An ethnographic study into the psychological impact and adaptive mechanisms of living with hand eczema.

BACKGROUND: Hand eczema (HE) severely impairs patients' quality of life, and causes significant psychological and social distress. There has been little focus on how people with HE perceive their disease and how they may be adapting their behaviours to cope with their condition. AIM: A survey was carried out to investigate how the physical and aesthetic impact of HE may affect patients psychologically, and to assess their associated behavioural changes and disease perception. METHODS: A 22-item survey covering demographics, disease-related questions and psychosocial items was completed by patients with HE via a website. RESULTS: In total, 1023 people with HE completed the survey. Of these, 89% stated they were embarrassed/self-conscious about their eczema, with 70% of respondents reporting wearing gloves or hiding their hands in their pockets. Many respondents reported their HE affected their daily activities and choices, with 74% of patients reporting that their condition affects the way they handle objects or touch people. Regarding relationships, 27% of respondents said physical relationships with their partners were affected, and 27% said that tension/disagreements between them and their partner or family/friends occurred because HE had stopped them doing certain activities. CONCLUSION: HE can have a very large psychological impact on sufferers, hugely reducing their self-esteem, and as a consequence, having a detrimental effect on their daily activities and relationships. The impact of these psychosocial comorbidities has been underinvestigated and often underestimated by clinicians, despite being of great importance to patients.

Psychological but not vasomotor symptoms are associated with temperament and character traits.

OBJECTIVE: Recent evidence suggests that climacteric symptoms may be intensified by specific temperament and personality traits in postmenopausal women. In this study we investigate Cloninger's model of personality in relation to menopausal symptoms. METHODS: One-hundred and seventy peri- and postmenopausal women consecutively recruited from a menopause clinic of an academic hospital completed the Cloninger's Temperament and Character Inventory (TCI-140) which measures four dimensions of temperament: Harm avoidance, Novelty seeking, Reward dependence and Persistence, as well as three dimensions of character: Self-directedness, Cooperativeness, and Self-transcendence. Menopausal somatic, vasomotor and psychological symptoms were also assessed using the Greene Climacteric Scale. RESULTS: In comparison to the norms of the Greek general population, postmenopausal women presented lower scores in Novelty seeking and Reward dependence and higher scores in Persistence, Self-directedness, Cooperativeness and Self-transcendence. Higher harm avoidance (the inclination to avoid potential punishment, be shy and fearful of uncertainty) significantly correlated with anxiety and depressive symptoms while lower Self-directedness (the ability to have the willpower to adapt to or overcome any changes) correlated with depressive symptoms only. By multivariate regression analysis, higher Harm avoidance and lower Self-directedness were independently associated with the presence of depressive symptoms. No significant associations were observed between TCI-140 traits and somatic or vasomotor symptoms. CONCLUSIONS: Our findings indicate that most temperament and character traits according to Cloninger's model in peri- and postmenopausal women varied significantly as compared to the general population. Among several traits, high Harm avoidance and low Self-directedness were most strongly associated with psychological climacteric distress but not with somatic and vasomotor symptoms.

Core beliefs and psychological distress in patients with psoriasis and atopic eczema attending secondary care: the role of schemas in chronic skin disease.

BACKGROUND: The role of ingrained cognitive and emotional patterns (schemas) in patients with psoriasis and eczema has not previously been investigated. High levels of psychiatric morbidity and psychological distress observed in these populations suggest the presence of maladaptive schemas and therefore a possible target for future successful psychological intervention. OBJECTIVES: To investigate the presence of early maladaptive schemas (EMS) in patients with psoriasis and eczema and to explore their links with psychological distress. METHODS: A sample of 185 adults (psoriasis n = 55, atopic eczema n = 54, chronic disease control n = 23, normal control n = 53) completed validated, self-administered questionnaires. RESULTS: Differences were found between dermatology patients and control groups. Patients with psoriasis differed on seven EMS from the normal control group: emotional deprivation (P = 0·011), social isolation (P < 0·001), defectiveness (P < 0·001), failure (P < 0·001), vulnerability to harm (P < 0·001), subjugation (P = 0·009) and emotional inhibition (P = 0·002). They differed from the chronic disease group on vulnerability to harm (P = 0·002) only. Patients with eczema differed from the normal control group on eight EMS: emotional deprivation (P < 0·001), social isolation (P < 0·001), defectiveness (P < 0·001), failure (P < 0·001), dependence (P = 0·010), vulnerability to harm (P = 0·002), subjugation (P = 0·006) and insufficient self-control (P = 0·010). EMS were strongly positively related to psychological distress experienced by dermatology patients. Hierarchical regressions demonstrated two schemas, vulnerability to harm (P < 0·001) and defectiveness (P = 0·029), to be predictive of anxiety, and social isolation (P = 0·012) and vulnerability to harm (P = 0·018) to be predictive of depression, irrespective of age and years of coping for dermatology patients. CONCLUSIONS: The findings have important theoretical and clinical implications for psychological management of patients with psoriasis and eczema. Treatment protocols may benefit by targeting schemas. Further studies are needed to investigate the benefits of schema-focused therapy in patients with skin disease.

Development and preparation of lean meat products.

When the effect of food on human lipoprotein levels is tested, or when human consumption of dietary lipids must be controlled or limited, all food needs to be provided under controlled conditions to achieve consistent composition and sensory traits. It is especially important to control the composition of foods, particularly fat and fatty acid content. Because of the inherent biologic variability in the chemical composition of animal tissues (beef in particular), raw materials must be selected carefully and prepared under strict guidelines. In addition, chemical composition should be verified initially and during the production of the product to ensure the accuracy necessary for controlled dietary intake. Furthermore, the meat provided must be easy for the study subject to prepare, be of consistent serving size, and yet be highly palatable to maintain the subject's interest and participation. This article outlines the protocol for developing lean meat products for use in nutrition studies in which fat content must be controlled, especially those studies designed to examine the effect of fat content on human lipoproteins. Preliminary studies, procurement of raw materials, procedures for recipe selection, product preparation, and sampling procedures for verification of chemical composition are described. Our findings indicate that fat intake from beef, chicken, and fish can be controlled for use in nutrition studies.

The use of an expert system of composite risk factors in breast cancer screening.

Mass Screening seems to be the only promising way to discover breast cancer patients at an early and more curable stage and a positive method improving the cost-effectiveness and compliance of mass screening is the use of prognostic factors, to identify the high-risk group, who alone then would be screened. In a 200 women sample, who had undergone screening for breast cancer with clinical examination and bilateral mammography, we calculated the Composite Risk Factors of six Characteristics (C6RF), which are family history for breast cancer, pregnancy history, menstrual history, history of cystic breast disease, history of regular breast clinical or self-examination and presence or not of breast lump, using an expert system in IBM-compatible personal computer. In these cases the average C6RF was 0.18 (SD +/- 0.19) in low-risk group and 2.61 (SD +/- 4.76) in high-risk group and all cases with C6RF values higher than 0.56 were put in the high-risk group. Under these conditions, the sensitivity of the C6RF method, in discovering breast cancer, was 90% and the specificity 81.5% and the C6RF method was proved to be clinically valuable in identifying the high-risk group and controlling breast cancer.

Complementary treatment with oral pidotimod plus vitamin C after laser vaporization for female genital warts: a prospective study.

This is a prospective study to assess a complementary treatment for genital warts after laser vaporization. 62 patients were enrolled in two randomized groups: Al: laser vaporization alone. A2: laser vaporization, followed with Pidotimod plus vitamin C for 2 1/2 months. The latter treatment shortened the time of warts remission and marginally decreased the rate of the warts' recurrence: 81% versus 67% (N.S.). Despite the non-significant difference, this complementary treatment seems to have some efficiency.

Paediatric eczema and psychosocial morbidity: how does eczema interact with parents' illness beliefs?

BACKGROUND: Thus far there has been relatively little work on children's illness representations regarding eczema and how these relate to parental conceptualizations of their child's psychosocial health. This is important because the challenge of raising a child with a serious illness can affect many facets of a parent's everyday life and the behaviour of parents can be closely related to the health of the child. METHODS: Two hundred and thirty-two children with eczema, asthma, eczema and asthma, and healthy controls between 7 and 12 years of age and their parents were recruited. Children were administered the Children's Illness Perception Questionnaire. Questionnaires completed by the parents were The Personality Inventory for Children and The Parental Stress Inventory. RESULTS: Parents of children with eczema did not judge their children to have poorer psychosocial health than controls, but parents of children with eczema could not be distinguished between in terms of whether their child was significantly affected by their eczema or not. CONCLUSIONS: This work could have important implications for the quality of life of the child and for the parent-child relationship and these implications are considered.

The importance of children's illness beliefs: the Children's Illness Perception Questionnaire (CIPQ) as a reliable assessment tool for eczema and asthma.

A lack of information about disease in children can lead to erroneous views such as children believing that hospital admittance or the presence of a disease is a punishment for a perceived wrong. There has thus far been no standard tool available to measure children's illness conceptualizations from a Leventhalian framework. Three groups of children with eczema, asthma and eczema and asthma between the ages of 7 and 12 years of age were recruited. Children were given the Children's Illness Perception Questionnaire (CIPQ), a 26-item instrument adapted from the Illness Perception Questionnaire for adults. A Kuder - Richardson 20 test of reliability for dichotomous data was performed allowing an estimate of the internal consistency of the measurement scales. It can be seen that, for all three illness groups, internal consistency is acceptable for the timeline and consequences scale. The cure/control scale, however, was not internally consistent for any illness group. As health professionals, we need to develop the means to further understand how paediatric illness beliefs relate to specific disease types, age and psychosocial factors and the utility of this instrument is discussed within this context.

Coping with the disfiguring effects of vitiligo: a preliminary investigation into the effects of cognitive-behavioural therapy.

Vitiligo is a progressive condition involving a loss of pigmentation in the skin; it can be disfiguring and no effective treatment or cure exists. Although vitiligo's medical effects have been studied extensively, little attention has been paid to its psychological impact or to the effects of psychological state on the illness itself. To address these issues, the present study examined the effect of cognitive behavioural therapy on coping with vitiligo and adaptation to the negative effects on body image, quality of life and self-esteem in adult patients. The study also examined whether any psychological gains acquired from psychological therapy would influence the progression of the condition itself. Two matched groups of vitiligo patients were compared, one of which received cognitive-behavioural therapy over a period of 8 weeks, while the other received no changes to their treatment status. All patients were assessed on self-esteem, body image and quality of life, prior to, immediately following and 5 months following the end of therapy. The progression of the condition was assessed by photographing patients prior to the start of counselling and 5 months following counselling. Results suggest that patients can benefit from cognitive behavioural therapy in terms of coping and living with vitiligo. There is also preliminary evidence to suggest that psychological therapy may have a positive effect on the progression of the condition itself. Implications for incorporating psychological counselling into patient care and management are discussed.

Impact of life events on the onset of vitiligo in adults: preliminary evidence for a psychological dimension in aetiology.

The present study retrospectively examines the role of stressful life events in the onset of vitiligo in adults. A matched clinical sample of patients with other forms of disfigurement or skin disease (dystrophic epidermolysis bullosa and naevi, not thought to be associated with stress) served as a control group. Newly diagnosed patients and matched controls were thus asked to complete the 12-month version of the Schedule of Recent Experience, a questionnaire which measures the frequency and number of stressful life events occurring over a specified period. The results suggest that such patients endure a significantly higher number of stressful life events than do controls, suggesting that psychological distress may have contributed to the onset of their condition. The implications of the results are discussed and suggestions made for future research.

MRI findings of extramedullary haemopoiesis.

Extramedullary haemopoiesis (EH) is a compensatory process associated with chronic haemolytic anaemia. It is rare, however, for such an abnormality to cause spinal cord compression. We present two patients with known beta-thalassaemia intermedia who developed spinal cord compression due to masses of extramedullary haematopoietic tissue in the epidural space of the thoracic spine. The EH masses were diagnosed by MRI as an isointense epidural lesion on both T1- and T2-weighted images, compressing severely the spinal cord. After administration of a paramagnetic agent, an intermediate enhancement of the masses was evident. All the vertebral bodies had low to intermediate signal intensity as a result of displacement of fatty marrow by haematopoietic marrow. Expansion of thoracic ribs with bilateral paravertebral masses were characteristic. A small dose of radiotherapy was given and marked improvement in neurological symptoms was evident. An MRI examination established shrinkage of the mass and decompression of spinal cord. The role of MRI in diagnosis of EH masses is essential and radiation therapy is a very effective treatment for this rare complication.

Effect of varying concentrations of follicle stimulating hormone on the production of gonadotrophin surge attenuating factor (GnSAF) in women.

OBJECTIVE: We studied the time-course of production of gonadotrophin surge attenuating factor (GnSAF) in relation to varying serum concentrations of FSH in women. DESIGN: Normally cycling women were investigated in four cycles, i.e. a spontaneous cycle treated with placebo (cycle P) and three cycles treated with three different FSH dosages (1 ampoule, cycle 1; 3 ampoules, cycle 3 and 6 ampoules, cycle 6). Placebo or FSH were given as a single i.m. injection on cycle day 2 (0900 h). The response of LH to an i.v. injection of 10 micrograms GnRH (GnSAF bioactivity) was investigated 4, 8, 12 and 24 hours after the injection of placebo or FSH. PATIENTS: Six normally ovulating women with long-standing unexplained infertility were studied. The women were used as their own controls during the cycle treated with placebo. MEASUREMENTS: Pituitary response to GnRH was calculated as the net increase in LH at 30 minutes (delta LH) above the basal value. RESULTS: Serum FSH concentrations increased after the injection of FSH in a dose dependent manner. Compared with cycle P, delta LH was significantly attenuated in cycle 3 and cycle 6 at 8, 12 and 24 hours and in cycle 1 at 12 hours after the injection of FSH. Basal concentrations of oestradiol (E2) and LH did not differ significantly among the four cycles at any point except in cycle 6 at 24 hours after the FSH injection when E2 values were significantly higher and LH values significantly lower than in cycle P. CONCLUSIONS: These results suggest that GnSAF bioactivity increases significantly as early as 8 hours from a single injection of FSH before any significant increase in serum E2 values. We conclude that in women the effect of FSH on the production of GnSAF in the early follicular phase is concentration dependent.

Drug-resistant tuberculous mastoiditis in 2 children.

Tuberculosis of the middle ear and mastoid is uncommon nowadays. Two cases of drug-resistant tuberculous mastoiditis in immunocompetent Greek native children are reported and the diagnostic and therapeutic difficulties of this rare condition are discussed.