bluuebunny/crossref_metadata_2025_split huggingface dataset:
Efficacy of a transdiagnostic emotion–focused exposure treatment for chronic pain patients with comorbid anxiety and depression: a randomized controlled trial
Authors: Boersma Katja , Södermark Martin , Hesser Hugo , Flink Ida K. , Gerdle Björn , Linton Steven J. 
Published: April 2019

Abstract
The comorbidity between chronic pain and emotional problems has proven difficult to address with current treatment options. This study addresses the efficacy of a transdiagnostic emotion–focused exposure treatment (“hybrid”) for chronic pain patients with comorbid emotional problems. Adults (n = 115) with chronic musculoskeletal pain and functional and emotional problems were included in a 2-centre, parallel randomized controlled, open-label trial comparing this treatment to an active control condition receiving a guided Internet-delivered pain management treatment based on CBT principles (iCBT). The hybrid treatment (n = 58, 10-16 sessions) integrates exposure in vivo for chronic pain based on the fear-avoidance model with an emotion-regulation approach informed by procedures in Dialectical Behavior Therapy. The iCBT (n = 57; 8 treatment modules) addresses topics such as pain education, coping strategies, relaxation, problem solving, stress, and sleep management using standard CBT techniques. Patient-reported outcomes were assessed before and after treatment as well as at a 9-month primary end point. Across conditions, 78% participants completed post-treatment and 81% follow-up assessment. Intent-to-treat analyses showed that the hybrid had a significantly better post-treatment outcome on pain catastrophizing (d = 0.39) and pain interference (d = 0.63) and significantly better follow-up outcomes on depression (d = 0.43) and pain interference (d = 0.51). There were no differences on anxiety and pain intensity. Observed proportions of clinically significant improvement favoured the hybrid on all but one comparison, but no statistically significant differences were observed. We conclude that the hybrid emotion–focused treatment may be considered an acceptable, credible, and efficacious treatment option for chronic pain patients with comorbid emotional problems.
OPRM1 rs1799971, COMT rs4680, and FAAH rs324420 genes interact with placebo procedures to induce hypoalgesia
Authors: Colloca Luana , Wang Yang , Martinez Pedro E. , Chang Yen-Pei C. , Ryan Kathleen A. , Hodgkinson Colin , Goldman David , Dorsey Susan G. 
Published: April 2019

Abstract
Genetics studies on the placebo hypoalgesic effect highlight a promising link between single nucleotide polymorphisms (SNPs) in the dopamine, opioid, and endocannabinoid genes and placebo hypoalgesia. However, epistasis and replication studies are missing. In this study, we expanded on previous findings related to the 3 SNPs in the opioid receptor mu subunit (OPRM1 rs1799971), catechol-O-methyltransferase (COMT rs4680), and fatty acid amide hydrolase (FAAH rs324420) genes associated with placebo hypoalgesia and tested the effect of a 3-way interaction on placebo hypoalgesia. Using 2 well-established placebo procedures (verbal suggestion and learning paradigm), we induced significant placebo hypoalgesic effects in 160 healthy participants. We found that individuals with OPRM1 AA combined with FAAH Pro/Pro and those carrying COMT met/met together with FAAH Pro/Pro showed significant placebo effects. Participants with COMT met/val alleles showed significant placebo effects independently of OPRM1 and FAAH allele combinations. Finally, the model that included the placebo procedure and genotypes predicted placebo responsiveness with a higher accuracy (area under the curve, AUC = 0.773) as compared to the SNPs alone indicating that genetic variants can only partially explain the placebo responder status. Our results suggest that the endogenous mu-opioid system with a larger activation in response to pain in the met/val allele carriers as well as the synergism between endogenous mu-opioid system and cannabinoids might play the most relevant role in driving hypoalgesic responses. Future epistasis studies with larger sample sizes will help us to fully understand the complexity of placebo effects and explain the mechanisms that underlie placebo responsiveness.
Cortisol affects pain sensitivity and pain-related emotional learning in experimental visceral but not somatic pain: a randomized controlled study in healthy men and women
Authors: Benson Sven , Siebert Carsten , Koenen Laura R. , Engler Harald , Kleine-Borgmann Julian , Bingel Ulrike , Icenhour Adriane , Elsenbruch Sigrid 
Published: April 2019

Abstract
Despite growing interest in the role of stress mediators in pain chronicity, the effects of the stress hormone cortisol on acute pain remain incompletely understood. In a randomized, double-blind, placebo-controlled study with N = 100 healthy volunteers, we tested the effects of oral hydrocortisone (20 mg) in 2 widely used pain models for the visceral and somatic modality. Salivary cortisol was increased in the hydrocortisone group (time × group: P < 0.001). For the visceral modality, assessed using pressure-controlled rectal distensions, hydrocortisone decreased the pain threshold from before to after treatment (time × group: P = 0.011), an effect primarily driven by women (time × sex: P = 0.027). For the somatic modality, cutaneous heat pain thresholds remained unaffected by hydrocortisone. Hydrocortisone did not alter perceived pain intensity or unpleasantness of either modality. Conditioned pain-related fear in response to predictive cues was only observed for the visceral modality (time × modality: P = 0.026), an effect that was significantly reduced by hydrocortisone compared with placebo (time × group: P = 0.028). This is the first psychopharmacological study to support that acutely increased cortisol enhances pain sensitivity and impairs pain-related emotional learning within the visceral, but not the somatic pain modality. Stress-induced visceral hyperalgesia and deficits in emotional pain-related learning could play a role in the pathophysiology of chronic visceral pain.
How are pain and traumatic stress symptoms related in acute whiplash–associated disorders? An investigation of the role of pain-related fear in a daily diary study
Authors: Eather Adele , Kenardy Justin , Healy Karyn L. , Haynes Michele , Sterling Michele 
Published: April 2019

Abstract
Comorbidity of pain and posttraumatic stress disorder is well recognized, but the reason for this association is unclear. This study investigated the direction of the relationship between pain and traumatic stress and the role that pain-related fear plays, for patients with acute whiplash–associated disorder. Participants (n = 99) used an electronic diary to record hourly ratings of pain, traumatic stress, and fear of pain (FOP) symptoms over a day. Relationships between pain, traumatic stress, and pain-related fear symptoms were investigated through multilevel models including variables lagged by 1 hour. Traumatic stress was associated with previous pain, even after controlling for previous traumatic stress and current pain; current pain was not associated with previous traumatic stress. The relationship between traumatic stress and previous pain became negligible after controlling for FOP, except for traumatic stress symptoms of hyperarousal that were driven directly by pain. Overall, these results support a pain primacy model, and suggest that pain-related fear is important in the maintenance and development of comorbid pain and traumatic stress symptoms. They also confirm that traumatic stress symptoms of hyperarousal are central in this relationship. Differences between this study and others that reported mutual maintenance can be understood in terms of different stages of whiplash-associated disorder and different intervals between repeated measurements. Traumatic stress may affect pain over longer time intervals than measured in this study. Future research could explore how relationships between traumatic stress symptoms, pain, and FOP change over time, and whether previous experiences of traumatic stress influence these relationships.
Remembering the pain of surgery 1 year later: a longitudinal examination of anxiety in children's pain memory development
Authors: Noel Melanie , Rosenbloom Brittany , Pavlova Maria , Campbell Fiona , Isaac Lisa , Pagé M. Gabrielle , Stinson Jennifer , Katz Joel 
Published: April 2019

Abstract
Children who develop greater negatively-biased recall of pain (ie, recalled pain is higher than the initial pain report) following surgery are at risk for developing chronic pain; therefore, identifying risk factors for the development of biased pain memories is important. Higher anxiety has been implicated in the development of greater negatively-biased recall of pain; however, studies have not examined anxiety at multiple time points before and after a surgery and its relationship to children's postsurgical pain memories after 1 year. This prospective study examined a cohort of 237 children and adolescents undergoing major surgery. Anxiety sensitivity, pain catastrophizing, and pain anxiety were assessed at baseline, 48 to 72 hours after surgery, and at 6- and 12-month follow-ups. Pain intensity at rest, movement-evoked pain intensity, and pain unpleasantness were assessed daily in hospital. Memories for pain were elicited via telephone 1-year post surgery. Findings revealed that children who had higher levels of anxiety at baseline and 48 to 72 hours after surgery developed greater negatively-biased recall of pain intensity 12 months after surgery. Specifically, higher anxiety sensitivity at baseline and greater tendencies to catastrophize about pain at baseline and in the immediate acute recovery phase were most strongly linked to greater negatively-biased recall of pain. Greater negatively-biased recall of pain was related to higher pain intensity at 6 and 12 months post surgery. Findings support conceptual models of anxiety and pain memory biases and can inform intervention efforts to reduce anxiety in the pre- and post-op periods to minimize negative biases in pain memories.
Development and course of chronic widespread pain: the role of time and pain characteristics (the HUNT pain study)
Authors: Landmark Tormod , Romundstad Pål , Butler Stephen , Kaasa Stein , Borchgrevink Petter 
Published: April 2019

Abstract
Chronic widespread pain (CWP) is common and associated with loss of functioning and health. Subjects with chronic nonwidespread pain (CnWP) are at increased risk of developing CWP, but few studies have described the nature of the development over time. We followed a random sample of 3105 participants from the population-based HUNT 3 study with 5 annual measurements of pain over 4 years. Although 29% reported CWP on at least 1 occasion, only 7% reported it consistently on 4 or 5 occasions. The average annual cumulative incidence was 5%, and the recovery rate was 38%. In mutual adjusted analysis, the risk of developing CWP from 1 year to the next was higher in subjects with chronic pain (relative risk [RR] = 2.4; 95% confidence interval [CI]: 1.8-3.4), 2 or more pain regions (RR = 3.3; 95% CI: 2.5-4.4), moderate pain or more (RR = 1.8; 95% CI: 1.5-2.6), and with comorbid chronic disease (RR = 1.6; 95% CI: 1.3-1.9). Developing CWP was associated with a modest concurrent change in self-reported mental and physical health. The risk of developing CWP between the fourth and fifth occasions was 80% lower for subjects without a history of CWP, compared to those with a history of CWP. For subjects without previous CWP, the development was associated with previously reported CnWP, but not with the number of occasions with CnWP, in analyses adjusted for sex, age, and pain severity. A substantial proportion of the new cases of CWP originates from subjects floating below and above the definition for CWP over time and, thus, does not seem to involve major transitions in health.
Medical therapeutics: mortality effects, uncertainty, and informed consent
Authors: Nunes José Pedro L. 
Published: April 2019

ABSTRACT
Many drugs used in medical therapeutics are able to save human lives. Unfortunately, many such drugs have also led to the death of patients. This fact raises important issues discussed in light of a number of cases taken from cardiovascular therapeutics. Medical therapeutics currently includes a vast number of different types of interventions, including drugs, devices, surgery, and diets. In what regards drugs, we currently use molecules with profound influences on the human body—some of which leading occasionally to negative outcomes or even to patient death. A reasonable degree of statistical certainty goes along with a large degree of individual uncertainty—a phenomenon is seen in a group of patients but a quite different phenomenon may be seen in a particular case. When treating an individual patient, it is his/her interest and personal preferences that must be taken into consideration, not the interests of society or of science. The choice of medical therapy with a definite intrinsic mortality risk must imply strict accordance from the part of the patient. Since many therapeutic modalities do carry a definite mortality risk, an overall change in medical practice is necessary. Informed consent should be the rule, and should be the starting point for medical therapeutics.
Congenital muscular torticollis: where are we today? A retrospective analysis at a tertiary hospital
Authors: Amaral Daniela M. , Cadilha Rui P.B.S. , Rocha José Afonso G.M. , Silva Ana Isabel G. , Parada Fernando 
Published: April 2019

Abstract

Background:
The congenital muscular torticollis is characterized by a persistent lateral flexion of the head to the affected side and cervical rotation to the opposite side due to unilateral shortening of the sternocleidomastoid muscle. The majority of the cases resolve with conservative management, with parents/caregivers education and physical therapy.
The aim of this study was to assess demographic and clinical characteristics, treatment options, and outcome, amongst infants referred to pediatric rehabilitation consultation due to congenital muscular torticollis.

Methods:
Retrospective cohort study of infants diagnosed with congenital muscular torticollis between January 2012 and December 2014. Obstetric and perinatal data, clinical presentation, comorbidities, treatment, and outcome were abstracted from clinical records.

Results:
One hundred six infants were included. There was no sex predominance and mean age at first pediatric rehabilitation consultation was 11.6 (10.4) weeks. Most women were primiparous (76.4%), dystocic labor predominated (73.6%), and pelvic fetal presentation occurred in 20.8%. At examination, 49.1% of the infants had abnormalities, beyond the tilt cervical, mainly range of motion restrictions and palpable nodule in sternocleidomastoid muscle. Among the 87 children who performed the cervical ultrasound, 29 (27.4%) had anomalies. Associated clinical conditions such as hip dysplasia were identified. The majority (71.7%) were submitted to conservative treatment, 30.2% in the Pediatric Rehabilitation Department. Most infants (97.2%) showed a complete resolution of the torticollis.

Conclusions:
Congenital muscular torticollis is the most common cause of torticollis in the infants. Early diagnosis, parent/caregivers education, and conservative treatment are crucial to achieving good results.
Knowledge Regarding Child Victims of Commercial Sexual Exploitation and the Feasibility of Using a Smartphone Application: A Pilot Study
Authors: Goldman Sheree , Goyal Deepika 
Published: April 2019

ABSTRACT

Purpose:
This pilot study examined the knowledge level and feasibility of using a smartphone application (app) to identify victims of sexual exploitation.

Methods:
Using a quantitative, pretest–posttest design, a convenience sample of 103 law enforcement officers living in the Western United States was assigned to a control (n = 38) or intervention (n = 65) group. Participants provided demographic data and completed an investigator-developed questionnaire to assess their knowledge of commercial sexual exploitation of children (CSEC). Questionnaires were completed twice, with the intervention group completing the posttest after being given the opportunity to test-drive a smartphone app designed to identify CSEC victims. Participants in the intervention group were also asked to rate the ease and usefulness of the app and preferred format of resources. Data were analyzed using descriptive statistics and mixed analysis of variance.

Results:
Few participants had received training in CSEC. Knowledge increased significantly more for the intervention group compared with the control group (p = 0.009), and similar results were noted with CSEC protocol questions (p = 0.005). Intervention group participants stated the app was easy to use (59%) and useful (63.9%) and preferred the CSEC information in the form of an app versus printed materials (85%).

Conclusion:
Results of this study suggest an overall low level of CSEC knowledge in our sample of law enforcement officers. However, a smartphone app may be feasible in identifying victims of sexual exploitation. Earlier recognition of CSEC victims promotes earlier referral to interdisciplinary health and human services.
An Evidence-Based Approach to Suicide Risk Assessment After Sexual Assault
Authors: Cochran Courtney B. 
Published: April 2019

ABSTRACT
Sexual violence occurs in all gender, socioeconomic, religious, and ethnic groups. The trauma of sexual violence negatively affects both a person's physical and mental health. Individuals often experience suicidal ideations in the aftermath of a sexually violent event. On the basis of an understanding of the causative relationship between sexual violence and increased suicidality, a quality improvement study was developed to enhance the direct nursing care provided to clients at the time of the forensic examination and the aftercare provided to clients after discharge at a single-site sexual assault clinic. The study consisted of the implementation of three interventions including (a) use of an evidence-based suicide risk assessment tool, (b) establishment of a nursing protocol to standardize the community resource referral process, and (c) education of the clinic's nursing staff. These interventions provided the nursing staff with a standardized method to identify each client's suicide risk while also referring them to appropriate aftercare services in the local community. Results indicated that it was highly beneficial to screen all clients for suicide risk as it promoted client safety and acted as a catalyst for the emotional healing process.
The Acceptability and Feasibility of Implementing an Online Educational Intervention With Nurses in a Provincial Prison Context
Authors: Almost Joan , Gifford Wendy A. , Doran Diane , Ogilvie Linda , Miller Crystal , Rose Donald N. , Squires Mae , Carryer Jennifer , McShane Julie , Miller Kim 
Published: April 2019

ABSTRACT

Background
Correctional nursing requires a strong knowledge base with access to continuing education (CE) to maintain and enhance competencies. Nurses working in provincial prisons have reported many challenges in accessing CE, with online learning being identified as a potential solution. Limited research was found, however, which examined the correctional context in the development and delivery of online learning for nurses. The purpose of this study was to develop an online educational intervention tailored to correctional nurses and determine the feasibility and acceptability of implementing the intervention in a provincial prison context.

Methods
A sequential mixed methods study was conducted. Participants included nurses from three correctional settings in the province of Ontario, Canada. Semistructured interviews examined contextual factors and educational needs. Delphi surveys determined the educational topic. Preintervention and postintervention questionnaires examined the context, educational content, and intervention's acceptability and feasibility.

Results
The online intervention focused on mental health and addictions with two 30-minute webinars delivered back-to-back over 15 weeks. Respondents expressed satisfaction with the convenience of online learning at work using short webinars, as well as the topics, relevance of information, and teaching materials, but dissatisfaction with presentation style. The feasibility of the intervention was limited by access to technology, time to attend, education space, and comfort with technology.

Discussion
The findings from this study provide insight to guide the future development of online CE for correctional nurses. If changes are made within correctional facilities in collaboration with nurses and managers, online learning holds the potential to facilitate access to ongoing professional development.
Pediatric and Adolescent Figure Skating Injuries: A 15-Year Retrospective Review
Authors: Kowalczyk Agnieszka D. , Geminiani Ellen T. , Dahlberg Bridget W. , Micheli Lyle J. , Sugimoto Dai 
Published: April 2019

Objective:
To analyze the characteristics of injuries sustained by young figure skaters who were evaluated at regional pediatric sports medicine clinics.

Design:
Retrospective chart review (2003-2017).

Setting:
Sports medicine clinics at a tertiary-level pediatric medical center.

Patients:
Two hundred ninety-four figure skaters (271 female and 23 male). Age rage: 9 to 19 years. Mean age: 14.2 ± 2.3 years.

Interventions:
None.

Main Outcome Measures:
Mechanism of injury (acute vs overuse), injured body areas, diagnoses for most commonly injured body areas, and distribution of bone stress injuries.

Results:
Eight hundred sixty-four figure skating–related injuries were identified. Approximately 68.9% were overuse and 31.1% were acute. In female figure skaters, the most frequently injured body areas were foot/ankle (29.6%), knee (19.3%), and back (15.8%). In male figure skaters, they were foot/ankle (25.4%), hip (16.4%), and knee (14.9%). Most common diagnoses at these body areas were tendinopathy (foot/ankle), extensor mechanism (knee), and posterior column bone stress injuries (back). All injuries to anterior knee structures, excluding bone contusions, were categorized as extensor mechanism injuries. About 11.8% of all injuries were bone stress reactions/fractures with the majority occurring at the back (42.2%), foot/ankle (32.4%), and lower leg (15.7%).

Conclusion:
Most injuries sustained by figure skaters were overuse and occurred most commonly at the foot/ankle (29.6%), knee (19.3%), and back (15.8%). Approximately 1 in 10 injuries were bone stress reactions/fractures, and nearly 1 in every 3 skaters who presented with back pain was diagnosed with a posterior column bone stress injury. Health care providers who take care of young figure skaters need to maintain a high index of suspicion for overuse injuries, especially bone stress reactions/fractures.