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Taddio A, Coldham J, Logeman C, McMurtry CM, Bucci LM, Gudzak V, MacDonald NE, Little C, Samborn T, Moineddin R. CARD (Comfort Ask Relax Distract) for school-based immunizations in Calgary, Canada: a pragmatic cluster trial. Pain 2024; 165:644-656. [PMID: 37824173 PMCID: PMC10859848 DOI: 10.1097/j.pain.0000000000003050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 07/10/2023] [Accepted: 07/27/2023] [Indexed: 10/13/2023]
Abstract
ABSTRACT School-based immunizations are fear-inducing events for many students and contribute to vaccine hesitancy. We developed an immunization delivery framework called the CARD (Comfort Ask Relax Distract) system that incorporates evidence-based interventions to improve the experience (eg, reduce fear, pain, dizziness). We evaluated CARD in grades 6 and 9 students in Calgary, Canada. In this pragmatic, hybrid, effectiveness-implementation, cluster trial, we randomized 8 Community Health Centres providing regional immunization services to CARD or control (usual care). In the CARD group, public health staff educated students about CARD and planned processes to reduce fear cues and support student coping choices during immunization. Students self-reported fear, pain, and dizziness during immunization using a 0-10 numerical rating scale; staff recorded procedure details, including vaccines administered, fainting episodes, and coping strategies used. Staff participated in focus groups afterward. Altogether, 8839 children from 105 schools in the 2019 to 2020 school calendar year were included. Fear was lower for CARD (mean = 3.6 [SD = 3.1] vs control 4.1 [3.2]; mean difference = -0.5; 95% confidence interval = -0.74 to -0.21; P < 0.001). Effectiveness persisted after stratification by student gender (male and female) and grade level (grade 6 and grade 9). Other symptoms did not differ. Compared with control, CARD students used peers, privacy, muscle tension, and topical anesthetics more; verbal distraction, deep breathing, and adult support were used less frequently ( P < 0.05, all analyses). Immunization rate did not differ. Staff reported positive to neutral attitudes about CARD. In summary, this pragmatic trial demonstrated that CARD improved the immunization experiences of students at school.
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Affiliation(s)
- Anna Taddio
- Leslie Dan Faculty of Pharmacy, University of Toronto, Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, ON, Canada
| | | | - Charlotte Logeman
- Child Health Evaluative Services, The Hospital for Sick Children, Toronto, ON, Canada
| | | | - Lucie M. Bucci
- Bucci-Hepworth Health Services Inc., Pincourt, QC, Canada
| | - Victoria Gudzak
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON, Canada
| | - Noni E. MacDonald
- Faculty of Medicine, Dalhousie University, IWK Health Centre, Halifax, NS, Canada
| | | | - Tracy Samborn
- Cochrane Community Health Centre, Alberta Health Services, Cochrane, AL, Canada
| | - Rahim Moineddin
- Department of Family and Community Medicine, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
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Andias R, Silva AG. The Onset of Chronic Musculoskeletal Pain in High School Adolescents: Associated Factors and the Role of Symptoms of Central Sensitization. Phys Ther 2022; 102:6478902. [PMID: 34939105 DOI: 10.1093/ptj/pzab286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Revised: 07/30/2021] [Accepted: 11/14/2021] [Indexed: 11/13/2022]
Abstract
OBJECTIVE This study aimed to investigate the association between sociodemographic data, physical activity, depression, anxiety, and stress, sleep, and self-reported symptoms of central sensitization at baseline, in asymptomatic adolescents, and the onset of pain at 6-months follow-up. METHODS A total of 252 asymptomatic adolescents were assessed at baseline with an online questionnaire that included sociodemographic data, the Nordic Musculoskeletal Questionnaire; the International Physical Activity Questionnaire for Adolescents; the Depression, Anxiety and Stress Scale for Children; the Basic Scale on Insomnia complaints and Quality of Sleep; and the Central Sensitization Inventory. The same questionnaire was repeated at 6-months follow-up. RESULTS Of the 231 (91.7%) adolescents who completed the questionnaire at the follow-up, 127 (55.0%) remained asymptomatic and 88 (38.1%) reported a new onset of pain. At the 6-month follow-up, the mean (SD) number of painful body sites was 1.81 (1.04), and the neck region was the most reported (n = 29, 33%). Multivariable analysis showed that being female (OR = 2.34; 95% CI = 1.28-4.27) and reporting more self-reported symptoms of central sensitization (OR = 1.04; 95% CI = 1.01-1.07) were associated with the onset of chronic pain at follow-up. CONCLUSION Female sex and self-reported symptoms of central sensitization were considered risk factors for the onset of pain in adolescents but should be further explored in future studies. IMPACT Considering the increasing prevalence of chronic musculoskeletal pain in adolescents, understanding the factors that may be associated with its new onset may help to better design preventive strategies and thus minimize the appearance of this type of pain in adolescents.
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Affiliation(s)
- Rosa Andias
- School of Health Sciences (ESSUA), University of Aveiro, Campus Universitário de Santiago, Aveiro, Portugal.,Center for Health Technology and Services Research (CINTESIS), Porto, Portugal
| | - Anabela Gonçalves Silva
- School of Health Sciences (ESSUA), University of Aveiro, Campus Universitário de Santiago, Aveiro, Portugal.,Center for Health Technology and Services Research (CINTESIS.UA), University of Aveiro, Aveiro, Portugal
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Caes L, van Gampelaere C, Van Hoecke E, Van Winckel M, Kamoen K, Goubert L. Parental Catastrophizing and Goal Pursuit in the Context of Child Chronic Pain: A Daily Diary Study. Front Psychol 2021; 12:680546. [PMID: 34276501 PMCID: PMC8281243 DOI: 10.3389/fpsyg.2021.680546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Accepted: 05/25/2021] [Indexed: 11/16/2022] Open
Abstract
Background: Despite daily variability in children's chronic pain experiences, little is known about how parents' emotions and goals toward their child's pain are influenced by these daily changes. This diary study examined how daily child pain intensity (as perceived by parents) moderates the associations between parental catastrophic thoughts about child pain on the one hand, and daily parental distress and parents' goals with regard to their child's pain (pain control vs. activity engagement) on the other hand. Method: Participants were 25 parents of 20 different children (N = 18; 90% girls). Children, aged 8–14 years (M = 9.5, SD = 2.09), experienced either chronic headache or functional abdominal pain with an average pain duration of 22.5 months (SD = 24.5 months). Daily parental responses (i.e., perceived child pain intensity, distress and goal endorsement) were collected through a 3-week daily diary (resulting in 413 valid diary reports). Parents completed the Pain Catastrophizing Scale for Parents prior to starting the diary (PCS-P general) and a daily measure (PCS-P daily) included in the diary. To account for the interdependence of the data, the data were analyzed using multilevel modeling. Results: Perceived daily child pain intensity moderated the impact of parental general and daily catastrophic thoughts on parents' daily distress. Only for parents experiencing low general catastrophic thoughts an increase in distress was observed on days when they perceived their child's pain intensity as high. For all parents, high levels of perceived child pain intensity were related to more distress on days where parents reported high levels of catastrophic thinking (i.e., PCS-P daily). Perceived daily child pain intensity also moderated the impact of parental general catastrophic thinking on parents' daily endorsement of goals. Parents with high levels of general catastrophic thinking reported a lower focus on child pain control on days when child pain intensity was perceived to be low. Parents with low general catastrophic thinking reported lower endorsement of the activity engagement goal on days where the child's pain intensity was perceived to be low. Conclusion: These findings highlight the complexity of daily fluctuations in parental distress and goals regarding their child's pain. Clinical implications and future directions are critically assessed.
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Affiliation(s)
- Line Caes
- Division of Psychology, Faculty of Natural Sciences, University of Stirling, Stirling, United Kingdom
| | - Cynthia van Gampelaere
- Department of Experimental, Clinical and Health Psychology, Faculty of Psychology and Educational Sciences, Ghent University, Ghent, Belgium
| | - Eline Van Hoecke
- Pediatric Psychology, Department of Pediatrics, Ghent University Hospital, Ghent, Belgium
| | - Myriam Van Winckel
- Department of Internal Medicine and Pediatric, Faculty of Medicine and Health Sciences, Ghent University Hospital, Ghent, Belgium
| | | | - Liesbet Goubert
- Department of Experimental, Clinical and Health Psychology, Faculty of Psychology and Educational Sciences, Ghent University, Ghent, Belgium
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Abdominal Pain After Pediatric Inflammatory Bowel Disease Diagnosis: Results From the ImproveCareNow Network. J Pediatr Gastroenterol Nutr 2020; 71:749-754. [PMID: 32910089 DOI: 10.1097/mpg.0000000000002933] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
OBJECTIVES Although abdominal pain is a hallmark symptom of pediatric inflammatory bowel disease (IBD), limited research has examined pain during the first year after diagnosis. The purpose of the present study is to examine prevalence, predictors, and impact of abdominal pain during the 12 months after pediatric IBD diagnosis using data from the ImproveCareNow (ICN) Network. PATIENTS AND METHODS Participants consisted of 13,875 youth (age 8-18 years, 44% female, 81% Caucasian) with IBD (65% Crohn's disease; 27% ulcerative colitis, 8% indeterminate colitis) enrolled in the ICN Network with data from clinic visits during the first year after diagnosis (1-22 visits; mean = 3.7). Multivariable mixed effects logistic regression models were conducted to analyze the presence versus the absence of abdominal pain, activity limitations, and decrements in well-being. RESULTS The percentage of youth reporting abdominal pain decreased significantly during the first year after diagnosis and yet a sizeable group reported continued pain at 12 months (55.9% at diagnosis; 34.0% at 12 months). Multivariable analyses revealed that greater time since diagnosis (odds ratio [OR] = 0.98, P < 0.001), higher disease severity (OR = 11.84, P < 0.001), presence of psychosocial risk factors (OR = 2.33, P = 0.036), and female sex (OR = 1.90, P < 0.010) were significant correlates of continuing abdominal pain. Abdominal pain was significantly associated with decrements in well-being (OR = 5.11, P < 0.001) as well as limitations in activity (OR = 9.31, P < 0.001), over and above the influence of disease severity. CONCLUSIONS Abdominal pain is prevalent and impactful, even when controlling for disease activity, during the first year after pediatric IBD diagnosis. Results from the present study can inform screening and tailored pain management intervention efforts in pediatric IBD.
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Fayão JG, Libardoni TDC, Martins J, Souza CDS, Oliveira ASD. Queixas musculoesqueléticas no ombro: características dos usuários e dos atendimentos na atenção primária. FISIOTERAPIA E PESQUISA 2019. [DOI: 10.1590/1809-2950/18016826012019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
RESUMO A dor no ombro representa a terceira principal queixa musculoesquelética da população. Afeta fatores físicos, psicológicos e econômicos do indivíduo. A atenção primária à saúde é essencial para a eficácia do cuidado dos pacientes acometidos. Este estudo é observacional transversal e obteve um perfil dos usuários e das consultas médicas com relato de dor no ombro durante um ano na atenção primária do município de Ribeirão Preto (SP). Foram analisados em prontuários os registros das consultas médicas agendadas e sem agendamento prévio. Nestes registros foram coletados dados dos pacientes que apresentaram queixas de dor musculoesquelética no ombro (dados sociodemográficos e características das consultas), que foram analisados de forma descritiva e pelos testes qui-quadrado de Pearson, razão de chance e regressão logística múltipla. A frequência de consultas médicas por queixa de dor no ombro foi de 9,2%. O perfil dos indivíduos que se queixaram de dor no ombro se caracterizava por mulheres, com idade avançada, casadas, alfabetizadas e que apresentavam alguma ocupação. As consultas em sua maioria tiveram retornos agendados, oferecimento de orientações terapêuticas e poucos encaminhamentos.
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Systematic review with meta-analysis of childhood and adolescent risk and prognostic factors for musculoskeletal pain. Pain 2016; 157:2640-2656. [DOI: 10.1097/j.pain.0000000000000685] [Citation(s) in RCA: 81] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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Chen B, Li L, Donovan C, Gao Y, Ali G, Jiang Y, Xu T, Shan G, Sun W. Prevalence and characteristics of chronic body pain in China: a national study. SPRINGERPLUS 2016; 5:938. [PMID: 27386382 PMCID: PMC4929094 DOI: 10.1186/s40064-016-2581-y] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/18/2016] [Accepted: 06/15/2016] [Indexed: 01/20/2023]
Abstract
Background Chinese citizens regularly experience some form of bodily pain, yet little is known regarding the epidemiology of pain. Methods We conducted a nationally representative sample cross sectional study to estimate the prevalence of pain and identify risk factors of pain among 19,665 community residents aged 18–65 years in China. The China Sub-optimal Health Survey (CSHS) data was used to estimate pain prevalence. Body pain was also estimated by self-reports from the sample population. A logistical regression model was applied to estimate the odds ratio and 95 % CIs of acute pain and chronic pain to explore the potential risk factors. Results Women had a higher prevalence of pain than men (39.92 vs. 32.17 % for chronic pain). The prevalence of pain increased with age (29.72 % for ages 18–25 vs. 42.23 % for ages 45–65). The most common complaints were head, neck/shoulder, and waist/back pain. Females (OR 1.57, 95 % CI 1.44–1.71) ages 25 or older (25–45: OR 1.19, 95 % CI 1.04–1.36; 45–65: OR 1.47, 95 % CI 1.26–1.73) were more likely to report having chronic pain. Subjects’ living areas, and their drinking status (OR 1.32, 95 % CI 1.13–1.53) or smoking status (OR 1.01, 95 % CI 0.91–1.11), were also factors that were significantly associated with increased reporting of chronic pain. Conclusion Women had a higher prevalence of chronic pain than men, although both sexes had a high prevalence for chronic pain. There were significant differences between the two sexes and the location of chronic pain in the body, most notably in the shoulders, stomach, abdomen, and waist.
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Affiliation(s)
- Beifeng Chen
- School of Public Health, Wannan Medical College, Wuhu, 241002 China
| | - Linlin Li
- University of California Davis Health System, Sacramento, CA 95817 USA
| | - Connor Donovan
- College of Business, University of Arkansas at Little Rock, Little Rock, AR USA
| | - Yongqing Gao
- School of Food Science, Guangdong Pharmaceutical University, Zhongshan, 528458 China
| | - Gholam Ali
- School of Medicine, Tulane University, New Orleans, LA 70112 USA
| | - Yan Jiang
- Infocast Company, Kowloon, Hong Kong
| | - Tan Xu
- Department of Epidemiology, School of Public Health and Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, Medical College of Soochow University, Suzhou, Jiangsu Province 215123 China ; Tulane University, School of Public Health and Tropical Medicine, 1440 Canal Street, New Orleans, LA 70112 USA
| | - Guangliang Shan
- Department of Epidemiology and Statistics, Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences; School of Basic Medicine, Peking Union Medical College, Beijing, 100005 China
| | - Wenjie Sun
- School of Food Science, Guangdong Pharmaceutical University, Zhongshan, 528458 China ; Tulane University, School of Public Health and Tropical Medicine, 1440 Canal Street, New Orleans, LA 70112 USA
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