Internet-based treatment for adolescents with symptomatic temporomandibular joint disc displacement with reduction. A randomized controlled clinical trial

OBJECTIVE

To evaluate treatment outcome of a jaw exercise (JE) intervention program combined with an information/counselling program (IC) vs. information/counselling alone.

MATERIALS AND METHODS

A clinical sample of 83 adolescents, experiencing painful clicking or catching/locking of the jaw, and diagnosed with symptomatic disc displacement with reduction according to RDC/TMD, were randomly assigned to JE/IC or IC program. Both programs were internet-delivered. The adolescents were examined clinically at baseline, at a 2-month mid-evaluation, and at 4months posttreatment by examiners blinded to which programs the adolescents were assigned to.

RESULTS

The JE/IC group showed significantly more improvements of painful catching/locking (p = .017), eating ability (p = .006) and of their jaw function limitation (p = .026) compared to the IC group. Significantly more adolescents in the JE/IC group also reported a ≥50% improvement of the catching/locking of the jaw with pain (p = .024) and for eating ability (p = .034) based on a severity index. Treatment method credibility and satisfaction were also significantly higher in the JE/IC group.

CONCLUSION

The internet-delivered JE/IC program showed a better outcome compared to IC alone. The former is thus a feasible and cost-effective treatment for adolescents with symptomatic disc displacement with reduction.

Pain intensity and pressure pain thresholds after a light dynamic physical load in patients with chronic neck-shoulder pain

Background

To investigate the development of pain intensity and pressure pain thresholds during and 24 h after a light dynamic physical load among patients with chronic neck-shoulder pain.

Methods

Twenty-six patients with chronic neck-shoulder pain and 12 healthy controls were included. The participants arm-cycled on an ergometer. Effort was rated with the Borg Rating of Perceived Exertion scale (RPE), and pain intensity with an numeric rating scale (NRS). Pressure pain thresholds were measured by an algometer. Participants started a pain diary 1 week before the physical exercise and continued until 1 week after. Pain intensity was assessed before, during and the following two evenings after arm-cycling. Pressure pain thresholds were assessed before, 15 min after, 105 min after and 24 h after.

Results

The chronic pain group showed increased pain intensity during, and the following two evenings after the arm cycling, and decreased pain thresholds immediately after the arm cycling involving painful regions. In the patient group there were no impact on pain thresholds in the neck the following day.

Conclusions

Patients with chronic neck-shoulder pain reported increased pain intensity during and in the evenings after a light dynamic load involving painful regions. In addition, they showed decreased pain thresholds close to the exercise, indicating mechanical hyperalgesia.

The course of pain intensity and frequency of adolescents treated because of temporomandibular disorders: A long-term follow-up

OBJECTIVES

To evaluate the course of pain intensity and frequency related to temporomandibular disorders (TMDs) 15 years (range 5-21 years) after having received TMD treatment as adolescents due to frequent (at least once a week) TMD pain in two controlled trials.

MATERIALS AND METHODS

In the first trial, subjects (n = 122) were randomly allocated to either information only, received in a control condition (Co), or information and an occlusal appliance (OA) versus relaxation therapy (RT). In the second trial, including 64 subjects, nonresponders to OA or RT were subsequently allocated to the alternate treatment (ST). All study participants having completed the trials (n = 167) were invited to a long-term follow-up evaluations, with a response rate of 69.5% (n = 116). Patient-reported outcomes of TMD-related frequency and intensity were appraised relative to baseline data and short-term outcomes as observed in the two trials by use of general linear mixed model and generalized estimation equation statistics.

RESULTS

A significantly higher proportion of participants treated with OA and in the combined RT/Co condition than those in the ST group, reported a frequency level of TMD pain less than once week at post-treatment and the long-term follow-up. Adolescents treated with OA showed significantly lower TMD pain intensity levels post-treatment than those in the other two treatment conditions. While no difference between the OA and the RT/Co conditions was found in the long-term follow-up, participants in these two conditions were significantly more improved than those in the ST group.

CONCLUSION

Adolescents treated with an OA clearly showed better outcome with regard to intensity and frequency in a long-term follow-up of TMD pain than those treated with RT and ST for nonresponders. These latter individuals need special clinical attention and more effective supplementary treatment methods to be developed.

Enzymatic Determination of Lactose and Galactose in Foods: NMKL Collaborative Methods Performance Study

Enzymes are widely used in food chemistry as analytical tools. An enzymatic method for determining lactose and galactose in foods was evaluated in an interlaboratory methods performance study by 12 laboratories in 4 countries. The method is based on enzymatic hydrolysis of lactose and enzymatic oxidation of the hydrolysis products. The exchange of the coenzyme in the second reaction is the basis of quantitation. The method may be used for various types of foods, such as liquid and solid milk products, meat products, cereal products, fats, dressings, sweets, chocolate, and foods for special dietary uses. It is also applicable to lactose-free foods but not to products in which lactose has been partially hydrolyzed enzymatically to glucose and galactose. Six commonly used foodstuffs with lactose concentrations ranging from 0.4 g/100 g to 40 g/100 g and galactose concentrations up to 0.7 g/100 g were analyzed: crisp rye bread, milk chocolate, sausage, cheese, margarine, and baby food containing milk powder. They were distributed to the 12 participants as 12 randomly numbered test samples, representing blind duplicates of the 6 materials. The relative standard deviations for reproducibility (RSDR) were between 2.3-11% for lactose and 6.8-50% for galactose.

Long term effectiveness of dialectical behavior therapy versus enhanced usual care for adolescents with self-harming and suicidal behavior

BACKGROUND

Knowledge is lacking on the long-term outcomes of treatment for adolescents with repetitive suicidal and self-harming behavior. Furthermore, the pathways through which treatment effects may operate are poorly understood. Our aims were to investigate enduring treatment effects of dialectical behavior therapy adapted for adolescents (DBT-A) compared to enhanced usual care (EUC) through a prospective 3-year follow-up and to analyze possible mediators of treatment effects.

METHODS

Interview and self-report data covering the follow-up interval were collected from 92% of the adolescents who participated in the original randomized trial.

TRIAL REGISTRATION NUMBER

NCT01593202 (www.ClinicalTrials.gov).

RESULTS

At the 3-year follow-up DBT-A remained superior to EUC in reducing the frequency of self-harm, whereas for suicidal ideation, hopelessness and depressive and borderline symptoms and global level of functioning there were no inter-group differences, with no sign of symptom relapse in either of the participant groups. A substantial proportion (70.8%) of the effect of DBT-A on self-harm frequency over the long-term was mediated through a reduction in participants' experience of hopelessness during the trial treatment phase. Receiving more than 3 months follow-up treatment after completion of the trial treatment was associated with further enhanced outcomes in patients who had received DBT-A.

CONCLUSIONS

There were on average no between-group differences at the 3-year follow-up in clinical outcomes such as suicidal ideation, hopelessness, depressive and borderline symptoms. The significantly and consistently larger long-term reduction in self-harm behavior for adolescents having received DBT-A compared with enhanced usual care, however, suggests that DBT-A may be a favorable treatment alternative for adolescents with repetitive self-harming behavior.

Long-term follow-up of a community sample of adolescents with frequent headaches

Background

Several outcome studies have reported on the short- and long-term effects of migraine in selected clinical samples of children and adolescents. However, current knowledge of the course, incidence, and outcome predictors of frequent headaches in early adolescents in community populations is limited, and little is known about the long-term effects. Headache remains untreated in most of these young people. Here we examined the course, incidence, and outcome predictors of frequent headaches (at least once a week) over the long term (14 years) using previously assessed data at the baseline and 1-year follow-up of early adolescents.

Methods

Out of an original sample of 2440 who participated in the first two assessments, a sample of 1266 participants (51.9% response rate) aged 26–28 years (mean = 27.2 years) completed an electronic questionnaire comprising questions about their headache frequency and duration at the long-term follow-up. These headache characteristics together with gender, age, parental divorce, number of friends, school absence, impairment of leisure-time activities and seeing friends, pain comorbidity, and emotional (in particular, depressive symptoms) and behavioral problems were analyzed.

Results

In these young people, 8.4% reported frequent headaches (at least once a week) at the extended follow-up, while 19% of the participants having such headaches at baseline again reported such levels with a negligible gender difference. Over the follow-up period, 7.4% had developed frequent headaches, and a higher percentage of females reported such headaches (11.3% in females, 1.5% in males). In a multivariate model, frequent headaches at the baseline, gender (worse prognosis in females), impairment of leisure-time activities and seeing friends, and higher level of depressive symptoms significantly predicted headache frequency at the long-term follow-up.

Conclusions

Our findings suggest that gender, greater social impairment, and comorbid depressive symptoms are important indicators for both the short- and long-term prognosis of frequent headaches in early adolescents in community populations.

Percutaneous Treatment with a Mucopolysaccharide Polysulphate of Experimentally Induced Subcutaneous Haematomas in Man

In a double blind trial on ten healthy volunteers, the efficacy of a topically applied mucopolysaccharide polysulphate* in the treatment of subcutaneous haematomas was assessed. Standardized haematomas were induced by subcutaneous injection of a mixture of autogenous blood and 125I-fibrinogen. The absorption of the haematoma, expressed as the removal of the labelled fibrin(ogen), could thus be objectively measured by the decrease in radioactivity.

The results show an exponential absorption of these haematomas. The absorption time was reduced to about half compared with placebo, when treated topically with mucopolysaccharide polysulphate. The difference is statistically highly significant and is also considered clinically relevant.

Long-term treatment outcome for adolescents with temporomandibular pain

OBJECTIVES

This study aims to evaluate long-term, self-perceived outcome in adulthood for individuals treated as adolescents for temporomandibular disorder (TMD) pain in two previous randomized controlled trials (RCTs).

MATERIALS AND METHODS

The study included 116 subjects (81% females) treated for frequent TMD pain in two separate RCTs 5-21 (M = 14.8, SD =4.9) years previously. Treatment consisted of occlusal appliance (OA) (n = 41, 35.3%) or relaxation training (RT) combined with information for the control (Co) group (n = 50, 43.1%), both compared to non-responders receiving additional, sequential treatment (ST) in a crossover study (n = 25, 21.6%). Participants answered a questionnaire on their experience of frequency and intensity of TMD pain impaired chewing capacity and daily social activities, help-seeking behaviour and treatment, general health, other pain, and depressive symptoms.

RESULTS

Older participants reported lower levels of frequency and intensity of TMD pain, impairment, and depressive symptoms, as well as better general health. Females reported more frequent and more intense TMD pain, greater impairment and more often reported 'other pain' compared to males. Non-responders receiving ST experienced significantly more TMD, and other pain and higher impairment levels compared to other groups. Those treated with an OA had sought additional treatment significantly less often since the RCTs than ST and RT/Co-treated individuals.

CONCLUSIONS

Adolescents treated with OA showed somewhat better sustained improvement over the extended follow-up period than those treated with RT/Co. Non-responders to treatment and females exhibited a poorer outcome. These groups need particular attention and extended or different treatments to achieve a better long-term outcome.

Predictors of Clinically Significant Outcome for Adolescents with Temporomandibular Disorders

AIMS

To evaluate and identify baseline characteristics of the adolescent patients included in two previous randomized controlled trials (RCTs) that may predict a clinically significant outcome after treatment of temporomandibular disorders (TMD) with an occlusal appliance (OA) or relaxation training (RT) in a clinical sample of adolescents.

METHODS

This study combined two patient samples from the earlier RCTs for a total of 167 adolescents with frequent TMD pain (once a week or more often), diagnosed according to the Research Diagnostic Criteria for TMD. They were treated with OA, RT, or received information only (control). Outcome (response to treatment vs nonresponse) was assessed using four measures: the Patient Global Impression of Change (PGIC), pain intensity rated on a numeric rating scale (NRS), pain frequency levels, and pain severity levels prospectively recorded in a pain diary. Predictors of outcome were evaluated posttreatment for the whole sample and at 6 months follow-up for participants from the first trial. Associations and differences between groups obtained in the bivariate analyses were further examined in subsequent multivariate logistic regression analyses.

RESULTS

At posttreatment, treatment condition (OA being more effective than RT/control), gender (boys being more responsive than girls), arthralgia (predicting lower response), lower levels of somatic complaints (predicting better response), and shorter TMD pain history (predicting better response) emerged as significant predictors of a clinical response. At 6-month follow-up, lower consumption of analgesics and shorter TMD pain history emerged as significant predictors of treatment outcome, while treatment condition approached significance after multivariate analysis.

CONCLUSION

This study revealed that treatment condition and gender were the most consistent predictors of a clinically significant outcome across outcome measures in a clinical sample of adolescents with TMD. Treatment with OA reduced TMD pain in the adolescents.

Association of insomnia severity with well-being, quality of life and health care costs: A cross-sectional study in older adults with chronic pain (PainS65+)

BACKGROUND

Insomnia is one of the most common complaints in chronic pain. This study aimed to evaluate the association of insomnia with well-being, quality of life and health care costs.

METHODS

The sample included 2790 older individuals (median age = 76; interquartile range [IQR] = 70-82) with chronic pain. The participants completed a postal survey assessing basic demographic data, pain intensity and frequency, height, weight, comorbidities, general well-being, quality of life and the insomnia severity index (ISI). Data on health care costs were calculated as costs per year (€ prices) and measured in terms of outpatient and inpatient care, pain drugs, total drugs and total health care costs.

RESULTS

The overall fraction of clinical insomnia was 24.6% (moderate clinical insomnia: 21.9% [95% CI: 18.8-23.3]; severe clinical insomnia: 2.7% [95% CI: 1.6-3.2]). Persons who reported clinical insomnia were more likely to experience pain more frequently with higher pain intensity compared to those reported no clinically significant insomnia. Mean total health care costs were € 8469 (95% CI: €4029-€14,271) for persons with severe insomnia compared with € 4345 (95% CI: €4033-€4694) for persons with no clinically significant insomnia. An association between severe insomnia, well-being, quality of life, outpatient care, total drugs costs and total health care costs remained after controlling for age, sex, pain intensity, frequency, body mass index and comorbidities using linear regression models.

CONCLUSIONS

Our results determine an independent association of insomnia with low health-related quality of life and increased health care costs in older adults with chronic pain.

SIGNIFICANCE

The concurrence and the severity of insomnia among older adults with chronic pain were associated with decreased well-being and quality of life, and increased health care costs to society.

Illness beliefs among patients with chronic widespread pain - associations with self-reported health status, anxiety and depressive symptoms and impact of pain

Background

Chronic widespread pain (CWP) is a disabling condition associated with a decrease in health. Illness beliefs are individual and are acquired during life. Constraining beliefs may prevent patients from regaining health. Understanding these patients’ illness beliefs may be a way to improve the health care they are offered. The aim of this study was to describe illness beliefs among patients with CWP and associations with self-reported health, anxiety and depressive symptoms, and impact of pain.

Method

In this cross-sectional study, questionnaires were sent by mail to 330 patients including socio-demographic information, the Illness Perception Questionnaire (IPQ-R), the Short-Form General Health Survey (SF-36) and the Hospital Anxiety and Depression Scale (HADS). Data were analysed using descriptive statistics, non-parametric tests and linear regression analyses.

Results

Patients experienced and related a high number of symptoms to CWP (mean (SD) 9 (3)). The patients believed their illness to be long lasting, to affect their emotional well being, and to have negative consequences for their lives. Some 72% reported having severe or very severe pain, and impact of pain according to SF-36 was negatively correlated to several illness beliefs dimensions, anxiety- and depressive symptoms. In regression analyses, the Identity, Consequences and Personal control dimensions of IPQ-R and Anxiety- and Depressive symptoms explained 32.6–56.1% of the variance in the two component scores of SF-36.

Conclusion

Constraining illness beliefs in patients with CWP are related to worse health status, especially in cases of high number of physical or mental symptoms, beliefs of negative consequences or the illness affecting them emotionally. Identification and understanding of these beliefs may reduce patients’ suffering if they are taken into consideration in rehabilitation programs and in development of new evidence-based interventions aimed at increasing health in patients with CWP.

Different DHEA-S Levels and Response Patterns in Individuals with Chronic Neck Pain, Compared with a Pain Free Group-a Pilot Study

Objective

To test, in this pilot study, whether DHEA-S (Dehydroepiandrosterone, sulfated form) plasma levels are lower among persons with chronic neck pain, compared to control persons, and to investigate the DHEA-S response after a physical exercise.

Subjects

Included were 12 persons with chronic neck pain and eight controls without present pain, all 18 and 65 years of age. Exclusion criteria for both groups were articular diseases or tendinosis, fibromyalgia, systemic inflammatory and neuromuscular diseases, pain conditions due to trauma, or severe psychiatric diseases.

Design and methods

The participants arm-cycled on an ergometer for 30 minutes. Blood samples were taken before, 60 minutes, and 150 minutes after this standardized physical exercise.

Results

The estimated plasma DHEA-S levels at baseline were 2.0 µmol/L (95% confidence interval [CI] 1.00; 4.01) in the pain group and 4.1 µmol/L (95% CI2.0; 8.6) in the control group, adjusted for sex, age, body mass index (BMI), and Shirom-Melamed Burnout Questionnaire (SMBQ), with a ratio of 0.48 ( P  = 0.094).

Conclusions

In this pilot study, the plasma DHEA-S levels appeared to be lower among the persons with chronic neck pain, compared with the control group. It was indicated that DHEA-S decreased during the physical exercise in the control group, and either increased or was unaffected in the chronic pain group.

Prevalence of different pain categories based on pain spreading on the bodies of older adults in Sweden: a descriptive-level and multilevel association with demographics, comorbidities, medications, and certain lifestyle factors (PainS65+)

Background and objective

There is limited knowledge about the prevalence of pain and its relation to comorbidities, medication, and certain lifestyle factors in older adults. To address this limitation, this cross-sectional study examined the spreading of pain on the body in a sample of 6611 subjects ≥65 years old (mean age = 75.0 years; standard deviation [SD] = 7.7) living in southeastern Sweden.

Methods

Sex, age, comorbidities, medication, nicotine, alcohol intake, and physical activity were analyzed in relation to the following pain categories: local pain (LP) (24.1%), regional pain medium (RP-Medium) (20.3%), regional pain heavy (RP-Heavy) (5.2%), and widespread pain (WSP) (1.7%).

Results

RP-Medium, RP-Heavy, and WSP were associated more strongly with women than with men (all p<0.01). RP-Heavy was less likely in the 80–84 and >85 age groups compared to the 65–69 age group (both p<0.01). Traumatic injuries, rheumatoid arthritis/osteoarthritis, and analgesics were associated with all pain categories (all p<0.001). An association with gastrointestinal disorders was found in LP, RP-Medium, and RP-Heavy (all p<0.01). Depressive disorders were associated with all pain categories, except for LP (all p<0.05). Disorders of the central nervous system were associated with both RP-Heavy and WSP (all p<0.05). Medication for peripheral vascular disorders was associated with RP-Medium (p<0.05), and hypnotics were associated with RP-Heavy (p<0.01).

Conclusion

More than 50% of older adults suffered from different pain spread categories. Women were more likely to experience greater spreading of pain than men. A noteworthy number of common comorbidities and medications were associated with increased likelihood of pain spread from LP to RP-Medium, RP-Heavy, and WSP. Effective management plans should consider these observed associations to improve functional deficiency and decrease spreading of pain-related disability in older adults.

A 3-Year Follow-Up of Headache Diagnoses and Symptoms in Swedish Schoolchildren

Information is sparse concerning the incidence and prognosis of headache in children from the general population, especially of tension-type headache. In this study, headache diagnoses and symptoms were reassessed in 122 out of 130 schoolchildren after 3 years. Nearly 80± of those with headache at first evaluation still reported headache at follow-up. Although the likelihood of experiencing the same headache diagnosis and symptoms was high, about one-fifth of children with tension-type headache developed migraine and vice versa. Female gender predicted migraine and frequent headache episodes predicted overall headache at follow-up. The estimated average annual incidence was 81 and 65 per 1000 children, for tension-type headache and migraine, respectively. We conclude that there is a considerable risk of developing and maintaining headache during childhood. Headache diagnoses should be reassessed regularly and treatment adjusted. Girls and children with frequent headache have a poorer prognosis and therefore intervention is particularly important in these groups.

Parent-reported symptoms, impairment, helpfulness of treatment, and unmet service needs in a follow-up of outpatient children with attention-deficit/hyperactivity disorder

BACKGROUND

Limited information exists regarding the associations between impairment, symptoms, helpfulness of treatments, and service needs after initial treatment of children with attention-deficit/hyperactivity disorder (ADHD).

AIMS

The aims of this study were to examine persistence rates and associations between parent-reported symptoms, impairment, helpfulness of treatments, and service needs in a retrospective follow-up study of children with ADHD.

METHODS

Parents of 214 children with a mean age of 12.6 years (SD = 2.1) who were diagnosed with ADHD at five child and adolescent mental health clinics (CAMHS) completed questionnaires 1-10 years (mean = 3.7 years, SD = 2.2) after baseline assessment. The response rate was 43.4%. A community comparison group (n = 110) was recruited from the same area.

RESULTS

Approximately two-thirds (60.3%) of the sample fulfilled the DSM-IV symptom criteria of ADHD at follow-up, 84.3% were functionally impaired, and most children (84.7%) were on medication. Inattentive and emotional symptoms were the strongest predictors of impairment across impairment areas. Perceived helpfulness of different treatments varied from 71.8-88.7%, and no significant difference was found between the ADHD sub-groups regarding reported helpfulness. 'Adjustment of the school situation' was the most frequent service need, and approximately half of the parents reported needs for care co-ordination. Children fulfilling the symptom criteria of the ADHD Combined sub-group were most impaired and had most service needs.

CONCLUSIONS

At follow-up, children were highly symptomatic and impaired, despite a high rate of persistent medication treatment. The findings underline the need for more tailored treatment and co-ordinated care over time.

Contrast Enhancement of Pathologic Lymph Nodes Demonstrated by Computed Tomography

Enlarged mediastinal, retroperitoneal and pelvic lymph nodes are often difficult to differentiate from vascular structures. Contrast medium is therefore used to help to discriminate arteries and veins from lymph nodes. This study was undertaken to investigate the degree to which pathologic lymph nodes become enhanced after an intravenous bolus injection of contrast medium. Computed tomography was performed in 25 patients with enlargement of retroperitoneal lymph nodes due to primary lymphoproliferative disease or metastases. A dynamic sequence of a well delineated lymph node was obtained over a period of two minutes. Contrast enhancement was seen in all lymph nodes, but of varying degree. The enhancement was correlated to that observed in the inferior vena cava. Most examined lymph nodes showed slight or moderate enhancement, but in five instances strong enhancement, more than 75 per cent of that of the vena cava, was found. These nodes could possibly have been misinterpreted as blood vessels.

Circulating cartilage oligomeric matrix protein in juvenile idiopathic arthritis

OBJECTIVES

Raised serum cartilage oligomeric matrix protein (sCOMP) has been reported to predict erosive disease in early rheumatoid arthritis (RA). In juvenile idiopathic arthritis (JIA), subnormal sCOMP levels have been associated with ongoing inflammation and growth retardation. In this study we aimed to assess sCOMP, C-reactive protein (CRP), and insulin-like growth factor (IGF)-1 in children/adolescents with JIA and in referents.

METHOD

We enrolled 52 JIA patients at planned outpatient visits and 54 inpatients with ongoing infection ('infection referents'). A total of 120 referents testing negative for immunoglobulin (Ig)E-mediated allergy ('IgE referents') served as controls. All serum samples were analysed for COMP, IGF-1, and CRP.

RESULTS

The average sCOMP level was highest among the IgE referents and lowest among the infection referents. In the JIA patients, the level of sCOMP was not associated with the level of CRP or with clinical signs of disease activity.

CONCLUSIONS

The results of this study do not support routine clinical analysis of sCOMP levels in patients with JIA.

Prevalence of Different Pain Categories Based on Pain Spreading in Older Adults in Sweden: A Multilevel Association With Socio-Demographic Characteristics, Comorbidities and Drug Consumption (Pain S65+)

Introduction

Understanding of factors related to chronic pain in elderly is limited.

Objectives and aims

To estimate the prevalence of pain categories based on spreading of pain on the body and to investigate how such spreading is related to demographic variables, pain intensity, comorbidities and medication in an elderly general population in southeastern Sweden.

Methods

A total of 6611 adults aged ≥ 65 years participated (mean age = 76.2; SD = 7.4). Pain categories were assessed by a self-reported postal questionnaire covering 45 anatomical predefined pain regions along with demographics, pain intensity during previous seven days, comorbidities and medication. Poisson regression models with robust error variance were used for data analyzing.

Results

The prevalence of pain spreading categories was: chronic local pain (CLP) 16%; chronic regional pain medium (CRP-Medium) 17%; chronic regional pain heavy (CRP-Heavy) 5% and chronic widespread pain (CWSP) 2%. Overall, increased prevalence for CRP-Heavy and CWSP in subjects 75–79 years old compared to those 65–69, 70–74, 80–84 and ≥ 85 years were revealed. In men, 75–79 years old, CRP-Heavy was more common than in the other pain categories. In women, 75–79 years old CWSP, was more common than in the other pain categories. Pain intensity was strongly associated with all pain categories (P < 0.001). CLP was associated with trauma, rheumatoid arthritis, cancer, prescribed and non-prescribed analgesics. CRP-Medium was associated with rheumatoid arthritis, CRP-Heavy with rheumatoid arthritis and lung diseases and CWSP with rheumatoid arthritis and prescribed analgesics (P < 0.001).

Conclusions

Our findings elucidate heterogeneity of pain in elderly which has to be further investigated.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

Assessment of headache characteristics in a general adolescent population: a comparison between retrospective interviews and prospective diary recordings

Background

Reliable information on headache characteristics, including frequency and intensity, headache-associated impairment, and use of analgesic medications, may depend on the assessment method used. This study analyzed the correlations between headache characteristics determined in structured interviews and those determined in prospective diary recordings kept by adolescents in the general population.

Methods

In this cross-sectional school-based study, a representative sample of 488 adolescents aged 12–18 years were interviewed about headaches experienced during the previous year. Headache diaries for a three-week period were kept by 393 participants: 244 girls (62 %) and 149 (38 %) boys.

Results

Most adolescents (88 %) who reported headaches during their interview also recorded headaches in their diary. In contrast, 51 % of those who reported being headache-free during the last year recorded headaches in their diary. In the interviews, frequent headaches (at least 50 % of days during the last year) were reported by 2.9 % of participants, while 25.5 % reported this headache frequency in their diary. Overall, the ratings of headache frequency were significantly higher in diaries than in interviews (p < 0.001). Significant but low correlations were observed between intensity levels reported retrospectively and prospectively (rho = 0.28; p < 0.001) and between average scores of headache-related impairment reported retrospectively and prospectively (rho = 0.35; p < 0.001). The use of medications by those who reported one or more current headache disorder during their interview was significantly lower in prospective recordings than in the retrospective interview estimates (p < 0.001).

Conclusions

There is inconsistency in the estimates of headache characteristics between retrospective reports and diary recordings. A comprehensive picture of headache complaints among adolescents may be better obtained through a combination of prospective diary recordings and interviews by school health and clinical services.

Prevalence, stability, 1-year incidence and predictors of depressive symptoms among Norwegian adolescents in the general population as measured by the Short Mood and Feelings Questionnaire

Background In numerous surveys the prevalence of depressive symptoms in adolescents has been examined in single sites and at one time point. Aims We examined depressive symptoms among adolescents aged 10-19 years in four different large school samples including two cohorts over a 10-year period in different locations in the same health region in central Norway including a total of 5804 adolescents. Two cohorts were retested within a 1-year time period to predict high versus low depressive symptom scores. Changes over a 6-year period in depressive symptom levels were examined in two of the samples of 12-14-year olds. Methods Depressive symptoms were estimated by the 13-item Short Mood and Feelings Questionnaire (SMFQ). Covariates were student age, sex, school size and location. Results "Miserable or unhappy", "Tired", "Restlessness" and "Poor concentration" were the most commonly reported depressive symptoms. Depressive symptom levels and proportions of high scoring students were consistently higher among girls, in particular in mid and late adolescence. Poisson regression analysis showed that all SMFQ items significantly predicted total scores for the whole sample, while sex (girls having a higher risk) emerged as a consistent 1-year predictor of high depressive symptom levels. Conclusions The SMFQ constitutes a short, practical and feasible measure. We recommend that this standardized measure should be used in the assessment of depressive symptoms among adolescents in school, primary care and clinical settings but also to evaluate treatment outcome. High scorers should be evaluated in subsequent clinical interviews for the presence of a depressive disorder.

A comparison between prospective Internet-based and paper diary recordings of headache among adolescents in the general population

AIM

The aim of this article was to develop and apply an Internet-based headache diary (i-diary) for adolescents and compare it with a paper-diary (p-diary) regarding adherence, user acceptability and recorded headache activity.

METHODS

In a cross-sectional school-based study, a representative sample of 488 adolescents aged 12-18 years were randomly allocated by cluster sampling to record for three weeks in i-diaries or p-diaries their headache intensity, disability, and use of acute medication.

RESULTS

A significantly (p = 0.008) higher proportion of adolescents in the i-diary group used the diary at least once during the 21-day period (86% vs 76% for the p-diary). However, the p-diary group completed a significantly (p < 0.001) higher number of diary days (20.8 vs 15.0 days for the i-diary). The response rate for the i-diary-group was largely evenly distributed over the study period; conversely, approximately two-thirds of the adolescents using the p-diary responded on all 21 days, whereas one-fourth did not respond at all. The two diary types were rated as equal in easiness to remember (p = 0.25), but the i-diaries were more bothersome to use (p = 0.029).

CONCLUSION

Although p-diary users completed a higher proportion of diary days, i-diaries provided more reliable and credible estimates of headache parameters because of better real-time assessment.

Accumulation of substances with melanin affinity to the internal ear. Therapeutic or ototoxic mechanism?

The capacity of the melanin in the internal ear to accumulate and retain labelled lidocaine, bupivacaine and chlorpromazine after intravenous and intraperitoneal injection was examined by whole-body autoradiography. Both young pigmented hooded rats and albino rats were studied. In the pigmented rats chlorpromazine showed the greatest accumulation, which was more pronounced in the cochlea than in the vestibular portion. The other two substances were evenly distributed in the internal ear. After a single injection of chlorpromazine and of bupivacaine these substances were still bound to the melanin of the internal ear after 14 days, which was the longest survival time. Lidocaine, on the other hand, had disappeared after only 4 days. In albino animals there was very weak, transient uptake of chlorpromazine and bupivacaine, but not of lidocaine, in the internal ear. In studies in vitro on isolated bovine eye melanin there was considerably greater adsorption of chlorpromazine than of lidocaine and bupivacaine.

Consumer satisfaction with the Child and Adolescent Mental Health Service and its association with treatment outcome: a 3-4-year follow-up study

BACKGROUND

Consumer satisfaction studies with the Child and Adolescent Mental Health Service (CAMHS) have mainly assessed evaluations in a short-term follow-up perspective. Adolescent reports with CAMHS have not been included nationally.

AIMS

The purposes of this study were to explore adolescent and parental satisfaction with the CAMHS in a 3-4-year follow-up perspective, and to examine the relationships between reported consumer satisfaction and clinical parameters such as reason for adolescent referral, emotional/behavioral symptoms and treatment outcome.

METHODS

Of 190 adolescent-parent pairs in a sample of CAMHS outpatients, 120 completed a Consumer Satisfaction Questionnaire. Parents assessed adolescent emotional/behavior problems both at baseline and at follow-up by completing the Child Behavior Checklist (CBCL). Correlations were examined between adolescent and parental evaluations. The relationships between service satisfaction and symptom load at baseline and follow-up and treatment outcome at follow-up were explored.

RESULTS

Overall, adolescents and parents were satisfied with the services received from the CAMHS. The correlations between adolescent and parent consumer satisfaction ratings were low to moderate. Consumer satisfaction was significantly and negatively correlated with symptom load on the CBCL Total Problems scores at baseline, but not at follow-up. There was no difference in satisfaction levels between those who improved after treatment and those who did not.

CONCLUSIONS

Given the differences in informant ratings of consumer satisfaction, it is important to include both adolescent and parental perceptions in evaluations of CAMHS services and treatment outcomes. Consumer satisfaction should serve as a supplement to established standardized outcome measures.

Prevalence and disability of headache among Norwegian adolescents: A cross-sectional school-based study

Background

Headache is common in adolescents and affects schoolwork and relations with friends and family. In most previous epidemiological surveys, only the most bothersome headache has been documented. The aim was to determine headache prevalence not only taking into account the most bothersome headache, but also to compare characteristics of the most bothersome and less bothersome headaches, and to investigate headache-related disability.

Methods

A cross-sectional school-based study was conducted in which 493 representative adolescents aged 12–18 years were recruited by stratified cluster sampling and interviewed. Headache diagnosis was made according to the new classification system of the International Headache Society (ICHD-3 beta), and the Pediatric Migraine Disability Assessment (PedMIDAS) was used to evaluate disability.

Results

The one-year prevalence of any headache type, definite migraine, probable migraine and tension-type headache was 88%, 23%, 13% and 58%, respectively. The point prevalence of any headache was 38%. Nine percent of participants fulfilled criteria for more than one headache diagnosis. The most bothersome headache had a significantly longer duration ( p < 0.001) and higher intensity ( p < 0.001) than the less bothersome headache, but similar frequency ( p = 0.86). Adolescents with headaches lost up to nine days of activity each year, implicating headache as a major health issue.

Conclusions

Headaches are very common and disabling among adolescents. The full extent of this health problem is better appreciated if inquiry is not limited to the most bothersome subtypes.

Headache prevalence and characteristics among adolescents in the general population: a comparison between retrospect questionnaire and prospective paper diary data

Background

In the present school-based study, a convenience sample of 237 adolescents in grade 6-9 and second year in high school (age 12-18 years) was recruited from a city and a smaller town. The aim of the study was to compare information on the prevalence and various characteristics of headaches not related to disease in a retrospect questionnaire and prospective daily recordings of headaches in a standard paper diary during a 3-week period.

Methods

Besides headache severity, number of headache days, intensity levels and duration of headache episodes were estimated with both assessment methods. Most of the school children suffered from tension-type headaches and a smaller portion of migraine attacks.

Results

The overall results showed that school children significantly (p < 0.001) overestimated headache intensity in questionnaires as compared to diary recordings, whereas they underestimated frequency (p < 0.001) and duration (p < 0.001) of headaches. While the correlations on headache severity, frequency and duration between retrospect information in questionnaires and prospective diary recordings were low, the agreement varied with levels of headache characteristics.

Conclusions

Our findings concur well with results from a few similar community studies on headache complaints in school-aged children. We recommend that prospective recordings in diaries should be systematically used in clinical practice but also in epidemiological surveys to increase the validity and reliability in estimates of point prevalence of headache complaints in children and adolescents.

Comparative metabolomics of muscle interstitium fluid in human trapezius myalgia: an in vivo microdialysis study

Purpose

The mechanisms behind trapezius myalgia are unclear. Many hypotheses have been presented suggesting an altered metabolism in the muscle. Here, muscle microdialysate from healthy and myalgic muscle is analysed using metabolomics. Metabolomics analyse a vast number of metabolites, enabling a comprehensive explorative screening of the cellular processes in the muscle.

Methods

Microdialysate samples were obtained from the shoulder muscle of healthy and myalgic subjects that performed a work and stress test. Samples from the baseline period and from the recovery period were analysed using gas chromatography—mass spectrometry (GC–MS) together with multivariate analysis to detect differences in extracellular content of metabolites between groups. Systematic differences in metabolites between groups were identified using multivariate analysis and orthogonal partial least square discriminate analysis (OPLS-DA). A complementary Mann–Whitney U test of group difference in individual metabolites was also performed.

Results

A large number of metabolites were detected and identified in this screening study. At baseline, no systematic differences between groups were observed according to the OPLS-DA. However, two metabolites, l-leucine and pyroglutamic acid, were significantly more abundant in the myalgic muscle compared to the healthy muscle. In the recovery period, systematic difference in metabolites between the groups was observed according to the OPLS-DA. The groups differed in amino acids, fatty acids and carbohydrates. Myristic acid and putrescine were significantly more abundant and beta-d-glucopyranose was significantly less abundant in the myalgic muscle.

Conclusion

This study provides important information regarding the metabolite content, thereby presenting new clues regarding the pathophysiology of the myalgic muscle.

Comparison of mother, father, and teacher reports of ADHD core symptoms in a sample of child psychiatric outpatients

OBJECTIVE

To explore the significance of adding father ratings to mother and teacher ratings in the assessment of ADHD symptoms in children.

METHOD

The ADHD Rating Scale-IV, the Child Behavior Checklist, and the Teacher Report Form were filled out by all three informants for a sample of 48 clinically referred children (79% boys) aged 6 to 15 (M = 10.1) years.

RESULTS

Correspondence between father and teacher reports on ADHD-specific symptoms (intraclass correlation coefficient [ICC] = .38) exceeded that between mothers and teachers (ICC = .23). Fathers rated their children as having fewer problems than did mothers and teachers on Total scale scores and the Inattention subscale of the ADHD Rating Scale-IV. Mother ratings were more sensitive to an ADHD diagnosis, whereas father ratings better predicted an ADHD diagnosis requiring the two-setting criterion.

CONCLUSION

The choice of parent informant and informant combination had a considerable impact on parent-teacher concordance and estimates of ADHD symptoms and subtypes in the child.

Nonsuicidal self-harm and suicide attempts in adolescents: differences in kind or in degree?

PURPOSE

The purpose of the present study was to measure the prevalence of self-harm (SH) behaviours and examine potential differences in characteristics among adolescents reporting on self-harm (SH), depending on whether they had attempted suicide (SA), performed nonsuicidal self-harm (NSSH), or both.

METHODS

Cross-sectional survey of 11,440 adolescents aged 14-17 years in the city of Oslo, Norway. Responses regarding measures of lifetime SH and risk factors were collected. The response rate was 92.7%. Data were analysed by segregating SH responses into the categories of NSSH, SA, and NSSH + SA.

RESULTS

Among all respondents, 4.3% reported NSSH, 4.5% reported SA, 5.0% reported both NSSH and SA, and 86.2% reported no SH. The group reporting to have engaged in both behaviours comprised more girls and reported more suicidal ideation, problematic lifestyles, poorer subjective health, and more psychological problems compared with the other groups. The four groups could be distinguished by one discriminant function that accounted for most of the explained variance.

CONCLUSIONS

Our findings suggest that NSSH and SA are parts of the same dimensional construct in which suicidal ideation carries much of the weight in adolescents from a school-based sample. They also indicate the group of adolescents who seems to alternate between NSSH and SA is more burdened with mental ill-health and behavioural problems compared with others. These adolescents should therefore be targeted by clinicians and school health personnel for identification and provision of adequate help and services.

International epidemiology of child and adolescent psychopathology ii: integration and applications of dimensional findings from 44 societies

OBJECTIVE

To build on Achenbach, Rescorla, and Ivanova (2012) by (a) reporting new international findings for parent, teacher, and self-ratings on the Child Behavior Checklist, Youth Self-Report, and Teacher's Report Form; (b) testing the fit of syndrome models to new data from 17 societies, including previously underrepresented regions; (c) testing effects of society, gender, and age in 44 societies by integrating new and previous data; (d) testing cross-society correlations between mean item ratings; (e) describing the construction of multisociety norms; (f) illustrating clinical applications.

METHOD

Confirmatory factor analyses (CFAs) of parent, teacher, and self-ratings, performed separately for each society; tests of societal, gender, and age effects on dimensional syndrome scales, DSM-oriented scales, Internalizing, Externalizing, and Total Problems scales; tests of agreement between low, medium, and high ratings of problem items across societies.

RESULTS

CFAs supported the tested syndrome models in all societies according to the primary fit index (Root Mean Square Error of Approximation [RMSEA]), but less consistently according to other indices; effect sizes were small-to-medium for societal differences in scale scores, but very small for gender, age, and interactions with society; items received similarly low, medium, or high ratings in different societies; problem scores from 44 societies fit three sets of multisociety norms.

CONCLUSIONS

Statistically derived syndrome models fit parent, teacher, and self-ratings when tested individually in all 44 societies according to RMSEAs (but less consistently according to other indices). Small to medium differences in scale scores among societies supported the use of low-, medium-, and high-scoring norms in clinical assessment of individual children.

Experimental myalgia induced by repeated infusion of acidic saline into the human masseter muscle does not cause the release of algesic substances

BACKGROUND

Animal studies have shown that two repeated intramuscular injections of acidic saline induce mechanical allodynia that lasts for 4 weeks with spread to the contralateral side. In this study, we tested the hypothesis that two repeated intramuscular infusions of acidic saline into the human masseter muscle is associated with pain, mechanical allodynia and release of algesic substances. Eighteen healthy volunteers participated. On day 1, 2.5 mL of acidic saline (pH 3.3) was infused into one of the masseter muscles and isotonic saline (pH 6.0) into the other (randomized and single-blind). Two days later, intramuscular microdialysis was performed to sample serotonin, glutamate, pyruvate, lactate and glucose, during which the saline infusions were repeated. Pain and pressure pain thresholds (PPTs) were recorded before and after infusions on both days.

RESULTS

Pain intensity induced by the infusions was higher after acidic than that after isotonic saline (p < 0.05). PPTs were decreased on both sides after microdialysis compared with baseline day 1 (p's < 0.05), but there were no differences in PPTs between sides at any time point. The levels of serotonin, glutamate, pyruvate, lactate or glucose did not change significantly during microdialysis.

CONCLUSION

Infusion of acidic saline caused low levels of muscle pain, but no mechanical allodynia and no increased release of algesic substances. The value of this model appears modest, but future studies could be performed with larger sample size and higher flow rate before definite conclusions about the validity of the model for craniofacial myalgia can be drawn.

Competence and emotional/behavioural problems in 7-16-year-old Norwegian school children as reported by parents

BACKGROUND

Previous studies from Nordic countries suggest that parent ratings of children's emotional and behavioural problems using the Child Behavior Checklist (CBCL) are among the lowest in the world. However, there has been no Norwegian population study with acceptable response rates to provide valid Norwegian reference data.

AIMS

Firstly, to compare CBCL Internalizing, Externalizing, Total Problems and Competence scores of Norwegian children and adolescents with those from 1) previous Norwegian studies, 2) other Nordic countries, and 3) international data. Secondly, to present Norwegian reference data in order to perform these comparisons. Thirdly, to investigate the effects of age, gender, socio-economic and urban/rural status on the CBCL.

METHODS

A stratified cluster sample of 2582 school children (1302 girls and 1280 boys) was identified from the general Norwegian population and their parents were asked to complete the CBCL.

RESULTS

The response rate was 65.5%. The mean Total Problems score for the whole sample was 14.2 (standard deviation, s = 14.1). Girls were rated as having greater Competence and fewer Total Problems than boys. Younger children had more Total Problems than adolescents. Parents with low education reported more child Total Problems and lower Competence than those with high education. All effect sizes were small, except for the effect of parental education on child Competence, which was moderate.

CONCLUSIONS

Total Problems scores were lower than in other societies. The data from this study obtained from one county in central Norway provide an important reference for clinical practice and treatment outcome research.

One-year stability, change and incidence in anxiety symptoms among early adolescents in the general population

To examine prospectively the stability, changes, and incidence in DSM-IV-related anxiety symptom clusters in a community sample of adolescents. On two occasions, 1 year apart, 946 Norwegian adolescents aged 13-16 years completed the SCARED, a 41-item multidimensional anxiety self-report scale that measures the levels of five principal DSM-IV-related anxiety symptom clusters. Seventy-three percent of the adolescents participated in the study at baseline, and only 7 % were lost to follow-up. Both sexes in all age cohorts, except girls aged 14-15 years, showed the same 1-year developmental pattern of stable scores, or small reductions in the total anxiety score, for all DSM-IV-related anxiety symptom clusters. Adolescents defined as "high anxiety scorers" showed a girl:boy ratio of 4:1. Whereas approximately half these students remained high scorers at the 1-year follow-up, the same proportion returned to normal anxiety levels. The 1-year incidence of high-level anxiety was 8.2 % for the whole sample, 12.6 % for the girls and 3.4 % for the boys. These results underscore the need for improved identification of adolescents in the general population with stable high anxiety levels, as opposed to those with transient high anxiety. The normative findings of this study also provide reference data with which to evaluate individual changes in clinical practice and the results of efficacy trials, including 1-year follow-up evaluations.

Headache prevalence and characteristics among school children as assessed by prospective paper diary recordings

In the present school-based study, a convenience sample of 477 students in grades 6-9 and second year in high school from a city and a smaller town recorded daily occurrence and intensity of headaches in a standard paper diary during a 3-week period. Total headache activity (headache sum), number of headache days, intensity level and duration for weekly headaches were estimated. Approximately 85% of the adolescents had experienced headache of any intensity level during the 3-week recording period. On the average, they reported 2.5 headache days per week and a mean intensity level for headache episodes of 1.7. Our estimates for headache of any intensity level (1-5) occurring at least once a week was surprisingly high (73.8%). For the highest intensity level across the whole 3-week period, almost identical proportions of mild and moderate headaches were reported by students (22.3-22.5%), while about twice as many (40.7%) had experienced severe headaches. Girls consistently reported more headaches than boys, in particular of the moderate and severe intensity types. Students in the city also reported more frequent and intense headaches than those in the town. Peak headache activity was observed at noon and in the afternoon and in the days from the middle of the week until weekend. The use of prospective recordings in diaries will further advance our knowledge on the prevalence and characteristics of recurrent headaches among children and adolescents in community samples.

Genetic and Environmental Influences on Expression of Recurrent Headache as a Function of the Reporting Age in Twins

To explore age-related mechanisms in the expression of recurrent headache, we evaluated whether genetic and environmental influences are a function of the reporting age using questionnaire information that was gathered in 1973 for 15- to 47-year-old Swedish twins (n =12,606 twin pairs). Liability to mixed headache (mild migraine and tension-type headache) was explained by non-additive genetic influences (49%) in men aged from 15 to 30 years and additive genetic plus shared environmental influences (28%) in men aged from 31 to 47 years. In women, the explained proportion of variance, which was mainly due to additive genetic effects, ranged from 61% in adolescent twins to 12% in twins aged from 41 to 47 years, whereas individual specific environmental variance was significantly lower in twins aged from 15 to 20 years than in twins aged from 21 to 30 years. Liability to migrainous headache (more severe migraine) was explained by non-addi-tive genetic influences in men, 32% in young men and 45% in old men, while total phenotypic variance was significantly lower in young men than in old men. In women, the explained proportion of variance ranged from 91% in the youngest age group to 37% in the oldest age group, with major contributions from non-additive effects in young and old women (15–20 years and 41–47 years, respectively) and additive genetic effects in intermediate age groups (21–40 years). While total variance showed a positive age trend, genetic variance tended to be stable across age groups, whereas individual specific environmental variance was significantly lower in adolescent women as compared to older women.