吉林省女性自然绝经年龄及其影响因素的调查分析

目的：了解吉林省女性自然绝经年龄的状况,阐明影响吉林省女性自然绝经年龄的相关因素。方法：采用多阶段分层随机整群抽样方法,在吉林省9个市(州)共32个区/市/县选取18～79岁的23 050名居民进行面对面的问卷调查及体格检查,实际完成有效样本21 435名,共筛选出女性样本11 098名,其中已自然绝经女性4 875名作为本次研究样本。采用复杂加权方法估计平均自然绝经年龄和自然绝经年龄中位数,采用方差分析比较不同出生年份女性自然绝经年龄差异,并应用多元线性回归分析自然绝经年龄的影响因素。结果：吉林省女性平均自然绝经年龄为（49.11
±4.19）岁,自然绝经年龄中位数为50.00岁,自然绝经者4 881名,＜40岁绝经者111名（2.27%）,40～45岁绝经者643名（13.17%）,46～53岁绝经者3 513名（71.97%）,54岁以上绝经者573名（11.74%）,另有41名（0.85%）绝经年龄缺失。不同出生年份（70~79岁为1933-1942年、60～69岁为1943-1952年、57～59岁为1953-1955年）女性自然绝经年龄比较显示,城市和农村不同年份出生女性自然绝经年龄比较差异均有统计学意义(F=16.633,P<0.001;F=7.400,P<0.001),未分地区女性自然绝经年龄比较差异有统计学意义（F=21.178,P<0.001）,经SNK法
比较,3组女性自然绝经年龄两两之间比较差异均有统计学意义（P<0.01）,自然绝经年龄分别为1953-1955年出生组50.38岁、1943-1952年出生组49.51岁、1933-1942年出生组48.81岁;城市不同年份出生女性自然绝经年龄差异有统计学意义（F=16.633,P<0.001）,经SNK-q检验比较,3组女性自然绝经年龄任意2组之间比较差异均有统计学意义(P<0.05),自然绝经年龄分别为 1953-1955年出生组50.77岁、1943-1952年出生组49.73岁和1933-1942年出生组48.85岁;农村不同年份出生女性自然绝经年龄比较差异有统计学意义（F=7.400,P=0.001）,经SNK-q检验比较,1953-1955年出生组与另外2组自然绝经年龄比较差异有统计学意义(P<0.05),自然绝经年龄分别为 1953-1955年出生组50.09岁、1943-1952年出生组49.33岁和1933-1942年出生组48.74岁。多元线性回归分析显示,体质量指数（BMI）、体育锻炼与女性自然绝经年龄呈正相关关系(r=0.089,P＜0.001;r=0.150,P=0.025),吸烟、心理健康状况得分与女性自然绝经年龄呈负相关关系(r=－0.257,P=0.002;r=－0.061,P=0.016)。饮食因素,例如蔬菜、水果、牛奶、豆制品和肉类食用频率与自然绝经年龄无相关性。结论：吉林省不同出生年份的女性平均自然绝经年龄有差异;BMI、吸烟、心理健康状况和体育锻炼可能是女性自然绝经年龄的影响因素。     

Correlates of satisfaction with pain treatment in the acute postoperative period: Results from the international PAIN OUT registry

Patient ratings of satisfaction with their postoperative pain treatment tend to be high even in those with substantial pain. Determinants are poorly understood and have not previously been studied in large-scale, international datasets. PAIN OUT, a European Union-funded acute pain registry and research project, collects patient-reported outcome data on postoperative day 1 using the self-reported International Pain Outcome Questionnaire (IPO), and patient, clinical, and treatment characteristics. We investigated correlates of satisfaction and consistency of effects across centres and countries using multilevel regression modelling. Our sample comprised 16,868 patients (median age 55 years; 55% female) from 42 centres in 11 European countries plus Israel, USA, and Malaysia, who underwent a wide range of surgical procedures, for example, joint, limb, and digestive tract surgeries. Median satisfaction was 9 (interquartile range 7–10) on a 0–10 scale. Three IPO items showed strong associations and explained 35% of the variability present in the satisfaction variable: more pain relief received, higher allowed participation in pain treatment decisions, and no desire to have received more pain treatment. Patient factors and additional IPO items reflecting pain experience (eg, worst pain intensity), pain-related impairment, and information on pain treatment added little explanatory value, partially due to covariate correlations. Effects were highly consistent across centres and countries. We conclude that satisfaction with postoperative pain treatment is associated with the patients’ actual pain experience, but more strongly with impressions of improvement and appropriateness of care. To the degree they desire, patients should be provided with information and involved in pain treatment decisions.     

Exploring the Social Determinants of Health Outcomes for Adults with Low Back Pain or Spinal Cord Injury and Persistent Pain: A Mixed Methods Study

Developing a greater understanding of the social and environmental factors that are related to differential outcomes for individuals who experience persistent pain and disability is important for achieving health equity. In this study, we aimed to develop insights into the role of the social determinants of health (SDH) in care experiences and health status for socio-economically disadvantaged adults who experience persistent low back pain or persistent pain following spinal cord injury. Our objectives were to investigate 1) relationships between the SDH and health outcomes, 2) care experiences, and 3) perceived barriers and facilitators to optimal pain care. We conducted a mixed-methods convergent parallel study involving an online survey and semistructured interviews. We analyzed the data from each method separately and integrated the findings. One hundred sixty-four adults completed the survey and 17 adults completed the semistructured interviews. We found large or moderate-sized correlations between greater selfreported social isolation and poorer health outcomes. Experiencing a higher number of adverse SDH was moderately correlated with lower quality of life and was significantly correlated with all other outcomes. We generated 5 themes from the qualitative analysis: active strategies are important for well-being; low agency; facilitators of optimal care; barriers to optimal care; and health inequities, and derived meta-inferences that highlight the complex inter-relationships between the SDH and health outcomes in this cohort. The findings of our study can importantly inform endeavors to improve equity of pain care for adults with low back pain or spinal cord injury and persistent pain.PerspectiveThis study illustrates the complex interplay between adverse social determinants of health and poorer health status for adults with persistent pain and provides evidence to support the important role of social isolation. Developing an understanding of the life-contexts of those seeking care is a vital step towards addressing health inequities.     

Chronic Pain,Insomnia and their Mutual Maintenance: A Call for Cognitive Bias Research

Chronic pain and insomnia are highly comorbid: Approximately 50% of those with chronic pain experience insomnia or clinically significant sleep disturbances, and 50% of those with insomnia experience chronic pain. Further, these conditions can be extremely disabling, particularly when they co-occur. There is increasing recognition of the need to tackle both chronic pain and insomnia together, as evidenced by growing empirical research in this area. Cognitive processing biases have been independently implicated in both chronic pain and in insomnia. Given their trans-diagnostic status, cognitive biases may therefore have a role in explaining the co-occurrence and mutual maintenance of these conditions. These biases also represent novel, potentially modifiable targets for treatment. However, the role of cognitive biases has not been adequately explored in comorbid chronic pain and insomnia. Here, we describe the state of cognitive bias research in chronic pain and insomnia, considering evidence for the roles of attentional bias, interpretation bias, expectancy bias, and memory bias. In reviewing the literature, it is apparent that similar cognitive biases operate in insomnia and chronic pain, with preliminary, albeit sparse, evidence of pain-related cognitive biases influencing sleep-related outcomes. On the basis of current findings and separate theoretical models, we present a novel, testable cognitive model of comorbid chronic pain and insomnia, to guide future research in this area. Key recommendations for the future of this relatively new field are provided.PerspectiveChronic pain and insomnia are highly co-morbid, suggesting an overlap in causal mechanisms. Empirical research, although sparse, suggests that cognitive biases may play a role in their development and mutual maintenance. Our novel cognitive model generates research avenues of clinical importance for treating co-morbid chronic pain and insomnia.     

Intolerance of Uncertainty in Pediatric Chronic Pain: Dyadic Relationships Between Youth and Parents

The current study used a dyadic analytic approach (actor-partner interdependence models) to assess the stability and interrelationships of intolerance of uncertainty (IU) among a cohort of youth with chronic pain and their parents (n = 156 dyads). Relationships between parent and youth IU, parent and youth pain interference, and parent and youth internalizing mental health symptoms were examined. At baseline and follow-up, youth and parents completed psychometrically-sound questionnaires to assess their respective IU, pain characteristics, and clinical outcomes (pain interference, anxiety, depressive, and posttraumatic stress symptoms). Our findings support the construct stability of IU over time, as well as intrapersonal (ie, actor) effects of IU on follow-up youth pain interference and mental health symptoms and parents’ mental health symptoms (but not parent pain interference). There were no interpersonal (ie, partner) effects over time between youth and parent IU or between youth and parent IU and pain interference or mental health symptoms. These findings align with previous research evidencing IU as a transdiagnostic risk factor for a range of mental health concerns and extend previous findings by showing the stability of parent and youth IU over time and its potential predictive relevance to outcomes in a clinical sample of youth with chronic pain.PerspectiveThis article presents dyadic analyses assessing intrapersonal and interpersonal associations between intolerance of uncertainty (IU) and pain and mental health symptoms in youth with chronic pain and their parents. Analyses evidenced short-term construct stability of IU and intrapersonal (but not interpersonal) effects of IU on pain and mental health symptoms.