Having a child who is suffering with chronic pain can profoundly impact a parent’s life. Reciprocally, parent cognitive, emotional, and behavioral responses to their child’s chronic pain can influence the child pain experience. We developed the Parent Risk and Impact Screening Measure (PRISM) to assess parent physical and emotional functioning, behavioral responses to child pain, and impact on daily life due to their child’s chronic pain. In an effort to validate this screening tool, we examined the PRISM in relation to existing measures of parent distress, parent behavior, and child functioning. The 30-item PRISM was administered via RedCAP survey to 112 parents of children with persistent pain presenting to a multidisciplinary pain clinic at Boston Children’s Hospital. Parents also completed the Patient Reported Outcomes Measurement Information System (PROMIS-29), Bath Adolescent Pain Questionnaire-Parental Impact Questionnaire (BAQ-PIQ), Adult Responses to Children’s Symptoms (ARCS), and Pain Catastrophizing Scale (PCS). Children completed the Functional Disability Inventory (FDI), Fear of Pain Questionnaire (FOPQ), and Pediatric Quality of Life Inventory (PedsQL). Parents were predominantly mothers (84%), married (74%), and college- educated (70%). Their children (ages 8-18) were predominantly female (88%) and endorsed daily pain (84%; Mean=6/10). PRISM total scores were strongly correlated with parent general symptoms of depression, anxiety, fatigue, social restrictions, and pain interference (PROMIS-29; r=0.47, 0.54, 0.59, 0.57, 0.38). PRISM total scores were also highly associated with parent pain-specific domains including self-blame and helplessness (BAP-PIQ; r=0.62), parent behavior (BAP-PIQ; r=0.54), and protective responses (ARCS; r=0.59). For child outcomes, higher PRISM scores correlated with more disability (FDI; r=0.49), higher fear of pain (FOPQ; r=0.53), and lower functioning within emotional, social, and psychosocial domains (PedsQL; r=0.36, 0.34, 0.48). Altogether the PRISM tool appears to be a brief and clinically important means of screening parent distress and behaviors associated with child pain-related dysfunction. Future work will include item level analysis with the goal of reducing the length of this screening tool.

OBJECTIVES: This study compared mother, father, and child self-reported pain sensitivity and psychosocial functioning during an intensive pediatric pain rehabilitation treatment. METHODS: Twenty children with chronic pain and their parents were enrolled in an intensive pediatric pain rehabilitation center and completed measures of pain sensitivity, fear of pain, pain catastrophizing, functional disability, and current and usual pain ratings at admission and discharge. RESULTS: Bivariate correlations and one-way ANOVAs were used. Pain sensitivity and psychosocial variables for mother, father, and child decreased from admission to discharge. There was no correlation between pain sensitivity and psychosocial variables and no significant main effect for time. CONCLUSIONS: Results indicate a need for a larger sample to further explore the relationship between these variables.

O objetivo geral deste estudo foi monitorar a atividade da doença periodontal e sugerir potenciais biomarcadores salivares relacionados a esta atividade em pacientes com periodontite crônica associada ou não Diabetes mellitus tipo 2, a partir da avaliação do perfil da expressão gênica de sítios periodontais progressivos e de proteínas inflamatórias salivares. Foram incluídos 56 pacientes, sendo 21 com periodontite crônica (DP), 20 com periodontite crônica associada ao Diabetes mellitus tipo 2 (DP+DM) e 15 periodontal e sistemicamente saudáveis (controle). Foi realizado exame radiográfico antes e dois meses após a terapia periodontal básica, e posteriormente foi feita a subtração radiográfica a partir dos pares das radiografias. As medidas das áreas com perda de densidade foram registradas. Coleta de saliva não estimulada, verificação da hemoglobina glicada (HbA1c) e exame clínico periodontal profundidade de sondagem (PS), nível clínico de inserção relativo (NCIR), sangramento à sondagem (SS) e índice de placa (IP) também foram realizados antes e dois meses após a terapia periodontal básica. Os sítios periodontais com perda de inserção progressiva 1 mm na reavaliação foram considerados ativos de acordo com uma adaptação do método de tolerância. Biópsias de tecido gengival de sítios ativos e inativos com parâmetros clínicos semelhantes foram analisadas com real time PCR Array para análise do perfil de expressão gênica da resposta imune-inflamatória. As amostras de saliva foram submetidas ao imunoensaio Multiplex Cytokine Profiling para análise de expressão de proteínas. No grupo DP, 9% dos sítios foram classificados como ativos e no grupo DP+DM, 12% (p > 0,05). A média de perda de inserção clínica foi maior no grupo DP+DM (1,34 mm) em relação ao grupo DP (1,21 mm) (p < 0,05). Houve correlação entre a perda de inserção clínica e a área da perda de densidade radiográfica tanto nos sítios ativos do grupo DP (R = 0,79; p = 0,001), quanto do grupo DP+DM (R = 0,86; p < 0,001). Ambos os grupos DP e DP+DM apresentaram um perfil down-regulated em relação aos pacientes saudáveis (grupo controle). Quando comparado o grupo DP+DM ao grupo DP, pacientes diabéticos apresentaram um perfil up-regulated. Sítios ativos do grupo DP mostraram nove genes (ABCF1, CD40LG, IL10, IL5, CCR2, CCR4, CCR7, CCL18 e CXCL1) diferencialmente expressos (p < 0,05) com um perfil up-regulated. Sítios ativos do grupo DP+DM mostraram seis genes (LTA, CXCR1, CCL19, CCL8, CCL17 e CXCL12) diferencialmente expressos (p < 0,05) com um perfil up-regulated. Após a terapia periodontal básica, houve uma significante redução de algumas proteínas salivares (IL1b, IL1ra, IL10, IL17, TGFb, IL8, eotaxin e MCP-3) nos grupos DP e DP+DM, mas sem diferença estatisticamente significante (p > 0,05). Concluindo, este estudo foi capaz de monitorar a atividade da doença periodontal em pacientes com e sem diabetes após a terapia periodontal básica; foi possível identificar genes diferencialmente expressos em sítios ativos de ambos os grupos, que podem ser úteis na indicação de potenciais biomarcadores para diagnóstico da doença periodontal na fase ativa; as proteínas salivares analisadas mostram uma tendência em diferenciar o padrão de saúde e de doença, podendo ser futuramente utilizadas como potenciais biomarcadores de periodontite associada ou não ao diabetes. / The overall aim of this study was to monitor the periodontal disease activity and suggest potential salivary biomarkers related to this activity in chronic periodontitis patients with or without type 2 Diabetes mellitus (DM), based on the evaluation of gene expression profile of progressive periodontal sites and salivary inflammatory proteins. Fifty-six patients were enrolled, 21 with chronic periodontitis (PD group), 20 with chronic periodontitis and DM (PD+DM group) and 15 periodontal- and systemically healthy (control). Radiographs were taken before and two months after non-surgical periodontal therapy, and radiographic subtraction was performed from pairs of these radiographs. Measurements of the areas with density loss were recorded. Unstimulated saliva collection, glycated hemoglobin (HbA1c) measurement and periodontal examination probing pocket depth (PPD), relative clinical attachment level (rCAL), bleeding on probing (BOP) and plaque index (PI) were also conducted before and two months after non-surgical periodontal therapy. The periodontal sites with progressive attachment loss 1 mm at the recall visit were considered active sites according to the adapted method of tolerance. Gingival biopsies of active and non-active sites with similar clinical parameters were harvested for gene expression analysis of the immune-inflammatory response with Real Time PCR Array. Saliva samples were analyzed by Multiplex Cytokine Profiling Immunoassay for analysis of protein expression profile. In PD group, 9% of the sites were classified as active and in PD+DM group, 12% (p > 0.05). The clinical attachment loss mean was higher in the PD+DM group (1.34±0.23 mm) compared to the PD group (1.21±0.16 mm) (p < 0.05). There was a correlation between clinical attachment loss and darkened radiographic areas in active sites of the PD group (R = 0.79, p = 0.001) and PD+DM group (R = 0.86, p < 0.001). Both PD and PD+DM groups showed a down-regulated profile compared to healthy subjects (control group). When compared PD group to PD+DM, patients with diabetes had an upregulated profile. Active sites of the PD group showed nine genes (ABCF1, CD40LG, IL10, IL5, CCR2, CCR4, CCR7, CCL18 and CXCL1) differentially expressed (p < 0.05) with an up-regulated profile. Active sites of the PD+DM group showed six genes (LTA, CXCR1, CCL19, CCL8, CCL17 and CXCL12) differentially expressed (p < 0.05) with an up-regulated profile. After non-surgical periodontal therapy, there was a significant reduction of clinical parameters and HbA1c levels (p < 0.05), accompanied by a reduction of some salivary proteins (IL1b, IL1ra, IL10, IL17, TGFb, IL8, eotaxin and MCP-3) in groups PD and PD+DM, but without statistically significant difference (p > 0.05). In conclusion, this study was able to monitor the periodontal disease activity in periodontal patients with or without diabetes after the non-surgical periodontal therapy; it was possible to identify genes differentially expressed in active sites from both groups, which may be considered useful in indicating potential biomarkers for the diagnosis of active periodontal disease; salivary proteins show a trend in distinguishing the standard of health and disease and may be used in the future as potential biomarkers of periodontitis with or without diabetes.

Mindfulness is a cognitive attribute that is associated with better health and well-being. Fibromyalgia is a neurosensory disorder primarily characterized by chronic pain and comorbid depression, leading to an increased risk for alcohol-related problems. Empirical literature confirms mindfulness has beneficial associations with chronic pain, depression, alcohol-related problems, and fibromyalgia. Mindfulness may lead to better health and well-being by facilitating self-monitoring, objective reperceiving, and purposeful changing of health-related behaviors. It was hypothesized that higher levels of mindfulness would be related to lower levels of chronic pain and depressive symptoms, and, in turn, to fewer alcohol-related problems among individuals with fibromyalgia. Cross-sectional data was collected from 287 participants, and statistically analyzed using parallel mediation models. Hypotheses were only partially supported; mindfulness had an inverse relationship with alcohol-related problems, as hypothesized, although the relationship was not mediated by chronic pain or depressive symptoms.

Individuals with chronic illness often face the added burden of stigma associated with their chronic conditions. Stigma has been associated with fewer psychosocial resources of social support, self-esteem, and self-compassion, as well as less access and usage of mental and physical healthcare. However, it is unclear whether stigma experiences vary by age of the individuals with chronic illness. It was hypothesized that emerging adults would report more perceived stigma, fewer psychosocial resources and less access to medical treatments. It was additionally hypothesized that perceived stigma would mediate the association between age and outcomes. 197 participants completed an online survey using Survey Monkey. Results of multiple regression analysis testing for mediation did not support hypotheses. In fact, emerging adults reported easier access to treatments than older adults. Post-hoc analyses were conducted and revealed that among emerging adults – but not older adults – perceived stigma was significantly related to less access to medical treatments. Thus, age may moderate the impact of stigma of chronic illness on access to healthcare in individuals with chronic illness, rather than predict more or less stigma of chronic illness. This indicates that in spite of easier access to care for emerging adults, increased stigma might interfere with their seeking of that care. Future studies should examine the impact of stigma on emerging adults’ treatment access.

No description available.

Background. Type 1 diabetes requires intensive management, including blood glucose monitoring, carbohydrate counting and dietary modification, and administering insulin. When a child is diagnosed with type 1 diabetes, family dynamics are often altered as family schedules revolve around care for the child with diabetes. In addition, siblings face unique challenges as they become involved in the care of the child with type 1 diabetes. Therefore, it is important to understand experiences of siblings of youth with type 1 diabetes. Aims and Objectives. To identify experiences of siblings of children with type 1 diabetes from their own perspectives. Sample. As part of a larger IRB approved study, 51 children and adolescents ages 8-18 years with diabetes (M = 13.18), who have a sibling ages 8-18 years (M = 12.6), were recruited from diabetes summer camps and the diabetes clinic at a regional medical center. Methods. A qualitative descriptive design was used to ascertain experiences of siblings of youth with T1DM using semi-structured, scripted interviews. Interviews were audio recorded, transcribed verbatim, and analyzed for common themes according to qualitative methodology. Results. Common themes emerging from the data are: (1) knowledge about type 1 diabetes – how it was obtained and what more siblings wanted to know; (2) feelings experienced; (3) sibling relationship – the impact of diabetes on the relationship; and (4) involvement in diabetic care. Implications. It is important for healthcare providers working with children with T1DM and their families need to be aware of and address the psychological effects of the disease on all family members. While providers cannot alleviate all challenges and fears experienced by siblings of a youth with T1DM, they can make the parents aware of the challenges siblings face, facilitate communication among family members, and help connect brothers/sisters with resources such as education, support groups, and counseling.

The American College of Rheumatology (ACR) 1990 criterion classifies fibromyalgia as a clinical syndrome characterized by chronic widespread muscular pain and tenderness with hyperalgesia to pressure over 11/18 tender points of at least 3 months duration. Fibromyalgia is characterized by chronic widespread musculoskeletal pain and is associated with fatigue and cognitive dysfunction. The cause of fibromyalgia is unknown, but it has been shown to demonstrate sensitization of the central nervous system pain pathways by demonstrating lower pain pressure thresholds and reduced conditioned pain modulation (CPM). Pain and fatigue associated with fibromyalgia can interfere with daily function, work, and social activities. Without greater understanding of the interaction of pain, fatigue and function, we are limited in our ability to improve these symptoms for individuals with fibromyalgia. We designed three experiments to examine the relationship of pain, fatigue and function in individuals with fibromyalgia. Regression analyses demonstrated significant models that included pain, fatigue and fear of movement for prediction of function and quality of life in individuals with fibromyalgia and healthy controls. The fatigue study (cognitive fatigue, physical fatigue and dual fatigue task) demonstrated that people with fibromyalgia show enhanced pain and fatigue to both cognitive and physical fatigue tasks and reduced function in the physical fatigue task in comparison to healthy controls. Our final study showed active TENS restores CPM, decreases deep tissue pressure pain, decreases pain and fatigue during movement for individuals with fibromyalgia.

The purpose of this study was to identify risk factors for repeated child maltreatment in Iceland. Only cases that had never been reported to child protection services before were included in this study (N=77 total). Each case was followed for 18 months. In all cases the first reported incident was neglect. In the study, a group of cases that had only been reported once (single incident) was compared with another group of cases that had been reported two or more times (repeated incidents). Risk factors were identified and compared on different levels according to an ecological model: 1) Demographics, 2) Parental figure problems, 3) Children's characteristics, 4) Family problems, 5) Social support. In addition, the two groups were compared on parental non-cooperation and services received. In a logistic regression model, the groups differed significantly on the following factors; the mother figures in the repeated incidents group had lower education level and the mothers in that group had more personal problems than the mother figures in the repeated incidents group. In addition, the repeated incidents group experienced more family dynamic problems than the single incident group.

No description available.