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Friedner K, Solomons W, Flannery H, Harrington J. Family narratives of lives with persistent physical symptom conditions. Clin Child Psychol Psychiatry 2021; 26:1257-1270. [PMID: 34329564 PMCID: PMC8593315 DOI: 10.1177/13591045211033188] [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] [Indexed: 11/18/2022]
Abstract
BACKGROUND Literature reviews revealed no existing research on family narratives of living with multigenerational persistent physical symptom (PPS) conditions. The current study examined the personal and family narratives of one such family, from a relational/systemic perspective. METHOD This research employed a qualitative research design, specifically using narrative methodologies to explore the experiences of a single family comprising two parents and their three children. All the children and their mother had a diagnosis of Ehlers-Danlos syndrome (EDS) but are specifically afflicted with PPS. The father is in good health. Using narrative inquiry, the family members were interviewed together and then individually. The interviews were audio-recorded, transcribed and analysed using narrative analysis in NVivo. FINDINGS Overarching narratives were stories of loss and sacrifice and stories of family unity. An exploration of the family's negotiation of roles and identities is presented in the context of stigmatised illness. DISCUSSION Novel findings are presented in the context of the central role of the mother, the importance of family cohesion and the impact to family life resulting from living with stigmatised illness. Lastly, clinical implications and future research ideas are discussed.
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Affiliation(s)
- Kimberley Friedner
- Clinical Psychologist, 3769University of Hertfordshire, Hatfield, Hertfordshire, UK
| | - Wendy Solomons
- Clinical Psychologist, 3769University of Hertfordshire, Hatfield, Hertfordshire, UK
| | - Halina Flannery
- Clinical Psychologist, Child and Adolescent Psychology Service, 8964University College London Hospital, London, UK
| | - Jenna Harrington
- Clinical Psychologist, 4964Royal Brompton & Harefield NHS Foundation Trust, London, UK
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Rytter D, Rask CU, Vestergaard CH, Nybo Andersen AM, Bech BH. Non-specific Health complaints and self-rated health in pre-adolescents; impact on primary health care use. Sci Rep 2020; 10:3292. [PMID: 32094433 PMCID: PMC7039989 DOI: 10.1038/s41598-020-60125-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Accepted: 02/04/2020] [Indexed: 12/31/2022] Open
Abstract
The objective of the present study was to explore past and future primary health care use in preadolescents reporting frequent non-specific health complaints or a low self-rated health compared to that of preadolescents with no frequent health complaints or with good self-rated health. The study was conducted as a cohort study based within the Danish National Birth Cohort (1996–2002). Information on non-specific health complaints and self-rated health was obtained by an 11-year follow-up questionnaire. Information about number of general practitioner (GP) contacts was obtained from the Health Insurance Service Register. A total of 44,877 pre-adolescents gave complete exposure information. Pre-adolescents who reported frequent non-specific health complaints had a higher use of GP compared to pre-adolescents without complaints across the five years following the index date (somatic complaints: IRR = (1.46 [1.38; 1.55], mental complaints: IRR = 1.16 [1.12; 1.19], both complaints: IRR = 1.58 [1.47; 1.69]). The same pattern was found for the association between low self-rated health and number of GP contacts (IRR = 1.41 (1.36; 1.46)). Non-specific health complaints and a poor self-rated health in pre-adolescents was associated with a higher past and future use of GP, indicating a need for development of early interventions with help for symptom management.
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Affiliation(s)
- Dorte Rytter
- Department of Public Health, Aarhus University, Bartholins Allé 2, 8000, Aarhus C, Denmark.
| | - Charlotte Ulrikka Rask
- Department of Child and Adolescent Psychiatry, Research Unit, Psychiatry, Aarhus University Hospital, Palle Juul Jensens Boulevard 175, entrance K, 8200, Aarhus N, Denmark.,Department of Clinical Medicine, Aarhus University, 8000, Aarhus C, Denmark
| | - Claus Høstrup Vestergaard
- Research unit for general practice Department of Public Health, Aarhus University, Bartholins Allé 2, 8000, Aarhus C, Denmark
| | - Anne-Marie Nybo Andersen
- Department of Public Health, University of Copenhagen, Øster Farimagsgade 5, 1014, Copenhagen K, Denmark
| | - Bodil Hammer Bech
- Department of Public Health, Aarhus University, Bartholins Allé 2, 8000, Aarhus C, Denmark
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The proportion of women with central sensitivity syndrome in gynecology outpatient clinics (GOPDs). Int Urogynecol J 2018; 30:483-488. [PMID: 29974141 DOI: 10.1007/s00192-018-3709-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2018] [Accepted: 06/20/2018] [Indexed: 10/28/2022]
Abstract
INTRODUCTION AND HYPOTHESIS Patients in gynecology outpatient clinics (GOPDs) may present with symptoms that do not correlate well with the observed pathology and are usually labelled as having a functional disorder or medically unexplained symptoms (MUS). Underlying central sensitivity syndrome (CSS) with central sensitization (CS) as a potential mechanism may be responsible for some of their symptoms. The aim of this study is to identify the proportion of women with central sensitivity syndrome attending GOPDs. METHODS This was a prospective study. All women attending a GOPD included in the study were asked to complete a validated Central Sensitization Inventory (CSI). The responses were graded on a Likert scale from 0 (never) to 4 (always). The total score ranges from 0 to 100. For screening purposes, a single CSI cutoff score of 40 was used to identify the group of women who may have central sensitization syndrome. RESULTS Three hundred twenty-six women participated in the study. Overall, 123 (37%) women achieved a score above 40. This could be interpreted as these patients having increased risk of underlying central sensitization. Of these, 43 had a previously confirmed diagnosis of migraine, 55 (44%) depression, 39 (31.7%) anxiety, 11 fibromyalgia (FM), 34 irritable bowel syndrome (IBS) and 16 chronic fatigue syndrome (CFS/ME). CONCLUSIONS Managing patients and their expectations in gynecological outpatient departments when symptoms are inconsistent with observable pathological findings is challenging. This is further complicated when patients have a concomitant central sensitivity syndrome, which can also influence the surgical outcome. Identifying these patients is a key factor for appropriate management.
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Andreucci MSc A, Campbell P, Dunn KM. Are Sleep Problems a Risk Factor for the Onset of Musculoskeletal Pain in Children and Adolescents? A Systematic Review. Sleep 2017; 40:3836926. [PMID: 28531332 DOI: 10.1093/sleep/zsx093] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Study Objectives Musculoskeletal pain is a major burden on the society. Adults with sleep problems are at higher risk of musculoskeletal pain onset, but there is no evidence for this relationship in children and adolescents. This study aimed to systematically review prospective studies on the risk of musculoskeletal pain onset in children and adolescents with sleep problems. Methods Five databases (MEDLINE, PsycINFO, AMED, EMBASE, and HMIC) were systematically searched to identify prospective studies that investigated if children and adolescents (aged 6-19 years) with sleep problems are at higher risk of musculoskeletal pain onset. Included studies were assessed for study quality and a best evidence synthesis was carried out on extracted data. Results Thirteen prospective studies were identified. Overall, evidence indicates that sleep problems (quality, quantity, and day time tiredness) are not risk factors for musculoskeletal pain onset. Further analysis on specific body regions shows strong evidence that sleep problems are a risk factor for neck pain onset (only in girls) and that sleep problems are not a risk factor for the onset of widespread pain. Conclusions Overall, sleep problems are not a risk factor for musculoskeletal pain onset in children and adolescents. Increased risk was found for some specific body regions and subgroups, but the evidence base was less strong and generally inconsistent. This review found a lack of quality in research methodology compared to research in adults, and further research with improved methodology is required.
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Affiliation(s)
- Alessandro Andreucci MSc
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care and Health Sciences, Keele University, UK
| | - Paul Campbell
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care and Health Sciences, Keele University, UK
| | - Kate M Dunn
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care and Health Sciences, Keele University, UK
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Græsholt-Knudsen T, Skovgaard AM, Jensen JS, Rask CU. Impact of functional somatic symptoms on 5-7-year-olds' healthcare use and costs. Arch Dis Child 2017; 102:617-623. [PMID: 28137707 DOI: 10.1136/archdischild-2016-311808] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2016] [Accepted: 01/09/2017] [Indexed: 11/04/2022]
Abstract
OBJECTIVE Knowledge about childhood functional somatic symptoms (FSS) and healthcare costs is scarce. This study aims to assess whether FSS in children aged 5-7 years are associated with increased future primary healthcare. DESIGN At baseline of the observational cohort study, between years 2005 and 2007, 1327 children from the Copenhagen Child Cohort were assessed at ages 5-7 years for FSS and chronic physical diseases using the Soma Assessment Interview. Information on primary healthcare use was obtained from the National Health Insurance Service Register, and measured as the price of all medical services outside the hospital during a 4.5-year follow-up period from the day of assessment. Regression with bootstrap bias-corrected and accelerated CIs were performed. RESULTS 1018 (76.8%) children had no FSS with primary healthcare use adjusted for other child health problems, maternal education and family changes of €448.2, 388.2-523.8 and number of face-to-face contacts: 11.90, 10.71-13.25; 250 (18.9%) had FSS with healthcare use €441.0, 355.0-550.3 and face-to-face contacts: 11.22, 9.60-12.91, and 58 (4.4%) had impairing FSS with healthcare use: €625.9, 447.9-867.8 and face-to-face contacts: 14.65, 11.20-19.00. In unadjusted regression analysis, impairing FSS were associated with increased healthcare use (increased costs: €246.0, 67.6-494.3). The adjusted association was slightly attenuated (increased costs: €177.8, 1.3-417.0). CONCLUSIONS Impairing FSS in children aged 5-7 years is a predictor for the child's future primary healthcare use. More research on complex predictive models is needed to further explore the clinical significance of these results, and to contribute to the underpinning of early interventions towards impairing FSS in children.
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Affiliation(s)
- Troels Græsholt-Knudsen
- Research Clinic for Functional Disorders and Psychosomatics, Aarhus University Hospital, Aarhus N, Denmark
| | - Anne Mette Skovgaard
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark.,National Institute of Public Health, University of Southern Denmark, Odense, Denmark
| | - Jens Søndergaard Jensen
- Research Clinic for Functional Disorders and Psychosomatics, Aarhus University Hospital, Aarhus N, Denmark
| | - Charlotte Ulrikka Rask
- Research Clinic for Functional Disorders and Psychosomatics, Aarhus University Hospital, Aarhus N, Denmark.,Regional Centre for Child and Adolescent Psychiatry, Risskov, Aarhus University Hospital, Aarhus N, Denmark
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A qualitative study of adolescents with medically unexplained symptoms and their parents. Part 2: How is healthcare perceived? J Adolesc 2015; 45:317-26. [DOI: 10.1016/j.adolescence.2015.10.003] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2015] [Revised: 09/28/2015] [Accepted: 10/05/2015] [Indexed: 11/18/2022]
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Fleming KC, Volcheck MM. Central sensitization syndrome and the initial evaluation of a patient with fibromyalgia: a review. Rambam Maimonides Med J 2015; 6:e0020. [PMID: 25973272 PMCID: PMC4422459 DOI: 10.5041/rmmj.10204] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
In both primary care and consultative practices, patients presenting with fibromyalgia (FM) often have other medically unexplained somatic symptoms and are ultimately diagnosed as having central sensitization (CS). Central sensitization encompasses many disorders where the central nervous system amplifies sensory input across many organ systems and results in myriad symptoms. A pragmatic approach to evaluate FM and related symptoms, including a focused review of medical records, interviewing techniques, and observations, is offered here, giving valuable tools for identifying and addressing the most relevant symptoms. At the time of the clinical evaluation, early consideration of CS may improve the efficiency of the visit, reduce excessive testing, and help in discerning between typical and atypical cases so as to avoid an inaccurate diagnosis. Discussion of pain and neurophysiology and sensitization often proves helpful.
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Affiliation(s)
- Kevin C. Fleming
- Assistant Professor of Medicine, College of Medicine; Division of General Internal Medicine, Section of Complementary and Integrative Medicine, and Fibromyalgia and Chronic Fatigue Clinic, Mayo Clinic, Rochester, Minnesota, USA
- To whom correspondence should be addressed. E-mail:
| | - Mary M. Volcheck
- Nursing in Fibromyalgia/Pain Rehabilitation Center, Mayo Clinic, Rochester, Minnesota, USA
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Shraim M, Blagojevic-Bucknall M, Mallen CD, Dunn KM. Repeated primary care consultations for non-specific physical symptoms in children in UK: a cohort study. BMC FAMILY PRACTICE 2014; 15:195. [PMID: 25477255 PMCID: PMC4261613 DOI: 10.1186/s12875-014-0195-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/04/2014] [Accepted: 11/12/2014] [Indexed: 02/02/2023]
Abstract
BACKGROUND Non-specific physical symptoms (NSPS), such as headache and abdominal pain, are common reasons for children to consult primary care. NSPS represent a significant burden not only on society, but also on health care services, through frequent physician consultations and referrals to secondary care. Research evidence suggests a positive relationship between health and consulting behavior of parents and their children, but research on whether repeated physician consultations for NSPS in children is influenced by parental consultations for NSPS is lacking. The aim was to measure the frequency of repeated physician consultations for NSPS in children, and investigate whether this is influenced by maternal consultations for NSPS. METHODS A cohort study of children registered with primary care practices contributing to the Consultation in Primary Care Archive database. Participants were child-mother pairs registered between January 2007 and December 2010. The cohort comprised all children (n = 1437) aged 2 to 16 years who consulted a physician for NSPS in 2009. Mothers' consultations for NSPS were measured between 2007 and 2008. Main outcome measures were repetition and frequency of consultations for NSPS in children (consultations for NSPS in both 2009 and 2010). RESULTS Overall, 27% of children had repeated consultations for NSPS. The three most common repeated consultations were for back pain, constipation and abdominal pain. Exposure to maternal consultation for NSPS was associated with 21% increase in consultation frequency for NSPS (adjusted incidence rate ratio 1.21; 95% CI 1.12, 1.31). After adjusting for child age and maternal age, maternal consultation for NSPS was associated with an increased risk of repeated consultations for NSPS in children (relative risk 1.41; 95% CI 1.16, 1.73). This association was also significant for specific NSPS groups including painful, gastrointestinal, and neurologic symptoms. CONCLUSIONS Repeated consultation for NSPS is common among children. It is important for primary care physicians and secondary care clinicians, managing children referred from primary care for NSPS, to be aware that consultation for NSPS in mothers is a risk factor for repeated consultations for NSPS among children. More research is needed to uncover exactly how parental health influences health and consulting behavior of children.
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Affiliation(s)
- Mujahed Shraim
- Arthritis Research UK Primary Care Centre, Keele University, Keele, UK. .,Work Environment Department, University of Massachusetts Lowell, Lowell, Massachusetts, USA. .,Center for Disability Research, Liberty Mutual Research Institute for Safety, Hopkinton, Massachusetts, USA.
| | | | | | - Kate M Dunn
- Arthritis Research UK Primary Care Centre, Keele University, Keele, UK.
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Shraim M, Blagojevic-Bucknall M, Mallen CD, Dunn KM. The association between GP consultations for non-specific physical symptoms in children and parents: a case-control study. PLoS One 2014; 9:e108039. [PMID: 25251344 PMCID: PMC4176724 DOI: 10.1371/journal.pone.0108039] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2014] [Accepted: 08/25/2014] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Non-specific physical symptoms (NSPS) such as abdominal pain, headache and musculoskeletal pain are widespread in the community, and are common reasons for visiting a general practitioner (GP). Causes of NSPS are multifactorial, but may include parental influences. OBJECTIVE To investigate associations between GP consultations for NSPS in parents and their children. METHODS Matched case-control study using GP consultation data from 12 GP practices in the United Kingdom. Participants were 1328 children who consulted a GP for NSPS in 2009 (cases), 3980 controls who consulted a GP in 2009 but not for NSPS, plus parents of cases and controls (n = 8354). PRIMARY OUTCOME MEASURE child consultation status for NSPS. RESULTS Maternal consultation for NSPS was associated with significantly increased odds of their child consulting for NSPS (odds ratio (OR) 1.51, 95% confidence intervals (CI) 1.33, 1.73); there was no significant association with paternal consultations (OR 0.87, 95% CI 0.71, 1.08). Each additional maternal consultation for NSPS was associated with an increase in the rate ratio for number of consultations for NSPS in the child by 1.03 (95% CI 1.01, 1.05). This overall association was clearest in maternal-child consultations for painful NSPS and for specific bodily systems including gastrointestinal, musculoskeletal and neurologic symptoms. CONCLUSIONS Maternal GP consultation for NSPS is associated with increased odds of GP consultations for NSPS in children. This study included a large sample of children and parents and used medical records data which is not subject to recall bias. However, analysis was based on medical records, thus the presence of NSPS not leading to consultations is unknown. Medical practitioners managing children with NSPS need to be aware of this association.
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Affiliation(s)
- Mujahed Shraim
- Arthritis Research UK Primary Care Centre, Keele University, Keele, United Kingdom
- Work Environment Department, University of Massachusetts Lowell, Lowell, Massachusetts, United States of America
- Center for Disability Research, Liberty Mutual Research Institute for Safety, Hopkinton, Massachusetts, United States of America
| | | | - Christian D. Mallen
- Arthritis Research UK Primary Care Centre, Keele University, Keele, United Kingdom
| | - Kate M. Dunn
- Arthritis Research UK Primary Care Centre, Keele University, Keele, United Kingdom
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Abstract
Back pain episodes are traditionally regarded as individual events, but this model is currently being challenged in favour of treating back pain as a long-term or lifelong condition. Back pain can be present throughout life, from childhood to older age, and evidence is mounting that pain experience is maintained over long periods: for example, people with pain continue to have it on and off for years, and people without pain do not suddenly develop long-term pain. A number of factors predict back pain presence in epidemiological studies, and these are often present, and predictive, at different life stages. There are also factors present at particular life stages, such as childhood or adolescence, which predict back pain in adulthood. However, there are little published data on long-term pain patterns or predictors over the life course. Such studies could improve our understanding of the development and fluctuations in back pain, and therefore influence treatment approaches.
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Affiliation(s)
- Kate M Dunn
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care & Health Sciences, Keele University, Staffordshire ST5 5BG, UK.
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van der Windt DA, Dunn KM. Low back pain research – Future directions. Best Pract Res Clin Rheumatol 2013; 27:699-708. [DOI: 10.1016/j.berh.2013.11.001] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
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Dunn KM, Hestbaek L, Cassidy JD. WITHDRAWN: Low back pain across the lifecourse. Best Pract Res Clin Rheumatol 2013. [DOI: 10.1016/j.berh.2013.10.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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