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Sensation of smell does not determine nutritional status in patients with cystic fibrosis.

Poor nutritional status in patients with cystic fibrosis (CF) is associated with increased mortality. Patients with CF often have a decreased sensation of smell secondary to recurrent sinus infections or sinus surgery; in other CF populations, a decreased sensation of smell has been associated with poor nutritional status. We hypothesized that a decreased sensation of smell would be associated with worse nutritional status in patients with CF. We studied 50 (26 F and 24 M) of 58 consecutive patients with CF (86%) aged 14-53 years (28 +/- 8; mean +/- SD) who attended the University of Washington Medical Center from June 1994 to March 1995 and who agreed to participate. Demographic information was obtained, and nutritional status was assessed by ideal body weight, arm muscle area, arm fat area, pancreatic sufficiency, insulin-requiring diabetes, vitamins A and E levels, albumin, iron, iron binding capacity, ferritin, cholesterol, and zinc levels. Objective sensation of small was examined (Sensonics, Philadelphia, PA), a sinus compacted tomogram (CT) was performed, and a questionnaire for prior sinus symptoms, sinus surgery, medications, and subjective sensation of smell was administered. Twenty-seven of 49 subjects (55%) had an objective decrease in sensation of smell, 23/50 (46%) had had prior sinus surgery. 46/50 (92%) were pancreatic insufficient, and 8/50 (16%) were insulin-requiring diabetics. Weight for height ranged from the 38th to 157th percentile (100 +/- 18; mean +/- SD). Arm muscle area ranged from the < 5th to the 75th percentile (25 +/- 23; mean +/- SD). Arm fat area ranged from the < 5th to the 95th percentile (45 +/- 39; mean +/- SD). Sinus CT scans were abnormal in all patients (100%). Patients with anosmia were more likely to have had sinus surgery, but their nutritional status was no different from that of patients with a normal sensation of smell. We conclude that decreased sensation of smell is common in patients with CF, especially those with prior sinus surgery. Subjective sensation of smell and sinus CT scans were unreliable indicators of a decreased objective sensation of smell. In this pilot study, no association was found between sensation of smell and nutritional status.

Adolescent↗

Relation between anal electrosensitivity and rectal filling sensation and the influence of age.

PURPOSE: The aim of this study was to assess the effect of age and sex on the rectal filling sensation and anal electrosensitivity and to explore the relation between anal electrosensitivity and the parameters of the rectal filling sensation. METHODS: Anal mucosal electrosensitivity and anorectal manometry, including the rectal filling sensation test were performed in 19 control subjects; 10 were younger than 60 years and 9 were older than that. Altogether, there were 11 men and 8 women. RESULTS: Anal electrosensitivity did not differ between the two age groups. Women had a significantly lower electrosensitivity 4 and 5 cm from the anal verge than men, as well as a significantly shorter anal high-pressure zone. The rectal filling sensation did not differ between sexes. In the older age group, the rectal volumes required to induce filling sensations were smaller than those observed in the younger age group, but rectal pressures were comparable; as a consequence, rectal compliance was lower in older subjects. Anal electrosensitivity at different anal levels did not correlate with the rectal volume or pressure parameters of successive rectal filling sensations. The pressure recorded in the proximal anal canal at the consecutive rectal filling sensations strongly correlated with the rectal balloon pressure needed to elicit them. CONCLUSIONS: The zones of high anal electrosensitivity and high pressure seem to coincide. The fact that both are shorter in females did not influence the parameters of the rectal filling sensation. Lower rectal volumes but comparable rectal pressures were needed to induce the rectal filling sensation in the older age group. Rectal sensation did not correlate with anal electrosensitivity, probably because the receptors are not stimulated by the type of anal stimulation used or because different receptors are involved. Hence, the rectal filling sensation test cannot be replaced by the simpler anal electrosensitivity test.

Adult↗

Paradoxical heat sensation in healthy subjects: peripherally conducted by A delta or C fibres?

Paradoxical heat sensation upon cooling of the skin has been reported in central as well as in peripheral neurological conditions. In our study, we examined this phenomenon in 35 naive healthy test subjects, of whom 23 experienced paradoxical heat sensation under test conditions. We measured the peripheral conduction velocities of cold sensation, warm sensation and of paradoxical heat sensation by using a quantitative sensory testing model of indirect peripheral conduction velocity measurement. This was based on comparison of measurements at a proximal and a distal site using two measurement methods, one inclusive and the other exclusive of reaction time. We found that the conduction velocity of paradoxical heat sensation (0.70 m/s) was similar to that of warm sensation (0.68 m/s), and that the conduction velocity of cold sensation (7.74-8.01 m/s) was considerably faster. Thus, we conclude that paradoxical heat sensation in healthy subjects is conducted peripherally via slow unmyelinated C fibres and not via the faster A delta fibres. Consequently, we propose that paradoxical heat sensation is encoded via the heat sensing pathway, in accordance with the labelled-line code theory. The mechanisms proposed suggest a malfunctioning cold-sensing pathway disinhibiting the heat-sensing pathway, at peripheral, central or both levels, thus facilitating a paradoxical heat sensation.

Adolescent↗

Physiology of rectal sensations: a mathematic approach.

PURPOSE: The first awareness of balloon inflation (first sensation (FS)), flatus sensation (constant sensation (CS)), urge to defecate (UD), and maximum tolerated threshold (MTT) are the four commonly evaluated rectal sensations. The traditional view that these sensations are attributable to pelvic floor mechanoreceptor stimulation is challenged by current evidence in favor of rectal wall mechanoreceptors. The aim of this study was to determine the physiology of these sensations, using a dynamic mathematic model of the rectum. METHODS: In a group of 15 healthy adult volunteers (11 female and 4 male; median age, 51.5 (range, 31-74) years), the polynomial behavior of the two smooth muscle components of a dynamic mathematic model of the rectum was analyzed to find strain levels of smooth muscle activity in relation to corresponding strain levels of each of the four "rectal" sensations. RESULTS: Longitudinal and circular smooth muscle relaxation appeared to be the rate detection and signaling mechanisms, respectively. The latter triggered sensations of CS, UD, and MTT. FS was an anal canal sensation, related temporally with onset of rectoanal inhibitory reflex. In vitro validation of the model suggested MTT to be a physiologic protective mechanism associated probably with tetanic smooth muscle contraction. CONCLUSIONS: Evaluation of rectal sensations should be confined to CS and UD because MTT is painful and does not contribute any additional information, and FS is not a true rectal phenomenon.

Adult↗

Corneal sensation after laser epithelial keratomileusis for the correction of myopia.

BACKGROUND: Subepithelial nerve fibre bundles and stromal nerves are damaged during laser epithelial keratomileusis (LASEK). The aim of this study was to investigate the recovery of corneal sensation after LASEK for the correction of myopia. METHODS: Corneal sensation was evaluated in 40 eyes of 20 patients using a Cochet-Bonnet aesthesiometer before surgery and 3 days, 14 days, 1, 3 and 6 months after LASEK for the correction of mild to moderate myopia (range -2.5 D to -8.0 D). At every examination corneal sensation was tested in the apex of the cornea and in one point each at the 12, 3, 6 and 9 o' clock positions 2 mm from the centre of the cornea. RESULTS: Corneal sensation was significantly reduced at 3 days and 14 days after surgery (P<0.01). The loss of corneal sensation was greatest 3 days after surgery and corneal sensation increased during the first month after LASEK. After 1 month, 3 months and 6 months no significant difference was found between preoperative and postoperative sensation. There was no significant difference in sensation between different areas of the cornea after LASEK. CONCLUSIONS: Corneal nerves are disrupted during LASEK surgery and the procedure results in a significant reduction in corneal sensation. During the first month after surgery the depressed corneal sensation improved and subsequently went back to preoperative values, staying stable 3 months and 6 months after surgery.

Adult↗

Presence of lobeline-like sensations in exercising patients with left ventricular dysfunction.

Since there is evidence that lobeline-induced sensations, associated with discomfort in the mouth, throat and chest arise by stimulating juxtapulmonary or J receptors, we were interested in investigating if similar sensations are felt by patients with left ventricular dysfunction (LVD) in whom a natural stimulation of these receptors would occur by transient interstitial oedema or during augmentation of the stimulus, by increased pulmonary blood flow during exercise. Threshold doses of lobeline produced three or more respiratory sensations simultaneously in 9 out of 10 patients, which was greater than the response of the controls (P < 0.01). With mild exercise, a greater number of patients (7) than controls (1) reported feeling two or more sensations (P < 0.01); in fact half the controls did not express a respiratory sensation with equivalent exercise (P < 0.05). The predominant lobeline-like sensations reported by patients with exercise were a feeling of heat or burning and pressure in the throat or chest (P < 0.05). The presence of cough in three patients and in none of the controls was noteworthy. The mean latency with which sensations appeared during exercise in patients (4.4 +/- 0.3 min) was almost half that in controls (7.4 +/- 0.2 min) (P < 0.005). Since, respiratory sensations in response to lobeline and exercise were intensified in patients compared to controls and since both lobeline and exercise-induced sensations were similar (P < 0.05), we speculate that a common origin exists. Despite important caveats, that we discuss, in our view these respiratory sensations and cough arise from stimulation of J receptors.

Adult↗

The effect of punctal occlusion on tear production, tear clearance, and ocular surface sensation in normal subjects.

PURPOSE: To evaluate the effect of temporary punctal occlusion on tear production, tear clearance, and ocular surface sensation in normal subjects. METHODS: Noncomparative interventional case series. Punctal occlusion with silicone punctal plugs was performed on nine normal subjects without complaints of ocular irritation and no known history of ocular surface disease. The lower punctum of both eyes was occluded in five subjects. The upper and lower puncta of only one eye were occluded in four subjects. Corneal and conjunctival sensations were measured with the Cochet-Bonnet anesthesiometer. Tear fluorescein clearance was evaluated with a CytoFluor II fluorophotometer by measuring the fluorescein concentration in minimally stimulated tear samples collected from the inferior tear meniscus 15 minutes after instillation of fluorescein. Schirmer test was performed without anesthesia. The tests were performed at days 0, 1, 3, 7, and 14 to 17 after punctal occlusion. Relationships were analyzed with linear regressions, and a quadratic term was used to model a return to preocclusion levels. Paired t test was used to study the change in tear fluorescein concentration. RESULTS: In subjects who had the lower puncta of both eyes occluded, conjunctival sensation decreased in both eyes (right eye, P =.008; left eye, P =.003), but there was no change in corneal sensation. Their tear fluorescein clearance did not show a significant change from baseline (P =.90). However, a decrease in Schirmer test scores approached statistical significance (P =.056). In subjects with both puncta of only one eye occluded, we noted a decrease in corneal sensation (occluded eye, P =.042; nonoccluded eye, P =.036), conjunctival sensation (occluded, P =.001; nonoccluded, P =.060), and Schirmer scores (occluded, P =.022; nonoccluded, P =.011). Linear regression did not show a significant change in tear fluorescein clearance for either eye (occluded, P =.28; nonoccluded, P =.44). However, paired t test showed a significant worsening of tear clearance in the occluded eye from day 0 to day 3 (P =.001) followed by a subsequent improvement in tear clearance from day 3 to the end of the study period (P =.045). Paired t test did not reveal any significant changes in tear clearance in the nonoccluded eye. The quadratic term of the linear regression model demonstrated an increase toward preocclusion levels that approached statistical significance for corneal sensation (occluded, P =.053; nonoccluded, P =.099). It was statistically significant for conjunctival sensation (occluded, P =.001; nonoccluded, P =.045) and Schirmer scores (occluded, P =.047; nonoccluded, P =.044). CONCLUSIONS: Temporary punctal occlusion in normal subjects decreases tear production and ocular surface sensation. Our findings suggest that in addition to blocking tear drainage, punctal occlusion may affect the ocular surface/lacrimal gland interaction. These effects were more pronounced in subjects with both upper and lower puncta occluded. In normal subjects, there appears to be an autoregulatory mechanism to return tear production, tear clearance, and ocular surface sensation to preocclusion levels 14 to 17 days after punctal occlusion.

Conjunctiva↗

Patients' sensations after breast cancer surgery. A pilot study.

PURPOSE: The purpose of this study was to obtain information about the prevalence and characteristics of breast sensations after breast cancer surgery, the impact they had on patients, and aggravating and relieving factors. DESCRIPTION OF STUDY: Within 1 month after the date of their surgery, 132 patients with breast cancer completed an instrument rating the prevalence, severity, and level of distress of breast sensations. Information also was obtained on the impact that those sensations had on activities of daily living and factors that triggered and provided relief from sensations. RESULTS: Certain sensations remain prevalent (numb, tender), severe (burning, sharp), and distressing (cramping, painful). Overall these sensations significantly interfered with patients' activities of daily living. Certain activities (movement, position change) triggered sensations, while others (position change, medication) provided relief. CLINICAL IMPLICATIONS: Healthcare professionals can use the information learned from this pilot study to educate patients both preoperatively and postoperatively about prevalent breast sensations after surgery for breast cancer and about the types of activities that may aggravate or relieve these sensations. As patient educators and advocates, oncology professionals must continue to explore the long-term effects and treatment options to provide optimal care and support to patients who have or are likely to have post-surgical breast sensations. More studies are needed to explore long-term effects and treatment options.

Activities of Daily Living↗

[Disturbance of deep sensation in medial medullary syndrome. Topographical localization of medial lemniscus in the medulla oblongata].

Medial medullary infarction is characterized by ipsilateral hypoglossal nerve palsy with contralateral hemiparesis and disturbance of deep and discriminative sensory perception. We examined the extent and distribution of disturbances in deep sensation and compared the findings with the lesion location in the medial lemniscus detected by MRI in 3 patients with medial medullary infarction. We classified the lesion location into 2 groups; type I and type II. Type I was ventral to the middle medial lesion of the medial lemniscus, and type II was ventral to the dorsal medial lesion. In our series, type I (Case 1) impairment of the three kinds of deep sensations was more severe in the lower extremities than in the up-per extremities. In type II (Cases 2, 3) the severity or impairment in the upper extremities was moderate or severe and nearly equal to that in the lower extremities. There was no difference in the severity of impairment for the four kinds of discriminative sensations. In the literature, type I (8 patients) impairment of position sense in deep sensation was found in 1 of 7 patients in the upper extremities and 5 of 7 patients in the lower extremities. Impairment of vibration sense was found in 1 of 7 patients in the upper extremities and in all patients in the lower extremities. In type II (14 patients) severe impairment of position and vibration sense in deep sensation was found in 3 patients in the upper extremities equal to that in the lower extremities. There was no tendency in the severity of impairment of four kinds of discriminative sensations. Including our 3 cases and 22 in the literature, impairment of deep sensation was more severe in the lower extremities than in the upper extremities in type I (9 patients) and the extent was none (7), mild or moderate (2) in the upper extremities, mild (2), moderate (1), severe (2), obscure (4) in the lower extremities, while in type II (16 patients) the severity in the upper extremities was nearly equal to that in the lower extremities and the extent was none (1), mild or moderate (1), severe (5), obscure (9) in the upper extremities, none (2), mild or moderate (1), severe (6), obscure (7) in the lower extremities. It is concluded that hemiparesis appeared with lesions located in the pyramidal tract of the medulla, hemiparesis and disturbance of deep sensation in the upper and lower extremities, predominantly in the lower extremities with the lesion of the pyramidal tract to the middle of medial lemniscus in the medulla, hemiparesis and disturbance of the upper and lower extremities deep sensation with lesions of the pyramidal tract to the whole of the medial lemniscus in the medulla. Evaluating deep sensation of the upper and lower extremities is useful for speculation of the lesion location in the medial lemniscus in medial medullary infarction.

Cerebral Infarction↗

Sensation seeking and auditory evoked potentials.

The relationship between auditory evoked potentials (AEP) and the German version of Zuckerman's Sensation Seeking Scale was examined. The slope of the amplitude/stimulus intensity function (N1/P2 component) and the N1 latency were particularly studied, as these variables have been found to be potential predictors of the response to lithium prophylaxis. Thirty-three healthy subjects participated in two testing series on the first day and in a third run 3 weeks later. Binaural clicks at four intensity levels (58, 68, 78, 88 dB HL, ISI 2.1 sec) were presented in randomized order by headphone. Eighty responses were averaged at each intensity level. The pattern of correlation between the German version of the Sensation Seeking Scale and a personality inventory (FPI) supports the validity of the Sensation Seeking Scale. Only a tendency toward steeper slopes of the amplitude/stimulus intensity function (ASF) in high sensation seekers was observed in the first run. However, there was a significant interaction of sensation seeking and the test run. Only high sensation seekers showed an influence of retesting on the slope of the ASF, leading to a decrease of the slope in the second, compared with the first run. This might correspond to the psychological pattern of sensation seeking, which is characterized by a permanent need for new and exciting situations and, at the same time, by a rapid loss of interest in these situations. With regard to the N1 latency, a significant interaction of sensation seeking and lead was found. Low sensation seekers showed longer N1 latencies over the right than over the left hemisphere, a finding that accords with some psychophysiological theories on the relation between asymmetric hemispherical activation and certain psychological constructs. Our results support the view that sensation seeking is a personality feature that is closely related to certain physiological variables.

Adult↗

Characterization of obese individuals who claim to detect no relationship between their eating pattern and sensations of hunger or fullness.

OBJECTIVE: To study the phenomenon that obese subjects show considerable individual variability in their reported relationships between eating and sensations of hunger and fullness. DESIGN: A laboratory study of the relationship between eating behaviour traits and the episodic oscillations in sensations of hunger and fullness in response to obligatory, fixed energy breakfast (481 kcal) and lunch (675 kcal) meals. SUBJECTS: Obese subjects were divided into two groups based on their responses to four 'screening' questions associated with their habitual experience of hunger and fullness sensations before and after eating: those who experienced sensations of hunger and fullness related to eating (Related-R; n=20, body mass index (BMI)=42.4 kg/m(2)) and those for whom eating was not related to hunger or fullness sensations (Unrelated - UR; n=19, BMI=41.3 kg/m(2)). In addition, a control, lean group (Control - C; n=14, BMI=22.6 kg/m(2)) who experienced sensations of hunger and fullness related to eating was studied. MEASUREMENTS: The Three-Factor Eating Questionnaire (TFEQ) was used to measure the eating behaviour traits, disinhibition, restraint and hunger. Profiles of subjective appetite sensations were continuously monitored across the day using visual analogue scales. RESULTS: All groups displayed clear meal-related oscillations in subjective sensations of hunger, fullness, desire to eat and prospective consumption. In contrast, the TFEQ disinhibition and hunger scores (but not restraint scores) were significantly different (P<0.05) between the groups ((UR; D=13.5+/-0.5, H=10.0+/-0.5), R (D 7.5+/-0.6, H 6.1+/-0.4), C(D 3.7+/-0.5, H 3.7+/-0.5)). In addition, analysis of the intra-meal changes in subjective appetite sensations revealed that the UR group displayed a smaller meal-induced suppression of hunger and elevation of fullness. CONCLUSION: These data indicate that the reported relationship between eating and hunger/fullness was associated with obese individuals showing high or low disinhibition scores. In addition, the data suggest that the processes underlying disinhibition may be associated with a modulation of the recognition of meal-related satiety sensations.

Adult↗

Acupuncture needle sensations associated with De Qi: a classification based on experts' ratings.

BACKGROUND: Many English language words have been used to describe the acupuncture needle sensation known as de qi, words such as dull, aching, and spreading. However, there is little agreement on which actual words are acceptable as descriptors. In experimental trials of acupuncture in which the needle sensation is an important variable, a quantitative measure is needed to monitor and control for variability in de qi. METHODS: An established scale in the literature provides a list of 25 sensations associated with acupuncture needling that patients might experience. An international group of acupuncture experts rated these 25 sensations in two categories: those predominantly associated with de qi and those with acute pain at the site of needling. For each category, sensations were classified into hierarchic clusters, one for de qi and one for acute pain, and the results were presented in dendrograms. RESULTS: Twenty-nine international experts were invited to participate; 22 (76%) responded and 20 completed the questionnaire. On average, they had 21 years' experience in acupuncture practice (range 10-30 years). Seven sensations were found to be in the cluster associated with de qi: aching, dull, heavy, numb, radiating, spreading, and tingling. Nine sensations were found to be in a cluster associated with acute pain at the site of needling: burning, hot, hurting, pinching, pricking, sharp, shocking, stinging, and tender. The experts also raised a number of issues regarding the limitations of the questionnaire used, providing useful data for future research. CONCLUSIONS: Data from experienced acupuncturists have been analyzed to provide two separate clusters of sensations associated with acupuncture needling: a de qi cluster and an acute pain cluster. In the design of experimental trials involving acupuncture needling, researchers will find these two clusters of sensations useful for monitoring and controlling for variation in needle sensation.

Acupuncture Points↗

Alcohol consumption, sensation seeking and ski injury: a case-control study.

OBJECTIVE: Alcohol consumption is known to be associated with both risk of accidental injury and with sensation seeking, and sensation seeking has been found to be common among those engaging in such high-risk activities as skiing. However, few studies have examined the joint association of alcohol consumption and sensation seeking on injury. METHOD: Alcohol consumption prior to injury and sensation-seeking disposition are analyzed on 389 injured skiers (clinic sample) and 899 randomly selected uninjured skiers (trailside sample) at a Northeastern ski resort. Cases and controls were asked questions pertaining to drinking within 24 hours, amount consumed, time lapsed between the last drink and the event, skiing ability, and sensation seeking. RESULTS: The clinic sample was more likely to be female, to have less skiing experience, to score lower on sensation seeking and to have been drinking within 24 hours compared to the trailside sample. However, they were less likely to have had six or more drinks within 24 hours and were more likely to report a greater time lapse between the last drink and injury or interview. A larger proportion of those who reported drinking in both samples scored high on sensation seeking compared to those who reported not drinking. Logistic regression analysis found the following variables predictive of ski injury: female, low on sensation seeking, amount of alcohol consumed prior to the event, a longer time lapsed between drinking and the event, time of day (later) and day of the week (weekend). CONCLUSIONS: The data suggest that, while drinking within 24 hours is positively associated with sensation seeking, drinking and not sensation seeking is positively predictive of injury. Drinking at least 12 hours prior to skiing, not drinking in close proximity to skiing, may increase risk for accidental injury, possibly due to a hangover or residual alcohol effect in which fatigue may play a part.

Adolescent↗

Report of altered sensation in patients with cleft lip.

OBJECTIVE: To determine whether patients with cleft lip have normal perioral sensation. DESIGN: Each subject was carefully questioned about the following: sensation in the face at rest, light touch of different areas, and sensation in natural situations (e.g., exposure to cold weather) that reveal sensory abnormalities. A cotton-tip applicator stick was stroked lightly across the facial skin. The subject's descriptions of the evoked sensations were used to identify and outline areas with abnormal sensation. SETTING: Data were obtained from subjects participating in a longitudinal, university-based study of the functional outcomes of lip revision surgery. PATIENTS: Seventeen patients with cleft lip and 12 control subjects (aged 7 to 22 years, mean 12.9 years) participated. RESULTS: In contrast to control subjects, 9 of 16 patients (56%) reported loss in sensation, described as decreased touch, scratch, tickle, or tingle intensity. Six other patients (38%) reported additional sensation, described as increased scratch, tickle, or tingle intensity. In eight patients, the altered sensation was restricted to the skin area flanking and including the visible scar, encompassing no more than 25% of the total area bound by the inferior nose, nasolabial grooves and inferior vermilion. In seven patients (unilateral cleft), the altered area extended to the contralateral, noncleft side of the upper lip or onto the philtrum. CONCLUSIONS: In contrast to the literature, sensation in the upper lip of many patients with cleft lip is not normal. Loss in sensation is exhibited most commonly and limited largely to the skin overlying tissues traumatized during reconstructive surgery.

Adolescent↗

Sensation seeking as it relates to burnout among emergency medical personnel: a Texas study.

INTRODUCTION: Burnout among emergency medical personnel (EMP) is suspected, but largely unsupported in the literature. An investigation of the phenomenon of burnout and factors contributing to its existence are essential steps in designing effective interventions. RESEARCH QUESTIONS: Three research questions were proposed: 1) Are EMP sensation seekers as measured by Arnett's Inventory of Sensation Seeking? 2) Are EMP burnt out as measured by Revicki's Work-Related Strain Inventory? 3) Is there a relationship between sensation seeking and burnout among EMP? METHODS: Emergency medical personnel attending a statewide conference in Texas, USA in late 1996 completed 425 survey instruments measuring sensation seeking and burnout as well as demographic items. Survey instruments were included in each registrant's conference package. Completed surveys were deposited anonymously in labeled receptacles throughout the statewide conference site. Data collection ceased at the end of the conference. RESULTS: EMP had significantly higher sensation-seeking total and intensity subscale scores than the general public. Full-time employees reported more sensation-seeking than volunteers or part-time employees. The younger the EMP, the greater were their reported sensation seeking tendencies. EMP reported more burnout in 1996 than in 1991. The older the EMP, the lower was the reported level of burnout. EMP who sought counseling for a work-related event reported more burnout than those who did not. Paid full-time EMP reported higher burnout than did volunteers. There was a weak but positive correlation between sensation seeking and burnout, suggesting that these two dimensions may be unrelated. CONCLUSIONS: The field of emergency medical services attracts sensation seekers, and EMP today report more burnout than their counterparts did in 1991. Although EMP appear to be high in sensation seeking, this dimension alone does not protect them from the effects of burnout.

Adult↗

The effect of hinge position on corneal sensation and dry eye after LASIK.

PURPOSE: To investigate the effect of hinge position on corneal sensation and dry eye syndrome after laser in situ keratomileusis (LASIK). DESIGN: Prospective, randomized, self-controlled trial. PARTICIPANTS: Fifty-two patients >/=18 years of age undergoing bilateral LASIK. INTERVENTION: Patients underwent bilateral LASIK with the superior-hinge Hansatome microkeratome in one eye and the nasal-hinge Amadeus microkeratome in the other eye. In all eyes, the flaps were 160 micro m thick, with a diameter of 9.5 mm. MAIN OUTCOME MEASURES: Masked Cochet-Bonnet esthesiometry was performed centrally before surgery and at 1 week, 1 month, 3 months, and 6 months after surgery. Dry eye was evaluated at the same time intervals with lissamine green corneal and conjunctival staining, Schirmer testing with anesthesia, and tear-film breakup time. Subjective evaluation of dry eye sensation was performed at 3 and 6 months after surgery. RESULTS: Corneal sensation was reduced in eyes with either superior- or nasal-hinge corneal flaps at 1 week, 1 month, and 3 months after surgery (P < 0.001). Compared with preoperative values, a significant reduction in corneal sensation remained at 6 months in corneas with superior-hinge flaps (P < 0.001) but not in corneas with nasal-hinge flaps (P = 0.263). Mean corneal sensation was greater in corneas with a nasal-hinge flap compared with corneas with a superior-hinge flap at all postoperative visits (P < 0.001). The loss of sensation was greatest at 1 week and showed improvement at each subsequent time interval up to 6 months. Overall, dry eye signs and symptoms were greatest during the immediate postoperative period and improved at all subsequent time intervals. Dry eye signs and symptoms were generally greatest in the eyes with a superior-hinge flap and milder in eyes with a nasal-hinge flap. CONCLUSIONS: The long posterior corneal nerves, which innervate the cornea, enter the eye at 3- and 9-o'clock. A superior-hinge flap transects both arms of the neuroplexus, whereas a nasal hinge transects only the temporal arm. LASIK results in a significant reduction in corneal sensation. Corneal sensation and dry eye signs and symptoms decreased immediately after LASIK and improved at all time periods between 1 week and 6 months in eyes with both a nasal-hinge flap and a superior-hinge flap. However, the loss of corneal sensation and presence of dry eye syndrome were greater in eyes with a superior-hinge flap than in eyes with a nasal-hinge flap.

Adult↗

Investigation into the correlation between sensation and leg movement in restless legs syndrome.

We evaluated rest effects on restless legs syndrome (RLS) sensory and motor symptoms. During two 60-minute Suggested Immobilization Tests (SIT) subject's signals of RLS leg sensations and periodic leg movements while awake (PLMW) were recorded. Sensations, PLMW, sensations preceding or after PLMW, sensations occurring without following PLMW, and PLMW occurring without preceding sensation were determined. The RLS patients were divided into equal-sized high and low PLMW groups for further analysis. Data from 46 subjects (28 RLS and 18 controls) revealed sensations increased linearly with rest in RLS patients and controls. Movement rate increased linearly with rest for controls but increased rapidly for the first 45 minutes for all RLS patients. PLMW/hour increased with further rest for low but not high PLMW patients. Sensations followed by PLMW and PLMW without preceding sensations followed similar patterns. Sensations without subsequent PLMW increased dramatically in the last 15 minutes of the SITs. Whereas both sensory and motor signs of RLS increase with rest, there is minimal increase for controls. Patients with higher but not lower PLMW rates reached a ceiling for PLMW after 35 to 40 minutes. The temporal dissociation between sensory and motor events supports viewing these motor and sensory events as separate but loosely linked manifestations of RLS.

Aged↗

Frequency-volume charts: a tool to evaluate bladder sensation.

AIMS: Bladder sensation is routinely evaluated by cystometric bladder filling and electrical stimulation. These methods require catheterization and stimulate the bladder artificially. In this study, we evaluated whether frequency-volume charts can be used as a non-invasive tool to study bladder sensation during normal daily life. Furthermore the agreement between sensory data obtained from frequency-volume charts and conventional cystometric bladder filling is studied. MATERIALS AND METHODS: Fifteen healthy female students filled out frequency-volume charts at home and scored the grade of perception of bladder fullness at each micturition. They also measured the volume of three voidings after postponing micturition as long as possible. Sensation of bladder filling was finally evaluated during cystometry. RESULTS: On frequency-volume charts, 65% of all voidings was made without desire to void, only 9.5% was with strong desire. Urgent desire to void was not reported except after voluntarily postponing micturition. Higher grades of perception of fullness were associated with significantly higher voided volumes. Mean volumes for the different sensations of fullness on the charts were not significantly different from volumes at different sensations reported during cystometry. CONCLUSIONS: In conclusion, bladder sensation during daily life can be evaluated by scoring the grade of perception of fullness on frequency-volume charts. During life voiding usually occurs without desire to void. The voided volumes at different sensations of fullness are comparable to the volumes at different sensations of filling during cystometry. Therefore, frequency-volume charts with evaluation of perception of fullness may provide an initial non-invasive tool to study bladder sensation.

Adolescent↗