Data from daily diaries were used to examine the relationships between daily pain appraisals (Catastrophizing, Self-Efficacy, and perceived control over pain) and coping strategy use (Distraction, Ignoring Pain, Praying and Hoping, and Reinterpreting Pain Sensation) and nighttime negative mood and pain intensity for 88 women (mean age 46.83 years, SD 11.90) with chronic low back pain who were not attending a specialized pain treatment program. These relationships were examined at two levels using the Hierarchical Linear Modeling program (Bryk & Raudenbush, 1992). The first level of analyses examined whether pain appraisals and coping strategy use during the day predicted levels of nighttime depressed and anxious mood, and pain. This analysis was based on 30 days of monitoring for each participant. The second level of analyses examined whether these daily processes could be predicted by psychosocial and functional variables important to the experience of chronic pain. This analysis was based on the Mutidimensional Pain Inventory (Kerns, Turk, & Rudy, 1985) completed prior to participants beginning the daily monitoring. There were four major findings in this study. First, pain appraisals were more predictive of negative mood and pain intensity than coping strategy use, with Catastrophizing the strongest predictor of depressed and anxious mood, and control the strongest predictor of pain intensity. Second, general affective distress predicted higher levels of negative mood on a daily basis. Third, women who perceived their pain to be interfering a great deal in their lives were more anxious on a daily basis. Fourth, punishing spousal responses predicted nightly negative mood and pain more than solicitous or distracting spousal responses. These results are similar to findings based on patients attending pain treatment programs. This suggests that some of the same processes identified in clinical pain patients may apply to low back pain sufferers in the community who are comparable to study participants. The implications of these findings for pain research and treatment are discussed.

Understanding chronic pain and disability in young people: A study with Catalan schoolchildren Anna Huguet Roselló Tesis doctoral dirigida pel Dr. Jordi Miró Martínez Departament de Psicologia, Universitat Rovira I Virigili, Tarragona Juny, 2007 El dolor crònic i recurrent és un problema molt estès; de fet és considerat un problema de salut pública (Crombie i col., 1999); que requereix d'una atenció especial pel sofriment i la discapacitat que pot generar tant al mateix individu com a les persones més pròximes a aquest (família). El dolor ha estat motiu d'atenció dels éssers humans des dels inicis de la història (veure per exemple, Sabatowski i col., 2004). No obstant, i paradoxalment, el dolor en nens ha estat totalment mancat d'interès fins a la dècada dels 70. Afortunadament, la situació en l'àmbit del dolor pediàtric ha canviat dràsticament. Durant els últims 25 anys, hi ha hagut un augment d'interès per a l'estudi del dolor en nens. Cada vegada més recursos estan sent invertits pel seu tractament, i la recerca paral·lelament també ha anat en augment. Aquest interès, no obstant, no és evident a tot arreu. Per exemple, i tal i com Reinoso-Barbero reconeix (2003), el dolor crònic és encara el germà pobre de la recerca del dolor en adults a Espanya. A pesar de l'elevat número de nens en necessitat de tractament, pocs clínics i investigadors estan donant a aquest problema l'atenció que es mereix. Per tant, la majoria d'aquests no estan rebent el tractament més apropiat perquè els clínics no estan familiaritzats amb aquestes condicions cròniques, mesures d'avaluació, i estratègies d'intervenció. En general, es pot dir que aquests nens han de combatre contra el seu dolor per ells mateixos, la majoria de les vegades sense rebre un tractament apropiat pel seu problema. Al mateix temps, les preocupacions i el sofriment dels pares augmenta perquè el dolor dels nens no remet, i ells no saben què fer. El propòsit d'aquest estudi és ajudar a entendre millor els problemes de dolor en nens i adolescents. Per això la tesi planteja tres objectius generals. (1) Treballar en l'àmbit de l'avaluació del dolor, i desenvolupar, adaptar i estudiar les propietats psicomètriques d'instruments de mesura que contribueixen a fer una avaluació multicontextual de nens catalano-parlants amb problemes de dolor. (2) Treballar en l'àmbit de l'epidemiologia, i aportar dades sobre els índex de prevalença i incidència dels problemes de dolor crònic en la nostra població de nens i adolescents d'entre 8 i 16 anys. I, aportar dades sobre les característiques d'aquests problemes i l'impacte que aquests problemes tenen sobre la vida del mateix nen. (3) Treballar per en l'àmbit de la prevenció secundària, i identificar predictors de tipus psicosocial del dolor crònic i/o la discapacitat. Understanding chronic pain and disability in young people: A study with Catalan schoolchildren Anna Huguet Roselló Tesis doctoral dirigida pel Dr. Jordi Miró Martínez Departament de Psicologia, Universitat Rovira I Virigili, Tarragona Juny, 2007 Recurrent and chronic pain is a widespread problem; in fact it has been considered to be a public health issue (Crombie, et al., 1999), one that requires careful attention due to the enormous amount of suffering and functional disability that it may cause. Pain has attracted attention of the humans since earliest recorded history (see for example, Sabatowski et al., 2004). However, and somewhat paradoxically, pain in children was completely devoid of interest until 1970s. Fortunately, the field of pediatric pain has changed dramatically. Over the last 25 years, there has been an increased interest in the study of pain as it occurs in youth. More and more resources have been invested into its treatment and prevention, research has paralleled growth too. This interest, however, is not so evident everywhere. For example, and as Reinoso-Barbero acknowledged (2003), pediatric pain still seems to be the poor brother of pain research in Spain. That is, despite the significant number of children in need of treatment, few clinicians and researchers are giving the attention to this problem that it deserves. Thus, most of these children do not receive the most appropriate treatment because clinicians are not familiar with these chronic conditions, assessment tools, and intervention strategies. In general, it can be said that children have to fight against their pain on their own, most of the times without receiving an appropriate treatment for their problem. At the same time, parents' concerns and suffering rise because their child's pain does not remit, and they do not know what to do. The propose of this study is to better understand chronic pain problems among the general population of children and adolescents. This thesis has tree aims. (1) To develop and examine the psychometric properties of assessment measure which allow us to understand pain problems from a biopsychosocial perspective. (2) To estimate the prevalence and incidence of chronic pain problems in Catalan schoolchildren aged 8 to 16 years and to examine the impact of pain problems on children's quality of life. (3) To work on the field of the secondary prevention and to identify psychosocial prognostic factors of the children's functioning and/or the course of pain complaints.

Chronic non-cancer pain (CNCP) affects approximately 25% of Canadians. Opioids are medications frequently prescribed for management of patients with CNCP. Concern about addiction, misuse, and diversion for illicit use led the Canadian medical regulatory bodies to release a national guideline on the safe and effective use of opioids in CNCP. This thesis used an online survey to determine how closely the self-reported practices of Canadian family physicians matched the recommendations of the Canadian Guideline. We received 710 responses suitable for analysis. Thirteen percent of respondents did not prescribe strong opioids for CNCP. Practice gaps indentified were infrequently using a management agreement and monitoring pain with a scale; incorrect choice of second line opioid for mild to moderate pain; incorrect choice of first, second, and third line opioids for severe pain, and starting fentanyl incorrectly. Findings provide baseline information for future follow-up to compare physicians’ adherence to the guideline.

The risk of crude oil exposure to the early life stages (ELS) of fish is difficult to assess, given the complexity of the chemical composition of different oils. The aromatic portion of crude oil contains polycyclic aromatic hydrocarbons (PAH), which are known to be toxic. In 2004, an “effects-driven” fractionation research program was initiated in an attempt to better identify toxic constituents of two unique crude oils, Alaskan North Slope Crude (ANSC; medium-heavy crude) and Scotia Light (SCOT; light crude). The ANSC contained much more PAH than SCOT. These oils induced cytochrome P4501A1 (CYP1A) enzymes in juvenile rainbow trout (Oncorhynchus mykiss) and caused blue-sac disease (BSD) and mortality in larval Japanese medaka (Oryzias latipes). Four unique fractions (F1-F4) were produced from both oils via low temperature vacuum distillation. The F3 contained an array of unsubstituted and alkyl-PAH, and was responsible for most of the CYP1A induction and chronic toxicity associated with whole oil. Cold acetone extraction (CAE) of F3 produced 2 new sub-fractions (F3-1 and F3-2). The F3-1 was rich in alkyl-PAH, was a potent CYP1A inducer, and was chronically toxic to ELS of fish. The F3-1 was further separated into five more sub-fractions via normal phase HPLC (F3-1-1 – F3-1-5). Neither F3-1-1 nor F3-1-2 induced CYP1A or produced BSD, but F3-1-2 was lethal. The F3-1-3, 4, and 5 were all potent CYP1A inducers and were all chronically toxic. Induction of CYP1A proved to be an effective tool for tracing potentially toxic PAH throughout fractionation (Chapter 2), and sub-fractions rich in alkyl-PAH caused the most BSD and mortality (Chapter 3). Alkyl-homologues of phenanthrene, fluorene, naphthobenzothiophene (NBT), pyrene, and chrysene are perhaps the most toxic of the known constituents present in crude oil. The ANSC sub-fractions were more toxic than the SCOT ones, indicating that heavier crude oils with a higher proportion of intermediate-sized alkyl-PAH may be more toxic than lighter crude oils that are comprised of fewer of these compounds. / Thesis (Master, Biology) -- Queen's University, 2007-12-20 13:18:50.794 / This research was accomplished with funding assistance from the Nationmal Oceanic and Atmospheric Administration (NOAA), Petroleum Research Atlantic Canada (PRAC), Environment Canada, and the Department of Fisheries and Oceans.

Chronic pain affects approximately 16% to 36% of Canadian adults and is one of the most common reasons for physician visits in Canada. The effects of a self-referral community-based education/exercise program (Y-PEP) on physical function and well-being were initially evaluated in 20 individuals with chronic pain who had attended one of three Y-PEP sessions in 2007. The 10-week program incorporated chronic pain education/self-management and various exercise modalities to allow individuals with chronic pain to try different physical activities in a safe and supported environment. Questionnaires were administered pre-, post-program, and at 10-weeks follow-up and provided data on demographic information, physical activity levels, depression, pain perception, and pain catastrophizing. Maximal activity levels and adjusted activity levels increased 7% and 10% respectively at post-program, but only the adjusted activity levels remained elevated at the 10-week follow-up. No significant changes occurred in any of the other outcome measures, however, the extent to which maximal and daily activity increased was significantly correlated with greater improvements in the extent to which pain interfered with one’s life (r=0.45) and with pain catastrophizing (r=0.45). These latter two improvements were significantly associated with greater decreases in depression score (r=0.50). Overall, these findings suggest that a community-based program for individuals with chronic pain can improve physical function and psycho-social well-being. Further effort is required to establish such programs in communities for individuals with chronic pain. / Thesis (Master, Rehabilitation Science) -- Queen's University, 2009-09-14 13:01:08.784

Chronic kidney disease (CKD) is a worldwide health problem with rising incidence and high cardiovascular mortality. CKD compromises cardiovascular function, in part, characterized by vascular calcification (VC), elevated pulse wave velocity (PWV) and pulse pressure (PP). Through manipulation of dietary adenine, we produced a model characterized by graded severity of CKD, VC and hyperphosphatemia. To our knowledge, we are the first to explore the relationship between aortic calcium content and changes in circulatory function in rodents with CKD. Fourteen-week old Sprague-Dawley rats received a diet containing an adenine concentration (0.25-0.75%) plus high-normal dietary phosphate (1%), for up to 10 weeks. Circulatory changes were determined by arterial radiotelemetry (n=6) and by assessment of aortic pulse wave velocity (PWV, n=32). VC was assessed using the calcium-O-cresophthalein-complexone assay. At sacrifice, kidney function (creatinine (µmol/L)) was worst in the group with VC (251.3±60.2 µmol/L), compared to non-calcifying CKD (200.3±68.8 µmol/L) or control (50.0±16.2 µmol/L). PWV (cm/s) adjusted for blood pressure (BP) was markedly elevated in animals with VC (3.23±0.33 log(cm/s)) versus non-calcifying CKD (2.85± 0.12 log(cm/s)) or control (2.96±0.08 log(cm/s)). Arterial pressure radiotelemetry revealed that there was an increase in pulse pressure (38±4.7 mmHg to 58 ±15.2 mmHg) during the development of VC. Systolic pressure remained relatively stable throughout (129±8.7 mmHg), diastolic pressure fell during weeks 9 and 10 of the study (91±6.0 mmHg down to 74±9.1 mmHg), a fall that almost fully accounted for the changes in pulse pressure. The calcifying CKD animals also exhibited left ventricular hypertrophy (LVH) compared to CKD or control animals (2.32±0.3 vs 2.03±0.2, 1.80±0.1 g/kg respectively). Manipulating dietary adenine produces a graded severity of CKD with calcification which impact circulatory changes (PP and PWV). These altered circulatory functions are likely to be key factors in the enhanced LVH. This model appears to be a useful for the study of CKD-associated VC. / Thesis (Master, Pharmacology & Toxicology) -- Queen's University, 2009-12-16 15:10:49.384

Background: Chronic pain is prevalent worldwide and is estimated to range from 2% to 55% in the general population. There is a limited understanding of the prevalence and incidence of chronic pain in Canada. Furthermore, our understanding of the sociodemographic predictors of chronic pain is limited; thus we are poorly positioned to identify potential populations at risk. Objectives: The primary objectives for this study included: 1) to determine the prevalence and incidence of chronic pain and pain-related interference in Canada over time and, 2) to determine the influence of sociodemographic predictors on the development of chronic pain by sex in the Canadian adult population over 12 years. Methods: Using data from the cross-sectional components of the National Population Health Survey (NPHS) (1994/95, 1996/97, 1998/99) and the Canadian Community Health Survey (2000/01, 2003, 2005, 2007/08), we examined the prevalence and interference of chronic pain. The longitudinal component of the NPHS was used to determine the incidence and sociodemographic predictors of chronic pain. Chronic pain was defined as the presence of “usual pain”. Results: The prevalence in the cross-sectional samples ranged from 15.1% to 18.9%. In the longitudinal sample, the incidence ranged from 5.4% to 7.8% and the prevalence ranged from 15.3% to 19.5%. Women, compared to men, had a higher prevalence, but not incidence of chronic pain each year. Of those individuals reporting chronic pain, the majority reported at least a few activities prevented. Women who were older, with lower education, and widowed, separated, or divorced were more likely to develop chronic pain. There were no sociodemographic risk factors for chronic pain in men. Conclusion/Implications: This population-based study supports previous research findings indicating that chronic pain affects daily activities of many Canadians. Furthermore, this is the first population-based prospective study examining the incidence and sociodemographic predictors of chronic pain in Canadians. Further study with more detailed definitions of pain and pain-related interference is warranted. Moreover, our findings suggest that older women are more likely to develop chronic pain and that men and women may have different risk factors for chronic pain, suggesting the need for gender-based preventative interventions. / Thesis (Master, Nursing) -- Queen's University, 2010-07-20 13:38:13.996

Background: Chronic conditions comprise a significant amount of healthcare utilization. For example, people with chronic diseases account for 51% of family physician encounters. Therefore, diagnostic algorithms based on comprehensive clinical records could be a rich resource for clinicians, researchers and policy-makers. However, limitations such as misclassification warrant the need for examining the accuracy of these algorithms. Purpose: To investigate and enhance the accuracy of the diagnostic algorithms for five chronic diseases in the Canadian Primary Care Sentinel Surveillance Network. Methods: DESIGN: A validation study using primary chart abstraction. SETTING: A stratified random sample of 350 patient charts from Kingston practice-based research network. OUTCOME MEASURES: Sensitivity and specificity for the diagnostic algorithms. ANALYSIS: A multiple logistic regression model along with the receiver operating characteristic curve was employed to identify the algorithm that maximized accuracy measures. Results: The sensitivities for diagnostic algorithms were 100% (diabetes), 83% (hypertension), 45% (Osteoarthritis), 41% (COPD), and 39% (Depression). The lowest specificity was 97% for depression. A data-driven logistic model and receiver-operating characteristic curve improved sensitivity for identifying hypertension patients from 83% to 88% and for osteoarthritis patients from 45% to 81% with areas under the curve of 92.8% and 89.8% for hypertension and osteoarthritis, respectively. Conclusion: The diagnostic algorithms for diabetes and hypertension demonstrate adequate accuracy, thus allowing their use for research and policy-making purposes. A multivariate logistic model for predicting osteoarthritis diagnosis enhanced sensitivity while maintaining high specificity. This approach can be used towards further refining the diagnostic algorithms for other chronic conditions. / Thesis (Master, Community Health & Epidemiology) -- Queen's University, 2012-07-23 17:58:11.302

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