Roger Bartrop

Developing a model of associations between chronic pain, depressive mood, chronic fatigue, and self-efficacy in people with spinal cord injury.

UNLABELLED Chronic pain, chronic fatigue, and depressive mood are prevalent conditions in people with spinal cord injury (SCI). The objective of this research was to investigate the relationship between these conditions in adults with SCI. Multivariate analysis of variance, contingency analyses, and hierarchical regression were used to determine the nature of the relationship, as well as the contribution to this relationship of self-efficacy, a potential mediator variable. Seventy participants with SCI living in the community completed an assessment regimen of demographic and psychometric measures, including validated measures of pain, fatigue, depressive mood, and self-efficacy. Results indicated that participants with high levels of chronic pain had clinically elevated depressive mood, confusion, fatigue, anxiety and anger, low vigor, and poor self-efficacy. Participants with high chronic pain had 8 times the odds of having depressive mood and 9 times the odds of having chronic fatigue. Regression analyses revealed that chronic pain contributed significantly to elevated depressive mood and that self-efficacy mediated (cushioned) the impact of chronic pain on mood. Furthermore, both chronic pain and depressive mood were shown to contribute independently to chronic fatigue. Implications of these results for managing chronic pain in adults with SCI are discussed. PERSPECTIVE The relationship between pain, negative mood, fatigue, and self-efficacy in adults with SCI was explored. Results support a model that proposes that chronic pain lowers mood, which is mediated (lessened) by self-efficacy, whereas pain and mood independently increase chronic fatigue. Results provide direction for treating chronic pain in SCI.

Cardiovascular risk in early bereavement: A literature review and proposed mechanisms

OBJECTIVES The purpose of this review was to examine the evidence of cardiovascular risk in early bereavement to identify potential risk factors and possible mechanisms for risk that may inform future research directions. DESIGN A comprehensive search of electronic databases PubMed Medline, CINAHL and PsycINFO, bereavement related textbooks and reviewed reference lists was undertaken on literature related to evidence of increased risk in bereavement. No limits were set on the searches in terms of date or publication type, but only English language articles were selected. FINDINGS Bereavement represents a time of heightened cardiovascular risk for the surviving spouse. The immediate weeks following bereavement represent the highest risk period with both men and women across all ages. Risk is evident irrespective of the nature of death, expected or unexpected, although higher level of social support at the time of death may be protective. Evidence would suggest that for many, bereavement results in a time of increased psychological stress and potential for altered behavioural health risk factors that in the presence of altered physiological state, may serve as a potential trigger of cardiovascular events, especially in those most at risk. CONCLUSION The findings from this review provide insight into the impact of early bereavement on health and the recognition that bereavement is associated with increased cardiac risk. This recognition should provide an impetus for individuals to act on cardiac symptoms by seeking medical advice and for health care providers to monitor such individuals more closely.

Participation in faecal occult blood screening for colorectal cancer

Chemical faecal occult blood testing has been proposed as a means of screening for colorectal cancer (C.C.) in populations or in identified high-risk groups. The level of public participation is a critical factor in the effectiveness of screening programmes. This study was conducted as a methodological pretest for an intended investigation of factors influencing screening participation. Faecal occult blood screening was offered to 728 employees of a teaching hospital in Sydney, New South Wales and 41% participation was obtained. Both participants and non-participants were questioned on demographic and social background factors, on their experience of C.C. in others, and on their reasons for participating or not participating. Major reasons for participation were: a general feeling of the importance of health checks and screening tests; a belief that it is important to diagnose C.C. early; and the fact that the test was simple and easy to do. Prominent self-acknowledged reasons for non-participation were indifference, procrastination, absence of previous bowel complaints, preference for ones own doctor to do such tests and inconvenience or lack of time. Those more likely to participate were: females; those of Australian or British origin; single, separated or divorced persons; those having two or more dependents and those with personal knowledge of a C.C. patient.

Deliberate overdose of uranium: toxicity and treatment

A case is described of deliberate ingestion of 15 g of uranium acetate which resulted in acute renal failure requiring dialytic therapy for 2 weeks, refractory anaemia, rhabdomyolysis, myocarditis, liver dysfunction with a disproportionate coagulopathy and paralytic ileus. Despite significant elevations in plasma uranium levels, treatment with both calcium EDTA and calcium DTPA were ineffective in promoting uranium excretion. Six months later the initial significant renal impairment exists with a persistent incomplete Fanconi syndrome. Future options for management of this unusual cause of acute renal failure are discussed.

Prospective study of early bereavement on psychological and behavioural cardiac risk factors.

Background: Increasing evidence supports the role of emotional stress in the onset of cardiovascular disease. Although bereavement is a major emotional stress with both acute and more long‐term features, the mechanism of its association with cardiovascular risk is not well understood, in particular because of limited studies of acute bereavement. The aim of the study was to identify psychological and behavioural changes in acute bereavement and potential modifiers of these changes.

Placebo-Controlled Biofeedback Blood Pressure Effect in Hypertensive Humans

The role of biofeedback in blood pressure control remains ill-defined because of nonspecific (placebo) effects, small study numbers, and the technical limitations of continuous pressure feedback. Clarification of its potential is awaited by those seeking a nonpharmacological approach to blood pressure control. This study examines the capability for systolic pressure lowering of 5 mm Hg or more using continuous pressure feedback in a statistical sample of untreated, well-characterized, mildly hypertensive individuals. Subjects were randomized in a double-blind study to active or placebo biofeedback. Placebo consisted of a modified contingency approach, using a partial disguise based on a digital high pass filter with 15 elements. Blood pressure-lowering capability was assessed during two laboratory sessions. Continuous visual feedback resulted in 11 of 28 subjects on active treatment and 12 of 28 on placebo treatment lowering their systolic pressure by 5 mm Hg or more (11 +/- 5.6 and 12 +/- 8.4 mm Hg, respectively; P = NS). Prestudy pressure was well-matched (153 +/- 9/97 +/- 4 and 154 +/- 8/98 +/- 4 mm Hg, respectively). An initial small difference in diurnal profile did not change. These findings indicate that among mildly hypertensive individuals, almost half can lower systolic pressure at will for short periods. This capability is independent of the real or placebo nature of the feedback signal. We conclude that there is no specific short-term biofeedback pressure-lowering capability in hypertensive individuals. Further exploration is needed to determine whether specific components of the placebo effect can be delineated, whether personality characteristics influence the response, and whether further biofeedback training can alter the outcome.

Inflammatory and thrombotic changes in early bereavement: a prospective evaluation

Aims: Although there is an increased cardiovascular risk in the immediate weeks following bereavement, the mechanism is not well understood. The aim of this study was to determine whether inflammatory and thrombotic changes were present in acute bereavement. Methods and results: Eighty bereaved spouses or parents were prospectively studied within 2 weeks of bereavement (acute) and at 6 months, and compared to 80 non-bereaved participants. Haemostatic measures were obtained between 8 a.m. and 11 a.m. and processed within 1 h. Compared to non-bereaved participants, those acutely bereaved had a higher neutrophil count (4.34 ± 0.19 vs 3.79 ± 0.15, p = <0.001), von Willebrand factor antigen (132.33 ± 3.6 vs 119.95 ± 3.29, p = 0.02), Factor VIII (1.43 ± 0.06 vs 1.25 ± 0.04, p = 0.02) and platelet/granulocyte aggregates (median 383.0 vs 343.5, p = 0.02). Levels of neutrophils, monocytes, eosinophils, platelet count, platelet/monocyte granulocytes and von Willebrand factor were lower in bereaved at 6 months compared to acutely (all p < 0.05). Conclusion: Acute bereavement is associated with inflammatory and prothrombotic changes that may contribute to the increased cardiovascular risk with bereavement and provide clues for future preventative strategies.

Haemodynamic Changes During Early Bereavement: Potential Contribution To Increased Cardiovascular Risk

BACKGROUND bereavement is associated with increased cardiovascular risk, particularly in surviving spouses and parents, however the mechanism is not well understood due to limited studies. The purpose of this study was to evaluate haemodynamic changes (blood pressure (BP) and heart rate (HR)), that may contribute to increased cardiac risk in early bereavement. METHODS we enrolled 80 bereaved individuals and 80 non-bereaved as a reference group. Twenty-four hour ambulatory blood pressure monitoring was performed within two weeks (acute assessment) and at six months following bereavement. RESULTS compared to the non-bereaved, the acutely bereaved had higher 24-hour systolic BP (mean (SE) 130.3 (1.5) vs 127.5 (1.4)mmHg, p=0.03), higher daytime systolic BP (135.6 (1.5) vs 131.6 (1.4)mmHg, p=0.02) and higher daytime systolic load (median % 39.0 vs 29.3, p=0.02). By six months the BP of the bereaved tended to be lower than acute measures. This difference was significant amongst those not taking BP lowering medications for 24-hour systolic BP (126.5 (2.4) vs 129.7 (2.3)mmHg, p=0.04), daytime systolic BP (129.8 (2.1) vs 133.9 (2.0)mmHg, p=0.01) and daytime diastolic pressure (76.7 (1.0) vs 78.9 (0.9)mmHg, p=0.03). Twenty-four hour heart rate was also higher acutely in the bereaved compared with the reference group (74.0 (1.2) vs 71.7 (0.9) b/min, p=0.02); at six months heart rate in the bereaved had fallen to non-bereaved levels (70.4 (0.09), p=0.02). CONCLUSION early bereavement is associated with increased systolic blood pressure and heart rate. These haemodynamic changes may contribute to a time-limited increase in cardiovascular risk.

A controlled trial investigating the effect of music therapy during an acute psychotic episode.

Morgan K, Bartrop R, Telfer J, Tennant C. A controlled trial investigating the effect of music therapy during an acute psychotic episode.

Effect of early bereavement on heart rate and heart rate variability.

Early bereavement is associated with increased cardiovascular events. The mechanism, however, has not been well studied. We assessed whether bereavement is associated with an increased heart rate (HR) and decreased heart rate variability that might contribute to increased cardiovascular risk. A total of 78 bereaved spouses and parents (55 women and 23 men; aged 34 to 87 years, mean 65) were studied with 24-hour Holter monitoring within 2 weeks of bereavement (acute) and at 6 months. Their findings were compared to those from a nonbereaved reference group (52 women and 27 men) aged 33 to 91 years (mean 63.6). All participants were in sinus rhythm. We assessed the mean HR, atrial and ventricular arrhythmias, and both time and frequency domain heart rate variability measures. Acute bereavement was associated with increased 24-hour HR (mean ± SE, 75.1 ± 1.1 vs 70.7 ± 1.0; p = 0.004) and reduced heart rate variability, as indicated by lower standard deviation of the NN intervals index (median 45.4 vs 49.9, p = 0.017), total power (7.78 ± 0.10 vs 8.02 ± 0.09, p = 0.03), very low frequency (7.23 ± 0.09 vs 7.44, p = 0.046) and low frequency (5.76 ± 0.12 vs 6.16 ± 0.09, p = 0.01). At 6 months, the bereaved had a significantly lower HR (p = 0.001) and increased standard deviation of the NN intervals index (p = 0.02), square root of the mean square of differences of successive intervals (p = 0.045), number of interval differences of successive NN intervals >50 ms divided by the number of NN intervals (p = 0.039), low-frequency power (p = 0.02), and high frequency (p = 0.002) compared to the initial acute levels. In conclusion, the present study, the first to report 24-hour HR monitoring in the early weeks of bereavement, has demonstrated increased HR and altered autonomic function that might contribute to the increased cardiovascular events in early bereavement.