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Background: Previous research on alexithymia and depression has led to a controversy over whether alexithymia should be viewed as a state-dependent phenomenon or as a stable personality trait. The aim of this 5-year follow-up study was to examine the temporal stability of alexithymia in outpatients suffering from major depression. Methods: The study population comprised 116 (49 male and 67 female) outpatients with major depression. Alexithymic features were assessed with the Toronto Alexithymia Scale (TAS-20) and the degree of depression with the Beck Depression Inventory. The patients were retested after a period of 5 years. Results: Mean alexithymia and depression scores decreased significantly over the 5-year period. Alexithymia and depression were associated with each other, but the high test-retest correlations in the TAS-20 scores indicate relative stability of alexithymia. The three factors of alexithymia behaved differently. Difficulty in identifying feelings and difficulty in describing feelings were associated with alleviation of depressive symptoms, whereas externally oriented thinking was not. Conclusions: Alexithymia seems to be related with the severity of depression in outpatients with major depression, but it also shows relative stability over 5 years. Our findings support the view that the alexithymia construct represents a stable personality trait, but is also a state-dependent phenomenon.

Education and primary preventive measures provided individually by a podiatrist result in significant improvements in knowledge and foot self-care scores and in improvements in the prevalence of some minor foot problems. Long-term studies are needed to evaluate whether the intervention of podiatrists starting at an early phase would lead to a reduction in major foot problems.

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Abstract. Ha Èma Èla Èinen H, Ro Ènnemaa T, Halonen J-P, Toikka T (Social Insurance Institution, Turku; University of Turku, Finland). Factors predicting lower extremity amputations in patients with type 1 or type 2 diabetes mellitus: a population-based 7-year follow-up study. J Intern Med 1999; 246: 97± 103.Objectives. The aim of the study was to find factors predicting lower extremity amputation in patients with type 1 or type 2 diabetes mellitus through a 7-year follow-up period. Design. Follow-up study. Subjects. Altogether 733 diabetic patients, aged 10±79 years, were drawn from the national drug reimbursement register. Methods. At baseline, the patients underwent a podiatric, circulatory and neurophysiological examination. Seven years later a follow-up study was performed based on clinical and register data. Patient data for those who died during the followup were collected from hospital records and death certificates. All amputations were recorded. The patients with amputation were compared with the other patients and also, in a case-control manner, by taking three nonamputated patients matched by sex, type of diabetes, and age for each patient with amputation.Results. The number of amputations was 25 in the sample. Compared with all patients without amputation, patients with amputation differed in altogether 24 variables concerning diabetes and its complications. Compared with the matched nonamputated patients, the amputated patients had longer duration of diabetes, lower ankle/brachial pressure index (ABI), more often history of retinopathy, nephropathy, and hypertension, more often visual handicap, elevated serum creatinine level, abnormal neurophysiological indices and electrophysiological findings. In the logistic regression analysis, vibration perception threshold, low ABI, history of retinopathy, visual handicap, and male sex were independently associated with lower extremity amputation. Conclusions. Lower extremity amputations were strongly associated with retinopathy, nephropathy, and neuropathy. The presence of any of these complications should lead to intensified actions in order to prevent amputations. As far as arterial circulation is concerned, claudication or absent peripheral pulses were not good predictors of amputation, whereas low ABI, despite its known weaknesses, was a reliable indicator of future amputation.