Prevalence, characteristics, and predictors of chronic nonanginal postoperative pain after a cardiac operation: A cross-sectional study

ObjectiveThis study was designed to assess the prevalence, characteristics, effect, and predictors of chronic postoperative pain 1 to 3 years after cardiac surgery.MethodsSeven hundred thirty-six patients who underwent coronary artery bypass surgery, valve replacement, or both between 1999 and 2002 were mailed questionnaires (response rate, 79% [n = 579]; 564 questionnaires were analyzed), and their hospital records were reviewed.ResultsNonanginal chronic postoperative pain affected 23% of patients. Eighty percent of them had pain 1 or more days per week. The worst and usual pain intensities during the week preceding the survey reached moderate to severe levels (≥4/10) in more than half of the patients. Thirty-one percent of the patients with chronic postoperative pain had taken analgesic pain medication during that week. During the same period, pain interfered significantly (≥4/10) with various aspects of patients’ daily life (eg, general activity level: 39.1%, sleep: 36.7%). When patients with and without chronic postoperative pain were compared, the former group had significantly higher levels of anxiety and depression, and they perceived their health-related quality of life as more compromised. Multivariate logistic regression analysis revealed that greater analgesic needs in the first few days postoperatively were associated with an increased risk of chronic postoperative pain. The only other significant factor was the time elapsed from surgical intervention to survey: the longer it was, the less likely the patients were to report chronic postoperative pain.ConclusionThe prevalence, severity, and effect of chronic postoperative pain after cardiac surgery should not be underestimated. Longitudinal prospective studies are needed to further evaluate risk factors, including inadequate postoperative pain relief in the acute period

Sex differences in neuropsychiatric symptoms in Alzheimer’s disease dementia : a meta-analysis

Background: Neuropsychiatric symptoms (NPS) are common in individuals with Alzheimer’s disease (AD) dementia, but substantial heterogeneity exists in the manifestation of NPS. Sex differences may explain this clinical variability. We aimed to investigate the sex differences in the prevalence and severity of NPS in AD dementia. Methods: Literature searches were conducted in Embase, MEDLINE/PubMed, Web of Science Core Collection, Cochrane Central Register of Controlled Trials, PsycINFO, and Google Scholar from inception to February 2021. Study selection, data extraction, and quality assessment were conducted in duplicate. Effect sizes were calculated as odds ratios (OR) for NPS prevalence and Hedges’ g for NPS severity. Data were pooled using random-effects models. Sources of heterogeneity were examined using meta-regression analyses. Results: Sixty-two studies were eligible representing 21,554 patients (61.2% females). The majority of the included studies had an overall rating of fair quality (71.0%), with ten studies of good quality (16.1%) and eight studies of poor quality (12.9%). There was no sex difference in the presence of any NPS (k = 4, OR = 1.35 [95% confidence interval 0.78, 2.35]) and overall NPS severity (k = 13, g = 0.04 [− 0.04, 0.12]). Regarding specific symptoms, female sex was associated with more prevalent depressive symptoms (k = 20, OR = 1.60 [1.28, 1.98]), psychotic symptoms (general psychosis k = 4, OR = 1.62 [1.12, 2.33]; delusions k = 12, OR = 1.56 [1.28, 1.89]), and aberrant motor behavior (k = 6, OR = 1.47 [1.09, 1.98]). In addition, female sex was related to more severe depressive symptoms (k = 16, g = 0.24 [0.14, 0.34]), delusions (k = 10, g = 0.19 [0.04, 0.34]), and aberrant motor behavior (k = 9, g = 0.17 [0.08, 0.26]), while apathy was more severe among males compared to females (k = 11, g = − 0.10 [− 0.18, − 0.01]). There was no association between sex and the prevalence and severity of agitation, anxiety, disinhibition, eating behavior, euphoria, hallucinations, irritability, and sleep disturbances. Meta-regression analyses revealed no consistent association between the effect sizes across studies and method of NPS assessment and demographic and clinical characteristics. Discussion: Female sex was associated with a higher prevalence and greater severity of several specific NPS, while male sex was associated with more severe apathy. While more research is needed into factors underlying these sex differences, our findings may guide tailored treatment approaches of NPS in AD dementia

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Comprend des références bibliographiques

Parole d'historiens

L'histoire est-elle une science exacte ou le grand récit d'une épopée, la description méthodique du passé ou le roman vrai des origines ? L'historien doit-il se montrer attentif aux questions du présent ou, au contraire, s'en -méfier ? Est-il, avant tout, un antiquaire censé préserver avec précaution les belles choses du passé, un chercheur méticuleux en quête de vérités, un intellectuel engagé chargé de critiquer ou de reformuler les grands mythes de la nation ? Autant de questions que se sont posées les historiens québécois et auxquelles ils ont répondu, chacun à leur manière, depuis trois siècles. Cette anthologie réunit pour la première fois les noms qui ont marqué la manière d'écrire et d'enseigner l'histoire du Québec : de Pierre-François-Xavier de Charlevoix à Jocelyn Létourneau, en passant par François-Xavier Garneau, Thomas Chapais, Lionel Groulx, Marcel Trudel, Guy Frégault, Jean Hamelin, Louise Dechêne, Micheline Dumont, Paul-André Linteau, René Durocher, Gérard Bouchard et tant d'autres. Voici les références essentielles pour alimenter les débats actuels sur la fonction sociale de l'histoire

Dictionnaire des intellectuel.les au Québec

Qui connaît vraiment les intellectuel.les hors du cercle restreint des historiens et des littéraires ? Quelle mémoire avons-nous de celles et ceux qui, au Québec, eurent recours à la parole comme « mode d'action » ? Qui, comme Hubert Aquin, entreprirent et entreprennent encore de « comprendre dangereusement » la culture et la société de leur époque, remuant idées et images, bousculant pouvoirs et doxa ? Ce dictionnaire est conçu pour combler les lacunes d'une mémoire collective quelque peu défaillante, mais aussi pour donner envie de lire ou de relire les textes de ces femmes et hommes passionnés par les idées, qui ont contribué - et qui contribuent toujours - à bâtir la société québécoise. On y trouvera les noms de celles et ceux qui, depuis trois siècles, interviennent sur la place publique et soulèvent des questions d'intérêt civique et politique à propos d'enjeux collectifs importants ; de celles et ceux qui promeuvent ou incarnent la liberté de parole et la défendent contre différents pouvoirs et structures organisationnelles

Dictionnaire

ACTION FRANÇAISE (1917-1928) / ACTION NATIONALE (1933- ) Lancée une dizaine d’années après l’affaire Dreyfus, L’Action française (AF) de Montréal existe toujours sous le titre L’Action nationale (AN). C’est dire la place de la revue pour l’histoire des intellectuels, d’autant plus qu’au-delà de La Revue canadienne (1864-1922) et des journaux nationalistes du début du siècle – Le Nationaliste (1903) d’Olivar Asselin*, L’Action (1911-1916) de Jules Fournier*, Le Devoir (1910) d’Henri Bourassa* ..