Factor analysis of human pain responses: Pain endurance as a specific pain factor.

Induced cutaneous and deep somatic pain with chemical, electrical, and thermal noxious stimuli in 60 18-69 yr. Old chronic arthritis patients. Pain threshold, pain tolerance, and pain sensitivity range (psr) were measured psychophysically and correlated within and between techniques. The correlations were subjected to the centroid method of factor analysis and the 1st 4 factors extracted and rotated to a simple structure criterion. The 1st factor was identified as a cutaneous and the 2nd and 4th as gluteal sensitivity factors, but the 3rd appeared to be a specific pain factor, termed pain endurance, most highly loaded with psrs from different techniques and body loci. This pain factor was related to successful postoperative outcome of painful rehabilitation in the ss. (29 ref.) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Perceived threat as a major factor in tolerance for experimentally induced cold-water pain.

In Study 1, 12 undergraduates informed only of the normal physiological reactions to hand immersion in cold water and 12 Ss informed that they were participating in a "study of the perception of novel stimuli" showed much greater tolerance and reported significantly less pain than did 12 controls given no pretesting message. Therefore, giving Ss the chance to ascribe uncomfortable sensations to a nondamaging process increased tolerance. Study 2, with 5 graduate students, showed that repeated exposure to cold-water immersion (employed to demonstrate safety of the procedure) did not reduce the reported sensation of pain, indicating that the increased tolerance following assurances of safety was directly due to decreased threat and not to decreased sensation. Findings support the distinction between pain sensation and emotional-motivational reaction leading to escape or avoidance. (20 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Hepatocyte growth factor may act as a pulmotrophic factor on lung regeneration after acute lung injury

Hepatocyte growth factor (HGF) has been shown to have hepatotrophic and renotropic functions for regeneration of the liver and kidney through its mitogenic, motogenic, and morphogenic properties. To examine the involvement of HGF in lung regeneration after acute injury, we analyzed changes of HGF mRNA, HGF activity, and HGF receptors in the rat lung after lung insult and measured HGF concentration in sera of patients with various lung diseases. Following the onset of acute lung injury induced by intratracheal hydrochloride injection, a compensatory DNA synthesis occurred in the bronchial epithelium with a peak at 24 h and in the alveolar epithelium with a peak at 48 h. Expression of HGF mRNA in the rat lung remarkably increased only 3 h after the treatment and HGF activity in the lung also increased to about 3-fold at 6 h later. HGF receptors in the lung but not in the other noninjured organs were down-regulated 12 h later. These marked increases in HGF mRNA and HGF activity and the concomitant down-regulation of HGF receptor occurred before the marked compensatory DNA synthesis in bronchial and alveolar epithelial cells. HGF concentration in sera of patients with various lung diseases, as measured by radioimmunoassay, was much higher than that in healthy donors. These results suggest that HGF is newly produced in the lung after acute lung injury and may have a role in regeneration of the lung.     

Working hours as a risk factor for acute myocardial infarction in Japan: case-control study

OBJECTIVE: To clarify the extent to which working hours affect the risk of acute myocardial infarction, independent of established risk factors and occupational conditions. DESIGN: Case-control study. SETTING: University and general hospitals and routine medical examinations at workplaces in Japan. SUBJECTS: Cases were 195 men aged 30-69 years admitted to hospital with acute myocardial infarction during 1990-3. Controls were 331 men matched at group level for age and occupation who were judged to be free of coronary heart diseases at routine medical examinations in the workplace. MAIN OUTCOME MEASURES: Odds ratios for myocardial infarction in relation to previous mean daily working hours in a month and changes in mean working hours during previous year. RESULTS: Compared with men with mean working hours of >7-9 hours, the odds ratio of acute myocardial infarction (adjusted for age and occupation) for men with working hours of >11 hours was 2.44 (95% confidence interval 1.26 to 4.73) and for men with working hours of <=7 hours was 3.07 (1.77 to 5.32). Compared with men who experienced an increase of <=1 hour in mean working hours, the adjusted odds ratio of myocardial infarction for men who experienced an increase of >3 hours was 2.53 (1.34 to 4. 77). No appreciable change was observed when odds ratios were adjusted for established and psychosocial risk factors for myocardial infarction. CONCLUSION: There was a U shaped relation between the mean working hours and the risk of acute myocardial infarction. There also seemed to be a trend for the risk of infarction to increase with greater increases in mean working hours.     

Five-year outcomes in TMD: relationship of changes in pain to changes in physical and psychological variables

Factors influencing natural history and clinical course of pain in temporomandibular disorders (TMD) are largely unknown. Physical, psychological and behavioral data from a population-based epidemiologic study of TMD were examined in 234 cases of persons reporting TMD pain. The cases were assigned to one of five pain pattern groups based on changes in average TMD pain from baseline to 5-year follow-up: (i) remitted (49% of the sample), (ii) high-improvement (14%), (iii) low-improvement (9%), (iv) same (13%), and (v) worse (16%). For each pain change group, an ANOVA-derived pattern analysis was performed to assess whether the pattern of change in each of seven physical and three psychological variables was congruent or dissimilar to the pattern of change in average pain intensity. For none of the physical or psychological variables was the change over time completely congruent with the changes in pain. Changes in ambient average TMD pain were most closely related to those clinical variables whose assessment is influenced by pain or other self-reported symptoms (e.g., number of muscle sites painful to examiner palpation), while the amount of pain change was less closely related to changes in clinical variables, such as joint sounds, where assessment is not dependent on subjective report. The three psychological variables, anxiety, depression, and somatization, displayed similar change patterns, but these patterns were distinctly different from those of the physical variables in that the remitted pain group was at the population mean at baseline for these psychological variables and remained there; significant improvement in psychological status was observed only in the pain group showing high improvement. The other three pain change groups exhibited elevated psychological distress scores at both baseline and 5 years. These results indicate that although the relationships among the course of pain, of physical variables, and of psychological variables are complicated, the 5-year outcome in pain is largely independent of readily discernible changes in clinical signs.     

Identifying the patient with severe acute pancreatitis

Epidemiological studies have demonstrated a clustering of breast and prostate cancers in some families. Moreover, there is an increase in the number of cases of prostate cancer in families with inherited mutations of the breast cancer susceptibility gene BRCA1. We assessed the role of BRCA1 and BRCA2 in prostate cancer. We tested for the BRCA1 185delAG frameshift mutation, found in 0.9% of Ashkenazi Jews, and the BRCA2 6174delT mutation, found in 1% of Ashkenazi Jews, in Ashkenazi Jewish men with prostate cancer. We studied 60 Ashkenazi men with prostate cancer. A family history was obtained by interview or a self-report questionnaire. Histological confirmation of diagnosis was obtained for all subjects. Ethnic background was confirmed for all subjects by self-report or interview. Mutations of BRCA1 and BRCA2 were detected by amplification of lymphocyte DNA from peripheral blood according to standard polymerase chain reaction (PCR) and dot blot procedures. Patients' ages ranged from 55 to 80 years (mean +/- s.d. 70 +/- 5.25). There were six men with a family history of prostate cancer; three of these had a father with prostate cancer. Five of the men had a family history of breast cancer, in a mother, a sister or an aunt. None of the men had a family history of both breast and prostate cancer. None of the 60 men carried the 185delAG BRCA1 or 6174delT BRCA2 mutations. Of 268 Ashkenazi Jewish women with sporadic breast cancer, tested in an unrelated study, 16 carried either the 185delAG mutation of BRCA1 or the 6174delT mutation of BRCA2. There was a significant difference in the incidence of the BRCA1 and BRCA2 mutations in the breast and prostate cancer cases (P = 0.05, two-tailed Fisher's exact test). The contribution of germline BRCA1 and BRCA2 mutations to prostate cancer incidence is probably small and could be limited to specific subgroups.     

Intramuscular injection as a provoking factor for paralysis in acute poliomyelitis. A case control study

In order to identify the role of intramuscular injection (IM) as a provoking factor for poliomyelitis, a case control study as done at the Institute of Child Health, Madras from May 1988 to May 1989. The case was defined as acute poliomyelitis if he had acute asymmetric flaccid paralysis of lower motor neurone type without objective sensory disturbance following a short episode of fever. Controls were taken from children attending outpatient department for fever. Two controls matched for aged and sex were recruited for each case. Recruitment, data collection and clinical examination were done by a single pediatrician. IM injection received within 30 days prior to onset of paralysis or illness was considered to be the risk factor. The total number of cases and controls recruited were 257 and 515, respectively. Among cases, 172 (66.9%) out of 257 and among controls 252 (48.9%) out of 515, received IM injection within one month earlier to onset of paralysis or illness. The overall risk of paralysis, estimated for IM injection, was increased [odds ratio (OR) 2.1 (95% CI, 1.5-3.0)]. The maximum risk for paralysis was observed to be 2 weeks preceding the illness; the ORs for < 7 days was 2.2 (95% CI, 1.6-3.2) and for 7-13 days 3.2 (95% CI, 1.8 to 5.8). The risk of paralysis associated with IM injection was similar for unimmunized and immunized cases (OR 2.4 and 2.2). Multiple injections were not associated with a higher risk of developing paralysis.(ABSTRACT TRUNCATED AT 250 WORDS)     

Incident reporting in acute pain management

Incident reporting is an effective tool for continuous quality improvement in clinical practice. A prospective study on voluntary incident reporting in pain management was conducted at a major teaching hospital in Hong Kong. Over a 12-month period, 53 incidents were reported in 1275 patients who received pain relief treatments which were supervised by the acute pain service. The majority of the incidents were first detected by the pain team. The most common incidents involved delivery circuits, delivery pump and drug administration. A large proportion (81.4%) of the incidents were thought to be preventable. Human factors were involved in 41.9% of the patients reported, most commonly associated with unfamiliar technique/inexperience, inattention and inadequate communication. Four patients developed major morbidity of which two were attributed to inadequate analgesia, while three others had major physiological changes without morbidity. Strategies have been formulated to prevent further occurrence of these incidents. We propose that incident reporting is a potentially useful tool in identifying and preventing adverse events in postoperative pain management.     

Clinical standardization in acute abdominal pain

The purpose of this pilot study was: 1) to describe factors associated with a perceived harmful outcome following medication errors made by nurses and 2) to refine the Medication Error Risk Profile (MERP) (Wolf, 1992). Ninety-four registered nurses and licensed practical nurses completed the MERP. Multiple stepwise regression analyses were used to explain the variance in the dependent variable of perceived patient harm with: 1) phases of preparation and administration; 2) categories of person responsible for the error; 3) interventions needed following the error and symptoms related to the error. The exploratory regression analysis suggests a model in which the dispensing phase of administration, the physician and pharmacist categories of persons responsible for the error, and the interventions of patient transfer to another unit and additional medications given following the error explain 53% of the variance in perceived harmful outcome for patients consequent to medication errors. A moderately strong correlation (r = .46, P < .001) existed between perceived patient harm as measured on the four-point scale and total intervention score following medication errors.     

Meaning as a factor in learning.

(This reprinted article originally appeared in the Journal of Educational Psychology, 1938, Vol 29, 419–430. The following abstract of the original article appeared in PA, Vol 13:797.) This is a selective review of the experiments on the effect of meaning on learning and retention. It is concluded that "the principles of contiguity, practice, the conditioned reflex, and the law of effect have receded from the foreground (as a result of studies of meaning as a factor in learning); and in their place have come such terms as insight, understanding, intelligence, organization, pattern, and the like. When (these terms) are more precisely defined they will lead us to not only a truer understanding of the learning process, but also to more practical results." (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Color as a factor in food choice

From birth, nature teaches us to make judgements on our environment based in large measure on color. As such, it plays a key role in food choice by influencing taste thresholds, sweetness perception, food preference, pleasantness, and acceptability. Its role is elusive and difficult to quantify, however, which at times has placed color in a secondary role to the other sensory characteristics, a position not entirely consistent with the facts. Color, in a quantitative sense, has been shown to be able to replace sugar and still maintain sweetness perception in flavored foods. It interferes with judgments of flavor intensity and identification and in so doing has been shown to dramatically influence the pleasantness and acceptability of foods. Studies in the literature have used cross-sectional population panels to study these effects, but a recent investigation of color-sensory interactions in beverages has compared the response of a college age group with the response of a panel consisting of a more mature population. Interestingly, the older group showed significant differences from the college age group in their response to the effects of color on several sensory parameters as well as showing a direct correlation between beverage consumption and color. Color is often taken for granted, but this position must be reevaluated in view of such studies and the need to create more appealing foods for different segments of our society.     

Proglumide as a morphine adjunct in cancer pain management

PURPOSE: To determine the expression of CD44 isoforms in cultured human trabecular meshwork (HTM) and to discuss their possible relationship with outflow facility. METHODS: CD44 isoform expression in cultured HTM was qualitatively examined using immunohistochemistry and RT-PCR analysis. RESULTS: Immunohistochemistry of cultured HTM showed intense staining with a CD44s antibody, and with antibodies against CD44 exon 7, exon 11-12 and exon 14. By RT-PCR, at least three isoforms of CD44 were expressed in HTM: CD44s, CD44v-III and CD44v-I. CONCLUSIONS: At least three isoforms of CD44 are expressed in the HTM. CD44 may play a role in binding and turnover of hyaluronic acid in the trabecular meshwork, thereby regulating outflow facility.     

Spiral CT in acute non-cardiac chest pain

The sturgeons (order Acipenseriformes) are extant representatives of a group of ancient Actinopterygian (ray-finned) fish. Galanin and scyliorhinin I (a tachykinin with limited structural similarity to mammalian substance P) have been isolated from an extract of the gastrointestinal tract of a sturgeon (an F1 hybrid between the shovelnose sturgeon, Scaphirhynchus platorynchus, and the pallid sturgeon, Scaphirhynchus albus). The primary structure of sturgeon galanin (Gly-Trp-Thr-Leu-Asn-Ser-Ala-Gly-Tyr-Leu10-Leu-Gly-Pro-His-Ala-Val -As p-Gly-His-Arg20-Ser-Leu-Ser-Asp-Lys-His-Gly-Leu-Pro.NH2) contains only two amino acid substitutions (Ser23 --> Asn and Pro29 --> Ala) compared with galanin from the bowfin, Amia calva (Amiiformes), but five amino acid substitutions compared with galanin from the trout (Teleostei). Similarly, the sturgeon tachykinin (Ser-Lys-Tyr-His-Gln-Phe-Tyr-Gly-Leu-Met.NH2) contains only one amino acid substitution (Tyr3 --> Ser) compared with scyliorhinin I previously isolated from bowfin stomach but five amino acid substitutions compared with trout substance P. The data support the hypothesis that the Acipenseriformes and the basal Neopterygians (gars and bowfin) share a close phylogenetic relationship.     

Relaxation as a factor in semantic desensitization.

Assigned 32 female undergraduates with spider phobias to 1 of 4 groups: semantic desensitization (SD) and relaxation, SD and no relaxation, control-relaxation, and control-no relaxation. SD failed to promote modification of evaluative meanings evoked by the feared object. There appears to be a critical need to reassess the effectiveness of SD with other populations displaying varying types and amounts of fear. (PsycINFO Database Record (c) 2010 APA, all rights reserved)