Difficulty Relaxing Research Articles

Seronegative Neuromyotonia and Congenital Hyperinsulinism with Mutation of the Inwardly Rectifying Potassium Channel (KCNJ11) (P05.183)

Objective: We present a man with congenital hyperinsulinism due to mutation of the inwardly rectifying potassium channel (Kir6.2) and neuromyotonia. Background Patients with activating mutations in the KCNJ11 gene can have neonatal diabetes mellitus and associated DEND syndrome (developmental delay, epilepsy and hypotonia). Inactivating mutations of this ATP-sensitive potassium channel lead to congenital hyperinsulism due to insulin oversecretion from pancreatic beta-cells. Down-regulation of Kir6.2 expression in myometrium may contribute to enhanced uterine contractility with onset of labor. Neuromyotonia is a disorder of peripheral nerve hyperexcitability characterized by myokymia, muscle cramps and stiffness, usually due to autoantibodies against neuronal voltage-gated potassium channels (VGKC) or rare VGKC mutations. Design/Methods: The patient is of European descent and was born uneventfully to a family without neurologic or endocrine problems. He was hypoglycemic at birth and was eventually diagnosed with hyperinsulinism. He underwent a subtotal pancreatectomy at two months after unsuccessful medication trials and developed diabetes mellitus at 12. Around age 13, he noted muscle spasms and twitching, with difficulty relaxing his muscles after exertion and falls due to stiffness. He had no percussion or grip myotonia, muscle rippling or myokymia at rest. With hyperextension of his legs he demonstrated grouped fasciculations of the quadriceps. Results: Needle EMG captured increased neuromyotonic discharges. Antibodies against VGKC were negative. PCR and sequence analysis showed that he was heterozygous for an alanine to threonine mutation at codon 213 (p. Ala213Thr). Conclusions: Our patient has co-occurrence of congenital hyperinsulism and seronegative neuromyotonia in the setting of a known inactivating mutation in the Kir6.2 channel (KCNJ11). Inactivation of this channel decreases potassium flow into the cell and resting membrane potential. This channel is known to be expressed in the CNS; its distribution in the PNS is unknown. We speculate that KCNJ11 mutation is causally related to our patient9s peripheral nerve hyperexcitability. Disclosure: Dr. Thyerlei has nothing to disclose. Dr. Oakley has received personal compensation for activities with Neurovista as a consultant. Dr. Jayadev received personal compensation from About.com/New York Times for medical review. . . . . . . Dr. Jayadev has received personal compensation in an editorial capacity for About.com and The New York Times. Dr. Weiss has received personal compensation for activities with Walgreens, CSL Behring and Talecris Biotherapeutics as a consultant and/or speaker.

Pelvic floor dysfunction predicts abdominal bloating and distension in eating disorder patients

Objective.Little is known about the symptoms of abdominal bloating and distension in women with eating disorders (EDs). This study aimed to explore the prevalence and predictors of these symptoms in patients with EDs, by examining correlations with functional gastrointestinal disorders (FGIDs) including pelvic floor symptoms and other clinical features. Material and methods.184 ED inpatients, 16–55 years, completed on admission to hospital the ROME II symptom questionnaire, additional questions about abdominal bloating and distension, and psychological questionnaires. Prediction of abdominal bloating and distension was modeled using logistic regression analyses with individual FGIDs, psychological variables, ED type, and clinical features as the potential predictors. Results.Bloating (78%) was more common than distension (58%) in each ED type. In the final multivariate models, after controlling for BMI, the number of Rome II symptoms of pelvic floor dyssynergia (i.e., having to strain to pass a stool, feeling unable to empty the rectum, and having difficulty relaxing to evacuate the stool) was a significant predictor of both abdominal distension (p < 0.001) and bloating (p < 0.005). The presence of irritable bowel syndrome (IBS, 46%) was a significant predictor of bloating (p < 0.001) but not distension. Conclusions.Symptoms of pelvic floor dysfunction, but not IBS, appear to be especially important in the genesis of abdominal distension in patients with ED.

A mixed-methods evaluation of complementary therapy services in palliative care: yoga and dance therapy

To inform service provision and future research, we evaluated two complementary therapy services: yoga classes and dance therapy [The Lebed Method (TLM)]. Both were run as 6-week group courses. Patients completed the Measure Yourself Concerns and Wellbeing questionnaire pre- and post-course. Mean change over time was calculated for patient-nominated concern and well-being scores. Qualitative data regarding factors affecting health other than the therapy and benefits of the service were analysed using content analysis. Eighteen patients participated (mean age 63.8 years; 16 female; 14 cancer diagnoses); 10 were doing yoga, five TLM, and three both yoga and TLM; 14 completed more than one assessed course. Patients' most prevalent concerns were: mobility/fitness (n= 20), breathing problems (n= 20), arm, shoulder and neck problems (n= 18), difficulty relaxing (n= 8), back/postural problems (n= 8), fear/anxiety (n= 5). Factors affecting patients' health other than the therapy were prevalent and predominantly negative (e.g. treatment side effects). Patients reported psycho-spiritual, physical and social benefits. Concern scores improved significantly (P < 0.001) for both therapies; improved well-being was clinically significant for yoga. Evaluations of group complementary therapy services are feasible, can be conducted effectively and have implications for future research. Yoga and TLM may be of benefit in this population.

Failed ITB Syndrome Rehab in a Female Runner with Hip Pain

HISTORY: A 37 year old female with past medical history significant for uterine fibroids presented with persistent left hip pain. She described her left hip pain as an achy, heavy sensation brought on only with running or prolonged sitting. She was initially seen by her PCP and initial hip xray report was read as negative. The patient discontinued running for 10 months and during that time, was pain free. However resumed running, her hip pain returned. The patient then went to a sports medicine physician who referred her for physical therapy. The patient also had repeat hip/pelvis xrays which showed large calcified fibroid. The patient underwent months of physical therapy focusing on iliotibial band stretching but had little improvement in her left hip pain. The referral was then made to a musculoskeletal physiatrist specializing in pelvic floor dysfunction. PHYSICAL EXAMINATION: Examination revealed normal gait, lumbar spine and hip ROM. Gillet test, Faber's test and Scour tests were negative. Slump sit was negative. Ober's test was positive. Ely's test was positive. Left greater trochanter was non-tender to palpation. Mild pain with palaption of left psoas and iliacus muscles on left. Pelvic exam: Palpation of the left pelvic floor was tender with taut bands found in the left levator ani. Palpation of the left obturator internus muscle reproduced the patient's left hip pain. The patient had difficulty relaxing her left pelvic floor. DIFFERENTIAL DIAGNOSIS: Iliotibial band bursitis Femoral neck stress fracture Pelvic stress fracture Hyperonic pelvic foor dysfunction Gluteus medius strain TEST AND RESULTS: The patients most recent hip/pelvis xrays were reviewed which showed large calcified fibroid. No other abnormalities were seen in the hips or pelvis. FINAL WORKING DIAGNOSIS: Pelvic floor dysfunction secondary to fibroids causing referred pain to left hip TREATMENT AND OUTCOMES: Pelvic floor physical therapy for hypertonic pelvic floor with attention to releasing taut bands in her left levator ani muscle. The patient completed 4 wks of physical therapy and was instructed to slowly build up her previous running distance and speed. On follow up visit the patient reported diminished left hip pain with running as well as with prolonged sitting. Plan for future myomectomy prn

Four cases of myotonia congenita in a Turkish family*

Myotonia congenita is a rare muscular disorder with autosomal dominant or autosomal recessive inheritance, and is characterized by painless myotonia. A 44-year-old mother presented at our clinic with a son and a daughter, all sharing the same complaints of difficulty in relaxing their hands and beginning to walk, and spasms during chewing. The family had also another 16-year-old daughter, but she had no such complaints. The mother reported that her father and 2 sisters had the same disease, but that her brother was healthy. Their pedigree analysis revealed that the disease was present for 3 generations and had an autosomal dominant trait. During the neurologic examination of cases, action and percussion myotonia were observed in the hand, arm, and leg muscles. Her asymptomatic daughter had also generalized myotonia. Needle electromyography of all cases revealed generalized myotonic discharges in the muscles examined. The cases are presented due to the presence of MC in 3 generations of the family. This case study reveals that EMG studies are useful in determining myotonic disorders in asymptomatic cases.

Depression and sexual adjustment following breast cancer in low-income Hispanic and non-Hispanic White women.

Hispanics are the largest and fastest growing ethnic minority group in the United States and breast cancer is the most commonly diagnosed cancer in Hispanic women. However, Hispanics are underrepresented in the psychosocial breast cancer literature. This study included 677 low-income women (425 Hispanic, 252 non-Hispanic White) enrolled in the Medi-Cal Breast and Cervical Cancer Treatment Program. Data were gathered through phone interviews conducted in English or Spanish 6 and 18 months following breast cancer diagnosis. We focus on three variables that the literature indicates are salient for breast cancer survivors: sexual function, body image and depression. Results of an ANCOVA indicated worse sexual function for Hispanic women, even after controlling for significant covariates. Hispanics reported significantly less sexual desire, greater difficulty relaxing and enjoying sex, and greater difficulty becoming sexually aroused and having orgasms than non-Hispanic White women. Both Hispanic and non-Hispanic White women endorsed a lack of sexual desire more frequently than problems with sexual function. Body image did not differ between Hispanic and non-Hispanic White women. In all, 38% of Hispanic and 48% of non-Hispanic White women scored above cut-off scores for depressive symptoms. While there was no ethnic difference in depressive symptoms, single women reported more depressive symptoms than partnered women. Findings suggest that low-income breast cancer survivors may experience symptoms of depression more than a year following diagnosis, and that sexual dysfunction may be particularly salient for low-income Hispanic women.

Nonpolar ZnO film growth and mechanism for anisotropic in-plane strain relaxation

Using high-resolution transmission electron microscopy (HRTEM) and X-ray diffraction, we investigated the strain relaxation mechanisms for nonpolar (1 1 −2 0) a-plane ZnO epitaxy on (1 −1 0 2) r-plane sapphire, where the in-plane misfit ranges from −1.5% for the [0 0 0 1]ZnO‖[1 −1 0 −1]sapphire to −18.3% for the [−1 1 0 0]ZnO‖[−1 −1 2 0]sapphire direction. For the large misfit [−1 1 0 0]ZnO direction the misfit strains are fully relaxed at the growth temperature, and only thermal misfit and defect strains, which cannot be relaxed fully by slip dislocations, remain on cooling. For the small misfit direction, lattice misfit is not fully relaxed at the growth temperature. As a result, additive unrelaxed lattice and thermal misfit and defect strains contribute to the measured strain. Our X-ray diffraction measurements of lattice parameters show that the anisotropic in-plane biaxial strain leads to a distortion of the hexagonal symmetry of the ZnO basal plane. Based on the anisotropic strain relaxation observed along the orthogonal in-plane [−1 1 0 0] and [0 0 0 1]ZnO stress directions and our HRTEM investigations of the interface, we show that the plastic relaxation occurring in the small misfit direction [0 0 0 1]ZnO by dislocation nucleation is incomplete. These results are consistent with the domain-matching paradigm of a complete strain relaxation for large misfits and a difficulty in relaxing the film strain for small misfits.

Neuromyotonia in idiopathic hypoparathyroidism

Alpha 62-year-old man was presented with bilateral cataract, proximal muscle weakness and difficulty in relaxing the hands after voluntary contraction. Idiopathic hypoparathyroidism was diagnosed. Electrophysiological study showed spontaneous motor unit action potentials, occurring and disappearing abruptly, as duplets, triplets and multiplets, with an intra-burst frequency of up to 100 Hz and some of them waning in amplitude, findings consistent with neuromyotonia.

Age-specific symptom prevalence in women 35–64 years old: A population-based study

BackgroundSymptom prevalence is generally believed to increase with age. The aim of this study was to evaluate the age specific prevalence of 30 general symptoms among Swedish middle-aged women.MethodsA cross-sectional postal questionnaire study in seven Swedish counties in a random sample of 4,200 women 35–64 years old, with 2,991 responders. Thirty general symptoms included in the Complaint Score subscale of the Gothenburg Quality of Life Instrument were used.ResultsFour groups of age specific prevalence patterns were identified after adjustment for the influence of educational level, perceived health and mood, body mass index, smoking habits, use of hormone replacement therapy, and use of other symptom relieving therapy. Only five symptoms (insomnia, leg pain, joint pain, eye problems and impaired hearing) increased significantly with age. Eleven symptoms (general fatigue, headache, irritability, melancholy, backache, exhaustion, feels cold, cries easily, abdominal pain, dizziness, and nausea) decreased significantly with age. Two symptoms (sweating and impaired concentration) had a biphasic course with a significant increase followed by a significant decrease. The remaining twelve symptoms (difficulty in relaxing, restlessness, overweight, coughing, breathlessness, diarrhoea, chest pain, constipation, nervousness, poor appetite, weight loss, and difficulty in urinating) had stable prevalence with age.ConclusionSymptoms did not necessarily increase with age instead symptoms related to stress-tension-depression decreased.

Health-related quality of life predicts onset of asthma in a longitudinal population study

Health-related quality of life (HRQL) has been increasingly used as an outcome measure in asthma, but less is known about the prognostic implication of low health-related quality of life. The purpose of this study was to investigate if a set of quality of life measures could predict onset of asthma. In the baseline study 391 subjects without asthma answered a respiratory questionnaire and the Gothenburg Quality of Life (GQL) instrument in 1990. The GQL questionnaire included two parts: (1) the prevalence of HRQL-related symptoms and (2) well-being scores for physical, mental and social dimensions. The participants were also investigated with spirometry and allergy testing. In 2003, the same respiratory questionnaire that had been used in 1990 was sent. There were 290 responders, of whom 22 subjects had developed asthma. Participants who had developed asthma by the follow-up had a higher prevalence of sleep disturbances (30% vs. 10%), problems with chest pain (16% vs. 2%), depression (40% vs. 20%) difficulty relaxing (40% vs. 13%) and constipation (25% vs. 2%) at baseline than participants who did not develop asthma (p<0.05). Subjects who developed asthma also scored significantly lower on well-being variables as sleep, energy, mood, patience, memory, appetite, fitness and sense of appreciation outside home. These differences remained after adjusting for age, sex, smoking habits, asthma heredity, socioeconomic groups and building dampness. Participants with low health-related quality of life at baseline were more likely to report having developed asthma 12 years later.

Trait-Like Brain Activity during Adolescence Predicts Anxious Temperament in Primates

Early theorists (Freud and Darwin) speculated that extremely shy children, or those with anxious temperament, were likely to have anxiety problems as adults. More recent studies demonstrate that these children have heightened responses to potentially threatening situations reacting with intense defensive responses that are characterized by behavioral inhibition (BI) (inhibited motor behavior and decreased vocalizations) and physiological arousal. Confirming the earlier impressions, data now demonstrate that children with this disposition are at increased risk to develop anxiety, depression, and comorbid substance abuse. Additional key features of anxious temperament are that it appears at a young age, it is a stable characteristic of individuals, and even in non-threatening environments it is associated with increased psychic anxiety and somatic tension. To understand the neural underpinnings of anxious temperament, we performed imaging studies with 18-fluoro-deoxyglucose (FDG) high-resolution Positron Emission Tomography (PET) in young rhesus monkeys. Rhesus monkeys were used because they provide a well validated model of anxious temperament for studies that cannot be performed in human children. Imaging the same animal in stressful and secure contexts, we examined the relation between regional metabolic brain activity and a trait-like measure of anxious temperament that encompasses measures of BI and pituitary-adrenal reactivity. Regardless of context, results demonstrated a trait-like pattern of brain activity (amygdala, bed nucleus of stria terminalis, hippocampus, and periaqueductal gray) that is predictive of individual phenotypic differences. Importantly, individuals with extreme anxious temperament also displayed increased activity of this circuit when assessed in the security of their home environment. These findings suggest that increased activity of this circuit early in life mediates the childhood temperamental risk to develop anxiety and depression. In addition, the findings provide an explanation for why individuals with anxious temperament have difficulty relaxing in environments that others perceive as non-stressful.

Predicting Obstructive Defecation: Symptoms and Physiologic Tests

Purpose: Constipation can be from a variety of disorders including obstructive defecation (OD) and delayed colonic transit. Prior studies have not shown predictive value of symptoms in identifying patients with OD. AIM. To determine which physiologic tests and specific questions of the Rome Pelvic Floor Dyssynergia questionnaire can be used to suggest OD or delayed colonic transit. Methods: A retrospective analysis of patients from May to January 2007 was conducted. Each patient underwent anorectal manometry (ARM), anal electromyography (EMG), balloon expulsion, and whole gut transit scintigraphy. OD was defined by the presence of 2 of the following 3 criteria: 1) inadequate relaxation of the internal anal sphincter (IAS) on ARM; 2) paradoxical increase in EMG activity on bearing down (simulated defecation); 3) inability to expel a 50 cc rectally placed balloon within 3 minutes. The manometric defecation index (DI) was defined as the ratio of intrarectal pressure to external anal sphincter pressure during simulated defecation. Patients were asked questions from the Rome Pelvic Floor Dyssynergia questionnaire: A) straining during movements; B) feeling of incomplete evacuation; C) sensation of blocked stools; D) manual maneuvers to facilitate defecation; E) difficulty relaxing to allow defecation. Results: Of 76 patients, OD was identified in 55 and nonobstructive constipation (NOC) was present in 21 patients. Abnormal DI ( < 1.2) was present in 47/55 (85%) OD patients and 9/21 (43%) NOC patients. Paradoxical EMG response was present in 38/55 (69%) OD patients and only 1/21 (5%) NOC patients. Abnormal IAS relaxation ( < 75%) was present in 32/55 (58%) OD patients and 14/21 (67%) NOC patients. Prolonged balloon expulsion (>3 minutes) was present in 16/55 (29%) OD patients and 3/21 (14%) NOC patients. Question A was associated with OD (P= 0.054); B was associated with both OD (P= 0.035) and with delayed colonic transit (P= 0.032); C was associated with OD (P= 0.060); D was associated with delayed colonic transit (P= 0.056); E was not associated with either OD or delayed colonic transit. Conclusion: The manometric defecation index was sensitive and EMG paradoxical response was specific in identifying patients with obstructive defecation whereas balloon expulsion did not appear to be useful. Questions A (straining during bowel movements) and C (sensation of blocked stools) were associated with obstructive defecation but not delayed colonic transit whereas D (manual maneuvers to facilitate defecation) was associated with delayed colonic transit but not obstructive defecation.

Health Hazards in Middle-Aged Women with Cardiovascular Disease: A Case-Control Study of Swedish Women. The Women's Health in the Lund Area (WHILA) Study

To delineate the health profile in middle-aged women with cardiovascular disease (CVD). The Women's Health in the Lund Area (WHILA) project covered all women born 1935-1945 (n = 10,766) living in the Lund area; 6917 (64.2%) women completed a generic questionnaire and underwent physical and laboratory assessments. Of the 6917 women, 6416 were postmenopausal women, of whom 104 had CVD. For each woman with CVD, two controls were selected and matched for age, smoking habits, body mass index (BMI), waist/hip ratio (WHR), low-density lipoprotein cholesterol (LDL-C), high-density liproprotein cholesterol (HDL-C), diastolic blood pressure and hormonal status. One hundred four women (1.6%) reported CVD. Forty-nine had a myocardial infarction (MI), 49 had a stroke, and 6 women had both events; 71.4% were postmenopausal, with never use of hormone therapy (HT) (PM0), and 28.6% were postmenopausal with ever use of HT (PMT). Compared with the control group, serum androstendione was lower (p = 0.004) in the case group, and menopausal estradiol (E(2)) values were less frequent (p = 0.037) in cases from the PM0 group. Among psychological and somatic symptoms, nervousness (p < 0.05), difficulty relaxing, crying easily, visual disturbance (p </= 0.01 for all), dizziness, difficulties in voiding urine, shortness of breath, breast tenderness, and constipation (p </= 0.001 for all) were more common among women with CVD. Women with CVD expressed less satisfaction with feeling healthy, body image, memory loss, irritability, and sexuality (p </= 0.05 for all). The case group had more problems with daily activities, more days spent in hospital during the previous 5 years, and more regular medical appointments with healthcare centers, more often had diabetes mellitus (DM) (p < 0.001 for all), and had experienced more falls in the previous year (p < 0.05). Urinary incontinence and decreased body weight were more common among cases (p </= 0.01 for both). Several health hazards as well as somatic and psychological symptoms were more common in subjects with CVD, rendering them more susceptible to future disease.

Efavirenz and chronic neuropsychiatric symptoms: a cross‐sectional case control study

The aim of the study was to investigate symptoms of long-term central nervous system (CNS) toxicity in HIV-positive patients treated with efavirenz (EFV). We carried out a single-centre, cross-sectional case-control study comparing patients treated with EFV for at least 6 months with a matched control group. Self-administered, standardized questionnaires including the Depression, Anxiety and Stress Scales (DASS), the Cognitive Failures Questionnaire (CFQ) and a questionnaire on unusual dreams, insomnia, fatigue, dizziness, depersonalization and derealization were administered. Data for 32 matched pairs were analysed. Significantly higher total stress scores (P=0.008) were found in the EFV group. Of the patients in this group, 19% also reported severe to extremely severe levels of stress (P=0.014), indicating increased difficulty in relaxing, and being more irritable, impatient, agitated and easily upset. Nineteen per cent of patients treated with EFV also reported severe levels of anxiety (P=0.059) as assessed with the DASS scale. This patient group also reported a higher rate of unusual dreams (P=0.049). No significant differences between groups were found for measures of cognitive impairments, fatigue, dizziness, derealization or depersonalization. EFV-treated patients reported higher levels of severe stress and anxiety as well as a higher rate of unusual dreams than patients not treated with EFV. These differences may be an expression of persisting CNS side effects in patients who remain on EFV for a prolonged period.

Dyspareunia and quality of sex life after laparoscopic excision of endometriosis and postoperative administration of triptorelin

This observational cohort study examined the effect of laparoscopic full excision of endometriosis combined with postoperative triptorelin treatment on deep dyspareunia (DD) and quality of sex life. One year after completing the postoperative treatment, 45.9% of the patients had no DD and 34.7% reported a decrease in DD intensity; an increase in the frequency of sexual intercourse was reported by 62.2% of the women; objective improvements in several aspects of sex life were observed.

Influence of a low-level contractile response from the soleus, gastrocnemius and tibialis anterior muscles on viscoelastic stress-relaxation of aged human calf muscle-tendon units

Measuring viscoelastic stress-relaxation (VSR) as the decline in passive tension over time when the skeletal muscle-tendon unit (MTU) is held in a lengthened position may be difficult in older people who may have difficulty relaxing. This study examined the VSR of the aged calf MTUs with a low-level involuntary contractile response from the soleus (S), gastrocnemius (G) and tibialis anterior (TA) muscles. Calf MTUs of 29 men and women (65-90 years) were stretched to maximal dorsiflexion and held for 60 s while torque (Nm) and surface electromyograms (SEMG) were recorded. Subjects with normalized SEMG (% of maximal voluntary contraction SEMG) of the S, G or TA <1% were assigned to Group 1 (n=14) and subjects with SEMG of the S or G > or =1% and <10%, or in the TA > or =1% were assigned to Group 2 (n=15). Although the mean total percent torque decline for Group 1 (17.9%) and Group 2 (16.6%) did not differ statistically, multiple regression analysis within Group 2 indicated that the G and TA SEMG accounted for 58% of its variation (R (2)=0.581). The G SEMG from 0-15 s accounted for 56% (r (2)=0.563) of the variation in the percent decline normalized to total percent decline (100%). From 15-30 s Group 2 had less percent decline (2%) than Group 1 (14%) (P=0.043) and the S and G SEMG accounted for 67% of its variation (R (2)=0.673). The results indicated that a low-level involuntary contractile response from the S, G and TA muscles may be related to the VSR process of aged calf MTUs. Measuring VSR within time intervals normalized to the total percent decline offers a new method to study VSR, which should be measured with SEMG in the muscles <1% MVC SEMG to ensure valid measurements.

Relaxation and music reduce pain following intestinal surgery

Three nonpharmacological nursing interventions, relaxation, chosen music, and their combination, were tested for pain relief following intestinal (INT) surgery in a randomized clinical trial. The 167 patients were randomly assigned to one of three intervention groups or control and were tested during ambulation and rest on postoperative days 1 and 2. Pain sensation and distress were measured with visual analog scales (VAS). Multivariate analysis of covariance showed significantly less post-test pain in the intervention groups than in the control group on both days after rest and at three of six ambulation post-tests (p = .024-.001), resulting in 16-40% less pain. Mixed effects after ambulation were due to the large variation in pain and difficulty relaxing while returning to bed; but post hoc explorations showed effects for those with high and low pain. These interventions are recommended along with analgesics for greater postoperative relief without additional side effects.

Associations Between Hearing and Psychosocial Working Conditions in Rock/Jazz Musicians

A study on the assessment of hearing and hearing disorders in rock/jazz musicians concluded that 74% of the musicians had some kind of disorder. The main hearing disorders found were pure-tone hearing loss, tinnitus (an acoustic sensation of sounds), hyperacusis (a hypersensitivity to low or moderate sound levels), and distortion (music sounds out of tune). Affected musicians often were able to give the exact time of the first appearance of the hearing disorders, which often was associated with a period of excessive sound exposure, high workload, or some form of emotional stress. The aim of this study was to explore associations between psychosocial work conditions, mental load, and hearing disorders in rock/jazz musicians. A total of 139 (43 women and 96 men) voluntarily participating rock/jazz musicians answered a questionnaire on psychosocial work conditions and mental load. The data were correlated to hearing and sex. The median age was 35 years in the women and 37 years in the men. Results showed that rock/jazz musicians do not generally experience themselves as stressed at work. The influence of working conditions is good, and the work consists mainly of attractive tasks. In men, hyperacusis was associated with higher psychological demands, greater difficulty in relaxing after work, higher stress during individual preparation, not getting enough sleep, and higher perceived sound level. In women, tinnitus was associated with greater difficulty in relaxing after work and less energy during musical performances. No strong correlation between psychosocial parameters and hearing loss was found. Positive and negative effects of stress on hearing are discussed.

Access to Biofeedback Therapy for Women Suffering from Headache in Rural Wyoming

Biofeedback is an effective treatment for chronic headaches but is poorly utilized by those living in rural areas. An exploratory qualitative study was conducted to determine the barriers and benefits to seeking biofeedback therapy for women experiencing chronic headache pain while living in rural areas. In-depth individual interviews were employed. Barriers identified were numerous. Seven barriers identified were travel, time, lack of knowledge, skepticism, lack of referral by health care provider, difficulty relaxing, and pharmacologic therapy was already working. The two benefits identified were that biofeedback perceived as a natural therapy and is good for relaxation. Health care providers need to work toward eliminating barriers to biofeedback for rural women since it is a treatment of choice for migraine and tension type headaches. Keywords : rural, women, biofeedback http://dx.doi.org/10.14574/ojrnhc.v2i2.463

Tobacco. Smoking patterns during pregnancy: differences in socioeconomic and health-related variables

Background: The objective of this study was to assess different smoking patterns during and after pregnancy and relate these patterns to socioeconomic conditions and different health issues such as symptoms, drug consumption and health care use. Methods: The study group included 337 pregnant women from a district in south Sweden. A questionnaire was filled in during the first part of pregnancy and an interview was conducted after the baby was born. The women were categorised according to their smoking habits. Results: The categories defined were continuers, relapsers, decreasers, quitters and non-smokers. Among relapsers three symptoms, difficulty in relaxing (OR 4.48), restlessness (OR 9.59) and dysphoria (OR 3.98), were more common than among non-smokers. All three musculoskeletal symptoms were most common among continuers. Among quitters the OR for backache was 2.05, for numbness In the arms and legs 2.76 and for tearfulness 2.92. Educational level was relatively high among quitters and few had a smoking partner. Among smokers (decreasers, relapsers and continuers) 24% used drugs regularly, compared to 5% among non-smokers. Conclusions: To prevent smoking during pregnancy awareness of the relations between different smoking categories and symptoms could make it easier for hearth personnel to individualise support. A possible starting point is to discuss how to cope with different symptoms occurring during smoking cessation. Women with predictors for continued smoking during pregnancy, such as low education, unemployment, a smoking partner and multiparous, should be focused on more intensively and preventive strategies suitable for their special needs should be developed.