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The study of twins and their families provides a highly useful tool for disentangling the genetic and environmental origins of traits. The Cardiff Study of All Wales and North West of England Twins (CaStANET) has followed children and adolescents over time into early adulthood, assessing a wide range of aspects of behavior and psychopathology using self-, parent and teacher reports. Four main waves of data collection have taken place to date, which have provided a wealth of information on the contributions of genetic and environmental risk factors to the psychological health of young people. This article first describes the CaStANET register and subsequently presents some of the findings that have emerged from this resource, with a focus on depression and anxiety, chronic fatigue, attention-deficit/hyperactivity disorder, conduct problems and prosocial behavior. We describe in somewhat more detail the 4th wave of data collection, which has recently been completed and has provided us with extensive information on substance use and problem use as well as associated risk factors in the twins and their families, including longitudinal data on conduct problems and the relations between family members. Because of the wealth of data already collected and the opportunity for genetically informative analyses over time, CaStANET provides a valuable resource for understanding the complexities of the psychological development of young people.
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PMID:The Cardiff Study of all Wales and North West of England Twins (CaStANET): a longitudinal research program of child and adolescent development. 1753 61

Cardiac autonomic neuropathy associated with diabetes can cause silent myocardial ischemia and may influence the way that patients perceive symptoms of acute coronary syndromes (ACS). The purpose of this study was to examine symptoms of ACS in patients with and without diabetes while controlling for length of time with diabetes. A convenience sample of 256 patients from two large medical centers in the Midwest participated. Patients with diabetes comprised 33.2% of the sample and reported significantly less chest pain and more unusual fatigue. Patients with diabetes of longer duration (10 or more years) reported more difficulty breathing than did patients with diabetes of shorter duration (fewer than 10 years). Older patients with the same diabetes status also reported less chest pain. For older patients and for patients with diabetes, lack of chest pain during ACS could delay treatment and is thus a concern.
West J Nurs Res 2008 Feb
PMID:The association of diabetes and older age with the absence of chest pain during acute coronary syndromes. 1818 62

Wegener's Granulomatosis (WG) is a rare, Multisystem disease of the medium and small sized arteries and veins. It most commonly involves the upper respiratory tract, lungs, and kidneys and often presents as chronic fatigue, upper respiratory infection, sinusitis, and otitis media. Symptoms can include fever, weight loss and fatigue, though these are not usually the primary presenting complaints. development of the disease is highly skewed across ethnicities, with up to 98% of cases being reported in caucasians. We present the case of a 56-year-old African-American male who presented primarily with complaints of uncontrollable fever of unknown origin (FUO) for past two weeks with accompanying sore throat, nasal congestion, night sweats, malaise, and unexplained weight loss of 10 pounds over the past month. Treatment with antibiotics for one week prior to admission showed no relief of symptoms. Chest x-ray showed focal course markings in the right upper lobe. Urinalysis revealed microscopic hematuria and leukocyturia. Chest and abdominal CT scans revealed a right lower lobe pulmonary nodule and heterogeneous areas of enhancement in the spleen. Head CT revealed right mastoid opification. Labs revealed proteinase-3 antibody titer > 100, which is characteristic of WG. Steroids and cyclophosphamide were started with relief of presenting symptoms. Renal biopsy showed pauci-immune P-ANCA associated crescentic and focally necrotizing glomerulonephritis and vascilitis. This case is unique in that the patient presented with primary complaint of FUO. WG should be considered as a rule-out in cases of uncontrollable FUO, even if none of the classic triad of symptoms is present. Though rare, WG should be considered in cases involving non-Caucasian patients.
Proc West Pharmacol Soc 2007
PMID:Wegener's granulomatosis presenting as fever of unknown origin in an African-American male. 1860 51

Myasthenia gravis (MG) is a chronic neuromuscular disease which leads to varying degrees of weakness in the skeletal muscles. Some of the symptoms of the disorder include weakness of the eye muscles, difficulty in swallowing and slurred speech. When only the muscles of the eyes are affected, the illness is termed ocular myasthenia, which is often characterized by abrupt onset of diplopia and ptosis of the eyelid. In most patients with ocular-onset MG, there is a progression to involvement of other muscle groups within the first two years (generalized myasthenia). In the case reported here, a 39-year-old male of Ecuadorian descent complained of difficulty seeing, double vision, dizziness, unsteady gait, difficulty maintaining balance and fatigue for the previous two days. Neurological examination was remarkable for total external ophthalmoplegia. There was no external bulbar muscle paralysis, motor weakness, muscle wasting, sensory deficits or sphincter dysfunction. His laboratory workup was significant for elevated acetylcholine receptor antibody. He was diagnosed with ocular MG after differential diagnoses were ruled out based on the onset and presentation of symptoms, the patient's age and a normal magnetic resonance imaging exam. No signs of generalized myasthenia were detected. His symptoms improved dramatically after treatment with Acetyl cholinesterase (AchE) inhibitors and steroids, regaining much of his ocular mobility and ability to walk without gait imbalance. At follow-up visits, the patient remained healthy with no evidence development of other myasthenic signs. This case is atypical since ocular MG does not normally occur in the absence of other myasthenic forms.
Proc West Pharmacol Soc 2007
PMID:An atypical course of myasthenia gravis. 1860 52

Starting August 2006, a major epidemic of bluetongue (BT) was identified in North-West Europe, affecting The Netherlands, Belgium, Germany, Luxembourg and the North of France. It was caused by BT virus serotype 8 (BTV-8), a serotype previously unknown to the European Union (EU). In this outbreak, the virus caused clinical disease in a few individual animals within cattle herds, whereas overt clinical disease was usually restricted to sheep. Investigations in Belgium suggested that the first clinical signs of BTV-8 appeared mid July 2006 in a cattle herd, while the first suspicion of a BT-outbreak in Belgium was reported on 17 August 2006. In the first 10 BTV-8 outbreaks in the Netherlands, the owners indicated that the first clinical signs started approximately 12-17 days before a suspicion was reported to the veterinary authorities via a veterinary practitioner. In BTV-8 affected sheep flocks, erosions of the oral mucosa, fever, salivation, facial and mandibular oedema, apathy and tiredness, mortality, oedema of the lips, lameness, and dysphagia were among the most frequent clinical signs recorded. The most prominent clinical signs in BTV-8 affected cattle herds were: crusts/lesions of the nasal mucosa, erosions of lips/crusts in or around the nostrils, erosions of the oral mucosa, salivation, fever, conjunctivitis, coronitis, muscle necrosis, and stiffness of the limbs. Crusts/lesions of nasal mucosa, conjunctivitis, hyperaemic/purple coloration and lesions of the teats, and redness/hypersensitivity of the skin were relatively more seen on outbreak farms with cattle compared to sheep. Mortality, oedema of the head and ears, coronitis, redness of the oral mucosa, erosions/ulceration of tongue mucosa, purple coloration of the tongue and tongue protrusion and dyspneu were relatively more seen on outbreak farms with sheep compared to cattle.
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PMID:Field observations during the bluetongue serotype 8 epidemic in 2006. I. Detection of first outbreaks and clinical signs in sheep and cattle in Belgium, France and the Netherlands. 1862 Jul 67

Population-level right handedness is a human universal, whose evolutionary origins are the source of considerable empirical and theoretical debate. Although our closest neighbor, the chimpanzee, shows some evidence for population-level handedness in captivity, there is little evidence from the wild. Tool-use measures of hand use in chimpanzees have yielded a great deal of variation in directionality and strength in hand preference, which still remains largely unexplored and unexplained. Data on five measures of hand use across four tool-use skills--ant-dipping, algae-scooping, pestle-pounding and nut-cracking--among the wild chimpanzees of Bossou, Guinea, West Africa, are presented here. This study aims to explore age- and sex-class effects, as well as the influence of task motor, cognitive and haptic demands, on the strength and directionality of hand preference within and across all five measures of hand use. Although there was no age- or sex-class effect on the directionality of hand preference, immature <or=10 years old tended to be less lateralized than adults, especially adult females. Nut-cracking, the most cognitively complex of the four behaviors and the only one requiring complementary coordination of both hands, yielded the greatest strength in hand use with all adults expressing exclusive use of one hand over the other, without overall significant directional preference. The least lateralized behavior was pestle-pounding, which required bimanual coordination, but also imposed constraints owing to fatigue. It emerged that only the most hazardous tool use, i.e. ant-dipping, and the sole haptic task, i.e. the extraction by hand of crushed oil-palm heart, were laterally biased and both to the right. Shared motor or grip patterns in tool-use skills failed to reveal any specialization in hand use at the individual level. Finally, Bossou chimpanzees demonstrated a tendency for a population-level right-hand use.
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PMID:Laterality in hand use across four tool-use behaviors among the wild chimpanzees of Bossou, Guinea, West Africa. 1894 96

Evidence-based approach on the safety of acupuncture had been lagging behind both in the West and the East, but reliable data based on some prospective surveys were published after the late 1990s. In the present article, we, focusing on 'Japanese acupuncture', review relevant case reports and prospective surveys on adverse events in Japan, assess the safety of acupuncture practice in this country, and suggest a strategy for reducing the therapists' error. Based on the prospective surveys, it seems reasonable to suppose that serious adverse events are rare in standard practice by adequately trained acupuncturists, regardless of countries or modes of practice. Almost all of adverse reactions commonly seen in acupuncture practice-such as fatigue, drowsiness, aggravation, minor bleeding, pain on insertion and subcutaneous hemorrhage-are mild and transient, although we should be cautious of secondary injury following drowsiness and needle fainting. After demonstrating that acupuncture is inherently safe, we have been focusing on how to reduce the risk of negligence in Japan, as well as educating acupuncturists more about safe depth of insertion and infection control. Incident reporting and feedback system is a useful strategy for reducing therapist errors such as forgotten needles. For the benefit of acupuncture patients in Japan, it is important to establish mandatory postgraduate clinical training and continued education system.
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PMID:Safety of acupuncture practice in Japan: patient reactions, therapist negligence and error reduction strategies. 1895 34

Ibn Sina, known as Avicenna in the West, was a celebrated Persian thinker, philosopher, and physician who is remembered for his masterpiece, The Canon of Medicine. The Canon that served as an essential medical encyclopedia for scholars in the Islamic territories and Europe for almost a millennium consisted of 5 books. In the third book, Avicenna described patients with symptoms of carotid hypersensitivity syndrome. These patients, who had excessive yawning, fatigue, and flushing, dropped following pressure on their carotids. Based on such history, it seems that Avicenna was the first to note the carotid sinus hypersensitivity, which presents with vasovagal syncope following compression of the carotid artery. In this paper, we presented a brief account of Avicenna's life and works and discuss his description of the so-called carotid hypersensitivity syncope. Notwithstanding his loyalty to the Greek theory of humoralism, Avicenna set forth his own version of "theory of spirits" to explain the mechanism of this disease. An account of the theory of spirits is also given.
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PMID:Vasovagal syncope in the Canon of Avicenna: the first mention of carotid artery hypersensitivity. 2109 29

The purpose of this secondary analysis was to compare gender differences in retrospective reports of acute myocardial infarction (AMI) symptoms resulting from two different assessment methods: the open-ended inquiry and the combined assessment approach. Women reported more atypical symptoms in their responses to the open-ended inquiry and a greater number of typical, atypical, and total symptoms in the combined assessment approach in which the open-ended inquiry was followed by a series of closed-ended questions. Women reported more jaw/neck pain, dyspnea, and palpitations in response to the open-ended inquiry. In the combined assessment, men reported more chest pain/discomfort than women, whereas women were more likely to report jaw/neck pain, dyspnea, back pain, fatigue, paroxysmal nocturnal dyspnea, and palpitations. The data suggest that careful attention to the type of questions used to assess AMI symptoms could lead to more definitive conclusions regarding gender differences in AMI symptoms.
West J Nurs Res 2009 Aug
PMID:Influence of assessment methods on reports of gender differences in AMI symptoms. 1936 64

Relationships between chronic perceived stress, cortisol response (area under the curve) and posttraumatic brain injury fatigue were examined with persons from outpatient settings. Seventy-five injured persons with traumatic brain injury and their relatives/significant others participated in this cross-sectional study. Using interviews and self-reported data from the Neurofunctional Behavioral Inventory, the Perceived Stress Scale, the Profile of Mood States-Fatigue subscale, the McGill Pain Scale, as well as self-collection of salivary cortisol over a 12-hour period (N = 50), we found that perceived chronic stress explained 40% of the variance in fatigue until depressive symptoms and pain were in the model. Hypocortisolemia was evident. Somatic symptom frequency and perceived chronic stress represented 50% of the variability in post-TBI fatigue. Fatigue and stress management interventions, as suggested in the Centers for Disease Control Acute Concussion guidelines, may be beneficial in reducing this common symptom.
West J Nurs Res 2009 Oct
PMID:Psychological and biological correlates of fatigue after mild-to-moderate traumatic brain injury. 1950 73


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