bluuebunny/crossref_metadata_2025_split huggingface dataset:
Correlates of Illness Severity in Infectious Mononucleosis
Authors: Odame John , Robinson Joan , Khodai-Booran Nasser , Yeung Simon , Mazzulli Tony , Stephens Derek , Allen Upton D 
Published: March 2016

INTRODUCTION: Understanding the spectrum and frequencies of Epstein‐Barr virus (EBV) complications and markers of illness severity in immunocompetent patients with primary EBV infection will inform management of patients with EBV‐related illnesses.OBJECTIVES:To determine the clinical and laboratory correlates of illness severity among infants, children and youth with infectious mononucleosis (IM).METHODS: Study subjects with confirmed IM were prospectively enrolled. Illness severity was assessed at baseline and at six weeks using a scoring tool. Peripheral blood viral loads served as a measure of viral burden.RESULTS: Among 32 children and young adults with IM, the median age was 16 years (range two to 24 years). The predominant clinical findings were lymphadenopathy (23 of 32 [72%]), pharyngitis (16 of 32 [50%]), fever (nine of 32 [28%]) and splenomegaly (six of 32 [19%]). With respect to symptoms or signs that persisted to at least six weeks after illness onset, the predominant complaint was lymphadenopathy in 35% of subjects available for reassessment. Deranged liver function tests were present at presentation in up to 44% of subjects. Patients with the highest viral loads at presentation had significantly higher illness severity scores associated with fatigue (P=0.02). Other than the scores associated with fatigue, viral load values were not significantly correlated with the illness severity scores at baseline and at six weeks.CONCLUSION: In IM, viral loads are not necessarily correlated with illness severity, with the exception of fatigue. EBV‐related hepatitis is common in IM, confirming the status of this virus as a relatively common cause of transient hepatitis in children and youth. This entity is not necessarily a marker of disease severity.
Tough Guys or Sensitive Guys? Disentangling the Role of Examiner Sex on Patient Pain Reports
Authors: Vigil Jacob M , Alcock Joe 
Published: March 2016

BACKGROUND: Experimental and clinical pain studies are conflicting regarding whether individuals report heightened or dampened pain sensitivity in the presence of other men or women.OBJECTIVES: In the present preliminary study, two small medical record reviews of patients admitted for emergency care were conducted to examine the possibility that patients may report differential pain intensity to male and female health care examiners. The study also sought to determine whether these effects are moderated by and, thus, only detectable by examining patients at different pain (debilitation) levels.METHODS: Pain intensity scores were extracted from two medical record reviews of patients admitted for emergency care (n=64 and n=135, respectively). Pain intensity was measured using an 11‐point numerical scale during standard triage assessments and the sex of the examiner was recorded.RESULTS: Mean pain scores reported to male and female emergency staff did not differ in either set of medical records. However, when patients were split between low and high pain levels, male patients reported higher pain scores to male practitioners when experiencing relatively low pain levels, and both male and female patients reported higher pain scores to female practitioners when experiencing relatively high pain levels.DISCUSSION: The statistical magnitudes of these effects were large, suggesting that this phenomenon may be a pervasive feature in clinical settings and experimental pain studies.CONCLUSION: These preliminary findings warrant larger‐scale investigations of social contextual influences on patient pain reports, which are necessary for creating more standardized protocols for reliably assessing and treating patient pain experiences.
Longitudinal surveillance of outpatient β‐lactam antimicrobial use in Canada, 1995 to 2010
Authors: Glass-Kaastra Shiona K , Finley Rita , Hutchinson Jim , Patrick David M , Weiss Karl , Conly John 
Published: March 2016

INTRODUCTION: β‐lactam antimicrobials are the most commonly prescribed group of antimicrobials in Canada, and are categorized by the WHO as critically and highly important antimicrobials for human medicine. Because antimicrobial use is commonly associated with the development of antimicrobial resistance, monitoring the volume and patterns of use of these agents is highly important.OBJECTIVE: To assess the use of penicillin and cephalosporin antimicrobials within Canadian provinces over the 1995 to 2010 time frame according to two metrics: prescriptions per 1000 inhabitant‐days and the average defined daily doses dispensed per prescription.METHODS: Antimicrobial prescribing data were acquired from the Canadian Integrated Program for Antimicrobial Resistance Surveillance and the Canadian Committee for Antimicrobial Resistance, and population data were obtained from Statistics Canada. The two measures developed were used to produce linear mixed models to assess differences among provinces and over time for the broad‐spectrum penicillin and cephalosporin groups, while accounting for repeated measurements at the provincial level.RESULTS: Significant differences among provinces were found, as well as significant changes in use over time. A >28% reduction in broad‐spectrum penicillin prescribing occurred in each province from 1995 to 2010, and a >18% reduction in cephalosporin prescribing occurred in all provinces from 1995 to 2010, with the exception of Manitoba, where cephalosporin prescribing increased by 18%.DISCUSSION: Significant reductions in the use of these important drugs were observed across Canada from 1995 to 2010. Newfoundland and Labrador and Quebec emerged as divergent from the remaining provinces, with high and low use, respectively.
Anxiety, Depression and School Absenteeism in Youth With Chronic or Episodic Headache
Authors: Rousseau-Salvador Céline , Amouroux Rémy , Annequin Daniel , Salvador Alexandre , Tourniaire Barbara , Rusinek Stéphane 
Published: March 2016

BACKGROUND: Chronic daily headache (CDH) in children has been documented in general and clinical populations. Comorbid psychological conditions, risk factors and functional outcomes of CDH in children are not well understood.OBJECTIVES: To examine anxiety and depression, associated risk factors and school outcomes in a clinical population of youth with CDH compared with youth with episodic headache (EH).METHODS: Data regarding headache characteristics, anxiety, depression and missed school days were collected from 368 consecutive patients eight to 17 years of age, who presented with primary headache at a specialized pediatric headache centre.RESULTS: A total of 297 patients (81%) were diagnosed with EH and 71 were diagnosed with CDH. Among those with CDH, 78.9% presented with chronic tension‐type headache and 21.1% with chronic migraine (CM). Children with CDH had a higher depression score than the standardized reference population. No difference was observed for anxiety or depression scores between children with CDH and those with EH. However, children with CM were more anxious and more depressed than those with chronic tension‐type headache. Youth experiencing migraine with aura were three times as likely to have clinically significant anxiety scores. Headache frequency and history were not associated with psychopathological symptoms. Children with CDH missed school more often and for longer periods of time.CONCLUSIONS: These findings document the prevalence of anxiety, depression and school absenteeism in youth with CDH or EH. The present research also extends recent studies examining the impact of aura on psychiatric comorbidity and the debate on CM criteria.
The Relationship Between Pain and Eating among Overweight and Obese Individuals with Osteoarthritis: An Ecological Momentary Study
Authors: Choi Karmel W , Somers Tamara J , Babyak Michael A , Sikkema Kathleen J , Blumenthal James A , Keefe Francis J 
Published: March 2016

BACKGROUND: Osteoarthritis (OA) patients who are overweight or obese report higher levels of pain compared with their normal‐weight OA counterparts. Evidence suggests that overweight or obese OA patients also experience pain relief from eating foods high in calories, fat or sugar. Eating to alleviate pain may be problematic because it can lead to additional weight gain, which may contribute to heightened pain.OBJECTIVES: To investigate the relationship between pain and food intake using ecological momentary assessments in a sample of 71 over‐weight and obese OA patients.METHODS: Participants completed two consecutive days of diary entries in which they recorded their levels of pain, mood and food intake throughout the day. Data were analyzed using generalized estimating equations that modelled pain as a predictor of calorie, fat and sugar intake. All models were adjusted for sex, body mass index, negative mood, time and treatment history.RESULTS: Pain significantly predicted calorie (Z=2.57; P=0.01) and fat intake (Z=1.99; P=0.05).CONCLUSIONS: Using ecological momentary assessments as a novel approach, the present study provides preliminary data supporting a relationship between pain and food intake among overweight and obese OA patients. Continued advances in our understanding of the relationship between pain and eating behaviour may help to optimize intervention strategies for these patients.
Impact of Excessive Daytime Sleepiness on The Safety and Health of Farmers in Saskatchewan
Authors: King Nathan , Pickett William , Hagel Louise , Lawson Josh , Trask Catherine , Dosman James A 
Published: March 2016

BACKGROUND: Sleep disorders may negatively impact the health and well‐being of affected individuals. The resulting sleepiness and impaired cognitive functioning may also increase the risks for injury.OBJECTIVE: To examine the relationship between daytime sleepiness, defined as an Epworth Sleepiness Scale score >10, and self‐reported sleep apnea, as potential determinants of farming‐related injury and self‐perceived physical health.METHODS: Phase 2 of the Saskatchewan Farm Injury Cohort Study (2013) involved a baseline survey that included 2849 individuals from 1216 farms. A mail‐based questionnaire was administered to obtain self‐reports regarding sleep, demographics, farm injuries and general physical health. Multilevel logistic regression was used to quantify relationships between excessive daytime sleepiness and health.RESULTS: The prevalence of excessive daytime sleepiness was 15.1%; the prevalence of diagnosed sleep apnea was 4.0%. Sleepiness was highest in the 60 to 79 (18.7%) and ≥80 (23.6%) years of age groups, and was higher in men (19.0%) than in women (9.3%). Injuries were reported by 8.4% of individuals, and fair or poor health was reported by 6.2%. Adjusting for confounding, individuals with excessive daytime sleepiness appeared more likely to experience a farming‐related injury (OR 1.34 [95% CI 0.92 to 1.96]) and were more likely to report poorer physical health (OR 2.19 [95% CI 1.45 to 3.30]) than individuals with normal daytime sleepiness.CONCLUSION: Excessive daytime sleepiness, a potentially treatable condition, appeared to be common in farmers and to negatively affect their health. Sleep disorder diagnosis and treatment programs did not appear to be used to their full potential in this population.
A 29‐Year‐Old Man with Hospital‐Acquired Cavitary Pneumonia
Authors: Mehmood Mansoor , Halloush Ruba A , Khasawneh Faisal A 
Published: March 2016

Mucormycosis is an infection that can manifest in many forms and is an emerging complication in several health care procedures. Portals of entry can be attributed to surgical procedures and medical devices such as chest tubes; however, the skin and gastrointestinal tract are the most common sites of infection and outbreaks have been traced to adhesive bandages, wooden tongue depressors and ostomy bags. This article describes the presentation, work‐up, diagnosis and treatment of an East Asian immigrant who was admitted with acute hypoxemic respiratory failure.Cavitary lung processes pose a formidable diagnostic challenge. Causes vary widely and include cavitary pneumonia, vasculitis and malignancy. In some cases, patient history and basic work‐up may yield a diagnosis, but in others, an extensive work‐up, including tissue biopsy, may be necessary to establish the cause. The authors present a case of cavitary pneumonia that complicated an open lung biopsy. It developed in the hospital and was caused by mucormycosis, a potential emerging infection causing health care‐associated infections.
Systematic Review of Stimulant and Nonstimulant Laxatives for the Treatment of Functional constipation
Authors: Paré Pierre , Fedorak Richard N 
Published: March 2016

BACKGROUND: Constipation is an uncomfortable and common condition that affects many, irrespective of age. Since 1500 BC and before, health care practitioners have provided treatments and prevention strategies to patients for chronic constipation despite the significant variation in both medical and personal perceptions of the condition.OBJECTIVE: To review relevant research evidence from clinical studies investigating the efficacy and safety of commercially available pharmacological laxatives in Canada, with emphasis on studies adopting the Rome criteria for defining functional constipation.SEARCH METHODS: PubMed, Medline, Embase and Evidence-Based Medicine Reviews databases were searched for blinded or randomized clinical trials and meta-analyses assessing the efficacy of nonstimulant and stimulant laxatives for the treatment of functional constipation.RESULTS: A total of 19 clinical studies and four meta-analyses were retrieved and abstracted regarding study design, participants, interventions and outcomes. The majority of studies focused on polyethylene glycol compared with placebo. Both nonstimulant and stimulant laxatives provided better relief of constipation symptoms than placebo according to both objective and subjective measures. Only one study compared the efficacy of a nonstimulant versus a stimulant laxative, while only two reported changes in quality of life. All studies reported minor side effects due to laxative use, regardless of treatment duration, which ranged from one week to one year. Laxatives were well tolerated by both adults and children.
Breakthrough Pain in Patients with Controlled or Uncontrolled Pain: An Observational Study
Authors: Gatti Antonio , Gentili Marta , Baciarello Marco , Lazzari Marzia , Marzi Rossella , Palombo Elisa , Sabato Alessandro F , Fanelli Guido 
Published: March 2016

BACKGROUND: Breakthrough pain (BTP) is traditionally defined as a pain exacerbation in patients with chronic controlled pain. However, this definition has recently been challenged.OBJECTIVES: To evaluate the prevalence of unsatisfactory control in patients with chronic cancer pain, and investigate the frequency and intensity of BTP episodes.METHODS: A total of 665 patients with chronic cancer pain attending 21 pain therapy units in Italy were evaluated for baseline pain intensity and number of BTP episodes over a 30‐day period. All patients started, continued or modified treatment for BTP at enrollment, according to medical judgment.RESULTS: The number of BTP events was higher in patients with uncontrolled baseline pain, although the intensity and duration of episodes were similar. In patients with uncontrolled baseline pain, the number of events decreased with time and reached values comparable with those reported in patients with controlled pain. Both the intensity of the pain and the duration of the BTP events exhibited similar values in the two groups at all time points, following increased monitoring and the prescription of analgesic medication.CONCLUSION: Patients with uncontrolled baseline pain experienced BTP flares with higher frequency, but similar intensity and duration with respect to patients with controlled pain at baseline. Notably, a close follow‐up and adequate management of the BTP episodes led to an improvement of BTP in the observed patients.
Pain Patients and Who they Live with: A Correlational Study of Coresidence Patterns and Pain Interference
Authors: Vigil Jacob M , Pendleton Patricia , Coulombe Patrick , Vowles Kevin E , Alcock Joe , Smith Bruce W 
Published: March 2016

BACKGROUND: Mixed associations have been observed between various aspects of ‘social support’ and patient pain experiencesOBJECTIVE: To explore the possibility that more basic social factors, namely coresidence patterns, may be associated with variability in patient pain experiences.METHODS: Relationships between coresidence partners and self‐reported pain that interferes with activities were examined in a large representative sample of home health care patients (n=11,436; age range 18 to 107 years, mean [± SD] age 66.3±16.1 years; 55% females).RESULTS: After controlling for sex, age and behavioural risks, compared with living alone, coresidence with an intimate affiliate (eg, spouse, relative) predicted greater pain interference (Cohen’s d = 0.10 to 1.72), and coresidence with a less intimate type of affiliate (eg, friend, paid help) predicted lower pain interference (Cohen’s d = −0.21 tö0.83). In general, however, coresidence patterns accounted for small proportions of variance in pain interference, and the magnitudes of these effects varied widely according to patients’ sex, age and diagnosis.DISCUSSION: The findings suggest that fundamental components of patient’s home‐living environment may be associated with potential costs and benefits related to clinically relevant pain functioning for some subgroups of patients.CONCLUSION: Further research that incorporates quantitative and qualitative assessments of patient pain functioning is warranted to better understand how objective and subjective characteristics of patients’ home‐living environment may inform the development of more individualized pain treatment options for patients with differing social circumstances.
Assessment of Factors Affecting the Difficulty of Caudal Epidural Injections in Adults Using Ultrasound
Authors: Kim Young Hoon , Park Hue Jung , Cho Sungkun , Moon Dong Eon 
Published: March 2016

BACKGROUND: In unaided caudal epidural block (CEB), incorrect needle insertion has been reported to occur in 15% to 38% of attempts.OBJECTIVE: To statistically analyze the anatomical variables affecting difficult CEB using ultrasonographic measurement.METHODS: Preprocedural ultrasonography was performed and the following measurements were obtained in 146 patients: the distance from the skin to the apex of the sacral hiatus; the depth of the sacral canal at the apex of the sacral hiatus; the length of the sacrococcygeal ligament between the apex of the sacral hiatus and sacral base; the distance from the skin to the apex of the sacral cornu; and the distance between the apexes of bilateral cornua. One clinician, unaware of the ultrasonographic findings, performed the injections using the landmark technique. The procedures were videotaped and were subsequently reviewed by an independent investigator.RESULTS: The means (± SDs) of the abovementioned measurements were 12.1±3.7 mm, 6.1±2.1 mm, 25.9±7.4 mm, 10.0±4.0 mm and 16.4±3.2 mm, respectively. Injections failed in 16 (11%) patients and were defined as difficult in 21 (14.4%) patients. The depth of the sacral canal at the apex of sacral hiatus (P<0.001) and the length of the sacrococcygeal ligament between the apex of the sacral hiatus and sacral base (P=0.001) were significant predictors of difficult CEB. Of all patients, 85.7% and 75.2% were correctly classified as difficult or not difficult, respectively. The cutoff values of the depth of the sacral canal at the apex of the sacral hiatus and the length of the sacrococcygeal ligament between the apex of the sacral hiatus and the sacral base to predict a difficult CEB were 3.7 mm and 17.6 mm, respectively.CONCLUSIONS: Both the depth of the sacral canal at the apex of the sacral hiatus and the length of the sacrococcygeal ligament between the apex of the sacral hiatus and sacral base are significant variables affecting the difficulty of the CEB.
Do Obstructive Sleep Apnea Syndrome Patients Underestimate Their Daytime Symptoms before Continuous Positive Airway Pressure Treatment?
Authors: Leclerc Gabrielle , Lacasse Yves , Page Diane , Sériès Frédéric 
Published: March 2016

BACKGROUND: Daytime somnolence is an important feature of the obstructive sleep apnea (OSA) hypopnea syndrome and is usually subjectively assessed using the Epworth Sleepiness Scale (ESS).OBJECTIVE: To compare the scores of the ESS and different domains of the Quebec Sleep Questionnaire (QSQ) assessed before and after the first months of continuous positive airway pressure (CPAP) treatment, as well as retrospectively without treatment.METHODS: The ESS score and domain scores of the QSQ were obtained before and after a three‐month period of CPAP treatment using a retrospective assessment of the pretreatment scores in 76 untreated OSA patients.RESULTS: Fifty‐two patients completed the study. The ESS and QSQ scores significantly improved following CPAP therapy. Retrospective evaluation of the ESS score was significantly worse than pre‐ and post‐treatment values (mean [± SD] pretreatment score 11.0±4.8; retrospective pretreatment score 13.5±5.1). Such differences were not observed in any domain of the QSQ, including the domain assessing hypersomnolence.CONCLUSION: OSA patients underestimated their sleepiness according to the most widely used instrument to assess hypersomnolence. This finding may not be observed with other methods used to assess OSA‐related symptoms such as quality of life questionnaires.
Training Highly Qualified Health Research Personnel: The Pain in Child Health Consortium
Authors: von Baeyer Carl L , Stevens Bonnie J , Chambers Christine T , Craig Kenneth D , Finley G Allen , Grunau Ruth E , Johnston C Celeste , Riddell Rebecca Pillai , Stinson Jennifer N , Dol Justine , Campbell-Yeo Marsha , McGrath Patrick J 
Published: March 2016

BACKGROUND AND OBJECTIVES: Pain in Child Health (PICH) is a transdisciplinary, international research training consortium. PICH has been funded since 2002 as a Strategic Training Initiative in Health Research of the Canadian Institutes of Health Research, with contributions from other funding partners and the founding participation of five Canadian universities. The goal of PICH has been to create a community of scholars in pediatric pain to improve child health outcomes.METHODS: Quantitative analyses enumerated PICH faculty, trainees, training activities and scientific outputs. Interviews with PICH stakeholders were analyzed using qualitative methods capturing perceptions of the program’s strengths, limitations, and opportunities for development and sustainability.RESULTS: PICH has supported 218 trainee members from 2002 through 2013, from 14 countries and more than 16 disciplines. The faculty at the end of 2013 comprised nine co‐principal investigators, 14 Canadian coinvestigators, and 28 Canadian and international collaborators. Trainee members published 697 peer‐reviewed journal articles on pediatric pain through 2013, among other research dissemination activities including conference presentations and webinars. Networks have been established between new and established researchers across Canada and in 13 other countries. Perceptions from stakeholders commended PICH for its positive impact on the development of pediatric pain researchers. Stakeholders emphasized skills and abilities gained through PICH, the perceived impact of PICH training on this research field, and considerations for future training in developing researchers in pediatric pain.CONCLUSIONS: PICH has been successfully developing highly qualified health research personnel within a Canadian and international community of pediatric pain scholarship.