Underdiagnosis of asthma: is the doctor or the patient to blame? The DIMCA project.
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BACKGROUND: It is important to diagnose asthma at an early stage as early treatment may improve the prognosis in the long term. However, many patients do not present at an early stage of the condition so the physician may have difficulty with the diagnosis. A study was therefore undertaken to compare the proportion of patients who underpresented their respiratory symptoms with the proportion of underdiagnosed cases of asthma by the general practitioner (GP). A secondary aim was to investigate whether bad perception of dyspnoea by the patient was a determining factor in the underpresentation of asthma symptoms to the GP. METHODS: A random sample of 1155 adult subjects from the general population in the eastern part of the Netherlands was screened for respiratory symptoms and lung function and the results were compared with the numbers of asthma related consultations registered in the medical files of the GP. In subjects with reduced lung function the ability to perceive dyspnoea was investigated during a histamine provocation test in subjects who did and did not report their symptoms to their GP. RESULTS: Of the random sample of 1155 subjects 86 (7%) had objective airflow obstruction (forced expiratory volume in one second (FEV(1)) below the reference value corrected for age, length, and sex minus 1.64SD on two occasions) and had symptoms suggestive of asthma. Of these 86 subjects only 29 (34%) consulted the GP, which indicates underpresentation by 66% of patients. Of all subjects with objective airflow obstruction who presented to their GP with respiratory symptoms, 23 (79%) were recorded in the medical files as having asthma, indicating underdiagnosis by the GP in 21% of cases. Of the subjects with objective airflow obstruction who visited the GP with respiratory symptoms 6% had bad perception of dyspnoea compared with 26% of those who did not present to the GP in spite of airflow obstruction (chi(2) = 3.02, p = 0.08). CONCLUSIONS: Underpresentation to GPs of respiratory symptoms by asthmatic patients contributes significantly to the problem of underdiagnosis of asthma. Underdiagnosis by the GP seems to play a smaller role. Furthermore, there are indications that underpresentation of symptoms by the patient is at least partly explained by a worse perception of dyspnoea. (+info)
Influence of caffeine on the frequency and perception of hypoglycemia in free-living patients with type 1 diabetes.
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OBJECTIVE: To examine the influence of caffeine on the frequency and perception of hypoglycemia in "free-living" patients with type 1 diabetes. RESEARCH DESIGN AND METHODS: A total of 34 patients with type 1 diabetes were recruited for a prospective randomized placebo-controlled double-blind study. After a lead-in phase and while adhering to a low-caffeine diet, subjects were randomized to capsules containing either 200 mg caffeine or matched placebo with crossover at 3 months. Hypoglycemic episodes were monitored throughout with capillary blood glucose readings and a symptom questionnaire. During the study, measurements of blood pressure, middle cerebral artery blood velocity (a surrogate measure of cerebral blood flow), cognitive function (via a four-choice reaction time test), HbAlc levels, and lipid profiles were taken at the beginning and end of each phase. RESULTS: Throughout the study, no changes were evident regarding glycemic control or lipid profile. The number of symptomatic episodes was greater with caffeine (1.3 vs. 0.9 episodes/week; P < 0.03) and was associated with more intense warning symptoms (29 vs. 26 total symptom score; P < 0.05). For women, caffeine ingestion caused a modest pressor response (115 vs. 110 mmHg; P < 0.01). Four-choice reaction time improved slightly with caffeine supplementation (P < 0.05). CONCLUSIONS: Ingestion of modest amounts of caffeine enhances the intensity of hypoglycemia warning symptoms in patients with type 1 diabetes without altering the prevailing standard of glycemic control or increasing the incidence of severe hypoglycemic episodes. (+info)
Regulation of proprioceptive memory by subarachnoid regional anesthesia.
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BACKGROUND: Patient perception of limb position during regional anesthesia is frequently incorrect. The existing model ascribes this misperception, or phantom sensation, as a reversion to a fixed, slightly flexed, body schema. A model was developed to evaluate the influence of limb position changes on the incidence of incorrect or phantom sensations during regional anesthesia. METHODS: Forty American Society of Anesthesiologists physical status I-III adult patients undergoing genitourinary procedures under subarachnoid anesthesia were assigned to a lidocaine or bupivacaine treatment group and randomly assigned to one of four time groups (1, 4, 7, and 10 min). After blockade, patients were placed supine and blinded to limb positioning manipulations. One leg was flexed and the contralateral leg extended, with leg positions subsequently reversed at the assigned time point. At 10 min, patients were asked to identify the position of each leg. Percentage of incorrect response was analyzed using a logistic regression model with two independent variables: treatment and time. A supplemental study was undertaken to evaluate the observed difference in incorrect perceptions relative to flexed first versus extended limb first sequencing. RESULTS: The inability to perceive a change in limb position under regional anesthesia is dependent on the time after the block that the position change is initiated in relation to the onset characteristics of the local anesthetic. A phantom sensation of an extended leg position clearly exists. The flexed-first limb has a significantly higher incidence of incorrect or phantom perceptions. CONCLUSION: Proprioceptive memory involves a dynamic neuroplastic imprinting process that is influenced by limb or joint position prior to onset of regional anesthesia. This contrasts with previously held beliefs of a purely fixed body schema. (+info)
Sensory and cognitive contributions of color to the recognition of natural scenes.
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Although color plays a prominent part in our subjective experience of the visual world, the evolutionary advantage of color vision is still unclear [1] [2], with most current answers pointing towards specialized uses, for example to detect ripe fruit amongst foliage [3] [4] [5] [6]. We investigated whether color has a more general role in visual recognition by looking at the contribution of color to the encoding and retrieval processes involved in pattern recognition [7] [8] [9]. Recognition accuracy was higher for color images of natural scenes than for luminance-matched black and white images, and color information contributed to both components of the recognition process. Initially, color leads to an image-coding advantage at the very early stages of sensory processing, most probably by easing the image-segmentation task. Later, color leads to an advantage in retrieval, presumably as the result of an enhanced image representation in memory due to the additional attribute. Our results ascribe color vision a general role in the processing of visual form, starting at the very earliest stages of analysis: color helps us to recognize things faster and to remember them better. (+info)
Vibration perception thresholds in workers with long term exposure to lead.
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OBJECTIVES: To evaluate the impact of long term occupational exposure to lead on function of the peripheral nervous system as reflected by vibration perception threshold (VPT), measured with a portable vibrameter. METHODS: 217 Workers in a lead battery factory were required to have an annual blood lead measurement during each of the 5 years preceding this study. All were invited to take the VPT test. A total of 206 workers were studied. The associations were analysed between VPTs and current blood lead concentration, mean concentration of blood lead over the past 5 years, maximum blood lead concentration during the past 5 years, index of cumulative blood lead (ICL), time weighted index of cumulative blood lead (TWICL), and percentage of lifespan spent at work in the plant, as well as the other potential confounders. Ordinary multiple regressions, generalised additive models, and hockey stick regression analyses were used to explore the potential existence of a threshold effect of blood lead variables on VPT. RESULTS: VPT at a frequency of 220 Hz ranged from 6 to 100 (10(-2) g, or 0.098 m/s(2)) with a mean (SD) of 19.8 (14.2) for the feet and from 4 to 43 with a mean (SD) of 10.2 (6.1) for the hands. The five variables of exposure to lead were all significantly correlated with VPT of the feet but not the hands. In multiple linear regression analyses, the mean of the blood lead concentrations and the TWICL were significantly associated with VPT of the feet. The relation between VPT of the feet and mean blood lead was shown to be a J shaped curve with a generalised additive model and local smoothing technique. In the hockey stick regression, evidence was found of a threshold effect at a mean blood lead concentration of 31 microgram/dl. Above this threshold it was estimated that each increase of 1 microgram/dl mean blood lead over 5 years would increase VPT of the feet by 0.29 (10(-2) g) or 0.028 m/s(2) (at a frequency of 220 Hz) with other potential confounders held constant. CONCLUSION: This study suggests that measurement of vibration sensory threshold is a relatively effective tool for detecting lead neuropathy in field studies, and that lead might cause sensory neuropathy with an effect threshold corresponding to a 5 year mean blood lead concentration of 31 microgram/dl. (+info)
Quantification of odor quality.
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The relationship between odor quality and molecular properties is arguably the most important issue in olfaction. Despite sophistication in the chemical characterization of molecules, accompanying perceptual characterization has had little quantitative usefulness, relying mostly on enumerative description. As a result of weak interest in the topic outside industry and little agreement regarding how to measure quality, the field of olfactory psychophysics has failed to develop a substantial database for odor quality and has offered little help to other researchers, e.g. neurobiologists, in choice of stimuli, interpretation of outcome or testable hypotheses. This review scrutinizes how psychophysicists and others have measured quality and offers criteria for useful techniques. Most measures have had a subjective component that makes them anachronistic with modern methodology in experimental behavioral science, indeterminate regarding the extent of individual differences, unusable with infrahumans and of unproved ability to discern small differences. Techniques based upon performance, rather than on the more common reporting of mental content, offer firmer possibilities for growth. These techniques inevitably tap the discriminative basis of perception. The nonsubjective techniques have high sensitivity, can have counterparts in infrahuman research, are suitable to examine individual differences and yield non-negotiable answers with potential archival value. Discriminative techniques have their limitations, too-principally excess sensitivity that abridges their use to comparisons between similar-smelling stimuli. Research has begun to extend that range and may overcome the limitation. Application of discriminative methods may have the side-effect of shifting focus in structure-activity research from searches for molecular least common denominators that underlie often vague similarity to the search for molecular properties of importance in discrimination of small differences. (+info)
Comparing sensory experiences across individuals: recent psychophysical advances illuminate genetic variation in taste perception.
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Modern psychophysics has traveled considerably beyond the threshold measures that dominated sensory studies in the first half of this century. Current methods capture the range of perceived intensity from threshold to maximum and promise to provide increasingly accurate comparisons of perceived intensities across individuals. The application of new psychophysical tools to genetic variation in taste allowed us to discover supertasters, individuals who live in particularly intense taste worlds. Because of the anatomy of the taste system, supertasters feel more burn from oral irritants like chili peppers, more creaminess/ viscosity from fats and thickeners in food and may also experience more intense oral pain. Not surprisingly, these sensory differences influence food choices and thus health. A discussion of the milestones on the road to understanding genetic variation in taste must include discussion of some potholes as well. Often our failures have been as instructive as our successes in the effort to evaluate the impact of genetic variation in taste. (+info)
Effects of inhalation of essential oils on EEG activity and sensory evaluation.
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The purpose of this study was to investigate EEG changes in subjects directly after inhalation of essential oils, and subsequently, to observe any effect on subjective evaluations. EEG and sensory evaluation were assessed in 13 healthy female subjects in four odor conditions. Four odor conditions (including lavender, chamomile, sandalwood and eugenol) were applied respectively for each subject in the experiment. The results were as follows. 1) Four basic factors were extracted from 22 adjective pairs by factor analysis of the sensory evaluation. The first factor was "comfortable feeling", the second "cheerful feeling", the third "natural feeling" and the fourth "feminine feeling". In the score of the first factor (comfortable feeling), the odors in order of high contribution are lavender, eugenol, chamomile and sandalwood. 2) Alpha 1 (8-10 Hz) of EEG at parietal and posterior temporal regions significantly decreased soon after the onset of inhalation of lavender oil (p < 0.01). Significant changes of alpha 1 were also observed after inhalation of eugenol or chamomile. The change after inhalation of sandalwood was not significant. These results showed that alpha 1 activity significantly decreased under odor conditions in which subjects felt comfortable, and showed no significant change under odor conditions in which subjects felt uncomfortable. These results suggest a possible correlation between alpha 1 activity and subjective evaluation. (+info)