Clinical factors associated with pain in acute myocardial infarction

In an unselected population of 921 consecutive patients with acute myocardial infarction admitted to one single hospital, regardless of age and whether they were admitted to the coronary care unit or not, we describe the course of pain during hospitalization. Patients with a history of angina pectoris, patients with a particularly long delay time, and patients not transported by ambulance had the longest duration of pain.     

Risk factors associated with incisor injury in elementary school children

This study examined risk factors associated with incisor injury in 3396 third and fourth grade school children in Alachua County, Florida. One of six orthodontists completed a standardized examination form for each child to assess severity of incisor injury, gender, age, race, skeletal relationships, morphologic malocclusion, incisor exposure, interlabial gap, TMJ sounds, chin trauma, and history of lower facial trauma. One in five (19.2%) exhibited some degree of incisor injury. This was limited to a single tooth in 73.1% of those with injury, while enamel injury predominated (89.4%). The majority of the injuries (75.4%) were localized in the maxillary arch, with central incisors the most frequently traumatized. Chi-square tests of association indicated that gender, race, school, orthodontist, history of lower facial trauma, chin trauma, profile, and maxillary and mandibular horizontal positions were associated with incisor injury (P < 0.05). Wilcoxon rank sum tests identified differences in age, overjet, time of screening, and interlabial gap between those with and without injury (P < 0.05). Results of logistic regression analyses indicated risk of incisor injury was greater for children who had a prognathic maxilla, a history of trauma, were older, were male, and had greater overjet and mandibular anterior spacing.     

Is self-concealment associated with acute and chronic pain?

Objective: Self-concealment is the predisposition to hide negative personal information. The present research examined whether self-concealment was associated with acute and chronic pain. Methods: In Study 1, undergraduate students (N = 44) completed an online questionnaire packet and then completed a cold-pressor task in the laboratory. In Study 2, individuals with chronic pain (N = 85) completed an online survey. Results: Study 1: Trait self-concealment was negatively associated with pain tolerance. Study 2: Self-concealment of chronic pain (hiding aspects of one's chronic pain condition from others) was associated with higher levels of self-reported pain and lower psychological well-being, independent of disclosure of feelings regarding pain. Furthermore, this association was mediated by autonomy and competence needs. Conclusions: Self-concealment was found to be associated with higher levels of pain in both healthy and chronic pain samples. Moreover, the findings also suggest that intervention methods using the self-determination theory framework (i.e., autonomy and competence supportive) might be effective for individuals with chronic pain. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

The potential risk factors associated with acute viral hepatitis in children under 5 years old]

In studies of the effects of salt intake on blood pressure (SBP, MBP, DBP), influences on heart rate (HR) are usually neglected even though the longterm load on both left ventricle (LV) and systemic arteries (SA) is better related to the product of HR x SBP (or MBP) than to pressure alone. After all, altered salt intakes often induce considerable volume-related changes in HR, and the heart operates more economically at low HR and high stroke volume (SV). Thus, about 3/4 of LV metabolism is used for the build-up of systolic tension, while the cost for SV expulsion, or for SV increases, is far lower. Moreover, low HR prolongs the diastolic period, so important for LV coronary supply. Against this background we have used results from studies in both rats and man, in which both BP and HR were followed during marked changes in salt intake, to explore how this affected the HR x SBP (or HR x MBP) product. Briefly, in ordinarily salt-resistant organisms, whether normo- or hypertensive, salt intake increases, which in man ranged from 10-20 to 250-300 mM (in rats over 100-fold), if anything reduced the computed longterm load (HR x SBP, or MBP) on LV and SA, as consequences of an efficient reflex volume control. By contrast, in salt-sensitive man, HR reflex reductions to increased salt intake were almost absent despite substantial SBP elevations, suggesting the influence of a CNS suppression of bulbar reflex centres combined with CNS neurohormonal interference with renal salt volume excretion, as in SHR.     

Risk factors associated with fluorosis in a non-fluoridated population in Norway

BACKGROUND: Expression of the HER-2/neu oncogene has been suggested to confer added virulence or aggressive behavior in gynecologic malignancies. The aim of this study is to determine the frequency of HER-2/neu expression in invasive cervical cancer and its impact on survival in women with cervical cancer. DESIGN: Archival tissue from 150 patients with cervical carcinoma was evaluated immunohistochemically for HER-2/neu oncoprotein expression. Survival information was retrieved retrospectively from patients' medical records. RESULTS: The HER-2/neu expression was observed in 34 out of 150 tumors (22%). The HER-2/neu positive tumors exhibited considerable heterogeneity in the distribution of immunoreactive tumor cells. Tumor grade and histology did not influence the pattern or intensity of HER-2/neu expression. There was no statistically significant difference in survival of patients with HER-2/neu positive and those with HER-2/neu negative tumors (P = 0.50). Tumor stage at diagnosis was the only covariate with prognostic significance in patient survival (P < 0.001). CONCLUSION: Expression of HER-2/neu oncogene is a rare event in cervical cancer. Immunohistochemical detection of HER-2/neu expression is neither a predictor of survival of patients with cervical cancer nor does it identify subgroups of patients at higher risk for recurrence of disease.     

Outcome and predictive factors in children with chronic idiopathic musculoskeletal pain

The 18S rDNA sequences of the six most common European Lymnaeidae species (Mollusca:Gastropoda:Basommatophora) have been obtained by direct PCR cycle sequencing and silver staining methods. The sequence alignment and secondary structures of the 18S rRNA gene of Lymnaea stagnalis, L. auricularia, L. peregra, L. palustris, L. glabra, and L. truncatula are analyzed. This gene proves to be a good marker for both specific determination and supraspecific lymnaeid phylogeny. The malacological importance is evident, considering the specific determination problems of individual snails and the present systematic chaos in Lymnaeidae due to their pronounced morphoanatomic uniformity, which makes a classification by traditional methods impossible. The majority (17) of the total of 43 nucleotide-substituted positions appears to be confined to a small region included in helix E10-1 of the variable region V2, enabling species group distinction: (1) the first sequence is common to L. auricularia and L. peregra; (2) the second sequence is unique to L. truncatula; and (3) the third sequence is identical for L. glabra, L. palustris, and L. stagnalis. The other 26 nucleotide-substituted positions are dispersed over the entire gene, although four grouped nucleotide positions in helix 6 of V1 are of interest in distinguishing L. glabra from both L. palustris and L. stagnalis. The phylogenetic trees obtained by comparison with four other molluscan species (a polyplacophoran, two bivalves, and a stylommatophoran gastropod) show the presence of four well-defined subgenera among the genus Lymnaea sensu lato: (1) Lymnaea (Radix), (2) Lymnaea (Galba), (3) Lymnaea (Leptolimnaea), and (4) Lymnaea (Lymnaea). Two branches, L. auricularia-L. peregra-L. truncatula and L. glabra-L. palustris-L. stagnalis, are worth mentioning from the parasitological point of view, since the two digenean species of large medical and veterinary impact transmitted by lymnaeids, Fasciola hepatica and F. gigantica, appear to be linked to the first branch.     

Risk factors associated with mucositis in cancer patients receiving 5-fluorouracil

Oral mucositis is a dose-limiting toxicity of 5-fluorouracil (5-FU). This prospective cohort study investigated factors associated with mucositis in patients receiving 5-FU for cancer of the digestive tract. Sixty-three patients (mean age 65 years) completed self-administered questionnaires and had interviews, oral examinations and unstimulated whole salivary flow measurements at baseline and follow-up appointments. The duration of follow-up was 2 months. Predictor variables included sociodemographic data, body surface area, diabetes, smoking, alcohol consumption, salivary flow, oral hygiene, presence of prostheses, performance status, regimen of cytotoxic drugs, hematological data, and herpes simplex virus antibody titer. Forty-six per cent of patients developed at least one episode of oral mucositis during cytotoxic treatment. Pearson's chi-square analysis showed that mucositis was significantly associated with xerostomia at baseline, xerostomia during chemotherapy, and lower baseline neutrophil counts (P < or = 0.05). Multiple logistic regression analysis indicated that xerostomia at baseline (odds ratio, OR = 10.0), or baseline neutrophil level under 4000 cells/mm3 (OR = 3.9) were significant predictors of mucositis. Taking into account the effect of neutrophil level at baseline, xerostomia during chemotherapy (OR = 4.5) was also a significant predictor of mucositis. The results showed that xerostomia and lower baseline neutrophil levels are significantly associated with oral mucositis. These variables should be taken into consideration in the design of intervention studies to reduce the frequency and severity of mucositis. More research is required to investigate the role of saliva and neutrophils in the pathogenesis of chemotherapy-induced mucositis.     

Risk factors for adverse cutaneous reactions associated with intravenous vancomycin

We retrospectively studied adverse cutaneous reactions associated with intravenous vancomycin therapy over a 14-month period when two different brands of vancomycin were used. Of 224 adults, 12 (5.4%) had infusion-related reactions; ten of 174 patients who received more than one day of vancomycin (5.7%) had delayed cutaneous reactions. Age less than 40 years was a risk factor for both infusion-related and delayed reactions by both univariate and multivariate analysis. Duration of therapy greater than 7 days was a risk factor for delayed reactions. There was a significant increase in adverse cutaneous reactions associated with the use of a particular batch of vancomycin, although analytical testing of this batch failed to identify any difference from other batches associated with routine rates of adverse reactions. Awareness of vancomycin-associated infusion-related and delayed cutaneous reactions is necessary, and the risk factors associated with these reactions may have important clinical implications.     

Risk factors associated with recidivism among extrafamilial child molesters.

This study examined the predictive efficacy of 10 rationally derived, archivally coded variables for assessing reoffense risk among extrafamilial child molesters. Follow-up data on 111 child molesters who were discharged from the Massachusetts Treatment Center between 1960 and 1984 were used. Degree of sexual preoccupation with children, paraphilias, and number of prior sexual offenses predicted sexual recidivism. Juvenile and adult antisocial behavior, paraphilias, and low amount of contact with children predicted nonsexual victim-involved and violent recidivism. Area under the receiver-operating characteristic curves in all three analyses indicated discrimination that was substantially better than chance, ranging from .73 to .79. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Community survey of factors associated with consultation for low back pain

OBJECTIVE: To investigate the psychosocial factors associated with consultation for low back pain. DESIGN: Two phase cross sectional postal survey. SETTING: Bradford Metropolitan Health District. SUBJECTS: 1813 adults responding to the phase 1 questionnaire. 540 of the 782 with an episode of low back pain in the past 12 months completed the second questionnaire. MAIN OUTCOME MEASURES: Six psychosocial constructs. RESULTS: 406 (52%) of the respondents reporting back pain in the past 12 months had not consulted a health professional. Logistic regression showed that consultation was associated with externalised beliefs regarding pain management (odds ratio 3.6; 95% confidence interval 2.1 to 6.0). Duration of pain affected the factors associated with consultation. Consultation for episodes lasting less than two weeks (n=290) was associated with greater than median pain (3.0; 1.7 to 5.5), consultation for episodes over two weeks (n=243) was associated with increased disability (3.7; 1.5 to 9.0), and consultation for episodes over three months (n=143) with increased depression (3.9; 1.3 to 11.8). CONCLUSIONS: The results support a role for psychosocial factors in consultation for low back pain and suggest that the reasons for consultation vary with duration of pain. Duration of the episode may be a useful guide to management of non-specific low back pain.     

Risk factors for mortality among hospitalized children with persistent diarrhoea in Pakistan

We evaluated factors associated with mortality among a cohort of malnourished children with persistent diarrhoea (PD) admitted for nutritional rehabilitation with a defined rice-lentil (Khitchri) and yoghurt diet. Of 302 children consecutively admitted with PD, 13 (4 per cent) died, mostly (62 per cent) within 72 h of admission. Univariate analysis of risk factors at admission associated with mortality indicated significantly increased risk of death with severe stunting [relative risk (RR) 3.1, 95 per cent confidence interval (CI) 1.1-9.0], hypoalbuminaemia (RR 4.3, 95 per cent CI 1.5-12.3), stool frequency > 12/day (RR 6.0, 96 per cent CI 2.0-17.6), stool volume > 100 g/kg/day (RR 10.7, 95 per cent CI 3.0-37.6) and severe dehydration (RR 7.5, 95 per cent CI 2.6-21.8). Children who died also had comparatively shorter duration of diarrhoea at admission, and were also associated with higher rate of bacteremia at admission (Fisher's exact test P < 0.01). The logistic regression model evaluating multivariate risk of mortality identified weight-for-age z-score and sepsis as significant risk factors. Our data suggest that severe malnutrition and sepsis are associated with significantly increased risk of mortality in children with PD. Stringent screening for infections and recognition of subgroups with severe malnutrition and severe diarrhoea may improve screening and case management strategies for this disorder.     

Behavioral and environmental factors associated with acute exacerbation of asthma

Micellar catalysis plays a crucial role in NO metabolism because media in vivo are heterogeneous and the concentration of NO in different phases at different levels of solubility differs by degrees of magnitude. The relative volumes of the hydrophobic phases are usually small. At small volumes (which are calculated) of these phases the reaction rates of NO metabolism change. The dependence on the relative volumes is resonance-like. Not only regulation, but bifurcations and catastrophes are possible in vivo as a result of this changing due to the small change of effectiveness of micellar catalysis.     

Factors associated with acute and chronic pain following traumatic spinal cord injuries

Previous studies have estimated that between 25% and 45% of people with spinal cord injury report severe levels of chronic pain. Few studies have examined this longitudinally. This study examines the primary pain sites, intensity and variability of perceived pain in 76 patients, 6 weeks post injury and 45 patients from the same cohort, 8 year post discharge. Demographic information reveals a close similarity with the database (40,000) from Stover and Fine's cohort (1986). Data was assessed using visual analogue scales, measures were also taken of functional independence (FIM), emotional status and coping. At 6 weeks post injury, most pain is sited in the thoracic spine area, and in the upper and lower limbs. At 1 year post discharge, most pain is reported to be in the thoracic spine area, the lumbar region and the chest. Twenty-three per cent of the 6 week group reported that the intensity of their pain was severe, whilst at 1 year, 41% of the sample complained of severe pain. Factors associated with the pain at both time points were explored using correlational analyses. The emotional, functional and psychological factors that predict pain severity were explored using multiple regression analysis. Twenty-four per cent of those reporting moderate to severe pain at 6 weeks post injury were still reporting pain at 1 year post discharge. This study examines the relative contribution of psychological factors in reported pain.     

Risk factors for acute renal failure in trauma patients

OBJECTIVE: To elucidate the risk factors for the development of acute renal failure (ARF) in severe trauma. DESIGN: Prospective observational study. SETTING: A general intensive care unit (ICU) of a university hospital. PATIENTS: A cohort of 153 consecutive trauma patients admitted to the ICU over a period of 30 months. RESULTS: Forty-eight (31%) patients developed ARF. They were older than the 105 patients without ARF (p = 0.002), had a higher Injury Severity Score (ISS) (p < 0.001), higher mortality (p < 0.001), a more compromised neurological condition (p = 0.007), and their arterial pressure at study entry was lower (p = 0.0015). In the univariate analysis, the risk of ARF increased by age, ISS > 17, the presence of hemoperitoneum, shock, hypotension, or bone fractures, rhabdomyolysis with creatine phosphokinase (CPK) > 10000 IU/l, presence of acute lung injury requiring mechanical ventilation, and Glasgow Coma Score < 10. Sepsis and use of nephrotoxic agents were not associated with an increased risk of ARF. In the logistic model, the need for mechanical ventilation with a positive end-expiratory pressure > 6 cm H2O, rhabdomyolysis with CPK > 10000 IU/l, and hemoperitoneum were the three conditions most strongly associated with ARF. CONCLUSIONS: The identified risk factors for post-traumatic acute renal failure may help the provision of future strategies.     

Factors associated with dental anxiety

This study assessed dental anxiety in adults living in the Detroit tricounty area and identified factors associated with it. The prevalence of dental anxiety was 10.0 percent. Regression analysis revealed six factors associated with dental anxiety: unfavorable attitudes toward dentists, infrequent checkups, dissatisfaction with one's month, small numbers of filled surfaces, being female and lower income. Dentists should be aware of these factors when assessing dental anxiety in their patient populations.     

The effectiveness of acupuncture in treating acute dental pain: a systematic review

OBJECTIVE: Acupuncture is frequently advocated as an effective treatment of dental pain. The question whether or not it is effective for this indication remains controversial. The aim of this systematic review therefore was to assess the effectiveness of acupuncture in dental pain. DATA SOURCES: Four electronic databases were searched: Medline, Embase, CISCOM, and the Cochrane Library. Only controlled trials were included in this review. DATA EXTRACTION: Information was extracted from included studies and entered on standard forms independently by both authors. Methodological quality was assessed using the Jadad score. MAIN RESULTS: 16 such studies were located. The majority of these trials imply that acupuncture is effective in dental analgesia. However, important questions remain unanswered. CONCLUSION: It is concluded that acupuncture can alleviate dental pain and that future investigations should define the optimal acupuncture technique and its relative efficacy compared with conventional methods of analgesia.     

Psychosocial factors in children with idiopathic musculoskeletal pain: a prospective, longitudinal study

To explore the role of psychosocial factors in the development and persistence of idiopathic musculoskeletal pain (IMP) in children, 23 children with IMP and 52 children with juvenile chronic arthritis (JCA) were compared at first admission to hospital and at 9 y follow-up. Semistructured interviews were performed at both assessments. At first admission, the prevalence of psychiatric diagnoses was high both in patients with IMP and patients with JCA, but patients with IMP more often had pain models, reported more school stress and more often lived with one biological parent. At follow-up, overall psychosocial functioning and level of chronic family difficulties were improved in both groups, but patients with IMP had a higher prevalence of psychiatric diagnoses and more chronic family difficulties and life events than patients with JCA. The persistence of IMP at follow-up was related to pain models, school stress, less parental education and more chronic family difficulties at first admission. Findings support the association between psychosocial factors and childhood IMP.     

Risk factors and prevention of acute coronary syndrome

Acute coronary syndromes (ACS) such as unstable angina, myocardial infarction, or sudden ischemic death evolve from coronary thrombosis consequence of atherosclerotic plaque disruption. Plaque stabilization is an important therapeutic strategy in the prevention of ACS. Coronary risk factors include age, male sex, cigarette smoking, hypertension, dislipidemia, diabetes mellitus, insulin resistance and/or hyper insulinemia, obesity, sedentary lifestyle, stress, and the morning surge of sympathetic activity. New risk factors are emerging such as high homocystein, inflammation, and some kinds of infection. Control of blood pressure and cholesterol clearly reduce the risk of coronary events and mortality although the effects of antihypertensive therapy have been less than expected. The benefits of smoking cessation, moderate alcohol consumption, low-dose aspirin prophylaxis, estrogen-replacement therapy in postmenoposal women have also been shown.