Panic and avoidance in panic disorder with agoraphobia: clinical relevance of change in different aspects of the disorder

Different aspects of change were examined in 62 patients who fulfilled the DSM-IV criteria for a primary diagnosis of panic disorder with agoraphobia of moderate to severe magnitude, and who were treated with 16 sessions of behavioral therapy. The treatment resulted in substantial effects on panic attacks and agoraphobic avoidance. Panic-free status only differentiated the patients regarding mood at pre- and post-treatment. Changes in panic and avoidance were related to each other, but change in avoidance was more related to change in negative affect. Change in quality of life (QOL) was also more associated with change in avoidance at post-treatment. At follow-up change in QOL was more related to change in panic than change in avoidance.     

Circadian clock-related polymorphisms in seasonal affective disorder and their relevance to diurnal preference.

Disturbed circadian rhythms have been observed in seasonal affective disorder (SAD). The aim of this study was to further investigate this connection, and to test for potential association between polymorphisms in circadian clock-related genes and SAD, seasonality (seasonal variations in mood and behavior), or diurnal preference (morningness-eveningness tendencies). A total of 159 European SAD patients and 159 matched controls were included in the genetic analysis, and subsets were screened for seasonality (n=177) and diurnal preference (n=92). We found that diurnal preference was associated with both SAD and seasonality, supporting the hypothesis of a link between circadian rhythms and seasonal depression. The complete case-control material was genotyped for polymorphisms in the CLOCK, Period2, Period3, and NPAS2 genes. A significant difference between patients and controls was found for NPAS2 471 Leu/Ser (chi(2)=9.90, Bonferroni corrected P=0.035), indicating a recessive effect of the leucine allele on disease susceptibility (chi(2)=6.61, Bonferroni corrected P=0.050). Period3 647 Val/Gly was associated with self-reported morningness-eveningness scores (n=92, one-way ANOVA: F=4.99, Bonferroni corrected P=0.044), with higher scores found in individuals with at least one glycine allele (t=3.1, Bonferroni corrected P=0.013). A second, population-based sample of individuals selected for high (n=127) or low (n=98) degrees of seasonality, was also genotyped for NPAS2 471 Leu/Ser. There was no significant difference between these seasonality extreme groups, and none of the polymorphisms studied were associated with seasonality in the SAD case-control material (n=177). In conclusion, our results suggest involvement of circadian clock-related polymorphisms both in susceptibility to SAD and diurnal preference.     

Traffic-Related Air Pollution and Dementia Incidence in Northern Sweden: A Longitudinal Study

Background

Exposure to ambient air pollution is suspected to cause cognitive effects, but a prospective cohort is needed to study exposure to air pollution at the home address and the incidence of dementia.

Objectives

We aimed to assess the association between long-term exposure to traffic-related air pollution and dementia incidence in a major city in northern Sweden.

Methods

Data on dementia incidence over a 15-year period were obtained from the longitudinal Betula study. Traffic air pollution exposure was assessed using a land-use regression model with a spatial resolution of 50 m × 50 m. Annual mean nitrogen oxide levels at the residential address of the participants at baseline (the start of follow-up) were used as markers for long-term exposure to air pollution.

Results

Out of 1,806 participants at baseline, 191 were diagnosed with Alzheimer’s disease during follow-up, and 111 were diagnosed with vascular dementia. Participants in the group with the highest exposure were more likely than those in the group with the lowest exposure to be diagnosed with dementia (Alzheimer’s disease or vascular dementia), with a hazard ratio (HR) of 1.43 (95% CI: 0.998, 2.05 for the highest vs. the lowest quartile). The estimates were similar for Alzheimer’s disease (HR 1.38) and vascular dementia (HR 1.47). The HR for dementia associated with the third quartile versus the lowest quartile was 1.48 (95% CI: 1.03, 2.11). A subanalysis that excluded a younger sample that had been retested after only 5 years of follow-up suggested stronger associations with exposure than were present in the full cohort (HR = 1.71; 95% CI: 1.08, 2.73 for the highest vs. the lowest quartile).

Conclusions

If the associations we observed are causal, then air pollution from traffic might be an important risk factor for vascular dementia and Alzheimer’s disease.

Citation

Oudin A, Forsberg B, Nordin Adolfsson A, Lind N, Modig L, Nordin M, Nordin S, Adolfsson R, Nilsson LG. 2016. Traffic-related air pollution and dementia incidence in northern Sweden: a longitudinal study. Environ Health Perspect 124:306–312; http://dx.doi.org/10.1289/ehp.1408322     

The Linköping experience--ups and downs

This is a brief single-centre report of experiences regarding different prophylactic measures against sternal wound infection during a period of about 10 years. It illustrates the difficulties associated with evaluating the effect of specific prophylactic methods in the clinical situation. Possible explanations for perceived shifts in the rate of wound infections are discussed.     

Colonic perforation in collagenous colitis: an unusual complication

Collagenous colitis is generally regarded as a benign disease with few serious complications. We report two women with collagenous colitis who presented with colonic perforation, one spontaneously and one 7 days after a barium enema, and a review of the literature. Including the present cases, 13 patients with collagenous colitis and colonic perforation have been reported, in two patients spontaneously and in 11 patients after a colonoscopy or barium enema. All were operated on except one patient who recovered after medical treatment. The pathogenesis of this complication is unknown. We propose that there might be a connection between mucosal tears and colonic perforation in collagenous colitis.     

Quality improvement in primary health care using computerised journal,exemplified by a smoking cessation programme for diabetic patients

Objective. To explore decision-making on treatment with antidepressants among doctors and nurses in nursing homes. Design and subjects. A qualitative study based on interviews with three focus groups comprising eight physicians engaged full time, eight physicians engaged part time, and eight registered nurses, respectively. The interview guide comprised questions on initiating, evaluating, and withdrawing treatment with antidepressants. The interviews were audio-recorded, transcribed, and analysed by systematic text condensation. Results. The first theme was the diagnostic process. The informants expressed difficulty in differentiating between depression and sorrow resulting from loss in old age. Further, the doctors reported that they relied on nurses’ observations and rarely carried out systematic diagnostic work and follow-up of patients with depression. The second theme was treatment. Antidepressants were usually the only type of treatment provided, and patients were kept on medication even though staff felt uncertain whether this was effective. The third theme was who really determines the treatment. Registered nurses reported that unskilled and auxiliary nursing staff requested drug treatment, and doctors felt some pressure from the nurses to prescribe antidepressants. Conclusions. This study suggests that the quality of diagnosis and treatment for depression in nursing homes needs to be improved in Norway. Doctors should be more available and take responsibility and leadership in medical decisions.     

A non-invasive measure of changes in blood flow in the human anterior tibial muscle

We used photoplethysmography (PPG) to monitor blood flow changes in the human anterior tibial muscle during arterial occlusion and during isometric and concentric contractions. Single-fibre laser-Doppler flowmetry (LDF) was used as a reference in 12 healthy subjects (5 men, 7 women; mean age 24 years). Post-exercise hyperaemic muscle blood flow (MBF) was measured immediately after isometric dorsiflexion of the ankle joint at maximal contraction for 1 min and full range-of-motion dorsiflexion and plantar flexion of the ankle joint for 1 min. A thigh tourniquet was applied for the evaluation of post-occlusive reactive hyperaemia. The MBF (baseline=100%) was [mean (SD)] 150 (31)% (P=0.003) by PPG (880 nm) and 182 (66)% (P=0.012) by LDF. After 1 min of maximal isometric contraction, MBF increased to 150 (51)% (P=0.003) by PPG (880 nm) and to 169 (43)% (P=0.005) by LDF. After 1 min of maximal concentric contractions, MBF increased to 158 (59)% (P=0.003) by PPG (880 nm) and to 170 (99)% (P=0.008) by LDF. Skin blood flow, PPG (560 nm), did not change significantly after isometric or concentric contractions. The results indicate that reactive hyperaemia after exercise and arterial occlusion can be assessed in the human anterior tibial muscle using PPG. Electronic Publication     

Interactional effects of pudendal nerve section and social restriction on male rat sexual behavior

Transection of the pudendal nerve causing desensitization of the glans penis impaired the sexual behavior of male rats. Compared to intact males, fewer animals performed intromissions and ejaculations while no decrease in mounting frequency was observed. The total sexual activity as measured by number of mounts and intromissions was decreased and the copulatory efficiency as measured by the ratio of intromissions and total sexual activity was lowered. The impairment of the sexual activity following penile desensitization was more marked in inexperienced rats than in experienced ones. It was concluded that penile stimulation, although not a prerequisite for any specific component of the mating pattern, still is necessary for maintaining the behavior at a normal performance level.     

Elastofibroma

Summary Four cases of elastofibroma located in the subscapular region of 3 men aged 66, 74, and 83 years, and a woman 70 years old are reported. A correlated light and electron microscopic study including ultrastructural examination of Verhoeff's iron-hematoxylin (VIH)-stained sections was performed. Light microscopically, the elastofibromas were characterized by connective tissue built up by collagen fibers and sclerotic masses mingled with numerous fibers and globules of elastin material. In one micron thick Epon sections these elastin fibers often revealed a central axis surrounded by a mantle composed of periodic segments giving them a necklace-like appearance. The ultrastructural findings of these elastin structures, stained with VIH, and the appearance of the stroma cells and their relation to the elastin indicate that elastofibroma is a non-neoplastic reactive lesion in which elastin material is synthesized by the stromal cells and predominantly laid down around preexisting elastic fibers.