Respiratory consultations in asthmatic compared with non-asthmatic children in general practice.

In a retrospective study we found that before a diagnosis of asthma had been made children with asthma had consulted their general practitioner more often with respiratory symptoms than children who were non-asthmatic under the age of four. In the second, third, and fourth years the number of consultations differed significantly between the two groups. Asthma should be suspected in any child who presents often with respiratory symptoms. This should lead to earlier diagnosis in most cases.     

Promoting Sleep in Shiftworkers and Inter Continental Travelers

A number of techniques and treatments can be used to alleviate the sleep disturbance associated with both shiftwork and transmeridian travel. Optimization of the sleeping environment and avoidance of substances such as caffeine and alcohol before sleep are the best initial approach. Timing sleep to coincide with some of the normal sleep period where possible will improve sleep quality in shiftworkers. Similarly, following transmeridian flight, restricting sleep to the nocturnal period in the new time zone will assist adaptation. Hypnotic drugs may be of benefit to alleviate sleep disturbance experienced by shiftworkers or transmeridian travelers. Selection of the most appropriate medication must take into account required duration of action and possible residual effects of the drug on alertness. Hypnotics may be useful, particularly in middle-aged individuals who already have disturbed sleep, on those occasions when poor sleep is anticipated, for example following an eastward flight or after the initial change to night duty. Over-the-counter preparations should be avoided whenever possible unless it is known that they are not associated with residual sequelae. (Chronobiology International, 14(2), 133–143, 1997)     

Antibiotic anaphylaxis

Pulmonary cancer when localized to the lung, is curable by operation. Tumors found by routine x-ray examination before they cause symptoms are much more often confined to the lung and as such are curable. Unlike other internal growths which are more hidden, lung tumors can often be seen early on x-ray films of the chest.X-ray films of the chest were made routinely on all patients entering a hospital, regardless of the nature of their illness. In all, some 40,000 films were made. Sixty patients were found to have unsuspected solitary lesions in the lung. Twenty-four of the lesions were diagnosed and treated by operation and removal. Twelve were diagnosed by other methods. Of the 36, eight were cancer of the lung, an incidence of 22 per cent. There were also 14 localized tuberculous nodules which are best treated by removal. Since early cancer is surgically curable, it is felt that everyone over the age of 40 should have a routine x-ray examination of the chest every six months. Solitary lesions of the lung found should be excised for diagnosis.     

A comparison of lifelong and posttrauma nightmares in a civilian trauma sample: Nightmare characteristics, psychopathology, and treatment outcome.

Nightmares and sleep disturbances are thought to play a key role in the development of posttrauma problems. Research efforts have increased in an attempt to understand this association. The present study examined differences in nightmare characteristics, related psychopathology, treatment outcome, and trauma history among trauma-exposed individuals whose nightmares began before a traumatic event and those whose nightmares began after a traumatic event, while controlling for posttraumatic stress disorder status. Individuals whose nightmares began following a trauma experienced more depression and posttraumatic stress symptoms and poorer sleep quality, reported a higher number of traumatic events, and were more likely to report nightmares replicative of or similar to the trauma than those whose nightmares began before the trauma. No other between-groups differences were found for nightmare characteristics or response to treatment. This study is an important step in understanding the nature of nightmares and their relationship to traumatic events and consequences, but additional research is warranted. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Vasotocin, melatonin and narcolepsy: Possible involvement of the pineal gland in its patho-physiological mechanism

Both the pineal nonapeptide hormone arginine vasotocin (AVT) (2.5 μg) administered intra-nasally and the pineal indole melatonin (50 mg) administered intravenously to three male narcoleptics (two with auxiliary symptoms and one with sleep attacks only), dramatically increased the amount of REM sleep and decreased REM sleep latency. The duration of the sleep onset REM periods in the two narcoleptics with auxiliary symptoms increased by more than 100 percent after AVT and melatonin administration. In the narcoleptic with sleep attacks only both AVT and melatonin induced REM periods at sleep onset. The hypothesis is advanced that narcolepsy represents an impairment of the melatonin-AVT control in the induction and circadian organization of REM sleep associated with an immaturity of REM triggering centers.     

Vasotocin, melatonin and narcolepsy: Possible involvement of the pineal gland in its patho-physiological mechanism

Both the pineal nonapeptide hormone arginine vasotocin (AVT) (2.5 μg) administered intra-nasally and the pineal indole melatonin (50 mg) administered intravenously to three male narcoleptics (two with auxiliary symptoms and one with sleep attacks only), dramatically increased the amount of REM sleep and decreased REM sleep latency. The duration of the sleep onset REM periods in the two narcoleptics with auxiliary symptoms increased by more than 100 percent after AVT and melatonin administration. In the narcoleptic with sleep attacks only both AVT and melatonin induced REM periods at sleep onset. The hypothesis is advanced that narcolepsy represents an impairment of the melatonin-AVT control in the induction and circadian organization of REM sleep associated with an immaturity of REM triggering centers.     

<Emphasis Type="Italic">Khyâl</Emphasis> Attacks: A Key Idiom of Distress Among Traumatized Cambodia Refugees

Traumatized Cambodian refugees with PTSD often complain of khyal attacks. The current study investigates khyal attacks from multiple perspectives and examines the validity of a model of how khyal attacks are generated. The study found that khyal attacks had commonly been experienced in the previous 4 weeks and that their severity was strongly correlated with the severity of PTSD (PTSD Checklist). It was found that khyal attacks were triggered by various processes—such as worry, trauma recall, standing up, going to a mall—and that khyal attacks almost always met panic attack criteria. It was also found that during a khyal attack there was great fear that death might occur from bodily dysfunction. It was likewise found that a complex nosology of khyal attacks exists that rates the attacks on a scale of severity, that the severity determines how the khyal attacks should be treated and that those treatments are often complex. As illustrated by the article, khyal attacks constitute a key aspect of trauma ontology in this group, a culturally specific experiencing of anxiety and trauma-related disorder. The article also contributes to the study of trauma somatics, that is, to the study of how trauma results in specific symptoms in a specific cultural context, showing that a key part of the trauma-somatic reticulum is often a cultural syndrome.     

Sleep Epilepsy: Its Pattern and Prognosis

In a series of 645 patients with epilepsy only 38 had attacks exclusively during sleep. A further 111 had attacks while waking and sleeping. The total number of patients whose epilepsy started with sleep attacks and who later developed attacks when waking increased with each successive year. The prognosis of sleep epilepsy is important in relation to the granting of driving licences.     

Circadian Reactions to nCPAP Treatment

To determine possible effects of apnea attacks on the spontaneous behavior of the circadian system (body temperature, sleeping behavior, vigilance), 11 patients with obstructive sleep apnea (OSA) were observed before therapy over a 24h period under a special constant routine (bed-rest study) and again during therapy with nCPAP (nasal continuous positive airway pressure). Clinical indicators (polysomnographical, subjective sleep quality, etc.) indicated successful therapy. During the bed-rest study with nCPAP therapy, the 24h amplitude of core temperature was found to be greater than the amplitude measured before therapy. Also, therapy decreased sleep disturbances at night and reduced daytime sleeping times. Consequently, the level of subjective vigilance was higher during the daytime during therapy. OSA attacks do not only impair sleep; they disturb the whole circadian system. This may also impair recuperation and sleep. Further research should test whether measurements of the spontaneous circadian system could have additional diagnostic value and whether the stabilization of the circadian system has therapeutic value.     

Japanese sleep disturbance and fatigue disability weights in evaluating the effects of increasing temperatures on health by a life cycle approach

Purpose

This study aimed to establish a set of disability weights (DWs) for sleep problems and fatigue which could be applied in composite health outcome measures in order to quantify the burden of symptoms and economically evaluate the effects of increasing temperatures on a life cycle approach.

Methods

The conditions were evaluated by a two-step questionnaire study. In the first step, specialists determined the DW for each condition. The second step was identical to the first, except that the determinations were made by primary care physicians. Both groups of medical practitioners used an interpolation method consisting of a comprehensive set of 31 disease-specific DWs.

Results and discussion

Mean DWs for sleep disturbance were 0.101 for environmental sleep disturbance, 0.069 for mild sleep disturbance, and 0.086 for moderate sleep disturbance. Mean DWs for chronic fatigue syndrome (CFS) were 0.099 for a diagnosis of CFS, 0.164 for mild handicap, 0.281 for moderate handicap, and 0.459 for severe handicap. Mean DWs assigned by primary care physicians for sleep disturbance were 0.114 for environmental sleep disturbance, 0.140 for mild sleep disturbance, and 0.126 for severe sleep disturbance. Those for CFS were 0.154 for a diagnosis, 0.099 for mild handicap, 0.147 for moderate handicap, and 0.226 for severe handicap.

Conclusions

Using the present valuation protocol, it appeared feasible to establish the burden of symptoms as attributable to increasing temperatures. The results can be applied in composite health outcome measures for public health research, environmental research, and economic evaluations.     

Recurrent sigmoid volvulus in young people: a missed diagnosis.

In nine young patients with recurrent attacks of sigmoid volvulus there was a long delay before a correct diagnosis was made, yet volvulus was indicated in most of them by a well-taken history. All were treated successfully by excision of the redundant colon. This condition is not as uncommon in young people as was thought.     

Postpartum Idiopathic Brachial Neuritis in a Sport Medicine Physician

Idiopathic brachial neuritis is a distinctive condition that occurs most often in healthy individuals. It characteristically starts with an acute unilateral shoulder pain followed by a complex of symptoms, including weakness, paresthesias, and numbness. The cause of this syndrome is unknown and difficult to diagnose in the initial phase but may occur postsurgery, postinfection, posttrauma, or postvaccination. In this case, the patient''s inciting event appeared to be a cesarean section. There was no trauma to the shoulder or upper extremity by way of positioning during the procedure. Several months after denervation of the supraspinatus and infraspinatus muscles, electromyography revealed some improvement. The diagnosis was made through a combination of clinical evaluation, ultrasound, magnetic resonance imaging, and electromyography. With the exception of weakness, this patient experienced few symptoms. Treatment is symptomatic including anti-inflammatories, opiates, and neuroleptics for pain. There is some evidence that immunotherapy may help decrease the length of symptoms, but there is no strong evidence to support steroid use. Physical therapy, the foundation of therapy in this case, is a useful adjunct for rehabilitation. In general, this condition has a good prognosis for recovery, although often slow, even when there is complete denervation. This patient made a full recovery and has no lingering symptoms.     

Effects of an adjunctive,chronotype-based light therapy in hospitalized patients with severe burnout symptoms - a pilot study

Light therapy is a well-established treatment option for seasonal affective disorders and is effective in reducing sleep problems and daytime fatigue. Symptoms of severe burnout include feelings of exhaustion and impaired sleep and mood. Thus, light therapy seems promising for burnout treatment. So far, light therapy effects in burnout were investigated in outpatient settings only, with inconclusive results. The present study targeted light therapy effects in an inpatient setting. Participants with severe burnout were recruited in two psychosomatic clinics and randomly assigned to a control group with multimodal psychiatric treatment or an add-on light treatment group. Participants in the latter group were additionally exposed to morning bright light (illuminance: 4246 lux, irradiance: 1802.81 µW.cm^?2) for 3 weeks, 30 minutes a day, timed to their chronotypes. Light effects on burnout symptoms, depression, well-being, daytime sleepiness, sleep quality, and attentional performance were measured twice (pre-/postintervention design). Adjunctive chronotype-based bright light therapy was well tolerated and improved burnout symptoms and well-being without additional effect on severity of depression. Furthermore, reduced daytime sleepiness, improved nighttime sleep quality, a sleep phase advance of 25 minutes, shortened sleep latency, less sleep disturbances and increased sleep duration were observed in the light treatment group. No group differences were found in attentional performance. Chronotype-based bright light therapy seems to be effective in improving burnout symptoms and sleep problems in patients with severe burnout symptoms. Further studies with larger sample sizes and objective measures of sleep are necessary to confirm these preliminary results before practical recommendations can be made.     

Adolescent sleep misalignment: a chronic jet lag and a matter of public health

Sleep is a key element, both physiologically and psychologically, in adolescent development. The prevalence of sleep disorders in western countries is important, as with age the sleep–wake cycle of adolescents becomes irregular and delayed in relation with later sleep onset and waking time resulting in rhythm desynchronization. A large number of adolescents sleep for 7–8 h instead of 9–10 h per night, which can lead to a cumulative sleep debt with fatigue, behavioral problems and poor academic achievement. The effect of electronic media use (such as television, mobile phone, computer, and electronic gaming) on sleep has been the object of several international studies, though pubertal changes may also impact adolescent sleep. Adolescents and their parents should be educated by professionals, including physicians and nurses, on the key role of sleep in adolescent well being and quality of life. A number of basic rules are proposed to improve sleep in adolescents. The permanent social jet lag experienced by a number of adolescents should be considered as a matter of public health.     

Postthrombophlebitic syndrome; rehabilitation of patients

A common cause of disability in industrial workers is the postthrombophlebitic syndrome. Swelling of one or both lower extremities may require frequent rest periods during the day for relief. The disabling symptoms are aching, burning, heaviness, and bursting or throbbing pains in the legs. The nights are often disturbed by restlessness of the legs in which it is difficult to find a comfortable position to sleep. It follows from a few days to even years an inflammation of the veins of the legs. Treatment is directed at reducing the swelling of the legs. This often necessitates a change in the patient's routine of daily living. Frequent rest periods are often required with the legs in the horizontal position. Elastic bandages or stockings must be worn, and drugs must be taken to improve blood flow. The adjustment is necessary not only at work, but also at home. If the patient cannot continue at his previous job, efforts should be made to place him in a new job where the necessary adjustments can be made. This is possible primarily in industries manufacturing small items such as instruments, toys and appliances.     

POSTTHROMBOPHLEBITIC SYNDROME—Rehabilitation of Patients

A common cause of disability in industrial workers is the postthrombophlebitic syndrome. Swelling of one or both lower extremities may require frequent rest periods during the day for relief. The disabling symptoms are aching, burning, heaviness, and bursting or throbbing pains in the legs. The nights are often disturbed by restlessness of the legs in which it is difficult to find a comfortable position to sleep. It follows from a few days to even years an inflammation of the veins of the legs.Treatment is directed at reducing the swelling of the legs. This often necessitates a change in the patient''s routine of daily living. Frequent rest periods are often required with the legs in the horizontal position. Elastic bandages or stockings must be worn, and drugs must be taken to improve blood flow. The adjustment is necessary not only at work, but also at home.If the patient cannot continue at his previous job, efforts should be made to place him in a new job where the necessary adjustments can be made. This is possible primarily in industries manufacturing small items such as instruments, toys and appliances.     

Role of the general practitioner in managing patients with myocardial infarction: impact of thrombolytic treatment. Report of a British Heart Foundation Working Group.

Thrombolytic treatment, combined with aspirin, has been shown to reduce mortality by half in patients in hospital with suspected acute myocardial infarction if it is given early after the onset of symptoms. This fact adds to the importance of prompt and skillful intervention. At present in the United Kingdom the median time for receiving suitable management for this condition is about four to six hours. With better organisation this delay could, in most areas, be reduced to two or three hours. A major change in the care of patients with myocardial infarction is needed in which the general practitioner should have a crucial role. Health authorities, hospital physicians, general practitioners, and the ambulance services must coordinate their efforts if the potential reduction in mortality is to be realised. The district medical officer should consult colleagues and draw up guidelines for organising the care of patients who have had heart attacks. The management of patients who have had heart attacks in the community and in hospital should be continually audited. There are dangers inherent in the use of thrombolytic treatment, particularly when conditions other than myocardial infarction are treated in error. This treatment should be given only when the diagnosis is highly probable and when close observation of the patient can be ensured during the ensuing hours. Thrombolytic treatment should not, therefore, be given out of hospital except when trained, equipped personnel are in attendance. Treatment can be given in any hospital (including community hospitals) provided there are adequate diagnostic facilities and suitably experienced nursing staff.     

Thermal biofeedback and periodic movements in sleep: Patients' subjective reports and a case study

Periodic movements in sleep (PMS) is a sleep disorder characterized by repetitive leg kicks accompanied by arousals. In our clinical experience, many patients with PMS anecdotally report that they suffer from cold feet. This study explored whether there is an increased incidence of cold feet complaints in patients with periodic movements in sleep. Results indicated that, indeed, significantly more patients with leg kicks complain of cold feet as compared to patients without leg kicks. A case study was then conducted to determine whether foot thermal biofeedback training would alleviate symptoms of periodic movements in sleep. The number of leg kicks decreased from a mean of 536 per night before biofeedback training to a mean of 19.5 after training. These data lend support to our hypothesis that poor circulation may be contributing to the severity of periodic movements in sleep and that thermal biofeedback may afford an alternative treatment strategy.     

Anomalous hypothalamic responses to humor in cataplexy

Background

Cataplexy is observed in a subset of patients with narcolepsy and affects approximately 1 in 2,000 persons. Cataplexy is most often triggered by strong emotions such as laughter, which can result in transient, yet debilitating, muscle atonia. The objective of this study was to examine the neural systems underlying humor processing in individuals with cataplexy.

Methodology/Principal Findings

While undergoing functional Magnetic Resonance Imaging (fMRI), we showed ten narcolepsy-cataplexy patients and ten healthy controls humorous cartoons. In addition, we examined the brain activity of one subject while in a full-blown cataplectic attack. Behavioral results showed that participants with cataplexy rated significantly fewer humorous cartoons as funny compared to controls. Concurrent fMRI showed that patients, when compared to controls and in the absence of overt cataplexy symptoms, showed pronounced activity in the emotional network including the ventral striatum and hypothalamus while viewing humorous versus non-humorous cartoons. Increased activity was also observed in the right inferior frontal gyri -a core component of the inhibitory circuitry. In comparison, the one subject who experienced a cataplectic attack showed dramatic reductions in hypothalamic activity.

Conclusions

These findings suggest an overdrive of the emotional circuitry and possible compensatory suppression by cortical inhibitory regions in cataplexy. Moreover, during cataplectic attacks, the hypothalamus is characterized by a marked decrease in activity similar to that observed during sleep. One possible explanation for these findings is an initial overdrive and compensatory shutdown of the hypothalamus resulting in full cataplectic symptoms.     

Thermal biofeedback and periodic movements in sleep: patients' subjective reports and a case study

Periodic movements in sleep (PMS) is a sleep disorder characterized by repetitive leg kicks accompanied by arousals. In our clinical experience, many patients with PMS anecdotally report that they suffer from cold feet. This study explored whether there is an increased incidence of cold feet complaints in patients with periodic movements in sleep. Results indicated that, indeed, significantly more patients with leg kicks complain of cold feet as compared to patients without leg kicks. A case study was then conducted to determine whether foot thermal biofeedback training would alleviate symptoms of periodic movements in sleep. The number of leg kicks decreased from a mean of 536 per night before biofeedback training to a mean of 19.5 after training. These data lend support to our hypothesis that poor circulation may be contributing to the severity of periodic movements in sleep and that thermal biofeedback may afford an alternative treatment strategy.