Indiana University-Purdue University Indianapolis (IUPUI) / Chronic pain, defined as pain lasting more than 3 months, is a common and costly health condition. Thirty-three percent of adults and upwards of 35% of children report experiencing pain due to various diseases, disorders, or accidents. Recent research has identified perceived injustice and anger as important constructs in an adult’s pain experience and a possible focus for intervention efforts. The present study explored the extent to which perceived injustice and anger expression operate similarly in children with chronic pain as in adults. This was a retrospective analysis of data from 122 patients seeking treatment at a pediatric pain clinic. Results supported anger expression as a mediator in the relationship between perceived injustice and pain intensity but not psychological distress, suggesting that anger expression operates similarly in children as in adults with chronic pain. Unlike previous findings in adults with chronic pain, injustice did not moderate the relationship between pain intensity and psychological distress, suggesting that injustice operates differently in children with chronic pain compared to adults. The strong association between injustice and pain outcomes (i.e. pain intensity, quality of life, functional disability) suggests that injustice is an important construct to explore in the chronic pain experience of children.

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Approximately one in five adults in the United States experiences chronic pain. Over the last 50 years, spinal cord stimulation has become increasingly recognized as a minimally invasive, efficacious treatment modality for the management of chronic pain. The authors report a case study of a 46-year-old female in the first documented spinal cord stimulation simultaneously targeting intractable neuropathic and visceral pain caused by post-laminectomy syndrome and chronic pancreatitis, respectively. This case study demonstrates near-total relief of the patient's neuropathic low back/leg pain and visceral epigastric pain, showing evidence of potential clinical usefulness for spinal cord stimulation as a treatment option in patients who present with a combination of visceral and somatic pain symptoms.

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Bakgrund: I den systematiska litteratur studien Mat vid diabetes (SBU 2010) framgår det att lågkolhydratkost har likartade metabola effekter hos personer med diabetes i jämförelse med en traditionell lågfettskost. Trotts dessa råd visar en undersökning ifrån samma studie att endast 18 % av de tillfrågade sjuksköterskorna kliniskt tillämpade denna typ av kostintervention. Detta tycks vara problematiskt vilket nyligen uttryckts i en rad olika mediala sammanhang. Utöver denna debatt har vi idag också en epidemiskt stor utbredning av patienter med typ 2 diabetes mellitus vilket ställer krav på de allt mer begränsade resurser som finns inom vård och omsorg.  Syfte: Syftet var att beskriva lågkolhydratkostens metabola påverkan hos patienter med Diabetes Mellitus typ 2. Metod: Den elektroniska sökningen av artiklar utfördes i PubMed, CINAHL, Academic Search Elite, Scopus, Web of Science, PsycINFO (2009-2014) samt PMC (2011-2014). 13 artiklar bedömdes utifrån studiedesign, metabola markörer, intervention/kontrollgrupp, inklusions och exklusionskriterer vara lämpliga för studien. Resultat: En övergripande majoritet studierna visade på att lågkolhydratkosten gav signifikant förbättrade metabola markörer och framförallt gällande HbA1c och HDL-kolesterol. Endast en studie visade på ett negativt icke-signifikant resultat. Konklusion: Lågkolhydratkost förefaller utifrån studiens syfte och resultat som ett fullgott alternativ till den traditionella diabeteskost som utgör stora delar av den kostbehandling som patienter med T2DM får idag. Men kan innebära ett stort ansvar i det arbetsätt som sjuksköterskan tillämpar för att stödja och hjälpa en patient med T2DM att nå en god egenvård, hälsa och metabolkontroll  Nyckelord: Typ 2 diabetes mellitus. Lågkolhydratkost. Traditionell diabeteskost. Chronic Care Model. Egenvård. Empowerment. / Background: The systematic literature review Mat vid diabetes (SBU 2010) indicates that a low carbohydrate diet possesses similar metabolic effects in people with diabetes compared to a traditional low-fat diet. Contrary to this advice, a review from the same study portrayed that only 18% of the surveyed nurses clinically applied this type of diet intervention. This seems to be problematic, as was recently expressed in a variety of media. In addition to this debate, health care now also face a widespread epidemic of patients with type 2 diabetes mellitus which in turn puts the increasingly diminished and limited resources in health care under additional pressure.  Aim: The aim of this study was to describe a low-carbohydrate diet and its metabolic effects in patients with Diabetes Mellitus type 2. Method: Included articles in this review was found by searching PubMed, CINAHL, Academic Search Elite, Scopus, Web of Science, PsycINFO (2009-2014) and PMC (2011-2014). 13 articles were assessed to be eligible for this review by assessing study-design, metabolic markers, intervention / control group, inclusion and exclusions criteria.  Results: An overall majority of studies proved that a low carbohydrate diet could result in significantly improved metabolic markers, and in particular the HbA1c and HDL cholesterol. Only one study showed a negative non-significant result. Conclusion: A low-carbohydrate diet seems based on our findings as a viable alternative to the traditional diabetic diet which constitute a large part of the diet treatment that patients with T2DM receives from current healthcare. But this in turn implies that a greater responsibility is taken by the nurse in order to support and help a patient with T2DM to achieve a good self-care, health and metabolic control. Keywords: Type 2 diabetes mellitus. Low carbohydrate diets. Traditional diabetic diet. Chronic Care Model. Self-care. Empowerment.

published_or_final_version / Social Work / Master / Master of Social Work

The present study investigated the influence of a brief, intensive biofeedback-assisted imagery training regimen on psychological, physiological and neuroendocrinological measures of pain and stress in injury related chronic pain patients. The subjects were 36 patients (myelography examcandidates) who were assigned to the imagery or wait-list control group by order of referral presentation and to formulate equivalent groups.

End-stage renal disease (ESRD) introduces physical, psychological, social, emotional and spiritual challenges into patients’ lives. Spirituality has been found to contribute to improved health outcomes, mainly in the areas of quality of life (QOL) and well-being. No studies exist to explore the influences of spirituality on the health outcomes and general well-being in patients with end-stage renal disease receiving haemodialysis (HD) treatment in Scotland. This study was therefore carried out to examine and explore spirituality in the day-to-day lives of patients with ESRD receiving HD treatment and how it may influence their health outcomes and, in particular, QOL and general well-being. The study described in this thesis employed a sequential mixed method approach over two stages: quantitative and qualitative. Following ethical approval, a cross-sectional survey was conducted with 72 patients from 11 dialysis units recruited from four Health Boards in Scotland. The participants in the study were regular patients attending the dialysis units three times per week. Data on patients’ quality of life, general well-being, and spirituality were collected using self-administered questionnaires including demographic information: the Short Form Medical Outcome Study Questionnaire (SF-36v2), the General Health Questionnaire, and the Spiritual Well-Being Questionnaire. The data were analysed using the Predictive Analytics Software for Windows. The findings highlighted that patients’ quality of life was markedly lower than the United Kingdom general population average norms of 50. Increasing age was associated with better mental health but worse physical health. The survey also found that there were no significant associations between spirituality and patients’ quality of life and general well-being. However, it was considered important to complement and enrich the survey findings by gaining a deeper understanding of the influences of spirituality on patients’ health outcomes and general well-being by carrying out the qualitative component of the study. Qualitative data were collected using semi-structured interviews with a subsample of 21 patients from those who participated in the survey. A thematic approach using Framework Analysis informed the qualitative data analysis. Four main themes emerged from the qualitative interviews: ‘Emotional and Psychological Turmoil’, ‘Life is Restricted’, ‘Spirituality’ and ‘Other Coping Strategies’. The findings from the interviews confirmed that patients’ quality of life might be affected because of the physical challenges such as unremitting fatigue, disease unpredictability, or being tied down to a dialysis machine, or the emotional and psychological challenges imposed by the disease into their lives such as wholesale changes, dialysis as a forced choice and having a sense of indebtedness. The findings also revealed that spirituality was an important coping strategy for the majority of participants who took part in the qualitative component (n=16). Different meanings of spirituality were identified including connection with God or Supernatural Being, connection with the self, others and nature/environment. Spirituality encouraged participants to accept their disease and offered them a sense of protection, instilled hope in them and helped them to maintain a positive attitude to carry on with their daily lives, which may have had a positive influence on their health outcomes and general well-being. The findings also revealed that humour was another coping strategy that helped to diffuse stress and anxiety for some participants and encouraged them to carry on with their lives. The findings from this study contribute knowledge to increase our understanding of the influence of spirituality on the health outcomes and general well-being of patients with end-stage renal disease currently receiving haemodialysis treatment. Based on the findings from this thesis, recommendations are made for clinical practice, patient and nurse education and for future research.

Le virus de la paralysie chronique de l'abeille (Chronic bee paralysis virus, CBPV) est l'agent étiologique d'une maladie infectieuse et contagieuse des abeilles adultes (Apis mellifera L.), appelée la paralysie chronique. Le CBPV est un virus à ARN simple brin positif qui contient 2 fragments d'ARN majoritaires. L'ARN 1 (3674 nt) et l'ARN 2 (2305 nt) codent respectivement 3 et 4 cadres ouverts de lecture (ORF). La séquence d'acides aminés de l'ORF 3 de l'ARN 1 partage des similitudes avec l'ARN polymérase ARN dépendante (RdRp) des virus des familles Nodaviridae et Tombusviridae. Par analogie avec ces familles virales, il a été suggéré que l'ARN 1 coderait les protéines non-structurales tandis que l'ARN 2 coderait les protéines structurales. Cependant, la réalité de ces protéines virales doit être démontrée expérimentalement afin d'étudier leurs fonctions, de mieux décrire ce virus et sa position taxonomique ainsi que d'améliorer les outils de diagnostic. Dans ce but, différentes approches expérimentales ont été utilisées. Une comparaison des protéomes d'hémolymphe d'abeilles non-infectées et infectées par le CBPV a été effectuée. Les protéines différentiellement exprimées ont été identifiées par empreinte peptidique massique (peptide mass fingerprint, PMF). Cette étude a permis d'identifier des protéines de l'abeille dont certaines contribueraient à une réponse immunitaire antivirale, mais aucune protéine virale n'a été identifiée par cette approche. Les ARN extraits du CBPV ont été utilisés dans des expériences de traduction in vitro. Malgré plusieurs essais réalisés en faisant varier les conditions expérimentales, cette approche s'est révélée infructueuse. / Chronic bee paralysis virus (CBPV) is the etiological agent that causes an infectious and contagious disease in adult bees (Apis mellifera L.), called chronic paralysis. CBPV is a positive single-stranded fragmented RNA virus which contains 2 major viral RNA fragments. RNA 1 (3674 nt) and RNA 2 (2305 nt) encode 3 and 4 putative open reading frames (ORFs), respectively. The amino acid sequence of ORF 3 on RNA 1 shares similarities with the RNA-dependent RNA polymerase (RdRp) of virus families Nodaviridae and Tombusviridae. By analogy with these viral families, it has been suggested that RNA 1 encodes non-structural proteins and RNA 2 encodes structural proteins. However, the reality of viral proteins needs to be experimentally demonstrated in order to study theirs functions, to describe CBPV biology and its taxonomic position and to improve diagnostic tools. With this aim, different experimental strategies have been used.A comparison of hemolymph proteomes between uninfected bees and bees infected with CBPV was performed. Differentially expressed proteins have been identified using peptide mass fingerprint method (PMF). This study allowed only identifying proteins of bees which could contribute to an antiviral immune response but viral proteins were not identified using this approach. Extracted CBPV RNAs were used for in vitro translation experiments. Despite several assays in varying experimental conditions, this approach has been unsuccessful. Another approach was to generate antibodies directed against different proteins or parts of viral proteins.

INTRODUÇÃO: O Brasil ocupa o primeiro lugar entre os países com maiores taxas de cesariana no mundo. Pouco se sabe a respeito das consequências futuras deste procedimento, sobre a saúde materna. Este estudo investigou a influência da técnica anestésico-cirúrgica e analgesia pós-operatória, no aparecimento de dor crônica após a cesariana. Procuramos também identificar os fatores de risco de dor crônica pós-cesariana. MÉTODO: Este estudo prospectivo com distribuição aleatória foi conduzido em 443 pacientes que foram submetidas à cesariana (eletivas e emergenciais), com diferentes doses de bupivacaína 0,5% hiperbárica e opioides na raquianestesia, bem como uso de anti-inflamatórios não esteroidais peri-operatório. Os grupos foram: G8SMA- 8 mg bupivacaína hiperbárica + 2,5 mcg sufentanil + 100 mcg morfina; G10SMA- 10 mg bupivacaína hiperbárica + 2,5 mcg sufentanil + 100 mcg morfina; G12,5MA- 12,5 mg bupivacaína hiperbárica + 100 mcg morfina; G15MA- 15 mg bupivacaína hiperbárica + 100 mcg morfina; G12,5M - 12,5 mg bupivacaína hiperbárica + 100 mcg morfina. Somente as pacientes do grupo G12,5M não receberam AINE no peri-operatório. Dor em repouso e em movimento foram avaliadas no pós-operatório imediato. Fatores peri-operatórios, cirúrgicos e obstétricos foram investigados. Contato telefônico foi realizado, após três e seis meses do procedimento cirúrgico, para identificação das pacientes com dor crônica. RESULTADOS: A incidência de dor crônica nos grupos foi: G8SMA= 20%, G10SMA= 13%; G12,5MA= 7,1%; G15MA= 2,2% e G12,5M= 20,3%. Pacientes que apresentaram escores de dor mais elevados no período pós- operatório imediato, que referiram doenças crônicas em tratamento, que apresentaram maior tempo em trabalho de parto sem analgesia, tiveram maior incidência de dor crônica (p<0,05). CONCLUSÃO: A incidência de dor crônica diminui com emprego de doses maiores de anestésicos locais e uso de anti-inflamatórios não esteroidais. Escores mais elevados de dor no período pós-operatório imediato tiveram associação com aparecimento de dor crônica após a cesariana. Os fatores de risco encontrados foram: doença crônica em tratamento, maior tempo em trabalho de parto sem analgesia e escores de dor elevados no pós- operatório imediato / INTRODUCTION: Brazil holds first place in cesarean section rate in the world. Little is known about the consequences upon maternal health. This study investigated the influence of anesthetic, surgical techniques and postoperative analgesia on chronic pain after cesarean section. We also tried to identify risk factors for chronic pain after cesarean section. METHODS: A prospective randomized study was conducted among 443 patients who underwent elective or emergency cesarean section with different doses of hyperbaric bupivacaine 0.5% and opioids in spinal anesthesia, associated or not to non steroidal anti-inflamatory drugs. The groups were: G8SMA- 8mg hyperbaric bupivacaine + 2.5 mcg sufentanil + 100 mcg morphine; G10SMA- 10 mg hyperbaric bupivacaine + 2.5 mcg sufentanil + 100 mcg morphine; G12.5MA- 12.5 mg hyperbaric bupivacaine + 100 mcg morphine; G15MA- 15 mg hyperbaric bupivacaine + 100 mcg morphine; G12.5M- 12.5 mg hyperbaric bupivacaine + 100 mcg morphine (only in this group, non-steroidal anti-inflammatory drug was not used). Pain at rest and during movement were evaluated on the first two postoperative days using the verbal numerical rating scale. Perioperative, surgical and obstetric factors were investigated. Phone survey was conducted after three and six months to identify patients with chronic pain RESULTS: Incidences of chronic pain in groups were: G8SMA= 20%, G10SMA= 13%; G12.5MA= 7.1%; G15MA= 2.2% and G12.5M= 20.3 %. Patients with co-morbidities, and who had been more than 15 hours in labor before the cesarean (without analgesia) had more chance to have chronic pain than those who did not have pain. Patients who had higher pain scores on the two postoperative days were associated to chronic pain (p<0.05).!! CONCLUSION: The incidence of chronic pain decreases with higher doses of local anesthetic and the use of non-steroidal anti-inflammatory drugs. Patients who had higher pain scores in the immediate postoperative period were more likely to develop chronic pain. The only predictors of chronic pain were: previous history of disease, longer time in labor, intensity of postoperative pain and the use of lower doses of local anesthetic in spinal anesthesia