G*Power 3: a flexible statistical power analysis program for the social, behavioral, and biomedical sciences

Glucocorticoid sensitivity in fibromyalgia patients: decreased expression of corticosteroid receptors and glucocorticoid-induced leucine zipper

In fibromyalgia (FM) patients, differences in glucocorticoid receptor (GR) affinity and disturbances associated with loss of hypothalamic-pituitary-adrenal (HPA) axis resiliency have been observed. Based on these studies, we investigated whether FM would be associated with abnormalities in glucocorticoid (GC) sensitivity. Salivary and blood samples were collected from 27 FM patients and 29 healthy controls. Total plasma cortisol and salivary free cortisol were quantified by ELISA and time-resolved fluorescence immunoassay, respectively. GR sensitivity to dexamethasone was evaluated through IL-6 inhibition in stimulated whole blood. The corticosteroid receptors, GR alpha and mineralocorticoid receptor, as well as the glucocorticoid-induced leucine zipper (GILZ) and the FK506 binding protein 5 mRNA expression were assessed in peripheral blood mononuclear cells (PBMCs) by real-time RT-PCR. Furthermore, the corticosteroid receptors were analysed for polymorphism. We observed lower basal plasma cortisol levels (borderline statistical significance) and a lower expression of corticosteroid receptors and GILZ in FM patients when compared to healthy controls. The MR rs5522 (I180V) minor allele was found more often in FM patients than in controls and this variant was recently associated with a mild loss of receptor function. The lower GR and MR expression and possibly the reduced MR function may be associated with an impaired function of the HPA axis in these patients which, compounded by lower anti-inflammatory mediators, may sustain some of symptoms that contribute to the clinical picture of the syndrome.

Lowering LDL cholesterol in adults: a prospective, community-based practice initiative

PURPOSE

The purpose of our study was to see if a clinic-wide initiative, with low-density lipoprotein cholesterol (LDL)-lowering interventions, could be an effective health maintenance strategy to decrease LDL levels to <100 mg/dL in a community-based, internal medicine outpatient setting.

METHODS

There were 1375 patients screened with an initial/baseline LDL (LDL(1)) measurement. Patients whose LDL(1) levels were >100 mg/dL were put on a lipid-lowering action plan and re-evaluated with a follow-up LDL (LDL(2)) in 3-4 months. An additional action plan was given to patients whose LDL(2) values were still too high, and their values retested in 3-4 months for a third LDL (LDL(3)). LDL(1) levels versus postintervention LDL measurement (LDL(2) or LDL(3)) levels were the primary endpoints, with secondary endpoints of total cholesterol, total triglyceride, and high-density lipoprotein cholesterol (HDL) levels over the 3 measurement periods.

RESULTS

Of 514 patients who were given action plans, 443 returned for their follow-up lipid assessment. LDL levels in this group fell from 140.7 +/- 29.2 (mean+/-1 SD) mg/dL (LDL(1)) to 110.9 (29.6) mg/dL (LDL(2)) (P <.05). Of these 443 patients, 167 individuals had LDL(2) levels that now met National Cholesterol Education Program/Third Adult Treatment Panel III guidelines (<100 mg/dL) and 87 were now considered by their primary care provider as controlled (LDL 100-130 mg/dL). However, 158 individuals had LDL(2) levels that were either not controlled or not meeting National Cholesterol Education Program/Third Adult Treatment Panel guidelines. These 158 patients were provided with a second action plan, and of these, 50 (32%) returned to the clinic for a third lipid panel. Their LDLs, as a group, subsequently fell from an LDL(2) of 139.9 (24.4) mg/dL to 112.5 (28.2) mg/dL (LDL(3)) (P <.05). Sixteen of 50 now had LDLs <100 mg/dL, and 26 of 50 were considered controlled. Initial HDL (HDL(1)) levels rose from 55.4 (17.2) mg/dL to 57.3 (14.6) mg/dL (HDL(2)) (n=443). Blood levels of triglycerides and cholesterol also decreased in our returning patients over this time period (P <.05).

CONCLUSIONS

Community-based physicians can help their patients realize significant reductions in low-density lipoprotein cholesterol levels by implementing and closely monitoring lipid-lowering initiatives for their patients, resulting in potentially large positive impacts on the long-term health and well-being of their patients.

Circulating fibrinogen but not D-dimer level is associated with vital exhaustion in school teachers

Meta-analyses have established elevated fibrinogen and D-dimer levels in the circulation as biological risk factors for the development and progression of coronary artery disease (CAD). Here, we investigated whether vital exhaustion (VE), a known psychosocial risk factor for CAD, is associated with fibrinogen and D-dimer levels in a sample of apparently healthy school teachers. The teaching profession has been proposed as a potentially high stressful occupation due to enhanced psychosocial stress at the workplace. Plasma fibrinogen and D-dimer levels were measured in 150 middle-aged male and female teachers derived from the first year of the Trier-Teacher-Stress-Study. Log-transformed levels were analyzed using linear regression. Results yielded a significant association between VE and fibrinogen (p = 0.02) but not D-dimer controlling for relevant covariates. Further investigation of possible interaction effects resulted in a significant association between fibrinogen and the interaction term "VE x gender" (p = 0.05). In a secondary analysis, we reran linear regression models for males and females separately. Gender-specific results revealed that the association between fibrinogen and VE remained significant in males but not females. In sum, the present data support the notion that fibrinogen levels are positively related to VE. Elevated fibrinogen might be one biological pathway by which chronic work stress may impact on teachers' cardiovascular health in the long run.

Matrix Metallopeptidase 2 Gene Polymorphism is Associated with Obesity in Korean Population

The aim of this study was to determine whether single nucleotide polymorphisms (SNPs) of matrix metallopeptidase 2 (MMP2) are associated with obesity. MMP2 is an enzyme with proteolytic activity against matrix and nonmatrix proteins, particularly basement membrane constituents. To identify the relationship between polymorphisms of MMP2 and overweight/obese, we genotyped 5 SNPs (rs17242319, rs1053605, rs243849, rs2287074, and rs10775332) of the coding region of MMP2 using the Golden Gate assay on an Illumina BeadStation 500 GX. One hundred and forty two overweight/obese (BMI >/=23) and 145 normal (BMI 18 to <23) subjects were analyzed. SNPStats, Haploview, HapAnalyzer, SNPAnalyzer, and Helixtree programs were used for the analysis of genetic data. A linkage disequilibrium (LD) block was discovered among the 5 SNPs selected, including rs17242319, rs1053605, rs243849, and rs2287074. Of the 5 polymorphisms, 2 synonymous SNPs [rs17242319 (Gly226Gly) and rs10775332 (Phe602Phe)] were found significant associations with overweight/obese. Recently, rs1132896 replaced rs17242319 as a new number (SNP database, BUILD 129). In haplotype analysis using Haploview, a haplotype (haplotype: CCCA) containing a meaningful polymorphism (rs17242319) was found to be significantly different. The results suggest that MMP2 may be associated with overweight/obese in Korean population.

Randomized controlled trials: methodological concepts and critique

Randomized controlled trials, also known as true experiments or intervention studies, are considered to be the gold standard research design for demonstrating a cause-and-effect relationship between an intervention and an outcome. This article will describe key methodological concepts that make the randomized controlled trial this gold standard. Practicing from an evidence-based perspective requires practitioners to be able to critique the strengths and weaknesses of a research study in order to make decisions about adoption of the intervention into one's practice area. Key components to the critique of a randomized controlled trial are defined and the process is illustrated by a critique of Gallo and colleagues article, A Study of Naloxone Effect on Urinary Retention in the Patient Receiving Morphine PCA, published in this issue.

Analysing the relationship between target-to-target and distractor-to-target repetitions: evidence for a common mechanism

In the present study an assumption of retrieval theories of negative priming was tested. In particular, retrieval theories assume that the same underlying process causes benefits in target-to-target repetition trials and cost effects in distractor-to-target repetition trials in selection tasks in which targets are accompanied by distractor stimuli. More specifically, retrieval theories predict a negative correlation: The higher the benefit in target-to-target repetition trials is, the higher the cost effect in distractor-to-target repetition trials should be. In fact, in a study with considerable power (N = 110) and a design that allowed a confound-free detection of correlations, I observed a significant negative correlation between benefit and cost effects. This result is interpreted as evidence for a common retrieval mechanism.

Strong Association of Chromosome 1p12 Loci with Thyroid Cancer Susceptibility

Several genes directly related to thyroid cancer development have been described; nevertheless, the genetic pathways of this tumorigenesis process are unknown. Together with environmental factors, susceptibility genes could have an important role in thyroid cancer. Our previous studies suggest that the chromosome 1p12-13 is related to thyroid cancer incidence. Here, we extend the analysis with a case-control association study in a Spanish population. Thus, six single-nucleotide polymorphisms were genotyped, covering 2.4 Mb of the 1p12-13 region. A statistically significant association between thyroid cancer incidence and the rs2145418 and rs4658973 polymorphisms was found (P &lt; 0.0001). No association was detected for the other four polymorphisms studied. The rs2145418 marker showed a significant odds ratio of 5.0 [95% confidence interval (95% CI), 2.85-8.83] and 9.2 (95% CI, 4.50-21.6) for heterozygous and homozygous G-variant alleles, respectively. For rs4658973, the odds ratios were 0.40 (95% CI, 0.26-0.62) and 0.07 (95% CI, 0.03-0.18) for heterozygous and homozygous G-variant alleles, respectively. These markers map into the 1p12 region, and no linkage disequilibrium was found between them, indicating an independent relation of these polymorphisms with thyroid cancer susceptibility. Our data provide evidence of a strong association of the chromosome 1p12 with thyroid cancer risk, and it is the first study describing susceptibility loci for thyroid cancer in this region. (Cancer Epidemiol Biomarkers Prev 2008;17(6):1499–504)

Developmental differences in white matter architecture between boys and girls

Previous studies have found developmental differences between males and females in brain structure. During childhood and adolescence, relative white matter volume increases faster in boys than in girls. Sex differences in the development of white matter microstructure were investigated in a cohort of normal children ages 5-18 in a cross-sectional diffusion tensor imaging (DTI) study. Greater fractional anisotropy (FA) in boys was shown in associative white matter regions (including the frontal lobes), while greater FA in girls was shown in the splenium of the corpus callosum. Greater mean diffusivity (MD) in boys was shown in the corticospinal tract and in frontal white matter in the right hemisphere; greater MD in girls was shown in occipito-parietal regions and the most superior aspect of the corticospinal tract in the right hemisphere. Significant sex-age interactions on FA and MD were also shown. Girls displayed a greater rate of fiber density increase with age when compared with boys in associative regions (reflected in MD values). However, girls displayed a trend toward increased organization with age (reflected in FA values) only in the right hemisphere, while boys displayed this trend only in the left hemisphere. These results indicate differing developmental trajectories in white matter for boys and girls and the importance of taking sex into account in developmental DTI studies. The results also may have implications for the study of the relationship of brain architecture with intelligence.

A comparison of treatment completers and non-completers of an in-patient treatment programme for male personality-disordered offenders

BACKGROUND

In the treatment of offenders with personality disorders, one matter that requires attention is the rate of treatment non-completion. This is important as it has cost-efficiency and negative outcome implications.

METHOD

We compared the characteristics of those who participated in a personality disorder treatment programme divided into three groups: Group 1, treatment completers (N = 21); Group 2, those expelled for rule breaking (N = 16); and Group 3, those removed because they were not engaging in treatment (N = 19). We hypothesized that, compared with the other two groups, Group 2 would score higher on the impulsive/careless style scale, and that those in Group 3 would score higher on the avoidant style scale of the social problem-solving inventory-revised (SPSI-R). Further, we hypothesized that high anxiety would be associated with treatment non-completion in both the groups.

RESULTS

These differences were not found. However, in combining both groups of non-completers for comparison, completers were shown to score significantly higher on SPSI-R rational problem solving and significantly lower on SPSI-R impulsive/careless style.

CONCLUSION

Findings suggest that teaching impulsive people a rational approach to social problem solving may reduce their level of non-completion.

Effects of exercise in combination with epoetin alfa during high-dose chemotherapy and autologous peripheral blood stem cell transplantation for multiple myeloma

PURPOSE/OBJECTIVES

To determine the effect of aerobic and strength resistance training and epoetin alfa (EPO) therapy on transfusions, stem cell collections, transplantation recovery, and multiple myeloma treatment response.

DESIGN

Randomized clinical trial.

SETTING

A myeloma research and therapy center in the south central United States.

SAMPLE

135 patients with multiple myeloma, 120 evaluable.

METHODS

Random assignment to exercise or usual care groups. All patients received EPO based on an algorithm. Aerobic capacity, using the six-minute walk test, was assessed prior to induction chemotherapy, prior to stem cell mobilization, and following stem cell collection for all patients and before and after transplantation for patients continuing in the study. Data analysis included analysis of variance to compare other outcome variables by groups.

MAIN RESEARCH VARIABLES

Number of red blood cell and platelet transfusions during transplantation, number of attempts at and total number of days of stem cell collection, time to recovery after transplantation, and response to intensive therapy for multiple myeloma.

FINDINGS

Recovery and treatment response were not significantly different between groups after transplantation. The exercise group had significantly fewer red blood cell transfusions and fewer attempts at stem cell collection. Serious adverse events were similar in each group.

CONCLUSIONS

Exercise with prophylactic EPO therapy reduces the number of RBC transfusions and attempts at stem cell collection for patients receiving intensive treatment for multiple myeloma.

IMPLICATIONS FOR NURSING

Exercise is safe and has many physiologic benefits for patients receiving multiple myeloma treatment.

Validity of the Faces Anxiety Scale for the assessment of state anxiety in intensive care patients not receiving mechanical ventilation

OBJECTIVES

Anxiety is a commonly reported discomfort in critically ill patients in the intensive care unit (ICU) but is rarely assessed routinely in a systematic manner. The main aim of this study was to assess criterion validity of the Faces Anxiety Scale in relation to the State-Anxiety Inventory (SAI) in intensive care patients able to respond verbally to the items in the SAI of the Spielberger State-Trait Anxiety Inventory. It also reports on the severity of anxiety in intensive care patients not receiving mechanical ventilation.

METHODS

Nonventilated intensive care patients (n=100) self-reported anxiety levels on the Faces Anxiety Scale and on the SAI, administered in random order. Validity was examined using Spearman's rho.

RESULTS

Patients had a mean age of 59.8 years and 65% were male; were in ICU for mainly cardiovascular, respiratory, and neurological diagnoses; and had median length of stay of 2.1 days. The correlation between the two scales was .70 (P<.0005), indicating good criterion validity. Patients reported low to moderate levels of anxiety on both the Faces Anxiety Scale and the Spielberger SAI.

CONCLUSION

The Faces Anxiety Scale is a valid single-item, self-report measure of state anxiety in intensive care patients that is easy to administer and imposes minimal respondent burden. It has the potential to be a useful instrument for the assessment of state anxiety by clinicians and for research into the reduction of anxiety in this vulnerable population.

Assessment of Relationship between Fyn-related Kinase Gene Polymorphisms and Overweight/Obesity in Korean Population

The fyn-related kinase (FRK) belongs to the tyrosine kinase family of protein kinases. Recent studies have shown that Frk affects pancreatic beta cell number during embryogenesis and promotes beta cell cytotoxic signals in response to streptozotocin. To investigate the genetic association between FRK polymorphisms and the risk of obesity in Korean population, single nucleotide polymorphisms (SNPs) in the FRK gene region were selected and analyzed. The body mass index (BMI) was calculated, and biochemical data (systolic blood pressure, diastolic blood pressure, hemoglobin A1C, triglyceride, total cholesterol, high density lipoprotein, and low density lipoprotein) of blood sample from each subject were also measured. One hundred fifty five healthy control and 204 overweight/obesity subjects were recruited. Genotype frequencies of six SNPs [rs6568920 (+8391G>A), rs3756772 (+56780A>G), rs3798234 (+75687C>T), rs9384970 (+68506G>A), rs1933739 (+72978G>A), and rs9400883 (+75809A>G)] in the FRK gene were determined by Affymetrix Targeted Genotyping Chip data. According to the classification of Korean Society for the Study of Obesity, control (BMI 18 to <23) and overweight/obesity (BMI>/=23) subjects were recruited. For the analysis of genetic data, EM algorithm, SNPStats, Haploview, HapAnalyzer, SNPAnalyzer, and Helixtree programs were used. Multiple logistic regression analysis (codominant, dominant, and recessive models) was performed. Age and gender as covariates were adjusted. For biochemical data, Student's t test was used. The mean value of BMI in the control and overweigh/obesity groups was 21.1+/-1.2 (mean+/-SD) and 25.6+/-2.0, respectively. All biochemical data of the overweight/obesity group were statistically significance, compared with the control group. Among six SNPs, two linkage disequilibrium (LD) blocks were discovered. One block consisted of rs1933739 and rs9400883, and the other comprised rs3756772 and rs3798234. One SNP (rs9384970, +68506G>A) showed an association with overweight/obesity in the codominant model (p=0.03). Interestingly, the AA genotype distribution in the overweight/obesity group (n=7, 3.5%) was higher than those in the control group (n=1, 0.6%), which is not found in either Japanese or Chinese subjects. Therefore, the AA genotype of rs9384970 may be a risk factor for development of obesity in Korean population. The results suggest that FRK may be associated with overweight/obesity in Korean population.

Both intestinal and hepatic lipoprotein production are stimulated by an acute elevation of plasma free fatty acids in humans

BACKGROUND

Hepatic lipoprotein production has been shown previously to be regulated by free fatty acid (FFA) flux to the liver, whereas intestinal lipoprotein production is stimulated mainly by ingested fat absorbed from the intestinal lumen. Emerging evidence indicates that intestinal lipoprotein production is increased in insulin resistance and type 2 diabetes mellitus, conditions that are associated with increased levels of circulating FFAs. Here we investigated whether short-term elevation of plasma FFAs stimulates intestinal apolipoprotein (apo) B-48- and hepatic apoB-100-containing triglyceride-rich lipoprotein (TRL) production in humans in the fed state.

METHODS AND RESULTS

TRL apoB-48 and apoB-100 metabolism were examined in 12 healthy men during a constant fed state. The studies were as follows, respectively: (1) Intralipid/heparin was infused intravenously immediately before and during the kinetics study to induce an approximately 3-fold difference in plasma FFA compared with the saline study; (2) saline was infused intravenously as a control. ApoB-48- and apoB-100-containing TRL production and clearance were determined with a 12-hour primed constant infusion of [D3]L-leucine and multicompartmental kinetic modeling. TRL apoB-48 production rate was 69% higher in the Intralipid/heparin study than in the saline control (5.95+/-1.13 versus 3.53+/-0.58 mg/kg per day; P=0.027), and there was no significant difference in TRL apoB-48 clearance. TRL apoB-100 concentrations were also increased (P<0.001) and TRL apoB-100 production rate was 35% higher in the Intralipid/heparin study compared with saline (28+/-4 versus 21+/-3 mg/kg per day; P=0.020).

CONCLUSIONS

This is the first study to demonstrate that intestinal TRL apoB-48 production is increased after short-term elevation of plasma FFAs in humans in the fed state, similar to the well-described stimulation of hepatic TRL apoB100-containing particles by FFAs.

Both intestinal and hepatic lipoprotein production are stimulated by an acute elevation of plasma free fatty acids in humans

BACKGROUND

Hepatic lipoprotein production has been shown previously to be regulated by free fatty acid (FFA) flux to the liver, whereas intestinal lipoprotein production is stimulated mainly by ingested fat absorbed from the intestinal lumen. Emerging evidence indicates that intestinal lipoprotein production is increased in insulin resistance and type 2 diabetes mellitus, conditions that are associated with increased levels of circulating FFAs. Here we investigated whether short-term elevation of plasma FFAs stimulates intestinal apolipoprotein (apo) B-48- and hepatic apoB-100-containing triglyceride-rich lipoprotein (TRL) production in humans in the fed state.

METHODS AND RESULTS

TRL apoB-48 and apoB-100 metabolism were examined in 12 healthy men during a constant fed state. The studies were as follows, respectively: (1) Intralipid/heparin was infused intravenously immediately before and during the kinetics study to induce an approximately 3-fold difference in plasma FFA compared with the saline study; (2) saline was infused intravenously as a control. ApoB-48- and apoB-100-containing TRL production and clearance were determined with a 12-hour primed constant infusion of [D3]L-leucine and multicompartmental kinetic modeling. TRL apoB-48 production rate was 69% higher in the Intralipid/heparin study than in the saline control (5.95+/-1.13 versus 3.53+/-0.58 mg/kg per day; P=0.027), and there was no significant difference in TRL apoB-48 clearance. TRL apoB-100 concentrations were also increased (P<0.001) and TRL apoB-100 production rate was 35% higher in the Intralipid/heparin study compared with saline (28+/-4 versus 21+/-3 mg/kg per day; P=0.020).

CONCLUSIONS

This is the first study to demonstrate that intestinal TRL apoB-48 production is increased after short-term elevation of plasma FFAs in humans in the fed state, similar to the well-described stimulation of hepatic TRL apoB100-containing particles by FFAs.

Dopamine transporter polymorphisms and risperidone response in Chinese schizophrenia patients: an association study

Risperidone is a widely used atypical antipsychotic medication and there is currently considerable interest in individual differences in patient response to it. In this study, we investigated the pharmacogenetic correlates of SLC6A3 and response to risperidone treatment in 130 Chinese schizophrenia patients. We selected six polymorphisms, including two SNPs in the 5'-regulatory regions, two SNPs in intron 1, one SNP and a variable number tandem repeat in the 3'-flanking region of SLC6A3 for this study and analyzed the differences in the reduction of Positive and Negative Syndrome Scale (PANSS) scores among the subgroups with different genotypes and diplotypes after 8 weeks of risperidone treatment. The confounding effects of nongenetic factors were estimated and the baseline symptom score was included as a covariate for adjustment. We found no significant differences in response to treatment in terms of PANSS or subscores improvements among the subgroups according to different genotypes and diplotypes. In addition, we have found no significant differences between different diplotypic groups in the plasma levels of risperidone and 9-hydroxyrisperidone. Further studies on larger groups and on the effects of longer-term risperidone treatment are needed to confirm these results.

Auditory hallucinations and the mismatch negativity: processing speech and non-speech sounds in schizophrenia

BACKGROUND

In line with emerging research strategies focusing on specific symptoms rather than global syndromes in psychiatric disorders, we examined the functional neural correlates of auditory verbal hallucinations (AHs) in schizophrenia. Recent neuroimaging and behavioural evidence suggest a reciprocal relationship between auditory cortex response to external sounds versus that induced by AHs.

METHODS

The mismatch negativity (MMN), a well established event-related potential (ERP) index of auditory cortex function, was assessed in 12 hallucinating patients (HP), 12 non-hallucinating patients (NP) and 12 healthy controls (HC). The primary endpoints, MMN amplitudes and latencies recorded from anterior and posterior scalp regions, were measured in response to non-phonetic and phonetic sounds.

RESULTS

While schizophrenia patients as a whole differed from HCs, no significant between-group differences were observed when patients were divided into hallucinated and non-hallucinated subgroups but, compared to NPs and HCs, whose MMN amplitudes were greatest in response to across phoneme change at frontal but not temporal sites, MMN amplitudes in HPs at frontal sites were not significantly different to any of the presented stimuli, while temporal MMNs in HPs were maximally sensitive to phonetic change.

SIGNIFICANCE

These findings demonstrate that auditory verbal hallucinations are associated with impaired pre-attentive processing of speech in fronto-temporal networks, which may involve defective attribution of significance that is sensitive to resource limitations. Overall, this research suggests that MMN may be a useful non-invasive tool for probing relationships between hallucinatory and neural states within schizophrenia and the manner in which auditory processing is altered in these afflicted patients.

Association of common polymorphisms in GLUT9 gene with gout but not with coronary artery disease in a large case-control study

BACKGROUND

Serum uric acid (UA) levels have recently been shown to be genetically influenced by common polymorphisms in the GLUT9 gene in two genome-wide association analyses of Italian and British populations. Elevated serum UA levels are often found in conjunction with the metabolic syndrome. Hyperuricemia is the major risk factor for gout and has been associated with increased cardiovascular morbidity and mortality. The aim of the present study was to further elucidate the association of polymorphisms in GLUT9 with gout and coronary artery disease (CAD) or myocardial infarction (MI). To test our hypotheses, we performed two large case-control association analyses of individuals from the German MI Family Study.

METHODS AND FINDINGS

First, 665 patients with gout and 665 healthy controls, which were carefully matched for age and gender, were genotyped for four single nucleotide polymorphisms (SNPs) within or near the GLUT9 gene. All four SNPs demonstrated highly significant association with gout. SNP rs6855911, located within intron 7 of GLUT9, showed the strongest signal with a protective effect of the minor allele with an allelic odds ratio of 0.62 (95% confidence interval 0.52-0.75; p = 3.2*10(-7)). Importantly, this finding was not influenced by adjustment for components of the metabolic syndrome or intake of diuretics. Secondly, 1,473 cases with severe CAD or MI and 1,241 healthy controls were tested for the same four GLUT9 SNPs. The analyses revealed, however, no significant association with CAD or with MI. Additional screening of genome-wide association data sets showed no signal for CAD or MI within the GLUT9 gene region.

CONCLUSION

Thus, our results provide compelling evidence that common genetic variations within the GLUT9 gene strongly influence the risk for gout but are unlikely to have a major effect on CAD or MI in a German population.

Short Article: Coding Strategies in Number Space: Memory Requirements Influence Spatial–Numerical Associations

The tendency to respond faster with the left hand to relatively small numbers and faster with the right hand to relatively large numbers ( spatial numerical association of response codes, SNARC effect) has been interpreted as an automatic association of spatial and numerical information. We investigated in two experiments the impact of task-irrelevant memory representations on this effect. Participants memorized three Arabic digits describing a left-to-right ascending number sequence (e.g., 3– 4– 5), a descending sequence (e.g., 5– 4– 3), or a disordered sequence (e.g., 5– 3– 4) and indicated afterwards the parity status of a centrally presented digit (i.e., 1, 2, 8, or 9) with a left/right keypress response. As indicated by the reaction times, the SNARC effect in the parity task was mediated by the coding requirements of the memory tasks. That is, a SNARC effect was only present after memorizing ascending or disordered number sequences but disappeared after processing descending sequences. Interestingly, the effects of the second task were only present if all sequences within one experimental block had the same type of order. Taken together, our findings are inconsistent with the idea that spatial–numerical associations are the result of an automatic and obligatory cognitive process but do suggest that coding strategies might be responsible for the cognitive link between numbers and space.

Resting electroencephalogram asymmetry and posttraumatic stress disorder

The valence-arousal (W. Heller, 1993) and approach-withdrawal (R. J. Davidson, 1998a) models hypothesize that particular patterns of hemispheric brain activity are associated with specific motivational tendencies and psychopathologies. We tested several of these predictions in two groups-a posttraumatic stress disorder (PTSD) and a "supercontrol" group, selected to be maximally different from those with PTSD. Contrary to almost all hypotheses, individuals with PTSD did not differ from controls on resting electroencephalogram (EEG) asymmetry. Particular aspects of PTSD were also not related to EEG hemisphere differences. Our null findings are consistent with the few studies that have examined resting EEG asymmetries in PTSD and suggest that PTSD may be associated with different processes than psychopathologies previously examined in studies of hemispheric brain activity (e.g., major depressive disorder, panic disorder).

Health-related quality of life in significant others of patients dying from lung cancer

This study compares health-related quality of life (HRQOL) in significant others of patients dying from lung cancer, with a general population sample. Further, it explores the course of HRQOL from diagnosis (T1), at a time point close to the patient's death (T2), and six months after the patient's death (T3). The group comparisons at T1 showed that the significant others scored significantly lower on the scales in the mental domain compared with a general population sample. These results were the same at T3, when the significant others also scored lower on most of the scales in the physical and social domains. In the longitudinal analyses, there were significant changes in four scales, and three patterns of change were identified: a decrease-increase pattern for 'self-rated health' and 'positive affect'; a constant decrease pattern for 'family functioning'; and a decrease-stable pattern for 'satisfaction with family functioning'. Thus, living with inoperable lung cancer in the family and then facing the death of a family member affects most of the HRQOL dimensions.

Behaviour is not really at risk after surviving meningitis in childhood

AIM

To examine behaviour problems, personality, self-perceived competence and academic deficits in children who had recovered from non-Haemophilus influenzae type b (Hib) bacterial meningitis (BM) without obvious medical sequelae.

METHODS

Assessments in 182 children, mean age 10 (range 5-14) years, 4-10 years after surviving meningitis, were compared to scores of norm reference groups.

RESULTS

More children were estimated to have academic deficits (27%) than behaviour problems as perceived by the parents (9%). The mean deviation from normal was absent to moderate on behaviour problems, personality variables and self-perceived competence.

CONCLUSION

Children who survived non-Hib BM without severe medical sequelae hardly differ from normal children with respect to personality and self-perceived competence. A small proportion deviates from normal in behaviour problems.

Is bonewax safe and does it help?

BACKGROUND

Bonewax is routinely used to seal sternal edges after median sternotomy. Adverse effects on sternal healing, however, have been proclaimed although clear evidence does not exist. We performed a study on coronary bypass patients with or without bonewax application to verify negative effects and risk factors for early rethoracotomy, wound healing problems, and mediastinitis.

METHODS

In a prospectively randomized study on 400 patients undergoing isolated coronary bypass surgery, 200 patients with (bonewax) and 200 patients without bonewax (nonwax) application after median sternotomy were compared. Blood product consumption, early rethoracotomy, sternum stabilization, mediastinitis, and early mortality were compared. Risk factors such as age, sex, diabetes mellitus, and bonewax were analyzed by means of logistical regression analysis.

RESULTS

Blood product consumption was almost identical in both groups (red blood cells, 3.9 +/- 4.7 units in the bonewax group; 3.8 +/- 3.4 units in the nonwax patients; fresh frozen plasma, 0.5 +/- 1.6 units versus 0.5 +/- 1.3 units; platelet concentrates, 0.07 +/- 0.3 units versus 0.04 +/- 0.2 units). Early rethoracotomy (bonewax 6.5%; nonwax 5%), sternal stabilization (bonewax 3%; nonwax 3%), and mediastinitis (bonewax 1%; nonwax 0.5%) did not differ significantly. Early mortality was 2.5% in the bonewax group and 0.5% in the nonwax cohort. Bonewax did not appear as an independent risk factor for adverse outcome.

CONCLUSIONS

Negative effects of bonewax on the percentage of postoperative complications and outcome were not shown. However, positive effects such as a reduction of blood product substitution were also not observed. Using bonewax on sternal edges is obviously safe but not particularly beneficial.

Working memory deficits in boys with attention-deficit/hyperactivity disorder (ADHD): the contribution of central executive and subsystem processes

The current study investigated contradictory findings from recent experimental and meta-analytic studies concerning working memory deficits in ADHD. Working memory refers to the cognitive ability to temporarily store and mentally manipulate limited amounts of information for use in guiding behavior. Phonological (verbal) and visuospatial (nonverbal) working memory were assessed across four memory load conditions in 23 boys (12 ADHD, 11 typically developing) using tasks based on Baddeley's (Working memory, thought, and action, Oxford University Press, New York, 2007) working memory model. The model posits separate phonological and visuospatial storage and rehearsal components that are controlled by a single attentional controller (CE: central executive). A latent variable approach was used to partial task performance related to three variables of interest: phonological buffer/rehearsal loop, visuospatial buffer/rehearsal loop, and the CE attentional controller. ADHD-related working memory deficits were apparent across all three cognitive systems--with the largest magnitude of deficits apparent in the CE--even after controlling for reading speed, nonverbal visual encoding, age, IQ, and SES.

The effects of freezing on the tensile properties of repaired porcine flexor tendon

PURPOSE

When conducting complex testing of tendon repairs, it is essential that the samples are adequately preserved to prevent degradation. Freezing of samples is the most convenient method of preservation; however, there is no evidence in the literature to prove that freezing tendon before or after repair is acceptable. We aimed to prove that freezing tendons does not significantly alter the results of linear load-to-failure testing of tendon repairs.

METHODS

After a power study, 150 tendons were harvested from porcine forelimbs and randomized into 5 groups of 30 tendons. After division, tendons were repaired using a Pennington modified core technique with a Silfverskiöld peripheral cross-stitch. Tendons in group 1 were divided, repaired, and tested within 3 hours postmortem. Tendons in group 2 were refrigerated at 4 degrees C for 24 hours prior to repair and testing. Tendons in group 3 were frozen at -25 degrees C for 3 months prior to repair and testing. Tendons in group 4 were frozen at -25 degrees C for 6 months prior to repair and testing. Tendons in group 5 were frozen at -25 degrees C for 6 months, repaired, refrozen for 1 month, and then tested. All repairs were linear load tested to ascertain the ultimate strength and force to produce 3-mm gap in the repair.

RESULTS

Analysis of variance analysis of the results did not demonstrate any significant differences between groups.

CONCLUSIONS

Freezing tendons both before and after suture repair is an acceptable method of preservation when investigating the force to produce 3-mm gap and ultimate strength of tendon repairs.

Scan path differences and similarities during emotion perception in those with and without autism spectrum disorders

Typical adults use predictable scan patterns while observing faces. Some research suggests that people with autism spectrum disorders (ASD) instead attend to eyes less, and perhaps to the mouth more. The current experiment was designed as a direct measure of scan paths that people with and without ASD use when identifying simple and complex emotions. Participants saw photos of emotions and chose emotion labels. Scan paths were measured via infrared corneal reflectance. Both groups looked significantly longer at eyes than mouth, and neither overall looking time at eyes nor first fixations distinguished the groups. These results are contrary to suggestions that those with ASD attend preferentially to the mouth and avoid the eyes. Furthermore, there was no interaction between group and area of the face: the ratio of attention between eyes and mouth did not differ between the ASD and control groups. However, those with ASD looked at the eyes less than the control group when viewing complex emotions.

Lack of association between three serotonin genes and suicidal behavior in Chinese psychiatric patients

BACKGROUND

Suicide is a significant health problem throughout the world. The serotoninergic system is believed to be involved in suicidal behavior and there is evidence of biological abnormalities of two serotonin receptors (HTR2A, HTR2C) and one serotonin transporter (5HTT) in suicide victims. Rs6313 (T102C) of HTR2A and rs6318 (Cys23Ser) of HTR2C have been investigated in suicide behavior in other studies.

METHODS

Here, we investigated rs6313 and rs6318 and other 10 randomly chosen SNPs, of those three genes in a study of 329 psychiatric patients who had never attempted suicide and 297 patients who had attempted suicide.

RESULTS

No associations were found for the 12 SNPS.

CONCLUSIONS

Our results do not support the involvement of HTR2A, 5HTT or HTR2C in suicidal behavior in Han Chinese subjects.

Limits on the role of retrieval cues in memory for actions: enactment effects in the absence of object cues in the environment

Verb-object phrases (open the umbrella, knock on the table) are usually remembered better if they have been enacted during study (also called subject-performed tasks) than if they have merely been learned verbally (verbal tasks). This enactment effect is particularly pronounced for phrases for which the objects (table) are present as cues in the study and test contexts. In previous studies with retrieval cues for some phrases, the enactment effect in free recall for the other phrases has been surprisingly small or even nonexistent. The present study tested whether the often replicated enactment effect in free recall can be found if none of the phrases contains context cues. In Experiment 1, we tested, and corroborated, the suppression hypothesis: The enactment effect for a given type of phrase (marker phrases) is modified by the presence or absence of cues for the other phrases in the list (experimental phrases). Experiments 2 and 3 replicated the enactment effect for phrases without cues. Experiment 2 also showed that the presence of cues either at study or at test is sufficient for obtaining a suppression effect, and Experiment 3 showed that the enactment effect may disappear altogether if retrieval cues are very salient.

No effect of 5-day treatment with acetylsalicylic acid (aspirin) or the beta-blocker propranolol (Inderal) on free cortisol responses to acute psychosocial stress: a randomized double-blind, placebo-controlled study

BACKGROUND

The characterization of an individual's hypothalamic-pituitary-adrenal axis stress response is a main research topic in neuropsychobiology since alterations have been causally linked to several disease states. Over the last years, several studies focused on the identification of sources of inter- and intraindividual variability, but there is still a paucity of experimental data on the effect of different pharmaceuticals on cortisol responses to acute psychological stress. Therefore, in this randomized double-blind placebo-controlled study, we investigated the effect of treatment with two popular and clinically used pharmaceuticals on stress-related cortisol responses, namely acetylsalicylic acid (aspirin), a known prostaglandin synthesis inhibitor, and the beta-blocker propranolol (Inderal), a nonselective beta-receptor antagonist.

METHODS

For 5 days, 73 healthy subjects (50 men, 23 women; mean age 47.3 +/- 7.7 years) received either a daily oral dose of 100 mg aspirin, 80 mg propranolol (Inderal), aspirin + propranolol, or placebo. After treatment, subjects were confronted with the Trier Social Stress Test, a widely-used standardized psychosocial stress protocol. Cortisol responses were measured by six saliva samples taken before and after the stress exposure.

RESULTS

Subjects showed a significant cortisol increase after stress (p < 0.0001). The four treatment groups did not differ in their cortisol responses (group effect p > 0.44; interaction p > 0.97). Additionally, controlling for gender, age, smoking status, body mass index, mean arterial blood pressure or pre-stress cortisol levels yielded similar results in the total sample as well as in the male or female subgroups, respectively.

CONCLUSION

Neither short-term treatment with aspirin nor propranolol altered the acute free cortisol response to psychological stress in healthy adults.

Floral resources impact longevity and oviposition rate of a parasitoid in the field

1. The use of floral resource subsidies to improve herbivore suppression by parasitoids requires certain trophic interactions and physiological changes to occur. While the longevity and fecundity of parasitoids are positively affected by nectar subsidies in laboratory studies, the impacts of floral subsidies on the fecundity and longevity of freely foraging parasitoids have not been studied. 2. We studied the longevity and per capita fecundity of naturally occurring Diadegma insulare foraging in cabbage plots with and without borders of flowering buckwheat, Fagopyrum esculentum, as well as relationships between longevity, fecundity, sugar feeding and parasitism rates on larvae of the diamondback moth, Plutella xylostella. 3. Relative longevity was estimated by counting broken setae on the fringe of the forewing. Floral borders increased the longevity of males and females in adjacent cabbage plots. 4. The egg maturation rate of D. insulare was estimated by comparing egg loads of females collected early in the day with egg loads of females held without hosts in field cages throughout the day. Females in buckwheat cages matured 2.7 eggs per hour while females in control cages resorbed 0.27 eggs over the same time period. 5. The fecundity of females collected in the afternoon was estimated by comparing their actual egg load to the estimated egg load in the absence of oviposition for females in a given plot. Females foraging in buckwheat plots had marginally fewer eggs remaining in their ovaries, and laid marginally more eggs than females in control plots. Females from both treatments carried 30-60 eggs by the afternoon and therefore were time-limited rather than egg-limited. 6. Plots where a greater proportion of females had fed on sugar had longer-lived females. This suggests that feeding enhanced longevity of D. insulare. However, plots with longer-lived and more fecund females did not exhibit higher parasitism rates, although the power of these tests were low.

Orthopaedic surgeons' cardiovascular response during total hip arthroplasty

The literature contains limited and contradictory information regarding the amount of physical effort and/or emotional stress needed to perform surgery. We therefore investigated cardiovascular response to psychophysical stress in orthopaedic surgeons while they were performing surgery. We monitored 29 male orthopaedic surgeons from four university centers while they performed total hip arthroplasties. Changes in their cardiovascular parameters were recorded by ambulatory monitoring methods. Exercise stress testing of each participant was used as a control state. We compared the cardiovascular response during surgery to energy requirements of everyday activities. Preoperative and postoperative testing showed lower values of cardiovascular parameters than during physically less difficult parts of the operation; physically more difficult phases of the operation additionally increased the values of parameters. We concluded performing total hip arthroplasty increases surgeons' cardiovascular parameters because of psychologic stress and physical effort. Excitement of the cardiovascular system during total hip arthroplasty appears similar to the excitement during moderate-intensity daily activities, such as walking the dog, leisurely bicycling, or climbing stairs.

Genetic variation within adrenergic pathways determines in vivo effects of presynaptic stimulation in humans

BACKGROUND

Catecholamines govern stress blood pressure responses. Catecholaminergic responses may be partially genetic and contribute to the complex heritability of hypertension.

METHODS AND RESULTS

To evaluate catecholaminergic responses without systemic counterregulation, we infused graded concentrations of tyramine, an indirect presynaptic norepinephrine releaser, into dorsal hand veins of 49 normotensive men and women of 5 ethnicities. Vascular responses were coupled to common (minor allele frequency >10%) single-nucleotide polymorphisms at adrenergic target loci within presynaptic pathways. Significance was set at P<0.003 after Bonferroni correction. Generalized analysis of molecular variance (GAMOVA) was performed to determine whether genetic admixture contributed to results. Venoconstriction progressed to 47% with increasing concentrations of tyramine (0.129 to 25.8 mmol/L; P<0.001). Family history of hypertension (P<0.001) and female sex (P=0.02) predicted blunted tyramine responses. Two genetic loci significantly predicted vascular response: chromogranin B, which encodes a protein that catalyzes catecholamine vesicle formation (CHGB, exon 4, Glu348Glu; P=0.002), and cytochrome b-561 (CYB561, intron 1, C719G; P<0.001), an electron shuttle for catecholamine synthesis. Stepwise regression suggested important effects for the CHGB locus, with polymorphisms for the vacuolar-ATPase beta-subunit (ATP6V1B1, exon 1, Ile30Thr) and flavin-containing monooxygenase-3 (FMO3, exon 3, Lys158Glu, P=0.002). GAMOVA did not show a significant relationship between overall genetic profile and hand-vein constriction (P=0.29), which indicates that population stratification did not contribute to this phenotype.

CONCLUSIONS

Locally infused tyramine produced dose-dependent pressor responses, predicted by family history of hypertension, sex, and genetic variants at loci, particularly CHGB, that encode the biosynthesis, storage, and metabolism of catecholamines. Such variants may influence the complex heritability of adrenergic responses and perhaps hypertension.

Association between monoamine oxidase A polymorphisms and anger-related personality traits in Korean women

It has been suggested that polymorphisms in the monoamine oxidase A (MAO-A) gene are associated with aggressive and impulsive behaviors. In the present study, we investigated the association of the MAO-A variable number of tandem repeat polymorphism in the promoter region (MAO-A uVNTR) with anger-related personality traits. Specifically, MAO-A uVNTR polymorphisms were examined for associations with the State-Trait Anger Expression Inventory (STAXI) scores in 211 normal Korean women. All subjects were assessed using the STAXI and genotyped for MAO-A uVNTR status. The scores on the STAXI subscales differed significantly among the MAO-A uVNTR polymorphism genotypes in terms of anger expression-out (AX-Out) scores. Post hoc comparisons revealed significant differences between the 3/3 and 4/4, and between 3/4 and 4/4 polymorphisms. However, no significant difference was observed in other STAXI subscale scores among these genotypes. Subjects with the high-activity MAO-A uVNTR had significantly higher AX-Out scores than subjects with other genotypes. MAO-A uVNTR polymorphisms may contribute in part to the expression of anger. These findings support the hypothesis that this polymorphism in the MAO-A gene may be associated with anger-related personality traits in Korean women.

Minimizing Method-Specific Variance in the IAT

The present paper introduces a new variant of the Implicit Association Test (IAT; Greenwald, McGhee, & Schwartz, 1998 ) called the Single Block IAT (SB-IAT). By eliminating the IAT’s block structure, the SB-IAT is argued to solve the structural problem of recoding in the IAT and accordingly, its contamination by method-specific variance. In Study 1, a flower-insect SB-IAT, a task-switching ability SB-IAT, and a geometry SB-IAT showed reduced, but still significant effects. Zero correlations between the three SB-IATs indicated a substantially reduced amount of method-specific variance. Study 2 examined the SB-IAT’s psychometric properties. A political attitude SB-IAT showed acceptable reliability, discriminated between liberal and conservative voters, and correlated with the corresponding attitude rating in the same magnitude as the standard IAT. Results indicate that the SB-IAT minimizes method-specific variance while retaining the IAT’s satisfying psychometric properties. The discussion focuses on potentials and constraints of this newly developed measure.

Effect of dehydroepiandrosterone administration on fatigue, well-being, and functioning in women with primary Sjögren syndrome: a randomised controlled trial

OBJECTIVE

Dehydroepiandrosterone (DHEA) administration has been reported to improve fatigue, psychological distress, and physical disability. These are common features of primary Sjögren syndrome (pSS). We investigated the effects of DHEA administration on fatigue, well-being, and functioning in women with pSS.

METHODS

In a double-blind, randomised placebo-controlled clinical trial, 60 female patients with pSS received 200 mg oral DHEA or placebo. Primary outcome measures were general fatigue, depressive mood, mental well-being, and physical functioning. In addition, pain, sicca complaints and disease activity parameters were measured. Patients were assessed before treatment, after 3, 6, and 12 months on study medication, and 6 months after cessation of treatment.

RESULTS

Patients from both the DHEA- and placebo-treated group improved on general fatigue (p<0.001), mental well-being (p = 0.04), and depressive mood (p = 0.008). Physical functioning did not change (p = 0.44). Of the secondary outcome variables, complaints of a dry mouth diminished during treatment in both groups (p = 0.006), the erythrocyte sedimentation rate showed a decrease for the DHEA group (p = 0.02), and complaints of dry eyes improved in the placebo group (p = 0.01). The belief to have used DHEA was a stronger predictor for improvement of fatigue and well-being than the actual use of DHEA.

CONCLUSIONS

Our study does not support a superior effect of DHEA over placebo in female patients with pSS. Both DHEA and placebo induce improvement of fatigue and well-being. This may suggest possibilities for cognitive behavioural interventions.

Odor annoyance of environmental chemicals: sensory and cognitive influences

In low concentrations, environment pollutants like volatile organic compounds (VOCs) may be perceived via olfaction. Modulators of odor-mediated health effects include age, gender, or personality traits related to chemical sensitivity. Severe multi-organ symptoms in response to odors also characterize a syndrome referred to as idiopathic environmental intolerance (IEI). One prominent feature of IEI is self-reported odor hypersensitivity that is usually not accompanied by enhanced olfactory functioning. The impact of interindividual differences in olfactory functioning on chemosensory perceptions is sparsely investigated, and therefore this study addressed the influences of different types of modulators, including olfactory functioning. In a psychophysical scaling experiment, an age-stratified sample of 44 males and females was examined. After controlled application of nine concentrations of six chemicals by flow-olfactometry, the participants rated four olfactory and nine trigeminal perceptions. Weak effects were found for gender and age, as well as some modulating effects of self-reported chemical sensitivity and odor discrimination ability. For chemical sensitivity, the results were as expected: Subjects with higher sensitivity reported stronger perceptions. The individual odor threshold (n-butanol) exerted no influence on the subjects' ratings of olfactory and trigeminal perceptions. Surprisingly, above-average odor discrimination ability was associated with lower ratings of odor intensity and nausea. This particular aspect of olfactory functioning might be a reflection of a more objective odor evaluation model buffering emotional responses to environmental odors.

Factors predicting mortality in midlife adults with and without Down syndrome living with family

BACKGROUND

Little is known about the mortality of individuals with Down syndrome who have lived at home with their families throughout their lives. The current study evaluates the predictors, causes and patterns of mortality among co-residing individuals in midlife with Down syndrome as compared with co-residing individuals with ID owing to other causes.

METHOD

This paper examines mortality in 169 individuals with and 292 individuals without Down syndrome from 1988 to 2007. Dates and causes of death were obtained from maternal report, the Social Security Death Index and the National Death Index. Risk factors predicting mortality, including demographic variables, transition variables, and initial and change measures of health, functional abilities and behaviour problems, were obtained from maternal report.

RESULTS

Having Down syndrome is a risk factor of mortality, net of other risk factors including older age, poorer functional abilities, worsening behaviour problems, residential relocation and parental death. The causes of death among individuals with and without Down syndrome who are in midlife and co-residing with their families are similar, and are most commonly due to cardiovascular or respiratory problems.

CONCLUSIONS

The findings indicate that midlife adults with Down syndrome who co-reside with their families generally exhibit similar causes of mortality as do midlife adults with intellectual disability owing to other causes, but show an elevated risk of mortality in midlife net of other variables, such as age and changes in functional abilities and behaviour problems.

Discomfort and agitation in older adults with dementia

Background

A majority of patients with dementia present behavioral and psychological symptoms, such as agitation, which may increase their suffering, be difficult to manage by caregivers, and precipitate institutionalization. Although internal factors, such as discomfort, may be associated with agitation in patients with dementia, little research has examined this question. The goal of this study is to document the relationship between discomfort and agitation (including agitation subtypes) in older adults suffering from dementia.

Methods

This correlational study used a cross-sectional design. Registered nurses (RNs) provided data on forty-nine residents from three long-term facilities. Discomfort, agitation, level of disability in performing activities of daily living (ADL), and severity of dementia were measured by RNs who were well acquainted with the residents, using the Discomfort Scale for patients with Dementia of the Alzheimer Type, the Cohen-Mansfield Agitation Inventory, the ADL subscale of the Functional Autonomy Measurement System, and the Functional Assessment Staging, respectively. RNs were given two weeks to complete and return all scales (i.e., the Cohen-Mansfield Agitation Inventory was completed at the end of the two weeks and all other scales were answered during this period). Other descriptive variables were obtained from the residents' medical file or care plan.

Results

Hierarchical multiple regression analyses controlling for residents' characteristics (sex, severity of dementia, and disability) show that discomfort explains a significant share of the variance in overall agitation (28%, p < 0.001), non aggressive physical behavior (18%, p < 0.01) and verbally agitated behavior (30%, p < 0.001). No significant relationship is observed between discomfort and aggressive behavior but the power to detect this specific relationship was low.

Conclusion

Our findings provide further evidence of the association between discomfort and agitation in persons with dementia and reveal that this association is particularly strong for verbally agitated behavior and non aggressive physical behavior.