Validity and reliability of State-Trait Anxiety Inventory in Danish women aged 45 years and older with abnormal cervical screening results.

BACKGROUND: State Trait Anxiety Inventory (STAI) scale was developed in the 1980's and has been widely used both in clinical settings and in research. However the Danish version of STAI has not been validated. The aim of this study was to assess the validity and reliability of STAI - state anxiety scale in Danish women aged 45 years and older with abnormal cervical cancer screening results. METHODS: Women ≥45 years referred with an abnormal cervical cytology and healthy volunteers (n = 12) underwent cognitive interview after completing STAI. Further, STAI was sent out in an electronic questionnaire to women (n = 109) seen at the gynecological department with abnormal cervical cancer screening test during 2018. Validity and reliability of STAI was evaluated according to the Consensus-based Standards for the selection of health Measurement Instruments (COSMIN) checklist by examining internal consistency, test-retest reliability, measurement error, floor and ceiling, construct validity and content validity. RESULTS: In the cognitive interviews the content validity was evaluated to be very good. The internal consistency of the scale was excellent with Cronbach's α = 0.93. Test-retest reliability was good with an intra-class correlation coefficient of 0.80 and the systematic difference between test-retest results was negligible. The construct validity was good. CONCLUSION: To our best knowledge, this is the first validation study of the Danish translation of STAI-state anxiety scale. This version of STAI demonstrates an acceptable reliability and validity when used in a gynecological setting.

Expanding Panjabi's stability model to express movement: a theoretical model.

Novel theoretical models of movement have historically inspired the creation of new methods for the application of human movement. The landmark theoretical model of spinal stability by Panjabi in 1992 led to the creation of an exercise approach to spinal stability. This approach however was later challenged, most significantly due to a lack of favourable clinical effect. The concepts explored in this paper address and consider the deficiencies of Panjabi's model then propose an evolution and expansion from a special model of stability to a general one of movement. It is proposed that two body-wide symbiotic elements are present within all movement systems, stability and mobility. The justification for this is derived from the observable clinical environment. It is clinically recognised that these two elements are present and identifiable throughout the body in different joints and muscles, and the neural conduction system. In order to generalise the Panjabi model of stability to include and illustrate movement, a matching parallel mobility system with the same subsystems was conceptually created. In this expanded theoretical model, the new mobility system is placed beside the existing stability system and subsystems. The ability of both stability and mobility systems to work in harmony will subsequently determine the quality of movement. Conversely, malfunction of either system, or their subsystems, will deleteriously affect all other subsystems and consequently overall movement quality. For this reason, in the rehabilitation exercise environment, focus should be placed on the simultaneous involvement of both the stability and mobility systems. It is suggested that the individual's relevant functional harmonious movements should be challenged at the highest possible level without pain or discomfort. It is anticipated that this conceptual expansion of the theoretical model of stability to one with the symbiotic inclusion of mobility, will provide new understandings on human movement. The use of this model may provide a universal system for body movement analysis and understanding musculoskeletal disorders. In turn, this may lead to a simple categorisation system alluding to the functional face-value of a wide range of commonly used passive, active or combined musculoskeletal interventions. Further research is required to investigate the mechanisms that enable or interfere with harmonious body movements. Such work may then potentially lead to new and evolved evidence based interventions.

Does breastfeeding influence future sperm quality and reproductive hormones?

No human study has investigated the possible impact of breastfeeding on semen quality and levels of reproductive hormones, but a recent study of another hypothesis indicated an association with oligozoospermia. We investigated the association between breastfeeding, semen quality and levels of reproductive hormones. From a Danish pregnancy cohort established in 1984-1987, 347 sons were selected according to maternal smoking during pregnancy and followed up with questionnaires, semen analysis and blood sampling in 2005-2006. Complete data were available for 269 men aged 18-21 years. Breastfeeding was not statistically significantly associated with sperm concentration, total sperm count, sperm motility or morphology, oligozoospermia, follicle-stimulating hormone, inhibin B, luteinizing hormone, sex hormone-binding globulin (SHBG), the calculated level of free testosterone, free oestradiol, the free testosterone/free oestradiol ratio or the follicle-stimulating hormone/inhibin B ratio. Total testosterone and total oestradiol was 16% (p = 0.01) and 14% (p = 0.06), respectively, lower among men never breastfed in comparison with men breastfed exclusively for 1 month or longer. When taking SHBG into account, neither free testosterone nor free oestradiol was different between the two groups. This study shows no association between breastfeeding and sperm quality or reproductive hormones and a strong association is unlikely. A larger study would be needed to detect more subtle effects.

[Influence of different head-trunk positions to the upbeat-nystagmus]. / Einfluss der Kopf-Rumpf-Positionsänderung auf den Upbeat-Nystagmus.

The neck torsion test (NTT) can be used to evaluate the cervico-ocular reflex (COR). We think there are two main reasons why NRT has failed to gain general acceptance in clinical practice: the test does not fully exploit the somatosensory examination potential, and electronystagmography has been most commonly used but is inferior to videonystagmography for a very low-amplitude nystagmus. These considerations have led us to develop a modified neck torsion test (mNTT) with three-dimensional video-oculographic (3D-VOG) recording. Sensors on the video glasses enable three-dimensional and continuous registration of the head position. Horizontal, vertical and rotatory eye movements are determined in six different head-body positions (right/left head tilt, ante/retroflexion of the head, and right/left body rotation). The basis for assessing the mNTT is described in detail. We used the mNTT to examine prospectively compensated, vestibularly deficient (n = 52), and cervically deficient (n = 93) patients with vertigo against a control group (n = 22). Our results show that upbeat-nystagmus (UBN) significantly differentiated the groups. This occurs most frequently in the tonic analysis phase of head inclination and reclination. UBN is differential-diagnostically discussed on the basis of these examination findings, and its cervical origin is elucidated with the aid of model conceptions. We conclude that our modified NRT is an improved instrument for COR determination. A suspected cervical somatosensory reduction warrants testing particularly for UBN.

[Cervicoproprioceptive provocation of horizontal and vertical nystagmus in test subjects]. / Zervikopropriozeptive Provokation von horizontalen und vertikalen Nystagmen bei Probanden.

BACKGROUND: The cervico-ocular reflex (COR) has been confirmed in numerous animal experiments. On the other hand, its clinical assessment is disputed. Anteflexion and retroflexion of the head are among the main movements of the atlanto-occipital joint. We investigated whether these head movements produce neck proprioceptive stimulation in the vestibular system. SUBJECTS AND METHOD: We investigated 50 students under the experimental conditions of strictly cervical provocation. The trunk was rotated, anteflexed, and retroflexed into its end positions for 60 s under video-oculographic control without changing the head-space relationship. During the cervical provocation, horizontal, vertical, or rotational nystagmus within a time window of 5-30 s after the start of the provocation was detected as a target parameter. RESULTS: The results showed that, compared to the baseline, there was a significant increase in vertical and horizontal nystagmus after the cervical provocation. The horizontal nystagmus reaction, rather than the vertical, was increased significantly by the maximum trunk rotation. In addition, we found a significant amount of vertical rather than horizontal nystagmus under trunk flexion provocation. CONCLUSION: Under cervical provocation of test subjects, we were able to elicit horizontal and vertical nystagmus (upbeat nystagmus) via cervico-ocular roots. Due to a neck proprioceptive activation of the vestibular system we interpret our result as a "cervico-tonic provocation nystagmus".

[Investigations concerning the head-trunk-coordination]. / Untersuchungen zur Kopf-Körper-Koordination.

BACKGROUND: In the assessment of vertigo patients with suspected cervicocephalic somatosensory deficit, the studies published thus far have focused on reflectory systems like the cervico-ocular reflex or the postural systems. Our study examines the cervicocephalic kinesthetic sensibility of head and body coordination. We therefore introduce two preliminary test series: the "subjective zero chin-knee-angle of the occipital joints" and the "saccadic repositioning during trunk rotation". METHODS: Subjective recordings of dizziness complaints were done using the Dizziness Handicap Inventory. PATIENTS: The study population consisted of 24 patients with palpatory cervicocephalic somatosensory deficit (group I) and 23 patients with a central vestibular compensated unilateral vestibular deficit (group II). Twenty-two healthy patients served as controls. The aim of the study is to provide a detailed examination of the "subjective zero chin-knee-angle of the occipital joints" as well as a detailed discussion of "saccadic repositioning with trunk rotation" by three-dimensional videooculography (3D-VOG). RESULTS: We were able to separate patients with a cervicocephalic somatosensory deficit with the first test procedure and differentiate them from groups II and III. The second test procedure shows a significant difference between groups I and III. CONCLUSION: We conclude from the group difference that the recording of cervicocephalic kinesthetic sensibility is a further indication of disturbed cervical proprioception.

Multiple interstitial substances measured by microdialysis in patients with subarachnoid hemorrhage.

OBJECTIVE: Intracerebral microdialysis is a tool to monitor metabolic disturbances in the brains of patients with severe head injuries or subarachnoid hemorrhage (SAH). In the search for putative indicators of primary and secondary brain damage, we measured multiple metabolites in the dialysates of patients with SAH, to elucidate their significance for the outcomes of the patients as well as their temporal profiles of liberation after the insult. METHODS: Microdialysis probes were placed, with a ventriculostomy catheter for drainage of cerebrospinal fluid, into a frontal lobe of 10 patients with aneurysmal SAH, for 4.6 +/- 0.5 days. Amino acids, metabolites of glycolysis, purines, catecholamines, and nitric oxide oxidation byproducts were measured by high-performance liquid chromatography. Spearman's correlation coefficient and Student's t test were used to compare the levels of the metabolites with the outcomes of the patients, as assessed using the Glasgow Outcome Scale, 3 months after the ictus. RESULTS: For patients with unfavorable outcomes (Glasgow Outcome Scale scores of 1-3), which were primarily associated with the development of large infarctions, dialysate levels of excitatory amino acids increased up to 30-fold, those of lactate up to 10-fold, and those of nitrite up to 5-fold, compared with normal levels observed for patients with favorable outcomes (Glasgow Outcome Scale scores of 4 or 5). When average peak concentrations in the dialysates of patients with favorable and unfavorable outcomes were compared, significantly higher levels of excitatory amino acids, taurine, lactate, and nitrite, but not of purines and catecholamines, were observed for those with poor outcomes (P < 0.05). With respect to the temporal profiles of the average metabolite concentrations, the significantly increased levels of amino acids observed for patients with poor outcomes followed a biphasic course, with maximal concentrations on the first and second days or the seventh day after the insult (P < 0.01). CONCLUSION: These data confirm the usefulness of excitatory amino acids and lactate as major parameters for neurochemical monitoring for patients threatened by acute cerebral disorders. Other substances, such as taurine and nitrite, were also demonstrated to be potentially predictive. Release of these substances into the extracellular fluid of the brain might be particularly relevant for the development of secondary brain damage after SAH, e.g., infarction or brain swelling.