Enhancing Chronic Pain Management Motivational Interview Among Lower Back Pain Patients

Purpose: Untreated chronic pain is a nationwide epidemic affect individual physically, psychologically, and financially. Low back pain is the most common subset of chronic pain. Restricted clinic time and a focus on procedural/prescriptive methods for managing pain prohibits patient education regarding self-care, and formation of a relationship with the provider. Design: Article review yielded 20 articles that supported the use of motivational interviewing for chronic pain in lower back pain patients. They were evaluated for their strength of evidence on a scale of 1-6. One article was ranked level I as a meta-analysis, and six were ranked as level II which is randomized control trials. Methods: Implementation of monthly telephone follow-ups, guided by the 5A’s framework to strengthen self-motivated behavior modifications, develop patient-centered outcomes, and outline systematic follow-up care plans. Data collection utilized standardized rating scales and questionnaires. The process proceeded for six months concluding with program evaluation. Results: The average pain score improved from 4.6 down to 3.8 (-0.8) almost a 1-point decrease. The average QOL score had the most dramatic increase from 4.6 to 6 (+1.4). No improvement in pain medication usage. Conclusion: Timely utilization of evidence-based interventions for chronic back pain can improve patient-provider interaction and promote self-care by addressing quality of life issues, decreasing patient pain scores and limiting importance of opioid medications. Clinical Implications: Promotion of self-care behaviors encourages provider backed safety and holistic collaboration

Enhancing Chronic Pain Management: Motivational Interview Among Lower Back Patients –Phase II

Purpose: Chronic low back pain in adults is difficult to manage and can lead to clinical, psychological, and social consequences. Providers often have restricted clinic time that prevents patient education regarding self-care and non-pharmacological therapies. Design: This nurse practitioner-led, evidence-based project incorporates monthly telephone calls to improve patient pain, enhance quality of life, decrease opioid usage, increase physical activity, and promote the utilization of non-pharmacological multimodal therapies. Methods: Implementing a monthly telephone call utilizing motivational interviewing and a 5 A’s guided questionnaire assisted in providing individualized treatment plans. Data outcomes include pain scores, quality of life scores, number of opioid pain medications, amount of intentional physical activity, and utilization of non-pharmacological multimodal therapies. Results: Quality of life scores improved with each phone call and were not affected by pain medications. Higher pain scores were reported when taking one opioid medication. The most common non-pharmacological therapies used by patients were thermotherapy (heat/ice) and exercise but did not contribute to lower pain scores. Conclusion: Chronic low back pain is difficult to treat and often requires a variety of modalities to improve function. The utilization of telephone calls was a viable and cost-effective method of interaction with patients that promoted health care access and patient education. Clinical Implications: Utilizing the 5 A’s behavior change model, motivational interviewing techniques, and monthly telephone calls to patients resulted in improved patient-reported quality of life scores, increased patient knowledge of non-pharmacological therapies, improved patient treatment plans, and increased revenue for the pain management clinic

Early androgen exposure and human gender development.

During early development, testosterone plays an important role in sexual differentiation of the mammalian brain and has enduring influences on behavior. Testosterone exerts these influences at times when the testes are active, as evidenced by higher concentrations of testosterone in developing male than in developing female animals. This article critically reviews the available evidence regarding influences of testosterone on human gender-related development. In humans, testosterone is elevated in males from about weeks 8 to 24 of gestation and then again during early postnatal development. Individuals exposed to atypical concentrations of testosterone or other androgenic hormones prenatally, for example, because of genetic conditions or because their mothers were prescribed hormones during pregnancy, have been consistently found to show increased male-typical juvenile play behavior, alterations in sexual orientation and gender identity (the sense of self as male or female), and increased tendencies to engage in physically aggressive behavior. Studies of other behavioral outcomes following dramatic androgen abnormality prenatally are either too small in their numbers or too inconsistent in their results, to provide similarly conclusive evidence. Studies relating normal variability in testosterone prenatally to subsequent gender-related behavior have produced largely inconsistent results or have yet to be independently replicated. For studies of prenatal exposures in typically developing individuals, testosterone has been measured in single samples of maternal blood or amniotic fluid. These techniques may not be sufficiently powerful to consistently detect influences of testosterone on behavior, particularly in the relatively small samples that have generally been studied. The postnatal surge in testosterone in male infants, sometimes called mini-puberty, may provide a more accessible opportunity for measuring early androgen exposure during typical development. This approach has recently begun to be used, with some promising results relating testosterone during the first few months of postnatal life to later gender-typical play behavior. In replicating and extending these findings, it may be important to assess testosterone when it is maximal (months 1 to 2 postnatal) and to take advantage of the increased reliability afforded by repeated sampling

Childhood gender-typed behavior and adolescent sexual orientation: A longitudinal population-based study.

Lesbian and gay individuals have been reported to show more interest in other-sex, and/or less interest in same-sex, toys, playmates, and activities in childhood than heterosexual counterparts. Yet, most of the relevant evidence comes from retrospective studies or from prospective studies of clinically referred, extremely gender nonconforming children. In addition, findings are mixed regarding the relation between childhood gender-typed behavior and the later sexual orientation spectrum from exclusively heterosexual to exclusively lesbian/gay. The current study drew a sample (2,428 girls and 2,169 boys) from a population-based longitudinal study, and found that the levels of gender-typed behavior at ages 3.5 and 4.75 years, although less so at age 2.5 years, significantly and consistently predicted adolescents' sexual orientation at age 15 years, both when sexual orientation was conceptualized as 2 groups or as a spectrum. In addition, within-individual change in gender-typed behavior during the preschool years significantly related to adolescent sexual orientation, especially in boys. These results suggest that the factors contributing to the link between childhood gender-typed behavior and sexual orientation emerge during early development. Some of those factors are likely to be nonsocial, because nonheterosexual individuals appear to diverge from gender norms regardless of social encouragement to conform to gender roles. (PsycINFO Database RecordThe UK Medical Research Council and the Wellcome Trust (Grant ref: 102215/2/13/2) and the University of Bristol provide core support for ALSPAC. This specific study was supported by a Cambridge International Scholarship awarded to Gu Li and by research funding from the Department of Psychology, University of Cambridge

In Search of Emerging Same-Sex Sexuality: Romantic Attractions at Age 13 Years.

Sex-typed behavior in childhood is significantly related to sexual orientation in adulthood. In addition, same-sex attractions in early adolescence are more non-exclusive than in adulthood and can differ from later same-sex orientations. However, little research has focused on romantic attractions as they emerge during early adolescence. Drawing a sample from the Avon Longitudinal Study of Parents and Children (197 girls, 204 boys), the current study examined whether same-sex romantic attractions at age 13 years were exclusive, and whether they were predicted by sex-typed behavior at age 3.5 years. No young adolescents in this sample reported exclusive same-sex attractions, and increased same-sex attractions were not significantly related to reduced other-sex sexualities. Childhood sex-typed behavior did not significantly predict early same-sex attractions, suggesting that early same-sex attractions differ from later same-sex orientations. The current study highlights the importance of studying the development of sexuality beginning prior to adulthood.The UK Medical Research Council (Grant ref: 74882), the Wellcome Trust (Grant ref: 076467) and the University of Bristol currently provide core support for ALSPAC. The present study was funded by the Wellcome Trust (Grant ref: 069606)

How Large Are Gender Differences in Toy Preferences? A Systematic Review and Meta-Analysis of Toy Preference Research

Funder: Gates Cambridge Trust; doi: http://dx.doi.org/10.13039/501100005370Abstract: It is generally recognized that there are gender-related differences in children’s toy preferences. However, the magnitude of these differences has not been firmly established. Furthermore, not all studies of gender-related toy preferences find significant gender differences. These inconsistent findings could result from using different toys or methods to measure toy preferences or from studying children of different ages. Our systematic review and meta-analysis combined 113 effect sizes from 75 studies to estimate the magnitude of gender-related differences in toy preferences. We also assessed the impact of using different toys or methods to assess these differences, as well as the effect of age on gender-related toy preferences. Boys preferred boy-related toys more than girls did, and girls preferred girl-related toys more than boys did. These differences were large (d ≥ 1.60). Girls also preferred toys that researchers classified as neutral more than boys did (d = 0.29). Preferences for gender-typical over gender-atypical toys were also large and significant (d ≥ 1.20), and girls and boys showed gender-related differences of similar magnitude. When only dolls and vehicles were considered, within-sex differences were even larger and of comparable size for boys and girls. Researchers sometimes misclassified toys, perhaps contributing to an apparent gender difference in preference for neutral toys. Forced choice methods produced larger gender-related differences than other methods, and gender-related differences increased with age

How Large Are Gender Differences in Toy Preferences? A Systematic Review and Meta-Analysis of Toy Preference Research

Funder: Gates Cambridge Trust; doi: http://dx.doi.org/10.13039/501100005370Abstract: It is generally recognized that there are gender-related differences in children’s toy preferences. However, the magnitude of these differences has not been firmly established. Furthermore, not all studies of gender-related toy preferences find significant gender differences. These inconsistent findings could result from using different toys or methods to measure toy preferences or from studying children of different ages. Our systematic review and meta-analysis combined 113 effect sizes from 75 studies to estimate the magnitude of gender-related differences in toy preferences. We also assessed the impact of using different toys or methods to assess these differences, as well as the effect of age on gender-related toy preferences. Boys preferred boy-related toys more than girls did, and girls preferred girl-related toys more than boys did. These differences were large (d ≥ 1.60). Girls also preferred toys that researchers classified as neutral more than boys did (d = 0.29). Preferences for gender-typical over gender-atypical toys were also large and significant (d ≥ 1.20), and girls and boys showed gender-related differences of similar magnitude. When only dolls and vehicles were considered, within-sex differences were even larger and of comparable size for boys and girls. Researchers sometimes misclassified toys, perhaps contributing to an apparent gender difference in preference for neutral toys. Forced choice methods produced larger gender-related differences than other methods, and gender-related differences increased with age

The early postnatal period, mini-puberty, provides a window on the role of testosterone in human neurobehavioural development.

Experimental research in non-human mammals indicates that testosterone exposure during early periods of rapid brain development has enduring influences on brain and behaviour. These influences are exerted when testosterone is higher in developing males than females, and the affected characteristics are those that differ by sex. Testosterone is higher in males than in females from about weeks 8 to 24 of human gestation and then again during early infancy, and both of these periods are times of rapid brain development. Substantial evidence suggests that testosterone prenatally influences human neurobehavioral development. Emerging evidence suggests that the early postnatal period is important too. This early postnatal period could provide a window for studying testosterone interacting with experience to shape human gender development.The authors’ work on which this report was based was supported in part by the National Institutes of Health (HD24542), by the Economic and Social Research Council ((ES/J500033/1; ES/I901957/1; ES/H016406/1) and by the University of Cambridge.This is the author accepted manuscript. It is currently under an indefinite embargo pending publication by Elsevier

Pregnancy-associated cardiomyopathy in survivors of childhood cancer

Current information regarding pregnancy-associated cardiomyopathy among women treated for childhood cancer is insufficient to appropriately guide counseling and patient management. This study aims to characterize its prevalence within a large cohort of females exposed to cardiotoxic therapy

Postnatal penile growth concurrent with mini-puberty predicts later sex-typed play behavior: Evidence for neurobehavioral effects of the postnatal androgen surge in typically developing boys.

The masculinizing effects of prenatal androgens on human neurobehavioral development are well established. Also, the early postnatal surge of androgens in male infants, or mini-puberty, has been well documented and is known to influence physiological development, including penile growth. However, neurobehavioral effects of androgen exposure during mini-puberty are largely unknown. The main aim of the current study was to evaluate possible neurobehavioral consequences of mini-puberty by relating penile growth in the early postnatal period to subsequent behavior. Using multiple linear regression, we demonstrated that penile growth between birth and three months postnatal, concurrent with mini-puberty, significantly predicted increased masculine/decreased feminine behavior assessed using the Pre-school Activities Inventory (PSAI) in 81 healthy boys at 3 to 4years of age. When we controlled for other potential influences on masculine/feminine behavior and/or penile growth, including variance in androgen exposure prenatally and body growth postnally, the predictive value of penile growth in the early postnatal period persisted. More specifically, prenatal androgen exposure, reflected in the measurement of anogenital distance (AGD), and early postnatal androgen exposure, reflected in penile growth from birth to 3months, were significant predictors of increased masculine/decreased feminine behavior, with each accounting for unique variance. Our findings suggest that independent associations of PSAI with AGD at birth and with penile growth during mini-puberty reflect prenatal and early postnatal androgen exposures respectively. Thus, we provide a novel and readily available approach for assessing effects of early androgen exposures, as well as novel evidence that early postnatal aes human neurobehavioral development.We thank the participating families and the Cambridge Baby Growth Study team. Data were presented at Erasmus Medical Centre, Rotterdam, where suggestions were integrated into analyses. The study was supported by the European Union Fifth Framework Programme) (Grant #QLK4-CT-1999-01422, World Cancer Research Fund International, Mothercare Foundation, Newlife Foundation for Disabled Children and Medical Research Council (UK). We also thank the Wellcome Trust Clinical Research Facility and the National Institute for Health Research — Biomedical Research Centre Cambridge.This is the final published version. It first appeared at http://www.sciencedirect.com/science/article/pii/S0018506X15000033#