PURPOSE: The aim of this study is to explore differences between males and females with opioid-treated chronic lower back pain in order to gain a greater understanding of how these factors may affect treatment and inform approaches to clinical care. METHODS: 175 participants who completed a baseline visit for a trial comparing the effectiveness of mindfulness meditation (MM) to Cognitive Behavioral Therapy (CBT) for the treatment of chronic lower back pain in adults taking a moderate to high dose of opioid medication were included in the study. Participants provided demographic information, completed a series of baseline questionnaires regarding their pain, psychological status, and medication use, and underwent assessments of pain sensitivity and pain modulation. RESULTS: Analysis by t-test demonstrated that women reported greater pain intensity and pain interference than their male counterparts. Women also reported lower pressure pain thresholds and greater sensitivity to mechanical pinprick stimuli. The association between pain intensity and pain interference was found to differ significantly by sex, with pain interference more strongly associated with increased levels of pain intensity in males compared to females. CONCLUSIONS: In accordance with the available literature, women reported greater pain intensity, pain interference, and pain sensitivity than male participants. The weaker association between pain intensity and pain interference in women suggests that pain interference may be more mechanistically complex in this group, possibly with a greater role of psychosocial and other biological factors. Overall, these findings lend further support to the theory that certain biological and psychological factors which are known to differ between men and women appear to mediate the individual experience of pain. / 2022-05-30T00:00:00Z

Many healthcare providers report not feeling confident when prescribing opioids, which represents an educational gap in the clinical setting that must be addressed to improve patient care and outcomes (Dowell, Haegerich, & Chou, 2016b). Healthcare providers attribute this lack of confidence in opioid prescribing to insufficient training on the tools provided to them to ensure safe prescribing habits. Thus, healthcare providers do not feel confident in managing patients’ chronic pain. A healthcare provider’s time spent with their patient is limited and therefore, needs to be utilized efficiently. In order to achieve effective time management, healthcare providers need to be experts on chronic pain management and self-assured with their practice in relation to opioids. This practice improvement project focused on increasing healthcare providers’ knowledge and confidence when prescribing opioids for chronic pain and managing chronic pain. An educational intervention with health professionals working in federally qualified health centers in North Dakota was implemented via Skype. The intervention allowed healthcare providers to be up-to-date on the most recent evidence-based literature and guidelines regarding this topic. Throughout this practice improvement project, healthcare providers were educated on the latest Centers for Disease Control (CDC) and Prevention Guideline for Prescribing Opioids for Chronic Pain, provided resources for their clinical practice, and given an opportunity to evaluate their own knowledge and confidence. The implementation of the practice improvement project was comprised of an educational session. To assess the participants’ knowledge, a pre-test was provided prior to the educational session and a post-test was given following the educational session. Furthermore, a self-confidence evaluation survey was administered, which utilized a Likert scale. Lastly, the clinic’s policies and pain agreements related to pain and opioids were reviewed and discussed. The results of the project indicated an overall increase in the participants’ knowledge and self-confidence. In addition, the project promoted awareness of the clinic’s current pain agreement and the likelihood of a future implementation of a policy regarding chronic pain management. The educational session was beneficial in promoting the use of evidence-based research and guidelines in the primary care setting.

Obesity rates have reached epidemic proportions contributing to the majority of Americans experiencing a state of chronic inflammation. Associations between inflammation, oxidative stress, and increased disease risk contribute to detrimental consequences of obesity. Regulation of inflammation and oxidative stress is possible via antioxidants consumed through a diet adequate in fruits and vegetables but consumption among adults is poor. Previous studies have assessed the impact of fruit, vegetable, and antioxidant consumption on oxidative stress and inflammation among healthy individuals. However, no studies have examined effects of education and fruit and vegetable consumption on markers of oxidative stress, inflammation, and other chronic disease biomarkers in a single study of overweight and obese adults. The purposes of this study were to examine effects of nutrition education and fruit and vegetable consumption on: interest and knowledge related to antioxidants; consumption patterns; weight, body mass index (BMI), body composition, blood lipids, and blood glucose; and biomarkers of oxidative stress and inflammation. Fifty-four adults (19 men/35 women; age 44.7±12.1 y; BMI 33.2±7.7 kg/m2 were randomly assigned to one of three intervention groups. The control group received no intervention, the education group attended weekly nutrition lessons, and the fruit and vegetable group attended weekly nutrition lessons and received one serving of fruits and two servings of vegetables per day for 10 weeks. Fruit and vegetable-related knowledge, attitudes, and behaviors were assessed using questionnaires. Fruit, vegetable, and antioxidant consumption was assessed using semi-quantitative food frequency questionnaires and three-day food records and anthropometric measurements and fasting blood draws were conducted. Results indicated improvements in fruit and vegetable-related knowledge, attitudes, and behaviors and increased consumption of antioxidant-rich fruits and vegetables following nutrition education. Associations existed between increased fruit and vegetable consumption and improvements in LDL cholesterol. However, minimal associations between changes in consumption of fruits, vegetables, and antioxidants and biomarkers of inflammation and oxidative stress were indicated. In order to be effective, nutrition intervention programs need to thoroughly address participants' fruit and vegetable-related knowledge and attitudes, provide exposure to fruits and vegetables, and promote adequate consumption of antioxidant-rich fruits and vegetables while concurrently emphasizing management of overall energy intake.

Chronic Traumatic Encephalopathy (CTE) is a neuropathological disease that has been associated with contact sports involving repetitive brain injury. This disease is becoming more well-known due to an increase in media coverage, most notably for its possible association with professional football players. This has led to growing concern for the risks of participating in contact sports and the need for further research. There still remains much to be learned about this neurodegenerative disease. The current understanding of the epidemiology and risk factors for this disease are limited by biases in methodology, generalizability, and the use of retrospective data. The only method to diagnose CTE is via autopsy, which has contributed to some of these limitations. The pathogenesis of the disease involves hyper-phosphorylated (p-tau) tau accumulation in distinct areas in the cerebral cortex, leading to neuronal disfunction. The most accepted risk factor for this disease is recurrent brain trauma. Clinically, it can present with varying cognitive, mood, and behavior symptoms and different ages of onset, which often leads to a misdiagnosis of other neurodegenerative diseases. There are a few proposed treatments for CTE but more clinical trials must be performed before any are accepted in clinical practice. One potential modifying factor for CTE symptomology is cognitive reserve (CR). CR is an individual brain’s ability to cope with insults such as neuropathological disease, trauma, and the normal ageing process. Higher CR has shown to have a positive effect on other neuropathologies such as Alzheimer’s Disease (AD). This led to a preliminary study of CR which showed that one measure of CR, occupational attainment, was associated with delayed onset of symptoms of CTE. Our study builds upon this preliminary study by also examining the effect of CR on clinical symptoms of CTE. We expand on this study by using a previously validated tool to measure CR, including aspects such as education, occupational attainment, and social/leisure activities. Our study also includes subjects from other contact sports at varying levels of participation. The results of our study will provide a better understanding of the relationship between CR and clinical symptoms of CTE. This will allow future research to build upon these results and continue to advance our knowledge of this disease. These advances allow changes to be made in clinical practice and athletic organizations in order to improve an individual’s quality of life.

Bakgrund: Smärta framställs som ett flerdimensionellt fenomen och det innebär att teorier och modeller visar att det finns en stark kombination av fysiska, psykiska och sociala fenomen. Sjuksköterskan ansvarar för patienternas omvårdnad och därav är det viktigt att synliggöra patienternas upplevelser av långvarig smärta för att generera betydelsefull kunskap i vårdandet av dessa patienter. Syfte: Syftet var att beskriva patienters upplevelser av att leva med långvarig smärta. Metod: Designen är en litteraturstudie innehållande artiklar med kvalitativt material. Databaserna som har använts för att söka fram artiklarna var Cinahl Complete och PsycINFO. Artiklarna har granskats utifrån Högskolans Kristianstad granskningsmall för kvalitativa artiklar. Artiklarna har analyserats i form av textanalys med inspiration av Fribergs analysmodell. Resultat: Att leva med långvarig smärta är komplext och innefattar flera olika komponenter av upplevelser. För att synliggöra patienters upplevelser har fyra teman tagits fram. En omställning i livet, som handlar om strategier och acceptans. Osäkerhet inför behandling, som handlar om misstro, skam och att inte få tillräckligt med information kring symtomlindring. Förändrade relationer, som handlar om besvikelser och vikten av närståendes stöd. Brist på empati i mötet med vården, som handlar om att inte bli sedd och att leva med långvarig smärta upptar all tid. Dessa teman med tillhörande subteman synliggör patienters upplevelser av att leva med långvarig smärta. Diskussion: Metoden har diskuterats och bedömts utifrån Shentons beskrivning av trovärdighetsbegrepp för kvalitativa studier. Resultatet i studien diskuteras utifrån följande fyra fynd, Att acceptera och erkänna, att sociala relationer förändras, att det finns för-och nackdelar med att medicinera och att bli sedd som en person i vården. Även etik, omvårdnad och samhällsrelevans diskuteras.

Self-management support (SMS) is considered an effective approach to chronic pain (CP) management. However, the provision of SMS for chronic pain patients faces challenges within primary care facilities in Ontario. An innovative SMS program led by a Registered Nurse (RN) at the Bruyère Family Health Team in Ottawa has been created for chronic pain patients. The goal of this program is to improve the current chronic pain management using SMS in an outpatient facility by harnessing the skills of primary health care team members. The hope would be that this program could be spread and scaled across other programs in the region. This thesis exists in two parts: 1. Evaluate the RN-led chronic pain self-management program to determine its effectiveness in terms of self-reported pain scales and Morphine Equivalence Quotient (MEQ) 2. Understand the perspectives of health care practitioners, administrators and patients within the RN-led chronic pain self-management program Patients meet with the RN for initial face-to-face visit for an hour, for SMS and then for at least one follow up visit. The primary outcome variables of interest were their self-reported pain evaluated using validated pain scales. Opioid use was also assessed before and after the porgram based on the MEQ. Results were analyzed using SPSSversion20. An online questionnair was distributed to team members. All responses were conceptually arranged into a SWOT analysis, which will be directed toward the ongoing management needs of the clinic. Between January 2016 and August 2018, 125 patients were seen of these 58 patients (12 males and 46 females) had at least one follow up appointment with the RN. In 46.2% of the population there was a decrease in their total opioid dose from their first to their last appointment and of these 4 patients (15.4%) had a daily MEQ of 0 by their last appointment. There was a significant average difference between patient’s daily MEQs at their first and last appointment (t20= 2.245, p<0.05). On average patients came into their first appointment with a daily MEQ of 23.88 higher than at their last visit (95% CI [1.69, 46.07]). Staff and patients who participated in the online survey identified the following strengths: multidisciplinary approach, increased accessibility for patients, cost effectiveness, better patient engagement, and no refills of opioids Canada needs a better strategy to manage the CP epidemic. This chronic pain self-management program led by an RN focuses on a multidisciplinary approach that is readily accessible to patients and integrated within primary care to best meet and prioritize the needs of chronic pain patients.

OBJECTIVES: The present study aims to collect data on the pain and sensory perception of both male and female healthy individuals. Although the overarching project has been testing female controls for longer, males have been added to the protocol with the goal of expanding our understanding pain norms. This study compares pain and sensation perception between genders and looks at psychosocial factors that may cause differences between the two populations. METHODS: The protocol for this study is divided into quantitative sensory testing (QST) and questionnaires. QST is a non-invasive procedure that is used to study somatosensory functioning in individuals. This study specifically utilizes a QST battery to understand sensation and pain caused by mechanical and thermal stimuli. The deltoid and hand are used as control regions and the abdomen is the experimental area. Additionally, the Health Screening Form, Pain Rating Questionnaire, Pain Sensitivity Questionnaire, Pain Catastrophizing Scale questionnaire, and 36-item Short Form Survey Instrument are all used to gather information on participants’ medical history, mental status, and other psychosocial factors that may affect pain and sensory processing. Data collected from this protocol is then analyzed on SPSS through descriptive statistics and one-way analyses of variance. RESULTS: Throughout the protocol, there are only three values that are significantly different between the male and female control populations: the thermal sensory threshold of cold on the hand, thermal sensory threshold for heat on the hand, and pressure pain threshold on the hand. The p-values for these are 0.001, 0.013, and 0.044 respectively. Additionally, the abdomen is slightly more sensitive than the control site for certain QST measures like the pain threshold for cold temperatures. CONCLUSIONS: The lack of significant variance between genders for the majority of data points shows that both male and female healthy control perceive pain and sensation similarly. Although there may be some differences in anatomy and development, there are no distinct differences in the overall experience of these phenomena. Although these results suggest that gender does not play a significant role in pain and sensory perception, it is important to continue expanding the database in order to find more conclusive results. / 2021-06-14T00:00:00Z

One in four adults over the age of 60 suffers from diabetes. Around 85%-90% of individuals who have diabetes suffer from Type II diabetes. The prevalence of individuals with diabetes is expected to increase. This paper addresses the influence spousal support, friend support, and religion all have on diabetes mellitus. Gender difference in relation to spousal support benefits has also received limited attention. The limited amount of studies that have examined gender differences in relation to spousal support and diabetes management indicate that diabetic men benefit the most from spousal support due to their wives active involvement in meal preparation and grocery shopping. The results showed that neither spousal support nor religious salience was significantly related to diabetes management. There were observed gender differences in religious salience (males = 4.84, females = 5.36, p < .001) and positive spousal support (males = 3.19, females = 3.02, p <.001), but none of the major hypotheses were supported.

Excerpt: Chronic prostatitis is relatively common, with a lifetime prevalence of 1.8% to 8.2%.

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