Management of paediatric procedure-related cancer pain

Paediatric malignancy is not always painful in its own right; however, young patients with cancer undergo numerous painful procedures for diagnosis, therapy and supportive care, including lumbar puncture, bone marrow aspiration and biopsy. Children with cancer consider painful procedures to be the most difficult part of their illness and the frequent repetition of procedures does not desensitize them to the distress. This review provides a brief overview of the state of the art with regard to procedure-related pain in children, and presents some methods and strategies for assessing it and managing it effectively. The first section briefly identifies the dimensions of procedure-related pain and describes the most commonly used methods for its assessment. This followed by an examination of the pharmacological strategies for pain management, including local anaesthesia, conscious sedation and general anaesthesia. In the next section, psychological interventions for the management of procedure-related pain, such as preparation, cognitive–behavioural therapy and hypnosis, are reviewed. The review concludes with recommendations for clinical practice

Attention toward interpersonal stimuli in individuals with and without chronic daily headache

Attentional capture of threat is a normal and adaptive process, although facilitated processing of mildly threatening stimuli irrelevant to current goals may result in attentional interference and compromised performance. In the field of chronic pain, attentional biases towards pain-related information have been commonly found. Pain is inexorably connected with emotion however, and a transdiagnostic approach elucidating similar mechanisms underlying pain and mood disorders has been advocated. One such mechanism may be repetitive thinking on negative themes, including worry and rumination. Attentional biases for threatening (e.g., angry faces) and negative (e.g., sad faces) information have been observed in anxious and depressed populations, although to date it has not been fully established whether biases for such information are heightened in individuals with chronic pain relative to healthy individuals. In this study, attentional biases for angry, sad and also happy facial expressions, at 500 and 1250 ms presentation times, were assessed via visual-probe task in chronic daily headache (n = 20) and healthy control (n = 26) groups. Results showed participants to demonstrate significant bias towards angry and sad expressions at 500 and 1250 ms, and happy expressions at 1250 ms. No significant differences in attentional bias were found between chronic daily headache and healthy control groups. These results suggest that attentional biases towards interpersonal threat are not specifically heightened in individuals with chronic daily headache. While similar mechanisms such as rumination may underlie biases in different disorders, this does not translate to heightened biases for the same specific content

Exploring the interactions of irbesartan and irbesartan–2-hydroxypropyl-β-cyclodextrin complex with model membranes

The interactions of irbesartan (IRB) and irbesartan–2-hydroxypropyl-β-cyclodextrin (HP-β-CD) complex with Dipalmitoyl Phosphatidylcholine (DPPC) bilayers have been explored utilizing an array of biophysical techniques ranging from Differential Scanning Calorimetry (DSC), Small angle X-ray Scattering (SAXS), ESI Mass-Spectrometry (ESI-MS) and solid state Nuclear Magnetic Resonance (ssNMR). Molecular Dynamics (MD) calculations have been also conducted to complement the experimental results. Irbesartan was found to be embedded in the lipid membrane core and to affect the phase transition properties of the DPPC bilayers. SAXS studies revealed that irbesartan alone does not display perfect solvation since some coexisting irbesartan crystallites are present. In its complexed form IRB gets fully solvated in the membranes showing that encapsulation of IRB in HP-β-CD may have beneficial effects in the ADME properties of this drug. MD experiments revealed the topological and orientational integration of irbesartan into the phospholipid bilayer being placed at about 1 nm from the membrane centre

Cultural responses to pain in UK children of primary school age: a mixed-methods study.

Pain-measurement tools are often criticized for not addressing the influence of culture and ethnicity on pain. This study examined how children who speak English as a primary or additional language discuss pain. Two methods were used in six focus group interviews with 34 children aged 4-7 years: (i) use of drawings from the Pediatric Pain Inventory to capture the language used by children to describe pain; and (ii) observation of the children's placing of pain drawings on red/amber/green paper to denote perceived severity of pain. The findings demonstrated that children with English as an additional language used less elaborate language when talking about pain, but tended to talk about the pictures prior to deciding where they should be placed. For these children, there was a positive significant relationship between language, age, and length of stay in the UK. The children's placement of pain drawings varied according to language background, sex, and age. The findings emphasize the need for sufficient time to assess pain adequately in children who do not speak English as a first language

Appearance related concerns across the general and clinical populations

This thesis explores appearance related concerns across the general and clinical populations. Section A briefly describes the different parts comprising this thesis and discusses the common themes emerged. In Section B, a survey of 300 young adults is reported which was conducted with an aim to identify the nature, extent and correlates of appearance dissatisfaction in this population. It was found that a surprisingly large percent of men and women were dissatisfied with their appearance and that this discontent was not limited to shape/size concerns in women and muscularity concerns in men as has been suggested by previous investigators. In terms of predictors of appearance dissatisfaction, appearance schemata, social support and psychological distress were the stronger with investment in appearance (appearance schemata) being the most significant. This survey was followed up by two qualitative studies aiming to identify and explore in more depth the factors that contribute to the development or not of appearance dissatisfaction. Themes such as parental modelling, self-esteem social support, media influence emerged in the participants' discourse as important in the development or not of their dissatisfaction with appearance. In Section C the consultation revised the existing measures of appearance (dis)satis faction and recommended the most developmentally appropriate and psychometrically rigorous for the assessment of individuals with cleft lip/palate condition. From the review of the relevant literature it became obvious that the assessment of appearance related aspects is still at an early stage. 'Me consultation also briefly summarizes the effects on body image, self-concept, and social interaction of cleft lip/palate condition. Finally in Section D, a review paper critically summarizes the literature on body image and quality of life in patients with head and neck cancer and makes recommendations for further developments in research and clinical practice in this area

Dairy consumption and risk of mood disorders. A systematic review and meta-analysis

ΣΤΟΧΟΣ: Αυτή η συστηματική ανασκόπηση και μετα-ανάλυση αποτελεί μέρος μιας υπερ-ανάλυσης, η οποία στοχεύει στον εντοπισμό της πιθανής συσχέτισης μεταξύ της κατανάλωσης γαλακτοκομικών προϊόντων και του κινδύνου συναισθηματικών και γνωστικών διαταραχών. Η παρούσα μελέτη επικεντρώνεται αποκλειστικά στις συναισθηματικές διαταραχές. ΜΕΘΟΔΟΙ: Η μελέτη διεξήχθη σύμφωνα με τις κατευθυντήριες γραμμές PRISMA. Το PubMed και το EMBASE εξετάστηκαν για επιλέξιμες μελέτες από το σημείο έναρξης της μελέτης έως και την 31η Μαΐου 2020. Μελέτες κοόρτης, συγχρονικές, ασθενών-μαρτύρων και κλινικές δοκιμές κρίθηκαν κατάλληλες. Εξήχθησαν δεδομένα με τη μορφή μέτρων εκτίμησης του μεγέθους εκτίμησης (RR) με τη μέγιστη προσαρμογή. Η ποσοτική σύνθεση, οι υποανάλυσες (με βάση την περιοχή, το σχεδιασμό της μελέτης και το βαθμό προσαρμογής) και οι αναλύσεις ευαισθησίας πραγματοποιήθηκαν με τη χρήση μοντέλου τυχαίων επιδράσεων. ΑΠΟΤΕΛΕΣΜΑΤΑ: Επιλέχθηκαν 14 μελέτες (163.567 συμμετέχοντες), οι οποίες παρήγαγαν 16 σκέλη μελέτης σε σχέση με την κατανάλωση γαλακτοκομικών προϊόντων: 14 για την κατάθλιψη, μία για την κατάθλιψη μετά τον τοκετό και μία για την κατάθλιψη του περιγεννητικού. Ο κίνδυνος κατάθλιψης αυξήθηκε με την κατανάλωση γάλακτος υψηλής περιεκτικότητας σε λιπαρά (συγκεντρωτικός σχετικός κίνδυνος=1.46, 95% διάστημα εμπιστοσύνης: 1.10-1.95), ενώ ήταν αντιστρόφως σχετίζεται με την υψηλότερη πρόσληψη γιαουρτιού (συγκεντρωτικός σχετικός κίνδυνος =0.79, 95% διάστημα εμπιστοσύνης: 0.65-0.96) όπως προέκυψε από την ανάλυση ευαισθησίας. Τα αποτελέσματα από τις υποανάλυσες ήταν κατά κύριο λόγο σύμφωνα με τις συνολικές αναλύσεις. ΣΥΜΠΕΡΑΣΜΑΤΑ: Η ψυχική υγεία φαίνεται να επηρεάζεται διαφορετικά από τα γαλακτοκομικά προϊόντα, ανάλογα με τον τύπο, την ποσότητα και την περιεκτικότητα σε λιπαρά. Περιορισμένα διαθέσιμα στοιχεία δείχνουν την ανάγκη για πρόσθετη έρευνα δεδομένου ότι ο παγκόσμιος πληθυσμός γερνάει.OBJECTIVE: This systematic review and meta-analysis is part of a hyper-analysis that aims to identify the possible association between dairy product consumption and the risk of mood and cognitive disorders. The present study focuses exclusively dairy intake and mood disorders. METHODS: The study was conducted according to the PRISMA guidelines. PubMed and Embase were screened for eligible studies from study initiation point until May 31, 2020. Cohort, cross-sectional, case-control studies and clinical trials were deemed eligible. Maximally adjusted effect estimates for relative risk (RR) were extracted. The quantitative synthesis, subanalyses (based on region, study design and degree of adjustment) and sensitivity analyses were performed using a random-effects model. RESULTS: Eligibility criteria were met by 25 studies (199,118 subjects), which generated 16 study arms in relation to dairy product consumption: 14 for depression, one for postpartum depression, and one for peripartum depression. Risk of depression increased with high-fat milk consumption (pooled RR=1.46, 95% CI: 1.10-1.95), while it was inversely related with higher yogurt intake (pooled RR=0.79, 95% CI: 0.65-0.96) in the sensitivity analysis. Results from the subanalyses were predominantly consistent with the overall analyses. CONCLUSIONS: Mental health seems to be differently influenced by dairy products, depending on their type, quantity and fat content. Limited available evidence suggests the necessity for additional research given that the global population is aging

Unstimulated cortisol secretory activity in everyday life and its relationship with fatigue and chronic fatigue syndrome : a systematic review and subset meta-analysis

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