Presentation and outcome of idiopathic thrombocytopenic purpura in a single Australian centre.

Immune thrombocytopenia can be a therapeutic challenge with multiple first- and second-line treatment options. A change in idiopathic thrombocytopenic purpura (ITP) definition and classification in recent consensus guidelines suggests that past descriptions of ITP presentation and outcome may be outdated. In this single centre retrospective analysis of patients with thrombocytopenia from 1 January 2005 to 1 June 2010, 139 patients met current ITP diagnostic criteria. About 54/139 were new presentations of primary ITP. Six- and 24-month response rates were 39% and 30% respectively. About 26/54 patients did not require treatment at presentation: 15 were followed up for at least 6 months and none required treatment subsequently. These results suggest that almost half of all new primary ITP do not need treatment.

Muscle dysmorphia: a new syndrome in weightlifters.

AUTHOR:e-mail address please Recently more men have reported a desire for larger, more muscular bodies. Muscle dysmorphia (MD) is a new syndrome in which individuals (usually men), although highly muscular, have a pathological belief that they are of very small musculature. As more men are motivated to take up training with weights in order to develop greater musculature, more cases of MD are likely to be encountered. A greater understanding and awareness of the syndrome are therefore needed. Therefore the aim of this study was to investigate perceptions of physical self in male weightlifters, one group with MD (n = 24) and one without (n = 30). Between group comparisons were made using the multidimensional body-self relations questionnaire. The findings confirm the nature of the disorder in that those with MD syndrome have poorer body image and are less happy with their bodies. Moreover, in addition to a desire for greater muscularity, they are very concerned not to gain fat. The results also suggest that future research into perceptions of specific body parts and health is warranted.

Correlative assessment of hemodynamic parameters obtained with T2*-weighted perfusion MR imaging and SPECT in symptomatic carotid artery occlusion.

BACKGROUND AND PURPOSE: Perfusion MR imaging and single-photon emission CT (SPECT) are commonly used to evaluate hemodynamic status in patients with symptomatic occlusive cerebrovascular disease. These techniques rely on different underlying physiological mechanisms, and the data may not correspond. We studied the relationship between hemodynamic parameters obtained with these two methods. METHODS: We performed perfusion MR imaging and SPECT in 10 patients with symptomatic unilateral internal carotid artery occlusion. Relative cerebral blood volume (rCBV) and uncorrected mean transit time (uMTT) were obtained with dynamic contrast-enhanced T2*-weighted MR imaging. Relative cerebral blood flow (rCBF) and vascular reserve capacity were measured with 99mTc-HMPAO SPECT; vascular reserve capacity was calculated by the difference in CBF before and after acetazolamide challenge. Ratios of these hemodynamic parameters between the affected and contralateral vascular territories were calculated and compared. RESULTS: Normal-to-increased CBV, prolonged uMTT, decreased CBF, and normal-to-diminished vascular reserve capacity were observed in the affected vascular territories. Reduction of vascular reserve capacity corresponded well with uMTT but not with CBF and CBV. CBF, CBV, and uMTT did not correspond to one another. CONCLUSION: uMTT is more sensitive than the other parameters in estimating vascular reserve capacity. The relationship between parameters obtained with perfusion MR imaging and SPECT should be considered in assessing the hemodynamic status of patients with symptomatic occlusive cerebrovascular disease.

What are young undergraduate women's qualitative experiences of the menstrual cycle?

The dominant ideology of the premenstrual woman is that of a person who has no control over her moods, cognition and behaviour because of her fluctuating hormone levels. The social influence of this stereotype has been put forward as an explanation for discrepancies between retrospective and prospective accounts of premenstrual experiences. However, recent research has found that women can and do distinguish between their own experience and that of the stereotype. What their own experience is (positive as well as negative) was the question that we set out to answer in this study. Nine undergraduate women were interviewed about their menstrual cycle experiences. Using qualitative analysis of their subjective accounts, a clear distinction between self and other premenstrual experiences emerged. While the women did experience premenstrual symptoms, they considered them to be relatively minor in comparison to what they defined as premenstrual syndrome. Furthermore, none of them had previously considered any positive menstrual cycle related experiences but the management of menstruation was emphatically viewed as a 'hassle'. We conclude that women can and do distinguish their own experience from the premenstrual stereotype and this needs to be recognized in the treatment setting; there is a lack of positive discourse for the menstrual cycle which needs to be developed and more attention needs to be paid to menstrual management because it is of great concern to women but is currently not discussed openly.

The holistic approach in acupuncture treatment: implications for clinical trials.

The objective of this study was to assess, in a nonclinical sample, the credibility of four commonly used acupuncture needling techniques as potential control conditions in clinical trials, and to determine the influence of nonspecific factors such as style (holistic versus nonholistic) and gender of the acupuncturist. Four groups of participants viewed a video simulation of either a female or a male acupuncturist whose style was either holistic or nonholistic. Four treatments were administered producing a three factorial 2 (gender) x 2 (style) x 4 (treatment) split plot design. We found that, regardless of acupuncturist style or gender, the treatment of needles that remained in place for 10 minutes was perceived to be the most credible. The Moxa-only treatment was viewed as the least credible. All four treatments were considered more credible when the acupuncturist was holistic and male. Irrespective of gender, the holistic acupuncturist was rated significantly more attractive, expert, and trustworthy. We conclude that, whereas perceptions of treatment differed, this was affected by the style and gender of the acupuncturist. Such nonspecific factors are inherent in the holistic approach and the degree to which they explain the effects of acupuncture over and above any physiological effect of needling is, as yet, undetermined. Our findings suggest that, in both clinical trials and the real life treatment situation, this now needs to be ascertained.

Symptom changes across the menstrual cycle in competitive sportswomen, exercisers and sedentary women.

Anecdotal accounts and unsystematic reports have suggested that women who exercise experience fewer premenstrual symptoms and less severe dysmenorrhoea than women who are sedentary. The present study tested this belief. Mood states and physical symptoms of 143 women were monitored for five days in each of the three phases of the cycle (mid-cycle, premenstrual and menstrual). The women were 35 competitive sportswomen, two groups of exercisers (33 high exercisers and 36 low exercisers) and 39 sedentary women. Principal component analysis of their responses to a mood and physical symptom checklist revealed five dimensions: positive affect, negative affect, physical symptoms, fatigue and irritability. Component-based subscale scores were calculated for all dimensions. In general mood and symptoms were worse menstrually and premenstrually than mid-cycle. The high exercisers experienced the greater positive affect and sedentary women the least. The high exercisers also reported the least negative affect. The differences between exercise groups were greatest during the premenstrual and menstrual phases. These results are consistent with the belief that women who frequently exercise may be to some extent protected from deterioration of mood before and during menstruation. This, however, is not the case for competitive sportswomen.

Stress responsivity in exercisers and non-exercisers during different phases of the menstrual cycle.

It has been suggested that, premenstrually, women are more vulnerable to the effects of stress. It has also been proposed that the fitter the individual is, the less the body responds to, and the more quickly it recovers from, a stressful experience. The present study investigated whether premenstrual sensitivity to a stressful laboratory task would be attenuated in women who exercised. Responses to the task across the menstrual cycle were studied in 20 women who exercised regularly and 20 women who were sedentary. Heart rate and blood pressure as well as subjective mood responses were measured in each of three phases: premenstrual, menstrual and postmenstrual. Exercising and sedentary women differed in sensitivity to stress: heart rate responsivity to stress was less in exercisers, but mood fluctuation was greater. Menstrual cycle phase, by contrast, influenced general levels of heart-rate and mood, but did not affect responsivity to stress or performance. These findings suggest that the menstrual cycle and physical exercise have independent effects on cardiovascular and emotional state.

Assessment of attentional bias and mood in users and non-users of anabolic-androgenic steroids.

Forty-six male strength athletes took part in a study to measure the effects of anabolic-androgenic steroids on attentional bias to aggressive cues. They were 16 current users of anabolic steroids, 16 former users and 14 non-users. Testosterone, deca-durabolin and anadrol were the three most commonly taken steroids during the last cycle. Users generally took 2-3 drugs during each cycle; the average cycle lasted 8-11 weeks and they had completed 3-4 cycles. The subjects completed visual analogue scales of current feelings and were presented with a modified Stroop Colour Word Conflict Task containing sets of neutral, verbally aggressive and physically aggressive words. Current users tended to rate themselves more negatively. Users took longer than former users to name the colours of all word sets but there were no significant differences between word sets. Therefore, attentional bias did not differ between groups but current steroid use produced subtle mood changes and slowed performance compared to users not currently taking steroids.

How do women cope with menstrual cycle changes?

Very little is known about how women naturally cope with premenstrual and menstrual symptoms. A sample of 342 women was therefore surveyed to discover how they coped with menstrual cycle changes and how helpful these methods were. Principal components analysis of responses to a specially devised coping checklist revealed four components which corresponded to types of coping distinguished in the literature. These were termed: active-behavioural, active-cognitive, avoidance and menstrual cycle specific. There was no relationship between the extent to which particular coping strategies were used and how helpful they were thought to be. The most popular ways of coping were active-cognitive. The most helpful were active-behavioural and active-cognitive. Further analyses did not show any effect of parity or occupational group on the frequency or helpfulness of the different types of coping; nor was there any association with age. Modest correlations of coping methods with symptom severity emerged.

Anabolic steroid use by amateur athletes: effects upon psychological mood states.

Twenty-one male amateur athletes attending a Welsh needle-exchange clinic, were asked to complete the Buss-Durke Inventory on feelings of hostility/aggression, and a feeling state questionnaire. All were weight training in local gyms in order to increase their body mass. They were also using high doses of anabolic steroids during 6-14 week cycles, while between these cycles they were steroid free. Subjects reported significantly higher feelings of aggression, aggression towards objects, verbal aggression, and aggression during training (but not physical aggression towards people), during the on-steroid periods. Other changes on-drug, included significantly higher feelings of alertness, irritability, anxiety, suspiciousness, and negativism. While increased aggressiveness has been noted in many previous studies, the present findings demonstrate that anabolic steroids can affect a wide range of psychological mood states.

Violence toward women and illicit androgenic-anabolic steroid use.

Substantial evidence now suggests that increased aggression is associated with illicit use of anabolic-androgenic steroids (AAS) by athletes. Anecdotal reports claim that wives and girlfriends of the athlete sometimes become victims of physical abuse when their significant other is using these drugs. We sought to investigate these claims empirically. Twenty-three AAS user strength athletes and 14 nonuser athletes, recruited in the course of a larger study, were interviewed using the Dyadic Adjustment Scale and the Conflict Tactics Scales to assess their relationships with their significant other. AAS users were asked about their relationship during their most recent "cycle" of AAS use and their most recent AAS-free period. Nonusers were asked about their relationship in the last 3 months. AAS users reported significantly more fights, verbal aggression, and violence toward their significant others when using AAS than when not using AAS. The AAS users on-drug differed significantly from nonusers on two of these indices, but AAS users off-drug did not significantly differ from nonusers. These findings support the anecdotal evidence that wives and girlfriends of AAS users may be at risk of serious injury from users while they are on-drug. Thus, AAS use may impose risks not only to the user, but also to the women close to them.

Mood changes in women after an aerobics class: a preliminary study.

The psychological benefits of physical exercise have been well documented. Acute exercise (typically running) has been reported to improve mood, decrease anxiety, and increase vigor. Aerobics classes are increasing in popularity among women, and to investigate mood changes in women after an aerobics class, we asked 45 high-frequency and 52 low-frequency exercisers to complete a specially devised mood adjective checklist 5 min before and immediately after a class. Principal components analysis revealed three dimensions that emerged on both occasions: Positive Mood, Negative Mood, and Fatigue. Component subscale scores were calculated for each woman for each occasion. Significant differences in mood before and after the class emerged. Increased positive affect and decreased negative affect after the class were reported. Fatigue was also reduced. The high and low exercisers experienced the same degree of mood change.