Socioeconomic position and variations in coping strategies in musculoskeletal pain: a cross-sectional study of 1,287 40- and 50-year-old men and women.

OBJECTIVE: To examine the association between socioeconomic position and coping strategies in musculoskeletal pain. DESIGN AND SUBJECTS: Cross-sectional study of a random sample of 40- and 50-year-old Danes, participation rate 69%, n=7,125. The study included 1,287 persons who reported functional limitations due to musculoskeletal pain. METHODS: Data was collected by postal questionnaires and scales were developed on problem-solving coping and avoidant coping, based on a range of preliminary studies. Multivariate logistic regression analyses was used to study the correlation with socioeconomic position, measured by occupational social class. RESULTS: Among women, there was no correlation between social class and avoidant coping, but a significant decrease in the use of problem-solving coping by decreasing social class, adjusted odds ratio (OR) = 2.64 (95% confidence interval (CI) 1.31-5.32) in social class V vs social classes I + II. Among men, there was no correlation between social class and problem-solving coping, but a significant increase in the use of avoidant coping with decreasing social class, adjusted OR = 3.31 (95% CI 1.75-6.25) in V vs I + II. CONCLUSION: It is important for clinicians who advise and support patients in their response to musculoskeletal pain to be aware of socioeconomic differences in coping strategies. Gender differences in the association between socioeconomic factors and coping should be further investigated.     

Hippocampal Noradrenaline and Serotonin Release over 24 Hours as Measured by the Dialysis Technique in Freely Moving Rats: Correlation to Behavioural Activity State,Effect of Handling and Tail-Pinch

Hippocampal extracellular levels of noradrenaline (NA), 5-hydroxytryptamine (5-HT), and 5-hydroxyindoleacetic acid (5-HIAA) were monitored with the microdialysis technique in freely moving rats. In one experiment 30 min samples were collected during 24 h of continuous perfusion, and the monoamine output was compared to the behavioural activity state, as arbitrarily classified in three categories: sleep/rest, drowsiness and full alertness associated with complex behaviours. In the individual animal the hippocampal NA and 5-HT output showed pronounced fluctuations during the 24 h period, but the 30 min sampling times did not allow for a clear-cut correlation to behavioural activity state. However, the mean NA and 5-HT output for all animals during the dark period of the day was 43 and 38% higher, respectively, than during the light period, and the average NA and 5-HT levels in samples collected during periods of high behavioural activity was 34 and 45% higher, respectively, than during periods of rest or sleep. In contrast, there were no detectable changes in extracellular 5-HIAA. The selective serotonin uptake blocker indalpine, added to the perfusion fluid at 1 microM, increased the extracellular 5-HT levels 6-fold, with a similar correlation to behavioural activity state as without indalpine. In a second experiment the effect of handling and tail-pinch was studied in 15 min sample fractions. Gentle handling of the animals during the sampling period increased the hippocampal NA and 5-HT output by 32 and 72%, respectively, and a similar increase (63 and 48%) was obtained by application of tail-pinch. Maximum NA output was reached during the handling or tail-pinch period, whereas maximal 5-HT levels were detected in the subsequent 15 min sample fraction. No changes in extracellular 5-HIAA was observed. It is concluded (1) that intracerebral microdialysis provides a useful method for the study of extracellular NA and 5-HT in the hippocampal formation of conscious rats during active behaviour; (2) that there are substantial fluctuations in hippocampal NA and 5-HT output in freely moving rats which correlate with the light - dark cycle as well as with the activity state of the animals; (3) that the spontaneous variations in 5-HT output are maintained during reuptake blockade; and (4) that behavioural activation through gentle handling or tail-pinch elicits NA and 5-HT release. The present data support a role of the forebrain NA and 5-HT systems in behavioural state control and highlights the necessity of experimental designs in which the spontaneous fluctuations in transmitter release are controlled for in studies of, for example, drug effects on NA and 5-HT release in conscious animals.     

Prospective memory rehabilitation using smartphones in patients with TBI

Purpose: The aim of the present study was to investigate the effectiveness of a prospective memory aid that combines smartphones with Internet-based calendars among community-dwelling patients with traumatic brain injury.

Method: An uncontrolled pre- and post-assessment design was employed to study the use of unmodified, low-cost, off-the-shelf smartphones combined with Internet-calendars as a compensatory memory strategy in community-dwelling patients with traumatic brain injury. Thirteen participants received a 6-week group-based intervention with pre-, post- and 2-month follow-up-assessments by questionnaires and by daily assessment of target behaviors for 2-week periods.

Results: Participants reported significantly fewer retro- and prospective memory problems on questionnaires after the intervention and at follow-up with large effect sizes. The performance of target behaviors, however, improved insignificantly with moderate effect sizes. There were no changes in quality of life or symptoms of emotional distress.

Conclusions: This study adds to a growing body of evidence that smartphones are a useful compensatory aid in rehabilitation of prospective memory that should routinely be considered in rehabilitation of traumatic brain injury patients.

• Implication for rehabilitation

• Smartphones are easy-to-use and accessible assistive technology for compensatory memory rehabilitation to most traumatic brain injury patients.

• By using low-cost, off-the-shelf devices, the technology becomes available to a broader range of patients.

• By combining smartphones with Internet-based and cross-platform services (e.g., calendars, contacts) the participants are less device-dependent and less vulnerable to data loss.

• Smartphones should routinely be considered as compensatory aid in rehabilitation of prospective memory of traumatic brain injured patients.

     

Cost-effectiveness of the Danish smoking cessation interventions

The cost-effectiveness of smoking cessation interventions is well documented. However, most studies are based on randomized controlled trials (RCTs) and provide little information on the differences between subgroups. This study assessed the relative cost-effectiveness of smoking cessation interventions offered to various subgroups of smokers, based on real-life data. Regression analyses provided information on the factors determining abstinence and costs and led to the formation of relevant subgroups of smokers. Probabilistic Markov modeling was then used to estimate the relative cost-effectiveness of smoking cessation interventions for the entire database population and for the subgroups compared to a no-intervention case. The ICER for the base case population was estimated at €1,358. This is consistent with results from the existing literature. Group simulations showed lower ICERs for men, hospitals, and light smokers and falling ICERs with increasing age. Despite differences in the cost-effectiveness ratios between subgroups our results do not justify any kind of subgroup differentiation in a smoking prevention policy.     

Stability and change in structural social relations as predictor of mortality among elderly women and men

In a follow-up study of 70–95years old women and men (n = 911) we studied the association between change and stability in three structural aspects of social relations (contact frequency, contact diversity, cohabitation status) from 1986–1990 and mortality after the next four years in 1994. Women aged 70–74years who developed low contact frequency or developed small contact diversity showed significantly higher mortality, adjusted OR_freq: 3.78 (1.08–13.20), adjusted OR_div: 3.79 (1.24–11.58). Women aged 70–74years with continuously low contact frequency showed an increased mortality compared to women constantly experiencing high contact frequency, adjusted OR: 2.75 (1.04–7.26). A tendency in the same direction for sustained small contact diversity was found, adjusted OR: 1.98 (0.70–5.61). Among women aged 75+ years no impact of frequency and diversity was demonstrated, whereas continuously living alone was a significant predictor of mortality, when compared to women continuously living with somebody, adjusted OR: 2.57 (1.29–5.09). In men, we found a significantly increased mortality among those who developed high contact frequency and developed large contact diversity OR_freq: 3.91 (1.02–14.94) and OR_div: 6.04 (1.30–28.03). In summary, we found rather larger age differences in the strength of the association between change in structural social relations and mortality. Furthermore, the associations seemed stronger among women than men, which may however mainly be explained by the small number of men in our cohort.     

Diagnostic value of routine radioisotope bone scanning in a series of 63 patients with pulmonary sarcoidosis

BACKGROUND AND AIM: Routine use of diagnostic radioisotope bone scanning in patients with sarcoidosis has not previously been evaluated. The aim of this study was to assess whether routine radioisotope bone scanning might be of value in the detection of osseous lesions in sarcoidosis. METHODS: 63 consecutive Caucasian patients (32 men) with a median age of 39 years (range 17-66) and biopsy proven pulmonary sarcoidosis were included. None had symptoms suggesting osseous sarcoidosis. Extrathoracic, non-osseous sarcoidosis was present in 24 patients; 13 patients were on oral steroids. Radioisotope bone scanning was performed with a gammacamera after intravenous injection of 99mTechnetium-methylenediphosphonate. An abnormal bone scan was followed by a radiograph of the region of interest. RESULTS: 39 patients (61.9%) had normal bone scans. Minor bone scan abnormalities were found in 24 patients (38.1%). Of these, 11 patients had bone foci (8 in the vertebral spine, 9 in the ribs, 1 in a finger). Radiographically only one of these 11 patients had a bony lesion being typical of sarcoidosis, located in the second finger. 17 patients had joint foci. Radiographs of the joints showed sequelae after a fracture in 1 patient, and degenerative osteoarthritis in 1 patient. There was no difference between clinical and paraclinical variables in patients with normal and abnormal bone scans. CONCLUSIONS: There appears to be no indication for routine radioisotope bone scanning in patients with sarcoidosis. Scanning should be restricted to patients with clinical suspicion of osseous sarcoidosis.     

Is there any Evidence of β1-Adrenoceptors Mediating Relaxation of Guinea-pig Lung Parenchyma?

Abstract: We tried to find functional evidence for the existence of β₁ - and β₂-adrenoceptors in the isolated guinea-pig lung parenchymal strip preparation, using potent and selective β₁- and β₂-adrenoceptor stimulation. To obtain potent β₁-adrenoceptor stimulation the nonselective β-adrenoceptor agonist isoprenaline was combined with a highly selective β₂-adrenoceptor antagonist ICI 118,551. Potent β₂-adrenoceptor stimulation was obtained by procaterol. Practolol (β₁-adrenoceptor antagonist) and ICI 118,551 were used as antagonists. ICI 118,551, 10⁷ mol/l, shifted the concentration response (C/R) curve of isoprenaline to a higher concentration range. The C/R curve of procaterol was shifted in the same way and to the same degree by this concentration of ICI 118,551. The C/R curve of isoprenaline was not further shifted after blockade with a combination of ICI 118,551, 10^-7 mol/l, and practolol, 10^-6 mol/l. However, in the trachea preparation, a tissue containing both β₁- and β₂-adrenoceptors, there was a further shift of the C/R curve of isoprenaline to a higher concentration range after blockade with a combination of ICI 118,551 and practolol in the concentrations given above. In this preparation the shift of the C/R curve of procaterol was ten times greater than that of isoprenaline after blockade with ICI 118,551, 10⁷ mol/l. We conclude that it is possible to characterize small fractions of β₁-adrenoceptors coexisting with β₂-adrenoceptors with the technique used. Furthermore there is still no functional evidence of the existence of β₁-adrenoceptors in the lung parenchyma.:     

Epstein-Barr virus-specific leukocyte migration inhibition reaction with tumor biopsy extracts: correlation with the presence of viral DNA

The Epstein-Barr virus (EBV)-specific leukocyte migration inhibition (LMI) reaction was used to detect EBV antigens in human tumor biopsies in parallel with nuclei acid hybridization for EBV DNA. None of six EBV DNA-negative tumors gave any significant LMI reaction. Fourteen of 17 EBV DNA-positive tumors gave a significant difference between the migration of leukocytes from EBV-seropositive versus -seronegative donors. One tumor gave a borderline reaction. The two-LMI-negatives in this group had only a marginal EBV DNA content. It is suggested that the EBV-specific LMI test may be useful for detecting EBV genomes in tissue and tumor extracts.