Practical Overview of 123I-Ioflupane Imaging in Parkinsonian Syndromes.

Parkinsonian syndromes are a heterogeneous group of progressive neurodegenerative disorders involving the nigrostriatal dopaminergic pathway and are characterized by a wide spectrum of motor and nonmotor symptoms. These syndromes are quite common and can profoundly impact the lives of patients and their families. In addition to classic Parkinson disease, parkinsonian syndromes include multiple additional disorders known collectively as Parkinson-plus syndromes or atypical parkinsonism. These are characterized by the classic parkinsonian motor symptoms with additional distinguishing clinical features. Dopamine transporter SPECT has been developed as a diagnostic tool to assess the levels of dopamine transporters in the striatum. This imaging assessment, which uses iodine 123 (123I) ioflupane, can be useful to differentiate parkinsonian syndromes caused by nigrostriatal degeneration from other clinical mimics such as essential tremor or psychogenic tremor. Dopamine transporter imaging plays a crucial role in diagnosing parkinsonian syndromes, particularly in patients who do not clearly fulfill the clinical criteria for diagnosis. Diagnostic clarification can allow early treatment in appropriate patients and avoid misdiagnosis. At present, only the qualitative interpretation of dopamine transporter SPECT is approved by the U.S. Food and Drug Administration, but quantitative interpretation is often used to supplement qualitative interpretation. The authors provide an overview of patient preparation, common imaging findings, and potential pitfalls that radiologists and nuclear medicine physicians should know when performing and interpreting dopamine transporter examinations. Alternatives to 123I-ioflupane imaging for the evaluation of nigrostriatal degeneration are also briefly discussed. ©RSNA, 2024 Test Your Knowledge questions for this article are available in the supplemental material. See the invited commentary by Intenzo and Colarossi in this issue.

Decision-Making for HIV AIDS Prevention: Altruism and the Moral Norm.

The purpose of this enquiry was to understand how gay men form and maintain their attitudes toward HIV transmission preventative behaviors. Autobiographical life histories of sixteen gay men showed that once they acquired knowledge of preventative behavior they consistently adhered to that behavior. They adhered because of fear of HIV infection and because they held a moral norm that obligated them to behave altruistically (Schwartz, 1977) to protect not only themselves, but also their sex partners, loved ones, and their positive self-evaluation. They saw their HIV negative status, and their adherence, as pre-requisite and enabler for achieving their goals in life. Dick and Basu's (1994) Framework for Customer Loyalty, a commercial marketing communications theoretical framework, explains development and maintenance of these men's loyalty (their consistent adherence). This understanding, within a marketing communications framework, will inform development of social marketing communications aiming to increase adherence to behaviors that prevent HIV transmission.

Negative health impact of tourists through pandemic: hospitality sector perspective.

Although the impact of tourism development on residents has received a lot of attention in the literature, the health impact of tourism has not been sufficiently addressed. Due to outbreaks of COVID-19, the importance of recognition of the negative health impact of tourism is relevant. Thus, the present study aims to identify the health impact of tourism through COVID-19 outbreaks considering residents' perspectives. In the current research, we gathered data from semi-structured interviews conducted from 10th August to 30 August 2020 to investigate community perception regarding the negative health impact of tourism through the COVID-19 era. We conducted 30 interviews with some Iranian residents. Data is analyzed by thematic analysis via MAXQDA software. Residents perceived negative health impacts through COVID-19 outbreaks as containing three subthemes including general negative impacts, direct negative impacts, and indirect negative impacts. The results also show that residents use two coping strategies to face these negative health impacts, namely negative coping strategies and positive coping strategies. Perceived negative health impacts, and residents' coping strategies are two major themes regarding Iranian residents' perception toward tourism negative health impacts through COVID-19 outbreaks.

Historical loss: Implications for physical activity levels in American Indian adults.

PURPOSE: To investigate the relationship between daily thoughts about historical loss and daily levels of moderate to vigorous physical activity (MVPA) in American Indian (AI) adults residing on the Blackfeet reservation in Browning, Montana. METHODS: The study was designed and conducted using a community-based participatory research framework and ecological momentary assessment. Over a period of 1 week, 100 AI adults (mean age = 42.18, SD = 14.92) reported how often they thought about historical loss at the end of each day. During this week-long period, all participants wore a wrist-accelerometer to passively and objectively measure levels of physical activity. FINDINGS: We found that Blackfeet AI adults who reported thinking about historical loss more frequently over the course of the week had lower average levels of MVPA over the course of the week compared to Blackfeet AI adults who reported thinking about historical loss less frequently (B = -10.22, 95% CI = -13.83, -6.60). We also found that on days when Blackfeet AI adults thought more about historical loss compared to their weekly average, they had fewer minutes of MVPA compared to their weekly average of minutes of MVPA (B = -0.87, 95% CI = -1.48, -0.27). CONCLUSIONS: Our data indicate that thoughts about historical loss are linked to lower levels of MVPA. Given high incidence of chronic health conditions linked to physical inactivity in AIs, more work is needed to identify the mechanisms through which thoughts about historical loss may inhibit physical activity in this population.

Emotion Regulation Strategies Relate to Ambulatory Cardiovascular Activity in an American Indian Community.

OBJECTIVE: Poor emotion regulation is associated with risk for cardiovascular disease. However, much of this research is conducted in primarily White samples, thus limiting our understanding of this relationship in other racial/ethnic groups. American Indians (AIs) are uniquely and disproportionately at risk for cardiovascular disease. As such, the present study aimed to examine the relationships between emotion regulation strategies and ambulatory cardiovascular activity in an entirely AI sample. METHODS: The sample consisted of 100 AI adults living on a tribal reservation. Emotion regulation strategies (expressive suppression, cognitive reappraisal) were assessed via the Emotion Regulation Questionnaire. Using ecological momentary assessment, daily measurements of psychological stress and ambulatory cardiovascular activity were taken during a 7-day monitoring period. Statistical analyses included bivariate correlations, hierarchical linear regression models, and mediation models. RESULTS: Expressive suppression was associated with higher systolic and diastolic blood pressure, as well as higher pulse rate. In contrast, cognitive reappraisal was associated with lower systolic and diastolic blood pressure, lower pulse rate, and lower average daily psychological stress. These results remained statistically significant after adjusting for age, sex, body mass index, anxiety, depression, and early life trauma. In addition, psychological stress mediated the associations between blood pressure and cognitive reappraisal, but not expressive suppression. CONCLUSIONS: These results provide preliminary evidence for divergent associations of two emotion regulation strategies with cardiovascular activity and psychological stress in an AI community. Modifying health interventions to include training in effective emotion regulation may be beneficial.

COVID-19 and food insecurity in the Blackfeet Tribal Community.

To examine the impact of the COVID-19 pandemic on food insecurity in the Blackfeet American Indian Tribal Community. American Indian adults residing on the Blackfeet reservation in Northwest Montana (n = 167) participated in a longitudinal survey across 4 months during the COVID-19 pandemic (August 24, 2020- November 30, 2020). Participants reported on demographics and food insecurity. We examined trajectories of food insecurity alongside COVID-19 incidence. While food insecurity was high in the Blackfeet community preceding the pandemic, 79% of our sample reported significantly greater food insecurity at the end of the study. Blackfeet women were more likely to report higher levels of food insecurity and having more people in the household predicted higher food insecurity. Longitudinal data indicate that the COVID-19 pandemic exacerbated already high levels of food insecurity in the Blackfeet community. Existing programs and policies are inadequate to address this public health concern in AI tribal communities.

Historical Loss: Implications for Health of American Indians in the Blackfeet Community.

BACKGROUND: Historical loss in American Indians (AIs) is believed to contribute to high incidence of mental health disorders, yet less is known about the associations between historical loss and physical health. PURPOSE: To investigate whether frequency of thought about historical loss predicts risk factors for chronic physical health conditions in an AI community. METHODS: Using Community Based Participatory research (CBPR) and Ecological Momentary Assessment (EMA), we measured frequency of thoughts about historical loss in 100 AI adults residing on the Blackfeet reservation. Participants completed a 1-week monitoring period, during which ambulatory blood pressure and daily levels of psychological stress were measured. At the end of the week, we collected a dried blood spot sample for measurement of C-reactive protein (CRP). RESULTS: In hierarchical linear regression models controlling for demographics and relevant covariates, greater frequency of thoughts about historical loss predicted higher average daily psychological stress (B = .55, t = 6.47, p < .001, ΔR2 = .30) and higher levels of CRP (B = .33, t = 3.93, p < .001, ΔR2 = .10). Using linear mixed modeling with relevant covariates, we found that greater thoughts about historical loss were associated with higher systolic ambulatory blood pressure (B = .32, 95% CI = .22-.42, t = 6.48, p < .001, ΔR2 = .25; Fig. 1c) and greater diastolic ambulatory blood pressure (B = .19, 95% CI = .11-.27, t = 4.73, p < .001, ΔR2 = .19). CONCLUSIONS: The data suggest that frequency of thought about historical loss may contribute to increased subclinical risk for cardiovascular disease in the Blackfeet community.

Covid-19 and changes in sleep health in the Blackfeet Community.

We examined changes in psychological outcomes related to the COVID-19 pandemic (ie psychological stress, perceived control, and perceived ability to cope) and changes in sleep health in the American Indian Blackfeet community over 4 months (August 24, 2020-November 30, 2020). American Indian adults residing on the Blackfeet reservation (n = 167) completed measures of perceived control over contracting COVID-19, perceived ability to cope with pandemic stressors, psychological stress linked to the pandemic, and a measure of sleep health each month. Linear-effects mixed models were used to examine changes in our outcomes. Community members who reported more control over contracting the virus had better sleep health relative to those who reported less control (B = 0.72, SE = 0.29, p = 0.015). Further, during months when individuals felt they had more control over contracting the virus compared to their average perceived control levels, they had better sleep health relative to their own average (B = 1.06, SE = 0.13, p < 0.001). Average sleep health was the lowest in October, 2020, the month during which COVID-19 incidence was at its highest on the reservation. Declines in sleep health linked to low levels of control over contracting COVID-19 may exacerbate high incidence of chronic mental and physical health conditions in tribal communities. Interventions which highlight strategies known to reduce risk of contracting the virus, may increase perceived control and sleep health, and thus may improve downstream health outcomes for this at-risk population.

Loneliness and sleep in the American Indian Blackfeet community.

BACKGROUND: Sleep is largely understudied in American Indians (AIs), even though sleep is implicated in the chronic diseases which disproportionately affect AI communities. OBJECTIVE: To investigate relationships between daily self-reported loneliness and sleep as measured with actigraphy. METHODS: In a sample of 98 Blackfeet adults living on the Blackfeet reservation in Montana, we used Ecological Momentary Assessment and actigraphy over a week-long period to investigate relationships between loneliness and sleep. Loneliness was measured daily using the Short Loneliness Scale and actigraphy was used to measure total sleep time, sleep onset latency (SOL), wake after sleep onset (WASO), and sleep efficiency (SE). RESULTS: Using a series of generalized linear mixed-effects models controlling for demographic characteristics, anxiety and depressive symptoms, and adverse childhood experiences, we found that those who were lonelier had higher WASO and SOL, and lower SE relative to those who were less lonely. Within-subject effects indicate that participants who were lonelier for a given day relative to their own weekly average had higher WASO that night relative to their own weekly average. CONCLUSIONS: Our findings provide initial preliminary evidence suggesting that loneliness may be a psychosocial factor which contributes to poor sleep in AI communities.

Mental health message appeals and audience engagement: Evidence from Australia.

Social media platforms are increasingly used to disseminate social marketing messages about mental health and wellbeing. This study presents a range of message appeals used in social media enabled mental health promotion and stigma reduction messages. Furthermore, it examines the relationship between the type of message appeals and audience engagement. A content analysis of 65 organisation-generated YouTube videos about depression and anxiety and stigma reduction was conducted. The most utilised message appeal was Sorrow, followed by Affiliation, Ease/Convenience, Hope, Humour, Guilt/Shame, Heroic/Successful, and Fear. Multiple regression analysis was used to examine the relationship between the type of message appeals and audience engagement in terms of the number of likes, comments, and shares. The analysis revealed that Sorrow is the most useful message appeal for generating audience comments. However, Sorrow is negatively associated with the number of likes and shares. The results suggest that mental health promotion messages may engage a larger audience through Affiliation and Hope as they have a positive impact on the number of shares. This could, in effect, turn audiences into vocal advocates for mental health promotion and stigma reduction messages.

Technetium-99m pyrophosphate cardiac SPECT in endomyocardial biopsy negative cardiac amyloidosis.

Cardiac amyloidosis is an under-appreciated cause of heart failure. Establishing a diagnosis is important because traditional heart failure treatment regimens can worsen left ventricular failure in this disease. Endomyocardial biopsy is the gold standard for diagnosis; however, scintigraphy with radiolabeled phosphate derivatives and cardiac magnetic resonance imaging have been shown to have high sensitivity and specificity in diagnosing cardiac amyloidosis. Furthermore, cardiac scintigraphy can reliably differentiate amyloid subtypes. We present a case of transthyretin-related cardiac amyloidosis with a negative endomyocardial biopsy but positive 99m-technetium pyrophosphate single photon emission computed tomography scan and cardiac magnetic resonance imaging. We discuss the utility of 99m-technetium pyrophosphate imaging in cardiac amyloidosis and the role of single photon emission computed tomography. Finally, we review the several forms of cardiac amyloidosis and how they pertain to cardiac scintigraphy.

Intense 18F-FDG uptake in an organizing right atrial thrombus mimicking malignancy.

We present a case of an intensely hypermetabolic intracavitary cardiac mass, standardized uptake values max 44.4, that was pathologically proved to be organizing and organized thrombus, negative for tumor. Our patient had previous right atrial mass resection 2 years prior that was pathologically described as either thrombus or infarcted atrial myxoma. She had since been on lifelong controlled anticoagulation; and on routine follow-up imaging, she had recurrent slow growth of a new right atrial mass. During a later hospital admission for chest pain, the mass was evaluated on both transthoracic and transesophageal echo cardiogram, which could not differentiate thrombus vs neoplasm. Cardiac magnetic resonance imaging was equivocal for mass enhancement. The patient underwent fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) evaluation, which revealed intensely hypermetabolic activity within the mass concerning for malignancy, potentially an aggressive tumor. Subsequently, the mass was surgically excised for pathological diagnosis.

Indium-111 labeled leukocyte accumulation in extremity soft tissue sarcoma.

Nuclear medicine labeled leukocyte whole-body scintigraphy is commonly used to identify a source of infection in a patient with fever of unknown origin. White blood cells can also localize to other sites of inflammation, including sometimes tumors. A patient with a large myxofibrosarcoma in his left forearm was scanned due to chronic low-grade fever and persistent leukocytosis. This case demonstrates focal white blood cell activity in an extremity soft tissue sarcoma.

Delayed small bowel perforation following blunt abdominal trauma: A case report and review of the literature.

We report a case of delayed presentation of a small bowel perforation following blunt abdominal trauma (BAT). An initial computed tomography (CT) scan revealed that the patient (a 32-year-old man) had a mesenteric hematoma, which was managed conservatively. Four weeks later, he returned to the hospital complaining of abdominal pain. A CT scan of the abdomen showed a thickened loop of the small bowel adjacent to the mesenteric hematoma at the level of the ileum. He was discharged home, but re-presented with acute abdomen 6 weeks post-trauma. An exploratory laparotomy was performed, which showed a perforated thickened loop of the ileum forming a phlegmon in the lower abdomen. In the English medical literature, only eight other reports of delayed post-traumatic presentation of ileal/jejunal perforation following BAT have been reported. We propose that post-traumatic intestinal perforation be considered in the differential diagnosis even in patients who experience a delayed small bowel perforation following BAT.

What we know about management of traumatic abdominal wall hernia: review of the literature and case report.

Traumatic abdominal wall hernia (TAWH) is an uncommon form of hernia caused by blunt traumatic disruption of the abdominal wall musculature/fascia and abdominal organ herniation. Diagnosis of TAWH is challenging and requires a high level of suspicion. This form of hernia seems to be underrepresented in the English-language medical literature. There is currently no consensus on the optimal management for TAWH. In this article, we discuss the management of a 36-year-old motorcycle driver who was involved in a road traffic accident. On evaluation at our trauma center, he was found to have TAWH. Diagnostic criteria, imaging modalities and different management options for TAWH will be discussed.

Effectiveness of Choice Theory Connections: a cross-sectional and comparative analysis of California female inmates.

In the past 30 years, the rates of incarceration and recidivism for women in the United States have increased dramatically. Choice Theory® Connections (CTC) is a gender-tailored pre-release intervention program based on Choice Theory® (Glasser, 1999), and designed to achieve meaningful and sustainable cognitive and behavioral change. This evaluation examines CTC among 96 female participants in a California state prison enrolled in an introductory (n = 58) or advanced (n = 38) course. CTC significantly improved perceived stress, mindfulness, emotion regulation, impulsivity, and well-being on completion; effects were stronger for the introductory cohort, but significant effects also emerged for the advanced cohort. In addition, participants in the advanced cohort reported better scores at baseline, demonstrating the effects of prolonged engagement with the intervention. Results suggest that CTC can improve incarcerated women's well-being pre-release, a strong predictor of recidivism post-release. Further study and wider use of CTC are encouraged.

Frequency and clinical relevance of PET/CT incidentalomas.

RATIONALE AND OBJECTIVES: To assess the frequency of clinically significant incidental CT findings on PET/CT. MATERIALS AND METHODS: Reports of 345 cases of baseline standard skull base to thighs PET/CT exams done over the course of a 6 month period at an outpatient facility affiliated with a large tertiary care level 1 trauma medical center were retrospectively reviewed. Incidental CT findings were assigned a level of clinical significance on a scale of 1-5, from doubtful significance to very significant. CT findings already known from prior CT reports were not included. CT findings corresponding to PET findings were also excluded. A score of 3 or greater was considered significant and reportable. RESULTS: Out of 345 cases, 171 (50%) had a least one CT finding rated at or above a score of 3 on our scale of significance, while 96 (28%) were found to have at least one CT finding with score at or above 4, and 25 cases (7%) showed at least one CT finding rated 5. CONCLUSION: A substantial percentage of baseline PET/CT studies contain previously undiagnosed, significant incidental findings on the CT images.