Geographic dissemination of methicillin-resistant Staphylococcus aureus strains: a French regional study

The aim of this study was to compare methicillin-resistant Staphylococcus aureus strains collected in eight hospitals located in the same region of France (Brittany) over a short period (January 1999-July 2000). Ninety-two isolates of methicillin-resistant S. aureus were characterised by their pulsotype and their antibiotype. Pulsotype analysis permitted the definition of three clusters. Two of them comprised 83% of the studied isolates. Phenotypic analysis showed two major antibiotypes, widespread in Brittany but with a heterogeneous geographic distribution and one antibiotype fitting the definition of glycopeptide intermediate S. aureus. These data argue for the high epidemicity of methicillin-resistant S. aureus among the same region.     

The Pain Anxiety Symptoms Scale Fails to Discriminate Pain or Anxiety in a Chronic Disabling Occupational Musculoskeletal Disorder Population

Background: The Pain Anxiety Symptoms Scale (PASS) was developed to measure fear and anxiety responses to pain. Many studies have found associations between PASS scores and self‐report measures of pain, anxiety, and disability as well as among inhibited movement patterns and activity avoidance behaviors (eg, kinesophobia). This study aimed to identify clinically meaningful cut‐off points to identify high or low levels of pain anxiety and to determine if the PASS provides additional useful information in a functional restoration (FR) treatment program for chronic disabling occupational musculoskeletal disorder (CDOMD) patients. Methods: A consecutive cohort of 551 patients with CDOMD, who entered and completed a FR program, was administered a battery of psychosocial assessments, including the PASS, at admission and discharge. Socioeconomic outcomes were collected 1 year after discharge. After identifying clinical ranges for mild, moderate, and severe pain anxiety, the three groups were compared on self‐report measures of psychosocial distress, clinical diagnoses of psychosocial disorders, and 1‐year socioeconomic outcomes. Results: Correlations between the PASS and all measures of pain, anxiety, and disability were statistically significant. However, only the Pain Disability Questionnaire showed a large correlation coefficient (r > 0.5). Patients with the highest PASS scores were more likely to be diagnosed with a number of Axis I (depression, opioid dependence) or Axis II (Borderline Personality) psychiatric disorders. They were more likely to display treatment‐seeking behavior at 1 year after discharge. However, the PASS failed to differentiate between any other 1‐year outcomes. Conclusions: The PASS is elevated when other measures of psychosocial distress are also elevated. However, the PASS fails to discriminate between different indices of depression and anxiety and it is not highly related to 1‐year outcomes in a CDOMD cohort. If time and resources are limited, a different measure of psychosocial distress that does relate to socioeconomic outcomes might be a better option in a CDOMD evaluation process.     

The Fear‐avoidance Components Scale (FACS): Development and Psychometric Evaluation of a New Measure of Pain‐related Fear Avoidance

Pain‐related fear avoidance (FA), a common problem for patients with painful medical conditions, involves pain‐related catastrophizing cognitions, hypervigilance, and avoidance behaviors, which can ultimately lead to decreased functioning, depression, and disability. Several patient‐reported instruments have been developed to measure FA, but they have been criticized for limited construct validity, inadequate item specificity, lack of cutoff scores, and missing important FA components. The Fear‐Avoidance Components Scale (FACS) is a new patient‐reported measure designed to comprehensively evaluate FA in patients with painful medical conditions. It combines important components of FA found in prior FA scales, while trying to correct some of their deficiencies, within a framework of the most current FA model. Psychometric evaluation of the FACS found high internal consistency (α = 0.92) and high test/retest reliability (r = 0.90–0.94, P < 0.01). FACS scores differentiated between 2 separate chronic pain patient samples and a nonpatient comparison group. When clinically relevant severity levels were created, FACS severity scores were highly associated with FA‐related patient‐reported psychosocial and objective lifting performance variables. These results suggest that the FACS is a psychometrically strong and reliable measure that can help healthcare providers assess FA‐related barriers to function and recovery.