Defensive High-Anxious Individuals Demonstrate Difference Responses to Pain Management to Those with Lower Levels of Defensiveness and Anxiety

© 2017 World Institute of Pain. Objectives: Few studies have considered the effect of Weinberger et al.'s personality types on the management of pain. The aims of this study were to (1) identify whether the relationships between pain intensity, cognitive factors, and disability at 3 and 6 months postbaseline differ as a result of personality type; and (2) identify whether personality type affects the likelihood of achieving a minimal clinically important change in pain intensity or disability at 3 and 6 months. Method: Patients completed a set of validated questionnaires assessing personality type, cognitive factors, pain intensity, and disability at 3 and 6 months postbaseline. Results: A greater proportion of defensive high-anxious individuals reported improvement for both pain (3 months = 25%; 6 months = 38%) and disability (3 months = 35%; 6 months = 50%) and showed stronger links between improvements in pain and disability and baseline psychological factors than nonextreme individuals. Conclusions: The high proportion of defensive high-anxious individuals highlights the need for psychologically based interventions to be delivered earlier in the care process. Stratifying the population, based on personality type, may allow for more targeted interventions, which could be more cost effective and reduce the number of patients remaining in the care system

A qualitative investigation of factors that matter to individuals in the pain management process

Objective: Chronic musculoskeletal pain is a complex condition to manage with widespread consequences including physical disability, psychosocial effects and increased use of healthcare. Previous research has found patients’ experiences within health care can be influenced by factors such as expectations, therapist characteristics and treatment process. This study used patient interviews to identify the key factors that influence individuals’ experiences in the management of chronic pain. Design: Qualitative study using semi-structured interviews in either a home or hospital setting. Methods: Semi-structured interviews were conducted on eight participants attending hospital-based pain management. Participants were asked about their experiences of pain management and living with a chronic pain condition. Interviews were transcribed and analysed thematically. Results: Three main themes were identified; impact of their condition on daily life, clinical interactions and the pain management process. Understanding the condition was a key factor for the patients, in particular, explanation by the clinician. The temporality of their pain meant timing of appointments was critical. Patients reported factors such as family days and follow-up sessions would improve their treatment experience. Conclusions: This study highlighted important factors for healthcare professionals and patients in the management of chronic pain. Participants indicated a desire to understand their condition and learn strategies for selfmanagement to allow them to cope better. As patients found benefit from being involved in the management process, discussions around the options for treatment may enhance management and rehabilitation. It is important we continue to research factors important to individuals with musculoskeletal pain to find an effective, evidence-based framework for understanding and managing this condition

Defensive high-anxious individuals with chronic back pain demonstrate different treatment choices and patient persistence

The aim of this study is to determine whether the experience of, and response to chronic back pain was different for defensive high-anxious individuals than other personality types (defensive high-anxious, high-anxious, repressor and low-anxious). Participants (n = 111) were recruited from a heterogeneous sample of individuals who had reported back pain within the last 6 months. Self-report measures of trait anxiety and defensiveness were used to determine personality type. In addition, pain, treatment history, disability, depression and satisfaction with treatment were recorded. Despite reporting similar levels of pain to other personality groups, defensive high-anxious individuals reported significantly greater disability and depression (p < 0.01). Of the defensive high-anxious individuals, 92% sought more than one intervention. In comparison, repressors predominantly self-managed their pain with only 10% utilising more than one intervention. Surprisingly, there were no differences in treatment satisfaction between the four groups. The present study suggests that personality type is an important factor influencing patients’ treatment options, with defensive high anxious individuals substantially more likely to seek multiple interventions and remain within the care system. The present study provides a basis for future research into the role of personality type in the management of chronic pain

Personality Type Influences Attentional Bias in Individuals with Chronic Back Pain

Attentional biases reflect an individual’s selective attention to salient stimuli within their environment, for example an experience of back pain. Eysenck suggests that different personality types show different attentional biases to threatening information. This study is the first to test Eysenck’s theory within a chronic back pain population by investigating the attentional biases of four different personality types using a back pain specific dot-probe paradigm. Participants were 70 volunteers (45 female) recruited from a back rehabilitation program at an NHS Trust. The four groups were selected on their trait anxiety and defensiveness scores: defensive high-anxious; high-anxious; repressor and non-extreme. Participants completed a dot probe task comprising 20 practice trials and 250 experimental trials. The experimental trials contained 100 threat-neutral pairs, 100 positive-neutral pairs and 50 neutral-neutral image pairings. The threat images were taken from the Photograph Series of Daily Activities (PHODA) and the neutral and positive images from the International Affective Picture System (IAPS) image bank. The results provided partial support for Eysenck’s theory; defensive high-anxious individuals showed an attentional bias for threatening information compared to high-anxious individuals who demonstrated no bias. Repressors showed an avoidant bias to threatening images and an attentional bias to positive stimuli relative to neutral images. The clear difference in responses demonstrated by high-anxious individuals who vary in defensiveness highlight the need for separate investigation of these heterogeneous groups and help to explain the cognitive processes of defensive high-anxious individuals within a pain population. The demonstration of an attentional bias in this group to threatening information could explain why defensive high-anxious individuals are more likely to re-present for treatment

A cross‐sectional analysis of the muscle strength, spinal shrinkage, and recovery during a working day of military police officers

Objective: Military personnel has a large prevalence of back pain, especially those involved in patrolling routines, as they wear heavy protective equipment. Patrolling includes long periods of sustaining the protective equipment in a sitting or in a motor vehicle (motorcycle or car). Thus, understanding spinal loading of military police officers after patrolling by car (CAR; n = 14), motorcycle (MOT; n = 14), and administrative (ADM; n = 14) routines is relevant to establish preventive strategies. Methods: The torque of the trunk and working and anthropometric characteristics were assessed to explain spinal loading using stature variation measures. Precise stature measures were performed before and after a 6 h journey (LOSS) and 20 min after a resting posture (RECOV). The trunk extensor (PTE BM−1) and flexor (PTF BM−1) muscles' isometric peak torque were measured before the working journey. Results: The LOSS was similar between CAR and MOT (4.8 and 5.8 mm, respectively) after 6 h of patrolling. The ADM presented the lowest LOSS (2.8 mm; P .05). Vibration may explain the greater spinal loading involved in patrolling in comparison to the ADM. A GLM analysis revealed that BMI was the only explanatory factor for stature loss. No independent variables explained RECOV. The ability of the trunk muscles to produce force did not influence LOSS or RECOV. Conclusions: Military police officers involved in patrolling may require greater post‐work periods and strategies designed to reduce the weight of the protective apparatus to dissipate spinal loading. The external load used in patrolling is a relevant spinal loading factor

Attitudes of healthcare workers in U.S. hospitals regarding smallpox vaccination

BACKGROUND: The United States is implementing plans to immunize 500,000 hospital-based healthcare workers against smallpox. Vaccination is voluntary, and it is unknown what factors drive vaccine acceptance. This study's aims were to estimate the proportion of workers willing to accept vaccination and to identify factors likely to influence their decisions. METHODS: The survey was conducted among physicians, nurses, and others working primarily in emergency departments or intensive care units at 21 acute-care hospitals in 10 states during the two weeks before the U.S. national immunization program for healthcare workers was announced in December 2002. Of the questionnaires distributed, 1,165 were returned, for a response rate of 81%. The data were analyzed by logistic regression and were adjusted for clustering within hospital and for different number of responses per hospital, using generalized linear mixed models and SAS's NLMIXED procedure. RESULTS: Sixty-one percent of respondents said they would definitely or probably be vaccinated, while 39% were undecided or inclined against it. Fifty-three percent rated the risk of a bioterrorist attack using smallpox in the United States in the next two years as either intermediate or high. Forty-seven percent did not feel well-informed about the risks and benefits of vaccination. Principal concerns were adverse reactions and the risk of transmitting vaccinia. In multivariate analysis, four variables were associated with willingness to be vaccinated: perceived risk of an attack, self-assessed knowledge about smallpox vaccination, self-assessed previous smallpox vaccination status, and gender. CONCLUSIONS: The success of smallpox vaccination efforts will ultimately depend on the relative weight in people's minds of the risk of vaccine adverse events compared with the risk of being exposed to the disease. Although more than half of the respondents thought the likelihood of a bioterrorist smallpox attack was intermediate or high, less than 10% of the group slated for vaccination has actually accepted it at this time. Unless new information about the threat of a smallpox attack becomes available, healthcare workers' perceptions of the vaccine's risks will likely continue to drive their ongoing decisions about smallpox vaccination

Abrasive water jet drilling of advanced sustainable bio-fibre-reinforced polymer/hybrid composites : a comprehensive analysis of machining-induced damage responses

This paper aims at investigating the effects of variable traverse speeds on machining-induced damage of fibre-reinforced composites, using the abrasive water jet (AWJ) drilling. Three different types of epoxy-based composites laminates fabricated by vacuum bagging technique containing unidirectional (UD) flax, hybrid carbon-flax and carbon fibre-reinforced composite were used. The drilling parameters used were traverse speeds of 20, 40, 60 and 80 mm/min, constant water jet pressure of 300 MPa and a hole diameter of 10 mm. The results obtained depict that the traverse speed had a significant effect with respect to both surface roughness and delamination drilling-induced damage responses. Evidently, an increase in water jet traverse speed caused an increase in both damage responses of the three samples. Significantly, the CFRP composite sample recorded the lowest surface roughness damage response, followed by C-FFRP, while FFRP exhibited the highest. However, samples of FFRP and hybrid C-FFRP recorded lowest and highest delamination damage responses, respectively. The discrepancy in both damage responses, as further validated with micrographs of colour video microscopy (CVM), scanning electron microscopy (SEM) and X-ray micro-computed tomography (X-ray μCT), is attributed to the different mechanical properties of the reinforced fibres, fibre orientation/ply stacking and hybridisation of the samples.Peer reviewe

Sparse canonical correlation analysis for identifying, connecting and completing gene-expression networks

<p>Abstract</p> <p>Background</p> <p>We generalized penalized canonical correlation analysis for analyzing microarray gene-expression measurements for checking completeness of known metabolic pathways and identifying candidate genes for incorporation in the pathway. We used Wold's method for calculation of the canonical variates, and we applied ridge penalization to the regression of pathway genes on canonical variates of the non-pathway genes, and the elastic net to the regression of non-pathway genes on the canonical variates of the pathway genes.</p> <p>Results</p> <p>We performed a small simulation to illustrate the model's capability to identify new candidate genes to incorporate in the pathway: in our simulations it appeared that a gene was correctly identified if the correlation with the pathway genes was 0.3 or more. We applied the methods to a gene-expression microarray data set of 12, 209 genes measured in 45 patients with glioblastoma, and we considered genes to incorporate in the glioma-pathway: we identified more than 25 genes that correlated > 0.9 with canonical variates of the pathway genes.</p> <p>Conclusion</p> <p>We concluded that penalized canonical correlation analysis is a powerful tool to identify candidate genes in pathway analysis.</p

Quality versus quantity of social ties in experimental cooperative networks

Recent studies suggest that allowing individuals to choose their partners can help to maintain cooperation in human social networks; this behaviour can supplement behavioural reciprocity, whereby humans are influenced to cooperate by peer pressure. However, it is unknown how the rate of forming and breaking social ties affects our capacity to cooperate. Here we use a series of online experiments involving 1,529 unique participants embedded in 90 experimental networks, to show that there is a ‘Goldilocks’ effect of network dynamism on cooperation. When the rate of change in social ties is too low, subjects choose to have many ties, even if they attach to defectors. When the rate is too high, cooperators cannot detach from defectors as much as defectors re-attach and, hence, subjects resort to behavioural reciprocity and switch their behaviour to defection. Optimal levels of cooperation are achieved at intermediate levels of change in social ties

Heterogeneity of the humoral immune response following Staphylococcus aureus bacteremia

Expanding knowledge on the humoral immune response in Staphylococcus aureus-infected patients is a mandatory step in the development of vaccines and immunotherapies. Here, we present novel insights into the antibody responses following S. aureus bacteremia. Fifteen bacteremic patients were followed extensively from diagnosis onwards (median 29 days, range 9-74). S. aureus strains (median 3, range 1-6) and serial serum samples (median 16, range 6-27) were collected. Strains were genotyped by pulsed-field gel electrophoresis (PFGE) and genes encoding 19 staphylococcal proteins were detected by polymerase chain reaction (PCR). The levels of IgG, IgA, and IgM directed to these proteins were determined using bead-based flow cytometry. All strains isolated from individual patients were PFGE-identical. The genes encoding clumping factor (Clf) A, ClfB, and iron-responsive surface-determinant (Isd) A were detected in all isolates. Antigen-specific IgG levels increased more frequently than IgA or IgM levels. In individual patients, different proteins induced an immune response and the dynamics clearly differed. Anti-ClfB, anti-IsdH, and anti-fibronectin-binding protein A IgG levels increased in 7 of 13 adult patients (p < 0.05). The anti-IsdA IgG level increased in 12 patients (initial to peak level: 1.13-10.72 fold; p < 0.01). Peak level was reached 7-37 days after diagnosis. In a bacteremic 5-day-old newborn, antistaphylococcal IgG levels declined from diagnosis onwards. In conclusion, each bacteremic patient develops a unique immune response directed to different staphylococcal proteins. Therefore, vaccines should be based on multiple components. IsdA is immunogenic and, therefore, produced in nearly all bacteremic patients.