Primary Sjögren's syndrome: Extraglandular manifestations and hydroxychloroquine therapy.

The use of hydroxychloroquine (HCQ) in Primary Sjögren's Syndrome (pSS) has been assessed in different studies over the last years, with conflicting results regarding its efficacy in sicca syndrome and extraglandular manifestations (EGM). The goal of this study was to compare the incidence rate of EGM in pSS patients with and without HCQ therapy.We performed a multicenter retrospective study, including patients with pSS (European classification criteria) with at least 1 year of follow-up. Subjects with concomitant fibromyalgia, autoimmune hepatitis, primary biliary cirrhosis, and primary sclerosing cholangitis were excluded. Demographics and pSS characteristics were recorded. The EGM were defined by EULAR-SS disease activity index (ESSDAI). Patients were divided into two groups according to their use or not of HCQ therapy. We evaluated the use of HCQ and its relationship to EGM. HCQ therapy was defined as the continuous use of the drug for at least 3 months. A descriptive analysis of demographics and pSS characteristics was performed. We compared the incidence of EGM between groups defined by HCQ therapy using chi2 test or Fisher's exact test. A total of 221 patients were included (97.3% women), mean age, 55.7 years (SD 14). Mean age at diagnosis, 48.8 years (SD 15); median disease duration, 60 months (IQR 35-84). One hundred and seventy patients (77%) received HCQ. About half of the patients had at least one EGM during the course of the disease, 20% of them developed an EGM before the onset of the sicca syndrome and 26% simultaneously with dryness symptom. Overall, EGM were less frequent in those on HCQ therapy (36.5% vs 63.5%, p < 0.001). Considering each EGM individually, the following manifestations were more frequent in the non-treated group: arthritis (p < 0.001), fatigue (p < 0.001), purpura (p = 0.01), Raynaud phenomenon (p = 0.003), and hypergammaglobulinemia (p = 0.006). Immunosuppressive treatment was indicated on 28 patients (12.7%), 13 of which were receiving also HCQ. The first reason for those treatments was the presence of arthritis in 12/28 patients (42.8%), and the drug used in all the cases was methotrexate. Only three patients required immunosuppressive therapy with cyclophosphamide, due to the presence of glomerulonephritis, vasculitis, and interstitial lung disease. None of the patients received biologic therapy. The lower incidence of EGM was observed in patients on HCQ therapy supports its efficacy in pSS. However, further large scale prospective studies are needed to confirm these findings.

Children's Pain Perspectives Inventory (CPPI): developmental assessment.

This study explored the reliability and validity of the Children's Pain Perspectives Inventory (CPPI), an instrument designed to assess the developmental progression of children's pain perspectives. The convenience sample included 88 children between 5 and 13 years of age. Results from this descriptive correlational study indicated that children's pain perspectives could be developmentally ordered, coded and scored reliably, and with validity. An interrater reliability of 0.94 and an internal consistency reliability of 0.86 was obtained on the final group of 48 children. The criterion validity of the CPPI was supported by significant positive correlations between scores on the CPPI and the Cartoon Conservation Scale (CCS), a measure of cognitive development (r = 0.67, P = 0.001). Additional testing and refinement of the CPPI is recommended.

Health related attitudes and health promoting behaviors: differences between health fair attenders and a community group.

Demographic, attitudinal, and behavioral differences between health fair attenders and a community comparison group were examined along with predictions of health promoting behaviors from demographic and attitudinal variables. Differences between questionnaire responses of 155 health fair attenders and 71 grocery shoppers indicated attenders perceived themselves having better current health and greater internal control of their health, and reported more behaviors indicating health responsibility, exercise, and nutrition than the comparison group. Psychological variables--particularly perceptions of greater self-efficacy and better health status--were the best predictors of attenders' health promoting behaviors; demographic variables were less important. On the other hand, demographic variables were most predictive of comparison group health promoting behaviors with psychological variables playing a lesser role. Further studies of relationships between the variables examined here and experimental studies of the effects of health fair attendance on health knowledge and performance of health promoting behaviors are needed. Assuming health fairs are effective in educating attenders, it was concluded that health fair planners should: 1) encourage nonattenders to become attenders and attenders to be repeat attenders, 2) carefully promote and advertise health fairs, and 3) hold health fairs in locations easily accessible to large numbers of people.

Distribution of Spiculopteragia pursglovei and S. odocoilei (Nematoda: Trichostrongyloidea) from white-tailed deer (Odocoileus virginianus) in the southeastern United States.

The distribution of Spiculopteragia pursglovei (= Apteragia pursglovei) and S. odocoilei (= A. odocoilei) in 12 southeastern states was determined after examining the abomasal contents of 1,369 white-tailed deer over an 8-yr period. Spiculopteragia odocoilei was encountered with much greater frequency than S. pursglovei except in some areas along the Mississippi River drainage and the coasts of North Carolina and South Carolina. In instances where both parasites were found in a population, one usually expressed a dominance in both prevalence and intensity. These findings are in agreement with those of an earlier study conducted in the southeastern United States.

Parasites, diseases, and health status of sympatric populations of sika deer and white-tailed deer in Maryland and Virginia.

In July 1981, investigations on parasites, diseases, and herd health status were conducted on sympatric populations of sika deer (Cervus nippon) and white-tailed deer (Odocoileus virginianus) from Blackwater National Wildlife Refuge (Maryland) and Chincoteague National Wildlife Refuge (Virginia) on the Delmarva Peninsula. Five adult deer of each species were collected from each location and subjected to thorough necropsy examinations and laboratory tests. White-tailed deer at both locations harbored protozoan, helminth, and arthropod parasites typically associated with this species throughout the southeastern United States. In contrast, sika deer at both locations harbored only light burdens of ticks, chiggers, and sarcocysts. Serologic tests for antibodies to seven infectious disease agents revealed evidence of exposure to bovine virus diarrhea (BVD) virus, infectious bovine rhinotracheitis virus, and parainfluenza3 virus in white-tailed deer, but only BVD virus in sika deer. At both locations the general health status of sika deer was superior to that of white-tailed deer.

Smoking areas on school grounds: are we encouraging teenagers to smoke?

In the United States, smoking has been identified as a major health hazard for the past 20 years. This study attempts to determine the relationship between the availability of a smoking area on school grounds, the incidence of smoking among teenagers, and the number of cigarettes smoked per day by teenagers. A questionnaire was administered to the target population and a matched control group at two suburban high schools, similar in size and socioeconomic status. One of the two schools provided a smoking area for students. The findings suggest a possible relationship between providing a smoking area for students and an increase in the number of teenage smokers. The findings also indicate a possible decrease in teenage, male smokers. Our findings should prompt health professionals, educators, and parents to ask, "Are we encouraging our teenagers to smoke?"

Assessment of pain coping styles: development of an inventory.

The Pain Coping Style Inventory (PCSI) is an instrument designed to measure the pain coping style of individuals. It is based on the pain coping model and typology described by Copp. A study with a convenience sample of 145 university graduates, undergraduates, and faculty revealed a Cronbach's alpha reliability coefficient of 0.90, adequate stability, and a nine factor analysis solution representing 57% of the variance. Four of Copp's five coping styles are clearly defined by the factor analysis: interactive, reactive, combatant, and victim. Five more coping styles are named: contractor, distractor, spiritual coping, substance users, and mind over matter. The development and piloting of the PCSI is a step towards empowering the nurse with the ability to provide patients with individualized pain coping strategies.

Recent experience with tetanus in Alabama.

In recent years, all cases of tetanus reported in the United States have occurred either in unimmunized persons, partially immunized persons, or persons whose immunization history was uncertain. We present our experience with three unimmunized individuals who acquired this disease. One patient became ill after a "clean, minor wound." Present guidelines do not encourage immediate protection with human tetanus immune globulin (TIG) for unimmunized patients with this type of injury. We believe serious consideration should be given to modification of current recommendations to include the more liberal use of TIG, especially in nonimmune persons.