The course of mental health problems in children presenting with abdominal pain in general practice

Objective. To investigate the course of mental health problems in children presenting to general practice with abdominal pain and to evaluate the extent to which abdominal pain characteristics during follow-up predict the presence of mental health problems at 12 months' follow-up. Design. A prospective cohort study with one-year follow-up. Setting. 53 general practices in the Netherlands, between May 2004 and March 2006. Subjects. 281 children aged 4-17 years. Main outcome measures. The presence of a depressive problem, an anxiety problem, and multiple non-specific somatic symptoms at follow-up and odds ratios of duration, frequency, and severity of abdominal pain with these mental health problems at follow-up. Results. A depressive problem persisted in 24/74 children (32.9%; 95% CI 22.3-44.9%), an anxiety problem in 13/43 (30.2%; 95% CI 17.2-46.1%) and the presence of multiple non-specific somatic symptoms in 75/170 children (44.1%; 95% CI 36.7-51.6%). None of the abdominal pain characteristics predicted a depressive or an anxiety problem at 12 months' follow-up. More moments of moderate to severe abdominal pain predicted the presence of multiple nonspecific somatic symptoms at follow-up. Conclusions. In one-third of the children presenting to general practice for abdominal pain, anxiety and depressive problems persist during one year of follow-up. Characteristics of the abdominal pain during the follow-up period do not predict anxiety or depressive problems after one-year follow-up. We recommend following over time children seen in primary care with abdominal pain

Early signaling, referral, and treatment of adolescent chronic pain: a study protocol

<p>Abstract</p> <p>Background</p> <p>Chronic pain is prevalent among young people and negatively influences their quality of life. Furthermore, chronic pain in adolescence may persist into adulthood. Therefore, it is important early on to promote the self-management skills of adolescents with chronic pain by improving signaling, referral, and treatment of these youngsters. In this study protocol we describe the designs of two complementary studies: a signaling study and an intervention study.</p> <p>Methods and design</p> <p>The signaling study evaluates the Pain Barometer, a self-assessed signaling instrument for chronic pain in adolescents. To evaluate the feasibility of the Pain Barometer, the experiences of youth-health care nurses will be evaluated in semi-structured interviews. Also, we will explore the frequencies of referral per health-care provider. The intervention study evaluates Move It Now, a guided self-help intervention via the Internet for teenagers with chronic pain. This intervention uses cognitive behavioural techniques, including relaxation exercises and positive thinking. The objective of the intervention is to improve the ability of adolescents to cope with pain. The efficacy of Move It Now will be examined in a randomized controlled trial, in which 60 adolescents will be randomly assigned to an experimental condition or a waiting list control condition.</p> <p>Discussion</p> <p>If the Pain Barometer is proven to be feasible and Move It Now appears to be efficacious, a health care pathway can be created to provide the best tailored treatment promptly to adolescents with chronic pain. Move It Now can be easily implemented throughout the Netherlands, as the intervention is Internet based.</p> <p>Trial registration</p> <p>Dutch Trial Register NTR1926</p

Childhood abdominal pain in primary care: design and patient selection of the HONEUR abdominal pain cohort

Background: Abdominal pain in children is a common complaint presented to the GP. However, the prognosis and prognostic factors of childhood abdominal pain are almost exclusively studied in referred children. This cohort study aims at describing prognosis and prognostic factors of childhood abdominal pain in primary care. In this paper we describe methods used for data-collection and determine possible selective recruitment. Methods/Design: We conducted an observational, prospective cohort study with a 1-year follow-up. From May 2004 to March 2006, 53 Dutch GPs recruited consecutive children aged 4-17 years with a new episode of abdominal pain not preceded by a consultation for this complaint in the previous 3 months. Participants filled in standardized questionnaires, and faeces and urine were sampled. To evaluate selective recruitment, the electronic medical records of participating GPs were retrospectively searched for eligible non-included children. Discussion: This study allows us to describe prognosis and prognostic factors of childhood abdominal pain in primary care. A total of 305 children were included of whom 142 (46.6%) met predefined criteria for chronic/recurrent abdominal pain at presentation; from the total group of eligible children identified from the electronic medical record, 27% were included. The included children were significantly younger than non-included children (mean age 8.49 and 9.20 years). In proportion to identified eligible children, significantly less children diagnosed with "gastroenteritis" (6.8%) and significantly more children with "generalized abdominal pain" (39%) were included compared to the 27% that was expected. This cohort represents young school-aged children consulting GPs for a new episode of abdominal pain, not diagnosed as gastroenteritis. Almost half of them fulfil the criteria for chronic abdominal pain at presentation

Earthquake nucleation in the lower crust by local stress amplification

Deep intracontinental earthquakes are poorly understood, despite their potential to cause significant destruction. Although lower crustal strength is currently a topic of debate, dry lower continental crust may be strong under high-grade conditions. Such strength could enable earthquake slip at high differential stress within a predominantly viscous regime, but requires further documentation in nature. Here, we analyse geological observations of seismic structures in exhumed lower crustal rocks. A granulite facies shear zone network dissects an anorthosite intrusion in Lofoten, northern Norway, and separates relatively undeformed, microcracked blocks of anorthosite. In these blocks, pristine pseudotachylytes decorate fault sets that link adjacent or intersecting shear zones. These fossil seismogenic faults are rarely >15 m in length, yet record single-event displacements of tens of centimetres, a slip/length ratio that implies >1 GPa stress drops. These pseudotachylytes represent direct identification of earthquake nucleation as a transient consequence of ongoing, localised aseismic creep

Morphology and microstructure of chromite crystals in chromitites from the Merensky Reef (Bushveld Complex, South Africa)

The Merensky Reef of the Bushveld Complex consists of two chromitite layers separated by coarse-grained melanorite. Microstructural analysis of the chromitite layers using electron backscatter diffraction analysis (EBSD), high-resolution X-ray microtomography and crystal size distribution analyses distinguished two populations of chromite crystals: fine-grained idiomorphic and large silicate inclusion-bearing crystals. The lower chromitite layer contains both populations, whereas the upper contains only fine idiomorphic grains. Most of the inclusion-bearing chromites have characteristic amoeboidal shapes that have been previously explained as products of sintering of pre-existing smaller idiomorphic crystals. Two possible mechanisms have been proposed for sintering of chromite crystals: (1) amalgamation of a cluster of grains with the same original crystallographic orientation; and (2) sintering of randomly orientated crystals followed by annealing into a single grain. The EBSD data show no evidence for clusters of similarly oriented grains among the idiomorphic population, nor for earlier presence of idiomorphic subgrains spatially related to inclusions, and therefore are evidence against both of the proposed sintering mechanisms. Electron backscatter diffraction analysis maps show deformation-related misorientations and curved subgrain boundaries within the large, amoeboidal crystals, and absence of such features in the fine-grained population. Microstructures observed in the lower chromitite layer are interpreted as the result of deformation during compaction of the orthocumulate layers, and constitute evidence for the formation of the amoeboid morphologies at an early stage of consolidation.An alternative model is proposed whereby silicate inclusions are incorporated during maturation and recrystallisation of initially dendritic chromite crystals, formed as a result of supercooling during emplacement of the lower chromite layer against cooler anorthosite during the magma influx that formed the Merensky Reef. The upper chromite layer formed from a subsequent magma influx, and hence lacked a mechanism to form dendritic chromite. This accounts for the difference between the two layers