Livstida socioekonomiska förhållanden vid akut, kronisk och funktionspåverkande smärta hos unga arbetstagare : ett dubbelt lidande

Abstract Background: Pain is known to be socio-economically patterned and associated with disability. However, knowledge is scarce concerning life-course socio-economic circumstances and pain among young adults. Our aim was to examine the associations of childhood and current socio-economic circumstances with acute pain and chronic pain with low and high disability levels among young Finnish municipal employees. Methods: We analyzed questionnaire data retrieved from the Young Helsinki Health Study (n=4683) covering 18–39-year-old employees of the City of Helsinki, Finland. We included a comprehensive set of indicators of childhood and current socio-economic circumstances and examined their associations with acute pain and with chronic pain with low and high disability levels. The level of chronic pain–related disability was assessed by the Chronic Pain Grade Questionnaire. Multinomial logistic regression analyses were conducted with stepwise adjustments for socio-demographic, socio-economic and health-related covariates. Results: Childhood and current socio-economic disadvantage were associated with acute and chronic pain, particularly with chronic pain with high disability level. The strongest associations after adjustments for covariates remained between chronic pain with high disability level and low education level (OR 3.38, 95% CI 2.18–5.24), manual occupation (OR 3.75, 95% CI 1.92–7.34) and experiencing frequent economic difficulties (OR 3.07, 95% CI 2.00–4.70). Conclusions: Pain is highly prevalent already among young employees and there is a socio-economic gradient in both pain chronicity and chronic pain–related disability. Life-course socio-economic determinants of pain should be considered in pain-preventing strategies and in clinical practice.Abstrakt Bakgrund: Smärta är ojämlikt socioekonomiskt fördelat och associerat med funktionspåverkan. Kopplingen mellan socioekonomiska förhållanden och smärta bland unga vuxna är dock inte klarlagd. Studiens mål var att undersöka associationen mellan tidiga och nuvarande socio-ekonomiska förhållanden med akut smärta samt kronisk smärta med låg respektive hög funktionspåverkan bland unga finländska kommunala arbetstagare. Metoder: Vi analyserade enkätdata insamlad inom ramen för Young Helsinki Health Study (n=4683), en kohortstudie omfattande 18-39 år gamla anställda vid Helsingfors stad, Finland. Vi inkluderade ett flertal indikatorer för socioekonomiska förhållanden i barndom och nutid och undersökte deras association till akut smärta och kronisk smärta med låg respektive hög grad av funktionspåverkan. Graden av funktionspåverkan bedömdes med skattningsskalan Chronic Pain Grade Questionnaire. Multinominella logistiska regressionsanalyser genomfördes med stegvis korrigering för sociodemografiska, socioekonomiska och hälsorelaterade kovariater. Resultat: Ofördelaktiga socio-ekonomiska förhållanden i barndom och nutid var associerade med akut och kronisk smärta, särskilt med kronisk smärta med hög funktionspåverkan. Starkast associationer efter korrigering för kovariater kvarstod mellan kronisk smärta med hög funktionspåverkan och låg utbildningsnivå (OR 3.38, 95% CI 2.18–5.24), manuellt arbete (OR 3.75, 95% CI 1.92–7.34) och frekventa ekonomiska svårigheter (OR 3.07, 95% CI 2.00–4.70). Slutsatser: Smärta är vanligt förekommande redan bland unga arbetstagare. Det finns en socioekonomisk gradient i avseende på både smärtkronicitet och funktionspåverkan relaterad till kronisk smärta. Livstida socioekonomiska förhållanden bör beaktas i smärtförebyggande arbete och i klinisk praxis

Efficacy and safety of prolonged-release lanreotide in patients with gastrointestinal neuroendocrine tumors and hormone-related symptoms

Purpose: To evaluate the prolonged release (PR) of the long-acting somatostatin analog lanreotide in patients with gastrointestinal neuroendocrine tumors and its effect on hormone-related symptomatology, tumor markers, tumor size, tolerability, and quality of life (QOL), Patients and Methods: Eligible patients had the follow substantial daily symptoms: for patients with carcinoid tumors, three or more stools and/or 1.5 or more flushing episodes; for patients with gastrinoma, greater than 50% elevated basic acid output; and for patients with vasoactive intestinal peptide-secreting tumors (VIPomas), four or more stools and/or a stool volume of greater than or equal to 800 mt, a measurable tumor, and an elevated biochemical tumor marker (greater than or equal to two times the upper limit of the normal reference range), Lanreotide PR was administered intramuscularly every 14 days at 30 mg for 6 months. We measured efficacy by studying symptoms, tumor markers, tumor size, and QOL, Side effects were scored according to the National Cancer Institute's toxicity grading system and ultrasound examination of the gallbladder. Results: Fifty-five patients were included in the study (48 patients with carcinoid tumors, six patients with gastrinoma, and one patient with VIPoma), Symptomatic improvement(> 50% reduction) occurred in 38% of the assessable patients with carcinoid tumors, in 67% of the gastrinoma patients, and in the VIPoma patient. Tumor markers normalized in two of 45 assessable patients, 19 patients exhibited a reduction(> 50%), 19 patients exhibited no change, and tumor markers rose by more than 50% in five patients. Tumor size was reduced in two of 31 assessable patients and remained stable in 25 patients; four patients experienced progression, QOL assessments after 1 month showed improvements in emotional and cognitive function, and diminished fatigue, sleeping disorders, and diarrhea, Eight of 30 assessable patients developed gallstones. Conclusion: Lanreotide PR is a well-tolerated somatostatin analog with significant clinical, biochemical, and antitumor effects that bring about a significant improvement in QOL for patients with neuroendocrine tumors. (C) 1999 by American Society of Clinical Oncology

Aryl hydrocarbon receptor interacting protein mutations seem not to associate with familial non-medullary thyroid cancer.

BACKGROUND: Over 95% of all thyroid malignancies are non-medullary thyroid carcinomas (NMTC). Familial NMTC are more aggressive and mortality is higher as compared with sporadic carcinomas. Known genetic factors do not explain all familial NMTC. Recently, thyroid disorders have been observed in families with germline mutations in aryl hydrocarbon receptor interacting protein (AIP) but, due to frequent occurrence of these conditions in the population, the significance of this co-occurrence is not clear. AIM, SUBJECTS AND METHODS: To examine whether AIP is involved in familial NMTC, we performed AIP mutation screening in 93 familial NMTC cases. In addition, the AIP status was studied in one follicular thyroid adenoma patient with a known AIP mutation from an additional cohort. RESULTS: No potentially pathogenic changes were identified, but two likely rare polymorphisms were detected. AIP mutation-positive patient's follicular thyroid adenoma showed no loss of heterozygosity or lack of immunohistochemical AIP staining. CONCLUSION: Our study indicates that germline AIP mutations are rare or do not exist in familial NMTC

Aryl hydrocarbon receptor interacting protein mutations seem not to associate with familial non-medullary thyroid cancer.

BACKGROUND: Over 95% of all thyroid malignancies are non-medullary thyroid carcinomas (NMTC). Familial NMTC are more aggressive and mortality is higher as compared with sporadic carcinomas. Known genetic factors do not explain all familial NMTC. Recently, thyroid disorders have been observed in families with germline mutations in aryl hydrocarbon receptor interacting protein (AIP) but, due to frequent occurrence of these conditions in the population, the significance of this co-occurrence is not clear. AIM, SUBJECTS AND METHODS: To examine whether AIP is involved in familial NMTC, we performed AIP mutation screening in 93 familial NMTC cases. In addition, the AIP status was studied in one follicular thyroid adenoma patient with a known AIP mutation from an additional cohort. RESULTS: No potentially pathogenic changes were identified, but two likely rare polymorphisms were detected. AIP mutation-positive patient's follicular thyroid adenoma showed no loss of heterozygosity or lack of immunohistochemical AIP staining. CONCLUSION: Our study indicates that germline AIP mutations are rare or do not exist in familial NMTC