Visceral Pain And Life Quality In Persons With Spinal Cordinjury: A Brief Report

Abstract

Background/Objective: Few studies have examined the prevalence of visceral pain in persons with spinalcord injury (SCI), and virtually no studies have looked at the relationship between visceral pain and selfreportedquality of life. We examined the frequency of reported visceral pain at 5, 10, and 15 years afterinjury to determine whether the presence of visceral pain is related to quality of life, and to determine towhat extent visceral pain should be of concern to clinicians treating patients with SCI.

Methods: Visceral pain and quality of life in persons with SCI were compared from a combined CraigHospital and National Model SCI Systems database at 5 (N=33), 10 (N=132), and 15 (N=96) years afterinjury.

Results: The rates of visceral pain increased at each measurement (10% at year 5, 22% at year 10, and 32%at year 15); although these numbers reflect cross-sectional data, they do show a clear statistical change.Only a limited true longitudinal sample was available, but at 10 years after injury, individuals who hadreported visceral pain at any time reported a significantly lower quality of life than those never experiencingvisceral pain, F1,188 = 3.95, P <0.05.

Conclusions: Although visceral pain may not be as prevalent as the more researched neuropathic andmusculoskeletal subtypes of pain, it may account for a higher percentage of people with SCI who report painthan previously recognized. More quantitative and longitudinal research is needed to examine therelationship of visceral pain with overall quality of life and to pursue interventions.     

Characteristics of Individuals Associated with Involvement in Different Types of Marriage Preparation Interventions

Recent research has shed light broadly on the individual, couple, and contextual characteristics of audiences that are predictive of their involvement in marriage preparation. This research investigates the individual personality characteristics and emotional readiness factors associated with the selection of specific types of marriage preparation interventions. Operating from an ecosystemic‐developmental perspective and the Five‐Factor model of personality, this study assessed eight individual personality and emotional health characteristics (anxiety, depression, extroversion, flexibility, kindness, maturity, organization, and self‐esteem) as predictors of involvement in each of four different kinds of marriage preparation interventions: premarital college classes, premarital counseling, self‐directed approaches, or premarital community workshops, among a sample of 1,461 participants. Logistic regression analysis revealed different patterns of prediction for each type of intervention. Latent profile analysis showed that distinguishing features of personality and emotional readiness typified participants in different interventions. Implications for the content and process of marriage preparation interventions are discussed.     

Associations between Nighttime Traffic Noise and Sleep: The Finnish Public Sector Study

Background: Associations between traffic noise and sleep problems have been detected in experimental studies, but population-level evidence is scarce.Objectives: We studied the relationship between the levels of nighttime traffic noise and sleep disturbances and identified vulnerable population groups.Methods: Noise levels of nighttime–outdoor traffic were modeled based on the traffic intensities in the cities of Helsinki and Vantaa, Finland. In these cities, 7,019 public sector employees (81% women) responded to postal surveys on sleep and health. We linked modeled outdoor noise levels to the residences of the employees who responded to the postal survey. We used logistic regression models to estimate associations of noise levels with subjectively assessed duration of sleep and symptoms of insomnia (i.e., difficulties falling asleep, waking up frequently during the night, waking up too early in the morning, nonrestorative sleep). We also used stratified models to investigate the possibility of vulnerable subgroups.Results: For the total study population, exposure to levels of nighttime–outside (L_{night, outside}) traffic noise > 55 dB was associated with any insomnia symptom ≥ 2 nights per week [odds ratio (OR) = 1.32; 95% confidence interval (CI): 1.05, 1.65]. Among participants with higher trait anxiety scores, which we hypothesized were a proxy for noise sensitivity, the ORs for any insomnia symptom at exposures to L_{night, outside} traffic noises 50.1–55 dB and > 55 dB versus ≤ 45 dB were 1.34 (95% CI: 1.00, 1.80) and 1.61 (95% CI: 1.07, 2.42), respectively.Conclusions: Nighttime traffic noise levels > 50 dB L_{night, outside} was associated with insomnia symptoms among persons with higher scores for trait anxiety. For the total study population, L_{night, outside} > 55 dB was positively associated with any symptoms.     

Limitations of the Rey Fifteen-Item test in the detection of malingering

Abstract

The capacity of Rey's (1964) Fifteen-Item Test (FIT) to detect feigned memory impairment in a group of clinical malingerers was investigated. Seven malingerers were identified by significantly below chance performance on a forced-choice memory measure, the Recognition Memory Test, and were given the FIT. A reference group of 7 patients with acute moderate and severe traumatic brain injuries was also given the FIT. The brain-injured subjects recalled significantly more items on the FIT than the malingering subjects. Using a cutoff score of 7, the FIT was able to detect only 57% of the malingerers but did not misclassify any brain-injured subjects. Although possessing good specificity, the FIT appears to lack adequate sensitivity to detect feigned impairment when used as a single measure. The FIT may be sensitive primarily to blatant deceptive strategies.     

Trigger Finger Release With Stepwise Preservation of the A1 Pulley: A Functional Pulley-Preserving Technique

The first annular (A1) pulley is an important structure of the hand, providing a biomechanical support to the metacarpophalangeal joint and maintaining joint stability and flexor tendon alignment. Albeit uncommon, disruption of this pulley can result in dislocation or ulnar drift of the digit, particularly pronounced in patients with rheumatoid arthritis. Despite this, the A1 pulley is commonly divided without reconstruction in trigger finger. Several annular pulley reconstructive techniques have been developed to preserve its function. However, development of recurrent triggering has been observed due to fibrosis, largely due to inadequate release of the pulley. We have developed a technique to increase the volume within the flexor sheath while preserving the A1 pulley by way of stepwise lengthening. This has enabled an increase in the diameter of the pulley to 4 times its original size. A prospective study was performed comprising 10 trigger finger releases with stepwise lengthening of the A1 pulley. In all patients, there were no complications, and good hand function was achieved with no recurrence of triggering at 6 weeks of follow-up. This technique can thus safely achieve trigger release without sacrifice of the function of the A1 pulley.