Young Adult Pain Rehabilitation: Interdisciplinary Development and Preliminary Outcomes of a Novel Treatment Program.

BACKGROUND: Young adults with chronic pain and symptoms experience disruptions to their social, emotional, physical, and vocational functioning. Interdisciplinary pain rehabilitation programs for pediatric and adult populations are not designed specifically to address the developmental needs of young adults. METHODS: This article describes the development of a novel intensive interdisciplinary outpatient rehabilitation program tailored to the unique needs of young adults with chronic pain and symptoms. Tailored content included vocational assessment and consultation, financial literacy education, and sexual health education. RESULTS: Outcome data demonstrate treatment gains, with reductions in pain interference, pain severity, pain catastrophizing, and depressive symptoms, as well as improvements in mental and physical quality of life, perceived performance, perceived satisfaction with performance, and objective measures of physical functioning. CONCLUSIONS: The article concludes with clinical recommendations for the management of chronic pain and symptoms in young adults, applicable across multiple treatment settings.

O Estranho em Les Contes d'Hoffmann, de Jacques Offenbach / The Uncanny in Les Contes d'Hoffmann,by Jacques Offenbach

Freud possuía uma vivência pessoal com Les Contes d'Hoffmann, ópera de Jacques Offenbach. Ela trata do horror da castração e da frustação amorosa em mais de quatro contos de E.T.A. Hoffmann na adaptação do libretista Jules Barbier. A paixão do personagem Hoffmann por Olímpia pode ser interpretada enquanto uma manifestação do fetichismo. Já Antonia o seduz pelo seu canto e pelo desejo de ser famosa, tal qual uma Hortense Schneider, que interpretou a Helena de uma ópera três vezes citada por Freud. E Giulietta, essa sedutora cortesã representa o papel de uma esfinge – pelos olhos ela ameaça o herói, tal como um Édipo atormentado pelas intrigas familiares. Educado por um tio severo, E.T.A. Hoffmann desenvolveu a sensibilidade artística a partir do contato com a tia Sophie. Les Contes d'Hoffmann foi a última contribuição do Maestro de Monmartre, que homenageia aquele que deixou seu registro na história enquanto juiz de direito, escritor e compositor(AU)

Freud had a personal experience with Les Contes d'Hoffmann, opera by Jacques Offenbach. The opera deals with the horror of castration and the sufferings of love in more than four tales by E.T.A. Hoffmann in the adaptation by the librettist Jules Barbier. The passion of the character Hoffman by Olympia might be interpreted as a manifestation of fetishism. As of Antonia, she seduces by means of her singing and by the desire of being famous, just like Hortense Schneider, who interpreted Helen in an opera thrice quoted by Freud. Giulietta was a seductive courtesan who represents the role of a sphinx – by her eyes she threatens the hero, an Oedipus tormented by his family issues. Educated by a severe uncle, E.T.A. Hoffmann developed artistic sensibility through his aunt Sophie. Les Contes d'Hoffmann was the last play by the Maestro of Monmartre, who pays his tribute to the one who left his mark in History as a Supreme Court judge, writer and as a composerFreud had a personal experience with Les Contes d'Hoffmann, opera by Jacques Offenbach. The opera deals with the horror of castration and the sufferings of love in more than four tales by E.T.A. Hoffmann in the adaptation by the librettist Jules Barbier. The passion of the character Hoffman by Olympia might be interpreted as a manifestation of fetishism. As of Antonia, she seduces by means of her singing and by the desire of being famous, just like Hortense Schneider, who interpreted Helen in an opera thrice quoted by Freud. Giulietta was a seductive courtesan who represents the role of a sphinx – by her eyes she threatens the hero, an Oedipus tormented by his family issues. Educated by a severe uncle, E.T.A. Hoffmann developed artistic sensibility through his aunt Sophie. Les Contes d'Hoffmann was the last play by the Maestro of Monmartre, who pays his tribute to the one who left his mark in History as a Supreme Court judge, writer and as a composer(AU)

Severe Hyponatraemia Associated with the Use of Arginine-Vasopressin in Two Neonates with Complex Congenital Heart Disease.

We report two cases of neonates with complex congenital heart disease and volume, catecholamine, and corticosteroid refractory shock treated with arginine-vasopressin. Arginine-vasopressin was able to reverse critical hypotension, but both patients developed severe hyponatremia, which recovered after discontinuation of arginine-vasopressin. Close control and prompt substitution of serum sodium is required in neonates with advanced heart failure on high-dose vasopressin therapy.

Stress-coping skills and neuroticism in apical ballooning syndrome (Takotsubo/stress cardiomyopathy).

INTRODUCTION: Apical ballooning syndrome (ABS) is typically associated with an antecedent stressful situation. Affected patients have been reported to have higher frequencies of premorbid affective disorders. We hypothesised that patients with ABS would have elevated levels of neuroticism (tendency to experience negative affect) and greater vulnerability to stress. METHODS: In this cross-sectional study, all active participants in the Mayo Clinic ABS prospective follow-up registry were invited to complete the third edition of the NEO Personality Inventory (NEO-PI-3). The NEO-PI-3 is the universally accepted measure of the 'Five-Factor Model' of personality. Inventory responses were scored using the NEO-PI-3 computer program and the data were compared with US normative sample used in standardisation of the inventory. Significance was set at 0.0014 to account for multiple comparisons. RESULTS: Of 106 registry participants approached, 53 completed the inventory. There was no difference in age, gender, time from ABS diagnosis, type of antecedent stressor (emotional, physical or none) or severity of initial illness between the responders and non-responders. Responders had mean Neuroticism T-scores of 48.0±10.6 (95% CI 45.1 to 50.9); p=0.18, when compared with the normal mean of 50. There was also no significant difference in the facet scale of Vulnerability: 46.9±8.4 (44.6 to 49.2), p=0.038, at α=0.0014. CONCLUSIONS: Contrary to our hypothesis, patients with ABS do not manifest higher levels of neuroticism and do not have greater vulnerability to stress than the general population. These findings have implications for the clinicians' perception of, and approach to, patients with ABS.

Anxious, introverted personality traits in patients with chronic subjective dizziness.

OBJECTIVES: Chronic subjective dizziness (CSD) is a neurotologic disorder of persistent non-vertiginous dizziness, unsteadiness, and hypersensitivity to one's own motion or exposure to complex visual stimuli. CSD usually follows acute attacks of vertigo or dizziness and is thought to arise from patients' failure to re-establish normal locomotor control strategies after resolution of acute vestibular symptoms. Pre-existing anxiety or anxiety diathesis may be risk factors for CSD. This study tested the hypothesis that patients with CSD are more likely than individuals with other chronic neurotologic illnesses to possess anxious, introverted personality traits. METHODS: Data were abstracted retrospectively from medical records of 40 patients who underwent multidisciplinary neurotology evaluations for chronic dizziness. Twenty-four subjects had CSD. Sixteen had chronic medical conditions other than CSD plus co-existing anxiety disorders. Group differences in demographics, Dizziness Handicap Inventory (DHI) scores, Hospital Anxiety and Depression Scale (HADS) scores, DSM-IV diagnoses, personality traits measured with the NEO Personality Inventory - Revised (NEO-PI-R), and temperaments composed of NEO-PI-R facets were examined. RESULTS: There were no differences between groups in demographics, mean DHI or HADS-anxiety scores, or DSM-IV diagnoses. The CSD group had higher mean HADS-depression and NEO-PI-R trait anxiety, but lower NEO-PI-R extraversion, warmth, positive emotions, openness to feelings, and trust (all p<0.05). CSD subjects were significantly more likely than comparison subjects to have a composite temperament of high trait anxiety plus low warmth or excitement seeking. CONCLUSION: An anxious, introverted temperament is strongly associated with CSD and may be a risk factor for developing this syndrome.

Promoting optimal functioning in spinal cord injury: the role of rehabilitation psychology.

Comprehensive treatment and rehabilitation includes attention to the psychological needs of individuals with SCI and their families. This chapter is designed to familiarize neurologists and other practitioners with psychological issues and care in SCI. While psychologists play a key role, attention to psychosocial health is a responsibility shared by all members of the rehabilitation team, beginning with the patient and family, and including clinicians who are not formally identified as mental health providers. Treatment planning for a person with SCI begins with a thorough assessment of the cognitive, emotional, personality, and social factors that influence functioning and rehabilitation. Rehabilitation psychologists use a mixture of assessment tools, including clinical interviews, behavioral observations, and a wide range of standardized test instruments. Psychological interventions can involve direct intervention with the patient, in individual, family or group-based therapies. Other psychological strategies involve assistance through less direct methods - consultation and training to other rehabilitation team members or facilitating peer role-modeling and support groups. The chapter provides an overview of core clinical issues (emotional responses, substance use, pain, cognitive deficits, sexuality and vocational rehabilitation), delineates the process of psychological assessment and intervention, and provides guidance on incorporation of rehabilitation psychology into SCI rehabilitation.

Vocational interests after recent spinal cord injury: comparisons related to sex and race.

OBJECTIVE: To compare vocational interests as a function of sex and race among persons with recent spinal cord injury (SCI), because previous research used almost exclusively white men. Limited research from nearly 2 decades ago suggested SCI selectively occurs to men whose vocational interests are consistent with the Realistic theme of the Holland typology, indicative of a preference for activities and occupations requiring physical strength and dexterity. DESIGN: The Strong Interest Inventory (SII) was completed an average of 50 days after SCI onset. SETTING: Data were collected at a specialty hospital and analyzed at a medical university. PARTICIPANTS: Adults with traumatic SCI (N=500) were assessed during inpatient rehabilitation. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURE: The SII, a 317-item measure of vocational interests. RESULTS: Although the findings for white men were consistent with elevation of the Realistic theme when compared with the reference group, the interests of women and black participants were substantially different. Women scored highest on Social, Enterprising, and Conventional themes compared with the reference group. Black participants reported significantly higher elevations than whites on 5 themes (all except Realistic), with elevations on the Social, Enterprising, and Conventional themes exceeding standardized norms. The Artistic and Investigative themes were least descriptive of the overall sample. CONCLUSIONS: Rehabilitation professionals should be aware of likely differences in patterns of vocational interests as a function of race and sex, and use vocational interests as a means of facilitating postinjury adaptation.

The benefits of pass-fail grading on stress, mood, and group cohesion in medical students.

OBJECTIVE: To objectively measure the effect of a pass-fail grading system on stress, mood, group cohesion, and test anxiety in medical students. PARTICIPANTS AND METHODS: Beginning with the class of 2006, the Mayo Medical School, Rochester, Minn, changed the grading system for first-year courses from a 5-interval grading system to a pass-fail grading system. Students in the previous class of 2005, who were graded using a 5-interval system during their first year of medical school, were compared with students in the class of 2006. Using a prospective study design, the 2 groups were compared at the end of both the first year and the second year of medical school on the Perceived Stress Scale, Profile of Mood States, Perceived Cohesion Scale, Test Anxiety Inventory, and (after year 2) the United States Medical Licensing Examination Step 1. Data collection occurred in 2002 and 2003 with the class of 2005 and in 2003 and 2004 with the class of 2006. RESULTS: Students graded with the pass-fail system had less perceived stress (median, 15.0 vs 21.0; P-.01) and greater group cohesion (median, 34.5 vs 30.0; P=.02) at the end of their second year of coursework than their 5-interval graded peers. The pass-fail group had better mood (median, 46.5) than the graded group (median, 64.0), but this difference was not statistically significant (P=.07). No significant differences were found between the 2 groups in test-taking anxiety or in United States Medical Licensing Examination Step 1 board scores. CONCLUSION: Pass-fail grading may reduce stress and increase group cohesion in medical students compared with traditional 5-interval grading.

Rehabilitation unit staff attitudes toward substance abuse: changes and similarities between 1985 and 2001.

OBJECTIVES: (1) To assess the attitudes of the members of an inpatient rehabilitation unit team toward their unit's substance abuse and tobacco use policies, and (2) to compare the findings with those of a survey 16 years earlier. DESIGN: An anonymous repeated assessment of staff attitudes and behaviors. SETTING: A 47-bed inpatient rehabilitation unit. PARTICIPANTS: Rehabilitation unit nurses, occupational and physical therapists, psychologists, physicians, social workers, and speech pathologists. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURE: Change in response with time. RESULTS: Seventy percent (89/128) of the staff members completed the survey. Seventy-two percent believed that they were "familiar or very familiar" with the unit's substance abuse policy and 51% were "concerned" or "very concerned" about their patients' alcohol and drug use. Nineteen percent reported complaints about the policy from their patients and 8% reported complaints from family members. Support for a uniform substance abuse policy remained high: 96% supported a uniform policy in both 1985 and 2001. However, only 15% believed that staff drug abuse education was adequate and only 45% believed that the current policy was "adequate" or "very adequate." (Corresponding responses in 1985 were 20% and 50%, respectively.) All but 1 respondent considered tobacco use an addiction, but only 48% believed that their patients were routinely assessed for its use. CONCLUSION: Support for a uniform substance abuse policy remains strong. Although most team members support the policy, they believe that their education about substance abuse is inadequate. Staff members almost unanimously accept tobacco use as an addiction, but they believe that assessment and intervention efforts are poor.

Frequency of sexual activity and prostatic health: fact or fairy tale?

OBJECTIVES: To evaluate whether the symptoms associated with benign prostatic hyperplasia can be aggravated by infrequent sex, which has been suggested historically, using cross-sectional data from the Olmsted County Study of Urinary Symptoms and Health Status Among Men. METHODS: In 1989 and 1990, 2115 white men between the ages of 40 and 79 years were recruited from a random sample of Olmsted County residents (55% participation rate). During follow-up, these men completed a self-administered questionnaire that assessed lower urinary tract symptom severity, and 81% reported the frequency of ejaculation during the previous month. RESULTS: Overall, men who reported ejaculating at least once a week were less likely to have moderate to severe (International Prostate Symptom Score greater than 7) symptoms than men reporting no ejaculations (odds ratio 0.62, 95% confidence interval 0.51 to 0.75). The dose-response relation was strong, with men who reported more frequent ejaculations having the lowest prevalence of moderate to severe symptoms. Similar associations were seen for peak urinary flow rates, prostate volume, and health-related quality of life. The associations with urologic measures did not exist within the age decade, however. Thus, after adjusting for age, the odds ratio for ejaculation frequency and symptom severity was 0.99 (95% confidence interval 0.79 to 1.24) and was similar for peak urinary flow rates and prostate volume. CONCLUSIONS: These cross-sectional data suggest that the frequency of ejaculation has no effect on lower urinary tract symptoms, peak urinary flow rates, or prostate volume; the apparent protective association appears to be an artifact caused by the confounding effects of age.

Substance abuse attitudes and policies in US rehabilitation training programs: a comparison of 1985 and 2000.

OBJECTIVE: To assess and compare the attitudes, beliefs, and policies of physical medicine and rehabilitation (PM&R) training programs toward substance abuse and tobacco use over the last 15 years. DESIGN: A blinded questionnaire was sent to all US rehabilitation medicine training program directors. Results were compared with a survey conducted in 1985. SETTING: US PM&R residency training programs with inpatient rehabilitation training. PARTICIPANTS: Training directors or their designated agents. INTERVENTION: A 35-item questionnaire was mailed between November 1999 and April 2000 to the 81 US training programs identified by the American Board of Physical Medicine and Rehabilitation as having rehabilitation training programs with inpatient rehabilitation units. Responses were pooled by our Survey Research Center to preserve anonymity. Training programs that did not respond received additional mailings and telephone calls to improve the response rate. MAIN OUTCOME MEASURES: Chi-square analysis to assess changes in responses with time. RESULTS: Forty-six of the 79 (58%) eligible training programs responded (1 program had merged, 1 did not provide inpatient rehabilitation). Programs were located in cities ranging from less than 100,000 (n = 2) to greater than a million inhabitants (n = 18). Eighty percent (37/46) of the respondents were "concerned or very concerned" about their patients' alcohol and drug use, and 69% routinely assessed patients for alcohol and drug use compared with only 25% in 1985 (P <.00001). Almost all respondents (43/46) supported written guidelines to prohibit alcohol and drug use by patients in the rehabilitation unit. Eighty-three percent had a prohibition policy, and 72% had written guidelines. Both of those rates represent increases from the 1985 response rates of 65% and 45%, respectively. Ambivalence persisted about appropriate treatment programs for persons with disabilities: in 1985, 51% of the respondents agreed that a person with a disability could be treated appropriately in a substance abuse program designed for persons without a disability; in 2000, the percentage had increased to 64%. All respondents believed that tobacco use is an addiction, but only 25% of their units offered tobacco cessation services to patients on their rehabilitation unit. CONCLUSION: The survey results are encouraging. Since 1985, not only have substance abuse issues been recognized, but also systemic institutionalized approaches (eg, regular screening, written guidelines) have increased markedly. Tobacco is now uniformly accepted as an addiction, but screening and access to cessation programs are similar to that available for alcohol and drug treatment programs 15 years ago.