Cardiovascular adaptation in people with multiple sclerosis following a twelve week exercise programme suggest deconditioning rather than autonomic dysfunction caused by the disease. Results from a randomized controlled trial

BACKGROUND

Guidelines for optimal exercise doses in people with multiple sclerosis (MS) have to be established. We need to ascertain the basic physiological and perceptual response and adaptation to different exercise doses in this clinical population.

AIM

The aim of this paper was to explore the response during maximal and sub-maximal exercise in people with MS prior to and following two different twelve week exercise programmes.

DESIGN

Sub-analysis of per protocol exercise data of a two group, single blinded, randomised control trial.

SETTING

Multicentre (community leisure and rehabilitation centres).

POPULATION

Participants with MS assigned to a continuous (N.=12; mean±SE age=52.3±2.08; Barthel index median & range=19&13-20) or interval (N.=9; mean±SE age=49.3±3.5; Barthel index median & range=19&18-20) exercise programme.

METHODS

Cardiovascular, respiratory and perceptual exercise response and adaption was measured at maximal and sub-maximal levels of physical exercise prior to and following a twelve week exercise programme, delivered at different intensities.

RESULTS

Irrespective of the type of exercise programme followed, there was a significant increase in peak power (z=-1.98; P=0.05) and normalised oxygen uptake during unloaded cycling (z =-2.00; P=0.05). At discharge from the exercise programmes, the cardiovascular response to sub-maximal exercise had significantly changed (t(360) =-4.62; p<0.01).

CONCLUSION

The response in people with MS at maximal and sub-maximal levels of physical exercise following a twelve week programme is analogous to non-diseased adults.

CLINICAL REHABILITATION IMPACT

Cardiovascular adaptation in people with MS following a twelve week exercise programme suggests deconditioning rather than autonomic dysfunction caused by the disease.

The myth of pulmonary Raynaud's phenomenon: the contribution of pulmonary arterial vasospasm in patients with systemic sclerosis related pulmonary arterial hypertension

OBJECTIVE

To investigate the contribution of cold induced pulmonary vasospasm by peripheral and central cold stimulus in exacerbating pulmonary arterial hypertension (PAH) in patients with systemic sclerosis undergoing cardiac catheterisation.

METHODS

In a prospective pilot study, 21 patients with systemic sclerosis and catheter proven PAH had mean pulmonary artery pressure (mPAP), pulmonary vascular resistance (PVR), and cardiac output (CO) measured before and after peripheral (hand immersion into cold water at 10-15 degrees C for two minutes if tolerated) and central (direct cold water at 4 degrees C injected into the right atrium) cold pressor challenge. Markers of endothelial activation, platelet function, and nitric oxide degradation were measured in blood sampled from the pulmonary artery.

RESULTS

19 of the patients (mean (SD) age, 56 (4) years; baseline mPAP, 34 (8) mm Hg; PVR, 420 (87) dyne.s.cm(-5); CO, 6.4 (1.8) l/min) tolerated cold hand immersion for the maximum two minute duration. All 21 tolerated central cold pressor challenge (three to five injections of 10 ml saline boluses at 4 degrees C). There was no significant change in haemodynamics after cold challenge by either route of provocation. Levels of endothelin-1, von Willebrand factor, fibrinogen, and 3-nitrotyrosine were raised compared with control values in patients with systemic sclerosis but without PAH, but did not change significantly after peripheral cold challenge.

CONCLUSIONS

Pulmonary vasospasm in response to peripheral and centrally administered cold pressor challenge is unlikely to contribute to persistence of pulmonary arterial hypertension in patients with systemic sclerosis.

Comparison of the performance of selenite cystine and mannitol selenite enrichment broths in the isolation of Salmonella spp. from faeces

Over a four-month period, 4,658 routine faecal samples were examined in four laboratories and the isolation rates of Salmonella spp. from mannitol selenite (MS) and selenite cystine (SC) broths plated to xylose lysine desoxycholate agar (XLD) compared. The isolation rate by MS was 1.55% and by SC was 1.48%, a small difference which is not statistically significant. Significantly fewer colonies were selected for supplementary testing from SC than MS (p = 0.029), thus reducing confirmatory work. In laboratories where SC is already used for food and environmental work, an opportunity exists to limit stocked salmonella enrichment broths to SC alone.

A comparison of the performance of commercially available chromogenic agars for the isolation and presumptive identification of organisms from urine

AIMS

To compare four media-UTI medium, BBL CHROMagar, CPS ID2, and Harlequin CLED-using a collection of fully characterised organisms and subsequent "field trial".

METHODS

Seven hundred and eighty seven fully characterised isolates (730 Gram negative bacteria, 47 Gram positive bacteria, and 10 yeasts) were used to test for accuracy of organism identification. To assess isolation rates and ability to detect mixed cultures, 1435 urine samples were cultured in the three best performing chromogenic media (UTI medium, BBL CHROMagar, and CPS ID2) and CLED.

RESULTS

The chromogenic agars differed in their accuracy of identification, with BBL CHROMagar performing best and Harlequin CLED performing least well. Similarly, BBL CHROMagar achieved a higher overall isolation rate than UTI medium and CPS ID2. When mixed growth was defined as greater than two organism types, BBL CHROMagar detected more mixed cultures than did UTI medium and CPS ID2, although the differences were not significant. When mixed growth was defined as greater than one organism type the increased number of mixed growths detected by BBL CHROMagar became significant, largely because of differences in enterococcal isolation rates.

CONCLUSION

The use of BBL CHROMagar, UTI medium, or CPS ID2 chromogenic agar as a replacement for CLED agar would improve the detection rate of contaminated urine samples. Enhanced identification helps to distinguish different species, facilitating the monitoring of bacterial resistance in support of the national antibiotic strategy. BBL CHROMagar gave the highest overall organism recovery rates, greatest ability to detect mixed cultures, and the most accurate identification of organisms.

Relationship of daytime asthma symptom frequency to morning peak expiratory flow

Since management plans based on peak flow measurements are increasingly used, the relationship between peak flow rate and ensuing symptom frequency is of particular interest to the treatment of asthma. The objective of this study was to examine to what extent morning peak flow was related to symptom frequency during the day. In 168 out of 307 randomly selected adult asthmatics from a general practice population, adequate recordings of morning peak flow (amPF) and symptom frequency during the day (DSF) were obtained for 28 days. In each individual, the relationship between these two variables was studied and the mean values of these two variables over 28 days were calculated. The relationship between the means of the variables was also examined for the group as a whole. In individuals, the correlation between amPF and DSF varied widely; only 16% of patients had a good relationship (Pearson r = -1 to -0.5). For the whole group, the relationship between mean amPF and mean DSF best fitted a curvilinear model (r = -0.6). This was unaffected by age, sex or the use of inhaled steroids. For the majority of asthmatics, morning peak flow may be an unreliable predictor of expected symptoms during that day. Reliance on peak flow measurement as a tool enabling asthmatics to manage their asthma on a daily basis needs to be reconsidered.

Using information from asthma patients: a trial of information feedback in primary care

OBJECTIVE

To test the effects of feedback of information about patients' asthma to primary care teams.

DESIGN

Patients' reports of morbidity, use of health services, and drug use on questionnaire was given to primary care teams. Randomised controlled trial with general practices as the subject of the intervention was used to test effectiveness of supplying information.

SETTING

Primary care in district health authority, London.

SUBJECTS

23 general practices, each of which notified at least 20 asthmatic patients aged 15-60 years for each principal. Practices were randomly allocated to an invention group (receiving feedback of information on control of asthma) or a control group (no feedback).

INTERVENTION

Information on cards inserted in patients' medical records; booklet copies of information for team members; formal presentation to primary care teams; poster displays of data on patients in each practice.

MAIN OUTCOME MEASURES

Type and frequency of asthma symptoms, use of health services, use of asthma drugs.

RESULTS

Reported morbidity at entry to the study was substantial: 45% (818) patients reported breathlessness at least once a week. Less than half these patients were using inhaled steroids regularly. Intervention and control groups did not differ in practice or patient characteristics on entry to the study. In spite of the potential for improvement no differences were observed between the two practice groups at the end of the study--for example, breathlessness at least once a week in last six months was experienced by 36% in intervention group v 35% in control group (t = -0.27, P < 0.79); surgery attendance in last six months by 48% v 48% (t = -0.05, P < 0.96); regular use of inhaled steroids by 60% v 58% (t = 0.51, P < 0.62).

CONCLUSION

Feedback to general practitioners of information about patients' asthma does not on its own lead to change in the outcome of clinical care.

Intellectual impairment, memory impairment, suggestibility and voir dire proceedings: a case study

The psychology and psychiatry of interrogation, confession and testimony have recently become the subjects of considerable theoretical analysis, research and professional interest (Gudjonsson, 1992). A case study is reported involving a defendant whose testimony under police interrogation incriminated himself and 13 other defendants in a murder trial. Issues of intellectual impairment, memory impairment, confabulation and suggestibility were addressed in voir dire proceedings, and are described in this paper. The case also demonstrates the importance of psychological tests being administered by suitably qualified personnel.

Autobiographical memory and problem-solving strategies of parasuicide patients

Recent research has noted the tendency of parasuicide patients to retrieve over-general autobiographical memories. Separate studies suggest problem-solving deficits within this group. The present study was concerned first with replicating these findings and, secondly, with developing a model of the relationship between over-general memory recall and poor problem-solving abilities in parasuicide patients. Anger and hopelessness were measured as markers for mood. In line with the hypotheses, the parasuicide group (N = 12) produced significantly over-general memories in contrast to a matched control group (N = 12). This occurred significantly in relation to positive cues, and latency to first responses was significantly delayed in the parasuicide group. The parasuicide group also provided fewer and less-effective problem-solving strategies than the control group, and a significant association was found between low effectiveness of problem-solving strategies and over-general memory recall in the parasuicide group. Anger and hopelessness levels were significantly higher within the parasuicide group in line with previous findings. The clinical implications of these findings are discussed.

Childhood sexual experiences with adults reported by women with eating disorders: an extended series

A total of 158 women presenting with clinical eating disorders have been investigated using a self-report questionnaire and subsequent interview concerning their recollections of sexual experiences with adults before the age of 16 and later adverse sexual experiences. About a third reported events in childhood and over half described some adverse experiences. It may be that these experiences are relevant to the subsequent illness in some cases, but greater certainty must await further research. In the meantime, inquiring about such matters would seem to be advisable in the assessment and therapy of eating-disordered patients.

Lay explanations of delinquency: global or offence-specific?

Lay explanations of delinquency have been shown to be both complex and multidimensional and to vary according to factors such as respondent age and sex. However, previous research has treated crime as a global construct, although some studies have highlighted specific attitudes towards individual crimes such as violence and sexual assault. The first of the studies described here directly compared lay explanations for three types of crime-burglary, robbery and sexual assault. Using previously validated scales to assess lay explanation of crime, it was found that there were significant differences in the rated importance of the various scales for the three types of crime. Whilst burglary and robbery were most likely to be explained by failings in education and parenting, sexual assault was most strongly explained in terms of mental instability. Some variation according to age and sex of respondent was also found. A second experiment replicated several of these findings for the crimes of robbery and rape. The race of offender did not, however, significantly influence the explanations for these two offences. Finally, the potential implications of these results are briefly discussed.

Pet owner attitudes to pets and people: a psychological study

A preliminary attempt was made to assess how pet owners view their relationships with their pets and how pet relationships compare with human relationships. In the sample studied there was a marked variation between individuals in their perceptions but two group trends emerged. First, the pet relationship was most similar to the relationship to the individual's own child and, secondly, the pet relationship was frequently valued because of the attributes of 'dependency', 'fun/play' and 'relaxation based on absence of demands'. It is suggested that the personal meaning of pets for people needs to be further explored.

Adverse sexual experience in childhood and clinical eating disorders: a preliminary description

Seventy-eight eating disordered patients were asked systematically about any history of adverse sexual experience. About two thirds gave such a history. The events reported were often distressing and significant to the subject. It is unclear what role such events play in the causation of later eating disorder.

Perceptions of rape in a British sample: effects of relationship, victim status, sex, and attitudes to women

A study of attitudes to rape in a non-student British sample is reported. Ninety-six subjects (64 male, 32 female) were presented with a newspaper rape account in which previous relationship between victim and rapist and victim status were manipulated. Respondents were divided into females, males with traditional attitudes to the female role, and males with progressive attitudes. Relationship and status had no effect on perceptions but consistent effects were found for sex of respondent and attitudes to the female role.