Specialized Outpatient Clinic vs Stroke Unit for TIA and Minor Stroke: A Cohort Study.

Objective: To evaluate the effects of an outpatient clinic set-up for minor stroke/TIA using subsequent admission of patients at 'high risk' of re-stroke.Methods: A cohort study of all patients with suspected minor stroke/TIA seen in an outpatient clinic at Aarhus University Hospital, Denmark, between September 2013 and August 2014. Stroke patients were compared to historic (same hospital) and contemporary (another comparable hospital) matched, hospitalized controls on the non-prioritized outcomes: Length-of-stay, re-admissions, care quality (10 process-performance measures) and mortality. TIA patients were compared to contemporary matched, hospitalized controls.Following complete diagnostic work-up, patients with stroke/TIA were classified into 'low'/high risk' of re-stroke ≤7 days. RESULTS: We analyzed 1,076 consecutive patients of whom 253 (23.5%) were subsequently admitted to the stroke ward. Stroke/TIA was diagnosed in 215/171 patients, respectively. Fifty-six percent (121/215) of the stroke patients were subsequently admitted to the stroke ward. Comparison with the historic stroke cohort (n=191) showed a shorter acute hospital stay for the strokes (median 1 vs 3 days); adjusted length-of-stay ratio 0.49 (95% CI 0.33-0.71). Furthermore, 30-day readmission rate was 3.2% vs 11.6%; adjusted hazard ratio 0.23 (0.09-0.59); and care quality was higher with a risk ratio of 1.30 (1.15-1.47). The comparison of stroke and TIAs to contemporary controls showed similar results. Only one patient in the 'low risk' category and not admitted experienced stroke within 7 days (0.6%). CONCLUSIONS: An outpatient clinic set-up for patients with minor stroke/TIA yields shorter acute hospital stay, lower re-admissions rates, and better quality than hospitalization in stroke units. CLASSIFICATION OF EVIDENCE: This study provides Class III evidence that a neurovascular specialist driven outpatient clinic for minor stroke/TIA patients with the ability of subsequent admission is safe and yields shorter acute hospital stay, lower re-admissions rates, and better quality than hospitalization in stroke units.

Short echo-time Magnetic Resonance Spectroscopy in ALS, simultaneous quantification of glutamate and GABA at 3 T.

Cortical hyperexcitability has been found in early Amyotrophic Lateral Sclerosis (ALS) and is hypothesized to be a key factor in pathogenesis. The current pilot study aimed to investigate cortical inhibitory/excitatory balance in ALS using short-echo Magnetic Resonance Spectroscopy (MRS). Patients suffering from ALS were scanned on a 3 T Trio Siemens MR scanner using Spin Echo Full Intensity Acquired Localized (SPECIAL) Magnetic Resonance Spectroscopy in primary motor cortex and the occipital lobe. Data was compared to a group of healthy subjects. Nine patients completed the scan. MRS data was of an excellent quality allowing for quantification of a range of metabolites of interest in ALS. In motor cortex, patients had Glutamate/GABA and GABA/Cr- ratios comparable to healthy subjects. However, Glutamate/Cr (p = 0.002) and the neuronal marker N-acetyl-aspartate (NAA/Cr) (p = 0.034) were low, possibly due to grey-matter atrophy, whereas Glutathione/Cr (p = 0.04) was elevated. In patients, NAA levels correlated significantly with both hand strength (p = 0.027) and disease severity (p = 0.016). In summary SPECIAL MRS at 3 T allows of reliable quantification of a range of metabolites of interest in ALS, including both excitatory and inhibitory neurotransmitters. The method is a promising new technique as a biomarker for future studies on ALS pathophysiology and monitoring of disease progression.

Reproducibility, and sensitivity to motor unit loss in amyotrophic lateral sclerosis, of a novel MUNE method: MScanFit MUNE.

OBJECTIVE: To examine inter- and intra-rater reproducibility and sensitivity to motor unit loss of a novel motor unit number estimation (MUNE) method, MScanFit MUNE (MScan), compared to two traditional MUNE methods; Multiple point stimulation MUNE (MPS) and Motor Unit Number Index (MUNIX). METHODS: Twenty-two ALS patients and 20 sex- and age-matched healthy controls were included. MPS, MUNIX, and MScan were performed twice each by two blinded physicians. Reproducibility of MUNE values was assessed by coefficient of variation (CV) and intra class correlation coefficient (ICC). Ability to detect motor unit loss was assessed by ROC curves and area under the curve (AUC). The times taken for each of the methods were recorded. RESULTS: MScan was more reproducible than MPS and MUNIX both between and within operators. The mean CV for MScan (12.3%) was significantly lower than for MPS (24.7%) or MUNIX (21.5%). All methods had ICC>0.94. MScan and Munix were significantly quicker to perform than MPS (6.3mvs. 13.2m). MScan (AUC=0.930) and MPS (AUC=0.899) were significantly better at discriminating between patients and healthy controls than MUNIX (AUC=0.831). CONCLUSIONS: MScan was more consistent than MPS or MUNIX and better at distinguishing ALS patients from healthy subjects. SIGNIFICANCE: MScan may improve detection and assessment of motor unit loss.

The influence of pyrithioxine on certain factors of intelligence1.

A double-blind trial with pyrithioxine was made with 22 pairs of visually handicapped children who were equal in IQ scores and in chronological age. Although an improvement of abstraction ability was noticed, the overall results were not in concurrence with the general tendency in relevant literature.

Subliminal stimulation, choice behavior and some personality correlates of subliminal sensitivity.

The aim of this study was to investigate the possible relations between specific personality variables and the effect of subliminal stimulation on choice behavior. It was hypothesized that subjects with low anxiety, less neuroticism, and external locus of control and the trait of extraversion would be more susceptible to subliminal stimulation. 38 undergraduate students were exposed to subliminal messages urging them to choose symbols instead of numbers or letters. Analysis showed that subliminal stimulation did not generate a preference for symbols over numbers or letters. No support was observed for the hypothesis of an association between susceptibility and personality variables. These results may be explained in terms of symbol choice being a neutral message that did not relate to the subjects' needs and motivation.

Expertise and performance on the emotional Stroop task.

40 undergraduate students participated in an emotional Stroop task to test the hypothesis that individuals with high interest in and formal knowledge of interpersonal relationships will react with significantly longer latencies to social-related threat words than individuals without such an interest or formal knowledge. The results did not support the hypothesis; however, an association between interference scores and order of card presentation was found.

Effects of a group rational-emotive behavior therapy program on the Type A behavior pattern.

A sample of 44 male Type A insurance representatives, selected by means of the Videotaped Structured Interview, were randomly assigned to a treatment (n = 22) and a delayed treatment control group (n = 22). The treatment group participated in 9 weekly sessions of group Rational-Emotive Behavior Therapy and were followed up after 10 weeks. After the control period, the delayed treatment control group received the same treatment program. Repeated measurements were obtained by means of the Videotaped Structured Interview, Jenkins Activity Survey, Cook-Medley Hostility Scale, and Type A Cognitive Questionnaire. Self and spouse/friend ratings of Type A behavior were obtained by means of the Bortner Rating Scale. Analysis indicated that, compared to the control condition, the therapy significantly reduced the intensity of Type A behavior and its time urgency component. These improvements were maintained at follow-up and were accompanied by self-reports of significant positive changes in Type A behavior and irrational beliefs.

Effect of auditory subliminal stimulation on GSR.

The present study was designed to investigate the possible effect of auditory subliminal stimulation on GSR. 38 undergraduate students were exposed subliminally to emotional words while GSR was monitored. The results confirmed the hypothesis that auditory subliminal stimulation would effect a significant increase in GSR.

Body dissatisfaction and irrational beliefs.

To test the hypothesis that the irrational evaluative beliefs, postulated by Rational-Emotive Behavior Therapy, are associated with body dissatisfaction, 94 women (21 diagnosed with an eating disorder, 38 with high body dissatisfaction but without an eating disorder, and 35 with low body dissatisfaction) completed the Survey of Personal Beliefs and the Eating Disorders Inventory. Analysis showed no significant difference in body dissatisfaction between the Eating Disordered and High Body Dissatisfaction subgroups. No significant correlations between body dissatisfaction and irrational beliefs were found for the Eating Disordered subgroup. For the High Body Dissatisfaction subgroup, significant but low correlations were found between scores on body dissatisfaction and irrational standards for self and others and with negative self-rating. In terms of irrational beliefs the Eating Disordered and High Body Dissatisfaction subgroups showed a significantly greater tendency towards Catastrophizing, Low Frustration Tolerance, and Negative self-rating, compared to the controls, without any significant difference between the former two groups. The Eating Disordered subgroup but not the High Body Dissatisfaction subgroup differed significantly from the controls in terms of more Self-directed demands.

Irrational beliefs and marital conflict.

To test the hypothesis that the major irrational evaluative beliefs postulated by Rational Emotive Behavior Therapy are related to marital conflict, 15 married couples participated in a thought-listing procedure. During this procedure, three idiosyncratic scenes portraying marital conflict and three control scenes free of conflict were identified for and presented to each member of the dyad. Analysis indicated that the conflict-portraying scenes were associated with significantly more irrational evaluative beliefs and significantly fewer rational cognitions than the control scenes.

Comparison of the effects of auditory subliminal stimulation and rational-emotive therapy, separately and combined, on self-concept.

The present study investigated the effects on self-concept of Rational-Emotive Therapy and auditory subliminal stimulation (separately and in combination) on 141 undergraduate students with self-concept problems. They were randomly assigned to one of four groups receiving either Rational-Emotive Therapy, subliminal stimulation, both, or a placebo treatment. Rational-Emotive Therapy significantly improved scores on all the dependent measures (cognition, self-concept, self-esteem, anxiety), except for behavior. Results for the subliminal stimulation group were similar to those of the placebo treatment except for a significant self-concept improvement and a decline in self-concept related irrational cognitions. The combined treatment yielded results similar to those of Rational-Emotive Therapy, with tentative indications of continued improvement in irrational cognitions and self-concept from posttest to follow-up.

Self-schemas in social phobia and panic disorder.

A modified Stroop color-naming task was used to investigate whether social phobia and panic disorder are associated with a hypervigilance to social and physical threat-related cues, respectively, as predicted by Beck's cognitive theory of anxiety disorders. Color-naming latencies of 13 individuals with social phobia and 15 with panic disorder for words representing social and physical threats, respectively, were compared to matched neutral control words. The results did not support the hypothesis that the self-schemas of individuals with panic disorder are hypersensitive to information association with physical threat and that persons with social phobia are overly concerned with social threat.

Haplotypes and gene expression implicate the MAPT region for Parkinson disease: the GenePD Study.

BACKGROUND: Microtubule-associated protein tau (MAPT) has been associated with several neurodegenerative disorders including forms of parkinsonism and Parkinson disease (PD). We evaluated the association of the MAPT region with PD in a large cohort of familial PD cases recruited by the GenePD Study. In addition, postmortem brain samples from patients with PD and neurologically normal controls were used to evaluate whether the expression of the 3-repeat and 4-repeat isoforms of MAPT, and neighboring genes Saitohin (STH) and KIAA1267, are altered in PD cerebellum. METHODS: Twenty-one single-nucleotide polymorphisms (SNPs) in the region of MAPT on chromosome 17q21 were genotyped in the GenePD Study. Single SNPs and haplotypes, including the H1 haplotype, were evaluated for association to PD. Relative quantification of gene expression was performed using real-time RT-PCR. RESULTS: After adjusting for multiple comparisons, SNP rs1800547 was significantly associated with PD affection. While the H1 haplotype was associated with a significantly increased risk for PD, a novel H1 subhaplotype was identified that predicted a greater increased risk for PD. The expression of 4-repeat MAPT, STH, and KIAA1267 was significantly increased in PD brains relative to controls. No difference in expression was observed for 3-repeat MAPT. CONCLUSIONS: This study supports a role for MAPT in the pathogenesis of familial and idiopathic Parkinson disease (PD). Interestingly, the results of the gene expression studies suggest that other genes in the vicinity of MAPT, specifically STH and KIAA1267, may also have a role in PD and suggest complex effects for the genes in this region on PD risk.

Stress and coping amongst South African dentists in private practice.

Stress and coping were investigated in a randomly selected sample of 311 South African dentists of whom 268 were in private practice and 43 were non-private practitioners. Some of the most important findings are the following: Indications were that about 40 per cent of the respondents reported extremely high stress levels, irrespective of type of employment. No significant relationships were found between stress levels and biographical variables. Stressors most often experienced by private practitioners were financial issues and time and scheduling pressures. Other important stressors included patients' unfavourable perceptions of dentists, being perceived as an inflictor of pain, working with children, treating nervous patients, concerns about the future and worrying about the oversupply of dentists. The most stressful stressors were financial issues. Although it was found that time and scheduling pressures were the next most prevalent category of stressors, dentists reported, next to financial issues, problems in dealing with patients as the second most stressful group of stressors. Making decisions about future career directions and limited future options were intense stressors for 47.54 per cent of respondents. Dentists identified rising costs and problems with medical aid schemes as the most prevalent and intense stressors, ones they experienced most difficulty in handling. Stressors which posed few coping problems were staff-related problems, difficulties in keeping to appointment schedules, working under constant time pressures, repetitive nature of the work, feeling isolated and the possibility of a viral contraction. The results indicated that, in general, drug use amongst South African dentists was low. However, fairly high numbers of dentists used analgesics on a regular basis. Substantial numbers of dentists reported marital problems. The prevalence of severe interpersonal problems with the dentists' own children was low. In addition to marital problems, substantial percentages of the sample reported severe problems in other personal relationships and experienced a severe lack of social involvement or outside interests. In the present study 27 (10.23 per cent) of the private practitioners and 2 (4.76 per cent) of the non-private practitioners reported severe suicide ideation.

Relationship beliefs, interpersonal perception, and marital adjustment.

To test the hypothesis that relationship beliefs are related to marital adjustment, 46 married couples completed the Relationship Belief Inventory (RBI) and the Dyadic Adjustment Scale (DAS). Significant correlations were found between the DAS scores and the D and S subscales of the RBI. It was shown that the low dyadic adjustment group made significantly more extreme evaluations compared to the high adjustment group. It also was found that individuals' perceptions of their spouses' relationship beliefs did not display the same trends observed with traditional personality questionnaire, in which marital adjustment was related to female accuracy and greater real similarity between spouses.

The psychosocial effects of living in an isolated community. A community health study.

Doctors working in isolated mining towns frequently remark on the number of psychosocial problems they encounter, particularly among women. A test was designed to study psychosocial well-being in three such towns. The results were compared with those from a diamond-mining town 30 km from a large city. There were 1,239 respondents. The results showed that, according to Goldberg's General Health Questionnaire, the number of people 'clinically disturbed' varied from 14.1% to 23.8%. On the Carroll Rating Scale for Depression, the number of depressed respondents varied from 21.9% to 37.6%. Of the respondents, 23.2 - 31.2% drank alcohol at least once a day, a much higher percentage than that found in the general population. Women suffered more than men from psychosocial illness. Isolation as a risk factor could not be proved, since all 4 towns were affected. Causal factors could be the personality type of the people drawn to such towns or the transient nature of life there or the effect of the towns being company owned.

Domestic violence in patients visiting general practitioners--prevalence, phenomenology, and association with psychopathology.

BACKGROUND: It has been suggested that domestic violence is not only highly prevalent and associated with significant morbidity, but that it is also overlooked by medical practitioners. Despite this, few studies have focused on domestic violence in the South African setting, so that there is a paucity of data here on its prevalence, phenomenology, and associated psychopathology. METHODS: Sixteen general practitioners from the South African Sentinel Practitioner Research Network (SASPREN) screened all their female patients aged 18 years or older for a 3-month period (N = 1,050). A sociodemographic questionnaire was completed, and symptoms of post-traumatic stress disorder (PTSD) and major depression were assessed, both in subjects with a history of domestic violence and in a control group without such a history. RESULTS: 21.5% of patients reported a history of domestic violence at screening. Patients and controls did not differ significantly in terms of age or race. However, patients with a history of domestic violence were significantly more likely to be married, not to have begun a high-school education, and to be working outside the home. Both PTSD and major depression were significantly more common in patients with a history of domestic violence (35.3% and 48.2%, respectively) than in controls (2.6% and 11.4%, respectively). Compared with other patients reporting domestic violence, those with either PTSD or major depression were subjected to more violence and were more likely to report a suicide attempt. CONCLUSION: In a large, diverse population of adult female patients presenting to a range of general practitioners in South Africa, there was a high prevalence of reported domestic violence. A significant association was found between domestic violence and both PTSD and major depression, with these diagnoses indicative of increased severity of abuse and increased morbidity. Routine screening by medical practitioners of all female patients for a history of domestic violence seems warranted, and patients with a history of domestic violence should be assessed for PTSD and depression.