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Ma K, Rahimi A, Rajagopal M, Yaskina M, Goldman RD, Jones A, Erickson T, Poonai N, McGahern C, Weingarten L, Lerman B, Auclair MC, Wong H, Hartling L, Schreiner K, Scott S, Ali S. A national survey of children's experiences and needs when attending Canadian pediatric emergency departments. PLoS One 2024; 19:e0305562. [PMID: 38917134 PMCID: PMC11198794 DOI: 10.1371/journal.pone.0305562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Accepted: 05/31/2024] [Indexed: 06/27/2024] Open
Abstract
BACKGROUND Optimizing a child's emergency department (ED) experience positively impacts their memories and future healthcare interactions. Our objectives were to describe children's perspectives of their needs and experiences during their ED visit and relate this to their understanding of their condition. METHODS 514 children, aged 7-17 years, and their caregivers presenting to 10 Canadian pediatric EDs completed a descriptive cross-sectional survey from 2018-2020. RESULTS Median child age was 12.0 years (IQR 9.0-14.0); 56.5% (290/513) were female. 78.8% (398/505) reported adequate privacy during healthcare conversations and 78.3% (395/504) during examination. 69.5% (348/501) understood their diagnosis, 89.4% (355/397) the rationale for performed tests, and 67.2% (338/503) their treatment plan. Children felt well taken care of by nurses (90.9%, 457/503) and doctors (90.8%, 444/489). Overall, 94.8% (475/501) of children were happy with their ED visit. Predictors of a child better understanding their diagnosis included doctors talking directly to them (OR 2.21 [1.15, 4.28]), having someone answer questions and worries (OR 2.51 [1.26, 5.01]), and older age (OR 1.08 [1.01, 1.16]). Direct communication with a doctor (OR 2.08 [1.09, 3.99]) was associated with children better understanding their treatment, while greater fear/ 'being scared' at baseline (OR 0.59 [0.39, 0.89]) or at discharge (OR 0.46 [0.22, 0.96]) had the opposite effect. INTERPRETATION While almost all children felt well taken care of and were happy with their visit, close to 1/3 did not understand their diagnosis or its management. Children's reported satisfaction in the ED should not be equated with understanding of their medical condition. Further, caution should be employed in using caregiver satisfaction as a proxy for children's satisfaction with their ED visit, as caregiver satisfaction is highly linked to having their own needs being met.
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Affiliation(s)
- Keon Ma
- Department of Pediatrics, University of Calgary, Calgary, AB, Canada
| | - Asa Rahimi
- Department of Pediatrics, University of Alberta, Edmonton, AB, Canada
| | - Manasi Rajagopal
- Department of Pediatrics, University of Alberta, Edmonton, AB, Canada
| | - Maryna Yaskina
- Women and Children’s Health Research Institute (WCHRI), University of Alberta, Edmonton, AB, Canada
| | - Ran D. Goldman
- Department of Pediatrics, University of British Columbia and BC Children’s Hospital Research Institute, Division of Emergency Medicine, The Pediatric Research in Emergency Therapeutics (PRETx) Program, Vancouver, BC, Canada
| | - Ashley Jones
- Department of Pediatrics, University of Calgary, Calgary, AB, Canada
| | - Tannis Erickson
- Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, MB, Canada
| | - Naveen Poonai
- Departments of Paediatrics, Epidemiology & Biostatistics, Schulich School of Medicine & Dentistry, Western University, London, ON, Canada
| | - Candice McGahern
- Division of Pediatric Emergency Medicine, Children’s Hospital of Eastern Ontario, Ottawa, ON, Canada
| | - Laura Weingarten
- Division of Pediatric Emergency Medicine, McMaster Children’s Hospital, Hamilton, ON, Canada
| | - Bethany Lerman
- Division of Emergency Medicine, Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | | | - Helen Wong
- Faculty of Health, Dalhousie University, Halifax, NS, Canada
| | - Lisa Hartling
- Department of Pediatrics, University of Alberta, Edmonton, AB, Canada
| | - Kurt Schreiner
- Pediatric Emergency: Advancing Knowledge (PEAK) Research Team, University of Alberta, Edmonton, AB, Canada
| | - Shannon Scott
- Women and Children’s Health Research Institute (WCHRI), University of Alberta, Edmonton, AB, Canada
- Faculty of Nursing, University of Alberta, Edmonton, AB, Canada
| | - Samina Ali
- Department of Pediatrics, University of Alberta, Edmonton, AB, Canada
- Women and Children’s Health Research Institute (WCHRI), University of Alberta, Edmonton, AB, Canada
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Abomoelak B, Saps M, Sudakaran S, Deb C, Mehta D. Gut Microbiome Remains Static in Functional Abdominal Pain Disorders Patients Compared to Controls: Potential for Diagnostic Tools. BIOTECH 2022; 11:biotech11040050. [PMID: 36412751 PMCID: PMC9680443 DOI: 10.3390/biotech11040050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Revised: 10/25/2022] [Accepted: 10/26/2022] [Indexed: 11/07/2022] Open
Abstract
Background: Functional Abdominal Pain disorders (FAPDs) are a group of heterogeneous gastrointestinal disorders with unclear pathophysiology. In children, FAPDs are more common in the winter months than summer months. The possible influence of school stressors has been proposed. Previously, our group showed differences in bacterial relative abundances and alpha diversity in the gut microbiome and its relationship with stressors in a cross-sectional evaluation of children suffering from FAPDs compared to a healthy control group. We present longitudinal data to assess whether the gut microbiome changes over school terms in the control and FAPDs groups. Methods: The longitudinal study included children with FAPDs (n = 28) and healthy controls (n = 54). Gastrointestinal symptoms, as well as stool microbiome, were assessed in both groups. Stool samples were serially collected from all participants during both the school term and summer vacation. The stool samples were subjected to total genomic extraction, 16S rRNA amplicon sequencing, and bioinformatics analysis. The gut microbiome was compared at school and during vacation. Other metrics, alpha diversity, and beta diversity, were also compared between the two school terms in every group. Results: In the healthy group, there were differences in microbiome composition between school terms and summer vacation. Conversely, we found no differences in the FAPDs group between the two terms. The healthy control group revealed differences (p-value < 0.05) in 55 bacterial species between the school term and vacation. Several of the differentially abundant identified bacteria were involved in short-chain fatty acids production (SCFAs), inflammation reduction, and gut homeostasis. Alpha diversity metrics, such as the Shannon index, were different in the control group and remained unchanged in the FAPDs group. Conclusion: Although preliminary, our findings suggest that the gut microbiome is static in FAPDs. This compares with a more dynamic healthy gut microbiome. Further studies are warranted to corroborate this and understand the interplay between stress, symptoms, and a less diverse and static microbiome. Future studies will also account for different variables such as diet and other patient demographic criteria that were missing in the current study.
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Affiliation(s)
- Bassam Abomoelak
- Arnold Palmer Pediatric Gastroenterology Clinic, Orlando Health, Orlando, FL 32806, USA
| | - Miguel Saps
- Pediatric Gastroenterology, Hepatology and Nutrition Division, University of Miami Miller School of Medicine, Miami, FL 33136, USA
| | | | - Chirajyoti Deb
- Arnold Palmer Pediatric Gastroenterology Clinic, Orlando Health, Orlando, FL 32806, USA
| | - Devendra Mehta
- Arnold Palmer Pediatric Gastroenterology Clinic, Orlando Health, Orlando, FL 32806, USA
- Correspondence:
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Secular trends in childhood pain and comorbid psychiatric symptoms: a population-based study. Soc Psychiatry Psychiatr Epidemiol 2022; 57:1017-1026. [PMID: 35182159 PMCID: PMC9042999 DOI: 10.1007/s00127-022-02234-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Accepted: 01/22/2022] [Indexed: 12/02/2022]
Abstract
PURPOSE Pain symptoms are common in childhood. They often lead to functional impairment and co-occur with psychiatric difficulties. Although children's lives have undergone enormous changes in recent decades, long-term data on changes in pain symptoms, and in comorbid psychiatric difficulties, is lacking. This knowledge is crucial, as co-occurring psychiatric symptoms are significant predictors of long-term outcome for children who suffer from pain. The main purpose of the present study was to explore secular changes in comorbid pain and psychiatric symptoms. METHODS Four population-based, cross-sectional surveys of 8-9-year-old children were conducted in Southwest Finland in 1989, 1999, 2005, and 2013. Identical methodologies and questionnaire-based measures were used each study year. Participation ranged from 891 to 986 over the study period. The children were asked about the frequency of headache, abdominal pain, and other pains. Children, their parents, and teachers provided information on the child's psychiatric difficulties, including internalizing and externalizing symptoms. RESULTS The cumulative odds ratios and 95% confidence intervals for the overall prevalence of pain symptoms increased among both genders from 1989 to 2013 and ranged from 1.4 (1.03-1.8) for other pains to 2.4 (1.7-3.3) for abdominal pain. Comorbid internalizing symptoms increased among girls with odd ratios and 95% CIs of 1.8 (1.03-3.1) for children with any kind of pain, and 3.0 (1.4-6.2) for children with headache. No changes were found among boys. CONCLUSION Overall pain symptoms doubled in both genders, but the most novel finding was that comorbid emotional difficulties tripled among girls who reported headaches. Further research is needed to confirm, and explain, these findings.
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Abomoelak B, Pemberton V, Deb C, Campion S, Vinson M, Mauck J, Manipadam J, Sudakaran S, Patel S, Saps M, Enshasy HAE, Varzakas T, Mehta DI. The Gut Microbiome Alterations in Pediatric Patients with Functional Abdominal Pain Disorders. Microorganisms 2021; 9:microorganisms9112354. [PMID: 34835479 PMCID: PMC8622193 DOI: 10.3390/microorganisms9112354] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Revised: 10/29/2021] [Accepted: 11/09/2021] [Indexed: 01/02/2023] Open
Abstract
In this prospective longitudinal study, we enrolled 54 healthy pediatric controls and 28 functional abdominal pain disorders (FAPDs) pediatric patients (mean age was 11 ± 2.58 years old). Fecal samples and symptom questionnaires were obtained from all participants over the course of the year. Clinical data assessment showed that FAPDs patients were more symptomatic than the control group. Microbiome analysis revealed that Phylum Bacteroidetes was higher in FAPDs compared to the control group (p < 0.05), while phylum Firmicutes was lower in FAPDs (p < 0.05). In addition, Verrucomicrobiota was higher in the control group than the FAPDs (p < 0.05). At the genus level the relative abundance of 72 bacterial taxa showed statistically significant differences between the two groups and at the school term levels. In the control group, Shannon diversity, Observed_species, and Simpson were higher than the FAPDs (p < 0.05), and beta diversity showed differences between the two groups (PERMANOVA = 2.38; p = 0.002) as well. Using linear discriminant analysis effect size (LEfSe), Enterobacteriaceae family and Megaspherae showed increased abundances in vacation term (LDA score > 2.0, LEfSe, p < 0.05). In the FAPDs group, the severity of symptoms (T-scores) correlated with 11 different taxa bacterial relative abundances using Pearson's correlation and linear regression analyses. Our data showed that gut microbiome is altered in FAPDs compared to the control. Differences in other metrics such as alpha- and beta diversity were also reported between the two groups. Correlation of the severity of the disease (T-scores) correlated with gut microbiome. Finally, our findings support the use of Faecalibacterium/Bacteroides ratio as a potential diagnostic biomarker for FAPDs.
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Affiliation(s)
- Bassam Abomoelak
- Pediatric Specialty Laboratory, Arnold Palmer Hospital, Orlando Health, Orlando, FL 32806, USA; (V.P.); (C.D.); (S.C.); (J.M.); (S.P.)
- Correspondence: (B.A.); (D.I.M.); Tel.: +1-608-770-9584 (B.A.)
| | - Veronica Pemberton
- Pediatric Specialty Laboratory, Arnold Palmer Hospital, Orlando Health, Orlando, FL 32806, USA; (V.P.); (C.D.); (S.C.); (J.M.); (S.P.)
| | - Chirajyoti Deb
- Pediatric Specialty Laboratory, Arnold Palmer Hospital, Orlando Health, Orlando, FL 32806, USA; (V.P.); (C.D.); (S.C.); (J.M.); (S.P.)
| | - Stephani Campion
- Pediatric Specialty Laboratory, Arnold Palmer Hospital, Orlando Health, Orlando, FL 32806, USA; (V.P.); (C.D.); (S.C.); (J.M.); (S.P.)
| | - Michelle Vinson
- College of Medicine, Florida State University, Tallahassee, FL 32306, USA; (M.V.); (J.M.)
| | - Jennifer Mauck
- College of Medicine, Florida State University, Tallahassee, FL 32306, USA; (M.V.); (J.M.)
| | - Joseph Manipadam
- Pediatric Specialty Laboratory, Arnold Palmer Hospital, Orlando Health, Orlando, FL 32806, USA; (V.P.); (C.D.); (S.C.); (J.M.); (S.P.)
| | | | - Samit Patel
- Pediatric Specialty Laboratory, Arnold Palmer Hospital, Orlando Health, Orlando, FL 32806, USA; (V.P.); (C.D.); (S.C.); (J.M.); (S.P.)
| | - Miguel Saps
- Pediatric Gastroenterology, Hepatology and Nutrition Division, University of Miami Miller School of Medicine, Miami, FL 33136, USA;
| | - Hesham A. El Enshasy
- Institute of Bioproduct Development (IBD), Universiti Teknologi Malaysia (UTM), Skudai 81310, Johor, Malaysia;
- School of Chemical and Energy Engineering, Faculty of Engineering, Universiti Teknologi Malaysia (UTM), Skudai 81310, Johor, Malaysia
- City of Scientific Research and Technology Applications (SRTA), New Burg Al Arab, Alexandria 21934, Egypt
| | - Theodoros Varzakas
- Food Science and Technology, University of Peloponnese, 24100 Kalamata, Greece;
| | - Devendra I. Mehta
- Pediatric Specialty Laboratory, Arnold Palmer Hospital, Orlando Health, Orlando, FL 32806, USA; (V.P.); (C.D.); (S.C.); (J.M.); (S.P.)
- Correspondence: (B.A.); (D.I.M.); Tel.: +1-608-770-9584 (B.A.)
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Lamparyk K, Burkhart K, Buzenski J, van Tilburg MAL. Challenges and opportunities in measuring the pediatric quality of life: exemplified by research in pediatric gastroenterology. Expert Rev Pharmacoecon Outcomes Res 2021; 21:211-219. [PMID: 33478299 DOI: 10.1080/14737167.2021.1879643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Introduction: Quality of life (QOL) is an important patient-reported outcome measure (PROM). Assessment of QOL in children is challenging particularly because developmental age affects the accuracy of self-reports.Areas covered: This paper gives an overview and expert opinion of the factors impacting quality assessment of pediatric QOL. Given this literature is vast, we focused on QOL measurement in pediatric gastroenterological conditions as an example, but the general principles apply across childhood chronic diseases. Child developmental stage affects self-reports. Younger children are less reliable reporters implicating the need for parental proxies. However, parents may not be as cognizant of their child's internal life especially as the child grows older. Adjustment to disease (QOL initially decreases then improves) as well as the time of year (QOL improves during summer) affects reports of QOL. Furthermore, it is important to acknowledge the impact of the child's disease on caregivers and families' QOL.Expert opinion: The numerous aspects impacting pediatric QOL make assessment and measurement complex. We propose several strategies to guide this process such as assessing both self-report and parent-proxy measures, as well as considering the timing of QOL assessments.
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Affiliation(s)
- Katherine Lamparyk
- Center for Pediatric Behavioral Health, Cleveland, Cleveland Clinic Children's Hospital, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, OH, USA
| | - Kimberly Burkhart
- Department of Pediatrics, Rainbow Babies and Children's Hospital, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Jessica Buzenski
- Department of Pediatrics, Emory University School of Medicine, Children's Healthcare of Atlanta, Atlanta, GA, US
| | - Miranda A L van Tilburg
- Department of Medicine, Division of Gastroenterology and Hepatology, University of North Carolina, Chapel Hill, NC, USA.,University of Washington, School of Social Work, Seattle, WA, USA.,Department of Clinical Research, College of Pharmacy & Health Sciences, Campbell University, Buies Creek, NC, USA
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Characterizing Social and Academic Aspects of School Anxiety in Pediatric Chronic Pain. Clin J Pain 2019; 35:625-632. [DOI: 10.1097/ajp.0000000000000720] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Nelissen L, Koppen I, Follett F, Boggio-Marzet C, Saps M, Garzon K, Benninga M. Prevalence of functional gastrointestinal disorders among adolescents in Buenos Aires, Argentina. REVISTA DE GASTROENTEROLOGÍA DE MÉXICO (ENGLISH EDITION) 2018. [DOI: 10.1016/j.rgmxen.2018.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
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Abstract
OBJECTIVES Abdominal pain-related pediatric functional gastrointestinal disorders (AP-FGIDs) are defined by abdominal discomfort or pain that may provide obstacles to everyday activities, such as school attendance. It has been reported that AP-FGID symptoms may be reduced in summer, but it is unclear what drives this seasonal variation. This pilot study aimed to explore whether the seasonal variation in AP-FGID symptoms could be explained by various psychological and behavioral factors. METHODS Parents of children with AP-FGID symptoms completed online questionnaires on symptoms, anxiety, parental responses to pain, sleep, diet, and physical activity once during spring months and again in the summer months. RESULTS In a sample of 34 participants who completed both questionnaires, 22 reported improvements during the summer months. These participants reported a significantly higher seasonal decrease in anxiety than participants whose children's symptoms did not improve from spring to summer (mean decrease 2.21 vs 0.08, P = 0.017). Both groups reported equal improvements in sleep and decreased stress from spring to summer. Neither group experienced statistically significant seasonal change in physical activity or fruit, vegetables, dairy, or caffeine consumption. CONCLUSIONS This study suggests that amelioration of gastrointestinal symptoms in pediatric patients with AP-FGID during summer months is associated with amelioration of anxiety in the same time period. It is not yet clear whether decreased anxiety is the cause or effect of decreased AP-FGID symptoms.
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Nelissen LG, Koppen IJN, Follett FR, Boggio-Marzet C, Saps M, Garzon K, Benninga MA. Prevalence of functional gastrointestinal disorders among adolescents in Buenos Aires, Argentina. REVISTA DE GASTROENTEROLOGÍA DE MÉXICO 2018; 83:367-374. [PMID: 29914714 DOI: 10.1016/j.rgmx.2018.02.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/14/2017] [Revised: 01/25/2018] [Accepted: 02/08/2018] [Indexed: 12/19/2022]
Abstract
INTRODUCTION AND AIMS The prevalence of functional gastrointestinal disorders (FGIDs) in Argentinean children and adolescents has not yet been studied. Our aim was to determine the prevalence of FGIDs among children and adolescents in Argentina using the Rome III diagnostic criteria. MATERIALS AND METHODS A total of 483 children, 12-18 years of age, from 3 private schools and 3 public schools, were included in the study. Each child completed the Spanish version of the Questionnaire on Pediatric Gastrointestinal Symptoms-Rome III), which is an age-appropriate and previously validated instrument for diagnosing FGIDs according to the Rome III criteria. Sociodemographic data (age, sex, type of school, family structure and size, family history of gastrointestinal disorders) and data on stressful life events were also obtained. RESULTS The mean age of the population studied was 15 years (standard deviation 1.74, range 12-18, 52.8% boys). Of the respondents, 229 children (47.4%) attended private school and 254 children (52.6%) attended public school. In total, 82 children (17.0%) were diagnosed with an FGID, according to the Rome III criteria. Abdominal migraine (16.4%) was the most common diagnosis, followed by irritable bowel syndrome (7.0%), functional constipation (6.4%), and aerophagia (5.6%). Girls suffered significantly more from FGIDs than boys (22.4 vs. 12.2%, P=.0032). Children attending private school had significantly more FGIDs than children in public schools (20.5 vs. 13.8%, P=.0499). CONCLUSION FGIDs are common among Argentinean children and adolescents.
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Affiliation(s)
- L G Nelissen
- Departamento de Gastroenterología Pediátrica y Nutrición, Emma Children's, Hospital, Centro Médico Académico, Ámsterdam, Holanda.
| | - I J N Koppen
- Departamento de Gastroenterología Pediátrica y Nutrición, Emma Children's, Hospital, Centro Médico Académico, Ámsterdam, Holanda
| | - F R Follett
- Departamento de Gastroenterología Pediátrica y Nutrición, Hospital Universitario Austral, Pilar, Buenos Aires, Argentina
| | - C Boggio-Marzet
- Departamento de Gastroenterología Pediátrica y Nutrición, Hospital Pirovano, Buenos Aires, Argentina
| | - M Saps
- División de Gastroenterología Pediátrica, Hepatología y Nutritción, Nationwide Children's Hospital, Columbus, Ohio, Estados Unidos
| | - K Garzon
- Charles E. Schmidt Facultad de Medicina, Florida Atlantic University, Boca Ratón, FL, Estados Unidos
| | - M A Benninga
- Departamento de Gastroenterología Pediátrica y Nutrición, Emma Children's, Hospital, Centro Médico Académico, Ámsterdam, Holanda
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Abstract
Objective: To determine the seasonal variation of acute appendicitis. Methods: A total of 320 patients fulfilling the inclusion criteria were enrolled in the study after getting the written informed consent. Appendectomies were performed by consultant surgeons and residents. After surgery histopathological examination of specimens was performed by consultant Histopathologists at Armed Forces Institute of Pathology Rawalpindi and CMH Peshawar. The patients presenting in different four seasons September to November as autumn, December to February as winter, March to May as spring, June to August as summer, were compared to determine seasonal variations. Results: In our study out of all 320 patients 188 (58.75%) were males and 132 (41.25%) were females. Sixty patients (18.75 %) presented in autumn season (Sep-Nov), 52 patients (16.25%) in winter season (Dec-Feb), 78 (24.25%) patients in Spring season (Mar-May).130 (40.62%) patients presented in Summer season (Jun-Aug). There was almost 24.37% increased incidence in summer as compared to winter season, 21.87% increased incidence as compared to autumn season, 16.37% increased incidence as compared to spring season. Conclusion: Acute appendicitis incidence is increased in summer months in Pakistan. Preventive measures can be taken during summer season (June to Aug) to decrease morbidity and mortality associated with this disease.
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Affiliation(s)
- Waqas Ahmed
- Dr. Waqas Ahmed, MBBS, FCPS. Department of Surgery, Combined Military Hospital, Kohat, Pakistan
| | - Muhammad Saeed Akhtar
- Dr. Muhammad Saeed Akhtar, MBBS, MACS, FCPS. Department of Surgery, Combined Military Hospital, Kohat, Pakistan
| | - Shahum Khan
- Dr. Shahum khan, MBBS. Department of Surgery, Combined Military Hospital, Kharian, Pakistan
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Seasonal Variation in Pediatric Chronic Pain Clinic Phone Triage Call Volume. Pain Manag Nurs 2017; 18:288-294. [DOI: 10.1016/j.pmn.2017.05.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2016] [Revised: 04/12/2017] [Accepted: 05/17/2017] [Indexed: 11/22/2022]
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School Anxiety in Children and Adolescents with Chronic Pain. Pain Res Manag 2017; 2017:8328174. [PMID: 29081682 PMCID: PMC5634599 DOI: 10.1155/2017/8328174] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2017] [Accepted: 08/14/2017] [Indexed: 11/23/2022]
Abstract
Anxiety is highly prevalent in pediatric chronic pain. This comorbidity has been explained by the presence of shared mechanisms underlying the development and maintenance of chronic pain and anxiety. Accumulating evidence demonstrates that school is a significant source of anxiety among youth with chronic pain and that anxiety contributes to school-related functional impairment in this population. This article reviews the cooccurrence of pediatric chronic pain and anxiety, identifies unique sources of heightened school anxiety among youth with chronic pain, and describes current approaches for assessing anxiety in pediatric pain settings. Highlighted by this review is the absence of a comprehensive evidence-based approach for assessing school anxiety in pediatric chronic pain. Given the psychometric limitations inherent to gathering data from a single source, recommendations for advancing measurement methods are provided. Novel approaches may be needed to shed more light on the way in which school anxiety is experienced in pediatric chronic pain.
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Abstract
Functional abdominal pain (FAP) occurs frequently in pediatric patients. Lacking clear biomarkers, clinicians and researchers must rely on patient reports of pain intensity. Presently, there are challenges affecting our ability to use existing measures of self-reported pediatric pain intensity. This report discusses those challenges, finding that: (a) inter-rater agreement of children's pain intensity is generally low; (b) typically used approaches to measuring outcomes may yield high levels of unreliable reports of improvement;
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Affiliation(s)
- John V Lavigne
- Department of Child and Adolescent Psychiatry, Ann & Robert H. Lurie Children's Hospital of Chicago, 225 E Chicago Ave, Chicago, 60611, IL, USA
- Feinberg School of Medicine, Northwestern University, Evanston, IL, USA
- Mary Ann and J. Milburn Smith Child Health Research Program, Chicago, IL, USA
- Children's Hospital of Chicago Research Center, Chicago, IL, USA
| | - Miguel Saps
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, Research Center for the Investigation of Functional and Gastrointestinal Motility Disorders in Children, Nationwide Children's Hospital, 700 Children's Drive, Columbus, 43205, OH, USA.
- College of Medicine, Ohio State University, Columbus, OH, USA.
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Játiva E, Velasco-Benítez CA, Koppen IJN, Játiva-Cabezas Z, Saps M. Prevalence of Functional Gastrointestinal Disorders in Schoolchildren in Ecuador. J Pediatr Gastroenterol Nutr 2016; 63:25-8. [PMID: 26771768 DOI: 10.1097/mpg.0000000000001108] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
The prevalence of functional gastrointestinal disorders (FGIDs) in children in Ecuador is unknown. We describe a survey study in 2 schools in Quito, Ecuador, using a Spanish translation of the Questionnaire on Pediatric Gastrointestinal Symptoms-Rome III Version (QPGS-RIII). A total of 417 children (51% boys) with a mean age of 12.0 years were included. FGIDs were present in 95 children (22.8%) and occurred in 25% of girls and in 20.7% of boys (P = 0.296). Functional defecation disorders were found in 12.0% of children, 9.4% had an abdominal pain-related FGID and 3.8% was diagnosed with a vomiting or aerophagia FGID.
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Affiliation(s)
- Edgar Játiva
- *Faculty of Medicine, Universidad Central del Ecuador, Quito, Ecuador†Department of Pediatrics, Universidad del Valle, Cali, Colombia‡Department of Pediatric Gastroenterology, Hepatology & Nutrition, Nationwide Children's Hospital, The Ohio State University, Columbus§Department of Pediatrics, Baca Ortiz Children's Hospital, Quito, Ecuador
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Saps M, Velasco-Benítez C, Kovacic K, Chelimsky G, Kovacic K, Játiva Mariño E, Chanís R, Zablah R. High Prevalence of Nausea among School Children in Latin America. J Pediatr 2016; 169:98-104.e1. [PMID: 26670052 DOI: 10.1016/j.jpeds.2015.10.052] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2015] [Revised: 09/03/2015] [Accepted: 10/15/2015] [Indexed: 12/19/2022]
Abstract
OBJECTIVES To evaluate the prevalence of nausea and its association with functional gastrointestinal disorders (FGIDs) in a large-scale, population-based study of Latin American school children. STUDY DESIGN This cross-sectional study collected data from children in 3 Latin American countries. A Spanish version of the Questionnaire on Pediatric Gastrointestinal Symptoms-Rome III Version (QPGS-III) was administered to school children in Central and South America. Subjects were classified into FGIDs based on Rome criteria (QPGS-III). Students from 4 public and 4 private schools in the countries of El Salvador, Panama, and Ecuador participated in this epidemiologic study. RESULTS A total of 1137 school children with mean age 11.5 (SD 1.9, range 8-15) years completed the QPGS-III (El Salvador n = 399; Panama n = 321; Ecuador n = 417). Nausea was present in 15.9% of all school children. Two hundred sixty-eight (24%) children met criteria for at least 1 FGID. Nausea was significantly more common in children with FGIDs compared with those without: El Salvador 38% vs 15% (P < .001); Panama 22% vs 7% (P < .001); Ecuador 25% vs 13% (P = .004). Among children with FGIDs, those with functional constipation had a high prevalence of nausea. Nausea was significantly more common in girls and children attending private schools. CONCLUSIONS Nausea is commonly present in Latin American school children. FGIDs are frequently associated with nausea.
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Affiliation(s)
- Miguel Saps
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, Nationwide Children's Hospital, Columbus, OH
| | | | - Katja Kovacic
- Center for Pediatric Neurogastroenterology, Motility, and Autonomic Disorders, Division of Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI
| | - Gisela Chelimsky
- Center for Pediatric Neurogastroenterology, Motility, and Autonomic Disorders, Division of Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI
| | - Karlo Kovacic
- Center for Pediatric Neurogastroenterology, Motility, and Autonomic Disorders, Division of Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI
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Zablah R, Velasco-Benítez CA, Merlos I, Bonilla S, Saps M. Prevalence of functional gastrointestinal disorders in school-aged children in El Salvador. REVISTA DE GASTROENTEROLOGÍA DE MÉXICO 2015. [PMID: 26297182 DOI: 10.1016/j.rgmxen.2015.03.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND We studied the epidemiology of functional gastrointestinal disorders (FGIDs) in school-aged Salvadoran children using standardized diagnostic criteria. AIMS To determine the prevalence of FGIDs in school-aged children in El Salvador. MATERIAL AND METHODS A total of 395 children participated in the study (one public school and one private school). School children completed the Spanish version of the Questionnaire on Pediatric Gastrointestinal Symptoms-Rome III (QPGS-III), an age-appropriate and previously validated instrument for diagnosing FGIDs according to the Rome III criteria. Sociodemographic (age, sex, type of school) and familial (family structure and size, family history of gastrointestinal disorders) data were obtained. RESULTS The mean age of the sample was 11.8 years ± 1.6 SD (median 10, range 8-15) and 59% of the participants were female. Eighty-one children met the diagnostic criteria for a FGID (20%). Defecation disorders were the most common group of FGIDs. Functional constipation was diagnosed in 10% of the children and 9.25% were diagnosed with abdominal pain-related FGIDs (most commonly IBS, 3.75%). IBS overlapped with functional dyspepsia in 11% of the cases. Children with FGIDs frequently reported nausea. Children attending private school and older children had significantly more FGIDs than children in public school and younger children. CONCLUSIONS FGIDs are common in school-aged Salvadoran children.
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Affiliation(s)
- R Zablah
- Department of Gastroenterology and Endoscopy, Hospital Nacional de Niños Benjamín Bloom, San Salvador, El Salvador
| | | | - I Merlos
- Department of Gastroenterology and Endoscopy, Hospital Nacional de Niños Benjamín Bloom, San Salvador, El Salvador
| | - S Bonilla
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, Boston Children's Hospital, Boston, Massachusetts, EE. UU
| | - M Saps
- Division of Digestive Diseases, Hepatology, and Nutrition, Nationwide Children's Hospital, Columbus, Ohio, EE. UU..
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Zablah R, Velasco-Benítez CA, Merlos I, Bonilla S, Saps M. Prevalence of functional gastrointestinal disorders in school-aged children in El Salvador. REVISTA DE GASTROENTEROLOGÍA DE MÉXICO 2015; 80:186-91. [PMID: 26297182 DOI: 10.1016/j.rgmx.2015.03.008] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/21/2015] [Revised: 03/24/2015] [Accepted: 03/26/2015] [Indexed: 12/19/2022]
Abstract
BACKGROUND We studied the epidemiology of functional gastrointestinal disorders (FGIDs) in school-aged Salvadoran children using standardized diagnostic criteria. AIMS To determine the prevalence of FGIDs in school-aged children in El Salvador. MATERIAL AND METHODS A total of 395 children participated in the study (one public school and one private school). School children completed the Spanish version of the Questionnaire on Pediatric Gastrointestinal Symptoms-Rome III (QPGS-III), an age-appropriate and previously validated instrument for diagnosing FGIDs according to the Rome III criteria. Sociodemographic (age, sex, type of school) and familial (family structure and size, family history of gastrointestinal disorders) data were obtained. RESULTS The mean age of the sample was 11.8 years ± 1.6 SD (median 10, range 8-15) and 59% of the participants were female. Eighty-one children met the diagnostic criteria for a FGID (20%). Defecation disorders were the most common group of FGIDs. Functional constipation was diagnosed in 10% of the children and 9.25% were diagnosed with abdominal pain-related FGIDs (most commonly IBS, 3.75%). IBS overlapped with functional dyspepsia in 11% of the cases. Children with FGIDs frequently reported nausea. Children attending private school and older children had significantly more FGIDs than children in public school and younger children. CONCLUSIONS FGIDs are common in school-aged Salvadoran children.
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Affiliation(s)
- R Zablah
- Department of Gastroenterology and Endoscopy, Hospital Nacional de Niños Benjamín Bloom, San Salvador, El Salvador
| | | | - I Merlos
- Department of Gastroenterology and Endoscopy, Hospital Nacional de Niños Benjamín Bloom, San Salvador, El Salvador
| | - S Bonilla
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, Boston Children's Hospital, Boston, Massachusetts, EE. UU
| | - M Saps
- Division of Digestive Diseases, Hepatology, and Nutrition, Nationwide Children's Hospital, Columbus, Ohio, EE. UU..
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Straube S, Derry S, Straube C, Moore RA. Vitamin D for the treatment of chronic painful conditions in adults. Cochrane Database Syst Rev 2015; 2015:CD007771. [PMID: 25946084 PMCID: PMC6494161 DOI: 10.1002/14651858.cd007771.pub3] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
BACKGROUND This review is an update of a previously published review in the Cochrane Database of Systematic Reviews (Issue 1, 2010) on 'Vitamin D for the treatment of chronic painful conditions in adults'.Vitamin D is produced in the skin after exposure to sunlight and can be obtained through food. Vitamin D deficiency has been linked with a range of conditions, including chronic pain. Observational and circumstantial evidence suggests that there may be a role for vitamin D deficiency in the aetiology of chronic painful conditions. OBJECTIVES To assess the efficacy and safety of vitamin D supplementation in chronic painful conditions when tested against placebo or against active comparators. SEARCH METHODS For this update, we searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, and EMBASE to February 2015. This was supplemented by searching the reference lists of retrieved articles, reviews in the field, and online trial registries. SELECTION CRITERIA We included studies if they were randomised double-blind trials of vitamin D supplementation compared with placebo or with active comparators for the treatment of chronic painful conditions in adults. DATA COLLECTION AND ANALYSIS Two review authors independently selected the studies for inclusion, assessed methodological quality, and extracted data. We did not undertake pooled analysis due to the heterogeneity of the data. Primary outcomes of interest were pain responder outcomes, and secondary outcomes were treatment group average pain outcomes and adverse events. MAIN RESULTS We included six new studies (517 participants) in this review update, bringing the total of included studies to 10 (811 participants). The studies were heterogeneous with regard to study quality, the chronic painful conditions that were investigated, the dose of vitamin D given, co-interventions, and the outcome measures reported. Only two studies reported responder pain outcomes; the other studies reported treatment group average outcomes only. Overall, there was no consistent pattern that vitamin D treatment was associated with greater efficacy than placebo in any chronic painful condition (low quality evidence). Adverse events and withdrawals were comparatively infrequent, with no consistent difference between vitamin D and placebo (good quality evidence). AUTHORS' CONCLUSIONS The evidence addressing the use of vitamin D for chronic pain now contains more than twice as many studies and participants than were included in the original version of this review. Based on this evidence, a large beneficial effect of vitamin D across different chronic painful conditions is unlikely. Whether vitamin D can have beneficial effects in specific chronic painful conditions needs further investigation.
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Affiliation(s)
- Sebastian Straube
- University of AlbertaDepartment of Medicine, Division of Preventive Medicine5‐30 University Terrace8303‐112 StreetEdmontonABCanadaT6G 2T4
| | | | - Carmen Straube
- University Medical Center GöttingenDepartment of Haematology and OncologyRobert‐Koch‐Straße 40GöttingenGermany37075
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Vitamin D and Pain: Vitamin D and Its Role in the Aetiology and Maintenance of Chronic Pain States and Associated Comorbidities. PAIN RESEARCH AND TREATMENT 2015; 2015:904967. [PMID: 26090221 PMCID: PMC4427945 DOI: 10.1155/2015/904967] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/17/2015] [Accepted: 03/15/2015] [Indexed: 12/25/2022]
Abstract
The emergence of new data suggests that the benefits of Vitamin D extend beyond healthy bones. This paper looks at Vitamin D and its role in the aetiology and maintenance of chronic pain states and associated comorbidities. The interfaces between pain and Vitamin D and the mechanisms of action of Vitamin D on pain processes are explored. Finally the association between Vitamin D and pain comorbidities such as sleep and depression is investigated. The paper shows that Vitamin D exerts anatomic, hormonal, neurological, and immunological influences on pain manifestation, thereby playing a role in the aetiology and maintenance of chronic pain states and associated comorbidities. More research is necessary to determine whether Vitamin D is useful in the treatment of various pain conditions and whether or not the effect is limited to patients who are deficient in Vitamin D.
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Ilves I, Fagerström A, Herzig KH, Juvonen P, Miettinen P, Paajanen H. Seasonal variations of acute appendicitis and nonspecific abdominal pain in Finland. World J Gastroenterol 2014; 20:4037-4042. [PMID: 24833844 PMCID: PMC3983460 DOI: 10.3748/wjg.v20.i14.4037] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2013] [Revised: 10/10/2013] [Accepted: 11/03/2013] [Indexed: 02/06/2023] Open
Abstract
AIM: To investigate whether seasonal changes had an effect on the incidence of acute appendicitis (AA) or nonspecific abdominal pain (NSAP).
METHODS: We carried out a national register study of all patients with a hospital discharge diagnosis of AA and acute NSAP in Finland. Data were analyzed for the whole country and correlated to seasonal and weather parameters (temperature, humidity). Moreover, additional sub-analyses were performed for five geographically different area of Finland.
RESULTS: The observation period spanned 21 years, with 186558 appendectomies, of which 137528 (74%) cases were reported as AA. The incidence of AA declined for 32% over the study period. The average incidence of the NSAP was 34/10000 per year. The mean annual temperature, but not relative humidity, showed clear geographical variations. The incidence of AA decreased significantly during the cold months of the year. No correlation was detected between temperature and incidence of NSAP. Humidity had a statistically significant impact on NSAP.
CONCLUSION: The incidence of acute appendicitis is declining in Finland. We detected a clear seasonality in the incidence of AA and NSAP.
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Prevalence of functional gastrointestinal disorders in Colombian school children. J Pediatr 2014; 164:542-5.e1. [PMID: 24332822 DOI: 10.1016/j.jpeds.2013.10.088] [Citation(s) in RCA: 86] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2013] [Revised: 09/16/2013] [Accepted: 10/30/2013] [Indexed: 12/12/2022]
Abstract
OBJECTIVES To determine prevalence for functional gastrointestinal disorders (FGIDs) in Colombian school children using the Questionnaire on Pediatric Gastrointestinal Symptoms-Rome III Version (QPGS-III) and to determine possible risk factors. STUDY DESIGN The QPGS-III was translated into Spanish then reverse translated by a team of bilingual physicians. Focus groups of Colombian children were conducted to assure understanding of the Spanish version. Children at 1 public school and 2 private schools in Pasto, Colombia were invited to participate in a prevalence study using the translated questionnaire. RESULTS A total of 373 children (95 private school, 278 public school), with mean age 9.9 years completed the QPGS-III. Twenty-nine percent of children were diagnosed with FGIDs. FGIDs were more common in females (OR, 1.63; 95% CI, 1.04-2.56). Functional constipation (14%) was the most common FGID. Irritable bowel syndrome was the most common abdominal pain-related FGID (5.4%). Abdominal migraine (1%) and cyclic vomiting syndrome (0.3%) were the least common FGIDs. CONCLUSION FGIDs are common in Colombian school children.
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Sandoughi M, Zakeri Z, Mirhosainee Z, Mohammadi M, Shahbakhsh S. The effect of vitamin D on nonspecific low back pain. Int J Rheum Dis 2013; 18:854-8. [PMID: 24119149 DOI: 10.1111/1756-185x.12172] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
BACKGROUND Nonspecific low back pain is known as one of the most common reasons for chronic low back pain (CLBP) that burdens healthcare systems with high costs. According to a hypothesis, CLBP has been associated with vitamin D3 deficiency, the goal of this study is to evaluate the effect of vitamin D3 administration on improvements in CLBP. MATERIALS AND METHODS This double blind randomized clinical trial included 53 patients aged between 18-40 years with nonspecific CLBP. Pain was measured using the pain visual analogue scale score (VAS), and serum 25-OH-vitamin D level was measured using an enzyme-linked immunosorbent assay kit. The patients were randomly divided into two groups based on sex and weight. Pearl of vitamin D(3) (50 000 IU) or placebo was administered orally every week for 8 weeks. Data were analyzed via SPSS 17th edition software using two-tailed paired t-test and chi-square test. RESULTS There were 26 and 27 patients in drug and placebo groups respectively. Out of 53 subjects, 75.47% were female. There was no statistically significant difference in the mean age, sex, and mean weight between the two groups. The mean serum 25-OH-vitamin D level was 18.86 ± 9.24 nmol/L on the first visit. After 8 weeks of intervention, the mean serum 25-OH-vitamin D level changed from 17.88 ± 9.04 to 27.52 ± 9.04 (P = 0.043) and from 19.81 ± 9.60 to 18.91 ± 7.84 (P = 0.248) in drug and placebo groups, respectively. The mean VAS score for pain decreased from 5.42 ± 1.65 to 3.03 ± 3.14 (P = 0.001) and from 6.42 ± 1.62 to 3.11 ± 3.08 (P = 0.001) among drug and placebo groups, respectively. The mean changes in chronic pain were 2.38 ± 2.62, 95% confidence interval (CI) = 1.32-3.44 in the drug group and 3.33 ± 3.67, 95%CI = 0.61-2.55 in the placebo group. No significant statistical difference between the two groups was observed. CONCLUSION According to our results, both vitamin D(3) and placebo treatments improved CLBP and there was no significant difference between vitamin D(3) and placebo groups.
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Affiliation(s)
- Mahnaz Sandoughi
- Department of Internal Medicine, Ali-Ebne-Abitaleb Hospital, Zahedan University of Medical Sciences, Zahedan, Iran
| | - Zahra Zakeri
- Department of Internal Medicine, Ali-Ebne-Abitaleb Hospital, Zahedan University of Medical Sciences, Zahedan, Iran
| | - Zahra Mirhosainee
- Department of Internal Medicine, Ali-Ebne-Abitaleb Hospital, Zahedan University of Medical Sciences, Zahedan, Iran
| | - Mahdi Mohammadi
- Biostatistics, Health promotion research center, Zahedan University of Medical Sciences, Zahedan, Iran
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Abstract
BACKGROUND AND AIM Consultations for chronic abdominal pain are frequent in adults and children. A seasonal pattern of abdominal pain consultations with winter predominance was shown in previous pediatric studies; however, no studies have investigated whether such a pattern exists in adult patients. Understanding the differences in seasonal patterns of abdominal pain consultations among adults and children may indicate that either different mechanisms exist for common chronic pain conditions or triggering factors may vary by age. The aim of the study was to investigate whether a seasonal variation in abdominal pain consultation patterns exists among adults and children. METHODS The number of outpatient consultations among children (5-17 years) and adults (18 years or older) with a diagnosis of abdominal pain of nonspecified origin (International Classification of Diseases-9 code 789.0) from May 2000 to December 2008 was identified in an administrative claims database. The primary outcome measure was the rate of abdominal pain consultations (total number of abdominal pain consultations/total number of distinct patients by month×1000) by season in children and adults. Seasons were defined as follows: winter (December-February), spring (March-May), summer (June-August), and fall (September-November). A trend test was conducted to determine the degree of linearity in the patterns between the 2 groups. Among children, subanalyses by age 5 to 11 years and 12 to 17 years and sex were conducted. RESULTS A total of 172.4 million distinct patients (13.4% children, 87.6% adults) were identified in the database between May 2000 and December 2008. During the same time period, 15.6 million patient consultations for abdominal pain were identified (10.1% children, 89.9% adults). Children demonstrated a seasonal pattern in abdominal pain consultations, which best fit a quadratic regression curve, with consultations less common during the summer months. Abdominal pain consultations in adults were linear with no seasonal predominance. The trend in seasonal variation of abdominal pain consultations among children stratified by age and sex remained consistent with the overall child population. CONCLUSIONS Abdominal pain consultations in children are less common during summer months, whereas no evidence of seasonal pattern of consultation was found in adults. Factors involved in the pathogenesis of abdominal pain in adults and children may differ.
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Abstract
BACKGROUND Vitamin D is produced in the skin after sun-light exposure and can also be obtained through food. Vitamin D deficiency has recently been linked with a range of diseases including chronic pain. Observational and circumstantial evidence suggests that there may be a role for vitamin D deficiency in the aetiology of chronic pain conditions. OBJECTIVES To assess the efficacy and adverse events of vitamin D supplementation in chronic painful conditions. SEARCH STRATEGY We searched Cochrane CENTRAL, MEDLINE, EMBASE and the Oxford Pain Relief Database for studies to September 2009. This was supplemented by searching the reference lists of retrieved articles, textbooks and reviews. SELECTION CRITERIA Studies were included if they were randomised double blind trials of vitamin D supplementation compared with placebo or with active comparators for the treatment of chronic pain conditions in adults. DATA COLLECTION AND ANALYSIS Two review authors independently selected the studies for inclusion, assessed methodological quality, and extracted data. Pooled analysis was not undertaken due to paucity and heterogeneity of data. MAIN RESULTS Four studies, with a total of 294 participants, were included. The studies were heterogeneous with regard to study quality, the chronic painful conditions that were investigated, and the outcome measures reported. Only one study reported a beneficial effect, the others found no benefit of vitamin D over placebo in treating chronic pain. AUTHORS' CONCLUSIONS The evidence base for the use of vitamin D for chronic pain in adults is poor at present. This is due to low quality and insufficient randomised controlled trials in this area of research.
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Affiliation(s)
- Sebastian Straube
- Department of Occupational, Social and Environmental Medicine, University Medical Center Göttingen, Göttingen, Germany
| | - Sheena Derry
- Pain Research and Nuffield Department of Clinical Neurosciences (Nuffield Division of Anaesthetics), University of Oxford, Oxford, UK
| | - R Andrew Moore
- Pain Research and Nuffield Department of Clinical Neurosciences (Nuffield Division of Anaesthetics), University of Oxford, Oxford, UK
| | - Henry J McQuay
- Pain Research and Nuffield Department of Clinical Neurosciences (Nuffield Division of Anaesthetics), University of Oxford, Oxford, UK
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Straube S, Moore RA, Derry S, Hallier E, McQuay HJ. Vitamin d and chronic pain in immigrant and ethnic minority patients-investigation of the relationship and comparison with native Western populations. Int J Endocrinol 2010; 2010:753075. [PMID: 20016681 PMCID: PMC2778183 DOI: 10.1155/2010/753075] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2009] [Accepted: 07/27/2009] [Indexed: 11/18/2022] Open
Abstract
Vitamin D deficiency has been implicated in chronic pain. Immigrant and ethnic minority populations have been shown to have lower vitamin D levels than native Western populations and often to be vitamin D deficient. This systematic review investigates the relationship between vitamin D and chronic pain in immigrant and ethnic minority populations. Included were studies reporting on 25-OH vitamin D levels in immigrant/ethnic minority populations affected by chronic pain, and/or reporting on the treatment of chronic pain with vitamin D preparations in such populations. We found that 25-OH vitamin D levels were low and often deficient in immigrant/ethnic minority populations. Vitamin D levels depended on the latitude of the study location and hence sunlight exposure. There was insufficient evidence to reach a verdict on the value of treating chronic pain in immigrant/ethnic minority patients with vitamin D preparations because the studies were few, small, and of low quality.
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Affiliation(s)
- Sebastian Straube
- Department of Occupational and Social Medicine, University of Göttingen, Waldweg 37 B, 37073 Göttingen, Germany
- *Sebastian Straube:
| | - R. Andrew Moore
- Pain Research, Nuffield Department of Anaesthetics, University of Oxford, John Radcliffe Hospital, Level 6 West Wing, Oxford OX3 9DU, UK
| | - Sheena Derry
- Pain Research, Nuffield Department of Anaesthetics, University of Oxford, John Radcliffe Hospital, Level 6 West Wing, Oxford OX3 9DU, UK
| | - Ernst Hallier
- Department of Occupational and Social Medicine, University of Göttingen, Waldweg 37 B, 37073 Göttingen, Germany
| | - Henry J. McQuay
- Pain Research, Nuffield Department of Anaesthetics, University of Oxford, John Radcliffe Hospital, Level 6 West Wing, Oxford OX3 9DU, UK
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Inaba R, Mirbod SM. Subjective musculoskeletal symptoms in winter and summer among indoor working construction electricians. INDUSTRIAL HEALTH 2010; 48:29-37. [PMID: 20160405 DOI: 10.2486/indhealth.48.29] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
To evaluate the effects of cold exposure on the musculoskeletal system, two surveys on the subjective musculoskeletal symptoms among male electricians working in the buildings under construction were performed in winter (N=74) and summer seasons (N=83). A self-administered questionnaire was used to collect information on age, occupational career, working habit, present illness, and subjective musculoskeletal symptoms. Mean age, occupational career and daily smoking of the supervisors were significantly higher than those of the other subjects. In general, prevalence rates of stiffness, numbness, pain and Raynaud's phenomenon in the fingers, finger cold sensation, dull movement of the fingers, pain in the wrist, knee joint pain, pain and numbness in the foot and foot cold sensation in winter were significantly higher than those in summer. These results were marked especially in the workers except supervisors. In winter, there were no significant differences in the prevalence rates of subjective musculoskeletal complaints between the supervisors and the other workers. On the other hand, in summer, prevalence of stiffness and pain in the shoulder, stiffness and pain in the neck, dullness and pain in the arm, finger cold sensation, low back dullness and low back pain in the supervisors were significantly higher than those in the other workers. These results suggest that effects of cold on the musculoskeletal symptoms markedly appeared in the workers except supervisors.
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Affiliation(s)
- Ryoichi Inaba
- Department of Occupational Health, Gifu University Graduate School of Medicine, 1-1 Yanagido, Gifu 501-1194, Japan.
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McNally JD, Matheson LA, Rosenberg AM. Epidemiologic considerations in unexplained pediatric arthralgia: the role of season, school, and stress. J Rheumatol 2009; 36:427-33. [PMID: 19040297 DOI: 10.3899/jrheum.080358] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To determine demographic and epidemiologic characteristics in children with unexplained joint pain. METHODS The study population included 730 children (< 18 yrs of age) referred between 1981 and 2007 to the Saskatchewan Pediatric Rheumatology Program, University of Saskatchewan, because of arthralgia. Parents and patients completed a questionnaire at the time of initial presentation, and a diagnosis of unexplained arthralgia was assigned based on clinical assessment. Serum vitamin D levels were measured in 73 patients diagnosed with arthralgia. RESULTS Subjects with arthralgia were more likely to report psychosocial stresses including family discord and illness in the family, and to be cared for by a single parent as a consequence of parental separation or death. Significantly more patients reported fall and winter (30%) as the season of symptom onset compared to spring or summer (20%; p = 0.01). Significantly more survey respondents in the arthralgia group reported missing school compared to the control group (62% vs 31%; p = 0.001). Referrals from northern Saskatchewan were significantly more numerous than from southern Saskatchewan (107 vs 45 per 100,000; p < 0.001). Serum vitamin D concentrations measured in a subgroup of patients (n = 73) showed that 62 (82%) were abnormally low, 42% between 50 and 75 nmol/l (insufficient), and 40% < 50 nmol/l (deficient). CONCLUSION Our results suggest an association between psychosocial stress, school absenteeism, vitamin D insufficiency, and unexplained arthralgia in children.
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Affiliation(s)
- J Dayre McNally
- Department of Pediatrics, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
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Straube S, Andrew Moore R, Derry S, McQuay HJ. Vitamin D and chronic pain. Pain 2008; 141:10-3. [PMID: 19084336 DOI: 10.1016/j.pain.2008.11.010] [Citation(s) in RCA: 87] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2008] [Revised: 11/12/2008] [Accepted: 11/13/2008] [Indexed: 01/13/2023]
Affiliation(s)
- Sebastian Straube
- Pain Research and Nuffield Department of Anaesthetics, University of Oxford, John Radcliffe Hospital, Level 6 West Wing, Oxford OX3 9DU, UK
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Abstract
Functional gastrointestinal disorders (FGIDs) commonly affect children and are associated with short- and long-term morbidity. Although the pathogenesis of pain-related FGIDs remains incompletely understood, most investigators agree on a multifactorial etiology and the presence of an altered brain-gut interaction. A continuous interplay of genetic and environmental factors appears to shape the development of the central and enteric nervous systems. The biopsychosocial model is the current operational framework for children with FGIDs, as it recognizes the interaction between social and environmental influences and psychological and physiologic processes. The biopsychosocial model proposes that specific permutations of genetic susceptibility, early life experiences, sociocultural issues, and coping mechanisms could explain the variability in clinical presentation and outcome among individuals.
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Affiliation(s)
- Ashis V Barad
- Children's Memorial Hospital, Northwestern University, 700 West Fullerton Avenue, Box 57, Chicago, IL 60614, USA.
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