Effect of age, sex and gender on pain sensitivity: A narrative review

© 2017 Eltumi And Tashani. Introduction: An increasing body of literature on sex and gender differences in pain sensitivity has been accumulated in recent years. There is also evidence from epidemiological research that painful conditions are more prevalent in older people. The aim of this narrative review is to critically appraise the relevant literature investigating the presence of age and sex differences in clinical and experimental pain conditions. Methods: A scoping search of the literature identifying relevant peer reviewed articles was conducted on May 2016. Information and evidence from the key articles were narratively described and data was quantitatively synthesised to identify gaps of knowledge in the research literature concerning age and sex differences in pain responses. Results: This critical appraisal of the literature suggests that the results of the experimental and clinical studies regarding age and sex differences in pain contain some contradictions as far as age differences in pain are concerned. While data from the clinical studies are more consistent and seem to point towards the fact that chronic pain prevalence increases in the elderly findings from the experimental studies on the other hand were inconsistent, with pain threshold increasing with age in some studies and decreasing with age in others. Conclusion: There is a need for further research using the latest advanced quantitative sensory testing protocols to measure the function of small nerve fibres that are involved in nociception and pain sensitivity across the human life span. Implications: Findings from these studies should feed into and inform evidence emerging from other types of studies (e.g. brain imaging technique and psychometrics) suggesting that pain in the older humans may have unique characteristics that affect how old patients respond to intervention

Sedentary Behavior and Physical Activity in Youth With Recent Onset of Type 2 Diabetes

With the rise of type 2 diabetes in youth, it is critical to investigate factors such as physical activity (PA) and time spent sedentary that may be contributing to this public health problem. This article describes PA and sedentary time in a large cohort of youth with type 2 diabetes and compares these levels with other large-scale investigations

The GCM-reality intercomparison project for SPARC (GRIPS): Scientific issues and initial results

To investigate the effects of the middle atmosphere on climate, the World Climate Research Programme is supporting the project "Stratospheric Processes and their Role in Climate" (SPARC). A central theme of SPARC, to examine model simulations of the coupled troposphere-middle atmosphere system, is being performed through the initiative called GRIPS (GCM-Reality Intercomparison Project for SPARC). In this paper, an overview of the objectives of GRIPS is given. Initial activities include an assessment of the performance of middle atmosphere climate models, and preliminary results from this evaluation are presented here. It is shown that although all 13 models evaluated represent most major features of the mean atmospheric state, there are deficiencies in the magnitude and location of the features, which cannot easily be traced to the formulation (resolution or the parameterizations included) of the models. Most models show a cold bias in all locations, apart from the tropical tropopause region where they can be either too warm or too cold. The strengths and locations of the major jets are often misrepresented in the models. Looking at three-dimensional fields reveals, for some models, more severe deficiencies in the magnitude and positioning of the dominant structures (such as the Aleutian high in the stratosphere), although undersampling might explain some of these differences from observations. All the models have shortcomings in their simulations of the present-day climate, which might limit the accuracy of predictions of the climate response to ozone change and other anomalous forcing

Thinking about going to the dentist: a Contemplation Ladder to assess dentally-avoidant individuals' readiness to go to a dentist

<p>Abstract</p> <p>Background</p> <p>The Transtheoretical Model suggests that individuals vary according to their readiness to change behavior. Previous work in smoking cessation and other health areas suggests that interventions are more successful when they are tailored to an individual's stage of change with regards to the specific behavior. We report on the performance of a single-item measure ("Ladder") to assess the readiness to change dental-avoidant behavior.</p> <p>Methods</p> <p>An existing Contemplation Ladder for assessing stage of change in smoking cessation was modified to assess readiness to go to a dentist. The resulting Ladder was administered to samples of English-speaking adolescents (USA), Spanish-speaking adults (USA), and Norwegian military recruits (Norway) in order to assess construct validity. The Ladder was also administered to a sample of English-speaking avoidant adolescents and young adults who were enrolled in an intervention study (USA) in order to assess criterion validity. All participants also had dental examinations, and completed other questionnaires. Correlations, chi square, t tests and one-way ANOVAs were used to assess relationships between variables.</p> <p>Results</p> <p>In two samples, participants who do not go to the dentist had significantly more teeth with caries; in a third sample, participants who do not go to the dentist had significantly worse caries. Ladder scores were not significantly related to age, gender, caries, or dental fear. However, Ladder scores were significantly related to statements of intention to visit a dentist in the future and the importance of oral health. In a preliminary finding, Ladder scores at baseline also predicted whether or not the participants decided to go to a dentist in the intervention sample.</p> <p>Conclusions</p> <p>The data provide support for the convergent and divergent construct validity of the Ladder, and preliminary support for its criterion validity. The lack of relationship between dental fear and Ladder scores suggests that avoidant individuals may be helped to decide to go to a dentist using interventions which do not explicitly target their fear.</p

A randomised controlled trial linking mental health inpatients to community smoking cessation supports: A study protocol

<p>Abstract</p> <p>Background</p> <p>Mental health inpatients smoke at higher rates than the general population and are disproportionately affected by tobacco dependence. Despite the advent of smoke free policies within mental health hospitals, limited systems are in place to support a cessation attempt post hospitalisation, and international evidence suggests that most smokers return to pre-admission smoking levels following discharge. This protocol describes a randomised controlled trial that will test the feasibility, acceptability and efficacy of linking inpatient smoking care with ongoing community cessation support for smokers with a mental illness.</p> <p>Methods/Design</p> <p>This study will be conducted as a randomised controlled trial. 200 smokers with an acute mental illness will be recruited from a large inpatient mental health facility. Participants will complete a baseline survey and will be randomised to either a multimodal smoking cessation intervention or provided with hospital smoking care only. Randomisation will be stratified by diagnosis (psychotic, non-psychotic). Intervention participants will be provided with a brief motivational interview in the inpatient setting and options of ongoing smoking cessation support post discharge: nicotine replacement therapy (NRT); referral to Quitline; smoking cessation groups; and fortnightly telephone support. Outcome data, including cigarettes smoked per day, quit attempts, and self-reported 7-day point prevalence abstinence (validated by exhaled carbon monoxide), will be collected via blind interview at one week, two months, four months and six months post discharge. Process information will also be collected, including the use of cessation supports and cost of the intervention.</p> <p>Discussion</p> <p>This study will provide comprehensive data on the potential of an integrated, multimodal smoking cessation intervention for persons with an acute mental illness, linking inpatient with community cessation support.</p> <p>Trial Registration</p> <p>Australian and New Zealand Clinical Trials Registry ANZTCN: <a href="http://www.anzctr.org.au/ACTRN12609000465257.aspx">ACTRN12609000465257</a></p

Randomized Controlled Trial of Intense Therapeutic Ultrasound for the Treatment of Chronic Plantar Fasciitis

Category: Sports Introduction/Purpose: Initial treatment of plantar fasciitis (PF), consisting of anti-inflammatories, stretching and in-shoe orthosis (heel pad, heel wedge, or arch support), leads to symptomatic resolution in over 90% of patients but takes 3-6 months. This study was conducted to test the effectiveness of a minimally invasive modality, intense therapeutic ultrasound (ITU), in accelerating the healing of chronic plantar fasciitis (PF). ITU uses high-frequency high-intensity focused ultrasound to create small thermal injury zones inside soft tissue without damage to surrounding structures. ITU has been shown to initiate a tissue repair cascade and promote collagen generation in dermal and musculoskeletal tissue and is FDA approved for use in non-surgical brow lifts [1,2]. The goal of this study was to determine if ITU when combined with standard therapy could speed the healing of chronic PF. Methods: 47 patients with chronic (greater than 3 months) heel pain due to PF were randomized to standard therapy (anti- inflammatory pills, stretching, and gel heel cups) plus ITU (“ITU”, n=33) or standard therapy plus sham ITU (“control”, n=14) groups. ITU treatments were administered at enrollment and two-weeks later using a custom 3.3 MHz therapeutic ultrasound system (Guided Therapy Systems, Mesa, AZ). Sham treatment utilized the same protocol but with the energy set to 0 Joules. Treatment effect was assessed at 2, 4, 6, and 12 weeks after the initiation of treatment using diagnostic ultrasound and patient reported outcomes (PROMIS physical function computer adaptive test, PROMIS global health, Foot Function Index pain subscale, and a non-validated heel pain specific questionnaire). Ultrasound images were analyzed to determine the size of lesions within the PF. Both the sonographer and the study coordinator administering the patient reported outcome instruments were blinded to group assignment. Results: 38 patients completed the 12 week study (ITU: n=37, Control: n=11.). The ITU group reported a significantly greater reduction in heel pain scores [Mean 8.27, SD 4.69, P=0.027] compared to the control group [Mean 2.25, SD 5.92] (Figure 1). Ultrasound imaging showed an 81% decrease in perifascial lesion size in the treatment group, compared to a 26% increase in lesion size in the control group (Figure 2). Conclusion: Preliminary results of this clinical study of noninvasive ITU for the treatment of chronic PF showed that ITU treatment as compared to sham control lead to a larger and more rapid reduction of heel pain and perifascial lesion size. ITU holds promise as a potential therapy to accelerate the healing of chronic plantar fasciiti

AROME-WMED, a real-time mesoscale model designed for the HyMeX special observation periods

During autumn 2012 and winter 2013, two special observation periods (SOPs) of the HYdrological cycle in the Mediterranean EXperiment (HyMeX) took place. For the preparatory studies and to support the instrument deployment during the field campaign, a dedicated version of the operational convective-scale Application of Research to Operations at Mesoscale (AROME)-France model was developed: the AROME-WMED (West Mediterranean Sea) model. It covers the western Mediterranean basin with a 48 h forecast range. It provided real-time analyses and forecasts which were sent daily to the HyMeX operational centre to forecast high-precipitation events and to help decision makers on the deployment of meteorological instruments. This paper presents the main features of this numerical weather prediction system in terms of data assimilation and forecast. Some specific data of the HyMeX SOP were assimilated in real time. <br><br> The forecast skill of AROME-WMED is then assessed with objective scores and compared to the operational AROME-France model, for both autumn 2012 (05 September to 06 November 2012) and winter 2013 (01 February to 15 March 2013) SOPs. The overall performance of AROME-WMED is good for the first HyMeX special observation period (SOP1) (i.e. mean 2 m temperature root mean square error (RMSE) of 1.7 °C and mean 2 m relative humidity RMSE of 10 % for the 0–30 h forecast ranges) and similar to those of AROME-France for the 0–30 h common forecast range (maximal absolute difference of 2 m temperature RMSE of 0.2 °C and 0.21 % for the 2 m relative humidity); conversely, for the 24–48 h forecast range it is less accurate (relative loss between 10 and 12 % in 2 m temperature and relative humidity RMSE, and equitable threat score (ETS) for 24 h accumulated rainfall), but it remains useful for scheduling observation deployment. The characteristics of parameters, such as precipitation, temperature or humidity, are illustrated by one heavy precipitation case study that occurred over the south of Spain