Psychological interventions for adults with asthma.

BACKGROUND: Many people have asthma, and for some their symptoms may be triggered by psychological factors. In addition compliance with medical therapy may have a psychological dimension. Therefore, psychological interventions aim to reduce the burden of symptoms and improve management of the disease. OBJECTIVES: To assess the effectiveness of psychological interventions for adults with asthma. SEARCH STRATEGY: The Cochrane Airways Group Specialised Register and PsycINFO were searched with pre-defined terms up until August 2005. SELECTION CRITERIA: Randomised controlled trials published in any language assessing the effects of a psychological intervention compared with a form of control in adult participants were included in the review. DATA COLLECTION AND ANALYSIS: Two reviewers assessed the relevance of abstracts identified by electronic searching and retrieved agreed studies for further scrutiny. The studies that met the inclusion criteria were assembled and data extracted. MAIN RESULTS: Fourteen studies, involving 617 particpants, were included in the review, however study quality was poor and sample sizes were frequently small. However, some pooled effects were analysed. The use of 'as needed' medications was reduced in two studies, (47 patients), by relaxation therapy (OR 4.47, CI 1.22 to 16.44). There was no significant difference in FEV1 for relaxation therapy in four studies of 150 patients, (SMD -0.01, CI -0.41 to 0.40). Quality of life, measured using the Asthma Quality of Life Questionnaire in two studies, (48 patients), showed a positive effect following CBT (WMD 0.71, CI 0.23 to 1.19). Peak Expiratory Flow outcome data in two studies, (51 patients), indicated a significant difference in favour of bio-feedback therapy (SMD 0.66, CI 0.09 to 1.23). The remainder of the findings between studies were conflicting. This may have been due to the different types of interventions used and the deficiencies in trial design. AUTHORS' CONCLUSIONS: This review was unable to draw firm conclusions for the role of psychological interventions in asthma due to the absence of an adequate evidence base. Larger, well-conducted and reported randomised trials are required in this area, in order to determine the effects of these techniques in the treatment of asthma in adults.

Psychotherapeutic interventions for adults with asthma.

BACKGROUND: Many people have asthma, and for some their symptoms may be triggered by psychological factors. In addition compliance with medical therapy may have a psychological dimension. Therefore, psychological interventions aim to reduce the burden of symptoms and improve management of the disease. OBJECTIVES: To assess the effectiveness of psychological interventions for adults with asthma. SEARCH STRATEGY: The Cochrane Airways Group specialised register and PsycINFO were searched with pre-defined terms until September 2003. SELECTION CRITERIA: Randomised controlled trials published in any language assessing the effects of a psychological intervention compared with a form of control in adult participants were included in the review. DATA COLLECTION AND ANALYSIS: Two reviewers assessed the relevance of abstracts identified by electronic searching and retrieved agreed studies for further scrutiny. The studies that met the inclusion criteria were assembled and data extracted. MAIN RESULTS: Twelve studies were included in the review, however study quality was poor and sample sizes were frequently small. No meta-analysis could be performed due to the diversity of interventions and the outcomes assessed. Findings between studies were conflicting. This may have been due to the different types of interventions used and the deficiencies in trial design. REVIEWER'S CONCLUSIONS: This review was unable to draw firm conclusions for the role of psychological interventions in asthma due to the absence of an adequate evidence base. Large, well-conducted and reported randomised trials are required in this area, in order to determine the effects of these techniques in the treatment of asthma in adults.

Administration of low doses of MK-801 during ethanol withdrawal in the developing rat pup attenuates alcohol's teratogenic effects.

BACKGROUND: Alcohol exposure during development can produce severe and long-lasting central nervous system damage and consequent behavioral alterations. Recent evidence suggests that NMDA receptor-mediated excitotoxicity during periods of withdrawal may contribute to this damage. We have demonstrated that blocking the NMDA receptor with MK-801 during alcohol withdrawal can attenuate ethanol's adverse effects on behavioral development in the rat. This study examined the dose dependency of MK-801's ability to mitigate ethanol's teratogenic effects. METHODS: Neonatal rat pups were exposed to 6.0 g/kg of ethanol in a binge-like manner on postnatal day (PD) 6, a period of brain development equivalent to a portion of the human third trimester. Alcohol administration was accomplished with an artificial rearing procedure. Twenty-one hours after ethanol treatment, pups were injected intraperitoneally with one of four doses of MK-801 (0.05, 0.1, 0.5, or 1.0 mg/kg) or saline vehicle. An artificially reared control and a normally reared control group were included. On PD 18-19, activity level was monitored, and on PD 40-42, serial spatial discrimination reversal learning was assessed. RESULTS: Alcohol exposure on PD 6 produced significant increases in activity level and deficits in reversal learning. These alcohol-induced behavioral alterations were significantly attenuated in subjects treated with one of the three lower doses (0.05-0.5 mg/kg) of MK-801 during withdrawal. The performance of ethanol-exposed subjects treated with the high dose of MK-801 (1.0 mg/kg) did not differ from that of the Ethanol Only group. CONCLUSIONS: These data suggest that alterations in NMDA receptor activation during alcohol withdrawal contribute to the neuropathology and consequent behavioral alterations associated with developmental alcohol exposure. These data have important implications for pregnant women and newborns undergoing ethanol withdrawal.

Role of Sertoli cells in injury-associated testicular germ cell apoptosis.

This review examines experimental models of Sertoli cell injury resulting in germ cell apoptosis. Since germ cells exist in an environment created by Sertoli cells, paracrine signaling between these intimately associated cells must regulate the process of germ cell death. Germ cell apoptosis may be signaled by a decrease in Sertoli cell pro-survival factors, an increase in Sertoli cell pro-apoptotic factors, or both. The different models of Sertoli cell injury indicate that spermatogenesis is susceptible to disruption, and that targeting critical Sertoli cell functions can lead to rapid and massive germ cell death.

Effect of work glove and type of muscle action on grip fatigue.

Fatigue plays a major role in limiting work performance. The objectives of this study were: (1) to determine the effect of wearing a work glove on handgrip fatigue; (2) to compare the effect of a sustained grip contraction of concentric versus eccentric nature, named in this study isometric and eccentric; and (3) to determine if there is a relationship between physiological muscle performance and subjective perceptional fatigue during isometric and eccentric gripping. The study had 2 x 2 repeated measures design. The two factors were: (1) glove condition (glove, no glove); and (2) type of contraction (eccentric and isometric). The measurements taken were: (1) time to limit of endurance (Tlim); (2) rate of perceived effort (RPE); (3) mean power frequency (MPF) derived from the electromyogram (EMG); and (4) the fatigue objective-subjective relationship (FOSR, which is the correlation coefficient between RPE and MPF). Twenty-one normal subjects maintained a handgrip of 60% of their maximal effort until exhaustion for each of the four conditions. During each trial EMG values were recorded every 5 s and RPE values were recorded every 10 s. The RPE was recorded as a subjective value selected from a 10-point Borg scale. The results showed that Tlim was greater for the no glove condition (p < 0.0005) and for the eccentric muscle action (p < 0.05). The FOSR was greatest for the glove condition (p < 0.03) and for the isometric muscle action (p < 0.013). The MPF decline showed no significant difference for any condition. These data indicate that glove condition and type of handgrip contraction have an effect on physiological fatigue and subjective perception of fatigue.

Randomized, double-blind trial of midazolam and diazepam for endoscopic sedation in children.

We performed a prospective, randomized, double-blind study of 41 children (6-18 years of age) who were undergoing esophagogastroduodenoscopy (EGD) to compare the efficacy of diazepam and midazolam with respect to quality of sedation and amnesia. The endoscopist assessed the patients for control of salivation, gag reflex, vomiting and cooperation after intravenous injection of either 0.1-0.15 mg/kg of midazolam or 0.2-0.4 mg/kg of diazepam. The patients answered a questionnaire at 1 and 24 h after the procedure to assess recall of procedure details, pain and/or discomfort, and their medication choice for future procedures. Vital signs were monitored for 1 h after injection. Although midazolam caused greater mean maximum increase in heart rate than diazepam (30 vs. 14/min), no difference was found between the two treatment groups with respect to other vital signs. There was also no difference in physician's assessment or patient recall of specific events during the procedure. However, significantly fewer patients recalled pain or discomfort with midazolam at both 1 and 24 h following the procedure (p = 0.02). In addition, more patients receiving midazolam indicated preference for the same sedation for future procedures. We conclude that midazolam may provide better amnesia in children undergoing endoscopic procedures.