Relationship between fibromyalgia and obesity in pain, function, mood, and sleep.

Unlabelled: Fibromyalgia syndrome (FMS) is a prevalent and disabling chronic pain disorder. Past research suggests that obesity is a common comorbidity and may be related to the severity of FMS. The main objective of the present study was to evaluate the relationships between FMS and obesity in the multiple FMS-related domains: hyperalgesia, symptoms, physical abilities, and sleep.

CISH and susceptibility to infectious diseases.

Background: The interleukin-2-mediated immune response is critical for host defense against infectious pathogens. Cytokine-inducible SRC homology 2 (SH2) domain protein (CISH), a suppressor of cytokine signaling, controls interleukin-2 signaling.

Methods: Using a case-control design, we tested for an association between CISH polymorphisms and susceptibility to major infectious diseases (bacteremia, tuberculosis, and severe malaria) in blood samples from 8402 persons in Gambia, Hong Kong, Kenya, Malawi, and Vietnam.

Assessing and treating pain in hospices: current state of evidence-based practices.

The aim of this study was to report on current provider evidence-based assessment and treatment practices for older adults with cancer in community-based hospice settings. Using the Cancer Pain Practices Index, a tool developed by the researchers to measure evidence-based pain management practices, patients received an average of 32% of those key evidence-based practices (EBPs) that were applicable to their situations. When examining individual practices, most of the patients had their pains assessed at admission using a valid pain scale (69.

The cancer pain practice index: a measure of evidence-based practice adherence for cancer pain management in older adults in hospice care.

Various clinical practice guidelines addressing pain assessment and management have been available for several years that pertain, at least to some extent, to older patients with cancer. Nonetheless, systematic evaluations or methodologically sound studies of adherence to pain management practice guidelines within Medicare-certified hospice programs are lacking. As part of a larger translating-research-into-practice pain improvement study involving older patients with cancer in hospice programs, we recognized the need to create a valid and reliable tool that can facilitate critical evaluation of hospice medical records for nurse and physician adherence to pain management guidelines to create a consolidated score for comparative and quality improvement purposes.

Approaches to improve pain relief while minimizing opioid abuse liability.

Unlabelled: Two strategies should greatly improve pain management while minimizing opioid abuse. The first strategy involves the systematic implementation in every clinical practice of "universal precautions," a set of procedures that help physicians implement opioid therapy in a safe and controlled manner. These procedures include: 1) carefully assessing the patient's risk for opioid abuse; 2) selecting the most appropriate opioid therapy; 3) regularly monitoring the patient to evaluate the efficacy and tolerability of the treatment and to detect possible aberrant behaviors; and 4) mapping out solutions if abuse and/or addiction is detected, or in case of treatment failure.

Opioid pharmacotherapy for chronic non-cancer pain in the United States: a research guideline for developing an evidence-base.

Unlabelled: This document reports the consensus of an interdisciplinary panel of research and clinical experts charged with reviewing the use of opioids for chronic noncancer pain (CNCP) and formulating guidelines for future research. Prescribing opioids for chronic noncancer pain has recently escalated in the United States. Contrasting with increasing opioid use are: 1) The lack of evidence supporting long-term effectiveness; 2) Escalating misuse of prescription opioids including abuse and diversion; and 3) Uncertainty about the incidence and clinical salience of multiple, poorly characterized adverse drug events (ADEs) including endocrine dysfunction, immunosuppression and infectious disease, opioid-induced hyperalgesia and xerostomia, overdose, falls and fractures, and psychosocial complications.

Determining Community Provider Practices in Hospices: The Challenges of Documentation.

Documentation is a key factor in supporting consistency and quality of patient care in the hospice setting, however variation among program provider practices, including documentation, were observed during the initial data collection phase of our National Cancer Institute (NCI) funded study, Cancer Pain in Elders: Promoting Evidence-Based Practices (EBPs) in Hospices. The study is a randomized trial to test a multifaceted intervention to promote adoption and maintenance of EBPs for cancer pain management involving 16 Midwestern hospices of varied size and structure. In the face of such variance, and especially in the absence of uniformly adopted outcome measures and documentation standards, quality improvement initiatives in this important and growing healthcare sector will be difficult to manage.

The decline of leprosy in Japan: patterns and trends 1964-2008.

Objective: Our purpose was to elucidate the patterns and trends of autochthonous leprosy in Japan from 1964 to 2008, to compare them with the findings from other studies of leprosy in decline, and to determine whether M. leprae transmission persists in Japan.

Design: Data on registered leprosy cases in Japan in the period 1964-2008 were analysed with reference to trends in case detection, geographical distribution, age at diagnosis, sex, classification, family history and broad correlation with socioeconomic conditions.

Effects of manure and cultivation on carbon dioxide and nitrous oxide emissions from a corn field under Mediterranean conditions.

The use of organic residues as soil additives is increasing, but, depending on their composition and application methods, these organic amendments can stimulate the emissions of CO(2) and N(2)O. The objective of this study was to quantify the effects of management practices in irrigated sweet corn (Zea mays L.) on CO(2) and N(2)O emissions and to relate emissions to environmental factors.

Implementing evidence-based practices: considerations for the hospice setting.

With increased regulation and scrutiny of outcomes, hospice programs are being challenged to consider the implementation of evidence-based practices (EBPs). This study reports findings from hospice director interviews and staff focus groups, which occurred following the completion of a multifaceted translating research into practice (TRIP) intervention designed to promote evidence-based pain management practices. The purpose of this article is to provide background on the use of EBPs, to report facilitators and barriers to overall implementation of pain management EBPs in hospice, and to provide recommendations for hospices interested in increasing the use of EBPs.

Ulipristal acetate versus levonorgestrel for emergency contraception: a randomised non-inferiority trial and meta-analysis.

Background: Emergency contraception can prevent unintended pregnancies, but current methods are only effective if used as soon as possible after sexual intercourse and before ovulation. We compared the efficacy and safety of ulipristal acetate with levonorgestrel for emergency contraception.

Methods: Women with regular menstrual cycles who presented to a participating family planning clinic requesting emergency contraception within 5 days of unprotected sexual intercourse were eligible for enrolment in this randomised, multicentre, non-inferiority trial.

Ulipristal acetate taken 48-120 hours after intercourse for emergency contraception.

Objective: To evaluate the efficacy and safety of ulipristal acetate as emergency contraception in women presenting 48-120 hours after receiving ulipristal acetate for unprotected intercourse.

Methods: Women aged 18 years or older with regular cycles who presented for emergency contraception 48 to 120 hours after unprotected intercourse were enrolled in 45 Planned Parenthood clinics and treated with a single dose of 30 mg ulipristal acetate. Pregnancy status was determined by high-sensitivity urinary human chorionic gonadotropin testing and return of menses.

Research participation by older adults at end of life: barriers and solutions.

The purpose of this article is to elaborate on barriers to research participation by older adults at end of life. We focus on the hospice setting and classify barriers to research participation into six domains: societal attitudes toward death, research procedures, health care organizations, agency staff, patients' families and caregivers, and patient characteristics. We characterize particular participation issues, uncertainties in participation for individuals with advanced illness, and infringements on patient self-determination, as well as potential solutions to these research challenges.

Recurrent TB: relapse or reinfection? The effect of HIV in a general population cohort in Malawi.

Objective: To estimate rates of recurrent tuberculosis due to reinfection and relapse, by HIV status, in a general population.

Design: Long-term cohort study in Karonga district, rural Malawi.

Methods: All tuberculosis patients with culture-proven disease in Karonga district were followed up after treatment.

Complex cytokine profiles induced by BCG vaccination in UK infants.

IFNgamma plays an important part in immunity to tuberculosis (TB), but although it is necessary, it is not on its own sufficient for protection against TB. To identify other cytokines that play a role in the protection against TB induced by BCG vaccination, immune responses were compared between vaccinated and unvaccinated infants from the UK where BCG is known to provide protection. Twenty-one cytokines and chemokines were tested in supernatants from diluted whole blood cultures that had been stimulated for 6 days with Mycobacterium tuberculosis PPD.

Landscape analysis of interactions between nutrition and vaccine responses in children.

The world's poorest children are likely to be malnourished when receiving their childhood vaccines. It is uncertain whether this affects vaccine efficacy and whether the coadministration of nutrient supplements with vaccines has beneficial or detrimental effects. More recently, a detrimental interaction between vitamin A (VA) supplementation (VAS) and the killed diphtheria-tetanus-pertussis vaccine given in early childhood has been suggested.

Opioid rotation: the science and the limitations of the equianalgesic dose table.

Opioid rotation refers to a switch from one opioid to another in an effort to improve the response to analgesic therapy or reduce adverse effects. It is a common method to address the problem of poor opioid responsiveness despite optimal dose titration. Guidelines for opioid rotation are empirical and begin with the selection of a safe and reasonably effective starting dose for the new opioid, followed by dose adjustment to optimize the balance between analgesia and side effects.

Establishing "best practices" for opioid rotation: conclusions of an expert panel.

Opioid rotation is a strategy applied during opioid therapy for pain that refers to a switch from one opioid to another in an effort to improve clinical outcomes (benefits or harms). It begins with the selection of a new drug at a starting dose that minimizes potential risks while ideally maintaining analgesic efficacy. The selection of a starting dose must be informed by an estimate of the relative potency between the existing opioid and the new one.

No association between prenatal viral infection and depression in later life--a long-term cohort study of 6152 subjects.

Objective: Previous studies have suggested a role for prenatal viral infections in the etiology of schizophrenia; however, little is known about depression. We examined whether in-utero viral infections result in increased risk of depression in later life.

Method: We identified a cohort (n = 3076) born between 1946 and 1980, whose mothers suffered known viral infections in pregnancy.

Primary particulate matter from ocean-going engines in the Southern California Air Basin.

The impact of primary fine particulate matter (PM2.5) from ship emissions within the Southern California Air Basin is quantified by comparing in-stack vanadium (V) and nickel (Ni) measurements from in-use ocean-going vessels (OGVs) with ambient measurements made at 10 monitoring stations throughout Southern California. V and Ni are demonstrated as robust markers for the combustion of heavy fuel oil in OGVs, and ambient measurements of fine particulate V and Ni within Southern California are shown to decrease inversely with increased distance from the ports of Los Angeles and Long Beach (ports).

Long-acting opioids and short-acting opioids: appropriate use in chronic pain management.

In recent years, opioid therapy for the management of chronic noncancer pain has become more widely accepted following the publication of data demonstrating the efficacy of this class of drugs in a variety of pain conditions, including osteoarthritis, neuropathic pain, and low back pain. An array of short-acting and long-acting opioids has been formulated to help prescribers more effectively tailor the management of chronic pain based on the quality and temporal profile of the pain as well as the functional goals of the individual patient. Evidence suggests that both of these groups of medications offer unique benefits to individual patients and that neither is more efficacious than the other.

Chronic pain management in older adults: special considerations.

The rising prevalence of neuropathic pain and the multifaceted sequelae of pain particularly within older adults are part of the increasing challenges in providing good geriatric pain management. Aging can lead to a higher sensitivity to pain within older adults, whereas physiological changes modify the absorption, bioavailability, and transit time of pharmaceutical agents. Ultimately, these differences within older adults require clinicians treating them to provide individually tailored analgesic approaches.

Disseminated bacille Calmette-Guérin disease in HIV-infected South African infants.

Objective: To determine the population-based incidence of disseminated bacille Calmette-Guérin (BCG) disease in HIV-infected infants (aged
Methods: The numerator, or number of new cases of disseminated BCG disease, was derived from multicentre surveillance data collected prospectively on infants with a confirmed HIV infection during 2004-2006. The denominator, or total number of HIV-infected infants who were BCG-vaccinated, was derived from population-based estimates of the number of live infants and from reported maternal HIV infection prevalence, vertical HIV transmission rates and BCG vaccination rates.