Attentional and Interpretational Biases Toward Pain-Related Stimuli in Children and Adolescents: ASystematic Review of the Evidence

This review investigated whether youth exhibit attention or interpretation biases toward pain-related information and whether such biases are more pronounced in youth with chronic pain. Three databases were searched to identify studies that assessed attention or interpretation biases using an accepted experimental paradigm. Ten studies were identified, 8 examining attentional biases and 2 examining interpretation biases. As in the adult literature, there was no evidence of attentional biases toward pain in youth without chronic pain. Three studies investigating youth without chronic pain found evidence for relationships between catastrophizing or anxiety and indicators of vigilance or avoidance (in 2 cases, for youth with low self-reported attentional control). For attentional biases, 5 studies compared youth with and without chronic pain. Two of these studies measured cortical correlates and found evidence of neurologic activity indicating a bias in orienting to pain-related stimuli. Three studies examined biases toward pain-related words or pictures. Of those, 2 found evidence of biases at subliminal presentation times, indicating vigilance (although 1 only after a stressful task). For supraliminal presentations, 1 study found evidence of avoidance, one of difficulty disengaging, and one of general slowing of responses. Only 1 study compared youth with and without pain for interpretation bias in adolescents, and interpretation biases were greater for youth with chronic pain. As with attention, no evidence for interpretation biases were found in youth without chronic pain. Overall, there is weak evidence to support vigilance in youth with chronic pain compared with those without. However, whether pain affects the subsequent deployment of attention is unclear. There is no evidence for biases toward pain in youth without chronic pain, but evidence suggests that anxiety or catastrophizing and attentional control may moderate pain-related attentional biases. There is also weak evidence of interpretation bias in youth with chronic pain compared with those without.

Weight status,diet quality,perceived stress,and functional health of caregivers of children with autism spectrum disorder

1 Purpose

Caring for children with autism spectrum disorder (ASD) can be highly demanding and can put significant strain on caregivers. To date, little is known about the extent to which caregivers of children with ASD experience increased levels of stress which may adversely affect health outcomes. The purpose of this secondary analysis was to compare caregivers of children with ASD and caregivers of typically developing children (TDC) in weight status, diet quality, perceived stress related to the parenting role, and functional health and well‐being.

2 Design and methods

Caregivers of 25 children with ASD and 30 TDC completed the 2005 Block Food Frequency Questionnaire, the 36‐item Short Form of the Parenting Stress Index (PSI/SF), and the Short Form Health Survey (SF‐36) and had their heights and weights measured during an onsite visit. Diet quality was assessed using the Healthy Eating Index (HEI)‐2010 and its dietary components and conformance to the 2010 Dietary Guidelines for Americans.

3 Results

ASD caregivers did not differ significantly from TDC caregivers in body mass index or overweight/obesity prevalence (p ≥ .28), even when controlling for covariates. In univariate analyses, ASD caregivers consumed significantly fewer empty calories from solid fats, alcohol, and added sugars than TDC caregivers (p = .03), but they did not differ significantly in any other dietary outcomes including nutrient adequacy (p ≥ .10) and mean total HEI scores (p = .20). ASD caregivers, when compared to TDC caregivers, reported significantly greater parenting stress for the subscales difficult child and parent–child dysfunctional interaction as well as total stress (p < .001). In addition, 56% of ASD caregivers compared with 6.7% of TDC caregivers showed clinically significant levels of stress (p < .0001); a finding which remained statistically significant when controlling for covariates. ASD and TDC caregivers did not differ significantly in any SF‐36 health domains related to functional health and well‐being (p ≥ .10).

4 Practice implications

Despite higher reported levels of stress, ASD caregivers did not differ significantly from TDC caregivers in diet‐ and health‐related outcomes. Nurses and other health professionals should use comprehensive screening tools to assess overall caregiver stress and levels of resilience.     

Alcohol consumption and the risk of incident pulmonary embolism in US women and men

Essentials

• The association of moderate alcohol consumption with pulmonary embolism (PE) risk remains unclear.
• In three large US cohorts, we evaluated the association of alcohol consumption with PE risk.
• We found no evidence of an association of alcohol consumption amount or frequency with PE risk.
• Secondary analyses of type and heavy episodic drinking also yielded null findings.

Summary

Background

Moderate alcohol consumption has been variably associated with hemostatic and fibrinolytic factor levels, but the association between alcohol consumption and the risk of incident pulmonary embolism (PE) remains uncertain.

Objective

To evaluate alcohol consumption amount and frequency in relation to PE risk.

Methods

Nurses’ Health Study (NHS), NHS II and Health Professionals Follow‐Up Study participants free of venous thromboembolism (VTE) at baseline (n = 217 442) reported alcohol consumption by type, quantity and frequency, every 2–4 years. Incident PE cases were identified by self‐report and confirmed for participants without cancer. In this cohort study, we used Cox proportional hazards models to estimate multivariable‐adjusted hazard ratios (HRs) for PE associated with alcohol consumption amount and, separately, frequency. Secondary analyses evaluated alcohol type and heavy episodic drinking in relation to PE risk, and amount and frequency in relation to medical record‐confirmed idiopathic PE and any self‐reported VTE risk. Cohort‐specific analyses were pooled using random‐effects meta‐analysis.

Results

During ≥ 20 years of follow‐up, we identified 1939 PE events. We found no strong evidence of an association between PE risk and alcohol consumption amount (pooled HR_adj for 5.0–14.9 g day^?1 vs. abstention = 0.97 [95% CI, 0.79, 1.20]) or frequency (pooled HR_adj for 5–7 drinking days per week vs. abstention = 1.04 [95% CI, 0.88, 1.23]). Secondary analyses of type, heavy episodic drinking, idiopathic PE and VTE also yielded null findings.

Conclusions

Among three large prospective cohorts of US men and women, we found no evidence of an association between the amount or frequency of alcohol consumption and PE risk.

     

In‐depth comparison of N‐glycosylation of human plasma‐derived factor VIII and different recombinant products: from structure to clinical implications

Essentials

• Glycosylation heterogeneity of recombinant proteins affects pharmacokinetics and immunogenicity.
• N‐glycomics/glycoproteomics of plasma‐derived Factor VIII and 6 recombinant FVIIIs were compared.
• Depending on cell line, significant differences to plasma‐derived FVIII were observed.
• Recombinant FVIIIs expressed distinct and immunologically relevant epitopes.

Summary

Background/Objective

Human factor VIII (FVIII) is a plasma glycoprotein, defects of which result in hemophilia A. Current substitution therapy uses FVIII products purified from human plasma or from various cell lines (recombinant FVIII) with different levels of B‐domain deletion. Glycosylation is a post‐translational protein modification in FVIII that has a substantial influence on its physical, functional and antigenic properties. Variation in glycosylation is likely to be the reason that FVIII products differ in their pharmacokinetics, pharmacodynamics and immunogenicity. However, the literature on FVIII glycosylation is inconsistent, preventing assembly into a coherent model. Seeking to better understand the glycosylation mechanisms underlying FVIII biology, we studied the N‐glycosylation of human plasma‐derived (pd)FVIII and six rFVIII products expressed in CHO, BHK or HEK cell lines.

Methods

FVIII samples were subjected to head‐to‐head detailed glycomic and glycoproteomic characterization using a combination of MALDI‐MS and MS/MS, GC‐MS and UPLC‐UV‐MS^E technologies.

Results/Conclusion

The results of our study detail the N‐glycan repertoire of pdFVIII to an unprecedented level, and for the first time, provide evidence of N‐glycolylneuraminic acid (NeuGc) found on pdFVIII. Although site‐specific glycosylation of rFVIII proved consistent with pdFVIII regardless of the expression system, the entire N‐glycan content of each sample appeared significantly different. Although the proportion of biologically important epitopes common to all samples (i.e. sialylation and high‐mannose) varied between samples, some recombinant products expressed distinct and immunologically relevant epitopes, such as LacdiNAc (LDN), fucosylated LacdiNAc (FucLDN), NeuGc, Lewis^X/Y and Gal_α1,3Gal epitopes. rFVIII expressed in HEK cells showed the greatest glycomic differences to human pdFVIII.     

Venous thromboembolism in patients with liver diseases

Essentials

• Emerging evidence shows that patients with liver disease are not protected from thrombotic events.
• We assessed the risk of venous thromboembolism (VTE) in patients with liver disease.
• The presence of VTE resulted in an increase in mortality for patients with liver disease.
• Hospitalized patients with moderate‐severe liver disease had low risk of VTE during admission.

Summary

Background and Aims

Patients with liver disease were traditionally believed to be protected against development of blood clots, but some studies have shown a potential increased risk of venous thrombotic complications. We assessed the risk of venous thromboembolism (VTE) in patients with liver disease.

Methods

Data in discharge reports of patients with liver disease and control patients without liver disease were analyzed from the national inpatient sample. Incidence of VTE was compared in patients with mild, moderate‐severe or no liver disease, and the impact on in‐hospital mortality and length of stay was calculated.

Results

The overall incidence of VTE for patients with no liver disease, mild liver disease and moderate‐severe liver disease was 2.7, 2.4 and 0.9 per 100 patient discharges, respectively. In the presence of VTE, in‐hospital mortality was 10.8%, 5.8%, and 21.7% for the no liver disease, mild disease and moderate‐severe liver disease, respectively. The presence of VTE resulted in an increase in mortality for patients with no liver disease (OR, 1.16; 95% CI, 1.14–1.18) and moderate‐severe liver disease (OR, 1.63; CI 95%, 1.42–1.88).

Conclusions

Patients with moderate‐severe liver disease have a lower risk of VTE than those without liver disease. Development of thrombosis during admission increased the risk of in‐hospital mortality.

     

Cadazolid: A new hope in the treatment of Clostridium difficile infection

Clostridium difficile infection (CDI) is a potential life-threatening consequence of antibiotic therapy. Although the risk increases with duration of treatment, it can also occur after a short treatment course. In addition to broad-spectrum antibiotics, anti-neoplastic agents, proton pump inhibitors, H² blockers, and several other drugs have been reported to induce intestinal dysbiosis, which is central to the pathogenesis of CDI. There is an increase in incidence and mortality attributed to CDI globally. Moreover, the epidemiology of C. difficile-associated diseases has changed significantly with an increasing occurrence of community-acquired CDI. Metronidazole and oral vancomycin are the first-line antibiotics used to treat CDI. However, metronidazole has limited effectiveness in severe cases and vancomycin use is associated with increasing risk of vancomycin resistance among Enterococcus spp. Cadazolid, a novel oxazolidinone antibiotic, has recently shown potent antimicrobial activity against C. difficile and has a lower propensity to induce resistance. The implications of its use in treating CDI have been reviewed based on current evidence.