using the Subjective Global Assessment was independently associated with skin tear incidence (odds ratio, OR: 1.63; 95% confidence interval, CI: 1.13‐2.36) and multiple skin tears (OR 2.48 [95% CI 1.37‐4.50]). BMI was not independently associated with skin tears or multiple skin tears. This study demonstrated independent associations between malnutrition and skin tear prevalence and multiple skin tears. It also demonstrated the limitations of BMI as a nutritional assessment measure.     

A prospective randomised trial comparing individualised pharmacokinetic dosage prediction for aminoglycosides with prediction based on estimated creatinine clearance in critically ill patients

A prospective randomised trial was conducted in critically ill patients to evaluate a computer aided pharmacokinetic method of aminoglycoside dose prediction based on 3 measured plasma concentrations following the loading dose. The ability of this method to achieve therapeutic plasma aminoglycoside concentrations early in the course of treatment was compared with that of a nomogram approach based on creatinine clearance estimated using the formula of Cock-roft and Gault. Ninety-two percent of patients in the computer group achieved peak plasma concentrations within the optimum range of 6–10 mg/l at 48–72 h compared with 21% of control group patients (p=0.0009). The mean peak plasma concentration of 7.45 mg/l at 48–72 h in the computer group was closer to the target concentration of 8 mg/l than was the 5.14 mg/l in the control group (p=0.0004). There was no significant difference between the groups in measured indices of renal function, both groups showing an improvement in mean estimated creatinine clearance from the beginning to the end of the course of treatment. Dosing based on individualised pharmacokinetic data is therefore a more reliable method of achieving therapeutic blood concentrations early in the course of treatment than is nomogram based dosing. Other studies suggest that this should be associated with a reduction in mortality in severe infections.     

Reinterpreting the pressure-volume curve in patients with acute respiratory distress syndrome

New evidence requires a reinterpretation of the inflation pressure-volume curve and suggests that neither the lower nor the upper inflection point provides reliable information to determine safe ventilator settings in the acute respiratory distress syndrome. Recruitment probably continues throughout the inflation pressure-volume curve, and studies of the deflation pressure-volume curve, reinflations after partial deflation, or decremental positive end-expiratory pressure trials after a recruitment maneuver are probably needed to determine open-lung positive end-expiratory pressure.     

JAK2 is associated with the c-kit proto-oncogene product and is phosphorylated in response to stem cell factor

Stem cell factor (SCF) is a hematopoietic growth factor that interacts with the receptor tyrosine kinase, c-kit. We have found that SCF- stimulates rapid and transient tyrosine phosphorylation of JAK2 in human and murine cell lines, as well as in normal human progenitor cells. JAK2 and c-kit were associated in unstimulated cells with further recruitment of JAK2 to the c-kit receptor complex after SCF stimulation. Treatment of cells with JAK2 antisense oligonucleotides resulted in a 46% decrease in SCF-induced proliferation. These data demonstrate that SCF induces tyrosine phosphorylation of JAK2 and suggest that JAK2 is a component of the SCF signal transduction pathway.