Clinicopathological findings in and prognostic factors for domestic rabbits with liver lobe torsion: 82 cases (2010-2020).

OBJECTIVE: To document clinicopathologic findings in domestic rabbits with liver lobe torsion and identify prognostic factors. ANIMALS: 82 rabbits. PROCEDURE: Medical records of 4 institutions were reviewed to identify rabbits with an antemortem diagnosis of liver lobe torsion that were examined between 2010 and 2020. RESULTS: The prevalence of liver lobe torsion was 0.7% (82/11,402). In all 82 rabbits, the diagnosis was made by means of abdominal ultrasonography. Fifty (60.1%) rabbits underwent liver lobectomy, 23 (28%) received medical treatment alone, and 9 (10.9%) were euthanized or died on presentation. Overall, 32 (39%) rabbits died within 7 days of initial presentation and 50 (61%) survived. Seven-day survival rate did not differ significantly between medical treatment alone and surgical treatment. However, median survival time following medical treatment (530 days) was shorter than that following surgical treatment (1,452 days). Six of 14 rabbits had evidence of systemic inflammatory disease on necropsy. Rabbits with right liver lobe torsion were less likely to survive for 7 days than were those with caudate torsions (P = 0.046; OR, 3.27; 95% CI, 1.04 to 11.3). Rabbits with moderate to severe anemia were less likely to survive for 7 days than were rabbits that were not anemic or had mild anemia (P = 0.006; OR, 4.41; 95% CI, 1.55 to 12.51). Other factors associated with a decreased 7-day survival rate were high heart rate at admission (P = 0.013) and additional days without defecation after admission (P < 0.001). Use of tramadol was associated with an increased survival rate (P = 0.018). CLINICAL RELEVANCE: The prognosis for rabbits with liver lobe torsions was more guarded than previously described. Rabbits that underwent liver lobectomy had a longer median survival time than did rabbits that only received medical treatment.

Hepatic copper accumulates in ferrets with and without hepatobiliary disease.

OBJECTIVE: To determine hepatic copper concentrations and zonal distribution in ferrets with and without hepatobiliary disease, validate rhodanine-based qualitative copper scoring and digital copper quantification in ferret hepatic samples, and ascertain whether clinical features predicted copper accumulation. ANIMALS: 34 ferrets, including 7 with necroinflammatory disease, 5 with hepatocellular carcinoma, 13 with non-necroinflammatory disease, and 9 with no hepatobiliary disease. PROCEDURES: Rhodanine-based digital copper quantification was validated by use of liver dually measured by atomic absorption spectroscopy and digital scanning (R2 = 0.98). Clinical features and hepatic copper scores and concentrations (dry weight liver) were compared between groups. Zonal copper distribution was determined. RESULTS: Hepatic copper concentration was strongly correlated with copper scores (ρ = 0.88). Ferrets with hepatobiliary disease were significantly older and had significantly higher serum alkaline phosphatase and γ-glutamyltransferase activities and creatinine concentrations. Centrilobular copper accumulated in 23 of 34 (64%) ferrets with (n = 15) and without (8) hepatobiliary disease. Median copper concentrations were not significantly different between ferrets with and without hepatobiliary disease but were significantly higher within neoplastic hepatic tissue in ferrets with hepatocellular carcinoma. Hepatic copper concentrations exceeded feline (> 180 µg/g) and canine (> 400 µg/g) reference limits in 19 and 9 ferrets, respectively. Hepatic copper > 1,000 µg/g occurred in 5 ferrets with and 2 without hepatobiliary disease. Clinical features did not predict copper accumulation. CLINICAL RELEVANCE: Rhodanine-based digital copper quantification and qualitative copper scoring discerned liver copper accumulation in ferrets. Ferrets with and without hepatobiliary disease displayed a propensity for centrilobular hepatic copper accumulation of uncertain clinical importance. Clinical and clinicopathologic features could not exclusively implicate pathologic copper accumulation.

Development and Testing of a Sedation Scale for Use in Rabbits (Oryctolagus cuniculus).

In biomedical research, rabbits are commonly sedated to facilitate a variety of procedures. Developing a sedation assessment scale enables standardization of levels of sedation and comparisons of sedation protocols, and may help in predicting sedation level requirements for different procedures. The goal of this study was to develop a rabbit sedation assessment scale using a psychometric approach. We hypothesized that the sedation scale would have construct validity, good internal consistency, and reliability. In a prospective, randomized, blinded study design, 15 (8 females, 7 males) healthy 1-y-old New Zealand white rabbits received 3 intramuscular treatments: midazolam (0.5 mg/kg; n = 6); midazolam (1.5 mg/kg)-ketamine (5 mg/kg; n = 7); and alfaxalone (4 mg/kg)-dexmedetomidine (0.1 mg/kg)-midazolam (0.2 mg/kg; n = 3). One rabbit received 2 treatments. A sedation scale was developed by using psychometric methods, with assessment performed by 6 independent raters who were blind to treatment. Final sedation scale items included posture, palpebral reflex, orbital tightening, lateral recumbency, loss of righting reflex, supraglottic airway device placement, toe pinch, and general appearance. The scale showed construct validity, good to very good interrater reliability for individual items (6 raters; intraclass correlation coefficient, 0.671 to 0.940), very good intrarater reliability (5 raters; intraclass correlation coefficient, 0.951 to 0.987), and excellent internal consistency (Cronbach α, 0.947). The sedation scale performed well under the conditions tested, suggesting that it can be applied in a wider range of settings (different populations, raters, sedation protocols).

Intracoelomic Teratoma in an Eclectus Parrot (Eclectus roratus).

A 26-year-old, male eclectus parrot (Eclectus roratus) was presented to its primary care veterinarian for a 10-day history of increased respiratory effort, lethargy, and a single episode of regurgitation. Hepatomegaly, proventricular enlargement, cranial displacement of the ventriculus, and coelomic effusion were suspected based on a 1-view radiographic image, and the patient was referred for further evaluation. On presentation to the referral veterinary hospital, a distended coelom and dyspnea with abnormal respiratory sounds were abnormalities noted upon physical examination of the patient. The bird was hospitalized for supportive care, and diagnostic tests were performed. Initial radiographic images at the referral hospital revealed a large intracoelomic mass. A computed tomographic scan was performed; however, the origin of the mass could not be determined. A fine-needle aspirate and cytologic evaluation of the intracoelomic mass revealed a neoplastic process but no specific tissue type. Two days after presentation to the referral hospital, an exploratory coeliotomy to surgically resect the mass was attempted. The mass occupied most of the coelomic cavity, with multiple adhesions to internal organs. The mass was successfully resected; however, the patient destabilized and died despite resuscitation efforts. Histopathologic examination of submitted tissue from the mass with immunohistochemistry revealed mixed populations of neoplastic cells differentiated from 3 primordial germinal layers, confirming the diagnosis of teratoma. Teratomas appear to be a rare tumor in avian species but should be included in a list of differential disease diagnoses for abnormal tissue masses of unknown origin. Only 2 cases of teratomas have, to our knowledge, been reported in psittacine species.

Successful xenotransfusion in a domestic ferret with spontaneous hemoperitoneum using feline packed red blood cells.

OBJECTIVE: To describe the diagnosis, management, and outcome of a ferret with spontaneous hemoperitoneum with surgical intervention and xenotransfusion of type A feline packed red blood cells (pRBCs). CASE SUMMARY: A domestic ferret diagnosed with a spontaneous hemoperitoneum secondary to a hepatic mass received isotonic crystalloids, hypertonic saline, and an allogenic blood transfusion perioperatively. Postoperatively, the ferret developed progressive anemia and tachycardia refractory to fluid therapy and, given a lack of additional allogenic blood sources, received a xenotransfusion of feline pRBCs. The ferret was hospitalized for 4 days postoperatively and developed a presumed delayed transfusion reaction characterized by transient hyperbilirubinemia. At a 6-month recheck, the ferret was doing well clinically. NEW OR UNIQUE INFORMATION PROVIDED: This is the first reported case of successful xenotransfusion of feline pRBCs in a ferret. Although xenotransfusion of ferrets with feline blood products is not recommended as a routine procedure, it remains a viable option in critical situations in which ferret blood is unavailable.

Clinical characteristics and short-term outcomes for rabbits with signs of gastrointestinal tract dysfunction: 117 cases (2014-2016).

OBJECTIVE: To describe the clinical findings and short-term outcomes for rabbits with signs of gastrointestinal tract dysfunction or rabbit gastrointestinal syndrome (RGIS). ANIMALS: 117 client-owned rabbits. PROCEDURES: The electronic medical records database of a veterinary teaching hospital was searched to identify rabbits that were examined because of altered or absent food intake and decreased or absent fecal output between June 1, 2014, and June 30, 2016. For each rabbit, information extracted from the record included history of prior episodes of gastrointestinal tract dysfunction, signalment, physical examination and diagnostic test results, and outcome. RESULTS: 117 of the 484 (24%) rabbits examined at the hospital during the study period met the inclusion criteria and were enrolled in the study. Fifty-nine and 58 rabbits were managed on an inpatient and outpatient basis, respectively. Gastrointestinal stasis without overt obstruction was diagnosed for 43 rabbits on the basis of abdominal radiographic, ultrasonographic, or necropsy results. Many rabbits had concurrent disease and biochemical abnormalities. Fifteen, 18, and 84 rabbits died, were euthanized, and survived to hospital discharge, respectively. Rabbits that were hypothermic (rectal temperature, ≤ 36.6°C [97.9°F]) during the initial examination were 5 times as likely to die or be euthanized as were euthermic rabbits, after controlling for potential confounders. CONCLUSIONS AND CLINICAL RELEVANCE: Results indicated that the prognosis was generally good for rabbits with signs of RGIS unless they were hypothermic during initial examination. Prospective studies are warranted to further elucidate and characterize RGIS and assess the efficacy of various treatments and outcomes for affected rabbits.

Infraorbital Keratin Cyst in an Umbrella Cockatoo (Cacatua alba).

A 10-year-old, female umbrella cockatoo (Cacatua alba) was presented for evaluation of a mass at the right commissure of the beak, with associated right periorbital swelling. A feather cyst was suspected, based on history and the results of a computed tomography scan and fine-needle aspirate. The cyst was surgically debrided and removed. Histopathologic results confirmed an infraorbital keratin cyst, most likely originating from a feather follicle. To our knowledge, this is the first reported case of a periorbital keratin cyst in a bird.

Evaluation of gastrointestinal activity in healthy rabbits by means of duplex Doppler ultrasonography.

OBJECTIVE: To use duplex Doppler ultrasonography to compare gastrointestinal activity in healthy sedated versus nonsedated rabbits and to evaluate agreement between B-mode and pulsed-wave Doppler (PWD) ultrasonographic measurements. ANIMALS: 10 healthy client-owned rabbits brought for routine physical examination and 11 brought for routine ovariohysterectomy or castration. PROCEDURES: Duplex Doppler ultrasonography of the gastrointestinal tract was performed once for the 10 rabbits that underwent physical examination and twice (before and after presurgical sedation) for the 11 rabbits that underwent routine ovariohysterectomy or castration. Mean number of peristaltic contractions during a 30-second period was determined for the stomach, duodenum, jejunum, cecum, and colon from B-mode and PWD ultrasonographic images that had been video recorded. Findings for the duodenum and jejunum were compared between B-mode and PWD ultrasonography and between sedated and nonsedated rabbits. RESULTS: Duodenal and jejunal segments had measurable peristaltic waves; however, the stomach, cecum, and colon had no consistent measurable activity. B-mode and PWD ultrasonographic measurements for the duodenum and jejunum had high agreement. No significant difference was identified between nonsedated and sedated rabbits in mean number of peristaltic contractions of the duodenum or jejunum. CONCLUSIONS AND CLINICAL RELEVANCE: Results suggested that both B-mode and PWD ultrasonography of the duodenum and jejunum may be suitable for noninvasive evaluation of small intestinal motility in rabbits and that the sedation protocol used in this study had no impact on measured peristaltic values.

Intravenous and intraosseous regional limb perfusion of ceftiofur sodium in an avian model.

OBJECTIVE: To assess whether IV regional limb perfusion (IVRLP) and intraosseous regional limb perfusion (IORLP) of ceftiofur sodium resulted in clinically relevant drug concentrations in the synovial fluid of the tibiotarsal-tarsometatarsal joint of chickens (ie, an avian model) and to determine whether one of those techniques was superior to the other. ANIMALS: 12 healthy adult hens. PROCEDURES: Birds were randomly assigned to receive ceftiofur sodium (2 mg/kg) by the IVRLP (n = 4), IORLP (4), or IM (control; 4) route once daily for 6 consecutive days. Blood and tibiotarsal-tarsometatarsal synovial fluid samples were collected 15 minutes after ceftiofur administration on predetermined days for quantification of ceftiofur concentration. Plasma and synovial fluid ceftiofur concentrations were compared among the 3 groups. RESULTS: All 4 birds in the IVRLP group developed mild to moderate bruising around the injection site, but this bruising did not prohibit completion of the prescribed treatment regimen. No adverse effects were observed in any of the other birds. The mean plasma and synovial fluid ceftiofur concentrations exceeded the therapeutic threshold for most common bacterial pathogens (> 1.0 µg/mL) at all sample acquisition times for all 3 groups. The mean synovial fluid ceftiofur concentration for the IVRLP group was significantly greater than that for the IORLP and control groups at all sample acquisition times. CONCLUSIONS AND CLINICAL RELEVANCE: Results suggested that IVRLP may be a safe and effective technique for antimicrobial administration to birds with joint infections, contaminated wounds, pododermatitis, and other musculoskeletal infections of the distal aspect of a limb.

SURGICAL CORRECTION OF A CERVICAL SPINAL FRACTURE IN A BENNETT'S WALLABY (MACROPUS RUFOGRISEUS).

Macropods are susceptible to trauma, and fractures of the cervical vertebrae due to collisions are relatively common. A 4-yr-old, intact male Bennett's wallaby (Macropus rufogriseus) was presented acutely nonambulatory and tetraparetic but with motor function present in all limbs. Cervical radiographs revealed a C4 vertebral fracture. Surgical stabilization was obtained through a ventral midline approach whereby the vertebral bodies were distracted and then secured with screws and polymethylmethacrylate (PMMA). Postoperative radiographs revealed restoration of the spinal canal and appropriate implant placement. The patient was discharged 4 days postoperatively and gradually recovered full neurologic function per the owner over the ensuing 10 wk. Subsequent radiographs obtained 10.5 mo postoperatively revealed a healed fracture with stable implants. The ventral spinal distraction and stabilization technique using screws and PMMA, as are used in the domestic dog, was successful in this wallaby despite its smaller vertebral size and comparable lack of soft-tissue support.

Comparison of the effects of glycerol, dimethyl sulfoxide, and hydroxyethyl starch solutions for cryopreservation of avian red blood cells.

OBJECTIVE: To compare effectiveness of glycerol, dimethyl sulfoxide (DMSO), and hydroxyethyl starch (HES) solutions for cryopreservation of avian RBCs. SAMPLE: RBCs from 12 healthy Ameraucana hens (Gallus gallus domesticus). PROCEDURES: RBCs were stored in 20% (wt/vol) glycerol, 10% (wt/vol) DMSO freezing medium, or various concentrations of HES solution (7.5%, 11.5%, and 20% [wt/vol]) and frozen for 2 months in liquid nitrogen. Cells were then thawed and evaluated by use of cell recovery and saline stability tests, cell staining (7-aminoactinomycin D and annexin V) and flow cytometry, and scanning electron microscopy. RESULTS: Percentage of RBCs recovered was highest for 20% glycerol solution (mean ± SE, 99.71 ± 0.04%) and did not differ significantly from the value for 7.5% HES solution (99.57 ± 0.04%). Mean saline stability of RBCs was highest for 10% DMSO (96.11 ± 0.25%) and did not differ significantly from the value for 20% HES solution (95.74 ± 0.25%). Percentages of cells with 7-aminoactinomycin D staining but without annexin V staining (indicating necrosis or late apoptosis) were lowest for 10% DMSO freezing medium (3%) and 20% glycerol solution (1%) and highest for all HES concentrations (60% to 80%). Scanning electron microscopy revealed severe membrane changes in RBCs cryopreserved in 20% HES solution, compared with membrane appearance in freshly harvested RBCs and RBCs cryopreserved in 10% DMSO freezing medium. CONCLUSIONS AND CLINICAL RELEVANCE: Cryopreservation of avian RBCs with HES solution, regardless of HES concentration, resulted in greater degrees of apoptosis and cell death than did cryopreservation with other media. Transfusion with RBCs cryopreserved in HES solution may result in posttransfusion hemolysis in birds.

Rumination and anxiety mediate the effect of loneliness on depressed mood and sleep quality in college students.

OBJECTIVE: We examined the mechanisms that underlie the observed relationships between loneliness and depressed mood and poor sleep quality in college students. This study was the first to investigate whether rumination and trait anxiety are psychological mechanisms that mediate this relationship. METHODS: In Study 1 (n = 1,244), using factor analysis with cross-sectional data, we established that loneliness and rumination are distinct constructs. We then collected survey data in two cross-sectional samples (ns = 300 and 218) and one prospective (n = 334) sample to test whether rumination and anxiety were mediators of the relationship between loneliness and depressed mood and poor sleep quality. Structural equation modeling was used to test the proposed relationships. Participants completed self-report measures of loneliness, rumination, trait anxiety, depressed mood, and sleep quality. In addition, measures of hostility, neuroticism, negative affect, and tobacco use were also assessed and tested as mediators, while social support was assessed and tested as a moderator. RESULTS: Consistent across the three studies, we found that rumination and trait anxiety fully mediated the associations between loneliness and depressed mood as well as poor sleep quality; these relationships held after testing all other factors. CONCLUSION: This study helps explain how loneliness dynamics relate to poor health and suggests specific points of departure for the development of interventions.

Acute pain speeds skin barrier recovery in healthy men and women.

OBJECTIVE: Psychological stress is known to impair skin barrier recovery, but little is known about the impact of pain on skin healing processes. Our primary goals were to examine the degree to which acute pain affects recovery from skin barrier disruption, and the potential mediating impact of cortisol and catecholamines. METHODS: Healthy non-smokers aged 18-43 (N = 53, 65% women) underwent a 3-minute cold pressor pain stimulus to their foot. Tape-stripping of forearm skin occurred at two separate locations: before (site 1) and after (site 2) the pain stimulus. Transepidural water loss (TEWL) was assessed at baseline (pre-stripping), immediately post-stripping, and at 75 min to determine skin barrier recovery. Cortisol and catecholamine responses were obtained from multiple saliva and plasma samples, respectively. RESULTS: Contrary to expectations, greater pain was associated with faster skin barrier recovery, even after controlling for demographics, mood, anxiety, and other factors. Those who reported higher pain showed faster recovery at site 2 compared to a) individuals who experienced lower pain; and b) their own recovery at site 1. Greater increase in norepinephrine (but not in cortisol) was also associated with faster recovery at site 2, and mediated the impact of pain on recovery. DISCUSSION: Results bolster evidence that acute pain can affect immune-related processes. It is possible that acute pain may speed recovery from dermal abrasions, although pain is likely to impair recovery from more severe wounds. As pain is an important potential target for clinical intervention, further investigation of pain, stress, and healing processes is warranted.

Successful outcome of hepatectomy as treatment for liver lobe torsion in four domestic rabbits.

CASE DESCRIPTION: 4 rabbits (1.5 to 6 years old) were evaluated at the Angell Animal Medical Center from June 2007 to March 2009 because of nonspecific clinical signs including anorexia, lethargy, and decreased fecal output. CLINICAL FINDINGS: Physical examination revealed signs of pain in the cranial portion of the abdomen, gas distention of the gastrointestinal tract, and diminished borborygmi. Serum biochemical analyses and CBCs revealed moderately to markedly high alanine aminotransferase, aspartate aminotransferase, and alkaline phosphatase activities and mild to moderate anemia with polychromasia. Abdominal radiographic findings were nonspecific. Three of the 4 rabbits underwent abdominal ultrasonography; abnormalities in shape, size, echogenicity, and blood flow of the liver, indicative of liver lobe torsion, were detected. TREATMENT AND OUTCOME: All 4 rabbits underwent surgery, during which liver lobe torsion was confirmed and the affected liver lobe was resected. Histologic examination of sections of the excised lobe obtained from 3 of the 4 rabbits revealed severe, diffuse, acute to sub-acute hepatic ischemic necrosis. All rabbits recovered from surgery; owners reported that the rabbits were doing well 22 to 43 months after surgery. CLINICAL RELEVANCE: Liver lobe torsions in any species are rarely reported, yet 4 cases of liver lobe torsion in domestic rabbits were treated at 1 referral center in a 2-year period. In rabbits, clinical signs of this condition are nonspecific and results of additional tests, including abdominal ultrasonography and serum biochemical analysis, are necessary for diagnosis. Prompt diagnosis and hepatectomy of the affected lobe are recommended and appear to be associated with an excellent prognosis.

Explaining gender differences in the white coat effect.

OBJECTIVES: To discern whether gender was a unique predictor of the white coat effect (WCE) in a population of normotensives and patients diagnosed with hypertension. METHODS: Participants (n=252) underwent a doctor's office visit to have their blood pressure measured. Multiple blood pressure readings were taken by both a research assistant and by the attending physician. In addition, measures of anxiety variables were collected during the visit. Participants then underwent a 36-h ambulatory blood pressure monitoring. RESULTS: Gender was a significant predictor of the systolic WCE, but, as expected, the effect size was small and was no longer significant when age and BMI were included in the regression model. State anxiety emerged as a significant independent predictor of systolic WCE; however, when household income was included in the model it became the only significant independent predictor (ß=0.203, P<0.05), in addition to gender, age, and BMI. CONCLUSION: This study suggests that the association between gender and the systolic WCE is small, and likely accounted for by other variables including age, BMI, state anxiety, and household income. Thus, gender may be of limited use in helping identify patients who may be more likely to have WCE or white coat hypertension. Gender differences in this area should be interpreted with great caution.

Sleep quality and acute pain severity among young adults with and without chronic pain: the role of biobehavioral factors.

Adequate sleep is essential for health across the lifespan and is likely to be influenced by different factors among those with chronic pain than among others. Questionnaires were administered to 362 college students, some of whom reported chronic pain from varied sources. Among chronic pain sufferers (n = 108), pain severity was uniquely associated with sleep quality after controlling for gender, BMI, perceived health, health behaviors, depressed mood, perceived stress, and scholastic/interpersonal self-esteem. For these participants, perceived health, alcohol use, pain medication use, and depressed mood were also associated with sleep quality, whereas for participants with non-chronic recent pain (n = 129) only perceived health and depressed mood predicted sleep. Individuals with both chronic pain and high stress had the worst sleep. Stress, alcohol use, pain, and mood may contribute to poor sleep among young adults with pain, which could lead to a cycle of long-term health problems.

Cognitive word use during marital conflict and increases in proinflammatory cytokines.

OBJECTIVE: To examine whether greater cognitive engagement during a marital conflict discussion, as evidenced by use of words that suggest thinking and meaning-making, results in attenuated proinflammatory cytokine increases to stress and wounding. DESIGN: Husbands and wives (N = 84 individuals) were observed during two separate 24-hr visits: each visit included a wounding procedure, which was followed by a nonconflictive marital discussion (first visit) and a conflictive marital discussion (second visit). MAIN OUTCOME MEASURES: Serum proinflammatory cytokines interleukin-6 (IL-6) and tumor necrosis factor-alpha (TNF-alpha). RESULTS: Individuals who used more cognitive processing words during the conflict discussion (but not the nonconflictive discussion) showed smaller increases in serum IL-6 and TNF-alpha over 24 hours; they also had lower levels of both cytokines 24 hours after baseline controlling for demographics, hostility, depressed mood, positive and negative interactions, and marital quality. Effects of word use were not mediated by ruminative thoughts after conflict. Although both men and women benefited from their own cognitive engagement, only husbands' IL-6 patterns were affected by spouses' engagement. CONCLUSION: In accord with research demonstrating the value of cognitive processing in emotional disclosure, this research suggests that productive communication patterns may help mitigate the adverse effects of relationship conflict on inflammatory dysregulation.

Pregnancy-specific stress, prenatal health behaviors, and birth outcomes.

OBJECTIVE: Stress in pregnancy predicts earlier birth and lower birth weight. The authors investigated whether pregnancy-specific stress contributes uniquely to birth outcomes compared with general stress, and whether prenatal health behaviors explain this association. DESIGN: Three structured prenatal interviews (N = 279) assessing state anxiety, perceived stress, life events, pregnancy-specific stress, and health behaviors. MAIN OUTCOME MEASURES: Gestational age at delivery, birth weight, preterm delivery (<37 weeks), and low birth weight (<2,500 g). RESULTS: A latent pregnancy-specific stress factor predicted birth outcomes better than latent factors representing state anxiety, perceived stress, or life event stress, and than a latent factor constructed from all stress measures. Controlling for obstetric risk, pregnancy-specific stress was associated with smoking, caffeine consumption, and unhealthy eating, and inversely associated with healthy eating, vitamin use, exercise, and gestational age at delivery. Cigarette smoking predicted lower birth weight. Clinically-defined birth outcomes were predicted by cigarette smoking and pregnancy-specific stress. CONCLUSION: Pregnancy-specific stress contributed directly to preterm delivery and indirectly to low birth weight through its association with smoking. Pregnancy-specific stress may be a more powerful contributor to birth outcomes than general stress.

Effects of written anger expression in chronic pain patients: making meaning from pain.

Based on prior research demonstrating benefits of emotional disclosure for chronically ill individuals and evidence that anger is particularly problematic in chronic pain sufferers, outpatients from a chronic pain center (N=102) were randomly assigned to express their anger constructively or to write about their goals non-emotionally in a letter-writing format on two occasions. Letters were coded for degree of expressed anger and meaning-making (speculation and insight into conditions that precipitated anger). Over a 9 week period, participants in the anger-expression group (n=51) experienced greater improvement in control over pain and depressed mood, and marginally greater improvement in pain severity than the control group (n=51). Degree of expressed anger uniquely accounted for intervention effects and meaning-making mediated effects on depressed mood. These findings suggest that expressing anger may be helpful for chronic pain sufferers, particularly if it leads to meaning-making.

Olfactory influences on mood and autonomic, endocrine, and immune function.

Despite aromatherapy's popularity, efficacy data are scant, and potential mechanisms are controversial. This randomized controlled trial examined the psychological, autonomic, endocrine, and immune consequences of one purported relaxant odor (lavender), one stimulant odor (lemon), and a no-odor control (water), before and after a stressor (cold pressor); 56 healthy men and women were exposed to each of the odors during three separate visits. To assess the effects of expectancies, participants randomized to the "blind" condition were given no information about the odors they would smell; "primed" individuals were told what odors they would smell during the session, and what changes to expect. Experimenters were blind. Self-report and unobtrusive mood measures provided robust evidence that lemon oil reliably enhances positive mood compared to water and lavender regardless of expectancies or previous use of aromatherapy. Moreover, norepinephrine levels following the cold pressor remained elevated when subjects smelled lemon, compared to water or lavender. DTH responses to Candida were larger following inhalation of water than lemon or lavender. Odors did not reliably alter IL-6 and IL-10 production, salivary cortisol, heart rate or blood pressure, skin barrier repair following tape stripping, or pain ratings following the cold pressor.