Degree Of Discomfort Research Articles

Determinants of Self-reported Health Outcomes in Adrenal Insufficiency: A Multisite Survey Study.

Current evidence on determinants of adverse health outcomes in patients with adrenal insufficiency (AI) is scarce, especially in regards to AI subtypes. To determine predictors of adverse outcomes in different subtypes of AI. Cross-sectional survey study at 2 tertiary centers. A total of 696 patients with AI: primary AI (PAI, 42%), secondary AI (SAI, 32%), and glucocorticoid-induced AI (GIAI, 26%). Patient-centered questionnaire. Patients' knowledge, self-management of AI, self-perceived health, and adverse outcomes. The incidence rate of adrenal crisis was 24/100 patient-years with 44% experiencing at least 1 adrenal crisis since diagnosis (59% in PAI vs 31% in SAI vs 37% in GIAI, P < .0001). All patients described high degrees of discomfort with self-management and receiving prompt treatment. Patients with PAI were most likely to develop adrenal crises (adjusted OR 2.8, 95% CI 1.9-4.0) despite reporting better self-perceived health (adjusted OR 3.3, 95% CI 2.1-5.3), understanding of their diagnosis (89% vs 74-81% in other subtypes, P = .002), higher comfort with self-management (62% vs 52-61% in other sub types, P = .005), and higher likelihood to receive prompt treatment for adrenal crises in the emergency department (42% vs 19-30% in other subtypes, P < .0001). Patients with AI reported high degrees of discomfort with self-management and treatment delays when presenting with adrenal crises. Despite better self-perceived health and understanding of diagnosis, patients with PAI experienced the highest frequency of adrenal crises. A multidimensional educational effort is needed for patients and providers to improve the outcomes of all subtypes of AI.

The additive effects of exercise and essential amino acid on muscle mass and strength in community-dwelling older Japanese women with muscle mass decline, but not weakness and slowness: a randomized controlled and placebo trial.

Exercise and essential amino acid supplementation have been separately shown to improve muscle mass in elderly people, however, the combined, added effects of both interventions have yielded inconsistent results on muscle mass, strength, and physical function improvement. To investigate the additive effects of exercise and essential amino acid supplementation on muscle mass, strength, and walking ability in older Japanese women with muscle mass decline, but not weakness and slowness. One hundred thirty women over 65years of age were defined as having muscle decline and randomly assigned into two groups; exercise and amino acid supplementation (n = 65) or exercise and placebo supplementation (n = 65). The exercise group attended a 60-min comprehensive training program once a week and were encouraged to perform a home-based exercise program. The amino acid or placebo group ingested a 3g supplement daily for 3-month. Body composition was determined by bioelectrical impedance analysis. Interview data and functional fitness measurements, such as muscle strength and walking ability were collected at baseline and after the 3-month intervention. There were no significant group × time interactions in primary outcomes such as muscle mass and strength. However, interactions were observed in the degree of low back discomfort (P = 0.014). Percent change of low back discomfort was significantly greater in exercise + amino acid group compared with exercise + placebo group. The combination of exercise and amino acid supplementation had a beneficial effect on low back discomfort. However, additional effects were not observed in primary outcomes including muscle mass and strength in this population.

Pooled saliva samples for COVID-19 surveillance programme

Health-care staff are at increased risk of COVID-19, thus putting themselves, their families, and their patients at risk. This increased risk negatively affects patient and staff mortality and morbidity (physical and mental). Furthermore, the need to isolate if either infected or exposed to severe acute respiratory syndrome coronavirus disease 2 (SARS-CoV-2) limits the ability of the UK NHS to deliver care when staff are absent from work. This potentially represents one of the biggest threats to providing timely health care as the second wave of SARS-CoV-2 infection develops. Locally, approximately one fifth of our patient-facing respiratory physicians were infected during the first COVID-19 surge in the UK (March–July, 2020), and one third have had to isolate with symptoms or symptomatic contacts at least once. Local ward-based outbreaks have also occurred. Hence, there is a clear need for a robust COVID-19 surveillance system for NHS staff, enabling both staff and patients to have confidence that the risk of workplace nosocomial infection is as low as it can be.

Modelling discomfort: How do drivers feel when cyclists cross their path?

Many cyclist fatalities occur on roads when crossing a vehicle path. Active safety systems address these interactions. However, the driver behaviour models that these systems use may not be optimal in terms of driver acceptance. Incorporating explicit estimates of driver discomfort might improve acceptance. This study quantified the degree of discomfort experienced by drivers when cyclists crossed their travel path. Participants were instructed to drive through an intersection in a fixed-base simulator or on a test track, following the same experimental protocol. During the experiments, three variables were controlled: 1) the car speed (30, 50 km/h), 2) the bicycle speed (10, 20 km/h), and 3) the bicycle-car encroachment sequence (bicycle clears the intersection first, potential 50 %-overlap crash, and car clears the intersection first). For each trial, a covariate, the car’s time-to-arrival at the intersection when the bicycle appears (TTAvis), was calculated. After each trial, the participants were asked to report their experienced discomfort on a 7-point Likert scale ranging from no discomfort (1) to maximum discomfort (7). The effect of the three controlled variables and the effect of TTAvis on drivers’ discomfort were estimated using cumulative link mixed models (CLMM). Across both experimental environments, the controlled variables were shown to significantly influence discomfort. TTAvis was shown to have a significant effect on discomfort as well; the closer to zero TTAvis was (i.e., the more critical the situation), the more likely the driver reported great discomfort. The prediction accuracies of the CLMM with all three controlled variables and the CLMM with TTAvis were similar, with an average accuracy between 40 and 50 % for the exact discomfort level and between 80 and 85 % allowing deviations by one step. Our model quantifies driver discomfort. Such model may be included in the decision-making algorithms of active safety systems to improve driver acceptance. In fact, by tuning system activation times depending on the expected level of discomfort that a driver would experience in such situation, a system is not likely to annoy a driver.

Negative social comparisons and social discomfort in dentofacial deformity: a cross-sectional study.

Patients with severe dentofacial deformities are more susceptible to psychological distress since they are more likely to be emotionally unstable, less sociable and have higher levels of anxiety and neuroticism. The aim of this study was to assess the relationship between dentofacial deformity, negative social comparisons, anxiety and discomfort in social situations due to face appearance in two independent samples. The sample consisted of 136 patients (group A: 90 college students; group B: 46 patients with dentofacial dysmorphosis that require orthognathic surgery). The impact of dentofacial deformity was evaluated through the following questionnaires: scale of social comparison through the appearance of the face and the scale of anxiety and discomfort in social situations due to the appearance of the face. Group B showed higher levels of anxiety and discomfort than the college student's sample (P=0.004). Individuals with dentofacial dysmorphosis presented a greater degree of anxiety and discomfort than individuals without dentofacial dysmorphosis (P=0.002). Finally, skeletal pattern and social comparison predicted anxiety and discomfort in the group A (F [1.88]=7.270; P<0.05], but only social comparison emerged as a significant predictor of anxiety and discomfort in the group B (F [2, 42]=4.463; P<0.05). Patients with dentofacial deformity have higher levels of anxiety and discomfort. This deformity can be reduced with orthodontic-surgical treatment, which can promote improvements in social and interpersonal well-being.

Effect of glucose pretreatment on the effect of rapid rehabilitation surgery in patients undergoing hip replacement

To explore the effect of glucose pretreatment in the rapid rehabilitation surgery of hip replacement patients, and to provide reference for the future clinical treatment. From June 2016 to June 2018, 168 patients (100 males, 68 females) were treated with hip replacement. The patients were divided into control group and observation group, 84 cases in each group, aged 25 to 90 (52.05±5.73) years old. Both groups were treated with the concept of rapid rehabilitation surgery, the control group was given traditional fasting water deprivation before operation, and the observation group was given glucose pretreatment before operation. The levels of fasting blood glucose(FBG), C-peptide, fasting insulin(FINS), IgG, IgM, IgA and total lymphocyte count (TLC) were compared before and after operation, and the sensitivity of thirst, nausea, fatigue, sweating, stomach discomfort, anxiety, hunger and dizziness were compared. All the 168 patients were followed up. There was no significant difference in FBG, C-peptide and fins levels between the observation group and the control group (P>0.05). The levels of FBG, C-peptide and fins in the observation group were higher than those in the control group (P<0.05). There was no significant difference in the serum IgG, IgM, IgA and TLC levels between the observation group and the control group(P>0.05);the serum IgG, IgM, IgA and TLC levels after operation were higher than those before operation, and the observation group was higher than the control group(P<0.05). There was no significant difference in the degree of thirst, nausea, fatigue, sweating and stomach discomfort between the observation group and the control group (P>0.05);the degree of anxiety, hunger and dizziness in the observation group was less than that in the control group (P<0.05). Glucose pretreatment before hip replacement can relieve insulin resistance, improve immunity and change energy storage under fasting, which can be widely used in clinic.

A neural correlate of visual discomfort from flicker.

The theory of “visual stress” holds that visual discomfort results from overactivation of the visual cortex. Despite general acceptance, there is a paucity of empirical data that confirm this relationship, particularly for discomfort from visual flicker. We examined the association between neural response and visual discomfort using flickering light of different temporal frequencies that separately targeted the LMS, L-M, and S postreceptoral channels. Given prior work that has shown larger cortical responses to flickering light in people with migraine, we examined 10 headache-free people and 10 migraineurs with visual aura. The stimulus was a uniform field, 50 degrees in diameter, that modulated with high-contrast flicker between 1.625 and 30 Hz. We asked subjects to rate their visual discomfort while we recorded steady-state visually evoked potentials (ssVEPs) from early visual cortex. The peak temporal sensitivity ssVEP amplitude varied by postreceptoral channel and was consistent with the known properties of these visual channels. There was a direct, linear relationship between the amplitude of neural response to a stimulus and the degree of visual discomfort it evoked. No substantive differences between the migraine and control groups were found. These data link increased visual cortical activation with the experience of visual discomfort.

Multisensory Audiovisual Processing in Children With a Sensory Processing Disorder (II): Speech Integration Under Noisy Environmental Conditions.

Background: There exists a cohort of children and adults who exhibit an inordinately high degree of discomfort when experiencing what would be considered moderate and manageable levels of sensory input. That is, they show over-responsivity in the face of entirely typical sound, light, touch, taste, or smell inputs, and this occurs to such an extent that it interferes with their daily functioning and reaches clinical levels of dysfunction. What marks these individuals apart is that this sensory processing disorder (SPD) is observed in the absence of other symptom clusters that would result in a diagnosis of Autism, ADHD, or other neurodevelopmental disorders more typically associated with sensory processing difficulties. One major theory forwarded to account for these SPDs posits a deficit in multisensory integration, such that the various sensory inputs are not appropriately integrated into the central nervous system, leading to an overwhelming sensory-perceptual environment, and in turn to the sensory-defensive phenotype observed in these individuals.Methods: We tested whether children (6–16 years) with an over-responsive SPD phenotype (N = 12) integrated multisensory speech differently from age-matched typically-developing controls (TD: N = 12). Participants identified monosyllabic words while background noise level and sensory modality (auditory-alone, visual-alone, audiovisual) were varied in pseudorandom order. Improved word identification when speech was both seen and heard compared to when it was simply heard served to index multisensory speech integration.Results: School-aged children with an SPD show a deficit in the ability to benefit from the combination of both seen and heard speech inputs under noisy environmental conditions, suggesting that these children do not benefit from multisensory integrative processing to the same extent as their typically developing peers. In contrast, auditory-alone performance did not differ between the groups, signifying that this multisensory deficit is not simply due to impaired processing of auditory speech.Conclusions: Children with an over-responsive SPD show a substantial reduction in their ability to benefit from complementary audiovisual speech, to enhance speech perception in a noisy environment. This has clear implications for performance in the classroom and other learning environments. Impaired multisensory integration may contribute to sensory over-reactivity that is the definitional of SPD.

Provider-Patient Communication on Pre-Exposure Prophylaxis (Prep) for HIV Prevention: An Exploration of Healthcare Provider Challenges

ABSTRACT Pre-exposure prophylaxis (PrEP) is a once-daily pill prescribed by healthcare providers to protect patients from contracting HIV. Current data suggests that a minority of healthcare providers have ever prescribed it to clinically-eligible patients. The present study employed a social ecological framework to understand the factors that influence providers’ engagement in patient-centered communication regarding PrEP. Semi-structured interviews (N = 20) with physicians, physician assistants, and nurse practitioners working in primary and specialty care practices in Western New York were thematically analyzed to understand provider-based PrEP communication challenges. Although participants never prescribed PrEP, all had clinical experience with patient populations at risk for HIV, such as people who inject drugs, men who have sex with men, transgender women, and people who exchange sex for resources. Results revealed three themes affecting provider engagement in PrEP-related discussions, which emerged across three levels of the social ecological model. At the individual level, challenges affecting provider engagement in patient-centered discussions included lacking PrEP knowledge to educate and counsel patients and discomfort with prescribing PrEP based on its perceived newness. At the interpersonal level, participants expressed varying degrees of discomfort discussing HIV risk behaviors with patients. At the organizational level, providers expressed that time constraints and managing concurrent health conditions were competing clinical priorities. Findings indicate expanding implementation efforts will require multilevel interventions that target potential PrEP-adopting healthcare providers to mitigate the perceived and real challenges surrounding provider-patient communication on PrEP for HIV prevention. Practical implications are discussed.

Selective amplification of ipRGC signals accounts for interictal photophobia in migraine

Second only to headache, photophobia is the most debilitating symptom reported by people with migraine. While the melanopsin-containing intrinsically photosensitive retinal ganglion cells (ipRGCs) are thought to play a role, how cone and melanopsin signals are integrated in this pathway to produce visual discomfort is poorly understood. We studied 60 people: 20 without headache and 20 each with interictal photophobia from migraine with or without visual aura. Participants viewed pulses of spectral change that selectively targeted melanopsin, the cones, or both and rated the degree of visual discomfort produced by these stimuli while we recorded pupil responses. We examined the data within a model that describes how cone and melanopsin signals are weighted and combined at the level of the retina and how this combined signal is transformed into a rating of discomfort or pupil response. Our results indicate that people with migraine do not differ from headache-free controls in the manner in which melanopsin and cone signals are combined. Instead, people with migraine demonstrate an enhanced response to integrated ipRGC signals for discomfort. This effect of migraine is selective for ratings of visual discomfort, in that an enhancement of pupil responses was not seen in the migraine group, nor were group differences found in surveys of other behaviors putatively linked to ipRGC function (chronotype, seasonal sensitivity, presence of a photic sneeze reflex). By revealing a dissociation in the amplification of discomfort vs. pupil response, our findings suggest a postretinal alteration in processing of ipRGC signals for photophobia in migraine.

Эффективность и безопасность феназопиридина в лечении неосложненной инфекции нижних мочевыводящих путей: результаты многоцентрового рандомизированного плацебо-контролируемого клинического исследования

to evaluate the efficiency and safety of phenazopyridine for the treatment of patients with uncomplicated lower urinary tract infection, accompanied by pain. A multicenter double-blind, randomized, placebo-controlled study with parallel groups to evaluate the efficacy and safety of phenazopyridine in patients with acute uncomplicated cystitis was performed. A total of 60 women were divided into two groups of 30 patients. In the main group (average age 32.6+/-7.4 years) phenazopyridine was prescribed (2 tablets of 100 mg p.o., with a total dose of 200 mg, once). In the control group, patients (mean age 35.53+/-8.79 years) received a placebo according to the same scheme. To evaluate the efficiency of treatment, the severity of the main symptoms 6 hours after taking the drug was analyzed. After that, patients started antibiotic therapy. They were followed-up for the next three days. The tolerance of therapy was evaluated by the presence of adverse events. All 30 patients taking phenazopyridine had an improvement after 6 hours, and the most frequent response was "significant improvement" (43.3%). The responses of patients in the main group significantly (p<0.05) differed from responses of patients in the control group. Six hours after taking phenazopyridine/placebo, the severity of all values according to VAS score, including the degree of general discomfort, pain during urination and increased frequency of urination improved significantly in the main group compared to the control group. The average assessment of general discomfort in the main group decreased by 53.4% in comparison with 28.8% in the control group, while the severity of pain during urination and urination frequency decreased by 57.4 vs. 35.9% and 39.6 vs. 27.6%, respectively. An analysis of the time before the complete absence of the general discomfort was performed. In the main group this period of time was significantly less than in the control group (p<0.05). There were no serious adverse events while taking phenazopyridine. Rate of adverse events was comparable between two groups. The results of the study showed that phenazopyridine is an effective and well-tolerated drug for symptomatic therapy in patients with acute uncomplicated cystitis and can be recommended in addition to etiological therapy.

Discomfort of the critically ill paediatric patient and correlated variables

IntroductionThe care of critically ill children is usually invasive and aggressive, requiring numerous traumatic procedures that may cause fear, pain, and discomfort. ObjectivesThe aim of this study was to analyse the level of discomfort of patients admitted to the paediatric intensive care unit of a specialist children's hospital and to determine the sociodemographic and clinical variables that influence the degree of discomfort experienced by critically ill paediatric patients. MethodsWe performed a descriptive observational cross-sectional study that included a total of 311 children with a median age of 5.07 y (interquartile range = 0.9–11.7). A team of 10 paediatric critical care nurses assessed the degree of discomfort once for each shift (morning, afternoon, and night) on 2 successive days using the COMFORT Behavior Scale—Spanish version. ResultsIn total, 49.8% (n = 155) of the patients were free of discomfort (score ≤10 points) vs. 50.2% (n = 156) who experienced discomfort. There was a significant negative correlation between discomfort and the length of stay in days (Rho = 0.16; p = 0.02), that is, the longer the stay, the less discomfort the patient felt. The correlation between age and degree of discomfort was found to be both positive and significant (Rho = 0.230, p < 0.001); the greater the age, the greater the discomfort. In comparison of all children who received analgosedation (n = 205), with discomfort levels of 10.77 ± 2.94, with those who did not receive analgosedation (n = 106), with discomfort levels of 11.96 ± 2.80, we did find a statistically significant difference (χ2 = −4.05; p < 0.001). ConclusionsHalf of the patients admitted to the paediatric intensive care unit experienced discomfort. Age and analgosedation were the two most important variables involved with a high degree of discomfort. Clinical care practices must consider these factors and try to plan activities designed to relieve discomfort in all critically ill paediatric patients.

Biomechanical influences of gait patterns on knee joint: Kinematic & EMG analysis.

As lumbar spinal stenosis commonly occurs between the L2 and L5 segments, hip abductors are easily affected. However, studies regarding the gait pattern in these patients from the coronal plane have not yet been conducted. To determine the effects of lumbar spinal stenosis on the gait pattern (stride width and femorotibial angle) and hip abductor surface electromyography in varied stride widths compared with healthy individuals. Prospective case-control study. Seventeen patients and 20 healthy individuals were enrolled. Each participant completed three gait assessments in their normal gait, adducted gait and abducted gait. The femorotibial angle and surface electromyography signals were measured. Pain scores was used to quantify the degree of discomfort in the gluteal area and medial side of the knee. When the hip abductors' surface electromyography signals were normalized by quadriceps femoris, patients group showed significantly higher activation ratios throughout all gait patterns. Generally, surface electromyography signals and ratios were significantly higher during abducted gait compared with a normal gait. Femorotibial angle became significantly closer to the varus in healthy individuals during abducted gait. When femorotibial angle during normal gait was compared between the two groups, patients group exhibited slightly wider stride width and FTA significantly closer to the varus. Pain scores were significantly higher in the patient group and during abducted gait. Wider stride widths indicated increased relative activation of the hip abductors, closer proximity between femorotibial angle and varus, and increased pain scores for discomfort. The same tendency was observed in patients group when compared with healthy individuals. Widening of stride width in patients group despite abductor weakness suggests that additional muscle recruitment may be needed to maintain balance. Furthermore, such a distinctive gait pattern exerts increased loading on the medial knee, relating to the escalated risk of degenerative knee osteoarthritis.

Physical and Psychological Discomfort Experienced by Hematopoietic Stem-Cell Donors.

This study investigates the types and degrees of physical and psychological discomfort experienced by hematopoietic stem cell donors before, during, and after the donation process in order to provide helpful information for developing education programs that can help donors to cope with their discomforts. One hundred and thirty-one individuals who donated hematopoietic stem cells from 2017 to 2019 were asked to self-report the types and degrees of physical and psychological discomfort they felt in the process, and the results were analyzed using SPSS. All participants donated peripheral blood stem cells; the most commonly reported physical discomfort was myalgia (72.5%), followed by bone pain (62.6%), fatigue (60.3%), and headache (55.0%). Of the donors, 88.5% responded that they experienced psychological discomforts, including fear (44.3%), anxiety (44.3%), stress (39.7%), depression (31.3%), loneliness (31.3%), regret (29.8%), and ambivalence (23.7%). In particular, female donors experienced more discomfort than males in rash (Z = −2.123, p = 0.034), fear (Z = −2.851, p = 0.004), and anxiety (Z = −1.861, p = 0.044). Therefore, it is necessary for healthcare providers and experts to make efforts to educate and help donors to prepare and mitigate their discomfort throughout the donation process, and to strategically manage donors’ well-being by monitoring and evaluating their discomfort levels and providing interventions if necessary.

Trypophobia as an urbanized emotion: comparative research in ethnic minority regions of China.

Trypophobia is a strong emotion of disgust evoked by clusters of holes or round objects (e.g., lotus seed pod). It has become increasingly popular and been studied since 2010s, mainly in the West and Japan. Considering this, trypophobia might be a modern emotion, and hence urbanization possibly plays key roles in trypophobia. To address this issue, we compared the degree of trypophobia between urban and less urban people in China. In an experiment, we asked participants about their degree of discomfort from trypophobic images. The results showed that trypophobia occurred in both groups, although the effect size was larger in urban than less urban people. Moreover, post-experimental interviews and post-hoc analyses revealed that older people in less urban area did not experience as much trypophobia. Our findings suggest that trypophobia links to urbanization and age-related properties.

Randomized placebo controlled study of diclofenac as premedication for endoscopic retrograde cholangiopancreatography

Background: Endoscopic retrograde cholangiopancreatography (ERCP) is a complex procedure which is commonly performed at various centres. It causes considerable amount of pain and discomfort to patients, and various centres have their own protocols regarding its management. Authors aim to study the efficacy of intravenous diclofenac as a premedication to reduce the pain and discomfort during and after ERCP.Methods: This was a randomized placebo-controlled trial evaluating 40 patients. The pain and degree of discomfort was investigated using a 4- point ordinal scale questionnaire.Results: The use of intravenous diclofenac as premedication for ERCP significantly reduces pain and discomfort during and after the procedure.Conclusions: Intravenous diclofenac should be used as a premedication for ERCP procedure as it significantly reduces the pain and discomfort during and after the procedure.

Effectiveness of transcutaneous tibial nerve stimulation at two different thresholds for overactive bladder symptoms in older women: a randomized controlled clinical trial

Objectives:To compare the effectiveness of transcutaneous tibial nerve stimulation (TTNS) at two different current amplitude thresholds (sensory and motor) in terms of urinary habit, symptoms and the degree of discomfort of overactive bladder (OAB) in older women. Study designThis is a randomized, controlled, 3-arm blinded trial. One hundred and one patients attending secondary care with OAB were randomized into one of three groups: group 1, TTNS sensitivity threshold (n = 39); group 2, TTNS motor threshold (n = 33); and control group 3 (n = 29). Main outcome measuresParticipants allocated to groups 1 and 2 had 8 sessions of TTNS for 30 min, twice a week. Group 3 received no intervention. The results measured were the symptoms of overactive bladder (ICIQ-OAB, overall score), bother scales (to indicate the impact of individual symptoms for the patient) and urinary habit (3-day bladder diary). A blind assessor measured outcomes at baseline and 5 weeks after randomization. ResultsAfter five weeks, a statistically significant difference between group 3 (control) and group 1 (TTNS sensitivity threshold) and group 2 (TTNS motor threshold) was observed in the intergroup analysis, but no difference in the outcomes analyzed was detected between the two groups receiving intervention (groups 1 and 2). ConclusionTTNS is effective in the treatment of OAB in older women, with no difference between the sensitivity and motor thresholds. Clinical trial registration numberRegistro Brasileiros de Ensaios Clínicos (RBR-39DZ5V)

A multicenter cross-sectional study on the prevalence of overactive bladder and its impacts on the quality of life in gynecologic outpatients.

ObjectiveThe present study assessed the prevalence of overactive bladder (OAB) symptoms in gynecologic outpatients and the effects of OAB on a patient's quality of life.MethodsThe survey was completed by adult female patients who visited the gynecology clinic for examination or treatment of gynecologic conditions. The subjects who met the exclusion criteria were excluded. The survey included a questionnaire assessing general characteristics, the purpose of the visit, diagnosis, and the presence or absence of OAB. The subjects were asked whether they were under medical treatment for OAB symptoms, and the degree of discomfort in daily activities was evaluated.ResultsIn total, 1,990 female subjects visiting the gynecology clinics of 4 different institutions were recruited. On OAB Symptom Score, 188 subjects responded with scores of ≥2 for question #3 (≥1 time(s) weekly). The severity of OAB symptoms was as follows: 345 subjects had mild OAB, 127 subjects had moderate OAB, and 12 subjects had severe OAB. The prevalence of OAB symptoms was 10.30%.ConclusionThe present study confirmed that OAB symptoms are common, with a prevalence of 10.30%. Patients with OAB symptoms frequently neglect to seek medical intervention. Our findings will help inform patients to recognize their condition and seek medical assistance, especially in gynecologic outpatient clinics.

Adventurous tourism: acclimatization problems and decisions in trans-boundary travels.

As the twenty-first-Century Maritime Silk Road tourism program aims on development of new tourist routes with special interest on the polar regions of the Arctic and the Antarctic, as well as the Tibetan Plateau, management of climate risks in travels and their reduction is an important issue for achievement of its goals at national and local levels. Acclimatization is crucial for adventurous tourists, and especially for those traveling to extremely cold and highly elevated environments, when climate and weather in tourist destination differ significantly from those at home. The Acclimatization Thermal Strain Index for Tourism (ATSIT) is designed and used to measure numerically the physiological expenses a traveler pays during the acclimatization process. The purpose of the present study is to examine acclimatization consequences for travels from Beijing, capital of China, to destinations at the Arctic, the Antarctic, and the Tibetan Plateau, collectively referred to as the 3Polar regions, during the main seasons of winter and summer, and back. The results show that acclimatizing to cold involves greater physiological strain than adjustment to heat. Acclimatization load in winter is low for all travels from Beijing and back home. ATSIT projections detect the most harmful degree of discomfort for summer travels from Beijing. The greatest acclimatization impact comes when changing locales from hot and humid to cold and dry climatic conditions, which might cause high and very high physiological strain. Moreover, as many destinations in the 3Polar regions, mostly in the Tibetan Plateau, are located in mountains, a special acclimatization plan is required to weaken the threat of mountain sickness. The results will be helpful for warning stakeholders and the decision makers in the tourism sector of economies, and are expected to be translated into action for the development of proper intervention procedures in health control, to minimize population loss.

Combined Oral Fentanyl Citrate and Midazolam as Premedication for Bone Marrow Aspiration and Biopsy in Patients with Hematological Malignancies: A Randomized, Controlled and Patient-Blinded Clinical Trial

Bone marrow aspiration and biopsy (BMAB) is a painful procedure, and the routinely used local infiltration anesthesia (LIA) with lidocaine is unable to provide pain relief during the most uncomfortable phases. The primary endpoint of the present randomized, patient-blinded trial was to evaluate the efficacy of an opioid and benzodiazepine combination plus LIA (sedoanalgesia) in patients undergoing BMAB for hematological malignancies. The secondary endpoint was the safety of the procedure in an outpatient setting. Ancillary assessments were anticipatory anxiety related to pain recall in the event of re-biopsy, and adequacy of bone tissue harvested. Patients were randomly assigned to one of 2 arms to receive either sedoanalgesic placebo plus LIA (standard group) or oral fentanyl citrate 200 μg plus oral midazolam 5 mg plus LIA (combo group) during BMAB. Pre-procedural anxiety and procedural pain were assessed according to the Numerical Rating Scale (NRS: 0–10), dividing the time of the procedure into five intervals (T0, T1, T2a, T2b and T3) and evaluating the degree of discomfort at each time (T) in both groups. One hundred and sixteen patients were eligible for the study. At T2b (time of biopsy) and T3 (time after biopsy), a significantly lower perception of pain was registered in the combo group. Moreover, there were no significant sedoanalgesia-related side-effects. Finally, histological specimens were higher in quality in the combo group. Sedoanalgesia was highly effective in reducing pain during biopsy, diminished anticipatory anxiety in patients undergoing re-biopsy and led to fewer non-diagnostic specimens being harvested.