Body image in patients with somatoform disorder.

BACKGROUND: Although body-related problems are common in patients with somatoform disorder, research focusing on how patients with somatoform disorder perceive and evaluate their body is scarce. The present study compared differences in body image between patients with somatoform disorder and respondents from a general population sample. It also examined differences within the somatoform disorder group between men and women and between the diagnostic subgroups conversion disorder, pain disorder and undifferentiated somatoform disorder. METHODS: Data were obtained from 657 patients (67.5% female) with somatoform disorder (DSM-IV-TR 300.7, 300.11, 300.81, 300.82) and 761 participants (58.6% female) from the general population. The Dresden Body Image Questionnaire (DBIQ) was used to assess body image in five domains: body acceptance, vitality, physical contact, sexual fulfilment, and self-aggrandizement. Confirmatory factor analysis and analyses of variance were performed. Since differences in age and sex were found between the somatoform disorder sample and the comparison sample, analyses were done with two samples of 560 patients with somatoform disorder and 351 individuals from the comparison sample matched on proportion of men and women and age. RESULTS: Patients scored significantly lower than the comparison sample on all DBIQ domains. Men scored higher than women. Patients with conversion disorder scored significantly higher on vitality and body acceptance than patients with undifferentiated somatoform disorder and pain disorder. CONCLUSIONS: The mostly large differences in body image between patients with somatoform disorder and the comparison sample as well as differences between diagnostic subgroups underline that body image is an important feature in patients with somatoform disorder. The results indicate the usefulness of assessing body image and treating negative body image in patients with somatoform or somatic symptom disorder.

Written information material and availability of sexual health care for men experiencing sexual dysfunction after prostate cancer treatment: An evaluation of Dutch urology and radiotherapy departments.

Objective was to investigate content of written information material and availability of sexual health care for men experiencing sexual dysfunction (SD) after prostate cancer treatment. A cross-sectional survey was conducted among Dutch urology and radiotherapy departments to evaluate information materials and availability of sexual health care. Out of 71 eligible departments, 34 urology and 15 radiotherapy departments participated in the survey (response rate 69.0%). Fifty-nine brochures corresponding to 31 urology and 11 radiotherapy departments were analysed. In 88.1% of collected information material, sexual health was mentioned. Regarding extensiveness, 20.4% of the brochures contained extensive information, 50.8% moderate amount of information and 28.8% contained little or no information. Urology departments provided pre-treatment nurse consultations more often than radiotherapy departments. Sexual counselling was more frequently provided by urology departments. Urology departments were more aware of adequate referral possibilities. Information material provided by Dutch urology and radiotherapy departments does not address treatment-related SD routinely. Sexual health care is not available everywhere for men experiencing SD. Applying a standard regarding content of sexual health in information material is recommended as well as improved awareness of referral possibilities and enhanced provision of pre-treatment nurse consultations for men experiencing SD after prostate cancer treatment.

Reshuffling of Aspergillus fumigatus cell wall components chitin and ß-glucan under the influence of caspofungin or nikkomycin Z alone or in combination.

Chitin and ß-glucan are major cell wall components of Aspergillus spp. We investigated the antifungal activity of chitin synthesis inhibitors nikkomycin Z, polyoxin D, flufenoxuron, lufenuron, and teflubenzuron, alone and combined with the ß-glucan synthesis inhibitor caspofungin. Only nikkomycin Z and caspofungin were found to act synergistically. The nikkomycin Z-induced chitin decrease corresponded with a ß-glucan increase, while with the caspofungin-induced ß-glucan decrease, an increase in chitin was found. This could explain the synergistic activity of this combination of drugs.

Intravesical protrusion of giant median prostatic lobe: A case report.

Benign prostatic hyperplasia (BPH) is a common disease in ageing men and the result of unregulated hyperplastic growth of the epithelial and stromal tissues of the prostate. Intravesical prostatic protrusion (IPP) of the median lobe is a phenomenon of overgrowth of the prostate adenoma into the bladder and associated with an increased risk for lower urinary tract symptoms (LUTS). This article reports an unusual case of severe intravesical protrusion of a giant median prostatic lobe in 85 years old male with progressive LUTS.

An extremely rare case of pseudomelanosis of the urinary bladder.

Pseudomelanosis (PM) is a rare, benign, condition that is characterized by deposition of melanin and/or melanin-like pigment in mucosal cells and macrophages and is best known as the entity pseudomelanosis coli. Pseudomelanosis primary of the urinary bladder has been reported only in a handful of cases worldwide. This article reports an extremely rare case of pseudomelanosis of the urinary bladder in a 79-year-old male with a history of macroscopic painless hematuria.

Body attitude, body satisfaction and body awareness in a clinical group of depressed patients: An observational study on the associations with depression severity and the influence of treatment.

BACKGROUND: Apart from changes in mood and cognition, depressive disorders are also characterized by changes in body experience, changes that largely influence daily functioning and aggravate distress. In order to gain more insight into this important issue, three domains of body experience - body attitude, body satisfaction and body awareness - and their associations with symptom severity of depression were studied pre- and post-treatment in a clinical sample of depressed patients in a multidisciplinary setting. METHODS: Body attitude (Dresden Body Image Questionnaire), body satisfaction (Body Cathexis Scale), body awareness (Somatic Awareness Questionnaire) and severity of depressive symptoms (Inventory of Depressive Symptomatology) were measured. Differences between pre-treatment and post-treatment scores were studied with paired t-tests. Associations between body experience and depression were analysed with Pearson correlations and partial correlations. RESULTS: At the start of treatment, patients scored significantly lower than a healthy comparison sample on body attitude and body satisfaction, but not on body awareness. After treatment, depression scores decreased with large effect sizes, scores for body attitude and body satisfaction increased with medium effect sizes and body awareness scores increased slightly. Medium pre-treatment and strong post-treatment associations were found between depression severity and body attitude and between depression severity and body satisfaction. LIMITATIONS: The design does not allow to draw causal conclusions. Because of the multidisciplinary treatment no information is available on the specific contribution of interventions targeting body experience. CONCLUSIONS: The study provides evidence for medium to strong associations in clinically depressed patients between body attitude, body satisfaction and depression.

Development of the interval endurance capacity in elite and sub-elite youth field hockey players.

OBJECTIVES: To gain more insight into the mechanisms that underlie the development of interval endurance capacity in talented youth field hockey players in the 12-19 age band. METHODS: A total of 377 measurements were taken over three years. A longitudinal model for interval endurance capacity was developed using the multilevel modelling program MLwiN. With the model, scores on the interval shuttle run test can be predicted for elite and sub-elite male and female field hockey players aged 12-19 years. RESULTS: A polynomial model of order 2 adequately represents development of the test scores over time. The fixed part of the model contains a different intercept and linear age term for boys and girls, and a common quadratic term; the random part of the model has a common level 2 variance and sex specific level 1 variances. The model was significantly improved by including differential effects of performance level for age and sex. A negative effect was found for percentage body fat, and positive effects for additional training and motivation. CONCLUSIONS: During adolescence, both male and female elite hockey players show a more promising development pattern of interval endurance capacity than sub-elite youth players. Percentage body fat, additional training hours, and motivation influence this development. However, differences between the individual players are still considerable.

Normal values of patellar and ankle tendon reflex latencies.

The clinical value of latency measurement of tendon reflexes in neurological patients has been reported by several authors. However, normal values are not readily comparable. In the present study, latencies and amplitudes of patellar (PTR) and ankle tendon reflexes (ATR) were measured at rest and after facilitation in 102 normal controls. A manually operated reflex hammer, tipped with electrically conductive rubber, ensured an immediate start of the sweep of the oscilloscope. Latencies showed a significant correlation with height (r = 0.70 for PTR and r = 0.72 for ATR, P < 0.0001) and to a lesser degree with age (r = 0.16 and r = 0.30, P < 0.0001). While amplitudes were highly variable, rendering them less useful for diagnostic purposes, latencies showed minimal intra-individual variability (CV 1.5 and 0.8%, respectively). Correlation of ATR-latency with the H-reflex latency of the soleus muscle was very high (r = 0.97, P < 0.0001). Comparison with three other hammer types yielded corresponding results with a hammer supplied with a piezo-electric element; however, significantly shorter latencies were found with a hammer with a microswitch, and with another hammer with a spring-contact, due to a delay from the tap on the tendon until the start of the sweep of the monitor.

Mechanical efficacy of the mobilising cervical support device (Mbrace).

This study evaluated the mechanical efficacy of a new "mobilising" cervical support device. This device has been developed in response to the requirements of whiplash patients to overcome the problems of heat and immobilisation which can occur in patients wearing conventional wrap-around cervical collars. All planes of cervical range of motion of 21 volunteer subjects without current or past cervical dysfunction were measured actively and passively under two conditions (no support and with cervical support) using the cervical range of motion (CROM) instrument. The results show that the mobilising cervical support device restricts hyperextension effectively while allowing substantial movement in other planes of motion (flexion, rotation and lateral bending). This potential mobility keeps nearly all muscles in the neck fit and problems of muscle atrophy, weakness and contraction, which can occur in patients using conventional cervical wrap around collars, can be avoided. Regarding mechanical efficacy, the mobilising cervical support device can be useful in the (early) mobilisation phase in patients needing gentle neck support after a soft tissue hyperextension or whiplash injury.

Barriers for early return-to-work of workers with musculoskeletal disorders according to occupational health physicians and human resource managers.

Recent studies have indicated positive effects of modified work for workers with musculosceletal complaints. The question remains how effectively modified work can be implemented in companies. This study describes barriers for introducing modified work for workers on sickness absence due to musculoskeletal complaints. Modified work was defined as gradually increasing the physical demands at work until the worker is ready for full duty in his regular job. In order to describe barriers in implementation of modified work, a model based on health education was used, consisting of six successive stages. A questionnaire derived from this model was sent to human resource managers of different companies and their occupational health physicians. The internal consistency was estimated with the Cronbach's alpha. The results showed a large number of barriers for modified work. According to 52% of the company management and 54% of the occupational health physicians evident barriers were found due to lack of knowledge on modified work and negative attitudes of the employees. Both companies and physicians reported a barrier in the possibilities to change the work tasks (45-54%) or the organization of the work (45-38%). About 62% of the companies reported barriers due to a mismatch between the education of the sick worker and the specific requirements of modified work. Despite the assumed positive effects of modified work, the implementation process is hampered by a large number of barriers. A maximum effort from all parties involved is required for a successful rehabilitation process.

Effects of genetic screening on perceptions of health: a pilot study.

The aim of the current study was to determine how carriers of a recessive gene, which confers no risk to their own health, perceive their health, relative to non-carriers. Perceptions of health in three groups were compared: those screened and found to carry the gene for Tay-Sachs disease, those screened and not found to carry the gene for Tay-Sachs disease, and a community based sample who, it was presumed, had not undergone screening. The groups did not differ in their perceptions of their current health or their past health. Carriers, however, viewed their future health with less optimism than the other two groups. The causes and consequences of this altered perception need to be explored in future studies. With the advent of population based screening for cystic fibrosis carrier status, these results highlight the importance of assessing in detail people's experiences of screening before the introduction of any mass genetic screening programmes.

Influence of caffeine and caffeine withdrawal on headache and cerebral blood flow velocities.

Caffeine consumption may cause headache, particularly migraine. Its withdrawal also produces headaches and may be related to weekend migraine attacks. Transcranial Doppler sonography (TCD) has shown changes in cerebral blood flow velocities (BFV) during and between attacks of migraine. In order to examine whether headache and changes in BFV could develop from controlled caffeine alterations, 20 healthy volunteers without a headache history, underwent clinical evaluation, TCD and serum caffeine measurements on four occasions, comparing conditions of regular caffeine intake, caffeine withdrawal and "re-caffeination". After 24 h of complete caffeine abstinence, 10 suffered from moderate to severe headaches with complete recovery within 1 h after caffeine intake. The BFVs in both middle cerebral, both posterior cerebral and basilar arteries were higher following the withdrawal period, reaching statistical significance in the left middle cerebral basilar and both posterior cerebral arteries. BFVs decreased significantly within half an hour after caffeine intake in all subjects, and were similar to baseline values after 2 h. Our results emphasize the relationship between caffeine withdrawal, the development of headache and alterations in cerebral blood flow velocities. Also, these findings indicate that accurate interpretation of TCD measurements should account for the influence of caffeine on BFVs.

The ascorbate: ascorbate free radical oxidoreductase from the erythrocyte membrane is not cytochrome b561.

Erythrocytes contain a plasma membrane redox system that can reduce extracellular ascorbate radicals by using intracellular ascorbate as an electron donor. In this study, the hypothesis was tested that cytochrome b561 was a component of this system. Spectroscopic analysis of erythrocyte membrane preparations revealed the presence of cytochrome b5 and hemoglobin but also of a cytochrome with properties similar to cytochrome b561, reducible by ascorbate and insensitive to CO. The presence of cytochrome b561 was studied further by reverse transcriptase-PCR analysis of erythrocyte progenitor cells, reticulocytes. However, no cytochrome b561 mRNA could be found. These results were corroborated by Western blot analysis with an anti-cytochrome b561 serum. No cytochrome b561 protein could be detected in extracts of erythrocyte membranes. It is therefore concluded that erythrocytes do not contain cytochrome b561 in their membranes. The possible involvement of other b-cytochromes in ascorbate-ascorbate free radical oxidoreductase activity is discussed.

Ascorbate stimulates ferricyanide reduction in HL-60 cells through a mechanism distinct from the NADH-dependent plasma membrane reductase.

The impermeable oxidant ferricyanide is reduced by the plasma membrane redox system of HL-60 cells. The rate of reduction is strongly enhanced by ascorbate or dehydroascorbate. The aim of this study was to determine the mechanism by which ascorbate and dehydroascorbate accelerate ferricyanide reduction in HL-60 cells. Addition of ascorbate or dehydroascorbate to cells in the presence of ferricyanide led to the intracellular accumulation of ascorbate. Control experiments showed that extracellular ascorbate was rapidly converted to dehydroascorbate in the presence of ferricyanide. These data suggest that intracellular ascorbate originates from extracellular dehydroascorbate. Accumulation of ascorbate was prevented by inhibitors of dehydroascorbate transport into the cell. These compounds also strongly inhibited ascorbate-stimulated ferricyanide reduction in HL-60 cells. Thus, it is concluded that the stimulation of ferricyanide reduction is dependent on intracellular accumulation of ascorbate. Changing the alpha-tocopherol content of the cells had no effect on the ascorbate-stimulated ferricyanide reduction, showing that a nonenzymatic redox system utilizing alpha-tocopherol was not involved. p-Chloromercuribenzenesulfonic acid strongly affected ferricyanide reduction in the absence of ascorbate, whereas the stimulated reaction was much less responsive to this compound. Thus, it appears that at least two different membrane redox systems are operative in HL-60 cells, both capable of reducing ferricyanide, but through different mechanisms. The first system is the ferricyanide reductase, which uses NADH as its source for electrons, whereas the novel system proposed in this paper relies on ascorbate.