Greater Number Of Days Research Articles

Chronic Diseases in the European Union: The Prevalence and Health Cost Implications of Chronic Pain

ABSTRACTThe objective of this study was to assess recent data on the prevalence of chronic pain as part of chronic diseases; the prevalence of chronic pain as a chronic condition in its own right; the costs attributed to chronic pain; and the European Union (EU) policies to addressing chronic pain. Recent literature was reviewed for data on the prevalence and cost implications of chronic pain in the EU. Following on from an earlier systematic review, 8 databases were searched for prevalence and 10 for cost information from 2009 to 2011 and relevant EU organizations were contacted. Ten cost and 29 prevalence studies were included from the 142 full papers screened. The general adult population reported an average chronic pain prevalence of 27%, which was similar to those for common chronic conditions. Fibromyalgia had the highest unemployment rate (6%; Rivera et al., Clin Exp Rheumatol. 2009;27[Suppl 56]:S39–S45) claims for incapacity benefit (up to 29.9%; Sicras-Mainar et al., Arthritis Res Ther. 2009;11:R54), and greatest number of days of absence from work (Rivera et al., Clin Exp Rheumatol. 2009;27[Suppl 56]:S39–S45). Chronic pain is common and the total population cost is high. Despite its high impact, chronic pain as a condition seems to have had little specific policy response. However, there does appear to be sufficient evidence to at least make addressing chronic pain a high priority alongside other chronic diseases as well as to conduct more research, particularly regarding cost.

FLAG ± Idarubicin Compared with 7+3 As Initial Induction for Secondary Acute Myeloid Leukemia: A Single Institution Experience

AbstractAbstract 4330 Objective:Acute myeloid leukemia (AML) that arises from an antecedent hematologic disorder (most often myelodysplastic syndrome, MDS) or that is related to prior chemotherapy (therapy-related AML, t-AML) carries a poor prognosis. Secondary AML occurs in 16–50% of patients with MDS and in <5% of patients previously treated with alkylating agents or topoisomerase II inhibitors. Although 50–70% of patients with de novo AML achieve complete remission (CR) with conventional induction chemotherapy (i.e., cytarabine plus an antracycline, “7+3”), secondary AML is more resistant to such treatment (40–50% CR rate). This has led to the use in some centers of alternative induction regimens such as FLAG (fludarabine, cytarabine, filgrastim) ± idarubicin (Ida) in patients with secondary AML. FLAG ± Ida has been used in patients with relapsed, high-risk MDS and in relapsed/refractory AML, and has an overall CR rate of 33% when used first-line for secondary AML (Clavio M et al. Leuk Lymphoma 2001 Jan; 40(3–4):305-13). There is currently no published data directly comparing 7+3 to FLAG ± Ida in this setting. The present study was undertaken to compare the effectiveness and safety of FLAG ± Ida and 7+3 induction regimens in patients with secondary AML. Methods:A retrospective medical record review was conducted between January 1, 2007 and September 30, 2011 of all patients with AML aged ≥18 years seen at our institution who had either cytogenetic abnormalities commonly associated with MDS or had received prior alkylating agents or topoisomerase II inhibitors, and received either FLAG ± Ida or 7+3 for initial treatment of secondary AML. Patients with chronic myelogenous leukemia in blast crisis were excluded. The primary outcome was the CR rate after induction chemotherapy. Secondary outcomes were 30-day mortality, hospital and intensive care unit (ICU) length of stay (LOS), sources and types of infections, antibiotic usage, and time to neutrophil recovery. Fisher’s exact test was used to compare categorical outcomes (CR, documented infections) between groups. Kaplan-Meier curves and corresponding log-rank tests were used for time-to-event outcomes (hospital stay, ICU days, neutrophil recovery). Results:291 charts were reviewed. 48 patients were found to be eligible and were included in the final analysis. There were no significant differences in baseline demographic characteristics between the two treatment groups, with the exception of AML transformation from MDS being more prevalent in the FLAG ± Ida group (Table I). There were no significant differences in CR rates, 30-day mortality, or hospital LOS between the two groups (Table II). 7+3 was associated with a shorter ICU LOS (0.2 ± 0.7 days vs 2.3 ± 6.8 days, p=0.04) but a greater number of days of antibiotic therapy (56.7 ± 36.3 vs 33.6 ± 31.1, p=0.03), while FLAG ± Ida was associated with a shorter time to neutrophil recovery compared with 7+3 (20.6 ± 4.4 days vs 25.8 ± 7.9 days, p=0.01). Conclusion:In this retrospective study, we found no difference in efficacy between 7+3 and FLAG ± Ida when used as initial induction therapy for patients with secondary AML. Limitations of this study include its retrospective nature, the small sample size and lack of power to detect differences between the groups for both primary and secondary outcomes. A prospectively designed trial is warranted before one regimen can be recommended over the other. [Display omitted] Disclosures:No relevant conflicts of interest to declare.

First-Year Clinical Outcomes in Gender-Mismatched Heart Transplant Recipients

Research indicates that gender mismatch of organ donor and recipient may adversely affect outcomes in heart transplant (HT) patients. However, there is a paucity of literature on gender-mismatched outcomes in patients receiving an HT, and only a few outcomes have been investigated. Objectives were to (1) determine if gender-mismatched HT recipients experienced decreased survival, more posttransplantation complications, and more days of hospitalization during the first postoperative year as compared with gender-matched recipients and (2) identify risk factors for decreased survival. Patients were 347 HT recipients; 21.3% (74) received a heart from the opposite gender. Three groups were compared: group 1: same gender donor-recipient (273 [78.7%]: 36 women, 237 men); group 2: female donor-male recipient (40 [11.5%]); group 3: male donor-female recipient (34 [9.8%]). Ten outcomes were compared with Kaplan-Meier survival analysis, logistic regression, and multivariate analysis of covariance, using a Bonferroni-adjusted P ≤ .005. Risk factors for decreased survival were examined with Cox regression. Gender-mismatched HT patients with a male donor and a female recipient (group 3) had more treated acute rejections and were rehospitalized for more days after HT discharge during the first postoperative year as compared with gender-matched patients. No significant differences were found in 8 other first-year outcomes: number of deaths, survival time, hospital length of stay for HT surgery, cardiac allograft vasculopathy, severe renal dysfunction, new-onset steroid-induced diabetes, nonskin cancers, or the number of infections treated with an intravenous antibiotic. Risk factors for decreased year 1 survival were higher year 1 cholesterol, earlier intravenous-treated infection, severe renal dysfunction, earlier treated rejection, and diabetes (both preexisting and new-onset steroid-induced diabetes). Gender-mismatched HT recipients had more complications due to rejection and higher resource utilization due to more rehospitalization during the first postoperative year as compared with gender-matched recipients. Therefore, these problem areas may provide targets for possible interventions.

Postnatal growth restriction and predictors of nutritional outcome in very low birth weight infants fed human milk and assisted by the Kangaroo Mother Care method

Objetive: The study sought to determine the prevalence of postnatal growth restriction (PNGR) and the predictors of nutritional outcome in very low birth weight (VLBW) infants. Methods: Cross-sectional study conducted in a maternity school between July 2005 and August 2006. One-hundred and twelve VLBW infants were assessed during hospitalization, fed unfortified human milk and assisted by Kangaroo Mother Care. The dependent variables included the number of days required to reach minimum weight and regain birth weight, the percentage of weight loss, and the deterioration of nutritional status. These parameters were converted into a factor termed “nutritional outcome” using factor analysis. Multiple linear regressions were used to identify predictors of nutritional outcome. Results: PNGR was observed in 89.3% of the infants at hospital discharge. The predictors of nutritional outcome were: appropriate-for-gestational-age infants, children of mothers aged ≤20 years old, need for mechanical ventilation, longer stays in the neonatal intensive care unit, and a greater number of days to achieve full enteral nutrition. Conclusion: It is important to know the factors that negatively influence the nutritional outcome of VLBW infants, as these can be modified through the improvement of perinatal care and can reduce PNGR.

The Survival Curve

When vascular compromise is detected, a free flap is immediately taken back to the operating room for attempted salvage. Which factors predict the success or failure of a take-back is currently unknown. A review of free flaps performed at a single institution over the last 10 years was performed. A total of 4965 flaps were identified, and an analysis of factors predicting salvage or failure of first, second, and third take-backs for microvascular complications was performed. Of 4965 flaps, 517 (10.3 percent) required return to the operating room, 157 (3.34 percent) for vascular complications. There were 66 (1.41 percent) total flap failures. Of 157 take-backs, 102 required return once, 44 twice, and 11 three times, with salvage rates of 72, 34, and 27 percent, respectively (p < 0.01). Overall salvage rate was 58 percent. The probability of a flap going back for a second time was 35 percent. Risks for flap failure included thrombotic (35.1 percent) versus mechanical (8 percent) etiology (p = 0.01) and arterial (37.5 percent) or mixed (61.5 percent) versus venous only (25 percent) etiology (p = 0.06). Failure was more likely the greater number of days postoperatively the take-back occurred (p = 0.02). The number of returns to the operating room is inversely proportional to flap salvage. Mechanical and venous etiologies tend to result in salvage and arterial and thrombotic etiologies in failure. Earlier take-backs are more likely to be successful. Knowledge of these predictors of salvage should guide clinical decision making and informed consent. Risk, II.

A Longitudinal Investigation of Posttraumatic Growth in Adult Patients Undergoing Treatment for Acute Leukemia

An acute leukemia diagnosis can be an extremely stressful experience for most patients. Posttraumatic growth (PTG) is positive psychological change experienced following a struggle with highly challenging life circumstances. The current study is the first longitudinal investigation of predictors of PTG and distress in adult acute leukemia patients undergoing induction chemotherapy. Findings suggest that these patients report PTG, and levels of PTG appear to increase over the weeks following leukemia diagnosis and induction chemotherapy. Variables associated with higher total PTG scores over time included greater number of days from baseline, younger age, and greater challenge to core beliefs. Variables associated with higher distress included greater number of days from baseline, greater perceived cancer threat, higher symptom severity, and lower spiritual well-being. Results underscore the critical role that examination of one's core beliefs may play in the development of PTG over time.

Preventing Ventilator-Associated Pneumonia

Ventilator-associated pneumonia (VAP) is among the most common infections in patients requiring endotracheal tubes with mechanical ventilation. Ventilator-associated pneumonia is associated with increased hospital costs, a greater number of days in the intensive care unit, longer duration of mechanical ventilation, and higher mortality. Despite widely accepted recommendations for interventions designed to reduce rates of VAP, few studies have assessed the ability of these interventions to improve patient outcomes. As the understanding of VAP advances and new technologies to reduce VAP become available, studies should directly assess patient outcomes before the health care community implements specific prevention approaches in clinical practice.

Stimulant abuser groups to engage in 12-Step: A multisite trial in the National Institute on Drug Abuse Clinical Trials Network

AimsThe study evaluated the effectiveness of an 8-week combined group plus individual 12-step facilitative intervention on stimulant drug use and 12-step meeting attendance and service. DesignMultisite randomized controlled trial, with assessments at baseline, mid-treatment, end of treatment, and 3- and 6-month post-randomization follow-ups (FUs). SettingIntensive outpatient substance treatment programs. ParticipantsIndividuals with stimulant use disorders (n=471) randomly assigned to treatment as usual (TAU) or TAU into which the Stimulant Abuser Groups to Engage in 12-Step (STAGE-12) intervention was integrated. MeasurementsUrinalysis and self-reports of substance use and 12-step attendance and activities. InterventionGroup sessions focused on increasing acceptance of 12-step principles; individual sessions incorporated an intensive referral procedure connecting participants to 12-step volunteers. FindingsCompared with TAU, STAGE-12 participants had significantly greater odds of self-reported stimulant abstinence during the active 8-week treatment phase; however, among those who had not achieved abstinence during this period, STAGE-12 participants had more days of use. STAGE-12 participants had lower Addiction Severity Index Drug Composite scores at and a significant reduction from baseline to the 3-month FU, attended 12-step meetings on a greater number of days during the early phase of active treatment, engaged in more other types of 12-step activities throughout the active treatment phase and the entire FU period, and had more days of self-reported service at meetings from mid-treatment through the 6-month FU. ConclusionsThe present findings are mixed with respect to the impact of integrating the STAGE-12 intervention into intensive outpatient drug treatment compared with TAU on stimulant drug use. However, the results more clearly indicate that individuals in STAGE-12 had higher rates of 12-step meeting attendance and were engaged in more related activities throughout both the active treatment phase and the entire 6-month FU period than did those in TAU.

Effect of Sowing Media and Gibberellic Acid on the Seedling Establishment and Growth of &lt;i&gt;Bougainvillea glabra, Ixora coccinea&lt;/i&gt; and &lt;i&gt;Rosa chinensis&lt;/i&gt;. 1: Shoot Characters

Two pot experiments were carried out in the screen house of the Faculty of Agriculture Bayero University Kano (Latitudes 80 421N and 90301N) during the wet and dry seasons of 2008/2009 to investigate the effects of Sowing Media and Gibberellic acid(GA 3 ) concentrations on the seedling establishment and growth of three ornamental plant species. The treatments consisted of three sowing media (Top soil TS, mixtures of Top soil plus Poultry manure TS+PM and Top soil plus Sawdust TS+SD) in the ratio of 2:1, three GA 3 concentrations (0, 100 and 200ppm) and three plant species ( Bougainvillea, Ixora and Rose ); factorially combined and laid out in a completely randomized design with four repetitions. The results indicated that TS and TS+SD gave significantly (P<0.05) greater number of days to bud break, leaf area, leaf fresh weight and leaf dry weight per plant. Application of GA 3 at 100ppm gave higher value of all the characters studied except number of days to bud break, where no significant difference was observed among the different concentrations. Bougainvillea was significantly (P<0.05) higher than the other plants in all the characters except days to bud break. The Combination of TS+SD medium and GA3 at 100ppm concentration is recommended for the good growth and development of the shoot characters. Keywords : Gibberellic Acid, Sowing Media, Bougainvillea glabra, Ixora coccinea, Rosa chinensis

Alcohol-Related Predictors of Delirium After Major Head and Neck Cancer Surgery

To identify specific alcohol-related predictors of postoperative delirium. Inception cohort, logistic regression with step-wise selection. Ohio State University Comprehensive Cancer Center, Columbus. A total of 774 patients undergoing major resection of head and neck squamous cell carcinoma. The correlation of 19 variables with postoperative delirium. One variable was an alcohol-related blood test: mean red blood cell volume (MCV). Eight variables were patient responses to alcohol-related questions. Eighty-nine of 774 surgical procedures (11.5%) were complicated by delirium. Six variables were significantly associated with delirium: age older than 69 years (odds ratio [OR], 2.43; P < .01), preexisting cognitive impairment (OR, 3.83; P < .01), surgery duration greater than 6 hours (OR, 2.40; P < .01), MCV greater than 95.0 femtoliters (OR, 2.23; P < .01), ever being advised to cut back on alcohol (OR, 2.25; P = .01), and not abstaining from alcohol for at least 1 continuous week in the preceding year (OR, 2.16; P = .02). The number of variables stratified delirium risk (0 variables: 198 patients, 2.5% incidence of delirium; 1 variable: 278 patients, 6% incidence of delirium; 2 variables: 206 patients, 18% incidence of delirium; and >2 variables: 92 patients, 34% incidence of delirium). Three clinical variables not related to alcohol drinking (age, preexisting cognitive impairment, and surgery duration), an alcohol-related laboratory test (MCV), and 2 alcohol-related questions ("At any time in your life, has anyone ever suggested that you should cut back on your drinking?" and "What is the greatest number of days in a row you have gone without an alcoholic drink in the past year?") may help in estimating a patient's risk for postoperative delirium.

Effectiveness of a Role-Modeling Intervention on Student Nurse Simulation Competency

Novice nurses are often inadequately prepared to respond to complex, patient care situations where patients' conditions deteriorate. Exposure to a video-taped intervention that role-models and reinforces expected behavior of an expert nurse before participation in a simulation may improve student nurse performance in a cost-effective manner. The primary purpose of this quasi-experimental pre-test, post-test study was to assess the preliminary effectiveness of a theory based role-modeling intervention on enhancing student nurse competency in responding to a simulated response to rescue event. Performance was measured by a previously validated Heart Failure Simulation Competency Evaluation Tool © (HFSCET). Total mean scores on the HFSCET for the pre-test (59.08) and post-test (87.08) were significantly different (p = .000); students performed better on the post-test after exposure to the role-modeling intervention. A power analysis indicated a large effect size (effect size = .926; alpha = 0.50; power = 0.991). Students who had a greater number of days between the intervention and the post-test had a lower score. This innovative intervention based on established learning theory may change the way educators prepare novice students to achieve expected clinical competencies in graded simulation performance assessments.

Shock collars as a site‐aversive conditioning tool for wolves

AbstractReduction of livestock losses from predators is a complex problem that requires the integration of lethal and nonlethal management tools. During 2005 and 2006, we tested shock collars for conditioning wild wolves (Canis lupus) in Wisconsin, USA, to avoid bait sites over an 80‐day period. Treatment wolves (n = 10) visited shock zones less and spent less time at shock zones compared to control wolves (n = 4) during 40‐day shock periods and 40‐day post‐shock periods. Treatment wolves remained away from shock zones for a greater number of days compared to control wolves. A smaller proportion of treatment pack members visited shock zones during shock and post‐shock periods compared to control packs. Shock collars conditioned treatment wolves to avoid bait sites for &gt;40 days and reduced visitation by other pack members. We also demonstrated the application of shock collars at the scale of livestock farms. Shock collars could serve as a useful nonlethal tool for managing livestock depredations, particularly in chronic problem areas and with endangered populations. © 2012 The Wildlife Society.

Fitness and physiology in a variable environment

The relationship between physiological traits and fitness often depends on environmental conditions. In variable environments, different species may be favored through time, which can influence both the nature of trait evolution and the ecological dynamics underlying community composition. To determine how fluctuating environmental conditions favor species with different physiological traits over time, we combined long-term data on survival and fecundity of species in a desert annual plant community with data on weather and physiological traits. For each year, we regressed the standardized annual fitness of each species on its position along a tradeoff between relative growth rate and water-use efficiency. Next, we determined how variations in the slopes and intercepts of these fitness-physiology functions related to year-to-year variations in temperature and precipitation. Years with a relatively high percentage of small rain events and a greater number of days between precipitation pulse events tended to be worse, on average, for all desert annual species. Species with high relative growth rates and low water-use efficiency had greater standardized annual fitness than other species in years with greater numbers of large rain events. Conversely, species with high water-use efficiency had greater standardized annual fitness in years with small rain events and warm temperatures late in the growing season. These results reveal how weather variables interact with physiological traits of co-occurring species to determine interannual variations in survival and fecundity, which has important implications for understanding population and community dynamics.

Detection of recent climate change using daily ­temperature extremes in Khorasan Province, Iran

CR Climate Research Contact the journal Facebook Twitter RSS Mailing List Subscribe to our mailing list via Mailchimp HomeLatest VolumeAbout the JournalEditorsSpecials CR 49:247-254 (2011) - DOI: https://doi.org/10.3354/cr01031 Detection of recent climate change using daily ­temperature extremes in Khorasan Province, Iran Sara Sanjani, Mohammad Bannayan*, Mohsen Kamyabnejad Faculty of Agriculture, Ferdowsi University of Mashhad, PO Box 91775-1163, Mashhad, Iran *Email: banayan@um.ac.ir ABSTRACT: Climate change is considered one of the main environmental concerns of the 21st century. Increased variation and changes in mean temperature and precipitation are expected to dominate future changes in climate and affect crop productivity. It is highly important to identify regions vulnerable to climate change and to identify suitable adaptation practices that can sustain productivity to some extent. In the present study, an iterative χ2 method was applied to detect recent possible climate change in extreme daily minimum and maximum temperatures for 5 different regions (Birjand, Boujnord, Mashhad, Sabzevar and Torbat Heydarieh) in Khorasan Province, Iran, during a recent 15 yr period and a prior 30 yr period. The method determines the values of extreme daily temperature that are most significantly different between the prior and recent periods and gives a measure of the weekly significance of that difference. We determined the percentage change in the frequency of the number of extreme days for each period of continuous significant weeks. In all 5 regions, a few days of extreme low minimum temperature (especially in Mashhad and Sabzevar) were experienced during the recent period. The major changes in climate for minimum temperature were determined in Mashhad. In this region the highest percentage change of climate (min. temperature) occurred during Week 33, when a 41% decrease of extreme low minimum temperatures occurred. In Mashhad the highest warming (decrease in days of min. temperature) occurred during late March to late December. Among 5 regions during the recent period some weeks experienced a greater number of days of extreme high maximum temperature (except Torbat Heydarieh and Birjand). In Torbat Heydarieh, the highest percentage change occurred during Week 24, when a 26% decrease of extreme high maximum temperatures was detected. In ­Torbat Heydarieh, the highest cooling occurred from April to early December. KEY WORDS: Global climate change · Daily minimum and maximum temperature · Temperature variability Full text in pdf format PreviousCite this article as: Sanjani S, Bannayan M, Kamyabnejad M (2011) Detection of recent climate change using daily ­temperature extremes in Khorasan Province, Iran. Clim Res 49:247-254. https://doi.org/10.3354/cr01031 Export citation RSS - Facebook - Tweet - linkedIn Cited by Published in CR Vol. 49, No. 3. Online publication date: November 21, 2011 Print ISSN: 0936-577X; Online ISSN: 1616-1572 Copyright © 2011 Inter-Research.

Espectro de gotas e idade de trifólios na taxa de absorção e efeito residual de fungicidas em soja

O objetivo do presente trabalho foi avaliar o efeito de espectros de gotas (grossas, médias e finas) na velocidade de absorção de fungicidas, para trifólios de diferentes idades através de medida indireta expressa pelo residual de controle de ferrugem asiática da soja (Phakopsora pachyrhizi). O delineamento experimental utilizado foi inteiramente casualizado, com quatro repetições, em arranjo fatorial (3x3x5x4), cujos fatores foram compostos por: três categorias de gotas (grossas, médias e finas); três diferentes posições de avaliação na planta (1°, 3° e 5° trifólios); quatro períodos de tempo entre a aplicação de fungicidas e aplicação de chuva simulada (0, 30, 60 e 120min), mais uma testemunha sem chuva; testemunha sem aplicação, mais os fungicidas azoxistrobina + ciproconazol (60+24g i.a. ha-1) + óleo mineral 0,6L ha-1, azoxistrobina (50g i.a. ha-1) + óleo mineral 0,6L ha-1 e ciproconazol (30g i.a. ha-1). Avaliou-se a densidade de gotas por centímetro quadrado, diâmetro mediano volumétrico, diâmetro mediano numérico e amplitude relativa, além do número de dias para o aparecimento da primeira pústula. Verificou-se que gotas de menor DMV proporcionam maior velocidade de absorção de fungicidas. Trifólios mais novos absorvem os fungicidas mais rapidamente. A utilização de azoxistrobina + ciproconazol + óleo mineral proporcionou o maior número de dias até o aparecimento da primeira pústula.

TEMPERATURE AND HEALTH IN GUADALAJARA, MEXICO

Background and Aims: The city of Guadalajara, like many other cities throughout the world, experiences a heat-island condition which has resulted in increased temperatures; thus, it is highly relevant to identify the temperature associated to higher morbidity rates among its inhabitants. Methods: The criteria to define excessive temperature levels are based on determining maximum temperature thresholds at a 95 percentile, of the series of maximum daily temperatures. That is, the temperature threshold is established based on merely statistical considerations, without necessarily taking into account at and above what temperature the effects on health begin to emerge. The study proposed to determine whether this is the temperature at which the highest association to heart and vascular diseases –coronary heart disease, cerebrovascular disease, peripheral artery or atherosclerotic disease, rheumatic heart disease, congenital heart defects, deep vein thrombosis and pulmonary embolisms as registered by the Public Health Department—can be established.. Results: The temperature representing the 95 percentile for the period of study, from 1996-2005, was 35.4°C. The greatest number of days with temperatures above 35.4 occurred in 1998 and 2002. Upon determining the correlation between the number of days with temperatures between 29.4 and 35.4 °C and percentage of the city of Guadalajara population suffering cardiovascular diseases, the results showed that at 29.4 °C there is a 0.76 correlation, with diseases increasing upon exposure to such temperatures for more than 150 days per year; 0.79 at 32.4 °C with diseases increasing upon exposure for more than 15 days per year, and 0.53 at 35.4 °C with diseases increasing upon exposures of 1 day per year. Based on the foregoing, it is established that a temperature of 32.4 °C results in a higher association to cardiovascular morbidity rates. Conclusions: The rise in cardiovascular diseases is determined at 62% due to increased exposure regarding the number of days with temperatures above 32.4 °C.

Is the systemic inflammatory reaction to surgery responsible for post-operative pain after tonsillectomy, and is it "technique-related"?

Investigate the influence of operative technique on post-operative morbidity and the systemic inflammatory response after tonsillectomy. In addition, our aim was to compare the systemic inflammatory reaction, post-operative pain severity, and required time before the resumption of normal physical activity between two groups of tonsillectomized children and to correlate characteristics of the systemic inflammatory reaction to post-operative morbidity. This prospective, randomized, and single-blind study included 100 children between the ages of 3-16 years and who were scheduled for a tonsillectomy at our department for chronic tonsillitis and/or respiratory obstruction. The children were randomly assigned into one of two groups: either a conventional tonsillectomy with bipolar diathermy coagulation or a radiofrequency tonsillectomy procedure; both groups had a 14-day follow-up. We investigated the severity and duration of postoperative pain (based on the use of analgesics during the postoperative period), the postoperative day that they resumed normal physical activity, and the rate of postoperative hemorrhage. In order to assess the systemic inflammatory response, serum C-reactive protein (CRP) levels were measured before the surgery and seven days after the procedure. After the surgery CRP levels increased to a statistically significant level (t = -4.7; p < 0.001) in conventional tonsillectomy group. There was a statistically significant correlation between increased blood CRP levels after the surgery and the level of post-operative analgesic consumption, which was based on an increased number of analgesic applications (r = 0.28; p < 0.01) and a greater number of days in which analgesics were consumed (r = 0.26; p < 0.01). There was also a correlation between increased blood CRP levels and a longer required time to resume normal physical activities (r = 0.30; p < 0.01). Post-operative morbidity after tonsillectomy appears to depend on the systemic inflammatory response to surgery. This response is "technique-related," wherein a less-aggressive surgical technique produces a weaker post-operative inflammatory response and less post-operative morbidity.

Increased Serum Brain-Derived Neurotrophic Factor Is Predictive of Cocaine Relapse Outcomes: A Prospective Study

Cocaine dependence is associated with high relapse rates, but few biological markers associated with relapse outcomes have been identified. Extending preclinical research showing a role for central brain-derived neurotrophic factor (BDNF) in cocaine seeking, we examined whether serum BDNF is altered in abstinent, early recovering, cocaine-dependent individuals and whether it is predictive of subsequent relapse risk. Serum samples were collected across three consecutive mornings from 35 treatment-engaged, 3-week-abstinent cocaine-dependent inpatients (17 males/18 females) and 34 demographically matched hospitalized healthy control participants (17 males/17 females). Cocaine-dependent individuals were prospectively followed on days 14, 30, and 90 posttreatment discharge to assess cocaine relapse outcomes. Time to cocaine relapse, number of days of cocaine use (frequency), and amount of cocaine use (quantity) were the main outcome measures. High correlations in serum BDNF across days indicated reliable and stable serum BDNF measurements. Significantly higher mean serum BDNF levels were observed for the cocaine-dependent patients compared with healthy control participants (p < .001). Higher serum BDNF levels predicted shorter subsequent time to cocaine relapse (hazard ratio: 1.09, p < .05), greater number of days (p < .05), and higher total amounts of cocaine used (p = .05). High serum BDNF levels in recovering cocaine-dependent individuals are predictive of future cocaine relapse outcomes and may represent a clinically relevant marker of relapse risk. These data suggest that serum BDNF levels may provide an indication of relapse risk during early recovery from cocaine dependence.

Alcohol involvement as a function of co-occurring alcohol use disorders and major depressive episode: Evidence from the National Epidemiologic Survey on Alcohol and Related Conditions

Background Co-occurring alcohol use disorder and major depression (C-ALDP) is a major public health problem. Yet, the available evidence is mixed regarding the implications of C-ALDP for alcohol involvement. The purpose of this research was to examine the associations between past 12-month co-occurring AUDs (abuse and dependence) and major depressive episode (MDE) and alcohol involvement in a representative community sample. Design The National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) is a national household survey of 43,093 adults ages 18 and older. For the NESARC, the target population is the civilian noninstitutionalized population, 18 years of age and older, living in the United States and the District of Columbia. Methods All NESARC interviews were conducted with the Alcohol Use Disorder and Associated Disabilities Interview Schedule – DSM IV Version (AUDADIS-IV; Grant et al., 2003a). Results Prevalence of past 12-month co-occurring AUD (abuse or dependence) and MDE was 1.2%, corresponding to about 2.4 million adults ages 18 and older. Among males with alcohol dependence, comorbid MDE was associated with a greater number of days drinking at home alone. Among females and males with alcohol abuse and dependence, comorbid MDE was associated with higher prevalence of drinking to enhance depressed mood. Comorbid MDE was also associated with lower levels of some drinking behaviors among those with alcohol abuse. Conclusions Co-occurring AUDs and MDE are associated with specific dimensions of alcohol involvement, and this association is more consistent for alcohol dependence than abuse.

Factors associated with occupational strain among Chinese teachers: a cross-sectional study

With the reform of the education system in China, teachers are suffering frommore occupational strain, which is believed to impair their working state indirectly and affect their health. This study assessed occupational strain and explored the related factors among Chinese teachers. Cross-sectional with cluster sampling. The study population was composed of 3570 school teachers working in 64 primary and middle schools in Heping District in Shenyang, China. Data were collected using a self-administered questionnaire (the Chinese version of the Occupational Stress Inventory scale). Multivariate linear regression analyses were performed to study the factors related to occupational strain. The average score on the Personal Strain Questionnaire (PSQ) for the whole study population was 106.5 (107.5 in men and 106.3 in women). Teachers with chronic disease, a greater number of days of sick leave, recent experience of a stressful life event and divorced/separated/widowed status tended to suffer greater strain than their peers. Regression analyses showed that the PSQ score was significantly associated with role overload, role boundary, responsibility and physical environment, and inversely associated with recreation and rational coping. The most crucial predictors of occupational strain were chronic disease, days of sick leave, recent experience of a stressful life event and marital status. Being a class teacher was the strongest indicator of interpersonal strain. Self-care was associated with vocational strain and psychological strain, and inversely associated with physical strain. Most teachers in this study experienced a high degree of occupational strain. Chronic disease, days of sick leave, recent experience of a stressful life event and divorced/separated/widowed status played prominent roles in occupational strain. In addition, role overload, role boundary, responsibility and physical environment induce occupational strain, while recreation and rational coping have a positive effect on occupational strain. Interventions such as proper management of chronic diseases and establishment of a balanced work-family life are crucial to reduce occupational strain. Recreation and training in coping abilities are needed to enhance positive working environments and attenuate the occupational strain imposed on teachers.