Prevalence of depersonalization and derealization experiences in a rural population.

BACKGROUND: Dissociative symptoms are common psychiatric symptoms whose prevalence in rural (agricultural) populations is unknown. The present study examines the prevalence of depersonalization and derealization experiences in a southern rural US population as well as socio-demographic and emotional factors associated with these experiences. METHOD: A random sample of 1008 adults in rural eastern North Carolina completed a survey by telephone, which included questions about experiences of depersonalization or derealization in the past year. Demographic information was gathered on all respondents; for those reporting these dissociative experiences, information on their frequency, duration, and whether they occurred during conditions of danger, severe stress, upsetting memories, nervousness or depression, or for no apparent reason was also elicited. RESULTS: The reported prevalence rates were 19.1% for depersonalization, 14.4% for derealization, and 23.4% for either dissociative experience. Logistic regression showed that women reported a significantly higher rate of dissociative experiences (26.5%) than men (19.5%), (Odds Ratio = 1.93, 95% CI = 1.37-2.74), particularly African-American women (29.9%). Experiencing chronic pain (OR = 2.96, 95% CI = 2.05-4.28) and irregular church attendance (OR = 1.18, 95% CI = 1.07-1.31) were also associated with increased frequency of dissociation. Increasing age (OR = 0.73, 95% CI = 0.65-0.81) and being employed (OR = 0.58, 95% CI = 0.39-0.86) were associated with reduced frequency of dissociation. Pain, gender, and age were related to both depersonalization and derealization experiences. Employment and church attendance were related to depersonalization experiences, while ethnic minorities experienced more derealization. CONCLUSIONS: A predominantly southern rural population reported a high 1-year prevalence of depersonalization and derealization experiences. The prevalence of dissociation experiences was common in this southern sample, as was found by Ross and colleagues (1990) in an urban population in Canada. Risk factors for depersonalization and derealization experiences had considerable overlap, but differed on several variables suggesting different underlying mechanisms.

Electroconvulsive therapy in old-old patients.

The authors compared falls, cardiovascular factors, confusion, gastrointestinal, pulmonary, and metabolic side effects for "old-old" (>75 years) patient groups treated with either electroconvulsive therapy (ECT) or pharmacotherapy. A subset of a pharmacotherapy patient group was selected to match for age, sex, and diagnosis in a case-control design. Side effects were recorded from each selected patient's medical record and compared between groups. Patients receiving ECT showed fewer cardiovascular and gastrointestinal side effects. Patients receiving ECT had longer lengths of stay and more favorable outcomes. Overall, there was a tendency for ECT to result in fewer side effects and better treatment outcomes. ECT appears to be relatively safe and more effective than pharmacotherapy for major depressive disorders in old-old patients.

Reporting and concordance of methodologic criteria between abstracts and articles in diagnostic test studies.

OBJECTIVE: To evaluate the quality and concordance of methodologic criteria in abstracts versus articles regarding the diagnosis of trichomoniasis. STUDY DESIGN: Survey of published literature. DATA SOURCES: Studies indexed in MEDLINE (1976-1998). STUDY SELECTION: Studies that used culture as the gold or reference standard. DATA EXTRACTION: Data from abstract and articles were independently abstracted using 4 methodologic criteria: (1) prospective evaluation of consecutive patients; (2) test results did not influence the decision to do gold standard; (3) independent and blind comparison with gold standard; and (4) broad spectrum of patients used. The total number of criteria met for each report was calculated to create a quality score (0-4). MEASUREMENTS AND MAIN RESULTS: None of the 33 abstracts or full articles reported all 4 criteria. Three criteria were reported in none of the abstracts and in 18% of articles (95% confidence interval [95% CI] 8.6% to 34%). Two criteria were reported in 18% of abstracts (95% CI, 8.6% to 34%) and 42% of articles (95% CI, 27% to 59%). One criterion was reported in 42% of abstracts (95% CI, 27% to 59%) and 27% of articles (95% CI, 15% to 44%). No criteria were reported in 13 (39%) of 33 abstracts (95% CI, 25% to 56%) and 4 (12%) of 33 articles (95% CI, 4.8% to 27%). The agreement of the criteria between the abstract and the article was poor (kappa -0.09; 95% CI, -0.18 to 0) to moderate (kappa 0.53; 95% CI, 0.22 to 0.83). CONCLUSIONS: Information on methods basic to study validity is often absent from both abstract and paper. The concordance of such criteria between the abstract and article needs to improve.

Figure skating injuries.

Figure skaters who train regularly sustain primarily lower extremity injuries, especially overuse injuries. Quadriceps and hamstring stretching may help prevent or decrease anterior knee pain. Foot and ankle problems may be related to the rigidity of the leather skating boot. The need for trunk strength to maintain body position is frequently under-emphasized. Air quality may also be a problem for those who skate in enclosed rinks.

Prevalence and nature of allergy and chemical sensitivity in a general population.

The objectives of this study were (a) to determine the self-reported prevalence of allergy and chemical sensitivity in a rural population of eastern North Carolina, (b) to determine the type and frequency of symptoms for each condition, and (c) to determine the demographic groups affected. A random general telephone survey was conducted during the period May 14, 1993, to September 10, 1993, and questions about allergy and chemical sensitivity were asked. Of the 1 446 households contacted, 1 027 (71%) individuals agreed to participate. Allergies were reported by 365 (35%) individuals. Thirty percent of allergic individuals reported that symptoms occurred once or more each week, whereas 61% reported that symptoms occurred, at most, once each month. Allergic symptoms that occurred daily were reported by 5.3% of the total population. Chemical sensitivity was reported by 336 (33%) individuals. Thirty-five per cent of chemically sensitive individuals reported symptoms at least once each week, whereas 53% reported that symptoms occurred once (or less) each month. Symptoms of chemical sensitivity that occurred daily were reported by 3.9% of the total population. Both allergy and chemical sensitivity were distributed widely across age, income, race, and educational groups. Simultaneous allergy and chemical sensitivity were reported by 16.9% of the population, allergy without chemical sensitivity by 16.0%, chemical sensitivity without allergy by 18.2%, and neither condition by 48.9%. If the prevalence of sensitivity to chemical irritants is, in fact, equivalent to that of allergy, as was found in this study, then support for the scientific investigation of chemical sensitivity is justified.

Integration of physical medicine and rehabilitation into the undergraduate medical curriculum. The Undergraduate Education Committee of the Association of Academic Physiatrists Workgroup.

The incorporation of PM&R into the medical student curriculum thus provides benefits at multiple levels: to patients, to medical students, and to practitioners already in the field. The knowledge about PM&R gained by the medical student is spread to disciplines outside of PM&R through the learning of principles and specific factual data that can be applicable for practitioners caring for a variety of patients. It is the position of this organization that each academic department work to integrate education in PM&R into the medical school curriculum.

Nasal pathology and ultrastructure in patients with chronic airway inflammation (RADS and RUDS) following an irritant exposure.

BACKGROUND: Reactive airways dysfunction syndrome is a chronic asthma-like condition developing after an acute irritant exposure, and chronic inflammation has been seen on endobronchial biopsy. Reactive upper-airways dysfunction syndrome is chronic rhinitis developing in temporal association with a toxic inhalation exposure, but the pathophysiology is unknown. OBJECTIVES: To study biopsies of the nasal mucosa in patients with reactive upper-airways dysfunction syndrome and in some cases reactive airways dysfunction syndrome developing in temporal association with a chlorine dioxide exposure, to see if a histologic basis for the persistent rhinitis and sensitivity to chemical irritants could be determined. METHODS: Specimens were stained with hematoxylin-eosin and immunoperoxidase stains for substance P, vasointestinal peptide, and S-100 (nerve fibers), and fixed in glutaraldehyde for electron microscopy. Biopsies of three nonexposed subjects were performed for comparison. A pathologist blinded to clinical data interpreted the specimens. RESULTS: Inflammation ratings of exposed individuals were higher than for the nonexposed individuals. The number of nerve fibers stained was greater for patients vs controls. Substance P and vasointestinal peptide staining was nonspecific. Electron microscopy showed desquamation of the epithelium and permeability of epithelial cell junctions. CONCLUSION: This study suggests a mechanism by which ongoing low level exposures perpetuate airway inflammation after an inducing toxic inhalation. A possible overlap between reactive airways dysfunction syndrome, reactive upper-airway dysfunction syndrome and the multiple chemical sensitivity syndrome is suggested.