Bodily pain and associated mental distress among immigrant adolescents

Abstract Objective The aim of this study was to describe differences among immigrant groups in bodily pain, and analyze its association with mental distress. Method A population-based cross-sectional study was carried out involving tenth grade pupils in Oslo. Of the 7,343 pupils that participated, one-quarter were first- or second-generation immigrants. The Hopkins Symptom Checklist-10 was used to measure mental distress. All information on pain and mental distress was self-reported. Results Girls reported more bodily pain from all types of pain. Headache was the most prevalent pain site across gender and immigrant groups. Strong associations between mental distress and number of pain sites were found for all immigrant groups. Neck and shoulder pain yielded the highest odds ratio (OR) for mental distress among the majority of the immigrant groups. The Sub-Saharan African group had the highest adjusted OR for mental distress [OR=9.8 (1.1–82.7)] when reporting three or more pain sites, and the Indian Subcontinent the lowest [OR=4.0 (1.8–8.8)]. Conclusion The differences in number and types of pain were small, though significant between the different immigrant groups. Adolescents from Sub-Saharan Africa seem to react with more mental distress to bodily pain than adolescents emigrating from the Indian Subcontinent.     

Levator ani muscle stretch induced by simulated vaginal birth

OBJECTIVE: To develop a three-dimensional computer model to predict levator ani muscle stretch during vaginal birth. METHODS: Serial magnetic resonance images from a healthy nulliparous 34-year-old woman, published anatomic data, and engineering graphics software were used to construct a structural model of the levator ani muscles along with related passive tissues. The model was used to quantify pelvic floor muscle stretch induced during the second stage of labor as a model fetal head progressively engaged and then stretched the iliococcygeus, pubococcygeus, and puborectalis muscles. RESULTS: The largest tissue strain reached a stretch ratio (tissue length under stretch/original tissue length) of 3.26 in medial pubococcygeus muscle, the shortest, most medial and ventral levator ani muscle. Regions of the ileococcygeus, pubococcygeus, and puborectalis muscles reached maximal stretch ratios of 2.73, 2.50, and 2.28, respectively. Tissue stretch ratios were proportional to fetal head size: For example, increasing fetal head diameter by 9% increased medial pubococcygeus stretch by the same amount. CONCLUSION: The medial pubococcygeus muscles undergo the largest stretch of any levator ani muscles during vaginal birth. They are therefore at the greatest risk for stretch-related injury.     

Contraceptive effectiveness and safety of five nonoxynol-9 spermicides: a randomized trial

OBJECTIVES: To estimate and compare the effectiveness and safety of 5 spermicides over 6 and 7 months of use, respectively. The spermicides included 3 gels containing 52.5 mg, 100 mg, and 150 mg of nonoxynol-9 per dose and a film and a suppository, each containing 100 mg of nonoxynol-9 per dose. METHODS: Women wishing to use only spermicide for contraception for 7 months were randomly assigned to use 1 of the 5 spermicides with emergency contraception backup. Participants were followed up for up to 30 weeks after admission. RESULTS: Of 1,536 women enrolled, 868 (57%) either relied on the spermicide for 6 months or became pregnant. The probability of pregnancy during 6 months of typical use of the spermicide was 22% (95% confidence limits 16%, 28%) in the 52.5-mg gel group, 16% (10%, 21%) in the 100-mg gel group, 14% (9%, 19%) in the 150-mg gel group, 12% (7%, 17%) in the film group, and 10% (6%, 15%) in the suppository group. The pregnancy risk in the 52.5-mg gel group was significantly different (P <.05) from that in either of the other gel groups. The pregnancy risks in the three 100-mg product groups were not significantly different (P =.35). No significant differences among groups were found in the 7-month probability of specified urogenital conditions. CONCLUSION: The gel with the lowest amount of nonoxynol-9 was less effective than the 2 higher-dose gels. Among 3 products containing 100 mg of nonoxynol-9, formulation did not significantly affect pregnancy risk. All products were safe. LEVEL OF EVIDENCE: I     

Reexpansion pulmonary edema following patent ductus arteriosus ligation in a preterm infant

Reexpansion pulmonary edema (RPE) is rare and usually follows rapid reexpansion of a collapsed lung. We report on a preterm infant who developed pulmonary edema within an hour of surgical ligation of patent ductus arteriosus (PDA). There were no other cardiac anomalies, fluid overload or airway obstruction to explain the change in clinical status. With supportive treatment the patient's condition became stable and was extubated within 48 hours. Lung retraction for better field exposure is often needed when performing PDA ligation in preterm infants. Reinflation of a retracted lung is thought to be the cause of our patient's pulmonary edema. We conclude that RPE, although uncommon, may occur following surgical ductal ligation and that clinicians should be aware of such a possible complication.     

Can the aspiration detected by videofluoroscopic swallowing studies predict long-term survival in stroke patients with dysphagia?

PURPOSE: This study aimed to evaluate whether the aspiration detected by videofluoroscopic swallowing study (VSS) could predict the long-term survival in stroke patients with dysphagia in the post-acute phase of stroke. METHODS: A cohort of 182 consecutive patients with stroke-related dysphagia referred for VSS from July 1994 to April 1999 was retrospectively constructed. VSS findings and clinical features in the post-acute phase of stroke were recorded. The records thus obtained were then linked to the National Death Register to track the occurrence of patient deaths until December 31, 2000. RESULTS: Of the 182 patients, 91 (50%) showed aspiration during VSS performed for a median duration of 8.4 weeks after stroke, and 76 (42%) had silent aspiration. In the post-acute phase of stroke (14.7 +/- 8.7 weeks after stroke, mean + standard deviation), 56 (31%) were tube-fed, and 88 (48%) were wheelchair-confined. A total of 65 patients died in a median follow-up duration of 30.8 months after VSS. Patients were classified into three groups based on the findings of VSS-detected aspiration or penetration, but no difference was noted in their survival curves. In the Cox stepwise regression analysis, only advanced age, recurrent stroke (hazard ratio 1.74, 95% CI 1.06-2.85), the need of tube-feeding (hazard ratio 2.07, 95% CI 1.19-3.59), and being wheelchair-confined (hazard ratio 2.83, 95% CI 1.54-5.19) during follow-up were independent predictors of long-term survival. CONCLUSIONS: VSS-detected aspiration during the post-acute phase of stroke was not predictive for the long-term survival in stroke patients with dysphagia.     

Structural analysis of gallstones with thin-section petrographic microscopy: a study of 100 gallstones from Taiwanese patients

Cholecystolithiasis is a common disease, making cholecystectomy a commonly performed surgical procedure. The gross appearance of gallstones differs from case to case. To classify gallstones on the basis of their structure, we randomly collected gallstones from 100 (64 of them women) of 3,289 patients who underwent cholecystectomy at our hospital. The stones were grossly classified into five major types: pure-cholesterol stones, combination stones, mixed stones, black stones, and calcium bilirubinate stones. We then used thin-section petrographic microscopic study (TSPMS) to inspect each stone under a polarizing microscope. Final classification of the stone depended on TSPMS findings. Of the 100 patients, 35 had pure-cholesterol stones, 12 had combination stones, 17 had mixed stones, 25 had black stones, and 8 had calcium bilirubinate stones; the stones from 3 patients could not be classified on TSPMS. Accurate structural classification of gallstones could be made by gross inspection with confirmation by TSPMS, a useful method of classifying gallstones.