Effect of anxiety on the experience of pain in implant insertion

Pain is a complex experience affected by such factors as stress, anxiety and cognitions. The purpose of this study was to examine the inter-relationship between anxiety and acute pain perception under an oral surgery procedure of implant insertion. The study population consisted of 60 dental patients (58% female, mean age 42 year), who were scheduled for implant insertion in a private clinic specializing in oral surgery. Patients were evaluated on three consecutive occasions: immediately preoperatively (T1), immediately post-operatively (T2), and at 4 weeks post-operative follow-up (T3). Patients were requested to complete questionnaires concerning their anxiety on each occasion and to indicate their subjective evaluations concerning pain (on visual analogue scales). Patient anxiety and pain evaluation were highest immediately before the surgical procedure (T1) with a significant decrease immediately afterwards (T2). The best predictor of the patient's pain evaluation at each time point was their state of anxiety at that time (T1: mean square = 7844.36, F = 16.26, P < 0.001; T2: mean square = 7652.74, F = 15.86, P < 0.001; T3: mean square = 5433.04, F = 8.99, P < 0.005). Pain experienced by patients in oral surgery is best predicted by their anxiety at each time point. Proper understanding of the variables that affect pain is important as they may produce emotional responses that could influence compliance.     

An intervention program to reduce the number of hospitalizations of elderly patients in a primary care clinic

Background  

The elderly population consumes a large share of medical resources in the western world. A significant portion of the expense is related to hospitalizations.     

Inhibition of P53-related apoptosis had no effect on PrP(Sc) accumulation and prion disease incubation time

Results from several laboratories indicate that apoptosis via the P53 pathway is involved in prion disease pathogenesis. Prion diseases, among them scrapie and BSE, are a group of fatal neurodegenerative disorders associated with the conversion of PrP(C) to PrP(Sc), its conformational abnormal isoform. In this work, we tested whether an established anti-apoptotic reagent, PFT, which has been shown in different systems to inhibit P53 activity, can delay the outbreak of prion disease in infected animals. Our findings indicate that although PFT efficiently reduced caspase 3 expression in brains from scrapie sick hamsters, as well as inhibited PrP(Sc) accumulation in cell culture, it had no effect on disease incubation time or PrP(Sc) accumulation in vivo. We conclude that the P53 dependent apoptosis may not be an obligatory mechanism for prion disease-induced cell death.     

Family support and victim identification in mass casualty terrorist attacks: an integrative approach

Terrorist bombing attacks in Israel between 2000 and 2004 caused mass casualties. After each attack in the north of Israel, Rambam Medical Center, the largest hospital in the region, absorbs the majority of injured, especially the more severely injured and unidentified victims. Immediately with the media reports of a terrorist attack, tens of relatives come to the hospital, looking for missing family members. This paper describes an assistance unit for families of unidentified victims. It is staffed by the hospital's social work department, and its tasks are to identify the unidentified victims, help relatives find and be united with them, and assist other relatives in the identification of bodies of deceased family members. The process involves gathering information from relatives and cross-checking it with data and pictures from the hospitals' emergency and operating rooms; and providing crisis intervention and psychological first aid to victims' relatives. The family assistance unit works with several other professional units in the hospital and in the community, and always adjusts its operations to the features of each event. Clearer guidelines for dynamic training of social workers and research-based interventions to prevent compassion fatigue among the workers must be further developed.     

The clinical and economic burden of fibromyalgia compared with diabetes mellitus and hypertension among Bedouin women in the Negev

BACKGROUND: Fibromyalgia (FM) is a common idiopathic chronic, widespread pain syndrome with tenderness in anatomically defined tender points. OBJECTIVES: The purpose of the present study was to describe and characterize the economic and daily work burden of FM compared with diabetes mellitus and hypertension. METHODS: A retrospective study was conducted in 2001 in a primary care clinic, the Kuseife clinic of the Clalit Health Services. Data for the three study groups were obtained from the computerized database of the Kuseife clinic and the Negev District, Israel. The study group included 102 FM patients. The control groups included 102 diabetes patients and 103 patients with hypertension. RESULTS: Hospitalization and hospital day care services were the main expenses incurred by patients in this study. There were no differences among the study groups in any cost parameter examined except for the cost of diagnostic tests (P < 0.01), which was less for FM patients. FM patients were referred to specialists and diagnostic procedures more frequently than the control groups. No statistical difference was found in the total number of clinic visits, but FM patients visited physicians more frequently and visited nurses less frequently than patients in the other two groups (P < 0.05). CONCLUSIONS: FM patients consume health care resources to a similar extent to patients with other chronic diseases such as diabetes mellitus and hypertension, but the latter usually receive much more attention from the health care system. Greater awareness of this disorder can improve management and facilitate planning of health care resources, thus improving quality of care.