Fibromyalgia and mortality: a systematic review and meta-analysis

Objective To conduct a systematic review of the literature on the association between fibromyalgia and mortality and to pool the results in a meta-analysis.Methods The authors searched the PubMed, Scopus, and Web of Science databases using the key words ‘fibromyalgia’ and ‘mortality’ to identify studies that addressed an association between fibromyalgia and mortality. Original papers that assessed associations between fibromyalgia and mortality (all or specific causes) and provided an effect measure (hazard ratio (HR), standardised mortality ratio (SMR), odds ratio (OR)) quantifying the relationship between fibromyalgia and mortality were included in the systematic review. Of 557 papers that were initially identified using the search words, 8 papers were considered eligible for the systematic review and meta-analysis. We used a Newcastle-Ottawa scale to assess the risk of bias in the studies.Results The total fibromyalgia group included 188 751 patients. An increased HR was found for all-cause mortality (HR 1.27, 95% CI 1.04 to 1.51), but not for the subgroup diagnosed by the 1990 criteria. There was a borderline increased SMR for accidents (SMR 1.95, 95% CI 0.97 to 3.92), an increased risk for mortality from infections (SMR 1.66, 95% CI 1.15 to 2.38), and suicide (SMR 3.37, 95% CI 1.52 to 7.50), and a decreased mortality rate for cancer (SMR 0.82, 95% CI 0.69 to 0.97). The studies showed significant heterogeneity.Conclusions These potential associations indicate that fibromyalgia should be taken seriously, with a special focus on screening for suicidal ideation, accident prevention, and the prevention and treatment of infections

An association between an organic foreign body and persisting itching-A case report

Background: To our knowledge there has been no previous report in the literature of persistent diffuse itching caused by an organic foreign body.Case presentation: The patient, 81-year-old woman, had suffered over the previous six months from diffuse itching of the scalp, the chest, and the abdomen. Her multiple chronic diseases and extensive laboratory tests didn’t explain the itching. The itching was accompanied by the appearance of red blotches on the skin. When a repeat history was taken the patient related that she had fallen in an open field six months earlier and felt a stabbing sensation in her lower abdomen. A repeat examination revealed a small lesion on the skin about 4cm below the umbilicus. Beneath the skin lesion a fluid collection that was sensitive to touch could be palpated. The collection was drained and the splinter removed, the patient reported significant improvement in the itching, which almost completely disappeared without a need for medication.Conclusion: The itching began soon after the patient fell and the splinter penetrated the abdominal wall tissue and only stopped after the splinter was removed. This leads us to assume that the organic foreign body was the cause of the persistent itching. As in many other cases a good history and careful physical examination can lead to the solution of a perplexing medical diagnostic problem.</p

Burnout among family medicine residents: a cross-sectional nationwide study

Abstract Background In addition to pressures typical of other medical professions, family physicians face additional challenges such as building long-term relationships with patients, dealing with patients' social problems, and working at a high level of uncertainty. We aimed to assess the rate of burnout and factors associated with it among family medicine residents throughout Israel. Methods A cross sectional study based on a self-administered questionnaire. Results Ninety family medicine residents throughout Israel completed the questionnaire. The rate of clinically significant burnout, assessed by the composite Shirom-Melamed Burnout Questionnaire score, was 14.4%. In univariate analyses several personal and professional characteristics, as well as all tested psychological characteristics, showed significant associations with burnout. However, in the multivariable logistic regression only psychological work-related characteristics (work engagement, psychological flexibility (reverse scoring), and perceived work-related stress) were significantly associated with burnout at OR (95% CI) = 0.23 (0.06–0.60), 1.31 (1.10–1.71), and 1.16 (1.05–3.749), respectively. Conclusion The integration of burnout prevention programs into academic courses during residency could explain the relatively low prevalence of burnout among family medicine residents in this study. Given the strong association of burnout with psychological characteristics, further investment in burnout prevention through targeted structured courses for residents should be encouraged