Worry and rumination: do they prolong physiological and affective recovery from stress?

BACKGROUND: Anxiety and depression have been linked to repetitive negative self-regulation styles in the form of worry and rumination respectively. Following predictions of the metacognitive model [Wells, A., & Matthews, G. (1994). Attention and emotion: A clinical perspective. Hove: Erlbaum], the current study compared the effect on recovery from stress of three strategies: worry, rumination, and distraction using a stress exposure paradigm. It was predicted that worry and/or rumination would be associated with delayed recovery on physiological and/or self-report indices when compared to distraction. METHOD: Fifty-four participants were randomly assigned to one of the self-regulation conditions and then completed a modified version of the Trier Social Stress Test [TSST; Kirschbaum, C., Pirke, K. M., & Hellhammer, D. H. (1993). The "TSST" - A tool for investigating psychobiological stress responses in a laboratory setting. Neuropsychobiology, 28, 76-81. doi: 10.1159/000119004 ]. Skin conductance and negative affect (NA) measurements were obtained at six different time points. RESULTS: Skin conductance indicated a prolonged recovery in the rumination condition when compared with the distraction condition. Individuals in the worry condition reported an immediate-delayed recovery from stress marked by higher NA scores in comparison to the distraction condition. CONCLUSIONS: These findings may provide important insights into the effects of different forms of repetitive negative thinking on physiological and psychological recovery from stress. The different response patterns observed are discussed within the context of the metacognitive model.

Prevalence of respiratory symptoms at two time points in a population of children in Manchester--a cohort study.

OBJECTIVE: Although the prevalence of asthma and atopy has been noted to have increased in recent decades, patterns of asthma prevalence have, traditionally, been difficult to track. Most reports on trends in childhood asthma have been cross-sectional measuring the prevalence in cohorts of similar aged children at different time points. The aim of this paper is to report on the prevalence of symptoms in the same cohort at two separate time points. DESIGN: Retrospective cohort study. SETTING: Community-based study, Central Manchester. PARTICIPANTS: MANCAS1, study n=5086, participation n=2414. MANCAS2, study n=6338, participation n=1608. Children born in a hospital in Manchester within specified dates and still living or attending a school in Central Manchester were eligible for inclusion. Children on an 'at-risk' register or living with short-term carers were excluded. OUTCOME MEASURES: Data on respiratory symptoms were collected at two separate time points using parent completed questionnaires. RESULTS: Response rate for MANCAS1 was 47.5% and 25.4% for MANCAS2. There were 801 individuals for whom a response to both studies was received. There was a significant reduction in the prevalence of night cough (29.5% vs 18.3%, McNemar <0.01) and antibiotic use for respiratory infections (9.1% vs 4.3%, McNemar <0.01) between the two study time points. The prevalence of hay fever/eczema increased (41.6% vs 46.9%, McNemar <0.01) between the two studies. There was no significant difference in the prevalence of wheeze, exercise-induced wheeze or asthma medication. CONCLUSIONS: Although this report of respiratory symptom prevalence in the same population at two time points over a 7-year period shows a constant burden of asthma symptoms, there is some suggestion of variability in asthma symptom prevalence within the cohort as the children matured while the burden of allergy symptoms increased.

Temporal change in health-related quality of life: a longitudinal study in general practice 1999-2004.

BACKGROUND: In order to assess and plan for changing healthcare needs, the lack of available information regarding temporal changes in the health-related quality of life of a population must be addressed. AIM: This paper aims to describe such changes over 5 years in a general population. DESIGN OF STUDY: Longitudinal postal questionnaire study. SETTING: UK general practice. METHOD: This was a longitudinal postal questionnaire study in two general practice populations, using the generic instrument EQ-5D to measure health-related quality of life. Individuals were included if they responded to three postal surveys in 1999, 2001, and 2004 and there were three consecutive values of EQ-5D(index) available between 1999 and 2004. RESULTS: A total of 2498 subjects were included in the study. After adjustment for potential confounders (including ageing), health-related quality of life declined significantly over the observation period. The change in EQ-5D(index) was from 0.79 to 0.74 and for EQ-5D(vas) 76.8 to 73.3 (P for both trends <0.001). CONCLUSION: Health-related quality of life deteriorated in these populations over 5 years. In an era of improvements in mortality, this has important implications for the use of health-related quality of life data in healthcare planning and resource allocation.

Prevalence of respiratory symptoms, features of asthma, and characteristics associated with respiratory disease, in 6-11 year olds in Manchester.

AIMS: This paper describes the prevalence of respiratory symptoms, features of asthma, and characteristics associated with respiratory disease in 6-11 year old children in an historical cohort study. METHODS: The study included 5086 children, all born in the same maternity unit in the north west of England over a four-year period. The prevalence of respiratory symptoms, features of asthma, and characteristics associated with respiratory disease were determined by the use of parent-completed questionnaires. Skin prick tests were used to ascertain atopic status. RESULTS: The response was 47.5%. The prevalence of wheeze, asthma medication use and atopic sensitisation were 20.3%, 16.2% and 37.1% respectively. Wheeze and atopy were significantly more prevalent in boys (22.4% versus 17.9% and 43.0% versus 29.3%, respectively). CONCLUSIONS: This study identified a high prevalence of respiratory disease in this population and provides a baseline for monitoring trends in respiratory disease in 6-11 year old children.

Factors influencing the response to postal questionnaire surveys about respiratory symptoms.

BACKGROUND: Response rates to postal questionnaires have been falling in recent years. AIM: To examine factors affecting the response to five postal respiratory questionnaire surveys. DESIGN: Cross sectional study. SETTING: General practice. METHOD: Five surveys were conducted in all adults registered with two UK general practices using an ECRHQ-based questionnaire, with two reminders at 4-week intervals. RESULTS: Response rates declined over time (1993 - 71.2%; 1995 - 70.5%; 1999 - 65.5%; 2001 - 65.3%; 2004 - 46.9%). Age and gender of non-responders were available for 2001 and 2004: responders were older (mean 48.8 years vs 37.6, p<0.001; 50.5 vs 38.8, p<0.001) and more likely to be female (54.9% vs 44.9%, p<0.001; 55.3% vs 48.5%, p<0.001). The response rate was increased by 18% (2004) and 23% (2001) by the use of two reminders. Early responders were older and more likely to be females, but were less likely to smoke than late responders after reminders. There was no important association between respiratory symptoms and associated feature prevalence and stage of response. CONCLUSION: Declining response rates may represent reduced motivation and reluctance to share personal information. Qualitative exploration of late/non-response could help reduce bias when planning and analysing such surveys. The use of two reminders is an important factor in improving response.

Long term prognosis in preschool children with wheeze: longitudinal postal questionnaire study 1993-2004.

OBJECTIVES: To follow a population of preschool children with and without parent reported wheeze over a period of 6-11 years to determine prognosis and its important predictive factors. DESIGN: Longitudinal series of five postal surveys based on the international study of asthma and allergies in childhood questionnaire carried out between 1993 and 2004. SETTING: Two general practice populations, south Manchester. PARTICIPANTS: 628 children aged less than 5 years at recruitment and those with at least six years' follow-up data. MAIN OUTCOME MEASURES: Parent completed questionnaire data for respiratory symptoms and associated features. RESULTS: Of 628 children included in the study, 201 (32%) had parent reported wheeze at the first observation (baseline), of whom 27% also reported the symptom on the second occasion (persistent asthma). The only important baseline predictors of persistent asthma were exercise induced wheeze (odds ratio 3.94, 95% confidence interval 1.72 to 9.00) and a history of atopic disorders (4.44, 1.94 to 10.13). The presence of both predictors indicated a likelihood of 53.2% of developing asthma; if only one feature was present this decreased to 17.2%, whereas if neither was present the likelihood was 10.9%. Family history of asthma was not predictive of persistent asthma among children with preschool wheeze. CONCLUSION: Using two simple predictive factors (baseline parent reported exercise induced wheeze and a history of atopic disorders), it is possible to estimate the likelihood of future asthma in children presenting with preschool wheeze. The absence of baseline exercise induced wheeze and a history of atopic disorders reduces the likelihood of subsequent asthma by a factor of five.

The estimated prevalence of chronic obstructive pulmonary disease in a general practice population.

OBJECTIVE: To estimate the prevalence of chronic obstructive pulmonary disease (COPD) in a general practice population in the UK. METHOD: Four postal respiratory questionnaire surveys were carried out between 1993 and 2001. Subjects from the 2001 study were invited for spirometry if they were aged 30 years or more, had indicated that they were 'ever smokers' in any of the surveys, and/or had been considered to have likely obstructive airways disease on the basis of their replies to the 2001 questionnaire. RESULTS: 2646 subjects were invited for spirometry of whom 871 (32.9%) attended. Results were available for 825 participants. 163 of these subjects were categorised as having COPD. The estimated prevalence in the whole population was 4.1% with the highest prevalence (14.7%) in those aged 60-69 years. In those aged over 40 years it was 9.6%. CONCLUSION: This study suggests that the prevalence of COPD is much higher than the previous estimates of between 1 and 2%.

Is the prevalence of wheeze in children altered by neonatal BCG vaccination?

BACKGROUND: The prevalence of asthma and atopic disease has increased in recent decades, but precise reasons for this increase are unknown. BCG vaccination is thought to be among a group of vaccines capable of manipulating the immune system toward T(H)1 dominance and therefore reducing the likelihood of atopic disease. OBJECTIVE: The aim of this study was to determine the influence of neonatal BCG vaccination on the prevalence of wheeze in a large community population of children. METHOD: In a historical cohort study, a parent-completed questionnaire was used to identify the prevalence of wheeze in BCG-vaccinated and nonvaccinated children in Manchester, England. RESULTS: There were 2414 participants aged between 6 and 11 years. In a univariate analysis neonatal BCG vaccination was associated with a significantly lower prevalence of wheeze (odds ratio, 0.69; 95% CI, 0.55-0.86), and statistical significance was retained when the analysis was adjusted for potential confounders (odds ratio, 0.68; 95% CI, 0.53-0.87). CONCLUSION: These results demonstrate an association between asthma symptom prevalence and neonatal BCG vaccination, relating to a possible 27% reduction in prevalence, and are therefore of considerable public health importance. CLINICAL IMPLICATIONS: The capacity of neonatal BCG vaccination to reduce the prevalence of respiratory symptoms in children warrants further investigation.

Parent and child psychological factors in pediatric syncope and other somatic symptoms.

The authors examined associations among parental and child adjustment, child syncope, somatic, and school problems. Participants were children (N = 56) ages 7-18 years with syncope. Measures included syncope severity, parental distress, and children's internalizing symptoms. For children diagnosed negative for neurocardiogenic syncope (NCS), their fathers' and their own psychological symptoms were positively associated with the severity of syncope, whereas their mothers' functioning was negatively associated with the severity of syncope. Also, for the negative NCS group, fathers' psychological functioning was associated with children's nonsyncope somatic complaints but not with their school problems. For the positive NCS group, few significant father-child associations were found, but several significant positive associations were revealed between mothers' psychological symptoms and their children's syncope as well as somatic and school problems.

Gender and irritable bowel syndrome: the male connection.

BACKGROUND/GOALS: Irritable bowel syndrome is more common in women; and this is generally considered to be caused by increased susceptibility. However, the opposite possibility that being male might actually protect from the disorder in some way, has largely been ignored. We have noticed that men with IBS seem to display less masculine and more feminine qualities and it was the purpose of this study to confirm or refute this clinical observation. STUDY: Seventy consecutive male, secondary care outpatients fulfilling the Rome 1 criteria for irritable bowel syndrome and 70 controls completed a questionnaire to determine male and female-trait scores. In addition, all subjects were assessed using the hospital anxiety depression inventory. RESULTS: A highly significant reduction in male-trait scores was observed in the irritable bowel syndrome patients compared with controls (-10.5[-15.7,-5.2] P < 0.001). There were no differences between the groups with respect to female-trait scores. The prevalence of homosexuality was no different between patients and controls. CONCLUSION: Men with irritable bowel syndrome exhibit less male characteristics and it remains to be determined whether this is cause or effect. Whatever the explanation, this study adds another dimension to the role of gender in functional gastrointestinal disorders.

Expression of exogenous protein in the egg white of transgenic chickens.

Using a replication-deficient retroviral vector based on the avian leukosis virus (ALV), we inserted into the chicken genome a transgene encoding a secreted protein, beta-lactamase, under the control of the ubiquitous cytomegalovirus (CMV) promoter. Biologically active beta-lactamase was secreted into the serum and egg white of four generations of transgenic chickens. The expression levels were similar in successive generations, and expression levels in the magnum of the oviduct were constant over at least 16 months in transgenic hens, indicating that the transgene was stable and not subject to silencing. These results support the potential of the hen as a bioreactor for the production of commercially valuable, biologically active proteins in egg white.