Interference In Daily Activities Research Articles

A Role for Complementary and Integrative Medicine in Alzheimer's Disease Prevention.

Complementary and Integrative Medicine has been maturing as a field to support treatment for a variety of medical conditions. The approaches, including yoga, meditation, acupuncture, and dietary supplements, may assist patients in a variety of ways, though clear explanations for their mechanisms of action or measurements of their possible benefit are in most cases elusive. In this issue of the Journal of Alzheimer's Disease, Khalsa examines the use of meditation as a stress-reduction technique and provides an argument that with a specific technique such stress reduction can be provided efficiently, with relatively little interference in daily activities, and might decrease Alzheimer risk. This thorough review provides some evidence of physiological benefit of meditation to brain function. While any actual effect of meditation on Alzheimer pathophysiology is only conjectural, meditation has received considerable attention as a tool that may have positive psychological and medical benefits. Consequently, this review is welcome. What is less certain is whether the recommended meditation approach is of specific benefit for Alzheimer's disease or any other condition above and beyond what might be provided by many other types of exercises (like singing in a chorus or doing cross-word puzzles) or physical activities (like swimming or yoga).

When treating the pain is not enough: a multidisciplinary approach for chronic pelvic pain

Chronic pelvic pain (CPP) is related to psychological distress and interference in daily activities; however, CPP is not as extensively researched as other forms of chronic pain. Therefore, the purpose of this study was to investigate the relationships among pain, psychological distress, and functional impairment in patients with CPP. There were chart reviews conducted of 107 female patients who completed a psychiatric evaluation at a specialty, CPP clinic as a part of a multidisciplinary evaluation. Results suggest that psychological distress and impairment in daily activities are common in CPP patients. Most areas of functional impairment were not associated with pain variables. Rather, several forms of functional impairment were related to higher levels of depression and anxiety. Results from this study suggest the possibility that psychiatric symptoms are contributing to functional impairment in this population. These findings highlight the importance of a multidisciplinary approach in the evaluation and treatment of CPP patients to help decrease functional impairment in these patients.

Autologous Whole Blood Injection for the Treatment of Antihistamine-Resistant Chronic Spontaneous Urticaria.

Dear Editor: Recently, the term chronic spontaneous urticaria (CSU) is used to indicate spontaneous and persistent wheals, independent of external physical stimuli1. CSU is classified into two groups according to the presence of autoantibodies: chronic autoimmune urticaria (CAU) and chronic idiopathic urticaria (CIU)2. Several treatment methods are available for patients with CSU. However, CSU can be resistant to conventional treatment, including high-dose antihistamines (up to 4-fold dose of H1 antihistamines). Autologous whole blood (AWB) injection, a prevalent method to treat allergic rhinitis, atopic dermatitis, and viral disease, is scientifically unproven3,4. Few reports have documented the clinical improvement of CSU after injection of AWB5,6. Although its mechanism of action remains widely unknown, we believe that AWB injection may desensitize the patient against triggering factors including autoanti-bodies. The aim of this study was to evaluate the efficacy of AWB injection in treating CSU, and to compare its efficacy on CAU and CIU. The study was approved by the hospital ethics committee (E-2013096), and all patients gave their informed consent. We treated 22 patients with CSU, who had uncontrolled urticaria most days of the week despite antihistamine therapy for >6 weeks, by administering AWB injections for 8 consecutive weeks. Patients who had developed urticarial due to foods, drugs, or physical and environmental factors, female patients who were pregnant or lactating, patients with any severe systemic disease, and patients who had taken any immunosuppressive agent within 4 weeks of entry were excluded from the study. The patients were classified into two groups after autologous serum skin test (ASST): positive (CAU) and negative (CIU). After the cessation of antihistaminic treatment for at least 3 days, ASST was performed. A wheal with a diameter at least 1.5 mm greater than that of a saline-induced wheal at 30 min was considered positive. We took venous blood samples and immediately administered a gluteal intramuscular AWB injection. The volume of injection was 2.5 ml at week 0, and 5 ml/week for the subsequent injections. All patients underwent laboratory examinations before treatment, including complete blood count, liver and renal function tests, urinalysis, and D-dimer analyses. Only antihistamines were allowed during the AWB injection phase for worsening pruritus or wheals. The outcome measures were pruritus intensity; wheal number, size, and duration; and sleep and daily activity interference by using score values from 0 to 3. The sum of all six severity parameters were calculated to obtain the urticaria activity score (UAS)7 every week, and the UAS at week 0 and week 8 was compared between responders and non-responders. The consumption of antihistamines was calculated at the endpoint. A was defined as a patient with >30% improvement of UAS after repeated AWB injections5. In total, 8 of 22 patients (36.4%) with CSU were responders to AWB injection; 2 of 7 (28.6%) CAU and 6 of 15 (40.0%) CIU patients were considered responders (Table 1). There was no significant difference in responder ratios between the CAU and CIU groups. The antihistamine consumption at week 8 did not show any significant differences compared with baseline (data not shown). Between responders and non-responders, we found that CSU patients with a high baseline UAS improved markedly after repeated AWB injections (p=0.019); however, there was no difference with respect to disease duration, sex, age, ASST result, D-dimer, and C-reactive protein level (Table 2). No patients experienced serious adverse events; however, minor adverse events such as bruising and injection pain were noted. Table 1 Efficacy of AWB injection after 8 week of treatment Table 2 Comparison between responders and non-responders to autologous whole blood injection among 22 CSU patients Although desensitization with repeated AWB injections theoretically provided better efficacy in patients with CAU than in those with CIU, our results showed that there were no significant differences between groups at the endpoint. Mori and Hashimoto8 reported that an ASST-positive patient was completely cured after AWB injections; however, the patient remained ASST positive. These findings suggest that the underlying mechanism of AWB injections is attributed to other pathogenetic factors. Unlike in previous reports5,8, AWB injection did not cause a dramatic response in patients with antihistamine-resistant CSU regardless of the skin test results to autologous serum. Nevertheless, the most important finding of this study is that AWB injection might be more efficient in treating patients with CSU who had high disease activity at baseline. Therefore, AWB injections may be an option in treating patients with antihistamine-resistant CSU who have high disease activity. Further studies are required to reinforce the current results concerning AWB injection in patients with CSU, and evaluate its efficacy, duration, treatment interval, and dose.

Progression of Pain in Ambulatory HIV-positive South Africans

Cross-sectional studies report that pain in ambulatory HIV-infected individuals is frequent and often undermanaged. Expanding access to HIV treatment in developing countries means that infected individuals are living longer, but there is a dearth of pain-directed studies from developing countries that describe the progression of pain and its treatment over any period of time. The aim of this study was to characterize the progression of pain and its treatment over a 6-month period in 92 ambulatory HIV-positive patients attending an outpatient clinic in Johannesburg, South Africa. We used the Wisconsin Brief Pain Questionnaire to assess changes in pain intensity, pain sites, pain interference, and pain treatment. At visit 1, pain was present in 78 of 92 patients (85%). Of the 78 patients with pain, 67 had moderate or severe pain (86%) and pain affected two or more body sites simultaneously in 57 of these patients (73%). After 6 months, pain prevalence still was high, but had fallen to 50 patients (54%). Of the patients with pain at visit 2, the proportion with moderate or severe pain (82%), or two or more pain sites (62%) had decreased. Analgesic use was low at both time points (5% and 25% analgesic use at visit 1 and 2, respectively). Despite the high pain burden, pain interference in daily activities was very low across the period assessed. The burden of pain in this cohort of ambulatory HIV-positive patients was high, but there were significant reductions in pain burden over time.

Self-compassion weakens the association between hot flushes and night sweats and daily life functioning and depression

ObjectivesSome women find hot flushes and night sweats (HFNS) to interfere more in daily life and mood than others. Psychological resources may help to explain these individual differences. The aim of this study was to investigate the role of self-compassion, defined as healthy way of relating toward the self when dealing with difficult experiences, as a potential moderator of the relationship between HFNS and daily life activities, which in turn influences symptoms of depression. Study designThis was a cross-sectional study using questionnaire data from 206 women aged 40–60 who were currently experiencing hot flushes and/or night sweats. Path analysis was used to model relationships among menopausal factors (HFNS frequency and daily interference ratings), self-compassion and mood. Main outcome measureHot flush interference in daily activities and depressive symptoms. ResultsOn average, women experienced 4.02 HFNS per day, and HFNS frequency was moderately correlated with interference ratings (r=0.38). In the path analytic model, self-compassion made significant direct contribution to hot flush interference ratings (β=−0.37) and symptoms of depression (β=−0.42), and higher self-compassion was associated with lower interference and depressive symptoms. Self-compassion also moderated the relationship between HFNS frequency and hot flush interference. Higher self-compassion was associated with weaker effects of HFNS frequency on daily interference. ConclusionsSelf-compassion may weaken the association between HFNS and daily life functioning, which in turn, could lead to less HFNS-related mood problems. These findings imply that self-compassion may be a resilience factor to help women manage hot flushes and night sweats.

Barriers to self-administered therapy for hereditary angioedema.

Presently, the movement of care for hereditary angioedema (HAE) is out of the clinic, emergency department, and hospitals and into the home. Much of the transition relies on specialized nurses who teach patients self-administration skills. Our goal was to assess nurses to uncover barriers that they have encountered in an effort to improve self-therapy education and patient care. A survey of 21 questions was sent to 38 HAE home care nurses throughout the United States. Results were collected anonymously and data were analyzed. Nurses feel that there is an increased need for teaching patients self-therapy skills. The majority are very comfortable teaching self-administration and troubleshooting-associated problems. Perceived difficulties in providing adequate teaching include distance to patient's home and logistics of coordinating, scheduling, and obtaining supplies. Teaching is preferred when done at home by a visiting nurse with a care partner available and multiple training sessions are needed. Very few patients refused self-administration after initially being taught; reasons cited for refusal include fear of injection or infection, lack of skills, interference of daily activities, and financial restraints. As for nurses, they were most worried about safety, lack of skill retention, and inappropriate use of the drug. Self- administration of HAE treatment is increasingly more accessible and should be offered to patients as a safe and practical option. The barriers to self-administration revealed in this study include distance to the patient's home, coordinating care, obtaining medications/equipment, and scheduling training sessions. Moving to self- or home treatment through nursing instruction will improve patient's independence and quality of life, lead to earlier therapy, and reduce costs associated with care.

Vallejo-Nágera (1926–1990) and the concept of ‘soteric neurosis’: a forgotten sketch of hoarding disorder in the obsessive-compulsive spectrum literature

Juan Antonio Vallejo-Nágera, psychiatrist, painter and writer, wrote a widely adopted textbook of psychiatry in Spanish- and Portuguese-speaking countries, particularly during the 1970s, the famous Introducción a la psiquiatría. There, he advanced the concept of soteric neurosis, a condition regarded as a 'mirror image' of phobias and similar to the diagnostic entity described in DSM-5 under the heading of hoarding disorder. Indeed, much earlier than the recent nosological discussions on hoarding, Vallejo-Nágera already reported soteric neurosis to be distinct from obsessive-compulsive disorder and to be associated with excessive attachment to objects and positive affect (pleasure), leading to accumulation, decreased treatment seeking, increasing interference in daily activities and blurred boundaries with normality. Vallejo-Nágera also made several predictions, including the propensity soteric neurosis patients may have towards the development of separation anxiety, obesity and other 'masked' symptoms. In the light of his original and insightful contributions to the concept of hoarding disorder, it would be interesting to assess his hypotheses in future studies.

Pain-related attitudes and functioning in elderly primary care patients.

This study examined the associations between specific pain-related beliefs and both mental health and pain interference in elderly patients with chronic pain. A total of 139 patients completed validated questionnaires assessing pain domains (i.e., intensity, duration and location), psychological functioning, pain interference and demographic variables. Pain-related beliefs were related with poorer mental health (Disability = -.27; Harm = -.23; Solicitude = -.24; Control = .18; Emotion = -.29) and greater interference in daily activities (Disability =.41; Harm =.13; Solicitude =.29; Control = -.31). Our findings are consistent with a biopsychosocial model of chronic pain which goes beyond physical variables in an attempt to understand and promote patients' adjustment to chronic pain problems.

The impact of post-herpetic neuralgia: a prospective multicentre study on health-care resource use and associated costs

Herpes Zoster (“shingles”) is caused by the reactivation of a latent varicella-zoster virus infection, acquired following a primary varicella infection, generally many years before the index episode. Herpes Zoster (HZ) is characterized by a typical cutaneous rash and localized pain specifically limited to the affected dermatomes, usually present during 2 weeks to one month. The annual incidence of HZ in European countries is estimated around 5 to 7 cases per 1000 person-years. The most common complication of HZ is post-herpetic neuralgia (PHN). PHN is frequently severe and incapacitating; it has an important impact on quality of life and is generally associated with high health-care resource use and costs. The aims of the present study were to assess, in HZ and PHN patients attending Chronic Pain Clinics in Portugal, the following : • Clinical characteristics of HZ and PHN patients; • Interference in activities of daily living and health related quality of life; • Health-care resource use associated with HZ and PHN (primary care visits, hospital visits and admissions, medications and other treatment modalities). In the present abstract we report specifically on the latter.

Pharmacist-led medication education in cancer pain control: A multicentre randomized controlled study in Guangzhou, China

To evaluate clinical pharmacist-led pain-medication education in patients with cancer. A controlled study was conducted prospectively at six tertiary hospitals in China. In-patients with cancer were randomized to receive conventional treatment plus medication education or no education (controls). Education consisted of access to information booklets and eight 30-min face-to-face counselling sessions given by clinical pharmacists over 4 weeks. Patients completed pain- and analgesic-knowledge assessments and a Brief Pain Inventory, pre- and post-study. A total of 123 and 114 patients in the education and control groups, respectively, completed follow-up. At the end of the study, patient knowledge regarding cancer pain and pain control was significantly increased in both groups; pain and analgesic knowledge scores were significantly higher in the education group compared with controls. In the control group, the increase in total pain-related knowledge was significantly greater in analgesic-naïve patients compared with those who were using/had used analgesics. Pain intensity scores and pain interference of daily activities were significantly reduced in the education group compared with controls. Clinical pharmacist-led medication education resulted in improved pain control in patients with cancer.

Long-term effect in ADL after an interdisciplinary rehabilitation programme for WAD patients: a mixed-method study for deeper understanding of participants’ programme experiences

Purpose: To evaluate long-term effects in self-perceived occupational performance and satisfaction in Activities of Daily Living (ADL) for patients with Whiplash Associated Disorders (WAD) with chronic pain in an interdisciplinary rehabilitation programme, and investigate patients’ opinions of programme effects. Method: A mixed-method with sequential explanatory design was used. Fifty-three patients with WAD were followed-up 12 months after discharge. The Canadian Occupational Performance Measure was used to evaluate the change in ADL and the Multidimensional Pain Inventory for psychosocial functioning. Telephone interviews, based on five structured questions about the perceived impact of the rehabilitation programme, were made. Results: The 12-month follow-up showed significant ADL improvement (p < 0.001). There was less interference in daily activities due to pain (p < 0.01), and life control increased. More people were back to work. Interviews revealed the programme’s environment as strengthening and safe, and participants felt they were met with respect. Key success factors were to be treated with respect to being part of the social context and to obtain new knowledge. Conclusions: The interdisciplinary rehabilitation programme had initiated a process of change towards a more active life for the participants. They had found a new way of managing their lives. Despite the absence of pain reduction, they managed ADL in a better way, had more life control and returned to work to a higher degree.Implications for RehabilitationChronic pain after WAD effects the entire life for many people.Long-term effects on activities of daily living, life control and work ability have shown positive results after an interdisciplinary rehabilitation programme based on behavioural and cognitive principles.The key success factors were to be treated with respect to being a part of a social context and to obtain new knowledge.

Epidemiology of ocular allergy and co-morbidities in adolescents

ObjectiveThe prevalence of allergic conjunctivitis (AC) has not been established. Estimates suggest that ocular allergies affect 15% to 20% of the worldwide population, yet most epidemiological studies encompass nasal and ocular allergy symptoms and have not been specific to AC. The aim of this study was to verify the prevalence of ocular allergy symptoms, co-morbidities, and their impact on adolescents. MethodsAdolescents were selected from a sample of schools, and completed in classrooms a previously validated questionnaire on symptoms of AC. AC diagnosis was considered when more than three episodes of ocular itching were reported in the past 12 months. Related symptoms such as tearing, photophobia, foreign body sensation, impact on daily activities, and diagnosis of AC were analyzed. ResultsQuestionnaires were obtained from 3,120 adolescents (mean age 13.3±1.1 years). Ocular itching in the past 12 months occurred in 1,592 (51%). The most frequently associated symptom was tearing (74%), followed by photophobia (50.1%) and foreign body sensation (37.1%). The prevalence of AC was 20.7%, affecting more females than males (56.1% versus 45.9%; p=0.01). The risks of an adolescent with ocular allergy to present asthma, rhinitis, and atopic eczema were (OR=5.7; 95% CI: 4.5 to 7.1), (OR=3.6; 95% CI: 3.0 to 4.3), and (OR=2.6; 95% CI: 2.0 to 3.5), respectively. Severe interference in daily activities was reported by 30.5%. ConclusionsSymptoms of ocular allergy are common, frequently associated to other allergic diseases, and impact the daily activities of adolescents.

Epidemiology of ocular allergy and co-morbidities in adolescents

ObjectiveThe prevalence of allergic conjunctivitis (AC) has not been established. Estimates suggest that ocular allergies affect 15% to 20% of the worldwide population, yet most epidemiological studies encompass nasal and ocular allergy symptoms and have not been specific to AC. The aim of this study was to verify the prevalence of ocular allergy symptoms, co-morbidities, and their impact on adolescents. MethodsAdolescents were selected from a sample of schools, and completed in classrooms a previously validated questionnaire on symptoms of AC. AC diagnosis was considered when more than three episodes of ocular itching were reported in the past 12 months. Related symptoms such as tearing, photophobia, foreign body sensation, impact on daily activities, and diagnosis of AC were analyzed. ResultsQuestionnaires were obtained from 3,120 adolescents (mean age 13.3±1.1 years). Ocular itching in the past 12 months occurred in 1,592 (51%). The most frequently associated symptom was tearing (74%), followed by photophobia (50.1%) and foreign body sensation (37.1%). The prevalence of AC was 20.7%, affecting more females than males (56.1% versus 45.9%; p= 0.01). The risks of an adolescent with ocular allergy to present asthma, rhinitis, and atopic eczema were (OR= 5.7; 95% CI: 4.5 to 7.1), (OR=3.6; 95% CI: 3.0 to 4.3), and (OR=2.6; 95% CI: 2.0 to 3.5), respectively. Severe interference in daily activities was reported by 30.5%. ConclusionsSymptoms of ocular allergy are common, frequently associated to other allergic diseases, and impact the daily activities of adolescents.

Disability in multiple sclerosis

To create a reference table of disability outcomes in multiple sclerosis (MS) that would enable patients to rank their disability relative to others' with similar disease duration and to develop a cost-effective research tool for comparing MS severity across patient populations and time periods. The North American Research Committee on Multiple Sclerosis (NARCOMS) Registry collects disability data from patients with MS on a validated, 9-point Patient-Determined Disease Steps (PDDS) scale. We compiled the Disability Expectancy Table, which displays cumulative frequencies of PDDS scores for each year of disease duration, from 0 to 45 years. We also tabulated disease duration-adjusted mean ranks of PDDS scores, referred to as Patient-derived MS Severity Scores (P-MSSS). The cohort consisted of 27,918 NARCOMS enrollees, 72.7% of whom were female and 90.1% of whom were white. Mean age at symptom onset was 30.1 ± 10.1 years, and age at enrollment was 47.1 ± 11.0 years. The Disability Expectancy Table and P-MSSS afford a detailed overview of disability outcomes in a large MS cohort over a 45-year period. In the first year of disease, 15% of patients reported need of ambulatory aid, and 4% needed bilateral assistance or worse; after 45 years of disease, 76% of patients required ambulatory aid, and 52% bilateral assistance or worse. Proportion of patients who reported minimal or no interference in daily activities (PDDS ≤ 1) declined from 63% in the first year to 8% after 45 years of disease. The Disability Expectancy Table allows individual patients to determine how their disability ranks relative to NARCOMS enrollees with the same disease duration. P-MSSS may be used to compare disability across patient populations and to track disease progression in patient cohorts. P-MSSS does not require a formal neurologic examination and may therefore find wide applicability as a practical and cost-effective outcome measure in epidemiologic studies.

Clinical utility and tolerability of JSPH-1 wireless esophageal pH monitoring system

BackgroundWireless esophageal pH monitoring system is an important approach for diagnosis of gastroesophageal reflux disease (GERD), the aim of this study is to test the tolerability and utility of the first wireless esophageal pH monitoring system made in China, and evaluate whether it is feasible for clinical application to diagnose GERD.MethodsThirty patients from Department of Gastroenterology of The First Affiliated Hospital of Chongqing Medical University who were suspected GERD underwent JSPH-1 pH capsule. The capsule was placed 5 cm proximal to the squamocolumnar junction (SCJ) by endoscopic determination, the data was recorded consecutively for 48 hours. Then all pH data was downloaded to a computer for analysis. The discomforts reported by patients were recorded.Results30 patients were placed JSPH-1 pH capsule successfully and completed 24-hour data recording, 29 patients completed 48-hour data recording. One patient complained of chest pain and required endoscopic removal. No complications and interference of daily activities were reported during data monitoring or follow-up period. 48-hour pH monitoring detected 15 patients of abnormal acid exposure, on day1 detected 9 patients, the difference had statistical significance (P<0.01). Positive symptom index (SI) was identified in 3 patients with normal pH data in both 24-hours. In total, 48-hour monitoring increased diagnosis of GERD in 9 patients.Conclusion48-hour esophageal pH monitoring with JSPH-1 wireless pH monitoring system is safe, well tolerated and effective. It can be feasible for clinical application to diagnose GERD.

Pain Severity Cut‐Points and Analgesic Use by Community‐Dwelling People for Chronic Pain

ABSTRACTAimTo define a descriptive scale for mild, moderate and severe chronic pain experienced by community‐dwelling people; and to use this scale to investigate chronic pain management in community‐dwelling people.MethodPeople with chronic pain were recruited through 20 randomly selected rural and urban community pharmacies in Victoria, Australia. Participants received a survey pack with their prescription medication and chose to participate in the study by returning the completed anonymous questionnaire. Multivariate analysis of variance was used to determine cut‐points on the 0 to 10 average pain intensity scale of the Brief Pain Inventory (short form) from participants' reports of pain interference in daily activities during the previous week.ResultsQuestionnaires were returned by 219 people (response rate 31%). Cut‐points on the average pain intensity scale of 3 and 6 were found to categorise chronic pain. Therefore, an average pain intensity of 1 to 3 can be considered mild, 3 to 6 moderate and 6 to 10 severe, with each increase in category indicating a significant increase in pain interference in daily activities. Gender, age and locality did not influence reported pain intensity. 191 participants (91%) reported experiencing moderate or severe pain during the previous week.ConclusionCut‐points on the average pain intensity scale of the Brief Pain Inventory (short form) for mild, moderate and severe pain are 3 and 6. Pain management of community‐dwelling people with chronic pain can be improved.

Prevalencia del dolor neuropático (DN), según DN4, en atención primaria

BackgroundPrimary Care Physicians are usually the first to see patients with neuropathic pain. The aim of this study is to assess the prevalence of neuropathic pain, its therapeutic management, and to clinically characterize these patients. Material and methodsAn epidemiological, observational, cross-sectional study was carried out in Spanish Primary Care settings. The first 25 patients older than 18 years with any type of pain (a total of 16,115) were registered, and the first 5 with a high neuropathic pain component according to the NP4 test, and was clinically confirmed (n= 3,836) were included in the study. Pain intensity and impact on daily activities, as well as overall satisfaction with treatment were assessed. ResultsA total of 45.7% of patients had neuropathic pain according to NP4 test. The median age was 59 years, and 60% were women. Patients took a mean of 2.4 drugs, with NSAIDs (53%) and non-opioid analgesics (51%) being the most common. The scores for Pain intensity and interference in daily activities were both 6.2. The overall opinion of the SATMED-Q test was 47.3/100, which was 1.4 points lower than the standardised score according to Spanish population. ConclusionsNeuropathic pain according to NP4 test is highly prevalent in Spanish Primary Care settings. The management of these patients with NSAIDs and non-opioid analgesics is not appropriate, as they are not recommended for this kind of pain. Although they were being treated with more than 2 analgesics, they still referred to high pain intensity, interference in daily activities, and a low general opinion of the treatment.

Influência de elementos meteorológicos na dor de pacientes com osteoartrite: revisão da literatura

Despite the frequent assertion that the weather conditions change the intensity of pain in osteoarthritis (OA), this influence is controversial and difficult to measure. This analysis aims to review articles related to the influence of meteorological elements in the OA pain. The literature review was performed with the bibliographical survey databases of the Medical Literature Analysis and Retrieval System Online (MEDLINE) and the Latin American and Caribbean Health Sciences (LILACS), and active search in the list of references of the articles and reviews retrieved. The inclusion criteria for this analysis were prospective studies that evaluated the presence of pain related to some variable of weather in OA patients. The articles were published in Portuguese, English, and Spanish. Of the 247 abstracts analyzed, eight (3.2%) included articles from the electronic database consulted (n = 7), and active case finding (n = 1). Atmospheric pressure was the most frequently variable with some influence on OA pain in five of the included studies, while precipitation was less related to the symptoms of OA; wind was not analyzed. Despite the methodological diversity and biases of the analyzed studies, there is a trend to confirm the influence of weather in OA pain intensity, mainly in more recent publications. Besides checking the effect of meteorological elements in the OA pain, it is necessary to evaluate the interference in daily activities and impairing of the quality of life.

Menstrual bleeding: perspective of Brazilian women

Background Menstrual patterns, induced amenorrhea and the use of some contraceptive methods which induce non-bleeding are issues under debate among health professionals and women. The objective of the study was to describe perspectives and attitudes of Brazilian women regarding menstruation and its interference in daily activities. Study Design A semistructured questionnaire was applied to nonpregnant, nonlactating women between 18 and 45 years old, who were menstruating, consulting at public health services for other complaints than gynecological or reproductive health care, and staff members and teachers of public universities in one city of each geographic region of Brazil and the Federal District. Results Of the 885 women interviewed, 51.5% were aged 20–29 years, almost 60% reported normal frequency of bleeding, 22% and 43% reported interference of menstruation in their school activities and in the relationship with their partner, respectively. The value attributed to each interference (<5; ≥5; in a scale up to 10) was >5 for more than 60% of the women in all evaluated domains. The most common reason for disliking menstruation was inconvenient and/or discomfort, and for liking menstruation were feeling healthy and confirmation of not being pregnant. The variables associated to liking menstruation were attending <8 years of school and low economic class, having more than one child and no history of premenstrual tension. Conclusion A great proportion of the interviewed women disliked having menstruation even when they did not present menstrual-related problems. However, some women still preferred monthly menstruation because they felt healthy and it was a free pregnancy test.

Epidemiology and Burden of Rhinitis and Rhinoconjunctivitis in 9- to 11-Year-Old Children

Rhinoconjunctivitis (RC) is regarded as the most common chronic disease of childhood; however, the currently available epidemiological studies on prevalence, burden, and risk factors of RC are insufficient. This analysis aimed to investigate potential risk factors, symptom frequency, and burden of RC. Using the International Study of Asthma and Allergies in Childhood Phase II questionnaires, 6963 elementary school children aged 9-11 years were surveyed in five different city centers of Turkey. All participants were skin-prick tested with common aeroallergens. The prevalence of ever rhinitis, physician-diagnosed rhinitis, current rhinitis, and current RC were 51.6, 31.0, 43.5, and 23.1%, respectively; 19.8% of children with RC symptoms were atopic to at least one allergen. Among students with RC symptoms, 42.2, 23.9, 35.8, and 28.2% reported moderate-severe interference of daily activities, at least 1 day of absence from school, visit to a health care professional, and any drug usage for rhinitis, respectively. Nasal decongestants and oral antihistamines were the most frequently used treatment. Approximately 70% of RC patients reported perennial symptoms and 42.8% were classified as mild to intermittent. Multivariate logistic regression analysis revealed family history of asthma and/or allergic rhinitis (odds ratio [OR] = 1.863; confidence interval, [CI] = 1.583-2.191; p < 0.001), living in a house with mold and dampness in the 1st year of life (OR = 1.651; CI = 1.356-2.01; p < 0.001), maternal smoking in pregnancy (OR = 1.425; CI = 1.089-1.864; p = 0.011), low monthly income (OR = 1.685; CI = 1.422-1.998; p = 0.001), current wheezing (OR = 2.543; CI = 2.151-3.006; p = 0.001), and current atopic eczema (OR = 2.503; CI = 1.96-3.196; p = 0.001) as significant risk factors for current RC. Along with the high prevalence of RC in childhood, underdiagnosis and undertreatment of the disease are also frequent. The socioeconomic burden of the disease can be reduced by increasing awareness and proper diagnosis/treatment.