Mary Morrissey

'On' freezing in Parkinson's disease: Resistance to visual cue walking devices

To measure “on” freezing during unassisted walking (UW) and test if two devices, a modified inverted stick (MIS) and a visual laser beam stick (LBS) improved walking speed and number of “on” freezing episodes in patients with Parkinsons disease (PD).

Nocturnal activity with nighttime pergolide in Parkinson disease: A controlled study using actigraphy

Pergolide is a dopamine agonist that improves Parkinson disease but is associated with dose-dependent sleepiness. This study evaluates the effect of a nighttime dose of 1 mg of pergolide on actigraphic measures of sleep using a randomized, double-blind, placebo-controlled study design. The pergolide group (n = 10) worsened in actigraphic measures of sleep efficiency and sleep fragmentation vs the placebo group (n = 12). Side effects were more frequent in the pergolide group.

Risk factors for recurrent episodes of work-related low back disorders in an industrial population.

Study Design. An observational longitudinal design. Objectives. To characterize the rate of and risk factors for recurrent episodes of work-related low back disorder in industrial workers. Summary of Background Data. Little data exist on risk factors for recurrent episodes of work-related low back disorders in employed persons. Methods. A total of 352 active hourly union employees who were diagnosed with a recent work-related low back disorder and who had at least one follow-up visit within 12 months enrolled for participation in a rehabilitation intervention study at the workplace. Information on clinical and job factors was obtained at each study visit. Job risk for low back disorder was quantified using the Lumbar Motion Monitor. The main outcome measure, recurrence of work-related low back pain, was derived from a computerized file of administrative records of visits to the plants medical department. Results. The rate of repeated episodes was 24.4%; an additional episode occurred in 2.3%. Adjusting for age, gender, health status and job exposures, lower levels of physical health, increasing back pain disability, spinal deformity, high stress, and increasing number of different jobs worked at the same plant were risk factors for a recurrent episodes of low back pain. Conclusions. Early identification of risk factors for a work-related low back disorder may signal the need for early and intense rehabilitation to prevent recurrent episodes. Because these findings were based on jobs with medium risk of low back disorders, other factors may be significant in higher risk jobs.

An analysis of acute changes in interleukin-6 levels after treatment of hepatitis C with consensus interferon

Cytokine production has been implicated in the antiviral response to interferon-alpha (IFN-alpha) in hepatitis C and in the development of IFN-alpha-related side effects. We characterized acute changes in serum cytokine levels following administration of a single dose of consensus IFN (IFN-con1) and during continuous treatment of chronic hepatitis C patients. Serum samples were collected at baseline, at multiple times early after IFN administration, and weekly thereafter. Viral RNA titers were assessed by RT-PCR, and viral kinetics were followed. ELISA assays were used to measure IFN-gamma, tumor necrosis factor-alpha (TNF-alpha), interleukin-2 (IL-2), IL-4, IL-6, and IL-16. Serum cytokine levels were low at baseline. IL-6 was detected in patients with hepatitis C but not in healthy control subjects by either ELISA or RT-PCR, indicating that low levels of circulating IL-6 were associated with hepatitis C infection. None of the cytokines measured increased significantly after IFN administration except for IL-6. IL-6 levels rose rapidly, peaked at 6-15 h in a dose-dependent manner, and returned to baseline by 48 h in both patients receiving a single dose of IFN and those receiving continuous treatment. This was confirmed by RT-PCR. Pretreatment IL-6 levels were directly correlated with area under the curve (AUC) for IL-6 during the 24 h after IFN dosing (r = 0.611, p = 0.007). Viral titers decreased within 24-48 h after a single dose of IFN-con1. Changes in hepatitis C RNA titers were not significantly associated with pretreatment IL-6 levels or with changes in IL-6 levels. In conclusion, (1) baseline serum cytokine levels, except for IL-6, were low or within the normal range in patients with hepatitis C, (2) IL-6 levels were detected in some patients with hepatitis C before treatment but not in healthy controls, (3) IL-6 levels increased acutely after a single dose of IFN-alpha, and IL-6 induction was related to baseline IL-6 level, and (4) changes in IL-6 levels did not correlate with the early virologic response to IFN.

A pilot study of the combination of cyclosporin A and interferon alfacon-1 for the treatment of hepatitis C in previous nonresponder patients

Goals To evaluate the safety and efficacy of the combination of interferon and cyclosporine for the treatment of hepatitis C in previous nonresponder patients. Background Preliminary data indicated that adding the immunosuppressive agent cyclosporin A to interferon might improve response rates in patients with hepatitis C. Study Ten previous virologic nonresponders with genotype 1 infection were included. Treatment consisted of interferon alfacon-1, 15 &mgr;g/d, and cyclosporine, 100 mg twice daily, for 4 weeks. The dose of interferon alfacon-1 was then decreased to 15 &mgr;g three times weekly, and cyclosporine was reduced to 50 mg twice daily. Therapy was continued for 48 weeks unless viremia persisted at week 24. Results Three of 10 subjects had an on-treatment virologic response, although one had a breakthrough with recurrent viremia during treatment and two relapsed after therapy was completed. On treatment responders had significantly higher trough cyclosporine levels at week 4 compared with nonresponders (P = 0.025). Serum creatinine levels remained stable, and no patient developed diabetes. Triglyceride levels increased during treatment. Cyclosporine was dose reduced in two patients for hypertension. Conclusions Selected patients with hepatitis C tolerated therapy, including cyclosporine without severe or irreversible toxicity. Despite an association between higher cyclosporine levels and on-treatment response, the combination of cyclosporine and interferon was ineffective in producing a sustained response in previous nonresponder patients.

Gilles de la Tourette syndrome: Patient's knowledge and concern of adverse effects

The objective of this study was to assess awareness and concern of neuroleptic (NL)‐induced side effects in Gilles de la Tourette syndrome (GTS) patients. Although NLs are effective tic suppressants, they can be associated with various side effects. Data on patient knowledge and concern about side effects can guide educational efforts. One hundred consecutive GTS patients or parents in a tertiary referral medical center responded to a standardized, in‐person questionnaire. They were given a list of 15 side effects and asked which could be ascribed to NLs (9) or not (6). Side effect concern was rated on a 0 (none) to 10 (extreme) scale. The mean age for the 100 patients was 19.4 ± 14 years; 55 had a history of NL use, and 45 were NL‐naive. Less than half the cohort met criteria for being well informed. Only one third of the listed NL side effects were accurately identified by at least 75% of the respondents. Patients with past or current NL treatment were more accurate in identifying NL side effects but less concerned about them than NL‐naive patients. The side effects of greatest concern were seizures, tardive dyskinesia, thinking and emotion disturbances, and cardiac irregularities. Overall, patient awareness of NL side effects is insufficient, and although past exposure to NLs enhances knowledge, it decreases concern.

Low Back Disorder Risk in Automotive Parts Distribution

The purpose of this study was to characterize the low back disorder (LBD) risk in jobs found in automotive parts distribution centers. This descriptive study analyzed 53 jobs at 7 automotive distribution facilities in the Northern United States. Data were collected using the Lumbar Motion Monitor (LMM) and analyzed using the LMM LBD risk model. Historically, the LMM risk model, which was developed primarily through an analysis of manufacturing jobs, has used the peak load moment in the calculations. A secondary purpose of this study was to compare the difference in LBD risk estimates obtained using the peak versus the mean load moment in the analysis of these highly variable lifting jobs. Given that each lifting task may be a different weight item from a different location the sampling process was validated using split-test reliability coefficients. These were found to be 0.90. Results indicate that, on average the jobs in automotive parts distribution are moderately high risk (mean= 56%, s.d.= 11%), however, nearly half the sample had LMM LBD risk probability values greater than 60% mark that has been used by some as a cut point in defining “high” risk (Marras et al., 2000). On average, use of the average moment instead of the maximum moment reduced the LBD risk probability value by 7.4 percent (s.d.= 5.3%), however, the range included no difference up to 17 percent. Many of the jobs contain trunk motions that are associated with high LBD risk, however, many of these same jobs had relatively low lifting frequencies which moderated the risk estimates. It should be noted that for many of the jobs the LBD risk probability was at the medium level due to the travel time required between lifts. This kept the frequency of lifting in many of these jobs relatively low for distribution type work; for many jobs the liftrates were less than 60 lifts per hour. The liftrate potentially contributes 20 percent to the overall risk calculation in the model. This suggests that efforts to increase the pick rates and efficiencies in these jobs will be accompanied by increased LBD risk if done without accompanying ergonomic interventions.