Factors explaining variance in perceived pain in women with fibromyalgia

BACKGROUND: We hypothesized that a substantial proportion of the subjectively experienced variance in pain in fibromyalgia patients would be explained by psychological factors alone, but that a combined model, including neuroendocrine and autonomic factors, would give the most parsimonious explanation of variance in pain. METHODS: Psychometric assessment included McGill Pain Questionnaire, General Health Questionnaire, Hospital Anxiety and Depression Rating Scale, Eysenck personality Inventory, Neuroticism and Lie subscales, Toronto Alexithymia Scale, and Multidimensional Health Locus of Control Scale and was performed in 42 female patients with fibromyalgia and 48 female age matched random sample population controls. A subgroup of the original sample (22 fibromyalgia patients and 13 controls) underwent a pharmacological challenge test with buspirone to assess autonomic and adrenocortical reactivity to serotonergic challenge. RESULTS: Although fibromyalgia patients scored high on neuroticism, anxiety, depression and general distress, only a minor part of variance in pain was explained by psychological factors alone. High pain score was associated with high neuroticism, low baseline cortisol level and small drop in systolic blood pressure after buspirone challenge test. This model explained 41.5% of total pain in fibromyalgia patients. In population controls, psychological factors alone were significant predictors for variance in pain. CONCLUSION: Fibromyalgia patients may have reduced reactivity in the central sympathetic system or perturbations in the sympathetic-parasympathetic balance. This study shows that a biopsychosocial model, including psychological factors as well as factors related to perturbations of the autonomic nervous system and hypothalamic-pituitary-adrenal axis, is needed to explain perceived pain in fibromyalgia patients

Pleasure-suffering indicators of nursing work in a hemodialysis nursing service

OBJECTIVE To measure the pleasure and suffering indicators at work and relate them to the socio-demographic and employment characteristics of the nursing staff in a hemodialysis center in southern Brazil. METHOD Quantitative research, with 46 workers. We used a self-completed form with demographic and labor data and the Pleasure and Suffering Indicators at Work Scale (PSIWS). We conducted a bivariate and correlation descriptive analysis with significance levels of 5% using the Epi-Info® and PredictiveAnalytics Software programs. RESULTS Freedom of Speech was considered critical; other factors were evaluated as satisfactory. The results revealed a possible association between sociodemographic characteristics and work, and pleasure and suffering indicators. There was a correlation between the factors evaluated. CONCLUSION Despite the satisfactory evaluation, suffering is present in the studied context, expressed mainly by a lack of Freedom of Speech, with the need for interventions to prevent injury to the health of workers

Consistência das informações de um estudo sobre o impacto da assistência nutricional no atendimento pré-natal Consistency of data in a study about the impact of nutritional assistance during prenatal care

OBJETIVO: Avaliar a consistência dos dados obtidos no estudo Avaliação do impacto da assistência nutricional pré-natal no resultado obstétrico, por análise da confiabilidade das informações e perdas de seguimento ocorridas. MÉTODOS: Trata-se de um estudo de intervenção, prospectivo, em uma coorte de gestantes. O grupo pré-intervenção (GI) foi constituído de 225 puérperas adultas (1999-2001) e o grupo intervenção (GII), de 208 gestantes adultas (2005-2006) e seus respectivos recém-nascidos, atendidos em Maternidade Pública do Rio de Janeiro. Visando à padronização dos procedimentos de coleta de dados, os pesquisadores receberam treinamento, reciclagem e foram supervisionados. Além disso, elaborou-se um manual de instruções para consulta no trabalho de campo, foi feito um estudo piloto para testar os instrumentos; a análise da consistência dos dados foi semanal. Para avaliar a confiabilidade da obtenção das informações, foram aplicadas as estatísticas Kappa (k) e o Índice de Concordância Intraclasse (ICC). RESULTADOS: As perdas de seguimento do GII foram de 8,4%. Houve boa padronização dos procedimentos de obtenção das informações em ambos os grupos, com ICC>0,92 e k>0,65 no GI e, para o GII, ICC>0,94 e k>0,71. Destaca-se a alta concordância entre o peso pré-gestacional informado e o aferido no primeiro trimestre (ICC=0,961). CONCLUSÕES: Os resultados sugerem que as estratégias adotadas no presente estudo contribuíram para o baixo percentual de perdas de seguimento e garantia da qualidade dos dados, permitindo a reprodutibilidade dos resultados.<br>OBJECTIVE:To assess the consistency of the results obtained in the study Assessment of the impact of prenatal nutritional assistance on pregnancy outcome by testing the reliability of data and analyzing follow-up losses. METHODS: This is a prospective intervention study in a cohort of pregnant women. Pre-intervention group (GI) was formed by 225 postpartum women (1999-2001) and the intervention group (GII), by 208 pregnant women (2005-2006) and their respective newborn infants assisted in a public maternity hospital of Rio de Janeiro, Brazil. In order to standardize data collection, field researchers were trained, recycled and supervised, and an instruction guide was developed. A pilot study was done to test the tools and assessment of data consistency was performed weekly. Evaluation of reliability used Kappa (k) statistics and intraclass correlation coefficient (ICC). RESULTS: The follow-up losses of GII were 8.4%. There was a good standardization of procedures to obtain information in both groups, with an ICC>0.82 and k>0.65 for GI and ICC>0.94 and k>0.71 for GII. There was a high concordance between the pre-pregnancy weight informed and the weight measured in the first trimester (ICC=0.96). CONCLUSIONS: The strategies adopted in the present study contributed to the low percentage of follow-up losses and to guarantee the quality of data, allowing reliability of results