Association of Preterm Birth With Long-term Survival, Reproduction, and Next-Generation Preterm Birth

Posted on April 2, 2008 by Maurice Preter MD
Association of Preterm Birth With Long-term Survival, Reproduction, and Next-Generation Preterm Birth
Geeta K. Swamy, MD; Truls Østbye, MD, PhD; Rolv Skjærven, PhD
JAMA. 2008;299(12):1429-1436.
Context Preterm birth is a major cause of infant morbidity and mortality. Less is known about long-term health among persons born preterm.
Objective To determine the long-term effects of preterm birth on survival, reproduction, and next-generation preterm birth.
Design, Setting, and Participants Population-based, observational, longitudinal study using registry data from 1 167 506 singleton births in the Medical Birth Registry of Norway in 1967-1988. The cohort was followed up through 2002 for survival. The cohort was truncated to births from 1967-1976 for assessment of educational achievement and reproductive outcomes through 2004.
Main Outcome Measures In relation to sex and gestational age at birth, absolute mortality, risk of fetal, infant, child, and adolescent mortality, and incidence and risk of reproduction and next-generation preterm birth. Singleton term (37-42 weeks) fetal deaths and live births, stratified by sex, served as the reference group for all analyses.
Results The percentage who were born preterm was higher among boys (5.6%) than among girls (4.7%). Preterm participants had an increased risk of mortality throughout childhood. For boys born at 22 to 27 weeks, mortality rates were 1.33% and 1.01% for early and late childhood death, with relative risks (RRs) of 5.3 (95% confidence interval [CI], 2.0-14.2) and 7.0 (95% CI, 2.3-22.0), respectively. The mortality rate for girls born at 22 to 27 weeks was 1.71% for early childhood death, with an RR of 9.7 (95% CI, 4.0-23.7); there were no late childhood deaths. For 28 to 32 weeks, the early and late childhood mortality rates among boys were 0.73% and 0.37%, with RRs of 2.5 (95% CI, 1.6-3.7) and 2.3 (95% CI, 1.3-4.1), respectively. Girls born at 28 to 32 weeks did not have a significantly increased risk of childhood mortality. Reproduction was diminished for index participants born preterm. For men and women born at 22 to 27 weeks, absolute reproduction was 13.9% and 25%, with RRs of 0.24 (95% CI, 0.17-0.32) and 0.33 (95% CI, 0.26-0.42), respectively. For 28 to 32 weeks, absolute reproduction was 38.6% and 59.2% for men and women, with RRs of 0.7 (95% CI, 0.66-0.74) and 0.81 (95% CI, 0.78-0.85), respectively. Preterm women but not men were at increased risk of having preterm offspring.
Conclusion In persons born in Norway in 1967-1988, preterm birth was associated with diminished long-term survival and reproduction.
Author Affiliations: Departments of Obstetrics and Gynecology (Dr Swamy) and Community and Family Medicine (Dr Østbye), Duke University Medical Center, Durham, North Carolina; Duke-NUS Graduate Medical School, Singapore (Dr Østbye); Section for Epidemiology and Medical Statistics, Department of Public Health and Primary Health Care, University of Bergen (Dr Skjærven), and Medical Birth Registry of Norway, Norwegian Institute of Public Health (Dr Skjærven), Bergen, Norway.
Posted in Aging |

Childhood physical abuse in outpatients with psychosomatic symptoms.

Posted on April 2, 2008 by Maurice Preter MD
Biopsychosoc Med. 2008 Mar 21;2(1):8 [Epub ahead of print]
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Childhood physical abuse in outpatients with psychosomatic symptoms.
Handa M, Nukina H, Hosoi M, Kubo C.
ABSTRACT: BACKGROUND: In Japan and Asia, few studies have been done of physical and sexual abuse. This study was aimed to determine whether a history of childhood physical abuse is associated with anxiety, depression and self-injurious behavior in outpatients with psychosomatic symptoms. METHODS: We divided 564 consecutive new outpatients at the Department of Psychosomatic Medicine of Kyushu University Hospital into two groups: a physically abused group and a non-abused group. Psychological test scores and the prevalence of self-injurious behavior were compared between the two groups. RESULTS: A history of childhood physical abuse was reported by patients with depressive disorders(12.7%), anxiety disorders(16.7%) , eating disorders (16.3%), pain disorders (10.8%), irritable bowel syndrome (12.5%), and functional dyspepsia(7.5%). In both the patients with depressive disorders and those with anxiety disorders, STAI-I (state anxiety) and STAI-II (trait anxiety) were higher in the abused group than in the non-abused group (p<0.05). In the patients with depressive disorders, the abused group was younger than the non-abused group (p<0.05). The prevalence of self-injurious behavior of the patients with depressive disorders, anxiety disorders and pain disorders was higher in the abused groups than in the non-abused groups (p<0.005). CONCLUSIONS: A history of childhood physical abuse is associated with psychological distress such as anxiety, depression and self-injurious behavior in outpatients with psychosomatic symptoms. It is important for physicians to consider the history of abuse in the primary care of these patients.
PMID: 18358076 [PubMed – as supplied by publisher]
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Associations Between Vitamin D Status and Pain in Older Adults: The Invecchiare in Chianti Study.

Posted on March 16, 2008 by Maurice Preter MD

J Am Geriatr Soc. 2008 Mar 5 [Epub ahead of print]
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Associations Between Vitamin D Status and Pain in Older Adults: The Invecchiare in Chianti Study.
Hicks GE, Shardell M, Miller RR, Bandinelli S, Guralnik J, Cherubini A, Lauretani F, Ferrucci L.
Department of Physical Therapy, University of Delaware, Newark, Delaware, USA.
OBJECTIVES: To examine cross-sectional associations between vitamin D status and musculoskeletal pain and whether they differ by sex. DESIGN: Population-based study of persons living in the Chianti geographic area (Tuscany, Italy). SETTING: Community. PARTICIPANTS: Nine hundred fifty-eight persons (aged >/=65) selected from city registries of Greve and Bagno a Ripoli. MEASUREMENTS: Pain was categorized as mild or no pain in the lower extremities and back; moderate to severe back pain, no lower extremity pain; moderate to severe lower extremity pain, no back pain; and moderate to severe lower extremity and back pain (dual region). Vitamin D was measured according to radioimmunoassay, and deficiency was defined as 25-hydroxyvitamin D (25(OH)D) less than 25 nmol/L. RESULTS: The mean age+/-standard deviation was 75.1+/-7.3 for women and 73.9+/-6.8 for men. Fifty-eight percent of women had at least moderate pain in some location, compared with 27% of men. After adjusting for potential confounders, vitamin D deficiency was not associated with lower extremity pain or dual-region pain, although it was associated with a significantly higher prevalence of at least moderate back pain without lower extremity pain in women (odds ratio=1.96, 95% confidence interval=1.01-3.59) but not in men. CONCLUSION: Lower concentrations of 25(OH)D are associated with significant back pain in older women but not men. Because vitamin D deficiency and chronic pain are fairly prevalent in older adults, these findings suggest it may be worthwhile to query older adults about their pain and screen older women with significant back pain for vitamin D deficiency.
PMID: 18331295 [PubMed – as supplied by publisher]

Posted in Aging |

Psychiatric comorbidity in different organic vertigo syndromes.

Posted on March 16, 2008 by Maurice Preter MD
J Neurol. 2008 Mar 14 [Epub ahead of print]
Psychiatric comorbidity in different organic vertigo syndromes.
Eckhardt-Henn A, Best C, Bense S, Breuer P, Diener G, Tschan R, Dieterich M.
Dept. of Psychosomatic Medicine, Klinikum Stuttgart – Bürgerhospital, Tunzhoferstrasse 14–16, 70191, Stuttgart, Germany, A.Eckhardt@klinikum-stuttgart.de.
OBJECTIVE : A high degree of psychiatric disorders has repeatedly been described among patients with organic vertigo syndromes and attributed to vestibular dysfunction. Yet almost no investigations exist which differentiate between various organic vertigo syndromes with regard to psychiatric comorbidity. The following prospective, interdisciplinary study was carried out to explore whether patients with different organic vertigo syndromes exhibit different psychological comorbidities. METHODS : 68 patients with organic vertigo syndromes (benign paroxysmal positioning vertigo (BPPV) n = 20, vestibular neuritis (VN) n = 18,Menière’s disease (MD) n = 7, vestibular migraine (VM) n = 23) were compared with 30 healthy volunteers.All patients and control persons underwent structured neurological and neuro-otological testing. A structured diagnostic interview (-I) (SCID-I) and a battery of psychometric tests were used to evaluate comorbid psychiatric disorders. RESULTS : Patients with VM and MD showed significantly higher prevalence of psychiatric comorbidity (MD = 57%, VM = 65%) especially with anxiety and depressive disorders, than patients with VN (22%) and BPPV (15 %) compared to normal subjects (20 %). These elevated rates of comorbidities resulted in significantly elevated odds-ratios (OR) for the development of comorbid psychiatric disorders in general (for VM OR = 7.5, for MD OR = 5.3) and especially for anxiety disorders (for VM OR = 26.6, for MD OR = 38.7). CONCLUSION : As a consequence, a structured psychological and psychometric testing and an interdisciplinary therapy should be proceeded in cases with complex and prolonged vertigo courses, especially in patients with VM and MD. Possible reasons of these unexpected results in VM and MD are discussed.
PMID: 18338198 [PubMed – as supplied by publisher]
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Our results suggest normal HPA responses to stress and ACTH stimulation in patients with CPP but reduced adrenal reactivity in patients with FMS, name

Posted on February 24, 2008 by Maurice Preter MD

Psychosomatic Medicine 70:65-72 (2008)
© 2008 American Psychosomatic Society
ORIGINAL ARTICLES
HPA Axis Reactivity and Lymphocyte Glucocorticoid Sensitivity in
Fibromyalgia Syndrome and Chronic Pelvic Pain
Katja Wingenfeld, PhD, Christine Heim, PhD, Iris Schmidt, PhD, Dieter
Wagner, PhD, Gunther Meinlschmidt, PhD and Dirk H. Hellhammer, PhD

From the Department of Psychobiology, University of Trier, Trier,
Germany (K.W., C.H., I.S., D.W., G.M., D.H.H.); Department of
Psychiatry and Psychotherapy Bethel, Bielefeld, Germany (K.W.);
Department of Psychiatry and Behavioral Sciences, Emory University
School of Medicine, Atlanta, GA (C.H.); and Institute of Psychology,
University of Basel, Switzerland (G.M.).

Address correspondence and reprint requests to Katja Wingenfeld, PhD,
Department of Psychiatry and Psychotherapy, Bethel, Remterweg 69–71,
33617 Bielefeld, Germany. E-mail: katja.wingenfeld@evkb.de

Objective: Chronic pelvic pain (CPP) and fibromyalgia syndrome (FMS)
have been associated with hypothalamic-pituitary-adrenal (HPA) axis
alterations, i.e., mild hypocortisolism and enhanced feedback
sensitivity. We tested the hypothesis of reduced cortisol release in
response to a psychosocial stressor and pharmacological stimulation.
Furthermore, glucocorticoid (GC) sensitivity was evaluated.

Methods: Plasma total and salivary-free cortisol concentrations were
measured in response to a standardized social laboratory stressor, the
Trier Social Stress Test, and to adrenocorticotropin (ACTH)1–24
stimulation. In the Trier Social Stress Test, we additionally measured
ACTH. GC sensitivity was measured by dexamethasone inhibition of
lipopolysaccharide-induced interleukin-6 and tumor necrosis factor-
alpha production in whole blood.

Results: There were no HPA axis alterations in women with CPP (N = 18)
in these tests. Patients with FMS (N = 17) showed lower total cortisol
release in response to the social stressor and exogenous ACTH, but
normal free cortisol and ACTH levels compared with controls (N = 24).
GC sensitivity was similar in all groups.

Conclusions: Our results suggest normal HPA responses to stress and
ACTH stimulation in patients with CPP but reduced adrenal reactivity
in patients with FMS, namely in total cortisol release. Free cortisol
on the other hand was unaltered, possibly reflecting an adaptation to
reduced circulating total cortisol.

Key Words: chronic pelvic pain • fibromyalgia syndrome • hypothalamic-
pituitary-adrenal axis • cortisol • glucocorticoid sensitivity

Abbreviations: FMS = fibromyalgia syndrome; CPP = chronic pelvic pain;
HPA = hypothalamic-pituitary-adrenal; TSST = Trier Social Stress Test;
ACTH = adrenocorticotropin; GC = glucocorticoid; GR = glucocorticoid
receptor; BMI = body mass index; LPS = lipopolysaccharide; IL-6 =
interleukin-6; TNF-{alpha} = tumor necrosis factor-alpha.

Posted in Psychiatry/Neurology |