Association between Migraine and Quality of Life, Mental Health, Sleeping Disorders, and Health Care Utilization Among Older African American Adults

PURPOSE

This study examines the associations between migraine headaches, well-being, and health care use among a sample of underserved older African American adults. Controlling for relevant variables, the association between migraine headaches and (1) health care utilization, (2) health-related quality of life (HRQoL), and (3) physical and mental health outcomes was examined.

METHODS

Our sample included 760 older African American adults from South Los Angeles recruited through convenience and snowball sampling. In addition to demographic variables, our survey included validated instruments, such as the SF-12 QoL, Short-Form McGill Pain Questionnaire, and the Geriatric Depression Scale. Data analysis included 12 independent multivariate models using multiple linear regression, log transferred linear regression, binary and multinomial logistic regression, and generalized linear regression with Poisson distribution.

RESULTS

Having migraine was associated with three categories of outcomes: (1) higher level of health care utilization measured by (i) emergency department admissions and (ii) number of medication use; (2) lower level of HRQoL and health status measured by (i) lower self-rated health (ii) physical QoL, and (iii) mental QoL; and (3) worse physical and mental health outcomes measured by (i) higher number of depressive symptoms, (ii) higher level of pain, (iii) sleep disorder, and (iv) being disabled.

CONCLUSIONS

Migraine headache significantly was associated with quality of life, health care utilization, and many health outcomes of underserved African American middle-aged and older adults. Diagnoses and treatments of migraine among underserved older African American adults require multi-faceted and culturally sensitive interventional studies.

Locomotor activity and behavior of mutant mice deleted for gastrin gene expression

The current studies were initiated to investigate the role of brain-gut peptide, gastrin, on locomotor activity and anxiety-like behavior. Young, male mutant mice, lacking gastrin gene expression (GAS-KO mice), were used in the experiments. The locomotor activity of GAS-KO vs wild type (WT) mice was compared by open field test. The anxiety-like behavior was examined using elevated plus maze. The time and entries to the open arms of the elevated plus maze were used as an indicator for the anxiety-like behavior and the data were analyzed using Hindsight program. On the open field test, locomotor activity of GAS-KO mice was similar to that of the WT mice for the first 10 min of the test, but decreased significantly after that. Anxiety-like behavior was more evident in the GAS-KO vs WT mice in the elevated plus maze experiments. The number of entries to and time spent on the open arms of plus-maze were significantly reduced for the GAS-KO vs WT mice suggesting an increased anxiety-like behavior of GAS-KO mice. Our studies suggest that normal circulating levels of gastrins may play a direct or indirect role in the regulation of locomotor activity and anxiety-like behavior.

Progastrin1-80 stimulates growth of intestinal epithelial cells in vitro via high-affinity binding sites

Proliferation and carcinogenesis of the large intestinal epithelial cells (IEC) cells is significantly increased in transgenic mice that overexpress the precursor progastrin (PG) peptide. It is not known if the in vivo growth effects of PG on IEC cells are mediated directly or indirectly. Full-length recombinant human PG (rhPG(1-80)) was generated to examine possible direct effects of PG on IEC cells. Surprisingly, rhPG (0.1-1.0 nM) was more effective than the completely processed gastrin 17 (G17) peptide as a growth factor. Even though IEC cells did not express CCK(1) and CCK(2) receptors (-R), fluorescently labeled G17 and Gly-extended G17 (G-Gly) were specifically bound to the cells, suggesting the presence of binding proteins other than CCK(1)-R and CCK(2)-R on IEC cells. High-affinity (K(d) = 0.5-1.0 nM) binding sites for (125)I-rhPG were discovered on IEC cells that demonstrated relative binding affinity for gastrin-like peptides in the order PG >or= COOH-terminally extended G17 >or= G-Gly > G17 > *CCK-8 (* significant difference; P < 0.05). In conclusion, our studies demonstrate for the first time direct growth effects of the full-length precursor peptide on IEC cells in vitro that are apparently mediated by the high-affinity PG binding sites that were discovered on these cells.

The gamma band response may account for poor P50 suppression in schizophrenia

The relationship between gamma band response (GBR) and P50 suppression was investigated among 10 DSM-IV schizophrenia patients and 10 normal comparison subjects using neuromagnetic and electrical recordings. In a paired-click paradigm, the neuromagnetic GBR and M100 suppression data improved schizophrenia-normal group separations over the typical electrical, vertex-recorded P50 suppression measure. The neuromagnetic GBR was also superior to the magnetic equivalent of P50 (M50) for discriminating schizophrenia and normal subjects. Our data are consistent with the hypothesis that P50 may be a subcomponent of the GBR, and that P50 suppression may be a proxy for GBR suppression. Measurement of the GBR should be given consideration as another, and perhaps better, means for evaluating auditory-evoked response abnormalities among schizophrenia patients.

Timing disclosure sessions: adding a narrative perspective to clinical work with adult survivors of childhood sexual abuse

Though the literature on the diagnosis and treatment of survivors of childhood sexual abuse has burgeoned in the last 20 years, relatively little guidance is available in the popular or professional literature to assist clients or therapists about issues of disclosure of this abuse to family members. When authors explicitly focus on disclosure, the timing of such disclosure is usually framed within a psychological and/or interpersonal perspective. In this article, we suggest that attention to characteristics of the sexual abuse narrative itself offers an important additional resource to guide decision making with respect to disclosure. We also describe ways that a narrative approach to disclosure can produce empowering conversational practices. A detailed case example provides the clinical material to illustrate this narrative approach to disclosure.

Visual attention modulates metacontrast masking

How does the human visual system 'bind' different fragments in the visual scene to create enduring representations of objects? A visual illusion known as 'metacontrast' or backward masking provides compelling evidence that perception is not instantaneous and that it occurs sequentially in distinct stages. If a solid white target square is displayed for 50 ms in a tachistoscope, switched off, and followed by a 50 ms display of two flanking mask squares, remarkably, subjects report seeing only the two flanking squares: the first square is simply not 'seen'. By plotting the magnitude of masking as a function of the delay between the target and mask (the stimulus onset asynchrony), one can obtain a characteristic 'U'-shaped function with optimum masking occurring at about 50 ms, and no masking with synchronous target and mask presentations or at delays higher than 300 ms. The illusion is also highly sensitive to elementary stimulus dimensions such as colour, orientation and spatial frequency, and it has been suggested that it is based on 'low level' autonomous visual mechanisms rather than cognitive processes. Here we describe a novel visual stimulus that demonstrates that metacontrast can be strongly modulated by 'top down' influence such as voluntary visual attention.

On the perception of illusory contours

Illusory contours are invoked by the visual system to account for otherwise inexplicable gaps in the image. We report three sets of novel observations on illusory contours. First, when an illusory square is superimposed on a checkerboard pattern there is a considerable enhancement of the contours so long as they are exactly coincident with the borders of the checks. If the checks are misaligned, on the other hand, the illusory contours associated with the pacman edges disappear and a novel percept emerges: the contours of the checks nearest to the illusory square appear enhanced. This result implies that subjective contours are generated by intermediate-level contour interactions rather than the top-down processes of three-dimensional interpretation. Second, we find that steady fixation for as little as 4 sec leads to a complete disappearance of the enhanced illusory contours caused, presumably, by adaptation or "fatigue" of cells that signal these contours. Such adaptation occurred even when the illusory contours were rendered invisible by displaying them on a misaligned checkerboard, suggesting that the adaptation occurs prior to the vetoing of the signal by the checks. Third, we found that illusory contours persist for a surprisingly long time (0.3 sec) after the inducing elements have been switched off. These results suggest that the stimuli we have designed ("enhanced illusory contours") might provide a novel probe for dissecting different stages involved in the processing of illusory contours and for understanding how the visual system combines different types of contours to construct object boundaries.

The neural locus of binocular rivalry and monocular diplopia in intermittent exotropes

Patients with intermittent exotropia (strabismus) can either fixate normally or allow one eye to deviate outward by as much as 60 degrees. Two such patients (D.N. and K.C.) were studied and it was found that during eye deviation, binocular correspondence is maintained by completely 'remapping' egocentric space for the deviating eye alone using extraretinal signals from that eye. Also, by using foveal afterimages we showed that binocular rivalry occurs at a site earlier than this egocentric remapping, probably in area 17 itself. And finally, consistent with the neural remapping hypothesis, patient K.C. also experienced monocular diplopia; objects appeared double when viewed with the deviating eye.

Noninvasive detection of cerebral plasticity in adult human somatosensory cortex

After upper limb deafferentation, adult macaques exhibit substantial reorganization of cortical somatosensory topography with enlargement of cortical areas responsive to facial stimuli. In the present study non-invasive magnetic source imaging technology has been used to map in detail the bilateral somatosensory homunculi in four neurologically normal controls and two upper arm amputees. Bilateral homuncular maps of normals and of the unaffected hemisphere of both amputees showed a wide hand area. The affected hemisphere of both amputees showed marked intrusion of facial representations into the digit and hand area consistent with the earlier observations in macaques. Our findings provide the first evidence of massive somatosensory plasticity in human adults and suggest a mechanism for post-amputation perceptual changes.

Effect of immunological differences on rat aortic valve allograft calcification

Calcification may be a cause of allograft valve degeneration. To determine whether immunological differences between donor and recipient affect the degree of calcification that occurs, adult Lewis rats received aortic valve allografts transplanted heterotopically into the abdominal aorta. All valves were transplanted immediately after harvest. The valves were not exposed to antibiotics or albumin before insertion. Valve donors were of the Lewis (syngeneic), F344 (weakly allogeneic, RT1 compatible, non-RT1 incompatible), LBN F1 (moderately allogeneic, one haplotype identical, one haplotype incompatible at the RT1 and non-RT1 loci), and Brown Norway (strongly allogeneic, RT1 and non-RT1 incompatible) strains. Valves were harvested 3-12 weeks following transplantation. Scanning electron microscopy and energy dispersion x-ray microanalysis were performed on one leaflet of each valve to evaluate calcium content. Calcium content expressed in counts (mean +/- standard error) according to donor strain were: Lewis, 1642 +/- 233; F344, 4853 +/- 1412; LBN F1, 4714 +/- 823; and Brown Norway, 4358 +/- 835. Significant differences (p less than 0.05) existed between valves from Lewis donors and those from each other strain. No differences among the other strains were statistically significant. It is concluded that syngeneic valve allografts calcify less than allogeneic grafts. However, the degree of allogenicity did not influence the magnitude of calcification.

Efficacy of chlorhexidine gluconate use in the prevention of perirectal infections in patients with acute leukemia

The frequency of rectal infections is increased in patients with acute leukemia. Complications associated with rectal lesions may be severe enough to cause life-threatening septicemia. Clinical research evaluating the effects of preventive perirectal skin care is scarce. This study's purpose was to determine whether using chlorhexidine gluconate (CHG) in a prophylactic perirectal skin-care regimen decreases perirectal infections and whether it produces more skin irritation than a nonmedicated skin cleanser. The sample consisted of 40 patients, 16 of whom were randomized to use chlorhexidine and 24 of whom were randomized to use nonmedicated skin cleanser. Chi-square and t-tests were used to analyze the incidence of skin breakdown and rectal infections; the correlation between the two factors; a positive history of rectal infections, fissures, or hemorrhoids; presence of hemorrhoids; severity of diarrhea; and duration and severity of granulocytopenia. A positive relationship was found between the severity of granulocytopenia and the incidence of rectal infections (p = 0.02). No significant difference was seen in the occurrence of perirectal infections (p = 0.35) or skin breakdown (p = 0.18) between the two groups. The data suggest that CHG does not offer increased protection against perirectal infections in patients undergoing intensive chemotherapy, nor is it more irritating than a nonmedicated skin cleanser. Further studies are needed to examine the efficacy of hygienic measures such as using skin disinfectants to prevent infections in patients who are immunocompromised.

A comparison of two temporary restorations: light-cured resin versus a self-polymerizing temporary restoration

Temporary restorative materials are an important component of endodontic therapy. They must both adequately seal the access preparation between visits and protect the obturated canal(s) from microleakage until a permanent restoration can be placed. The efficacy of Cavit and T.E.R.M. (a new light-cured composite product) was compared with the use of a carbon black coronal microleakage protocol. The teeth examined had previously received coronal restorations. After the teeth were accessed, restored with Cavit or T.E.R.M., and exposed to the dye, they were cleared. Three-dimensional assessment then revealed that Cavit more consistently provided an effective seal. In addition, a great deal of microleakage was observed around the permanent restoration-tooth interface. This indicates that perhaps leaking permanent restorations should be removed in their entirety before initiation of endodontic treatment.

Role of ligand in antibody-directed endocytosis of liposomes by human T-leukemia cells

The rate of uptake and intracellular processing of ligand-directed drug carriers may depend heavily on the endocytic pathway of the target antigen. We examined the role of the target antigen and type of antibody-liposome linkage in determining endocytosis of liposomes by three human T-cell leukemias, Jurkat, CEM, and Molt-4. Liposome-cell binding and internalization over time were studied using two independent assays for intracellular delivery of liposome contents: a new fluorescence assay using a pH-sensitive fluorescent dye; and a growth inhibition assay for delivery of cytotoxic drug, methotrexate-gamma-aspartate. Liposomes targeted against the transferrin receptor showed greater surface binding, internalization, and growth inhibition than liposomes targeted against the T-cell surface antigens, CD2, CD3, or CD5. Furthermore, liposomes made by conjugating the targeting antibody directly to the liposome surface were more efficiently internalized and retained than were liposomes linked to antibody-coated cells via Protein A. Selection of the type of antibody-liposome conjugate as well as the appropriate surface receptor to facilitate endocytosis is essential in antibody-directed drug treatment of cancer.

Dieulafoy's lesion associated with truncus arteriosus type IV: an unusual cause of upper gastrointestinal hemorrhage

Dieulafoy's lesion is an abnormal submucosal artery in the stomach characterized by massive and often fatal upper gastrointestinal hemorrhage. Diagnosis is usually made at operation, as endoscopy and arteriography frequently fail to identify the lesion. Embolization may be helpful, but surgery is generally the treatment of choice. We present the first reported case of Dieulafoy's lesion in a 17-yr-old boy with type IV truncus arteriosus. This congenital cardiac anomaly may have predisposed this patient to early manifestation of Dieulafoy's lesion, a rare and frequently unrecognized disorder.

Blunt traumatic dissection of the internal carotid artery treated by balloon occlusion

An extensive traumatic intimal dissection of the internal carotid artery was successfully managed by permanent occlusion of the vessel with percutaneously-placed, inflatable balloons in a young patient who had suffered transient ischemic neurological attacks despite anticoagulation. This technique has not been previously reported for treatment of dissection. Review of 34 published reports of symptomatic intimal dissection associated with non-penetrating trauma to the head and neck revealed that most did not have a direct injury to the carotid region and that development of symptoms was often delayed. Only 50% of these patients had onset of neurological symptoms within six hours of the episode of trauma, while 33% remained asymptomatic for more than one week before complications occurred. In 15 patients who were treated surgically, only nine (60%) achieved full recovery. Operative repair was considered unduly hazardous in our patient because of extension of the spiral dissection to the base of the skull. Successful use of percutaneous balloon occlusion of the carotid in this patient suggests that this technique should be considered a worthy alternative for management of selected cases.

The measurement of C-reactive protein and immune complexes in endocarditis caused by coagulase-negative staphylococci

Coagulase-negative staphylococci are a major cause of early endocarditis following the insertion of prosthetic heart valves but rarely cause endocarditis in natural valves. From a 2-year prospective study we report seven cases: six with endocarditis related to prosthetic valves and one with endocarditis related to a natural valve. Each isolate of coagulase-negative staphylococcus was identified biochemically (six Staphylococcus epidermidis; one Staphylococcus hominis) and characterised by bacteriophage typing. Six isolates were also examined for slime production and for extracellular toxins and enzymes: all produced toxin but enzyme and slime production was variable. Concentrations of immune complexes and C-reactive protein in the serum were measured in six of the patients. Our results suggest that measuring C-reactive protein may be useful but measuring immune complexes is not helpful and takes more time.

Inhibition of complement-mediated solubilisation of antigen-antibody complexes by serum factor(s) in patients with various connective tissue diseases

Control of immune complex formation is important to limit disease resulting from their deposition in tissues. Any inhibition of immune complex solubilisation is thus significant in the pathogenesis of immune complex diseases. More than half of our patients with various rheumatic connective tissue diseases were demonstrated to have serum inhibition of immune complex solubilisation (12/16 rheumatoid arthritis, 22/37 systemic lupus erythematosus, 16/29 primary Sjogren's syndrome, and eight of nine with mixed connective tissue disease). This serum inhibitory activity did not correlate well with serum levels of IgM rheumatoid factor or circulating immune complexes, and its nature remains to be elucidated.

Glaucoma treatment with once-daily levobunolol

Although twice-daily instillation of topical beta-blockers is the standard regimen for treatment of increased intraocular pressure, once-daily therapy might improve patient compliance and provide greater safety. In a three-month, double-masked clinical trial, 92 patients with open-angle glaucoma or ocular hypertension received levobunolol 0.5% or 1% or timolol 0.5% once daily, in both eyes. Overall mean decreases in intraocular pressure were significantly greater in the groups treated with levobunolol than in the group treated with timolol. Intraocular pressure decreases averaged 7.0 mm Hg with levobunolol 0.5%, 6.5 mm Hg with levobunolol 1%, and 4.5 mm Hg with timolol. The intraocular pressures of 72% (18 of 25 patients) of those treated with levobunolol 0.5%, 79% (22 of 28 patients) of those treated with levobunolol 1%, and 64% (16 of 25 patients) of those treated with timolol were successfully controlled during the study. Heart rate and blood pressure decreases were minimal with both levobunolol and timolol. Study results indicated that once-daily treatment with levobunolol and, to a lesser extent, timolol is sufficient to control intraocular pressure successfully and safely.

A general model for preventive intervention in clinical practice

A five-stage collaborative project to develop curriculum and associated instructional materials in preventive medicine has been initiated by the Association of Teachers of Preventive Medicine in cooperation with the Center for Educational Development in Health at Boston University. As part of the first stage, a general model delineating physician responsibilities in the preventive dimension of clinical practice was developed and analyzed in terms of requisite attitudes, knowledge, and skills. The model is based on a theoretical matrix modified by consideration of optimal physician performance in three tracer conditions (lung cancer, gonorrhea, and hypertension) and the results of a Delphi survey among a sample of 50 primary care practitioners. Competency in planning a practice-based program of prevention and the ability to assist patients in modifying patterns of behavior emerged as significant determinants of physician effectiveness in preventive intervention.

Electrical wiring configurations and childhood leukemia in Rhode Island

The study of the relationship between childhood leukemia and electric power line configurations in the greater Denver, Colorado, area by Wertheimer and Leeper (Am J Epidemiol 109:273-284, 1979) was repeated in Rhode Island, focusing on leukemia (age at onset, 0-20 years; year of onset, 1964-1978). The addresses of 119 leukemia patients and 240 controls were studied by mapping power lines within 50 yards (45.72 m) of each residence. The shortest distance between each power line and the point of the residence closest to it was found; the number and types of wires in each power line were noted. Exposure weights were assigned each type of wire using Wertheimer and Leeper's median field strength reading for each. Assuming that the strength of the field decreases with the square of the distance from its source, and that fields generated by different wires grouped in the same power line are simply additive, a summary value of relative exposure was calculated for each address. Quartile exposure values for controls were used to group patient exposures. Contrary to Wertheimer and Leeper's results, no relationship was found between leukemia and electric power line configurations.

The experience of losing a job: some effects on cardiovascular functioning

Men whose jobs were abolished because of a permanent plant closing were followed for 2 years as they went through the phases of anticipation, plant closing, unemployment, and reemployment. Changes in serum cholesterol, blood pressure, body weight, cigarette smoking, and pulse rate were examined in relation to these stages of the job loss experience. In general, these indicators revealed a good deal of sensitivity to the stages, as well as to the difference in the rural-urban setting of the plants and to levels of social support. However, overall cardiovascular risk never exceeded the levels for controls and any "stress' effects were found to be self-limiting.

Presidential Address-1976. Social support as a moderator of life stress

Social support is defined as information leading the subject to believe that he is cared for and loved, esteemed, and a member of a network of mutual obligations. The evidence that supportive interactions among people are protective against the health consequences of life stress is reviewed. It appears that social support can protect people in crisis from a wide variety of pathological states: from low birth weight to death, from arthritis through tuberculosis to depression, alcoholism, and the social breakdown syndrome. Furthermore, social support may reduce the amount of medication required, accelerate recovery, and facilitate compliance with prescribed medical regimens.

The experience of losing a job: reported changes in health, symptoms and illness behavior

Changes in health and in behavior related to health-illness were described in men whose jobs were abolished because of a permanent plant closing. Fluctuations in several measures based on a 2 week health diary (Days Complaint, Days Disability, Percent Days Complaint That Are Also Days Disability, Days Saw Doctor, Days Used Drugs), as well as in other indicators (Symptoms, Depression, Dissatisfaction with Social Support) were analyzed as the men went through the various phases of anticipation, plant closing, unemployment and re-employment. Differences in the objective and subjective severity of the experience, in the social setting of the plant closing (urban vs. rural) and in selected personal characteristics were also examined for their influence on the changes in the various health-related measures.

Epilogue: meditations on psychosomatic medicine

Presented are some personal views on the state of psychosomatic medicine as a science. It is suggested that the field needs more precision in language including exorcism of value judgments from certain dimensions, less circularity in stress-strain reasoning, more complex hypotheses, more emphasis on social support as a central variable and more acceptance of divergent research styles.