Posttraumatic stress disorder in migraine.

OBJECTIVE: To evaluate the relative frequency of posttraumatic stress disorder (PTSD) in episodic migraine (EM) and chronic daily headache (CDH) sufferers and the impact on headache-related disability. BACKGROUND: Approximately 8% of the population is estimated to have PTSD. Recent studies suggest a higher frequency of PTSD in headache disorders. The association of PTSD and headache-related disability has not been examined. METHODS: A prospective study was conducted at 6 headache centers. PTSD was assessed using the life events checklist and PTSD checklist, civilian version (PCL-C). We compared data from EM to CDH, and migraine with PTSD to migraine without PTSD. The PHQ-9 was used to assess depression, and headache impact test (HIT-6) to assess disability. RESULTS: Of 767 participants, 593 fulfilled criteria for EM or CDH and were used in this analysis. The mean age was 42.2 years and 92% were women. The frequency of PTSD was greater in CDH than in EM (30.3% vs 22.4%, P = .043), but not after adjusting for demographics and depression (P = .87). However, participants with major depression and PTSD were more likely to have CDH than EM (24.6% vs 15.79%, P < .002). Disability was greater in migraineurs with PTSD, even after adjustments (65.2 vs 61.7, P = .002). CONCLUSION: The frequency of PTSD in migraineurs, whether episodic or chronic, is higher than the historically reported prevalence of PTSD in the general population. In addition, in the subset of migraineurs with depression, PTSD frequency is greater in CDH sufferers than in episodic migraineurs. Finally, the presence of PTSD is independently associated with greater headache-related disability in migraineurs.

Skin-impedance in Fabry Disease: a prospective, controlled, non-randomized clinical study.

BACKGROUND: We previously demonstrated improved sweating after enzyme replacement therapy (ERT) in Fabry disease using the thermo-regularity sweat and quantitative sudomotor axon reflex tests. Skin-impedance, a measure skin-moisture (sweating), has been used in the clinical evaluation of burns and pressure ulcers using the portable dynamic dermal impedance monitor (DDIM) system. METHODS: We compared skin impedance measurements in hemizygous patients with Fabry disease (22 post 3-years of bi-weekly ERT and 5 ERT naive) and 22 healthy controls. Force compensated skin-moisture values were used for statistical analysis. Outcome measures included 1) moisture reading of the 100th repetitive reading, 2) rate of change, 3) average of 60-110th reading and 4) overall average of all readings. RESULTS: All outcome measures showed a significant difference in skin-moisture between Fabry patients and control subjects (p < 0.0001). There was no difference between Fabry patients on ERT and patients naïve to ERT. Increased skin-impedance values for the four skin-impedance outcome measures were found in a small number of dermatome test-sites two days post-enzyme infusions. CONCLUSION: The instrument portability, ease of its use, a relatively short time required for the assessment, and the fact that DDIM system was able to detect the difference in skin-moisture renders the instrument a useful clinical tool.

Decreased scholastic achievement in overweight middle school students.

The purpose of this study was to investigate whether overweight students achieved a lower relative degree of scholastic achievement compared to nonoverweight students. Subjects consisted of 6th and 7th grade students enrolled in a large public middle school in a suburb of Philadelphia, Pennsylvania. We compared grade point averages (GPAs), nationally standardized reading scores, school detentions, school suspensions, school attendance, tardiness to school, physical fitness test scores, and participation on school athletic teams among nonoverweight, at risk for overweight, and overweight students. Overweight students achieved lower grades (P<0.001) and lower physical fitness scores (P<0.0001) than their nonoverweight peers. Overweight students demonstrated a 0.4 letter grade lower GPA (on a 4.00 scale) and 11% lower national percentile reading scores than their nonoverweight peers. The overweight students also demonstrated significantly more detentions, worsened school attendance, more tardiness to school, and less participation on school athletic teams than their nonoverweight peers. Our study suggests that body mass is an important indicator of scholastic achievement, attendance, behavior, and physical fitness among middle school students, reiterating the need for healthy lifestyle intervention and prevention measures.

How does lack of insurance affect use of intensive care? A population-based study.

OBJECTIVE: One in six Americans aged <65 yrs are without health insurance. Although lack of insurance is associated with reduced access to many health services, the relationship between lack of insurance and use of intensive care services is unclear. We sought to compare the use of intensive care by insured and uninsured populations. DESIGN: Retrospective population-based cross-sectional study of five U.S. states (Florida, Massachusetts, New Jersey, New York, and Virginia), analyzing use of hospital and intensive care unit (ICU) services by all residents of these states <65 yrs of age. Data sources included the five 1999 state hospital discharge databases and the 2000 U.S. Census Bureau Current Population Survey. SETTING: Nonfederal hospitals in the five states (all hospitalizations in these during 1999). INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: There were 39.3 million and 7.8 million individuals aged 0-64 yrs with and without insurance, respectively, in the five-state sample. The uninsured population was far less likely to be hospitalized (odds ratio [OR], 0.458; 95% confidence interval [CI], 0.456-0.460; p < .001) and to be admitted to the ICU (OR, 0.581, 95% CI: 0.576-0.587, p < .001). Differences persisted irrespective of age, gender, ethnicity, or reason for admission. Among those hospitalized, the uninsured were more likely to receive intensive care (OR, 1.24; 95% CI, 1.22-1.25; p < .01). Hospital mortality rates for patients admitted to the ICU ranged by age from 4.0% to 6.9% for the uninsured and from 2.7% to 5.5% for the insured (OR, 1.12-1.54; p < .01). CONCLUSIONS: Americans without insurance use ICU services less often than those with insurance, primarily because of decreased likelihood of hospital admission in the first place. Outcome is worse for those who are admitted to the ICU, possibly because they are sicker when they seek care.