Evaluation of the impact of formaldehyde fumigation during the hatching phase on contamination in the hatch cabinet and early performance in broiler chickens

Commercial hatch cabinet environments promote replication of microorganisms. These pathogenic or apathogenic microorganisms may serve as pioneer colonizers of the gastrointestinal tract (GIT) of poultry. Some of these pioneer colonizers, such as Escherichia coli and Enterococcus spp., are opportunistic pathogens that lead to reduced performance in commercial poultry. Effective hatchery sanitation is imperative to limit contamination of naïve neonatal chicks and poults. Formaldehyde fumigation has been traditionally used to reduce the pathogen load in commercial hatch cabinets. To investigate potential alternatives to formaldehyde fumigation, models to mimic the microbial bloom in a laboratory setting must be utilized. The purpose of the present study was to evaluate the impact of a multispecies environmental challenge model (PM challenge) with and without formaldehyde fumigation during the hatching phase on early performance in broiler chicks. Three experiments were conducted to evaluate microbial contamination in the hatch cabinet environment (air samples, fluff samples), enteric colonization at day-of-hatch (DOH), and 7-day performance. In all experiments, significantly (P < 0.05) more gram-negative bacteria were recovered from the GIT at DOH in the PM challenge control group as compared to the nonchallenged control (NC) group and the formaldehyde-treated group (PM + F). There were no statistical differences in 7-day body weight gain or feed conversion ratio between the PM challenge control group, the NC group or the PM + F group. These data suggest this model could be utilized to evaluate alternatives to formaldehyde fumigation for controlling the microbial load during the hatching phase in a laboratory setting.

Development of an environmental contamination model to simulate the microbial bloom that occurs in commercial hatch cabinets

Microbial blooms that emerge in commercial hatch cabinets consist of apathogenic and pathogenic microorganisms, including Escherichia coli, Enterococcus faecalis, and Aspergillus fumigatus. Objectives of the present study included the development of a multipathogen contamination model to mimic commercial conditions and optimization of sampling methods to quantify bacterial or fungal presence within the hatch cabinet. The pathogen challenge mix (PM) was recreated from select bacterial or fungal isolates recovered from an egg homogenate (EH) derived from the contents of infertile eggs and late embryonic mortalities. Isolates selected for PM included Enterococcus faecalis (∼10⁸ CFU/egg), Staphylococcus aureus (∼10⁷ CFU/egg), Staphylococcus chromogenes (∼10⁷ CFU/egg), Aspergillus fumigatus (∼10⁶ spores/egg), and 2 Escherichia coli (∼10⁸ CFU/egg) isolates. Challenge (100 μL of PM or EH) was administered using a sterile loop to a 28 mm area on the blunt end of the eggshell at day 19 of embryogenesis (DOE). In 3 experiments, microbiological data were collected from environmental hatcher samples (open-agar plate method), fluff samples, postmortem whole-body chick rinse samples, and gastrointestinal tract (GIT) samples to evaluate select bacteria and fungi circulating within the hatch cabinet and colonization of GIT. Cumulative bacterial and fungal recovery from the PM hatching environment from DOE20 to hatch was higher than the nonchallenged group (NC) and EH group at ∼860 and ∼1,730 CFU, respectively. Bacterial recovery from GIT, fluff, and chick rinse samples were similar for the PM and EH group in Exp. 1. However, Aspergillus fumigatus recovery from fluff and chick rinse samples for the PM group was significantly (P < 0.001) higher than the NC and EH group. In Exp. 2 and 3, PM challenge significantly (P < 0.05) increased Gram-negative bacterial recovery from the GIT, fluff and chick rinse samples compared to both the NC and EH group. These data suggest this innovative multispecies environmental contamination model using PM could be utilized to evaluate strategies to mitigate microbial contamination in commercial hatch cabinets in a laboratory setting.

Development of a wild-type Escherichia coli environmental bloom model to evaluate alternatives to formaldehyde fumigation in broiler chicken hatch cabinets

Horizontal transmission of opportunistic Escherichia coli during hatch can have detrimental effects on early performance, particularly as pioneer colonizers. Commercially, formaldehyde is often applied in the United States to combat the bacterial bloom that occurs inside of the hatching environment. The purpose of these experiments was to develop a replicable E. coli horizontal challenge model to evaluate alternatives to formaldehyde sanitation applied to the hatching environment. In experiment 1, two trials were conducted for 2 wild-type (WT) E. coli isolates (isolate 1 [I1] or isolate 2 [I2]) to determine the appropriate in ovo challenge dose and day of embryogenesis (DOE) for challenge administration. In experiment 1 trial 1, the most appropriate inoculation dose and time point were determined to be 10² cfu/embryo on DOE 19. Experiment 1 trial 2 evaluated whether placement of seeder (direct-challenged) embryos with contact (indirect-challenged) embryos during hatch affected contact hatchability. Trial 2 showed no differences in hatchability between groups. A 7-day experiment (experiment 1 trial 2) was conducted to evaluate the effects of I1 or I2 on horizontal transmission, gram-negative bacterial (GNB) recovery from the gastrointestinal tract (GIT), and impact on BW gain (BWG). Compared with the negative control, seeder, and contact chicks challenged with I1 or I2, we observed increased (P < 0.05) GNB recovered from GIT on the day of hatch. There was a marked (P < 0.05) reduction in 7-day BWG between the I1 indirect-challenged group and the negative control group. To further validate the model, 2 7-day trials (experiment 2, experiment 3) were conducted to evaluate the effects of formaldehyde fumigation on coliform recovery from the hatching environment and on early performance using I1 for the challenge. Isolate 1 positive control hatchers had increased levels of circulating coliforms compared with the negative control and formaldehyde-treated hatchers, although there was no significant impact on performance induced by challenge or formaldehyde treatment in experiment 2 or experiment 3. These data provide a potential model for investigations related to horizontal transmission of WT E. coli at a low dose on DOE 19 to promote simulated commercially relevant bacterial blooms under laboratory conditions.

Development of a novel in ovo challenge model for virulent Escherichia coli strains

During the hatching process, chicks are exposed to opportunistic and/or pathogenic organisms, such as virulent or avirulent Escherichia coli. Virulent E. coli strains have not been feasible for induction of neonatal colibacillosis via in ovo challenge due to high embryonic mortality. In this manuscript, we describe the addition and co-administration of the bacteriostatic antibiotic tetracycline to a virulent E. coli challenge culture, improving hatchability and livability of seeder chicks while allowing robust horizontal transmission in the hatching cabinet to contact chicks. Experiment 1 consisted of 3 trials. Experiment 1, trial 1 was conducted to determine an effective ratio of E. coli challenge and tetracycline dose to be utilized in the seeder model. Trials 2 and 3 were conducted to evaluate the transmission of E. coli from seeder to contact chicks. Experiment 2 consisted of 3 independent 7-D trials where body weight gain (BWG), mortality, and selected enteric bacterial recovery were evaluated. In trials 1 to 3, significantly (P < 0.05) more Gram-negative bacteria were recovered from whole gut samples (GIT) vs. negative controls on day of hatch, from both seeder and contact chicks. At day 7 in trial 1, contact chicks had significantly (P < 0.05) more Gram-negative bacteria recovered from the GIT than the negative control, but not in trials 2 and 3. Presumptive lactic acid bacterial recovery was elevated in contact and seeder chicks compared to the negative control in all 3 trials. Contact challenge caused a significant (P < 0.05) reduction in BWG in 2 out of 3 trials at day 7, and there was a significant (P < 0.05) increase in mortality as compared to the negative controls in all trials. These data suggest that co-administration of a virulent E. coli strain with tetracycline allows for hatch of direct challenged chicks and effective horizontal transmission to contact chicks during the hatching process, as evidenced by reduced day 7 performance and altered selected enteric bacterial recovery.

Lignin-like compounds and sporopollenin coleochaete, an algal model for land plant ancestry

Unusual cell wall structure and resistance to microbial degradation led to an investigation of resistant biopolymers in Coleochaete (Chlorophyta, class Charophyceae), a green alga on the evolutionary lineage that led to land plants. In Coleochaete that are undergoing sexual reproduction, vegetative cell walls contain material similar to lignin, a substance generally thought absent from green algae, and the zygote wall includes sporopollenin. Knowledge of chemically resistant compounds in Coleochaete may facilitate interpretation of the fossil record. Placental transfer cells in Coleochaete orbicularis and in the hornwort Anthoceros survive acetolysis and contain lignin-like compounds, implying a close relation between these taxa.

Melorheostosis--an unusual cause of amputation

A 24-year-old female developed, in infancy, progressive right upper and lower limb muscle and soft tissue contractures and had a diagnosis of melorheostosis made on X-ray and pathological specimens. At the age of 11 years she began to have pain in the right hip and lower limb and this later became the dominant feature. She ultimately required amputation through the right hip joint and prosthetic fitting. She now has independent mobility with her prosthesis and has had no recurrence of pain. Her right arm remains flexed, shortened and contracted, but some hand function is retained. A review of the medical literature is discussed.

The Northern Ireland troubles and limb loss: a retrospective study

The Troubles in Northern Ireland have now lasted 34 years. Divisions and strife between the opposing loyalist and republican communities, and between the communities and the security forces, have led to thousands of deaths and injuries. The violence has often been indiscriminate injuring and killing totally innocent people. Staff at the Regional Disablement Services at Musgrave Park Hospital, Belfast have had the responsibility for helping to rehabilitate those who have suffered limb loss, both civilians and security forces personnel. In this study the authors present patient demographics for those survivors, referred for prosthetic fitting, who have sustained limb amputations as a result of the Troubles from 1969 to 2003, with the cause of injury, resulting levels of amputation, associated injuries, time to first prosthetic fitting and reason for any delay in fitting identified. One hundred and twenty-nine (129) patients sustained amputations, 110 male and 19 female with an age range at the time of injury from 7 to 60 years. Seventy-two (72) were civilian. Ninety-three (93) underwent immediate amputation, the most frequent level of amputation being trans-femoral. Delayed healing of deep wounds was the most common reason for delayed amputation; other causes were chronic osteomyelitis, malunited fractures and failed arthrodesis, often associated with chronic pain. Ninety-two (92) patients required amputation of one limb or part thereof, 35 required amputation of 2 limbs and 2 underwent triple amputation. Three (3) patients lost both hands. Sixty seven percent (67%) had other associated physical injuries. Thirty-two (32) patients had a delay of 6 months or more in fitting a prosthesis. The most common cause of injury was the car bomb.

Seasonal dynamics of phytoplankton and planktonic protozoan communities in a northern temperate humic lake: diversity in a dinoflagellate dominated system

Species diversity and richness, and seasonal population dynamics of phytoplankton, planktonic protozoa, and bacterioplankton sampled from the epilimnion of Crystal Bog in 2000, were examined in order to test the hypothesis that these groups' diversity and abundance patterns might be linked. Crystal Bog, a humic lake in Vilas County, Wisconsin, is part of the North Temperate Lakes Long-Term Ecological Research Site. Phytoplankton and planktonic protozoa were identified and enumerated in a settling chamber with an inverted microscope. Bacterial cells were enumerated with the use of fluorescence 4', 6'-diamidino-2-phenylindole (DAPI)-staining procedures, and automated ribosomal intergenic spacer analysis (ARISA) was used to assess bacterioplankton diversity. Bacterial cell counts showed little seasonal variation and averaged 2.6 x 10(6) cells/mL over the ice-free season. Phytoplankton and planktonic protozoan numbers varied by up to two orders of magnitude and were most numerous in late spring and summer. Dinoflagellates largely dominated Crystal Bog throughout the ice-free period, specifically Peridiniopsis quadridens in the spring, Peridinium limbatum in summer, and Gymnodinium fuscum and P. quadridens in fall. Brief blooms of Cryptomonas, Dinobryon, and Synura occurred between periods of dinoflagellate domination. The dominant dinoflagellate, Peridinium limbatum, was calculated to have a growth rate of 0.065 day(-1) and a doubling time of 10.7 days. Heterotrophic nanoflagellates (HNFs) were a consistent component of the planktonic protozoa; seasonal patterns were determined for three genera of HNFs (Monosiga, Bicosoeca, and Desmarella moniliformis). Three genera of ciliates (Coleps, Strobilidium, and Strombidium) comprised the greater part of the planktonic protozoa in Crystal Bog. The number of species of planktonic protozoa was too low to calculate a diversity index. Shannon-Weaver diversity indices for phytoplankton and bacterioplankton in the epilimnion followed very similar seasonal patterns in this lake, supporting the hypothesis that in freshwaters, diversity patterns of these groups are linked.

Two case study reports of sleep apnoea in patients with paraplegia

STUDY DESIGN

Case studies of sleep apnoea occurring in two patients with paraplegia.

OBJECTIVE

To raise awareness of sleep apnoea in paraplegia.

SETTING

Belfast, Northern Ireland.

CASE REPORT

We report two patients with paraplegia, one who was having apparent episodes of loss of consciousness and the other daytime somnolence, who were found to have sleep apnoea. The first patient had been medically investigated extensively and a diagnosis of epilepsy was being considered. A joint consultation with the respective partners in each case revealed periods of night-time apnoea and led to sleep study investigations.

CONCLUSION

Sleep apnoea is a treatable condition that can occur in patients with paraplegia who are not necessarily obese. Once diagnosed, resolution of symptoms can be rapid and can result in improved quality of life for patients.

Telemedicine--the way ahead for medicine in the developing world

An e-mail link with the facility to send high-resolution digital images is a cheap and uncomplicated telemedicine method. The Swinfen Charitable Trust helped establish such a link in Patan Hospital Kathmandu, Nepal in March 2000. Over 12 months using this link 42 telemedicine referrals were sent to specialists throughout the world. Referrals were: 36% respiratory medicine; 21% neurology, 21% dermatology; 14% cardiology; 5% nephrology; and 3% radiology--28 had digital pictures attached, of which 96% were of high enough quality on which specialists were able to comment. Thirty-nine replies were received. The average time for a specialist reply was 2 days, and 45% were answered within 24 hours. All replies were judged by independent assessors to be helpful or very helpful for diagnosis, management and education. The assessors decided that in 50% of cases the advice if acted upon would have shortened hospital stay. This pilot study has shown that a low-cost telemedicine link is technically feasible and can be of significant benefit for diagnosis, management and education in a developing world setting.

Complex regional pain syndrome post mastectomy

Complex regional pain syndrome includes the previously termed condition reflex sympathetic dystrophy. It is a chronic pain disorder diagnosed on the basis of symptoms and skin changes and is known to have a psychological element. It is a rare complication after surgery, especially mastectomy. We present two females who developed this syndrome after undergoing mastectomy for chronic mastalgia. These cases demonstrate that amputation of an organ for chronic pain can result in reflex sympathetic dystrophy developing in a nearby limb.

Minocycline-associated lupus-like syndrome with ulnar neuropathy and antiphospholipid antibody

Peripheral neuropathy in association with minocycline-induced lupus-like reaction has not previously been reported. We present a case of probable minocycline-induced lupus associated with antiphospholipid antibodies and an ulnar neuropathy which has slowly improved since the discontinuation of minocycline.

High-temperature, acid-hydrolyzed remains of Polytrichum (Musci, Polytrichaceae) resemble enigmatic Silurian-Devonian tubular microfossils

Gametophytes and sporophyte components of two species of the evolutionarily early-divergent moss Polytrichum were separately subjected to high-temperature acid hydrolysis, and remains were examined by fluorescence microscopy and scanning electron microscopy. Remains included fragments of capsule, seta, leaves, stems, and calyptra. Cell walls of all remains were autofluorescent in violet and UV excitation, suggesting occurrence of resistant polyphenolic compounds. Calyptras of both species dissociated into smooth- walled, acutely branched filamentous associations of tubular cells with distinctively thickened cell junctions. In these aspects and measurements of wall dimensions made from SEMs, the hydrolysis-resistant Polytrichum calyptra remains were similar to several tubular microfossils described from Silurian and Lower Devonian deposits, whose provenance is unknown or ascribed to fungi. Our data suggest the possibility that at least some ancient tubular microfossils might have originated from Polytrichum-like early mosses. They add to increasing evidence that bryophytes left microfossil evidence for their presence millions of years earlier than is indicated by their macrofossil record.

Glomalean fungi from the Ordovician

Fossilized fungal hyphae and spores from the Ordovician of Wisconsin (with an age of about 460 million years) strongly resemble modern arbuscular mycorrhizal fungi (Glomales, Zygomycetes). These fossils indicate that Glomales-like fungi were present at a time when the land flora most likely only consisted of plants on the bryophytic level. Thus, these fungi may have played a crucial role in facilitating the colonization of land by plants, and the fossils support molecular estimates of fungal phylogeny that place the origin of the major groups of terrestrial fungi (Ascomycota, Basidiomycota, and Glomales) around 600 million years ago.

Could a low-cost audio-visual link be useful in rheumatology?

We have investigated prospectively the diagnostic accuracy, specialist satisfaction and patient-specialist rapport of a low-cost audio-visual link between a junior doctor with a patient and a consultant rheumatologist. Using a telephone link and subsequently a video-phone link, 20 patients, with various rheumatological problems, were presented by a junior doctor to the consultant rheumatologist for provisional diagnosis. All patients were then seen face to face by the consultant, when a final diagnosis was made. An independent consultant rheumatologist made a 'gold standard' diagnosis. Thirty-five per cent of diagnoses were made correctly over the telephone and 40% over the video-phone--there was no significant difference in the diagnostic accuracy between these two methods of communication. Rapport over the video-phone was universally poor. Where it was important, clinical signs could not be visualized over the video-phone and in more than 85% of cases small joint swellings could not be seen clearly.

Evolutionary significance of isopreneemission from mosses

Isoprene emission has been documented and characterized from species in all major groups of vascular plants. We report in our survey that isoprene emission is much more common in mosses and ferns than later divergent land plants but is absent in liverworts and hornworts. The light and temperature responses of isoprene emission from Sphagnum capillifolium (Ehrh.) Hedw. are similar to those of other land plants. Isoprene increases thermotolerance of S. capillifolium to the same extent seen in higher plants as measured by chlorophyll fluorescence. Sphagnum species in a northern Wisconsin bog experienced large temperature fluctuations similar to those reported in tree canopies. Since isoprene has been shown to help plants cope with large, rapid temperature fluctuations, we hypothesize the thermal and correlated dessication stress experienced by early land plants provided the selective pressure for the evolution of light-dependent isoprene emission in the ancestors of modern mosses. As plants radiated into different habitats, this capacity was lost multiple times in favor of other thermal protective mechanisms.

Bacterial Abundance and Activity across Sites within Two Northern Wisconsin Sphagnum Bogs

Abstract Bacterial abundance, temperature, pH, and dissolved organic carbon (DOC) concentration were compared across surface sites within and between two northern Wisconsin Sphagnum peatlands over the summer seasons in 1995 and 1996. Sites of interest were the Sphagnum mat surface, the water-filled moat (lagg) at the bog margin, and the bog lake littoral zone. Significant differences in both bacterial populations and water chemistry were observed between sites. pH was highest in the lake and lowest in the mat at both bogs; the opposite was true for DOC. Large populations of bacteria were present in surface interstitial water from the mat; abundance in this site was consistently higher than in the moat or lake. Bacterial abundance also increased across sites of increasing DOC concentration and declining pH. Bacterial activities (rates of [3H]leucine incorporation) and growth in dilution cultures (with grazers removed) were also assessed in lake, moat, and mat sites. Results using these measures generally supported the trends observed in abundance, although high rates of [3H]leucine incorporation were recorded in the moat at one of the bogs. Our results indicate that bacterial populations in Sphagnum peatlands are not adversely affected by acidity, and that DOC may be more important than pH in determining bacterial abundance in these environments.

Speech characteristics and coronary heart disease incidence in the multiple risk factor intervention trial

To assess whether speech characteristics descriptive of Type A behavior were related to coronary heart disease (CHD) incidence in the Multiple Risk Factor Intervention Trial, we scored voice emphasis, speed of speaking, latency of answering, and answer content from 577 audiotaped structured interviews in a case-control design which included all 193 individuals who incurred CHD during the 7-year follow-up. These were matched with 384 CHD-free controls. Multivariate analyses showed that subjects' voice emphasis [relative risk ratio (RR) = 1.25, p = .02] and latency of answering (RR = .78, p = .02) were significantly associated with CHD incidence when controlled for baseline levels of diastolic blood pressure, serum cholesterol, and cigarette smoking.

Self-reference and coronary heart disease incidence in the Western Collaborative Group Study

Previous research has indicated that the spoken frequency of the self-references "I," "me," and "my" in a structured interview was prospectively related to coronary heart disease (CHD). To assess whether the findings would replicate in another population, we conducted a case-control analysis of 750 structured interviews from the Western Collaborative Group Study. To measure self-references, auditors counted all first person pronouns (I, me, my) and clauses spoken in the audiotaped baseline structured interviews. Matched multiple logistic regression analyses, with or without adjustment for major CHD risk variables, indicated that those who incurred CHD did not self-reference more frequently or densely than the CHD-free control subjects. Type As spoke more clauses and more total self-references but did not have a higher density of self-references than Type Bs. The results question both the method for measuring self-references and the hypothesis that self-referencing are associated with CHD.

Consequences of worksite hypertension screening. Changes in absenteeism

To confirm reports of increased absenteeism after worksite hypertension screening, we performed a three-stage blood pressure screening among 5888 self-selected heterogeneous workers at 11 electronics plants using standardized screening and labeling procedures. A total of 296 subjects with mean systolic blood pressure of 140 mm Hg or greater or diastolic blood pressure of 90 mm Hg or greater on all three occasions were considered to have sustained hypertension. From the untreated normotensive subjects matched for eight sociodemographic and occupational variables, we prospectively selected one to three controls for each sustained hypertensive subject. Uncorrected absenteeism rates for sustained hypertensive subjects increased 22% from baseline in the postscreening year. Correction by logarithmic transformation for skewed distributions and by rates for matched controls for temporal trends reduced these changes to statistical insignificance with high statistical power. Several subgroups exhibited trends to increased absenteeism. At 12-month follow-up, the blood pressure of the sustained hypertensive subjects showed mean decreases of 12.6/6.7 mm Hg (p less than 0.0001) after the majority had received pharmacological antihypertensive treatment. These results suggest that worksite hypertension screening and labeling produce insignificant absenteeism change overall among self-selected heterogeneous work force populations.

Speech characteristics and behavior-type assessment in the Multiple Risk Factor Intervention Trial (MRFIT) structured interviews

Four speech characteristics (SCs) were scored from 626 audiotaped Structured Interviews (SIs) designed to assess behavior type in the Multiple Risk Factor Intervention Trial (MRFIT). Analyses suggested that interviewers relied upon respondents' voice emphasis, speed of speaking, speed of answering, and answer content (in that order) for behavior typing. Across the clinics, there were large differences in the degree that each interviewer and auditor used these SCs for behavior-type judgments, and these differences appear to be related to differences in interauditor reliability. Correlations between the various SCs were very low, suggesting that key operationally defined characteristics of Type A behavior occurred independently in the SI. Analysis of interviewers' SCs indicated that they spoke and asked questions more quickly of Type A than Type B subjects--suggesting that interviewers' behaviors were biased by respondents' behavior type. Overall, the findings indicate the complexity of the behavior-type judgment process and how the criteria for assessment may change depending upon interviewer or population differences.

Consequences of worksite hypertension screening. Differential changes in psychosocial function

To evaluate reports of psychosocial dysfunction after worksite screening, a three-stage blood pressure screening was performed using standardized screening and labeling procedures. Of a heterogeneous group of 5,888 workers, 296 with sustained hypertension were identified and randomly assigned to traditional arousal or reassurance debriefings, matching each hypertensive subject with one to three normotensive control subjects on eight sociodemographic and occupational variables. Subjects exhibiting absenteeism increases or persistent hypertension six months after screening were randomly assigned to worksite health education programs or no intervention. After adjustment for values among matched control subjects, previously unaware hypertensive subjects had significant post-screening decreases in anxiety that were significantly associated with specific worksites and with reassurance rather than traditional debriefing (p less than 0.05). The health education program did not significantly affect anxiety, blood pressure, or absenteeism. Increased absenteeism was associated with higher baseline anxiety levels (p less than 0.05). It is concluded that worksite hypertension screening produces minimal adverse psychosocial changes, reassurance debriefing may be beneficial, and unspecified worksite characteristics may determine consequences of similar preventive medicine efforts.

Self-involvement and coronary heart disease incidence in the multiple risk factor intervention trial

At intake into a multiple coronary heart disease (CHD) risk factor intervention trial, 3110 individuals were interviewed to assess Type A behavior. After an average of 7 years followup, the 193 individuals who manifested their first CHD event were matched with 384 CHD-free individuals. To assess self-involvement, auditors counted all verbal self-references (I, me, my) and clauses spoken in the audiotaped baseline interviews. Self-references were entered into multiple logistic regression analyses that controlled for age, diastolic blood pressure, cholesterol, cigarette smoking, and Type A behavior. Relative to matched controls, those who incurred CHD spoke more self-references at baseline [p = 0.017; relative risk (RR) = 1.20], but did not self-reference more densely. Relative to matched controls, those who died from CHD spoke more self-references (p = 0.008; RR = 1.62) and self-referenced more densely (p = 0.027; RR = 1.54). Neither total self-references nor self-reference density was predictive of angina pectoris or nonfatal myocardial infarction (MI). However, among those who incurred MI, self-reference frequency was the strongest predictor of mortality among all the measured risk factors (p = 0.01, RR = 2.0). The results suggest that self-involvement is related to CHD incidence.

Setting generality of blood pressure reductions and the psychological treatment of reactive hypertension

The setting generality of treatment effects was examined for a client with 3 years' history of essential hypertension. Self-control progressive relaxation training led to durable normotensive blood pressures (BP) in the natural environment and psychology clinic, although medical setting BP remained elevated. Further assessment indicated that this latter problem was a function of conditioned anxiety to medical setting stimuli. Systematic desensitization led to reductions in medical setting BP to normotensive levels, and laboratory psychophysiological assessments confirmed the elimination of the anxiety response. The present case study raises the issue of to what extent such reactive hypertension is a problem for other individuals similarly diagnosed and demonstrates the importance of the assessment of generality of treatment effects for essential hypertension.