[Association of physical activity with fatigue and functional capacity in patients with rheumatoid arthritis]. / Zusammenhang von körperlicher Aktivität mit Fatigue und Funktionskapazität bei Patienten mit rheumatoider Arthritis.

BACKGROUND: Patients with rheumatoid arthritis (RA) tend to be less physically active. Physical activity has been shown to have a positive impact on disease activity and quality of life and is recommended by the European League Against Rheumatism (EULAR) as an integral component of standard treatment. OBJECTIVE: A cross-sectional analysis of RA patients was carried out assessing disease activity, functional capacity and fatigue associated with physical activity. MATERIAL AND METHODS: Physical activity, functional capacity and the global fatigue index (GFI) were examined using standardized questionnaires: the international physical activity questionnaire short form (IPAQ-SF), the functional questionnaire Hannover (FFbH) and the multidimensional assessment of fatigue (MAF). The data were evaluated using SPSS 26 (IBM, Armonk, NY, USA). The level of significance was tested with bivariate and partial correlations and nonparametric tests. RESULTS: In total 164 patients were included in the study. The majority of the patients were female (127/164; 77%) and the median age of the cohort was 58.3 years (range 21-86 years). The median duration of disease-related symptoms at inclusion was 169 months (range 0-713 months). Physical activity was low in 39%, moderate in 37% and high in 24%. Patients reporting higher levels of physical activity reported significantly lower GFI (p < 0.001), functional limitations (p < 0.001) and disease activity (p = 0.045) scores than those with less physical activity. CONCLUSION: Physical activity in RA patients was significantly correlated with functional capacity and levels of fatigue. In order to reduce the proportion of patients with low physical activity, the possibilities for functional training should be expanded and the patients should be encouraged to undertake sporting activities.

[Haemoglobin oxygenation of retinal vessels in branch retinal artery occlusions over time and correlation with clinical outcome]. / Nichtinvasive Messung der Sauerstoffsättigung retinaler Gefäße bei retinalen Astarterienverschlüssen unter Therapie.

OBJECTIVE: Purpose of these study was the evaluation of a new method for the measurement of haemoglobin oxygenation in retinal vessels. Patients with branch retinal artery occlusion have been measured before and after a rheological therapy. METHODS: The haemoglobin oxygenation in retinal vessels was measured by the "oxygen module" (Imedos GmbH, Jena, Germany) which uses a special filter (transmission at 548 and 610 nm, band width 10 nm) in the illumination path of a fundus camera. Fundus images were acquired by a colour CCD camera and specific software was used for vessel tracking and calculation of their haemoglobin oxygen saturation. 11 patients with branch retinal artery occlusions, average age 63.4 ± 11.7 years were investigated at time of diagnosis and at the 5th day of a rheological and intraocular pressure reduction therapy. RESULTS: 10 out of 11 patients have shown an increase of haemoglobin oxygenation over time (on average from 73 ± 16 % to 87 ± 11 %). This increase was statistically significant (p < 0.05, Wilcoxon test). Non-affected retinal areas have also shown an increase of haemoglobin oxygenation. The visual acuity improved by one line. This increase in visual acuity was, however, not statistically significant. CONCLUSIONS: We observed an increase of the arterial haemoglobin oxygenation. One possible reason of the improvement of the haemoglobin oxygenation by the therapy may be an increase of the rheological properties of the blood. All patients showed an increase or at least a stabilisation of their visual acuity. Retinal vessel oximetry might be used as an additional parameter in the follow-up of retinal artery occlusion.

[Comparison of parameters of time-resolved autofluorescence between healthy subjects and patients suffering from early AMD]. / Vergleich von Parametern der zeitaufgelösten Autofluoreszenz bei Gesunden und Patienten mit früher AMD.

BACKGROUND: A fluorescence lifetime mapper (FLM) was tested for quantitative estimation of early alterations in age-related macular degeneration (AMD) which are assumed to be in cellular metabolism. METHOD: In FLM time-resolved autofluorescence of the fundus is excited by picosecond (ps) laser impulses at 448 nm and detected in 2 spectral ranges (K1=490-560 nm and K2=560-700 nm) by time-correlated single photon counting. The time-dependent decrease in fluorescence intensity was approximated using 3 decay rates. The calculated lifetimes allow a comparison with endogenous fluorophores of cellular metabolism. RESULTS: Initially mean lifetimes were determined for 8 healthy subjects (K1: tau1=118 ps, tau2=584 ps, tau3=2826 ps, K2: tau1=104 ps, tau2=477 ps, tau3=1623 ps). In 15 AMD patients (AREDS categories I and II) the lifetimes were longer (K1: tau1=166 ps, tau2=986 ps, tau3=3309 ps, K2: tau1=137 ps, tau2=583 ps, tau3=1924 ps). The best separation between healthy subjects and patients with early AMD was possible by parameters 1 and 2 in the short-wave channel. Fluorophore-specific alterations in the macula could be demonstrated in isolated cases with advanced AMD. CONCLUSION: Measurements in the 30 degrees fundus field demonstrated that specific alterations were already present even in early AMD and also outside the macula. These act in the neuronal retina, because parameter tau2 is related to this layer. Increases in the lifetime of parameter tau2 in the short wave channel could at least partially be determined by an increase of protein bound NADH, the content of which increases with reduced cellular respiration.

The prevalence of premenstrual dysphoric disorder in a randomly selected group of urban and rural women.

BACKGROUND: Premenstrual dysphoric disorder (PMDD) was included as a provisional diagnostic category in the appendices of Diagnostic and Statistical Manual of Mental Disorders (DSM)-III-R (then called late luteal phase dysphoric disorder) and remained as an appendix in DSM-IV. Our study aimed to determine the prevalence of PMDD using all four DSM-IV research diagnostic criteria in a representative sample of women of reproductive age in the United States. METHOD: Data were collected in the homes of women between the ages of 13 and 55 years in two urban and two rural sites using a random sampling procedure developed by the National Opinion Research Center. Women completed daily symptom questionnaires and provided urine specimens each day for two consecutive ovulatory menstrual cycles (ovulation was estimated for women taking oral contraceptives) and were screened for psychiatric disorders by trained interviewers. Symptoms were counted toward a diagnosis of PMDD if they worsened significantly during the late luteal week during two consecutive ovulatory menstrual cycles, occurred on days in which women reported marked interference with functioning, and were not due to another mental disorder. RESULTS: In the final analysis, 1246 women who had had at least one menstrual cycle and were neither naturally nor surgically menopausal nor pregnant were selected. Of the women in the study, 1.3% met criteria for the diagnosis as defined in DSM-IV. CONCLUSIONS: The prevalence of PMDD is considerably lower than DSM-IV estimates and all but one of the estimates obtained from previous studies when all DSM-IV diagnostic criteria are considered. We suggest a new process for diagnosing PMDD based on our findings.

Premenstrual dysphoric disorder and risk for major depressive disorder: a preliminary study.

Investigators examined whether premenstrual dysphoric disorder (PMDD) poses a risk for major depressive disorder (MDD). In an initial study, women rated premenstrual symptoms and functional impairment daily for two menstrual cycles. A semistructured diagnostic interview was given to obtain psychiatric histories and differentiate PMDD from premenstrual exacerbations of other disorders. Participants in this pilot study were eight women with PMDD and a random subgroup without PMDD (n = 9) initially. Another semistructured interview was given to diagnose psychiatric disorders occurring during a two-year follow-up interval. In all, seven of the eight women with PMDD developed MDD within two years, including all those who had never had MDD before. The odds that a woman with PMDD developed MDD were 14 times the odds that a woman without PMDD developed MDD ( p <.05). Premenstrual dysphoric disorder may be a prodrome of or causal risk factor for MDD. Preliminary evidence for the diagnostic validity of PMDD is provided.

Rural and urban Midwestern United States contraception practices.

To address a paucity of demographic data on rural United States contraception practices, 370 randomly selected menstruating women, age 13-55 years, living in rural and urban Illinois and Missouri answered interview questions. Women with relatively few children and living in urban areas were likely to practice contraception more than those with relatively few children and living in rural areas, p < 0.01. In Illinois, more rural (23%) than urban (2%) women chose sterilization, p < 0.01. Single status was more frequent in Chicago (41%) and rural Missouri (32%) than in rural Illinois (19%), p < 0.002, and extant research links single status with risk for HIV and other sexually transmitted diseases (STDs). Condom use did not differ significantly by locale, p > 0.05. Urban-rural differences in contraception practices may be a function of life style choices (e.g. urban women may practice contraception to postpone having children, whereas rural women may practice contraception to prevent having more children after families are complete). Results do not strongly support that locale differences in contraception practices are a function of concern about contracting STDs.

Black-white differences in the psychosocial outcomes of epilepsy.

The present study tested the hypothesis that the stigma of being disabled and that of minority ethnic status yield more negative psychosocial outcomes for black than white persons with epilepsy. Black (n=55) and white (n=53) urban participants from a larger sample were matched for socioeconomic status and seizure frequency. Differences in these and key demographic variables were tested using chi(2) and t-tests and found to be non-significant. Group differences in psychosocial outcome variables were analyzed with the following results: (1) white subjects were more likely to have considered suicide and to have higher scores on the family background scale of the Washington Psychosocial Seizure Inventory (WPSI); (2) black subjects had significantly lower scores on the Beck Hopelessness Scale and significantly more optimistic attributional styles; and (3) no between-group differences were found on other psychosocial measures. The nature of family and community supports may determine intergroup differences.

Relationships of premenstrual dysphoric disorder to major depression and anxiety disorders: a re-examination.

Clarifying the relationships of premenstrual dysphoric disorder (PMDD) to depressive and anxiety disorders may contribute to the understanding of risk factors and etiologies associated with the disorders. A current belief is that women with PMDD have a higher percentage of past psychiatric disorders than women without the disorder, an assumption that may be premature. This review carefully examines existing literature on the nature of the relationships between PMDD and major depression and anxiety disorders. A re-evaluation of the literature and the resulting implications for risk factors and etiology, as well as for obstetric and gynecological practice, are provided.

Symptom patterns of premenstrual dysphoric disorder as defined in the Diagnostic and Statistical Manual of Mental Disorders-IV.

Premenstrual dysphoric disorder was included in an appendix of DSM-III-R (revised third edition of the Diagnostic and Statistical Manual of Mental Disorders) and DSM-IV to facilitate systematic research. Items contained in its set of research criteria were considered tentative. Only one previous study of premenstrual symptoms specifically addressed symptoms of premenstrual dysphoric disorder, and it did not use DSM-IV criteria. In the present study, prospectively measured symptoms of 99 women were analyzed using exploratory principal components analysis with orthogonal rotation on all 24 items derived from the 11 symptoms listed in DSM-IV. Variation was found across phases of cycle and groups, with five factors predominating: (1) anger/irritability, (2) depressed mood, (3) anxiety/tension, (4) decreased energy and interest with physical symptoms, and (5) eating problems.

Factor structure and dimensionality of the multidimensional health locus of control scales in measuring adults with epilepsy.

External locus of control has been implicated in the development of psychosocial problems in epilepsy, and adults with epilepsy exhibit scores that are more external than those of the normative sample of the Multidimensional Health Locus of Control (MHLC) scales. Although the MHLC scales has the potential to be quite useful in the assessment and treatment of adults with epilepsy, it has not been assessed psychometrically using data from persons with epilepsy. The present study examined the internal consistency, factor structure, and construct validity of the scales using data from a survey of 143 adults with epilepsy. Results from reliability analysis, confirmatory factor analysis, and Rasch analysis supported the hypothesized three-factor structure of the measure, which was internally reliable and factorially valid.

A design for studying the DSM-IV research criteria of premenstrual dysphoric disorder.

The DSM-IV estimate that 3-5% of women have premenstrual dysphoric disorder (PMDD) is based on studies that: used non-representative samples, did not consider all research criteria, or were retrospective. In the present study, prospective data from a multiethnic sample of women were analyzed to develop an effective method of considering all DSM-IV research criteria for PMDD. One-hundred and seventeen subjects between the ages of 13 and 55 years who were neither pregnant nor menopausal were recruited from outpatient clinics at a teaching hospital for a study of changes in women's health through time. Daily urine samples were taken for two menstrual cycles, analyzed to establish phase of cycle, and correlated with daily symptom ratings. Subjects were assessed for psychiatric disorders. Four methods of symptom analysis were used. Prevalence rates ranging from 1.0% to 7.1% were determined that differed according to the method of measuring the symptom change. The group of women with PMDD did not differ from the sample as a whole on variables including age, parity and birth control pill use. When all criteria were considered as they appear in DSM-IV, prevalence estimates of the present study did not differ markedly from those in DSM-IV.

Establishing the diagnostic validity of premenstrual dysphoric disorder using rasch analysis.

Premenstrual Dysphoric Disorder (PMDD) has remained in appendices of the last two editions of The Diagnostic and Statistical Manual of Mental Disorders due to lack of empirical study. Items included in its set of research criteria are considered tentative pending evidence of diagnostic validity. The present study attempts to establish the construct validity of the PMDD criteria using the Rasch method to analyze the validity of individual items as contributors to the diagnosis, in contrast to the usual but less precise approach of using an external validator to establish the diagnostic utility of psychiatric conditions. Analysis of which items best differentiate participants with and without PMDD provides an idea of the relative ability of these items to distinguish PMDD. It is recommended that the areas of anger/irritability, depressed mood, and problems in interpersonal functioning be expanded in further studies and corresponding items added to symptom checklists.

Attributional style and locus of control in adults with epilepsy.

Little agreement exists on how attributional style and locus of control relate to one another. Some consider the two to be interchangeable; others say that they overlap but are not identical. This study of the perceptions of control (conceptualized as attributional style and locus of control) of 144 adults with epilepsy, measured via a mailed survey, lends support to the latter notion. Attributional style for bad events, but not for good events, could be predicted by length of time that participants had been seizure free. Locus of control could not be predicted. Differences in the nature of the two concepts and how they develop within individuals are examined to explain how changes in seizure control would effect one but not the other. Implications for other medical conditions are discussed.

Perceptions of control in adults with epilepsy.

That psychosocial problems are extant in epilepsy is evidenced by a suicide rate among epileptic persons five times that of the general population and an unemployment rate estimated to be more than twice that of the population as a whole. External perceptions of control secondary to repeated episodes of seizure activity that generalize to the social sphere have been implicated as causes of these problems. The hypothesis that individuals who continue to have seizures become more and more external in perceptions of control was tested by a survey mailed to a sample of individuals with epilepsy in a metropolitan area of the Midwest. Dependent variables were, scores on instruments measuring locus of control and attributional style. The independent variable was a measure of seizure control based on present age, age at onset, and length of time since last seizure. Gender, socioeconomic status, and certain parenting characteristics were included as control variables, as they are also known to affect perceptions of control. Analysis by multiple regression techniques supported the study's hypothesis when perceptions of control was conceptualized as learned helplessness for bad, but not for good, events. The hypothesis was not confirmed when perceptions of control was conceptualized as either general or health locus of control.

Effects of field size when using Kerley's histological method for determination of age at death.

The field size at which a bone is read affects the results obtained when using Kerley's histological method for age estimation, even after applying the recommended correction factor. Whereas there is no tendency for any one of three field sizes tested to consistently underestimate or overestimate age, a field size closest to that used by Kerley in his original study had significantly lower variances for its age estimates, and thus provides greater reliability. This particular field size yields more precise estimates because it is sampling a pattern and number of structures more similar to that of Kerley. Correction factors cannot equalize the counts of osteons and osteon fragments because of spatial variations in the distributions of these histological structures. A field size similar to that used by Kerley in gathering the data from which he developed his regression equations must be used to assure that the same pattern and number of structures is being sampled. For this reason, we suggest a field size as close to 2.06 mm2 as possible be used when employing Kerley's method.

The relative accuracy and reliability of histological aging methods.

Histological aging methods of Kerley and of Ahlqvist and Damsten were applied to bone samples from thirteen individuals of known age at death. Relative accuracy and reliability were determined for six of Kerley's predicting formulas for the femur, fibula and tibia, and his profile method, Ahlqvist and Damsten's femoral predicting formulas, and age determined by averaging ages predicted by Kerley's six formulas. Averaging age estimates by Kerley's six formulas (mean regression) was found to produce the overall greatest accuracy and reliability. Dividing the sample into two age groups (13 - 51 and 60 - 102 years) altered the results only slightly. Kerley's femoral intact osteon formula produced the greatest accuracy for individuals in the younger age category, while his fibular osteon fragment formula was most accurate for older ages. Mean regression produced the greatest reliability for all age classes. Based upon both accuracy and reliability, averaging age predictions by Kerley's regression formulas appears to be the method of choice for broad application of histological aging.