Relationship between the prevalence of polycythemia and factors observed in the mental health and lifestyle survey after the Great East Japan Earthquake.

We have been examining the Comprehensive Health Check of the Fukushima Health Management Survey of residents of 13 municipalities who were forced by the government to evacuate due to the 2011 Great East Japan Earthquake (GEJE). Our findings showed that evacuation is a risk factor for polycythemia and suggested that experiencing an unprecedented disaster and exposure to chronic stress due to evacuation might be a cause of polycythemia.We analyzed the relationship between the prevalence of polycythemia and the following factors observed in the Mental Health and Lifestyle Survey in an observational study with a cross-sectional design: traumatic symptoms, depression status, socioeconomic factors such as residential environment, and working situation after the GEJE. Target population of the survey included men and women who were at least 15 years of age and who lived in the evacuation zones specified by the government. Participants analyzed consisted of 29,474 persons (12,379 men and 16,888 women) who had participated in both the 2011 Comprehensive Health Check and Mental Health and Lifestyle Survey from June 2011 through March 2012.The prevalence of polycythemia was not associated with mental states associated with traumatic symptoms (Post-Traumatic Stress Disorder Checklist Scale ≥ 44) and depression status (Kessler 6-item Scale ≥ 13). Furthermore, multivariate analysis showed that there was a tendency for males to develop polycythemia, with characteristics such as being aged 65 years and older, highly educated, obese (body mass index ≥ 25), hypertensive, diabetic, having liver dysfunction, and a smoker being significantly related to the prevalence of polycythemia.Our findings conclusively demonstrated that polycythemia was not significantly related to psychological factors, but was significantly related to the onset of lifestyle-related disease after the GEJE.

Poor sleep quality predicts decreased cognitive function independently of chronic mountain sickness score in young soldiers with polycythemia stationed in Tibet.

Little is known about the association between poor sleep and cognitive function in people with polycythemia at high altitude. The aim of this study was to survey the sleep quality of individuals with polycythemia at high altitude and determine its association with cognitive abilities. We surveyed 230 soldiers stationed in Tibet (all men; mean age 21-52±4.30 yr) at altitudes ranging from 3658 to 3996 m. All participants were given a blood tests for hemoglobin level and a questionnaire survey of cognitive function. Polycythemia was defined as excessive erythrocytosis (Hb≥21 g/dL in men or ≥19 g/dL in women). Poor sleepers were defined as having a global Pittsburgh Sleep Quality Index score (PSQI)>5. Cognitive abilities were determined by the Chinese revision of the Wechsler Adult Intelligence Scale and the Benton Visual Retention Test. Multiple linear regression analysis was used to determine the association between the PSQI and cognitive function. Logistic regression analysis was performed to determine the independent effect of sleep quality on cognitive function. The global PSQI score of enrolled participants was 8.14±3.79. Seventy-five (32.6%) soldiers were diagnosed with polycythemia. The proportion of poor sleepers was 1.45 times greater in those with polycythemia compared with those without polycythemia [95% (confidence interval) CI 1.82-2.56], and they had a statistically significant lower score for cognitive function. Multiple linear regression analysis showed that the global PSQI score was negatively associated with IQ (ß=0.11, 95% CI -0.16 to -0.05) and digit symbol scores (ß=0.66, 95% CI -0.86 to -0.44). Poor sleep quality was determined to be an independent predictor of impaired IQ [odds ratio (OR) 1.59, 95% CI 1.30-1.95] and digit symbol score (OR 1.18, 95% CI 1.07-1.31) in logistic regression analysis. The present study showed that for young soldiers with polycythemia at high altitude impaired subjective sleep quality was an independent predictor of decreased cognitive function, especially IQ and verbal short-term memory.

Short and long term outcomes following partial exchange transfusion in the polycythaemic newborn: a systematic review.

BACKGROUND: Severe polycythaemia in the neonate may produce symptoms due to hyperviscosity and may be associated with serious complications. Partial exchange transfusion will reduce the packed cell volume. OBJECTIVE: To determine whether partial exchange transfusion in term infants with polycythaemia (symptomatic and asymptomatic) is associated with improved short and long term outcomes. SEARCH STRATEGY: Medline, EMBASE, and the Cochrane Controlled Trials Register of the Cochrane Library were searched. The following keywords were used: polycythaemia, partial exchange transfusion, hyperviscosity, and limited to the newborn. This covered years 1966-2004. Abstracts of the Pediatric Academic Societies and personal files were also searched. SELECTION CRITERIA: Randomised or quasi-randomised trials in term infants with polycythaemia and/or documented hyperviscosity were considered. Clinically relevant outcomes included were short term (resolution of symptoms, neurobehavioural scores, major complications) and long term neurodevelopmental outcome. DATA COLLECTION AND ANALYSIS: All data for each study were extracted, assessed, and coded separately. Any disagreements were resolved by discussion. MAIN RESULTS: Six studies were identified; five had data that could be evaluated for analysis. There is no evidence of an improvement in long term neurological outcome (mental developmental index, incidence of mental delay, and incidence of neurological diagnoses) after partial exchange transfusion in symptomatic or asymptomatic infants. There is no evidence of improvement in early neurobehavioural assessment scores (Brazelton neonatal behavioural assessment scale). Partial exchange transfusion may be associated with an earlier improvement in symptoms, but there are insufficient data to calculate the size of the effect. Necrotising enterocolitis is probably increased by partial exchange transfusion (relative risk 8.68, 95% confidence interval 1.06 to 71.1). CONCLUSION: There is no evidence of long term benefit from partial exchange in polycythaemic infants, and the incidence of gastrointestinal injury is increased. The long term outcome is more likely to be related to the underlying cause of polycythaemia.

Aspectos psicológicos en pacientes con policitemia relativa hipovolémicos y normovolémicos / Phychological aspects in hypovolemic and normovolemic patients with relative polycythemia

En un grupo de 38 pacientes con policitemia relativa (PR) diagnosticados y atendidos en el IHI, se realizó un estudio retrospectivo de las características de personalidad y de elementos psicopatológicos a raíz de la nueva clasificación de PR normo e hipovolémica. No se encontraron diferencias significativas de las escalas psicológicas entre el total de pacientes hipovolémicos y el total de pacientes normovolémicos, aunque sí se hallaron diferencias entre los pacientes con valores extremos de las variables hematológicas. Los pacientes con mayores cifras de hematócritos se describen como más rígidos, oposicionistas, impulsivos, con tendencia a la acción y la propensión a brindar una imagen de masculinidad acentuada. Los sujetos que poseen los menores valores de índice plasmático se muestran como personas más dinámicas, enérgicas y emprendedoras, con tendencia a una mayor actitud defensiva ante la exploración de su área psicológica como resultado de una intención de ofrecer una imagen de rasgos socialmente deseables. El subgrupo de pacientes de mayores valores en el volumen globular resultaron ser menos reposados e introspectivos y más tendientes a la impulsividad, a ser expresivos y entusiastas. Los resultados obtenidos confirman la vinculación de los aspectos psicológicos con esta enfermedad.(AU)

Polycythaemia and agoraphobia.

Using single photon emission computerized tomography (SPECT), we demonstrated that in patient A, a 20-year-old male with polycythaemia, the cerebral blood flow was decreased (presumably as a result of increased viscosity and or microemboli), probably leading to frightening visual distortions (dysmorphopsia) associated with scintillating specks of bright colors (Teichopsia). This had presumably precipitated agoraphobia. After hospitalization, when the patient had not responded to efforts at systematic desensitization, he improved through a combination of multiple venesections and antiplatelet aggregation therapy (aspirin 75 mg o.d.) over 3 months combined with systematic desensitization. A subsequent SPECT demonstrated an increase in cerebral blood flow to normal levels, which coincided with improvement of agoraphobic symptoms and disappearance of visual distortions on further follow-up. This paper depicts another yet undocumented example of an alarming physical symptom probably leading to a cognitively-based panic sufficient to cause agoraphobia by classical conditioning. It also suggests that prior treatment of such physical symptoms is likely to facilitate the process of systematic desensitization.

Developmental outcome of infants with neonatal polycythemia.

The study of the developmental outcome of neonatal polycythemia was performed on 47 polycythemic and 21 controlled infants who were born at the same period of time. It was found that at the age of 1 1/2 to 2 years the number of infants with abnormal DQ was higher in the group of total polycythemic infants (47%) and in the group of asymptomatic polycythemic infants (45%) than that of the control groups (19% and 5.6% of the groups including twin sibs and excluding twin sibs respectively). There was no difference in the developmental test between the symptomatic and asymptomatic patients. In asymptomatic infants the benefit of partial plasma exchange transfusion on developmental outcome was not found and only low birthweight and small for gestational age infants are the risk factors for poor developmental outcome.

'Polycythaemia of stress' in subjects with Type A and Type B behaviour patterns.

To determine the importance of emotional stress for relative polycythaemia, we studied 11 subjects with the Type A and 11 subjects with the Type B behaviour patterns during short-term mental stress. All subjects were healthy, normotensive non-smoking young males aged 20-34 yr. without any medication. During rest there were no significant differences in heart rate, blood pressure, or plasma catecholamines between the two groups, but the A-group had significantly higher haemoglobin concentration (147 vs 140 g/l; p less than 0.005) and haematocrit (43.8 vs 42.1%: p = 0.05) than the B-group. In the whole group, there was a positive correlation between resting diastolic blood pressure and haemoglobin concentration (r = 0.53; p less than 0.05). In response to 10 min of mental arithmetic, haematocrit, haemoglobin and erythrocyte count rose approximately 2% (p less than 0.001 throughout). The stress-induced changes were not significantly different between the A- and B-groups. It is concluded that mild relative polycythaemia could be induced by acute emotional stress. In subjects with the Type A behaviour pattern a slight haemoconcentration is present already at rest, which further increases during stress.

Neonatal hyperviscosity association with lower achievement and IQ scores at school age.

A longitudinal study was conducted to determine whether the early neurologic and motor impairment observed in children with neonatal polycythemia and hyperviscosity persisted into school age. Forty-nine children who had neonatal polycythemia and hyperviscosity were evaluated at a mean age of 7 years. Of these, 21 (group 1) received a partial plasma exchange transfusion, whereas 28 (group 2) received symptomatic care. Forty control children (group 3) with a normal neonatal hematocrit were also evaluated. Testing consisted of a battery of measures to evaluate IQ, achievement, neuromotor function, and gross and fine motor skills. Maternal education and IQ were also assessed to avoid potential confounding by differences in the home environment. The neonatal course of the children with polycythemia and hyperviscosity was characterized by an increased number of problems, including hypoglycemia and cyanosis. At 7 years of age, the 49 children who had hyperviscosity (groups 1 and 2) had significantly lower "spelling" and arithmetic achievement test results and gross motor skill scores. Scores for reading, visual motor integration, and neurologic signs did not differ significantly from group 3. Maternal IQ scores were similar for both groups. Left-hand preference was seen in 14% of group 1 and 2 children and 7% of group 3 children (not significant). The scores for IQ, achievement, neuromotor function, and visual motor integration were compared for the hyperviscosity group (groups 1 and 2) and the control group (group 3) by multivariate analysis of variance with sex and hyperviscous group as independent variables and maternal education and maternal IQ as covariates (P = .040).(ABSTRACT TRUNCATED AT 250 WORDS)

Estilo de enfrentamiento al estrés en pacientes con hemopatías / Way of facing stress in hemopathological patients

Se estudian 109 pacientes adultos del sexo masculino (27 hemofílicos, 29 con anemia drepanocítica, 36 con policitemia relativa y 17 leucémicos) atendidos en el Instituto de Hematología e Inmunología. Para explorar los estilos de enfrentamiento al estrés emocional se utilizó una selección de 65 preguntas extraídas, por criterio de jueces, del Inventario Multifacético de la Personalidad de S.R.Hathaway y C.McKinley, de la prueba de los 16 factores de personalidad de R.B. Cattell y de la escala de ansiedad IPAT del mismo autor. Se realizó un análisis factorial de correspondencia del que se obtuvieron 4 factores independientes. Se determinó para cada sujeto el factor predominante, se analizó la frecuencia de pacientes existentes en cada grupo y se compararon los grupos entre sí. Para este análisis se utilizó el test de McNemar y la prueba exacta de Fischer. Los grupos de pacientes hemofílicos y con anemia drepanocítica presentaron una distribución similar sin diferencias significativas (p <0,05), agrupándose la mayoría de los pacientes en dos de los factores. En el grupo de pacientes leucémicos se observó una distribución más homogénea que en los otros grupos. El grupo de pacientes con policitemia relativa mostró una distribución peculiar, donde el 69,4 % de los pacientes presentaron el mismo factor predominante. Los resultados obtenidos apoyan el criterio de la vinculación de los estilos de enfrentamiento a la personalidad y resaltan la influencia de la enfermedad en el desarrollo de la misma

Estilo de enfrentamiento al estrés en pacientes con hemopatías / Way of facing stress in hemopathological patients

Se estudian 109 pacientes adultos del sexo masculino (27 hemofílicos, 29 con anemia drepanocítica, 36 con policitemia relativa y 17 leucémicos) atendidos en el Instituto de Hematología e Inmunología. Para explorar los estilos de enfrentamiento al estrés emocional se utilizó una selección de 65 preguntas extraídas, por criterio de jueces, del Inventario Multifacético de la Personalidad de S.R.Hathaway y C.McKinley, de la prueba de los 16 factores de personalidad de R.B. Cattell y de la escala de ansiedad IPAT del mismo autor. Se realizó un análisis factorial de correspondencia del que se obtuvieron 4 factores independientes. Se determinó para cada sujeto el factor predominante, se analizó la frecuencia de pacientes existentes en cada grupo y se compararon los grupos entre sí. Para este análisis se utilizó el test de McNemar y la prueba exacta de Fischer. Los grupos de pacientes hemofílicos y con anemia drepanocítica presentaron una distribución similar sin diferencias significativas (p <0,05), agrupándose la mayoría de los pacientes en dos de los factores. En el grupo de pacientes leucémicos se observó una distribución más homogénea que en los otros grupos. El grupo de pacientes con policitemia relativa mostró una distribución peculiar, donde el 69,4

de los pacientes presentaron el mismo factor predominante. Los resultados obtenidos apoyan el criterio de la vinculación de los estilos de enfrentamiento a la personalidad y resaltan la influencia de la enfermedad en el desarrollo de la misma

Policitemia relativa: características psicológicas, estrés emocional y entrenamiento autógeno / Relative polycythemia: psychologic characteristics, emotional stress and autogenic training

En un grupo de 16 pacientes con policitemia relativa (PR) se estudió la relación de un conjunto de características psicológicas con las variaciones de los valores de hemoglobina (Hb) y hematócrito (Hto) producidas por la inducción de una variante del entrenamiento autógeno (EA) y por una situación experimental de estrés emocional. El descenso en los valores de las determinaciones hematológicas producto de la inducción del EA se vió favorecido por rasgos psicológicos tales como la comunicabilidad, espíritu de cooperación, elevado sentido de la responsabilidad y la sociabilidad. Por el contrario, la desconfianza, la suspicacia y los elementos depresivos, entorpecieron el efecto del EA en estos sujetos. El incremento de los niveles de Hb y Hto provocados por la situación de estrés, se relacionaron significativamente con la presencia de elementos psicopatológicos, fundamentalmente de ansiedad, inseguridad ansiosa y de tendencia a la depresión. Los resultados obtenidos tienden a apoyar los criterios psicogénicos acerca de la PR y destacan la necesidad de un enfoque multidisciplinario en su estudio

Policitemia relativa. características psicológicas, estrés emocional y entrenamiento autógeno / Relative polycytheia: psychologic characteristics, emotional stress and autogenic training

En un grupo de 16 pacientes con policitemia relativa (PR) se estudió la relación de un conjunto de características psicológicas con las variaciones de los valores de hemoglobina (Hb) y hematócrito (Hto) producidas por la inducción de una variante del entrenamiento autógeno (EA) y por una situación experimental de estrés emocional. El descenso en los valores de las determinaciones hematológicas producto de la inducción del EA se vió favorecido por rasgos psicológicos tales como la comunicabilidad, espíritu de cooperación, elevado sentido de la responsabilidad y la sociabilidad. Por el contrario, la desconfianza, la suspicacia y los elementos depresivos, entorpecieron el efecto del EA en estos sujetos. El incremento de los niveles de Hb y Hto provocados por la situación de estrés, se relacionaron significativamente con la presencia de elementos psicopatológicos, fundamentalmente de ansiedad, inseguridad ansiosa y de tendencia a la depresión. Los resultados obtenidos tienden a apoyar los criterios psicogénicos acerca de la PR y destacan la necesidad de un enfoque multidisciplinario en su estudio

Particularidades psíquicas de un grupo de pacientes con policitemia relativa / Psychic peculiarities of a group of patients with relative polycythemia

Se estudiaron 36 pacientes con policitemia relativa diagnósticados y atendidos en el Instituto de Hematología e Inmunología de acuerdo con su rendimiento intelectual, características de personalidad y elementos psicopatológicos. Los resultados del grupo en la prueba de matrices progresivas ubicaron al 91,3

Particularidades psíquicas de un grupo de pacientes con policitemia relativa / Psychic peculiarities of a group of patients with relative polycytheia

Se estudiaron 36 pacientes con policitemia relativa diagnósticados y atendidos en el Instituto de Hematología e Inmunología de acuerdo con su rendimiento intelectual, características de personalidad y elementos psicopatológicos. Los resultados del grupo en la prueba de matrices progresivas ubicaron al 91,3