Disruption Of Daily Activities Research Articles

Efficiency of arthrocentesis treatment for different temporomandibular joint disorders

This study was performed to determine whether arthrocentesis therapy has different outcomes in three groups of patients with different temporomandibular disorders (TMDs). A clinical trial was conducted including 45 patients with 45 unilaterally affected joints divided into three groups (n=15): osteoarthritis (OA), disc displacement with reduction (DDWR), and disc displacement without reduction (DDWoR). All patients underwent the same arthrocentesis treatment protocol. The outcome variables, including visual analogue scale evaluations and measurements of mandibular motion (in millimetres), were recorded at baseline and at 1 and 6 months postoperative. Inter-group assessments showed significant short-term differences in joint sounds (P=0.016) and significant long-term differences in masticatory efficiency (P=0.046) and protrusive movement (P=0.048). The estimation of mean changes between baseline and long-term follow-up revealed significant differences in joint sounds (P<0.001), disruption in daily activities (P=0.002), maximum mouth opening (P=0.008), and protrusive movement (P=0.002) between the groups. Arthrocentesis therapy may be useful to improve clinical symptoms and range of mandibular movement in patients with all three types of TMD. However, the benefit of arthrocentesis may be greater for patients with DDWoR than for those in the other groups.

Patient perception, satisfaction and cosmetic results of platelet-rich plasma in the treatment of acne scars: a patient-reported outcome of a non-surgical management

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; Acne is a common skin condition of the pilosebaceous unit that is prevalent up to 80% of the adolescent population. Permanent, disfiguring scar is an unfortunate complication due to abnormal resolution following the damage during acne inflammation. Those troubling noticeable scars may lead to not only cosmetic problems but also psychological and social consequences which could impair the quality of life including diminished self-esteem and disruption of daily activities. We aimed to discuss our results of PRP procedure in the treatment of acne scars using scales based on patient satisfaction, perception and the quality of life.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; This study included 11 patients suffering from post-acne scars who underwent 3 sessions of platelet-rich plasma injection. The outcome was determined by the difference in pre- and post- procedure FACE-Q modules, dermatology life quality index (DLQI) and body image questionnaire (BIQ) which were designed as patient-reported outcome instrument to evaluate the unique outcomes of patients undergoing facial cosmetic procedures.&lt;strong&gt;&lt;/strong&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; Overall satisfaction with outcome was 77.18±8.30 (range 63–87). No major complications such as hyper-/hypopigmentation, scar formation, infections, skin necrosis, nodulation, fibrosis, or calcification were recorded. All patients developed ecchymosis and edema in the treated area and all were improved during follow-up. The patient-reported FACE-Q satisfaction, FACE-Q quality of life, DQLI and BIQ scores of pre- and post- procedure showed statistically significant improvement (&amp;lt;0.05).&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; PRP can increase the quality of life in patients with acne scars in terms of social and psychological function without large damage to the skin.&lt;/p&gt;

Premenstrual syndrome in Anand District, Gujarat: A cross-sectional survey.

Aim of Study:We assessed the prevalence and severity of premenstrual syndrome (PMS) in adolescents and identified probable associations of PMS and premenstrual dysphoric disorder (PMDD) with age, locality, food habits, obesity, stress, genetic influence, menorrhagia and dysmenorrhoea.Methods:Cross-sectional study in schools of Anand District in State of Gujarat, India. We conducted the study in 1702 girls in the age group of 8–23 years who had achieved menarche.Main Outcome Measures:Prevalence of PMS and PMDD using the self-administered Premenstrual Symptoms Screening Tool for Adolescents (PSST-A).Results:The prevalence of moderate to severe PMS was 19.3% and PMDD was 4.6%. Almost all (94.8%) girls had at least one PMS symptom with 65.7% having moderate to severe symptoms. We found dysmenorrhoea in 71.2% girls and menorrhagia in 15.2%. Physical symptoms were reported by 53.5%, disruption of daily activities by 41.7%, while 25.1% had to miss school/college. Majority (81.3%) felt that PMS was a normal part of menstruation and 53.0% reported moderate to severe stress. Multivariate logistic regression model revealed older age, dysmenorrhoea, menorrhagia, high levels of stress and PMS in mother to be significantly associated with PMS. In addition to these, lower age at menarche and junk food significantly contributed to PMDD.Conclusion:Prevalence of moderate to severe PMS and PMDD in this population falls within the range reported elsewhere. PMS/PMDD affects the lives of many, significantly reducing their efficiency and worsening the quality of life.

Association of Morning Distribution of Real-Time Indoor Ultrafine Particulate Matter (PM2.5) Concentrations with Daily Activity Patterns of Asthmatics in South Korea : Preliminary Study Results

Asthmatics may be more susceptible to ultrafine particulate matter (PM2.5), due to its large number of chemicals attached on it, compared to ordinary population. Acute exacerbations of RA can lead to such severe airway obstruction that mechanical ventilation is required as a lifesaving measure. Thus, knowing the risk factors for RA is important for minimizing both the need for emergency medical interventions and disruption of daily activities. And depending on patients&amp;#8217; degree of symptoms, acute exposure to PM2.5 can lead to severe airway obstruction. Indoor PM2.5 may be the mixture of the influx of outside air and indoor activities. Thus, understanding of the association of indoor activity pattern and variation of indoor PM2.5 level is important. The purpose of this study was to obtain the distribution of hourly indoor PM2.5 concentration in asthmatics&amp;#8217; houses, and to evaluate its association with their daily activity pattern. From November 2016 to November 2017, a real-time PM2.5 concentrations were measured at the livingroom of each asthmatic&amp;#8217;s house (n&amp;#61;30) for 3 weeks with 1 minute intervals. At the same time, self-reported daily activity patterns, i.e., hourly proportion(%) of cooking activities, were also recorded every hour over 3 weeks for each patient. The median concentration of PM2.5 at the morning cooking time (7:00 to 10:00 am) was 30.0 ug/m3. The distribution pattern of hourly proportion of cooking activities were similar to that of PM2.5 concentration level, but there was 1 or 2 hour time lag. Spearman correlation coefficient between the hourly proportion of cooking activities and the PM2.5 concentration was 0.67 and 0.65 (p&amp;#61;0.072 and 0.078) at child asthmatics&amp;#8217; houses and 0.7 and 0.87 (p&amp;#61;0.233 and 0.058 for 8 O&amp;#8217;clock and 9 O&amp;#8217;clock) at adult asthmatics&amp;#8217; houses. Our real-time monitoring results demonstrated that variation of indoor morning PM2.5 concentration level was potentially associated with indoor cooking activity patterns at home.

Predictive Factors for Developing Chronic Pain After Total Knee Arthroplasty

Total knee arthroplasty offers substantial improvements for patients as measured by functional status and quality of life; however, 8% to 34% of patients experience chronic postsurgical pain following surgery (CPSP). In addition to disruption in daily activities of life caused by the pain itself, CPSP has been associated with an overall reduction in quality of life following surgery. Risk factors for CPSP can be broadly defined as potentially modifiable or unlikely modifiable. Unlikely modifiable risks include gender, age, medical comorbidities, and socioeconomic status. Potentially modifiable risks include perioperative pain, physical function, psychological state, surgical factors, and possibly genomics. Understanding risks and the magnitude of their effect on outcomes such as CPSP is desirable because interventions designed to affect these factors may be able to dramatically improve outcomes.

KNEE FLEXION EXTENSION AND STRENGTHENING (FELS) EXERCISE TO PAIN INTENSITY IN KNEE OSTEOARTHRITIS PATIENTS

Introduction. Osteoarthritis (OA) is a degenerative disease due to the thinning of the joint cartilage, mostly in the knee joint (89.91%) with the pain manifestation. If the pain is not managed, it could lead to the limitation of movement and disruption of daily activities. Having physical exercise regularly could reduce pain. The purpose of study was to determine the effect of knee fl exion extension and strengthening (FELS) exercise in reducing pain intensity. Methods. This was a quasi-experimental study with pretest-posttest control randomized design, where 70 respondents were recruited and consisted of 53 in intervention and 17 in control group. Result. The statistical analysis used ordinal regression revealed (1) FELS exercise was effective in reducing pain intensity (p = 0.013); (2) a signifi cant difference in pain intensity before and after FELS exercise (p = 0.000); (3) a signifi cant difference of pain intensity in the intervention group compared to the control group (p = 0.004); (4) effect of other activities in reducing pain intensity (p = 0.042). While the factors of age, gender, pain experience, anxiety and support system were not signifi cantly effective in reducing pain. Discussion. FELS exercise was helpful in reducing pain intensity in patients with knee osteoarthritis. It was then suggested to OA patients are requested to perform regular FELS exercise while the families are keep on giving support to the patient to do FELS exercise.Keywords: Knee fl exion extension, strengthening exercise, pain intensity, knee OA

Robust Detection of Audio-Cough Events Using Local Hu Moments.

Telehealth has shown potential to improve access to healthcare cost-effectively in respiratory illness. However, it has failed to live up to expectation, in part because of poor objective measures of symptoms such as cough events, which could lead to early diagnosis or prevention. Considering the burden that these conditions constitute for national health systems, an effort is needed to foster telehealth potential by developing low-cost technology for efficient monitoring and analysis of cough events. This paper proposes the use of local Hu moments as a robust feature set for automatic cough detection in smartphone-acquired audio signals. The final system feeds a k-nearest-neighbor classifier with the extracted features. To properly evaluate the system in a diversity of noisy backgrounds, we contaminated real cough audio data with a variety of sounds including noise from both indoor and outdoor environments and noncough events (sneeze, laugh, speech, etc.). The created database allows flexible settings of signal-to-noise ratio levels between background sounds and events (cough and noncough). This evaluation was complemented using real patient data from an outpatient clinic. The system is able to detect cough events with high sensitivity (up to 88.51%) and specificity (up to 99.77%) in a variety of noisy environments, overcoming other state-of-the-art audio features. Our proposal paves the way for ubiquitous cough monitoring with minimal disruption in daily activities.

Ready or not, here they come! Care as a material and organizational practice in ECEC for children under two

Caring relationships between children and educators in early childhood education and care centers become in an array of entanglements with spaces, materials, and the organization of time. An exclusively dyadic understanding of care is insufficient in the material, institutional, pedagogic, and professional environment of early childhood education and care. This article reports on an ethnographic study of material and organizational professional care practices in a high-functioning full-day early childhood education and care center for children less than 3 years in Norway. Drawing on Tronto and Fisher’s feminist care ethics and a posthuman perspective, the study’s aim was to gain knowledge about how early childhood educators perform care as a professional practice beyond the dyad. The article explores care through the lens of a disruption in daily activities, when the laying down of new flooring in the center produced changes in the otherwise highly functioning caring environment. Changes in the availability of materials and the organization of space and time are analyzed using Malabou’s concept of plasticity. The effects of the agentic force of material changes on the caring practices of the center, despite the already strong and established dyadic relationships between the children and educators, are discussed.

The socio-economic burden of human African trypanosomiasis and the coping strategies of households in the South Western Kenya foci.

IntroductionHuman African Trypanosomiasis (HAT), a disease caused by protozoan parasites transmitted by tsetse flies, is an important neglected tropical disease endemic in remote regions of sub-Saharan Africa. Although the determination of the burden of HAT has been based on incidence, mortality and morbidity rates, the true burden of HAT goes beyond these metrics. This study sought to establish the socio-economic burden that households with HAT faced and the coping strategies they employed to deal with the increased burden.Materials and methodsA mixed methods approach was used and data were obtained through: review of hospital records; structured interviews (152); key informant interviews (11); case narratives (12) and focus group discussions (15) with participants drawn from sleeping sickness patients in the south western HAT foci in Kenya. Quantitative data were analysed using descriptive statistics while qualitative data was analysed based on emerging themes.ResultsSocio-economic impacts included, disruption of daily activities, food insecurity, neglect of homestead, poor academic performance/school drop-outs and death. Delayed diagnosis of HAT caused 93% of the affected households to experience an increase in financial expenditure (ranging from US$ 60–170) in seeking treatment. Out of these, 81.5% experienced difficulties in raising money for treatment resorting to various ways of raising it. The coping strategies employed to deal with the increased financial expenditure included: sale of agricultural produce (64%); seeking assistance from family and friends (54%); sale/lease of family assets (22%); seeking credit (22%) and use of personal savings (17%).Conclusion and recommendationCoping strategies outlined in this study impacted negatively on the affected households leading to further food insecurity and impoverishment. Calculation of the true burden of disease needs to go beyond incidence, mortality and morbidity rates to capture socio-economic variables entailed in seeking treatment and coping strategies of HAT affected households.

Characteristics of headaches in Japanese elementary and junior high school students: A school-based questionnaire survey

PurposeFew studies have investigated pediatric headaches in Japan. Thus, we examined the lifetime prevalence and characteristics of headaches among elementary and junior high school students in Japan. MethodsIn this school-based study, children aged 6–15years completed a questionnaire based on the diagnostic criteria of the International Classification of Headache Disorders-3β to assess headache characteristics and related disability. ResultsOf the 3285 respondents, 1623 (49.4%) experienced headaches. Migraine and tension-type headaches (TTH) were reported by 3.5% and 5.4% of elementary school students, respectively, and by 5.0% and 11.2% of junior high school students. Primary headaches increased with age. Compared with TTH sufferers, the dominant triggers in migraine sufferers were hunger (odds ratio=4.7), sunny weather (3.3), and katakori (neck and shoulder pain) (2.5). Compared with TTH, migraine caused higher headache-related frustration (P=0.010) as well as difficulty concentrating (P=0.017). Migraine-related disability was greater among junior high school students (feeling fed up or irritated, P=0.028; difficulty concentrating, P=0.016). TTH-related disability was also greater among junior high school students (feeling fed up or irritated, P=0.035). Approximately half of the students who complained of headache-related disability were not receiving medical treatment. ConclusionThis is the first detailed study of headaches in Japanese children to include elementary school students. Nearly 50% of the school children reported headaches and the disruption of daily activities caused by migraine was higher among junior high students than elementary school students.

An analysis of depressive symptoms in stroke survivors: verification of a moderating effect of demographic characteristics

BackgroundThe rehabilitation of depressed stroke patients is more difficult because poststroke depression is associated with disruption of daily activities, functioning, and quality of life. However, research on depression in stroke patients is limited. The aim of our study was to evaluate the interaction of demographic characteristics including gender, age, education level, the presence of a spouse, and income status on depressive symptoms in stroke patients and to identify groups that may need more attention with respect to depressive symptoms.MethodsWe completed a secondary data analysis using data from a completed cross-sectional study of people with stroke. Depression was measured using the Center for Epidemiologic Studies Depression Scale.ResultsIn this study, depressive symptoms in women living with a spouse were less severe than among those without a spouse. For those with insufficient income, depressive symptom scores were higher in the above high school group than in the below high school group, but were lower in patients who were living with a spouse than in those living without a spouse.ConclusionAssessing depressive symptoms after stroke should consider the interaction of gender, economic status, education level, and the presence/absence of a spouse. These results would help in comprehensive understanding of the importance of screening for and treating depressive symptoms during rehabilitation after stroke.

Ultrasound-guided Radiofrequency Lesioning of the Articular Branches of the Femoral Nerve for the Treatment of Chronic Post-arthroplasty Hip Pain

Background: Total hip arthroplasty (THA) is a common surgical treatment for several conditions of the hip. While the majority of patients obtain satisfactory results, many develop chronic postarthroplasty hip pain that can be difficult to treat. Objective: We evaluate the effectiveness of cooled (60°C) radiofrequency lesioning of the articular branches of the femoral nerve (ABFN) as a minimally invasive treatment for patients suffering from chronic post-arthroplasty hip pain. This treatment has never been described previously in this population. Study Design: Case report. Setting: Center for Pain Medicine, Massachusetts General Hospital, Harvard Medical School. Method: A 59-year-old woman with long-standing osteoarthritis of the right hip who underwent primary total hip arthroplasty and presented with chronic post-arthroplasty hip pain. Intervention: Cooled (60°C) radiofrequency lesioning of the ABFN under ultrasound guidance. Outcome Measure: Functional ability and numeric rating scale (NRS) scores at rest and with activity. Results: Prior to intervention, the patient reported severe disruption in daily activities, sleep, and relationships; NRS scores at rest and with activity were 4/10 and 10/10, respectively. At 4 weeks following intervention, the patient reported significant improvement in functional ability and NRS scores decreased to 1/10 and 2/10, respectively. At 6 months, the patient’s NRS scores at rest and with activity were 0/10 and 1/10, respectively. At 24-month follow-up, the patient continued to endorse significant pain relief with NRS scores at rest and with activity of 0 – 1/10 and 1 – 2/10, respectively. There were no side effects or complications including motor weakness, sensory loss, and neuralgias. Limitations: Although the patient obtained good results from the intervention, the description of the study is from a single case report. Further study is necessary to investigate the widespread use of this technique and its outcomes. Conclusion: Cooled (60°C) radiofrequency lesioning of the ABFN under ultrasound guidance is both an effective and minimally invasive intervention for chronic post-arthroplasty hip pain. Key words: Radiofrequency lesioning, articular branches, femoral nerve, post-arthoplasty, total hip arthoplasty, hip pain, chronic pain

Empirical evaluation of a theory of stigma in children and adolescents with sickle cell disease

Background. There is limited research in self-perceived stigma among children and adolescents with sickle cell disease (SCD). We applied the concept of “stigma dimensions” to measure the predictors of self-perceived stigma in young people with SCD. Objective . In accordance with “stigma dimensions”, we hypothesized that young people with visible clinical features of SCD (jaundice and leg ulcers), and greater interference with their daily lives and social activities (frequent hospital admissions and school absences) would have increased self-perceived stigma. Patients and methods. 93 children and adolescents with SCD aged 10-19 years in the UK completed questionnaires on self-perceived stigma. Socio-demographic and clinical characteristics of SCD were also obtained. Young people were recruited from paediatric haematology or sickle cell outpatient clinics in London and the Sickle Cell Society (National Charity). Participants with all types of SCD were included; exclusions were those who were not fluent in English or unwell at the time of the survey. Results. Mean age was 14.2 years (SD 2.1 years) with 51% males and 49% females. 66% of the respondents had one or more hospital admissions in the preceding year, 46% were jaundiced, and 5% had leg ulcers. Consistent with our hypothesis and “stigma dimensions”, regression analysis showed that those who experienced more disruption in their daily lives (frequent hospital admission and less school attendance) had increased self-perceived stigma. However, the presence of leg ulcers or jaundice was not associated with increased self-perceived stigma. Conclusion . Interventions in SCD that effectively moderate disruption of daily activities and improve quality of life could help reduce self-perceived stigma among young people with SCD.

Establishment and Characterization of UTI and CAUTI in a Mouse Model

Urinary tract infections (UTI) are highly prevalent, a significant cause of morbidity and are increasingly resistant to treatment with antibiotics. Females are disproportionately afflicted by UTI: 50% of all women will have a UTI in their lifetime. Additionally, 20-40% of these women who have an initial UTI will suffer a recurrence with some suffering frequent recurrences with serious deterioration in the quality of life, pain and discomfort, disruption of daily activities, increased healthcare costs, and few treatment options other than long-term antibiotic prophylaxis. Uropathogenic Escherichia coli (UPEC) is the primary causative agent of community acquired UTI. Catheter-associated UTI (CAUTI) is the most common hospital acquired infection accounting for a million occurrences in the US annually and dramatic healthcare costs. While UPEC is also the primary cause of CAUTI, other causative agents are of increased significance including Enterococcus faecalis. Here we utilize two well-established mouse models that recapitulate many of the clinical characteristics of these human diseases. For UTI, a C3H/HeN model recapitulates many of the features of UPEC virulence observed in humans including host responses, IBC formation and filamentation. For CAUTI, a model using C57BL/6 mice, which retain catheter bladder implants, has been shown to be susceptible to E. faecalis bladder infection. These representative models are being used to gain striking new insights into the pathogenesis of UTI disease, which is leading to the development of novel therapeutics and management or prevention strategies.

Establishment and Characterization of UTI and CAUTI in a Mouse Model.

Urinary tract infections (UTI) are highly prevalent, a significant cause of morbidity and are increasingly resistant to treatment with antibiotics. Females are disproportionately afflicted by UTI: 50% of all women will have a UTI in their lifetime. Additionally, 20-40% of these women who have an initial UTI will suffer a recurrence with some suffering frequent recurrences with serious deterioration in the quality of life, pain and discomfort, disruption of daily activities, increased healthcare costs, and few treatment options other than long-term antibiotic prophylaxis. Uropathogenic Escherichia coli (UPEC) is the primary causative agent of community acquired UTI. Catheter-associated UTI (CAUTI) is the most common hospital acquired infection accounting for a million occurrences in the US annually and dramatic healthcare costs. While UPEC is also the primary cause of CAUTI, other causative agents are of increased significance including Enterococcus faecalis. Here we utilize two well-established mouse models that recapitulate many of the clinical characteristics of these human diseases. For UTI, a C3H/HeN model recapitulates many of the features of UPEC virulence observed in humans including host responses, IBC formation and filamentation. For CAUTI, a model using C57BL/6 mice, which retain catheter bladder implants, has been shown to be susceptible to E. faecalis bladder infection. These representative models are being used to gain striking new insights into the pathogenesis of UTI disease, which is leading to the development of novel therapeutics and management or prevention strategies.

Juvéderm volbella with lidocaine for lip and perioral enhancement: a prospective, randomized, controlled trial.

Background:Juvéderm Volbella with Lidocaine is a new hyaluronic acid dermal filler.Methods:In this prospective, randomized, multicenter study, 280 subjects desiring lip volume enhancement were treated with Juvéderm Volbella with Lidocaine or Restylane-L. Investigators rated treatment outcomes on Allergan’s Lip Fullness Scale, Perioral Lines Scale, and Oral Commissures Severity Scale. A blinded independent central reviewer (ICR) assessed 3-dimensional digital photographs using these scales. Subjects evaluated outcomes using the FACE-Q Recovery Early Life Impact and Recovery Early Symptoms modules. The primary endpoint was noninferiority of Juvéderm Volbella with Lidocaine to Restylane-L based on responder rate (percentage of subjects with ≥1-point Lip Fullness Scale improvement at month 3 ICR assessment vs baseline).Results:Juvéderm Volbella with Lidocaine was noninferior to Restylane-L. Although responder rates based on ICR assessments of lip fullness, perioral lines, and oral commissures did not differ between treatments, investigator assessments showed significant improvements in perioral lines and oral commissures with Juvéderm Volbella with Lidocaine vs Restylane-L (P ≤ 0.029). Subjects treated with Juvéderm Volbella with Lidocaine had higher mean FACE-Q scores on day 1 (P ≤ 0.001), indicating less disruption of daily activities. Mean change in lip volume from baseline to day 1 was smaller in the Juvéderm Volbella with Lidocaine group (but similar between treatments on day 14), indicating less acute swelling. Severe injection site responses occurred less frequently with Juvéderm Volbella with Lidocaine.Conclusions:Juvéderm Volbella with Lidocaine is effective for lip enhancement, improves perioral lines and oral commissures, and results in less short-term swelling and disruption in daily activities than Restylane-L.

The Impact of Demand/Withdraw Patterns on Health in Emerging Adults’ Serial Arguments with Parents

Reoccurring argumentative episodes are known as serial arguments. Prior research on serial arguing has shown that engaging in demand/withdraw patterns during episodes with a romantic partner is detrimental to one's physical and mental health. This study asked emerging adults to report on a serial argument with their parents. Emerging adult-demand/parent-withdraw was related to a disruption in one's daily activities due to health problems, and this relationship was mediated by the degree to which the participants felt hyperaroused. Contrary to our hypothesis, parent-demand/emerging adult-withdraw also was positively related to a disruption in daily activities. This relationship also was mediated by hyperarousal.

Postburn pruritus: A practical review

The incidence of postburn pruritus is reported to vary between 80% and 100% and the persistence of itching leads to disabling symptoms such as sleep disturbance, anxiety, and disruption of daily activities. Recently, a few small randomized controlled trials by investigators have focused our attention to the neurobiology and molecular mechanisms of the postburn pruritus and the role of centrally acting agents in its treatment. It is now recognized that the central nervous system develops aberrant autonomous activity that causes maintenance of pruritic symptoms into a chronic state. This practical review on the topic aims to rationalize and simplify the current treatment options, through emerging and available evidence, to enable the physician to make an even better informed choice. While antihistamines and massage therapy will continue to be effective first-line strategy for most clinicians, the promising results in controlled studies obtained with gabapentin/pregabalin to ameliorate pruritic symptoms in a predictable fashion in burns patients have caused a paradigm shift in the therapeutic approach. Tailoring the drug therapy to the severity of symptoms leads to more successful therapy of this vexing malady and current evidence supports the use of gabapentin/pregabalin in patients with moderate to severe postburn pruritus (visual analog scale score >5) as the first line, even if as an off label indication. Other treatment modalities like doxepin, ondansetron, or transcutaneous electrical nerve stimulation may have applications on a case to case basis. However, massage therapy should continue to be an adjunct with all other modalities.

What influences patients with osteoarthritis to consult their GP about their symptoms? A narrative review.

BackgroundOsteoarthritis (OA) is a common cause of disability and consultation with a GP. However research suggests the majority of sufferers choose not to consult their GP regarding their symptoms. Understanding the reasons for consulting is central to optimising patient outcomes. This review aims to summarise existing literature to identify what influences patients with OA to consult their GP.MethodsDue to the diversity of both qualitative and quantitative research that has addressed this research question a narrative review of literature has been conducted, backed up by a systematic literature search.ResultsNineteen papers were identified describing influences on consulting behaviour in patients with likely OA. Health beliefs, such as perceiving OA as an inevitable part of older age about which nothing can be done, in addition to perceiving a negative attitude of the GP, are disincentives to consulting. Severity of pain and disruption of daily activities are important influences towards consultation. Social issues such as the availability of support networks are also likely to be influential. Evidence is lacking about the impact of multi-morbidity on consulting behaviour.ConclusionsPain and disruption of activities appear to push towards consulting and negative attitudes regarding OA (from either the patient or GP) appear to be disincentives to consulting. Findings are limited by estimates of consultation frequency and research involving observation of consultations may improve understanding of these issues. Specifically, further research may address how pain and disrupted function are addressed and if negative attitudes are evident in the consultation.

465 Premenstrual Syndrome in Adolescents of Anand - Cross-Sectional Study from India using Premenstrual Symptoms Screening Tool for Adolescents (Psst-A)

Background and AimsPremenstrual syndrome (PMS) disrupts lives of girls who otherwise would lead more productive lives. We assessed prevalence and severity of PMS in adolescents of Anand, a small town...