Dual-task interference: the effects of verbal cognitive tasks on upright postural stability in Parkinson's disease.

Although dual-task interference has previously been demonstrated to have a significant effect on postural control among individuals with Parkinson's disease, the impact of speech complexity on postural control has not been demonstrated using quantitative biomechanical measures. The postural stability of twelve participants with idiopathic Parkinson's disease and twelve healthy age-matched controls was evaluated under three conditions: (1) without a secondary task, (2) performing a rote repetition task and (3) generating a monologue. Results suggested a significant effect of cognitive load on biomechanical parameters of postural stability. Although both groups increased their postural excursion, individuals with Parkinson's disease demonstrated significantly reduced excursion as compared with that of healthy age-matched controls. This suggests that participants with Parkinson's disease may be overconstraining their postural adjustments in order to focus attention on the cognitive tasks without losing their balance. Ironically, this overconstraint may place the participant at greater risk for a fall.

Short-term response of macular oedema to intravitreal bevacizumab.

BACKGROUND/AIMS: Bevacizumab has been shown to be an effective treatment of macular oedema. This study assesses the response of macular oedema to bevacizumab with specific focus on the first 24 h postinjection. METHODS: Subjects with diabetic macular oedema (DMO) or exudative age-related macular degeneration (ARMD) received intravitreal bevacizumab injections. Early Treatment of Diabetic Retinopathy Study (ETDRS) visual acuity and OCT macular thickness measurements were obtained at baseline, 1, 3, 6, 24 and 48 h, 1 week and 1 month postinjection. RESULTS: The average baseline OCT was 452.91 microm (SD 182.96, range 249.00 to 784.00). After injection, there was a statistically significant decrease in OCT thickness within 2 h with a plateau phase out to 24 h, followed by a significant drop between 24 and 48 h, and a return towards baseline between 1 week and 1 month. Average changes in ETDRS visual acuity were not statistically significant, though many patients experienced a positive outcome. CONCLUSION: While there is an immediate pressure-related effect, it appears that the anti-VEGF effects of bevacizumab require approximately 24 h to become active and persist for 2-3 weeks. These results suggest that injections at 2-3-week intervals might provide improved clinical outcomes, compared with the currently typical 4-6-week interval of injections.

Inhaled beclomethasone dipropionate improves acoustic measures of voice in patients with asthma.

BACKGROUND: Inhaled corticosteroids have the potential to produce upper-airway side effects such as hoarseness. As new compounds and delivery devices are developed and compared, it is difficult to quantify their adverse upper-airway effects. OBJECTIVE: We undertook the following study to test the ability of an acoustic analysis technique to quantify changes in vocal function in steroid-naive patients with asthma who receive inhaled beclomethasone dipropionate (BDP), 1,000 microg/d for 4 months. METHODS: Patients self-administered one of four regimens of inhaled BDP. Group 1 patients received one 250-microg puff qid via metered-dose inhaler (MDI); group 2 patients received one 250-microg puff qid via MDI with a holding chamber; group 3 patients received two 250-microg puffs bid via MDI; and group 4 patients received two 250-microg puffs bid via MDI with a holding chamber. A smaller cohort of nonsmoking asthmatic patients was managed without steroid intervention for 4 months. At baseline and again at 8 weeks and 16 weeks after the initiation of BDP treatment, patients underwent spirometry and methacholine challenge. At baseline and again at 2, 4, 8, 12, and 16 weeks, patients underwent voice recording for analysis of voice parameters. The recorded vowels were low-pass filtered (10 KHz), digitized (22 KHz), and analyzed by software to obtain two acoustic measures: (1) jitter, the cycle-to-cycle variation in the time period of the voice signal; and (2) shimmer, the cycle-to-cycle variation in voice signal amplitude. RESULTS: We recruited 77 patients for randomization to inhaled steroid therapy and 10 patients who continued to receive only occasional inhaled bronchodilator therapy. In all active treatment groups, FEV(1), FVC, and provocative concentration of methacholine causing a 20% fall in FEV(1) improved significantly after BDP treatment. Mean jitter scores, a measurement of variation in voice pitch, were not significantly influenced by BDP treatment. However, mean shimmer scores, a reflection of perturbation in vocal amplitude, fell significantly (p < 0.05) in the active treatment groups. These reductions in shimmer scores were not significantly different in the active treatment groups. Shimmer scores in the bronchodilator-treated group were unchanged during the 16 weeks of follow-up. CONCLUSIONS: Our data show that a simple and noninvasive acoustic analysis of voice is sensitive to subclinical changes associated with inhaled corticosteroid therapy. We have shown that 1,000 microg/d of inhaled BDP actually improves specific acoustic measures of voice in patients with inadequately controlled asthma. These improvements were uninfluenced by dosing schedule and whether a spacing chamber was used.

Delusions and delusional reasoning.

In 2 studies, delusional participants assigned higher probabilities to narratives of actual delusions than participants with no history of delusions; previously delusional participants did not differ significantly from delusional participants or participants with no history of delusions. In Study 2, the authors found that this reasoning bias was specific to delusions and did not generalize to "neutral" text. Familiarity with the content of the delusion narratives played a mediating role in the estimation of their probability, but delusional status also had a significant, independent effect. These findings are consistent with the Bayesian model of delusion formation proposed by D. R. Hemsley and P. A. Garety (1986), and with R. P. Bentall, P. Kinderman, and S. Kaney's (1994) concept of "emotional saliency." A productive area of future research might be to further determine the elements of "emotional saliency" and their impact on the individual steps of the Bayesian model.

Antibiotic therapy in acute exacerbations of chronic bronchitis.

Chronic obstructive pulmonary disease (COPD) comprises a spectrum of conditions including chronic bronchitis, emphysema, asthma, and bronchiectasis. It has a prevalence in the United States of 5.1% to 5.4% in the middle-aged to elderly population, with a lower rate in nonsmoking individuals. Moreover, COPD is complicated by frequent and recurring acute exacerbations of chronic bronchitis (AECB). Overall, COPD represents the fourth leading cause of mortality in the United States and is the second leading cause of work disability. This condition is also associated with high morbidity and health care expenditures. Despite the controversy over the need to prescribe antibiotics for patients with AECB, high-risk patients have been identified who will benefit from this therapy.These include, patients with a history of repeated infections (>4 per year), comorbid illnesses (such as diabetes, asthma, coronary heart disease), or marked airway obstruction. Furthermore, a bacterial cause is shown in approximately 50% of AECB episodes, and primarily includes Haemophilus influenzae, Moraxella catarrhalis, and Streptococcus pneumoniae. Additionally, resistance among community-acquired respiratory pathogens in the United States has risen dramatically, with beta-lactamase production evident in 40% of H. influenzae and greater than 95% of M. catarrhalis isolates, and with approximately 10% of pneumococci highly resistant to penicillin and simultaneously resistant to macrolide antibiotics. The criteria used to make choices for antibiotic use in patients with AECB should include knowledge of the frequencies of pathogen resistance and patients' clinical characteristics. An effective antibiotic, however, must be able to rapidly resolve the acute infection with the least patient morbidity and need for hospitalization. Although there remains controversy as to when to initiate antibiotic therapy in patients with AECB, several guidelines have been published.

Treating acute exacerbations of chronic bronchitis in the face of antibiotic resistance.

Antibiotics can be effective against acute exacerbations of chronic bronchitis and chronic obstructive pulmonary disease, but with bacterial resistance to multiple antibiotics increasing worldwide, appropriate antibiotic selection is critical. Categorizing patients with acute exacerbations according to age, number of exacerbations per year, disease severity, degree of pulmonary impairment, and presence of comorbid conditions helps to direct therapy.

Grasper trauma during laparoscopic cholecystectomy.

BACKGROUND: The present study characterized the histopathological nature of laparoscopic grasper trauma during laparoscopic cholecystectomy in a prospective, blinded trial in order to establish a model for laparoscopic grasper trauma. The null hypothesis that graspers cause no histologically distinct tissue injury was tested. METHODS: The gall bladders of 19 patients undergoing laparoscopic cholecystectomy were examined. The area of gall bladder that had been grasped by Debakey laparoscopic forceps was excised (sample), along with an area of gall bladder that had not been grasped (control). Paired specimens were examined by a pathologist (blinded) to identify which was 'sample' and which was 'control' and to assess for histological markers of crushed tissue injury. The data were analysed by chi-squared or Fisher's exact tests. RESULTS: The pathologist was able to identify the sample (gripped) specimen in 13 of the 19 cases. In the remaining six cases the pathologist was unable to determine the specimen that had been gripped due to either absence of damage (four cases), or severe inflammation precluding assessment (two cases). The ability of the pathologist to distinguish the sample from the control specimen was significant (chi-squared test, P = 0.003). Of the histological markers of crushed tissue injury, focal thinning of the gall bladder wall and epithelial loss were present in significantly more sample (gripped) specimens than control specimens (chi-squared test, P = 0.0002 and P < 0.0001, respectively). CONCLUSIONS: Laparoscopic graspers cause tissue trauma that can be assessed histologically. The current study presents a relevant, reproducible, ethically acceptable human model for assessing the interaction between laparoscopic graspers and soft tissues.

Antibiotics are associated with lower relapse rates in outpatients with acute exacerbations of COPD.

BACKGROUND: COPD is a complex disease with exacerbations characterized by worsening of symptoms resulting in deteriorating lung function. STUDY OBJECTIVE: To assess predictive factors of relapse for patients with acute exacerbations of COPD (AECB). DESIGN: Retrospective cohort analysis of visits for AECB. SETTING: Veterans Affairs Medical Center. PATIENTS: Three hundred sixty-two visits (173 patients) with documented COPD treated as outpatients for AECB. MEASUREMENTS: Severity of underlying COPD, severity of AECB, comorbid conditions, therapy, and relapse rates (return visit within 14 days with persistent or worsening symptoms). RESULTS: Each visit was analyzed individually (referred to as a patient-visit). One group received antibiotics (270 patient-visits), and the second group (92 patient-visits) did not. Both groups had similar demographics and severity of underlying COPD. The overall relapse rate was 22%. The majority of patient-visits (95%) with severe symptoms at presentation were prescribed antibiotics vs only 40% of those with mild symptoms. Twenty-nine of 92 patient-visits (32%) were followed by relapse in the group that was not given antibiotics, whereas only 50 of 270 (19%) treated with antibiotics relapsed (p < 0.001). Those treated with amoxicillin had an even higher relapse rate (20 of 37 patient-visits, or 54%) than those who did not receive antibiotics (p = 0.006). CONCLUSIONS: Relapse from AECB was not related to the severity of underlying disease or to the severity of the acute exacerbation. Patients treated with antibiotics had significantly lower relapse rates than those who did not receive antibiotics. However, the specific choice of antibiotic is important because those treated with amoxicillin had the highest relapse rates of all groups.

Sociodemographic factors in Health Psychology research: 12 years in review.

The article provides a 12-year review of health psychology research through a content analysis of the journal Health Psychology. Empirical studies of adults (n = 490) and children (n = 103) published between 1985-1996 were assessed with respect to information reported on race, income, education level, gender, and age characteristics of study participants. Although gender and age were usually reported, several studies did not provide race, income, or education information. However, time-trend analyses revealed significant improvements over the past few years in reporting of race, education, and age in articles on adults and in race reporting in articles on children.

Velocity profiles of lip protrusion across changes in speaking rate.

The effects of speaking rate manipulation were examined in the velocity profiles of anticipatory lip protrusion gestures. Systematic changes in the shape, symmetry, and smoothness of the velocity profiles were observed as speaking rate was modulated across a wide range of self-selected rates, from fast to slow. Velocity profiles of movements produced at slower than normal speaking rates demonstrated greater asymmetry, irregularity, and differences in geometric form, compared to a normal and faster-than-normal rates. Subjects evidenced both inter- and intrasubject variability in the accomplishment of lip protrusion and rate manipulations. These results indicate that the velocity profiles of lip protrusion gestures do not necessarily remain invariant across changes in speaking rate. Rather, the data suggest that distinct movement patterns may be generated for slow speaking rates, with select characteristics of the movement pattern being maintained across normal and fast speaking rates.

Evaluation of vocal function in unilateral vocal fold paralysis following thyroplastic surgery.

Perceptual, acoustic, and aerodynamic measures of vocal function were examined, pre- and post-treatment, in nine patients who had received thyroplastic (type I) surgery for unilateral vocal fold paralysis. Following thyroplasty, the patients showed significant improvements in the following perceptual and acoustic measures of vocal function: perceived breathiness, maximum phonation time, s/z ratio, vocal shimmer, and signal-to-noise ratio. Significant post-treatment changes were also observed in the following aerodynamic measures of phonation: air pressure, average airflow, laryngeal resistance, and breath group duration. These findings suggest that a combination of perceptual, acoustic, and aerodynamic measures of vocal function may be useful for comparing the relative effectiveness of different treatment procedures (i.e., thyroplasty vs. Teflon injection) in unilateral vocal fold paralysis.

Assessment of sexual beliefs and information in aging couples with sexual dysfunction.

The incidence and prevalence of sexual dysfunction indicate that a large portion of the U.S. population will experience a sexual dysfunction, with older individuals being particularly at risk. Cognitive factors (e.g., attitudes, misinformation, beliefs) may contribute to the development of sexual dysfunction or influence response to treatments. The purpose of the current study was to evaluate the psychometric properties of a brief instrument designed to assess information and beliefs regarding sexual functioning in an aging population. Results indicate that the Sexual Beliefs and Information Questionnaire (SBIQ) had adequate test-retest reliability and is an internally consistent measure of sexual knowledge and beliefs. MOst individuals had adequate knowledge regarding sexual functioning as indicated by correct responses to most items; however, there were several items missed more often than expected. Exploratory factor analysis suggests an underlying five-factor structure of the SBIQ. Scores were not correlated with years of education, mood, or marital satisfaction. Scores on the SBIQ improved after a brief standardized educational intervention. The SBIQ is a simple and psychometrically sound measure of sexual knowledge and myths that can assist clinicians to identify and possibly rectify knowledge deficits.

Prospective study of patients' subjective responses to botulinum toxin injection for spasmodic dysphonia.

Adductor spasmodic dysphonia (SD) is a speech disorder resulting from involuntary contractions of the laryngeal muscles. Botulinum toxin (BT) injection of the thyroarytenoid muscle is an effective, though temporary, treatment for most SD patients. Though there are reports of objective improvements in voice quality, there are no large studies of patients' subjective responses to treatment over time. In the present study, patients were given voice diaries to rate vocal spasms, hoarseness, breathiness, volume problems, and dysphagia before and the after treatment. Analysis of these diaries revealed that: (1) most side effects had resolved 4 to 6 weeks after injection, whereas vocal spasm relief persisted; (2) vocal spasm relief and severity of side effects peaked within 1 week; and (3) unilateral injections, though as effective in relieving vocal spasms, caused less volume and swallowing problems than did bilateral injections.

Effects of botulinum toxin type A injections on aerodynamic measures of spasmodic dysphonia.

The effects of botulinum toxin type A (BOTOX) injections on aerodynamic measures of phonation were examined in 30 patients with adductor spasmodic dysphonia. Patients received bilateral injections of 2.5 U of botulinum toxin type A in each thyroarytenoid muscle. Measures of air pressure, average airflow, coefficient of variation (CV) of airflow, and laryngeal resistance were obtained before the injections and at 2 and 10 weeks after the injections. These measures were also obtained from 12 normal subjects. Compared with normal subjects, the spasmodic dysphonia patients had significantly higher preinjection values for air pressure, CV of airflow, and laryngeal resistance. At 2 and 10 weeks after the botulinum toxin type A injections, the spasmodic dysphonia patients showed a significant increase in the average airflow values and a significant decrease in the CV of airflow values and the laryngeal resistance values. At 10 weeks after the injections, the values for the three measures began to approach the preinjection values. It is concluded that these aerodynamic measures of phonation can provide useful measures of treatment outcome in adductor spasmodic dysphonia.

Comparison of botulinum toxin injection procedures in adductor spasmodic dysphonia.

This study compares the effects of unilateral and bilateral thyroarytenoid muscle injections of botulinum toxin in 50 patients with adductor spasmodic dysphonia. Patients were randomly assigned to two treatment groups of 25 patients each and a group of 15 normal control subjects was also included. Using a standard electromyographic guidance procedure, one patient group received unilateral thyroarytenoid muscle injections of 15 units of botulinum toxin, while the second patient group received bilateral thyroarytenoid muscle injections of 2.5 units of botulinum toxin on each side. Follow-up data were obtained at 2- and 6-week intervals. Acoustic and perceptual measures of vocal performance included maximum phonation time, fundamental frequency, standard deviation of fundamental frequency, jitter, shimmer, signal/noise ratio, voice break frequency, spasm severity rating, and vocal breathiness rating. Unilateral and bilateral group comparisons at 2-weeks postinjection revealed no significant difference on any of the measures examined. At 6-weeks postinjection, maximum phonation time was significantly lower in the bilateral group. All other measures failed to differentiate the two patient groups. These results suggest that standard unilateral and bilateral botulinum toxin injections provide equivalent degrees of improvement in the symptoms of spasmodic dysphonia. However, bilateral injections appear to be associated with a longer period of excessive phonatory airflow than do unilateral injections.

Effect of neuromuscular activity on the response to botulinum toxin injections in spasmodic dysphonia.

Spasmodic dysphonia (SD), a neurologic disorder characterized by involuntary vocal spasms during speech, has been effectively treated by injections of botulinum toxin (BT) into the laryngeal muscles. The aim of the present study was to determine if the therapeutic response to BT is enhanced by immediate and continuous activation of the injected muscles. Twenty SD patients were randomized into two groups following bilateral injections: vocal rest for 30 minutes and continuous vocalization for 30 minutes. Evaluations consisted of voice ratings by expert observers, acoustic measurements using computer analyses, and laryngeal aerodynamic measurements. The findings suggest that vocal rest, rather than vocalization, produces a superior and longer lasting response in SD patients receiving BT injections. It is recommended that SD patients refrain from post-injection vocalization to maximize the therapeutic effects of BT.

Laryngeal image analysis following botulinum toxin injections in spasmodic dysphonia.

The injection of botulinum toxin (BT) into laryngeal muscles has proven to be an effective treatment for spasmodic dysphonia (SD), a neurologic disorder characterized by intermittent vocal spasms during speech. BT treatment has reduced abnormal laryngeal muscle hyperactivity in SD patients, when measured by subjective visual rating scales. This paper utilizes images obtained from endoscopic laryngeal video recordings to quantify changes in pre- and post-injection parameters of 17 patients following bilateral BT injections. A previous study, utilizing perceptual, acoustic, and laryngeal aerodynamic measures, showed significant improvements following treatment with BT. In addition, post-injection vocal rest, rather than vocalization, enhanced therapeutic responses. Results of these measures are compared with data from the image analyses and those parameters that proved to be the most useful are highlighted.

Dangerousness: assessing the risk of violent behavior.

Results of discriminant analyses for identifying dangerous inpatients and prison inmates are presented. Analysis of a hospital sample (N = 100) yielded a discriminant function containing 5 variables, which was 85% accurate in classifying the sample. Analysis of a prison sample (N = 100) yielded a discriminant model with 6 variables, which was 72% accurate in classifying the sample. Stepwise discriminant analysis of the combined hospital and prison derivation sample (N = 200) yielded a discriminant function containing 8 variables, which was 75% accurate in classifying the sample as dangerous or nondangerous. It was concluded that the derived population-specific (i.e., hospital or prison) models constitute empirically valid measures of dangerousness for the populations studied.

Stress, depression, and anxiety predict average symptom severity and daily symptom fluctuation in systemic lupus erythematosus.

Forty-one subjects diagnosed with systemic lupus erythematosus (SLE) were recruited from across the United States. Regressions were conducted to evaluate the relation among stress, depression, anxiety, anger, and SLE symptom complaints. Negative weighting of major life events predicted symptom history. Significant hierarchical regressions using negative weighting of major life events, impact of daily stress, depression, anxiety, and anger were found for severity of joint pain, abdominal distress, and rash. Analyses using 1-day-lagged predictors yielded similar results. Within-subject analyses suggested that there was much individual variability in the strength of the stress-illness relation. Thus, some individuals appeared to be stress responders, while others did not. Findings for impact of minor life events and depression were consistent across the different levels of analyses. It was concluded that stress, depression, anxiety, and anger are associated with, and may exacerbate, self-reported symptomatology of SLE patients.

Predicting medication compliance in a psychotic population.

The compliance level of 42 acutely psychotic inpatients was assessed using a locally constructed standard interview and written questionnaire. Subjects rated their level of compliance and indicated variables that were associated with compliance and noncompliance. Reliable items from the written questionnaire were grouped into five categories: side effects, difficulties obtaining medication, reinforcement for not taking medication, symptom relief, and indirect benefits. A stepwise multiple regression indicated that indirect benefits accounted for 18% of the variance in the self-report measure of compliance. It was concluded that psychotic patients who recognize benefits that are secondary to symptom relief are more likely to comply with their medication regimen. The results suggest a need for research on variables associated with noncompliance and potential treatment interventions.