Non-organic Factors Research Articles

(221) ERECTILE DYSFUNCTION: THE CANARY IN THE COALMINE OF MEN’S HEALTH AND IMPULSION IN PUBLIC POLICIES

Abstract Introduction The onset of erectile dysfunction (ED) is attributed to organic and nonorganic factors that can mirror the state of an individual’s general health. Public health policies have the potential to leverage ED as a marker for non-communicable diseases that burden healthcare systems worldwide. Recognizing ED as an early warning sign facilitates reframing of public health policies to integrate preventive strategies, screening, and education campaigns. Objective This study aims to address the interconnectedness of men’s health issues with ED to reduce morbidity and enhance men’s quality of life. Methods We developed an expert consensus on addressing ED within the framework of public health policy, which requires an understanding of its multifaceted etiology and implications. We reviewed the epidemiology of ED, its association with systemic health conditions, and the imperative for public health policymakers to prioritize men’s sexual health as a window to overall well-being. Results Public health policies must advocate for comprehensive sexual health education that demystifies ED and encourages early medical consultation. Policy interventions should make recommendations for incorporating ED screening into routine health check-ups, subsidizing treatment options to enhance accessibility, promoting public awareness campaigns on the link between lifestyle factors and ED, and strengthening mental health support systems that recognize the psychological impact of ED. Conclusions ED, as an early detector of potential health threats, provides a unique opportunity for public health practitioners to broaden the scope of men’s health initiatives. By harnessing the predictive value of ED for more severe conditions, public health policies can galvanize an integrative health movement that promotes longevity and well-being for men, ultimately serving the community at large. Public health policies that acknowledge the sentinel role of ED offer a strategic entry point for addressing systemic health concerns, thus improving outcomes for individuals and populations. Disclosure Yes, this is sponsored by industry/sponsor: Viatris. Clarification: Industry initiated, executed and funded study. Any of the authors act as a consultant, employee or shareholder of an industry for: Viatris.

Infertility and female sexual dysfunction: A literature review

Female sexuality and fertility have been increasingly studied during the past decades. Although infertility was always viewed as a medical condition and treated by doctors, female sexual dysfunction was thought to be a psychological disorder until the late 90s. As a result, it is not until the beginning of 20th century that literature largely indicated that women diagnosed with infertility are more likely to experience sexual dysfunction. Both entities seem to be munltidimensional and complex conditions. Consequently, their treatment needs to include investigation of all the related aspects, such as the psychological assesment of the couple. The aim of this study is to review the literature on the complex relationship between infertility, its treatment and sexual dysfunction and to investigate the necessity of assesment of sexual function in women facing infertility. Scientific research published in the english language was used. The search for suitable studies was conducted with the research databases PubMed, ScienceDirect, Scopus using the keywords: sexual dysfunction, infertility, infertile couple, female sexuality. Overall, these studies revealed that sexual satisfanction is strongly impaired by the consequences of infertility. Furthermore, sexuality and fertility share many organic and non-organic risk factors that need to be profoundly investigated in the future.

Energy Adequacy, Body Composition, and Menstrual Cycle Disorder: A Correlation Study on Medical and Midwifery Students

Highlights:1. Menstrual cycle disturbance is related to organic and non-organic factors.2. BMI, waist circumference, and energy adequacy did not have a significant correlation with menstrual cycle frequencies among medical students. AbstractIntroduction: Menstrual cycle disturbance is related to irregular reproductive hormones, which are influenced by organic and non-organic factors. This study aimed to determine the correlation between energy adequacy, body composition, and menstrual cycle disorder. Methods: This was an observational analytic study with a case-control design. The population of this study was medical and midwifery students in the Faculty of Medicine, Universitas Airlangga, Surabaya. 72 subjects consisted of 36 women with a normal menstrual cycle between 24–38 days and 36 women with a menstrual cycle length of <24 days or >38 days. Data about body composition, energy adequacy, and menstrual cycle were all collected by questionnaire. Data were analyzed by Spearman and Continency Coefficient correlation.Results: Most participants (66.7%) had normal body mass index (BMI), while 19.4% were overweight. Meanwhile, waist circumference in 63.9% of subjects was categorized as not obese. The participants' physical activities ranged from sedentary to vigorous (0 to 7386 MET-minutes/week). Less than one-third of the participants (27.8%) had an energy balance, while in most subjects (56.9%), energy adequacy was classified as deficit or negative energy balance. The statistics showed a p-value >0.05 in BMI (p = 0.231), waist circumference (p = 0.141), and energy adequacy (p = 0.389) with the menstrual cycle, indicating no correlation between BMI, energy adequacy, and waist circumference with menstrual cycle frequencies.Conclusion: Statistical analysis showed no correlation between energy adequacy, BMI, and waist circumference with menstrual cycle frequency disorder in students in the Faculty of Medicine, Universitas Airlangga, Surabaya.

Neuropsychiatric complications of traumatic brain injury

IntroductionTraumatic brain injury (TBI) is a leading cause of morbidity and mortality, giving rise to a variety of neuropsychiatric syndromes associated with great functional impairments, chronic disability and poor quality of life. Depending on diagnostic criteria, 20-90% of victims of TBI develop at least one neuropsychiatric manifestation in the first month, and about 40% present at least three symptoms during three months, with higher incidence in females. Survivors of TBI are at increased risk for development of severe, long-term psychiatric disorders. The aetiology of these disturbances remains unclear.ObjectivesTo review current knowledge on the neuropsychiatric consequences associated with TBI.MethodsNon-systematic review of literature through search on PubMed/MEDLINE database for publications up to 2020, following the terms “traumatic brain injury” and “neuropsychiatry”.ResultsAlthough the experience of neuropsychiatric symptoms may be temporary and may resolve in the acute period, many patients with TBI can experience psychopathology that is persistent or that develops in the post-acute period, regardless of injury severity. These symptoms can involve personality changes, psychosis, major depression, generalized anxiety disorder, post-traumatic stress disorder, maladaptive social behaviours, poor disability adjustment, reduced coping skills and cognitive impairment. Evidence remains insufficient to conclude the role of TBI-related neuropathological consequences in the development of post-TBI neuropsychiatric disorder. Non-organic factors are also implicated in its generation and maintenance.ConclusionsNeuropsychiatric sequelae are common following TBI. Several of these syndromes are amenable to treatment. Further investigations are required to better understand the mechanistic aetiology of these conditions and the effectiveness of therapeutic modalities.

The Role of Psychology in Pediatric Concussion

Postconcussive symptoms in children and adolescents may include cognitive, psychological, and behavioral changes. When symptoms become chronic they are often not able to be identified with standard medical evaluations. Physicians may find that these chronic symptoms are also resistant to traditional medical treatments. Postconcussive symptoms may be associated with the injury itself and/or secondary to the resulting psychological issues or stressors/changes following a concussion. It is important to conduct an extensive evaluation of psychological and nonorganic factors that may be contributing to the presentation in order to determine appropriate referrals and interventions. Integrative care is an effective and essential care model for this population.

5. Psychophysiological responsivity and conscious appraisal of affective stimuli in non-organic syncope

Transient losses of consciousness and muscular tone that characterize syncope are due to a sudden decrease of blood flow to the brain. Nevertheless, in part of patients reporting syncope episodes, the classic diagnostic process does not lead to a proper organic etiology – e.g. neutrally mediated or cardiac. Psychological non-organic factors like emotional dysregulation or anxiety mechanisms might act as triggers for those clinical manifestations. Given the link between affective experience and sympathetic-parasympathetic autonomic system, this research aims at investigating the hypothesis of a psychogenic etiopathogenesis and at sketching a clearer picture of affective responses in syncope. Control (healthy volunteers) and clinical (syncope patients with no organic etiology) groups were presented with arousing affective visual stimuli and assessed by psychometric tests. In order to explore both automatic and conscious processing of affective information, we recorded participants’ psychophysiological responses (autonomic and EEG) and subjective appraisal ratings (valence and arousal). The comparison of psychometric, electrophysiological and autonomic data across patients and control subjects showed anomalous response profiles, with partially incongruent autonomic automatic psychophysiological responses and conscious appraisal ratings. While the dysregulation of psychophysiological responsivity might characterize syncope profiles, the complexity of clinical pictures suggest that different non-organic syncope subtypes may exist.

Frequency and severity of mental disorders in patients with non-organic chest pain and factors contributing to it, 2013

<p class="abstract"><strong><span lang="EN-US">Background:</span></strong><span lang="EN-US"> One of the most frequent causes of patients' visiting cardiovascular clinics is chest pain either with cardiac or non-cardiac reason. The cause of non-cardiac chest pain can be corporeal (such as esophageal, respiratory, or musculoskeletal) or mental. Mental factors that are mostly treated negligently can cause or worsen vascular diseases. This study was conducted with the purpose of determining the frequency and severity of mental disorders in patients with non-organic chest pain and its contributors. </span></p><p class="abstract"><strong><span lang="EN-US">Methods: </span></strong>This descriptive cross sectional study was carried out over195 patients with chest pain visiting Ardabil Imam Hospital. Data were collected by SCL-90-Rquestionaire and then analysed by statistical methods using SPSS.19.</p><p class="abstract"><strong><span lang="EN-US">Results:</span></strong><span lang="EN-US"> 41% of patients were men and 59% were women. The most frequent type of mental disorder in this study was somatization with 21.53% and the least frequent one was psychosis with 2%. Somatization intensity was mild in 64.34% of patients, moderate in 19% and severe in16.6%. The highest level of frequency for mental disorders was seen among women and those aged between 30 -40.</span></p><p class="abstract"><strong><span lang="EN-US">Conclusions: </span></strong>In this study, mild somatization and anxiety were respectively the most common mental disorders in patients with non-organic chest pain. It was recommended that patients with non-cardiac chest pain, women in particular, be clinically examined by psychiatrists.</p>

1060 Eating, Drinking and Swallowing Disorders: A New Regional Clinic Review

Background: Eating, drinking and swallowing (EDS) disorders can have serious consequences for children which include dehydration, malnutrition, failure to thrive, aspiration pneumonia, choking and possibly death. Paediatric feeding disorders have been reported in up to 25% of children. This number increases to 80% in developmentally delayed children. Therefore disordered feeding should involve assessment by a multidisciplinary team. The problem is seldom limited to the child alone and non-organic factors must also be addressed. Aims: To audit the first 18 months of practice in a new regional EDS clinic from July 2007-December 2008. Methods: Retrospective chart review of clinic reports was carried out. All patients had formal assessment of EDS by a speech and language (SALT) and occupational therapist (OT), a medical review by a doctor and dietetics consult at each clinic visit. Results: 28 patients received full assessment. Average age of 1st consult was 4.16 years. 27/28 patients had an underling diagnosis, the most common being; genetic disorder(n=7), autism(n=3), cerebral palsy(n=3), Ex-prem(n=3), developmental delay of unknown aetiology(n=3). Diverse reasons for referral included(often > 1); issues with coordination of swallow(n=14), perceived behavioural issues(n=6), chronic reflux(n=5), PEG feeding(n=4), aspiration(n=4). 22/28 patients had an abnormal EDS assessment. The two most common interventions initiated were a sensory feeding programme(n=15) or food desensitisation programme(n=4) by SALT/OT. Conclusion: Our EDS clinic has provided further therapeutic intervention for children already with complex medical needs. In conjunction with medical therapy, behavioural and oromotor strategies can be applied successfully even in feeding disorders with an underlying organic cause.

Eating, drinking and swallowing disorders: a new regional clinic review

Introduction Eating, drinking and swallowing (EDS) disorders can have serious consequences for children which include dehydration, malnutrition, failure to thrive, aspiration pneumonia, choking and possibly death. Adverse feeding behaviour can further perpetuate these problems leading to a cycle of food refusal, further nutritional compromise and considerable stress for the care giver. Background Paediatric feeding disorders have been reported in up to 25% of children. This number increases to 80% in developmentally delayed children. Therefore, disordered feeding should involve assessment by a multidisciplinary team. The problem is seldom limited to the child alone and non-organic factors must also be addressed. Medical treatment, behavioural modification and parental education are some interventions available for these children. Aims The aim of our study was to audit the first 18 months of practice in a new regional EDS clinic from July 2007 to December 2008. Methods Retrospective chart review of clinic reports was carried out. All patients had formal assessment of EDS by a speech and language therapist (SALT) and occupational therapist (OT), a medical review by a doctor and dietetics consult at each clinic visit. Results 28 patients received full assessment. Average age of 1st consult was 4.16 years. 12 patients referred from SALT, seven from local early intervention services, remainder from mixture of healthcare professionals. 27/28 patients had an underling diagnosis, the most common being; genetic disorder (n=7), autism (n=3), cerebral palsy (n=3), Ex-prem (n=3), developmental delay of unknown aetiology (n=3). Diverse reasons for referral included (often >1); issues with coordination of swallow (n=14), perceived behavioural issues (n=6), chronic reflux (n=5), PEG feeding (n=4), aspiration (n=4). 10 had prior video fluoroscopy. 22/28 patients had an abnormal EDS assessment. The two most common interventions initiated were a sensory feeding programme (n=15) or food desensitisation programme (n=4) by SALT/OT. There were nine specific medical interventions of which referral to another physician was the most common (n=5). Conclusion Our EDS clinic has provided further therapeutic intervention for children already with complex medical needs. In conjunction with medical therapy, behavioural and oromotor strategies can be applied successfully even in feeding disorders with an underlying organic cause.

Effectiveness of cognitive-analytic therapy (CAT) in major depression and systemic lupus erythematosus: a case report

Background A significant number of patients with systemic lupus erythematosus (SLE) suffer from depression. Most episodes of depression in SLE seem to be caused by non-organic factors i.e. patients' responses to the burden of disease and the social consequences of the disease. Therapeutic interventions should consist of a combined pharmacological and non-pharmacological treatment. Cognitive Analytic Psychotherapy (CAT) is a form of brief psychotherapy -its effectiveness has been showed in several studies with patients who manifested various psychological problems. The present study aims to present the appliance of CAT in a patient with SLE and depression.

Psychiatric comorbidity following traumatic brain injury

Primary objective: Survivors of traumatic brain injury (TBI) are at increased risk for development of severe, long-term psychiatric disorders. However, the aetiology of these disorders remains unclear. This article systematically reviews the most current prevalence rates and evidence for causality, in terms of established criteria.Main outcome and results: Psychiatric syndromes are consistently present at an elevated rate following TBI. Survivors of TBI are particularly susceptible to major depression, generalized anxiety disorder and post-traumatic stress disorder. Evidence for a biological gradient is generally lacking, although this criterion may not be appropriate in the case of TBI. The temporal pattern of onset is variable and reliable critical periods for the post-injury development of a psychiatric disorder remain to be identified; however, individuals appear to remain at risk for years following injury.Conclusions: Non-organic factors, including pre-morbid personality traits and post-injury psychological reactions to disability and trauma, are implicated in the generation and maintenance of post-TBI psychiatric disorder. There remains insufficient evidence to conclude what role the neuropathological consequences of TBI play in the development of post-TBI psychiatric disorder.

Prevalence of Erectile Dysfunction in Kidney Transplant Recipients

Prevalence and severity of erectile dysfunction increase with advancing age. Patients with end-stage renal disease (ESRD) experience disturbances in erectile function related to organic factors including as uremia, hypertension, endocrine, and nonorganic factors like depression. Recipients of kidney transplants show a high prevalence of erectile dysfunction, 32.2% to 50.7%. We conducted a study of the prevalence of erectile dysfunction among male renal transplant recipients using the International Index of Erectile Function. Among 182 men with kidney transplantations, there were 89 recipients (48.9%) with erectile dysfunction; 60 recipients had normal sexual function (32.9%); and whereas 33 recipients had no sexual activity.

Welcoming a paradigm shift in neuropsychology

In order to understand the relationships between brain structure and function, we need to appreciate both the biological and non-biological variables which can influence behavioural data. We do not dispute that mild brain injuries cannot, in principle, have lasting neuropsychological effects. We merely assert that, as injury severity becomes increasingly mild, the role of non-organic factors affecting performance increases commensurately. Among these factors is the phenomenon of incomplete effort. In the past decade, this topic has become a key focus in applied neuropsychological research. In our critique, we pointed out that Dr. Bigler has not addressed this phenomenon, although it is one that we cannot escape. It is now widely recognized that, if a patient does not put forth a full effort during testing, neuropsychological test scores will underestimate the person’s true capabilities. Whether in the single clinical case or in group studies, if such contaminated data go unrecognized and are incorrectly regarded as being valid, we will draw false conclusions. In the case of patients with mild head injuries, poor effort on testing not only has some effect on neuropsychological test scores but it can easily override the effects of most other variables. Poor effort creates the illusion that people with mild head injuries have suffered far more severe neuropsychological impairment than patients with well established severe brain injuries or brain tumors. Accordingly, the title of the paper by Green, Rohling, Lees-Haley, and Allen (2001) was “Effort has a greater effect on test scores than severe brain injury in compensation claimants.” In this study, patients with mild head injuries performed on many neuropsychological tests at a level very close to the normal mean established by independent normative studies. This finding applied to those who passed effort testing with the Word Memory Test (Green, Allen, & Astner, 1996; Green & Astner, 1995; Green, Lees-Haley, & Allen, 2002). However, the group of mild head injury patients, who failed effort testing, showed a severe suppression of neuropsychological test scores. Their overall performance was, on average, 1.4 standard deviations below the normal mean. In contrast, the patients with the most severe brain injuries scored only 0.4 standard deviations below the normal mean. It is very difficult to develop a biological explanation for these findings. The Word Memory Test effort subtests are so simple that even mentally retarded children or children with fetal alcohol syndrome can easily score almost 100% correct but adult patients with mild head injuries scored lower on the effort subtests than these children ( Green & Flaro,

Quantitative sensory testing: report of the Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology.

This assessment evaluates the clinical utility, efficacy, and safety of quantitative sensory testing (QST). By searching MEDLINE, Current Contents, and their personal files, the authors identified 350 articles. Selected articles utilized computer operated threshold systems, manually operated threshold systems, and electrical threshold devices. The authors evaluated the use of normal values and the degree of reproducibility between the same and different systems. Articles were rated using a standard classification of evidence scheme. Because of differences between systems, normal values from one system cannot be transposed to others. Reproducibility of results was also an important concern, and there is no consensus on how it should be defined. The authors identified no adequately powered class I studies demonstrating the effectiveness of QST in evaluating any particular disorder. A number of class II and III studies demonstrated that QST is probably or possibly useful in identifying small or large fiber sensory abnormalities in patients with diabetic neuropathy, small fiber neuropathies, uremic neuropathies, and demyelinating neuropathy. QST is a potentially useful tool for measuring sensory impairment for clinical and research studies. However, QST results should not be the sole criteria used to diagnose pathology. Because malingering and other nonorganic factors can influence the test results, QST is not currently useful for the purpose of resolving medicolegal matters. Well-designed studies comparing different QST devices and methodologies are needed and should include patients with abnormalities detected solely by QST.

Evaluation of Erectile Function in Renal Transplant Recipients

RECTILE dysfunction describes the inability to achieve and maintain penile erection sufficient for coitus. Renal insufficiency is a chronic disease during which erectile function deteriorates, however, the etiology of this condition in such patients is multifactorial, involving organic and nonorganic (psychogenic) factors. 1 The condition may result from neuroendocrine disturbance, uremia, hypoxia, and atherosclerosis. 2 Neuroendocrine disturbance is often reversed by renal transplantation, but not by dialysis. 3 Psychological factors may also cause erectile dysfunction in dialysis patients, since approximately one fourth of these individuals are depressed at any given time. 4 Patients often regain potency after transplantation but in some cases, especially second transplantations, erectile function is adversely affected by interference with arterial blood flow. In this study, we evaluated the effect of renal transplantation on erectile function. PATIENTS AND METHODS Information on erectile function was collected by means of a questionnaire given to 65 men who were renal transplant recipients. The patients ranged in age from 20 to 57 years (mean 42.5 years). A second transplantation had been performed in four cases (6%). Posttransplantation follow-up ranged from 2 to 168 months (mean 72 months). A detailed medical history was taken and complete blood count, urinalysis, and a biochemical and endocrinologic blood analysis were routinely performed for all patients. A papaverine test, penile Doppler ultrasonography, cavernosometry, cavernosography, and pudendal angiography were done where indicated. For patients who had no erectile dysfunction before or after renal transplantation, the questionnaire and routine tests completed the evaluation. This group was considered to have experienced no change in erectile function due to renal transplantation. Similarly, no further tests were performed on patients who were afflicted with erectile dysfunction prior to renal transplantation but regained sexual function following transplantation. These patients were defined as the group with improved sexual function. On the other hand, patients with deteriorated erectile function after renal transplantation were evaluated in detail. All underwent a papaverine test involving intracavernous injection of 50 mg of papaverine and observation of response after 30 minutes. The group which experienced full erection after papaverine treatment (papaverine responders) was considered to have nonorganic (psychogenic) erectile dysfunction. Patients who did not respond to papaverine were further evaluated by penile Doppler ultrasonography for vasculogenic impotence. Papaverine-stimulated penile Doppler ultrasound was performed using a 7.5-MHz linear probe. Peak systolic velocities in the cavernous arteries were measured bilaterally. A peak systolic velocity of ,25 cm/s was considered as arterial insufficiency. Patients with arterial insufficiency underwent pudendal angiography, while those with normal penile Doppler ultrasound findings underwent dynamic infusion cavernosometry and cavernosography to assess for suspected veno-occlusive dysfunction. RESULTS Thirty-two patients (49.2%) experienced no alteration in erectile function before or after renal transplantation. Twelve patients (18.4%) said they regained erectile function after renal transplantation. Twenty-one patients (32.3%) with normal erectile function prior to transplantation during the hemodialysis period reported erectile dysfunction after the transplantation, constituting the group which was evaluated further. Seven of these patients were papaverine responders (nonorganic impotence) and benefited from antiserotoninergic treatment. All seven men received 150 mg/d trazodone initially, however, two patients who reported severe side effects with this drug were switched to sertraline at a dose of 50 mg/d. All patients in this group achieved erections sufficient for coitus within 3 months. In three patients, deterioration of erectile function was associated with hyperprolactinemia accompanied by a low testosterone level. A papaverine test was not performed in these cases. Oral testosterone replacement resulted in improved sexual function. Eleven of 21 patients who reported a deterioration in erectile function after transplantation did not respond to papaverine. These individuals were considered to have vasculogenic impotence. According to penile Doppler ultrasound, nine of these men had arterial insufficiency, while two had normal peak systolic velocities in their cavernous arteries, indicating no arterial insufficiency. These two patients underwent cavernosometry and cavernosography, which confirmed veno-occlusive dysfunction. They were treated with deep dorsal vein embolization using n-butyl cyanoacrylate, and regained satisfactory erections within 3 months, at which time control cavernosometry was normal.

Post-Stroke depression and pathological crying: Clinical aspects and new pharmacological approaches

Despite it having been firmly established that depression and pathological crying are common and debilitating sequelae of stroke, one of the major unmet needs of stroke patients is still for these conditions to be recognized and treated. About 40% of stroke survivors become depressed the first year following stroke, with most cases developing within the early stroke period. Half of initially depressed patients will recover spontaneously within the first months, whereas the remainder are likely to develop chronic depression. As a consequence their quality of life suffers, greater stress is placed on the family and social activity decreases. While less is known of depression in aphasic patients, because of the lack of reliable assessment methods, the frequency is probably the same as in non-aphasic stroke patients. The aetiology of post-stroke depression seems to involve mainly organic but also non-organic factors, although no single factor has been identified which is able to explain the majority of cases. Pathological crying is extremely socially embarrassing for stroke patients. The frequency is lower than that of depression, the 1-year incidence being about 20%. In contrast to depression most cases occur in the very acute stroke period and 10% are still afflicted 1 year after stroke. There is now increasing evidence that post-stroke pathological crying is attributable to stroke-induced partial destruction of the serotoninergic raphe nuclei in the brainstem or their ascending projections to the hemispheres. Although the condition is classically described as being unrelated to depression, stroke patients with pathological crying have higher mood scores on quantitative measures, and are more likely to have depression than are other stroke patients. The need for active treatment of pathological crying is therefore two-fold. With both conditions effective and well tolerated treatment is provided by the selective serotonin re-uptake inhibitor, citalopram, side-effects if any being sparse, mild and transient.

Psychological dysfunction in patients with reflex sympathetic dystrophy

Patients with reflex sympathetic dystrophy (RSD) often present with pain and disability that cannot be explained on the basis of objective physical findings. This has led some to speculate that RSD may be caused or mediated by non-organic factors. Unfortunately, there have been few studies using standardized measures of mood and illness behavior that have compared patients with RSD to patients with other chronic pain disorders. The goal of the present study, therefore, was to compare the pattern of psychological dysfunction in patients with RSD to the pattern of dysfunction in patients with chronic back pain and local neuropathic pain. Patients with back pain resemble those with RSD in that both may report symptoms that cannot be reconciled with objective physical findings. Patients with local neuropathy, by contrast, report pain that is both circumscribed and consistent with a known organic cause. The records of 253 patients attending a tertiary pain service were retrospectively reviewed and three distinct (non-overlapping) diagnostic groups were formed: 25 were assigned to the RSD group; 44 to the back pain group; and 21 to the local neuropathy group. Using a set of stringent criteria to diagnose RSD and an analysis of covariance to control for differences in symptom duration and age, the present study found no evidence to suggest that patients with RSD were psychologically unique. Instead, RSD patients were remarkably similar to those with local neuropathy in terms of their symptom reporting, illness behavior, and psychological distress. The only exception was that RSD patients had more disability days during the preceding 6 months than those with local neuropathy ( P<0.05). The back pain group, on the other hand, presented with more diffuse pain complaints ( P<0.05) and had a greater number of non-specific medical symptoms ( P<0.05) compared to either the RSD or local neuropathy group. In contrast to previous research using less stringent diagnostic criteria, there was no evidence of higher pain scores or lower levels of psychological distress among patients with RSD. In addition, a validated survey of childhood trauma found that sexual abuse, physical abuse, emotional abuse, and cumulative trauma were evenly distributed among all three diagnostic groups. The burden of proof would appear to be upon those who advocate the non-organic hypothesis to provide credible evidence of psychological involvement in the etiology of RSD.

The Relationship of Non-Organic Factors to Perceived Disability of Injured Workers

This study explored the relationship between non-organic factors and perceived disability for work-injured Hispanic and White workers in Northern New Mexico. The results showed that Hispanic males perceived themselves to be significantly more disabled than White males and than Hispanic females. Also, less educated workers perceived themselves as significantly more disabled than those with more education, regardless of ethnicity. These findings indicate that the rehabilitation process of injured Hispanic workers is a complex one in which various systems interact including the injured worker, the family, the employer, the health care provider, the insurance company, the attorney, and the workers' compensation adjuster.

Decreased Serum Bicarbonate as a Manifestation of Undernutrition Secondary to Nonorganic Failure-to-Thrive

Eight of 101 children (8%) seen serially in consultation in an outpatient failure-to-thrive (FTT) clinic had isolated serum bicarbonate (TCO2) levels between 16 and 20 MEQ/dL (normal 22 to 30 MEQ/dL). None of these eight patients had signs or symptoms of renal disease, and all had nonorganic etiologic factors associated with their malnutrition. At the time of this review, follow-up TCO2 measurements were available for seven of the eight children who had attained normal weight (wt/age greater than fifth percentile on National Center for Health Statistics (NCHS) growth chart). All these children had normal TCO2 levels and no evidence of renal disease on follow-up more than 12 months later. Clinicians treating undernourished children who have low TCO2 measurements and have no signs or symptoms of renal disease and identified nonorganic factors, should consider a trial of therapies directed at nonorganic factors. Clinicians should be aware that a high percentage of undernourished children without other medical disease may have abnormal TCO2 measurements that correct after the institution of adequate caloric intake.

Predicting return to work for lower back pain patients receiving worker's compensation.

The results of a prospective study of 134 patients with lower back pain suggest that nonorganic factors are better predictors of return to work than organic findings. Patients who returned to work had fewer job, personal, or family related problems. There were no significant differences between patients who returned to work and those who did not when comparing myelograms, computed tomographic scans, or roentgenographs. The only significant difference in physical organic findings was for muscle atrophy. Patients who did not return to work had a statistically higher incidence rate of muscle atrophy. Length of time off from work was significantly related to outcome, but when patients were categorized according to time off the job, different factors predicted failure to return for patients off work for less than 6 months and patients off for more than 6 months. For patients off for less than 6 months, important predictors were a high Oswestry score, history of leg pain, family relocation, short tenure on the job, verbal magnification of pain, reports of moderate to severe pain on superficial palpation, and positive reaction to a "sham" sciatic tension test. None of these was a significant predictor for the group off for more than 6 months. For the group off work for more than 6 months, previous injuries, and stability of family living arrangements were among the significant predictors not significant for the group off less than 6 months. Using 21 factors selected from a larger group of 92 factors, three statistically significant (P less than or equal to 0.001) predictive measures were developed. These measures predicted return to work for the total sample, and for the two subgroups (off more than, or less than 6 months) more accurately than did the total set of 92 factors.