Interference In Daily Activities Research Articles

Prevalence and burden of pain across the entire spectrum of Huntington’s disease

BackgroundPain is an important symptom in Huntington’s disease (HD), however, not systematically studied and understood. The objective of the current study is to assess the prevalence of pain, pain interference...

Multilevel Characteristics of Cumulative Symptom Burden in Young Survivors of Childhood Cancer

Symptom burden and its characteristics among survivors of pediatric cancers aged 8 to 18 years remain understudied. To examine the prevalence of symptom burden among young childhood cancer survivors and identify associations with sociodemographic, clinical, and psychological resilience skills, and health-related quality of life (HRQOL). A cross-sectional analysis using data collected from November 1, 2017, to January 31, 2019, in a survivorship clinic at a US-based comprehensive cancer center was conducted. Participants included 302 dyads of children aged 8 to 18 years who survived at least 5 years beyond diagnosis and their primary caregivers. Data analysis was performed from March 13, 2023, to February 29, 2024. Diagnosis, caregiver-reported family conflict, self-reported caregiver anxiety, neighborhood-level social vulnerability, and survivor-reported meaning and purpose. Novel symptom-level burden, integrating the attributes of severity and daily activity interference using the pediatric version of the Patient-Reported Outcomes Version of the Common Terminology Criteria for Adverse Events, global cumulative symptom burden, and HRQOL using the EuroQol-5D. Multinomial logistic regression identified characteristics associated with symptom burden; linear regression assessed symptom burden and HRQOL associations. Among 302 survivors (mean [SD] age, 14.2 [2.9] years, mean [SD] time since diagnosis, 10.9 [2.9] years; 153 [50.7%] male), 186 (62.0%) had low, 77 (25.7%) moderate, and 37 (12.3%) high global cumulative symptom burden. Greater caregiver anxiety was associated with moderate (risk ratio [RR], 1.56; 95% CI, 1.09-2.24) global symptom burden. Greater neighborhood deprivation was associated with moderate global symptom burden (RR, 4.86; 95% CI, 1.29-18.26). Survivors with greater meaning/purpose were less likely to have moderate (RR, 0.42; 95% CI, 0.29-0.61) and high (RR, 0.27; 95% CI, 0.16-0.46) global symptom burden. The burden of individual symptoms displayed similar patterns. Low (Cohen d, -0.60; 95% CI, -0.87 to -0.32) and moderate/high (d, -0.98; 95% CI, -1.53 to -0.43) general pain, moderate/high numbness (d, -0.99; 95% CI, -1.69 to -0.29), and moderate/high worry (d, -0.55; 95% CI, -0.99 to -0.11) were associated with lower HRQOL. In this cross-sectional study of young childhood cancer survivors, symptom burden was prevalent. Caregiver anxiety and disparity-related neighborhood factors were associated with greater symptom burden, whereas meaning and purpose was a protective factor. Greater specific symptom burden contributed to poorer HRQOL. The findings suggest that interventions targeting resilience and neighborhood adversity may alleviate symptom burden and improve HRQOL.

The influence of COVID-19 on temporo-mandibular disorders.

Temporomandibular disorders are multi-factorial conditions affected by psychological, biomechanical, and neuromuscular factors. Stress and anxiety experienced during the pandemic are capable of influencing and aggravating temporomandibular disorders and orofacial pain. The study aimed to analyze whether the coronavirus infection can directly affect these diseases. All participants were asked to complete the Pain Screener and Patients Health Questionnaire and were assigned to Group I: healthy participants and Group 2: participants with existing complaints. In group II participants filled the questionnaires twice the Temporomandibular Disorders Symptom Questionnaire and Graded Chronic Pain Scale. The first time to self-report the severity of chronic pain before COVID-19 (T1 timeline) and the second time- to self-report the level of pain after COVID-19 infection (T2 timeline). Totally 150 participants were included in the study. In group II the difference between T1 and T2 timeline was significant for the level of average pain (p=0.022) and highest facial pain (p=0.043); Difference in level of interference of daily activities (p>0.05), recreational activities (p>0.05) and ability to work (p>0.05) was statistically not significant. Graded chronic pain status was the same "Grade I" for T1 and T2 timeline. There was no statistically significant difference in stress level between group I and II.

Impact of the COVID-19 pandemic on clinical and psychological aspects of temporomandibular disorders

BackgroundThe Coronavirus 2019 disease (COVID-19) caused drastic changes in people’s lifestyle that affected TMD characteristics through its physical and psychological influences. The aim of this study was to define the clinical and psychological characteristics of a large group of well-defined TMD patients and seek their differences between before and during the COVID-19 pandemic to establish points of care to be emphasized in the post-pandemic era.MethodsTMD patients diagnosed by the Diagnostic Criteria for Temporomandibular Disorders (DC/TMD) aged ≥ 18 were analyzed. Samples between September, 2017 to July, 2019 (n = 455) and March, 2021 to June, 2022 (n = 338) were collected to represent before and during COVID-19, respectively. The Graded Chronic Pain Scale (GCPS) and Symptom Checklist-90-Revision (SCL-90-R) were used to evaluate disability levels and psychological status. Clinical indices were compared between COVID periods and factors related to higher pain levels were investigated according to pandemic period.ResultsMore patients reported pain on palpation of the masticatory muscles during the pandemic (p = 0.021) while the number decreased for neck muscles (p = 0.001) and TMJ (p < 0.001) areas. Patients reporting nocturnal bruxism (23.3–29.6%) and clenching (45.1–54.7%) significantly increased during the pandemic. TMD patients with pain without disability were more common during the pandemic regardless of pain intensity (p < 0.001). The number of patients expressing interference in daily activities decreased drastically during COVID-19 regardless of disability level (p < 0.001). Factors associated with higher than moderate pain intensity (CPI ≥ 50) were insomnia (odds ratio [OR] = 1.603, p = 0.047) and somatization (OR = 1.082, p < 0.001) before the pandemic. During the pandemic, age (OR = 1.024, p = 0.007), somatization (OR = 1.070, p = 0.006), and paranoid ideation (OR = 1.117, p = 0.003) were significantly associated with higher pain intensity.ConclusionsThe results of our study underline the importance of evaluating psychological profiles of TMD patients, especially somatization, paranoid ideation and psychoticism, in exceptional situations that may cause a change in individual mental status. This will lead to a better understanding of the individual TMD patient and help in planning personalized treatment strategies that will assist the patient in adjusting to changes occurring in special environments such as the COVID-19 pandemic.

Adherence to Therapeutic Regimen among Patients with Chronic Obstructive Pulmonary Disease Attending at Medical OPD of BPKIHS

Background Chronic obstructive pulmonary disease (COPD) is a major health issue, associated with mortality and morbidities. The effective treatment of COPD requires long-term adherence to a therapeutic regimen. The objectives of this study were to assess the adherence to therapeutic regimens among patients with COPD and to find out the association of medication adherence with different factors.&#x0D; Methods The study used a descriptive cross-sectional research design. A total, 91 samples were chosen using a convenience sample method. An interview questionnaire was used for data collection. SPSS version 20 was used for data analysis. The level of confidence was set at 0.05.&#x0D; Results A high adherence rate was found in 60.4%. A significant association was found between mean adherence score with occupation, income to run family, opinion regarding the use of an inhaler, satisfaction with the time given by the physician during follow-up, presence of co-morbidity, interference in daily activities by the effect of medicine, perception about the need of medicine, presence of co-morbidity, family support in the treatment, stressful situation in the family affecting medication taking habit, stigmatization due to illness, support by social insurance, disease curability and feeling of susceptibility to illness or its complications. The study found a significant correlation between the mean adherence score and the frequency of total drugs (r= -0.221).&#x0D; Conclusion The finding of the study concluded that nearly two-thirds of the subjects had a high adherence rate to therapeutic regimens.

MMPI-2-RF Profiles of Treatment-Seeking Veterans in a VA Pain Clinic and Associations with Markers of Physical Performance.

Chronic pain is a debilitating condition for many military Veterans and is associated with posttraumatic stress disorder (PTSD). This study examined the Minnesota Multiphasic Personality Inventory-2-Restructured Form (MMPI-2-RF) in 144 Veterans (88.2% male, mean age = 57.95years) recruited from a VA outpatient pain clinic and associations with self-reported pain severity, pain-related interference in daily activities, prescription opioid use, and objective metrics of physical performance on tasks impacted by pain (walking, stair climbing, grip strength, indexed by a single latent variable). Among the cohort with valid responses on the MMPI-2-RF (n = 117) and probable PTSD, mean Somatic Complaints (RC1) and Ideas of Persecution (RC6) scores were clinically elevated. All MMPI-2-RF scales were more strongly correlated with self-reported pain interference than severity. Regressions revealed associations between self-rated pain interference (but not pain or PTSD severity) and physical performance scores (β = .36, p = .001). MMPI-2-RF overreporting Validity and Higher-Order scales contributed incremental variance in predicting physical performance, including Infrequent Psychopathology Responses (β = .33, p = .002). PTSD severity was associated with prescription opioid use when accounting for the effects of over-reported somatic and cognitive symptoms (odds ratio 1.05, p ≤ .025). Results highlight the role of symptom overreporting and perceptions of functional impairment to observable behaviors among individuals with chronic pain.

#4353 HEALTH-RELATED QUALITY OF LIFE IN ADULTS WITH PRIMARY GLOMERULAR DISEASES IN INDIA

Abstract Background and Aims Glomerular diseases pose a substantial burden on the healthcare system. While the medical and economic burden of glomerular diseases is well established, the data on the health-related quality of life impact is scant. Method We used the PROMIS 29 v2.1 (Patient-Reported Outcomes Measurement Information System) tool to assess HRQOL impact of primary glomerular diseases in adult Indian patients [1], under the domains: physical function, anxiety, fatigue, depression, sleep disturbance, ability to participate in social roles and activities and pain interference in daily activities. The questionnaire was administered in English and Hindi. Patient responses were then used to calculate T-scores with a mean of 50 and an SD of 10 with the score having positive correlation with the quantum of the outcome measured. Results 141 adult patients were recruited (39 minimal change disease/ focal segmental glomerulosclerosis, 36 membranous nephropathy, 56 IgA nephropathy, 9 membrano-proliferative glomerulonephritis). Mean T-scores across domains were as follows: physical function- 48.2 (46.8-49.6), fatigue- 49.2 (47.5-51), anxiety- 52.3 (50.6-53.9), sleep impairment- 43.5 (41.9-45.1), depression- 50.7 (49-52.4), ability to participate in social roles and activities- 55 (53.3-56.7), hindrance in daily activities due to pain 51.2 (49.7-52.8). Better physical function was associated with higher eGFR (T-score of 44 at eGFR&amp;lt;45 ml/min/1.73m2 and 49.8 at eGFR&amp;gt;45 ml/min/1.73m2, p&amp;lt;0.001), lower BMI (42.4 in obese vs 48.6 in non-obese, p = 0.02), and male sex (50.2 vs 44.5 in females, p&amp;lt;0.001). Fatigue was associated with eGFR&amp;lt;45 ml/min/1.73m2 (52.2 vs 48.1 at eGFR&amp;gt;45 ml/min/1.73m2, p = 0.04), and female sex (53.2 vs 47.1 in males, p&amp;lt;0.001). Worse anxiety was seen in females (55.8 vs 50.4 in males, p = 0.002) and patients with eGFR&amp;lt;45 ml/min/1.73m2 (55.4 vs 51.1 at eGFR&amp;gt;45 ml/min/1.73m2, p = 0.02). Sleep impairment was seen in patients having a history of steroid usage in the last 2 months (45.8 vs 42.1, p = 0.02), females (45.8 vs 42.3, p = 0.04), and patients with eGFR&amp;lt;45 ml/min/1.73m2 (46.2 vs 42.5 at eGFR&amp;gt;45 ml/min/1.73m2, p = 0.04). Pain interference was higher in females (55.9 vs 48.8 in males, p&amp;lt;0.001) and patients with eGFR&amp;lt;45 ml/min/1.73m2 (54 vs 50.2 at eGFR&amp;gt;45 ml/min/1.73m2, p = 0.03). eGFR&amp;gt;45 ml/min/1.73m2 (56.4 vs 51.4 at eGFR&amp;lt;45 ml/min/1.73m2, p = 0.008) was associated with better involvement in social roles. Depression was associated with female sex (54.2 vs 48.9 in males, p = 0.003). Degree of proteinuria, serum albumin, duration of disease, immunosuppressive drug use, age, patient-reported edema, and socio-economic status were not associated with a significant decrease in HRQOL. Multivariable linear regression models were evaluated for all domains. Physical function was negatively associated with eGFR&amp;lt;45ml/min/1.73m2 (β = -5.46), female sex (β = -5.16), and obesity (β = -6.36). Fatigue was associated with eGFR&amp;lt;45ml/min/1.73m2 (β = 3.89), female sex (β = 5.76), and obesity (β = 9.62). Worse anxiety was associated with eGFR&amp;lt;45ml/min/1.73m2 (β = 3.82) and female sex (β = 4.97). Sleep impairment was associated with eGFR&amp;lt;45ml/min/1.73m2 (β = 3.46) and female sex (β = 3.24). Pain interference was associated with eGFR&amp;lt;45ml/min/1.73m2 (β = 3.39) and female sex (β = 7.19) Ability to participate in social roles and activities was negatively associated with eGFR&amp;lt;45ml/min/1.73m2 (β = -4.86) and female sex (β = −3). Depression was associated with obesity (β = 6.16) and female sex (β = 5.22). Conclusion Glomerular diseases adversely impact the quality of life. Female sex, lower renal function (eGFR), higher BMI and history of recent steroid use correlated with higher morbidity.

The Patient Voice: Stent Experiences After Ureteroscopy-Insights from In-Depth Interviews with Participants in the USDRN STENTS Nested Qualitative Cohort Study.

Purpose: Ureteral stents are commonly used after ureteroscopy and cause significant discomfort, yet qualitative perspectives on patients' stent experiences remain unknown. We describe psychological, functional, and interpersonal effects of post-ureteroscopy stents and whether additional patient-reported assessments may be needed. Materials and Methods: Using a qualitative descriptive study design, we conducted in-depth interviews with a nested cohort of participants in the STudy to Enhance uNderstanding of sTent-associated Symptoms (STENTS). Participants shared their symptoms with a post-ureteroscopy stent and described symptom bother and impact on daily activities. All interviews were audio-recorded, transcribed, and analyzed using applied thematic analysis. During analysis, participants' experiences with interference in daily activities were categorized into three groups based on their impact: minimal, moderate, and substantial. Results: All 39 participants experienced pain, although descriptions varied and differentiated between feelings of pain vs discomfort. Almost all experienced urinary symptoms. Only a few reported other physical symptoms, although several psychological aspects were identified. In the areas of sleep, mood, life enjoyment, work, exercise, activities of daily living, driving, childcare, and leisure/social activities, the stent had little impact on daily living among participants placed in the minimal group (n = 12) and far greater impact for participants in the substantial group (n = 8). For patients in the moderate group (n = 19), some daily activities were moderately or substantially affected, whereas other activities were minimally affected. Conclusions: Counseling to better prepare patients for the impact of stent-associated symptoms may help mitigate symptom burden. While existing instruments adequately cover most symptoms, additional assessments for other domains, particularly psychological factors, may be needed.

Memantine May Reduce Hair-Pulling, Skin Picking

Memantine May Reduce Hair-Pulling, Skin Picking

Assessment of pain and quality of life in patients undergoing cardiac surgery: a cohort study.

This study aimed to evaluate postoperative pain and quality of life in patients undergoing median sternotomy. A cohort study was carried out on a sample of 30 patients who underwent elective cardiac surgery by longitudinal median sternotomy. Patients were interviewed at Intensive Care Unit discharge and hospital discharge, when the Visual Numeric Scale and the Brief Pain Inventory were applied, and 2 weeks after hospital discharge, when the World Health Organization Quality of Life-Bref questionnaire was administered. The normality of the results was analyzed by the Shapiro-Wilk test, and Wilcoxon Rank Sum and McNemar tests were utilized for the analysis of numerical and categorical variables. For correlation between numerical variables, Spearman's linear correlation test was applied. To compare numerical variables, Mann-Whitney U and Kruskal-Wallis tests were applied. Differences between groups were considered significant when the p-value was <0.05. Between Intensive Care Unit and hospital discharge, there was a reduction in median pain intensity assessed by the Visual Numeric Scale from 5.0 to 2.0 (p<0.001), as well as in eight Brief Pain Inventory parameters: worst pain intensity in the last 24 h (p=0.001), analgesic relief (p=0.035), and pain felt right now (p=0.009); and in interference in daily activities (p<0.001), mood (p=0.017), ability to walk (p<0.001), relationship with other people (p=0.005), and sleep (p=0.006). Higher pain intensity at Intensive Care Unit discharge was associated with worse performance in the psychological domain of quality of life at out-of-hospital follow-up. Proper management of post-sternotomy pain in the Intensive Care Unit may imply better quality of life at out-of-hospital follow-up.

Relationship Between Location of Pregnancy-Related and Postpartum-Related Back Pain and Limitations of Daily Activities and Work Participation

ObjectiveThe aims of this study were to (1) examine if the location of pregnancy-related back pain impacts activities of daily living and absence from work and (2) determine which types of pain were more likely to persist postpartum. MethodsThis was a secondary analysis of data from an observational cohort study. Data were collected in Ontario between 2013 and 2014. Four pain location groups were identified, including low back pain (LBP), pelvic girdle pain (PGP), combined pain, and mixed pain. Logistic regression models were used to examine the impact of pain location on activity and absence from work. Descriptive analyses explored the association between pregnancy pain location and postpartum pain patterns. ResultsWe surveyed 305 pregnant participants and followed up with 80 of these participants up to 6 months postpartum. Data analysis showed approximately a 2-fold increase in interference with employment (outside the home) and self-grooming for those with combined pain compared to those only experiencing LBP. Respondents with PGP and combined PGP and LBP had approximately a 5-fold increased likelihood of absence from work compared to respondents with only LBP; those with a mixture of LBP and PGP had a 13-fold increase in likelihood. Approximately 50% of respondents reported being pain-free, 16% experienced lingering pain, and 38% experienced persistent pain within 6 months postpartum. Those with combined pain during pregnancy continued to have persistent pain up to 6 months postpartum. ConclusionThe results suggest that the location of pregnancy-related back pain is associated with interference in daily activities, an increase in absence from work, and the persistence of postpartum pain. For this cohort, back pain did not always resolve after delivery, and those experiencing pregnancy-related combined pain continued to experience symptoms postpartum.

Chronic pain in adults with osteogenesis imperfecta and its relationship to appraisal, coping, and quality of life: A cross-sectional study.

Chronic pain is a common experience in osteogenesis imperfecta (OI). However, there are few studies on this topic, and none of them emerge from psychology as a discipline. The purpose of this work is to describe the frequency of chronic pain and its characteristics in a large sample of adults with OI, as well as its relationship with clinical, sociodemographic, psychological, and quality of life variables.A cross-sectional study was carried out in a sample of 418 adults with OI who answered a battery of online questionnaires. Sociodemographic and clinical variables, pain parameters, participants’ appraisal of pain, coping strategies, interference in daily activities, and health-related quality of life were evaluated. A descriptive and correlational analysis was performed.Up to 83% of the sample reported experiencing pain frequently. Both the frequency and intensity of pain were related to the accumulation of fractures over the years (P < .05), but were independent of other variables like the severity of the pathology or the use of bisphosphonates. Higher threat appraisal of pain was associated with an increase in perceived pain intensity and its interference with daily activities, as well as a decrease in physical and mental health (P < .001).Chronic pain frequent condition in adults with OI, regardless of the severity of the pathology. It interferes with their usual activities and has an impact on their quality of life. The way in which participants appraise their pain also have an influence on its intensity and its consequences. Interventions aimed at training strategies for managing appraisals about pain could potentially improve adaptation to chronic pain.

The Effect of Progressive Muscle Relaxation on Quality of Life and Pain Intensity in Patients with COVID-19 in 2021

Introduction: Some symptoms, such as fatigue and muscle pain remain in patients with COVID-19 after the acute phase of the disease. This reduces the quality of life of these patients. This study aims to evaluate the effect of progressive muscle relaxation on pain intensity and quality of life after discharge from hospital.&#x0D; Methods: The present quasi-experimental study was conducted in 1400 on 96 patients with COVID-19 with complaints of pain in Khoy city. The samples were randomly assigned to control and experiment groups. The intervention was in the form of training muscle relaxation exercises. Data were collected using pain intensity and quality of life questionnaires. Multivariate analysis of covariance test was used to analyze the data in SPSS-26 software.&#x0D; Results: The results showed that pain intensity scores, interference in daily activities in both groups had a decreasing trend and quality of life improvement in both groups had an increasing trend. The effect size for progressive muscle relaxation in reducing pain intensity was 0.65, reducing pain interference in daily activities was 0.71, and quality of life improvement was 0.78, indicating the average effect size of muscle relaxation for all the three components.&#x0D; Conclusion: The findings of this study show that muscle relaxation exercises reduce pain intensity and improve quality of life in patients with COVID-19. Itis suggested that these exercises be used as a complementary method to reduce pain intensity and improve the quality of life of patients.

Chronic postsurgical pain and quality of life after right minithoracotomy mitral valve operations.

Chronic postsurgical pain (CPSP) is a relatively common complication after cardio-thoracic operations with well-known consequences in terms of return to normal activities and quality of life. Little is known about the prevalence and severity of CPSP after minimally invasive cardiac surgery. The aim of this study was to measure the rate of CPSP in patients undergoing right minithoracotomy mitral valve (MV) surgery and to compare the effectiveness of different approaches to pain control. A prospective observational study was conducted between March 2019 and September 2020. All patients undergoing right minithoracotomy MV surgery treated with morphine, continuous serratus anterior plane block (SAPB), or continuous erector spinae plane block (ESPB) were included. The Brief Pain Inventory questionnaire was used to evaluate 6-month CPSP and quality of life. A total of 100 patients were enrolled: postoperative pain control was obtained with morphine in 26 cases, with SAPB in 37 cases, and with ESPB in 37 cases. Median intensive care unit and hospital length of stay were 1 day and 6 days, respectively. Pain severity index was lower than 10 in 81 patients, and no differences were recorded between groups (p = .59). No patients reported chronic use of medications for pain management or severe pain interference in daily activities at follow-up. Right minithoracotomy approach is not burdened by a high incidence of CPSP: pain severity index was lower than 10 in more than 90% of patients. Then, in our experience, chronic pain seems not to be related to the type of perioperative analgesia adopted.

PHYSICAL AND EMOTIONAL FACTORS ASSOCIATED WITH THE SEVERITY OF CHRONIC BACK PAIN IN ADULTS: A CROSS-SECTIONAL STUDY

ABSTRACT Objective: determining the multidimensional factors associated with the severity of chronic back pain is essential to design appropriate interventions. The objective of this study was to assess the physical and emotional factors associated with the severity of chronic back pain in adults. Method: a descriptive, analytical and cross-sectional study, carried out between November 2017 and December 2018 in Family Health Strategies, with 198 adults with chronic back pain. Pain severity, assessed by the Brief Pain Inventory, was considered the outcome variable; and the pain interference in daily activities (Brief Pain Inventory), physical disability (Roland Morris Disability Questionnaire), quality of life (World Health Organization Quality of Life-Brief) and pain threshold (digital algometer) variables were considered explanatory. A Multivariate Multiple Linear Regression analysis, using the stepwise method with 5% significance, was preformed to establish an explanatory model of pain severity. Results: the mean age was 48.03 years old (standard deviation: 12.41). Most of the participants were women, married and worked. The variables that had a significant and joint impact on pain severity were pain interference in daily activities (parameter: 0.196; p-value&lt;0.001) and in mood (parameter: 0.054; p-value=0.039) and physical domain of quality of life (parameter: -0.032; p-value&lt;0.001). Conclusion: physical factors (pain interference in daily activities and physical domain of quality of life) and emotional factors (pain interference in mood) play an important role in the severity of chronic back pain, which reinforces its multidimensional character.

Clinical Hypnosis For Pain Reduction In Breast Cancer Mastectomy: A Randomized Clinical Trial

ABSTRACT Surgical procedures for breast cancer treatment are commonly followed by pain. Clinical hypnosis has been shown to be effective in reducing pain during and after surgery, but most of the studies have used analogical scales, which only measure pain intensity. The aim of this study was to evaluate the effect of clinical hypnosis on pain intensity and its interference in daily activities in patients before and after mastectomy. The patients were evaluated using the Brief Pain Inventory. Forty patients were randomly assigned to an experimental or control group and evaluated 5 times: 1) baseline, 2) after clinical hypnosis session, 3) before surgery, 4) 1 day after surgery, and 5) 1 week after the surgery (follow-up). The results showed that after surgery the hypnosis group had a statistically significant reduction in pain intensity, less interference of pain with daily activities, sleep and life enjoyment compared with a control group. Clinical hypnosis may be recommended as a complementary treatment procedure for postmastectomy pain reduction and improving the quality of life of these patients.

Safety of an inactivated SARS-CoV-2 vaccine in elderly persons

Introduction. Brazil has the 2nd highest number of COVID-19 deaths (more than 530,000) and the 3rd highest number of confirmed cases (more than 19 million) worldwide. COVID-19 vaccination is the most effective strategy to prevent new cases and illness, reducing hospitalizations and deaths. The 1st vaccine used in Brazil was the Sinovac/Instituto Butantan CoronaVac, an inactivated SARS-CoV-2 vaccine. Elderly persons (EP) were among the first groups eligible for immunization, after healthcare workers, indigenous people and quilombolas. Objective. To evaluate adverse events following immunization (AEFI) with CoronaVac in EP. Methods. This observational retrospective study was conducted at the Reference Center for Special Immunobiologicals (CRIE) of the Hospital das Clínicas (HC-FMUSP), a tertiary/quaternary hospital attached to the University of São Paulo Medical School (FMUSP), in São Paulo city, from February to April 2021. EP, who searched or were referred to CRIE to receive the COVID-19 vaccine were asked for authorization for follow-up calls to evaluate AEFI. The on phone follow up was made by healthcare workers who conducted AEFI forms on day 4 and day 8 after the first and second vaccine doses; a sociodemographic questionnaire; and a modified functionality scale for EP based on the Independence in Activities of Daily Living index (ADLi), Instrumental Activities of Daily Living scale (IADLs) and Study of Osteoporotic Fractures index (SOFi). Results. During the study period, CoronaVac was used; 159 EP received the first dose and 155 EP were fully vaccinated at CRIE; 152 participants were contacted after the first dose and 142 participants were contacted after the second dose. The participants’ age ranged from 53 to 101 years (mean, 84 years), 65.4% were females, and 73.7% were white. 148 (93.1%) participants have at least one comorbidity, the most common was hypertension (59.8%) followed by heart disease (30.2%) and dyslipidemia (25.2%). 70/152 (46.1%) participants were classified as independent in IADLs, 117/152 (77.0%) in ADLi and 66/152 (43.4%) according to SOFi. 47 participants (30.2%) reported at least one AEFI at first dose. The most common local AEFI was pain at the injection site (13, 8.6%) and the most common systemic AEFI was fatigue (8, 6.0%), followed by headache (6, 4.0%). Thirty participants (21.1%) reported at least one AEFI at the second dose. The most common local AEFI was pain at the injection site (6, 4.3%) and the most common systemic AEFI was myalgia (11, 7.9%), followed by fatigue (9, 6.5%). Most AEFI were mild and had no or little interference in daily activities. There were five severe AEFI: two deaths after the first dose (a sudden death and another following a hemorrhagic stroke) and three hospitalizations (one after the first dose and two after the second dose). None of them were considered related to the vaccine. Discussion and conclusion. This unique studied population was composed of EP with comorbidities and some level of dependency. The participants reported few and mild AEFI, suggesting CoronaVac is safe in EP.

Psychological distress in early childhood and the risk of adolescent spinal pain with impact.

Spinal pain (SP), including neck and back pain, is common and often associated with poor mental health and reduced quality of life of adolescents. Contemporary understanding of SP favours a biopsychosocial approach, and emerging evidence suggests the stronger influence of psychological rather than other factors. We aimed to investigate if experiencing psychological distress in early childhood increases the risk of spinal pain with impact during adolescence. 1175 adolescents from a prospective cohort study (Raine Study Gen2) were included. Psychological distress was assessed at ages 2, 5, 8 and 10 using Child Behaviour Check List (CBCL). CBCL total and subscale scores (internalizing and externalizing symptoms) were converted to age-standardized scores and dichotomized according to t-scores (>60=high distress). Life-time spinal pain, including low back, mid back, or neck/shoulder, was measured at age 17. We were interested in adolescent SP with impact (care seeking, medication use, school absenteeism, daily activity interference, leisure activity interference) and defined cases as SP with impact (one or more) or greater impact (two or more) impacts. We investigated the longitudinal associations between childhood psychological distress and adolescent SP using univariate and multivariable logistic regression models. Psychological distress in childhood increased the odds of adolescent SP with impact by 33% (OR 1.33; 95% CI 1.01-1.76), but not spinal pain with greater impact (OR 1.22; 95% 0.83-1.80). Internalizing symptoms were associated with SP with greater impact and externalizing symptoms with SP with impact after adjusting for a range of potential child and family confounders. Psychological distress in childhood increases the risk of SP with impact in adolescence and may be a promising prevention target. Our findings provide evidence that psychological distress early in life is an independent risk factor for spinal pain with impact during adolescence. As psychological distress during childhood is potentially modifiable, it may be a promising target for research on the prevention of consequential spinal pain in adolescence. Identifying and addressing psychological distress in children may be an important component of best practice to reduce consequential spinal pain in adolescents.

LSTM-only Model for Low-complexity HR Estimation from Wrist PPG.

Continuous and non-invasive cardiovascular monitoring has gained attention due to the miniaturization of wearable devices. Particularly, wrist-worn photoplethysmography (PPG) sensors present an alternative to electrocardiogram recording for heart rate (HR) monitoring as it is cheaper and non-intrusive for daily activities. Yet, the accuracy of PPG measurements is heavily affected by motion artifacts which are inherent to ambulatory environments. In this paper, we propose a low-complexity LSTM-only neural network for HR estimation from a single PPG channel during intense physical activity. This work explored the trade-off between model complexity and accuracy by exploring different model dataflows, number of layers, and number of training epochs to capture the intrinsic time-dependency between PPG samples. The best model achieves a mean absolute error of 4.47 ± 3.68 bpm when evaluated on 12 IEEE SPC subjects.Clinical relevance- This work aims to improve the quality of HR inference from PPG signals using neural network, enabling continuous vital signal monitoring with little interference in daily activities from embedded monitoring devices.

Pain in Hemodialysis Patients: Prevalence, Intensity, Location, and Functional Interference in Daily Activities.

Although pain is a frequent complaint of patients with chronic kidney disease who undergo hemodialysis, few studies have assessed the functional interference of pain in activities of daily living (ADLs). Hence, the aim of this study was to evaluate the prevalence, location, intensity, and functional interference of pain in ADLs of chronic kidney disease patients undergoing hemodialysis and to estimate the association of specific pain sites with severe functional interference by pain in ADLs. This cross-sectional study included patients with chronic kidney disease undergoing hemodialysis. The prevalence, intensity, and functional interference of pain in ADLs were assessed using the brief pain inventory. Poisson regression was used to calculate the prevalence ratio. A total of 65 patients participated in the study. The overall prevalence of pain was 89.23%; the prevalence of headache was 18.46% and that of pain in the trunk was 55.38%, upper limbs was 35.38%, and lower limbs was 60.00%. The prevalence of moderate and severe pain at the time of hemodialysis was 13.85% and 21.54%, respectively. A high prevalence of severe functional interference of pain in general activity (61.54%), mobility (56.92%), and disposition (55.38%) was observed. Pain is a frequent complaint in patients undergoing hemodialysis, mainly musculoskeletal and intradialytic, and it interferes with ADLs and incapacitates the patient. Pain was highly prevalent in the upper and lower limbs and the trunk. Furthermore, a higher prevalence of severe pain at the time of hemodialysis and functional interference of pain, mainly in general activity, mobility, and disposition, were observed.