Multiple mediation path model of pain's cascading influence on physical disability in individuals with SCI from Colombia, South America.

BACKGROUND: Research has begun to document the bivariate connections between pain in individuals with spinal cord injury (SCI) and various aspects of health related quality of life (HRQOL), such as fatigue, social functioning, mental health, and physical functioning. OBJECTIVE: The purpose of this study was to construct and test a theoretical path model illuminating the stage-wise and sequential (cascading) HRQOL pathways through which pain increases physical disability in individuals with SCI in a sample from Colombia, South America. It was hypothesized that increased pain would lead to decreased energy, which would lead to decreased mental health and social functioning, which both would lead to emotional role limitations, which finally would lead to physical role limitations. METHODS: A cross-sectional study assessed individuals with SCI (n = 40) in Neiva, Colombia. Participants completed a measure indexing various aspects of HRQOL. RESULTS: The path model overall showed excellent fit indices, and each individual path within the model was statistically significant. Pain exerted significant indirect effects through all possible mediators in the model, ultimately suggesting that energy, mental health, social functioning, and role limitations-emotional were likely pathways through which pain exerted its effects on physical disability in individuals with SCI. CONCLUSIONS: These findings uncover several potential nodes for clinical intervention which if targeted in the context of rehabilitation or outpatient services, could result in salubrious direct and indirect effects reverberating down the theoretical causal chain and ultimately reducing physical disability in individuals with SCI.

Macrogeographical variability in the great call of Hylobates agilis: assessing the applicability of vocal analysis in studies of fine-scale taxonomy of gibbons.

Vocal characteristics have been used extensively to distinguish different taxonomic units of gibbons (family Hylobatidae). The agile gibbon (Hylobates agilis) has a disjunct distribution range in the Southeast Asian archipelago (remnants of the former Sunda landmass), and populations on different islands are currently recognized as distinct subspecies or even species. We recorded great calls from female agile gibbons from two populations on Sumatra and two populations on Borneo and examined the vocal variability on four levels: within-individuals, between-individuals, between-populations and between-islands. The primary objective was to evaluate the effect of geographical isolation on variability in song pattern and to test whether proposed island-specific song characteristics exist, reflecting evolutionary divergence between Sumatran and Bornean agile gibbons. One hundred great calls were recorded from 20 females and analyzed for 18 spectral and temporal acoustic parameters. Principal component analysis followed by a nested ANOVA on components revealed a complex pattern of song variability not likely to reflect taxonomic or evolutionary relationship. We found no evidence that Sumatran and Bornean agile gibbons have evolved different vocal characteristics, refuting a distinction between them based on vocal characteristics. A high level of plasticity was found in great calls from the same individual, and generally the inferred pattern of variability suggested that ecological or social factors may confound any genetically based island dialects.

A multicentre evaluation of a new surgical technique for urethral bulking in the treatment of genuine stress incontinence.

This prospective study assesses the surgeon and patient acceptability of a new implantation device for transurethral Macroplastique injection, as well as the safety and effectiveness of the technique. Ten women with genuine stress incontinence were recruited at each of four participating urogynaecological centres. Treatment was performed in an outpatient or day case setting and follow up took place at six weeks and three months after treatment. Those in whom treatment had failed were offered re-treatment. The operator acceptance of the device was rated as excellent or acceptable in 95% after the first treatment and 100% after re-treatment. Urethral insertions were rated acceptable in 92.5%. Pain was scored as mild to moderate in 89% of all insertions. The overall success rate was 74.3% at three months with an implantation rate of 1.35 which appears to be comparable to published endoscopic data. We have concluded from this study that the Macroplastique implantation device is safe to use and provides simplified, yet effective alternative to the endoscopic implantation of urethral bulking agents.

Cervical screening: management of patients referred for colposcopy with smear abnormalities less severe than dyskaryosis.

The cervical smear and biopsy results were reviewed for 141 patients who were referred for colposcopy with either a technically unsuitable smear or with cervical smear abnormalities less severe than dyskaryosis. The number of referrals due to minor smear abnormalities more than doubled from 8.6% to 22.3% of the total colposcopy referrals over the 4 year period studied. The minor smear abnormalities were only associated with cervical intraepithelial neoplasia (CIN) in patients aged < 50 years. In 19 (13.5%) of the 141 patients high-grade lesions (CIN II or CIN III) were diagnosed. There were no cases of invasive cancer. Furthermore, the increased number of patients being referred for colposcopy with minor cervical smear abnormalities highlights the increasing pressures on colposcopy services, with prolonged waiting times for all patients.

A single transurethral Macroplastique injection as primary treatment for stress incontinence in women.

The clinical records of 102 women were analysed to estimate the success rate of a single transurethral Macroplastique (Uroplasty BV, Netherlands) injection for the treatment of stress incontinence. We then compared the results of those who had had the injection as primary treatment (71/102) with those women who had undergone previous failed incontinence surgery (31/102). The overall success rate was 68% following a single injection of Macroplastique at a mean follow-up period of 3.2 months; the success rate was obtained by including all patients who were either cured or markedly improved requiring no further intervention. The success rate of those who had had previous surgery was 71% and for the primary treatment group it was 66%. This difference was not statistically significant. These results suggest a potential role of Macroplastique transurethral injection as primary treatment for genuine stress incontinence in women.

Oral amino acids and gastric emptying: an investigation of the mechanism of levodopa-induced gastric stasis.

To investigate possible mechanisms of levodopa-induced gastric stasis, we have studied the effect of other amino acids on gastric emptying. The large neutral amino acid tryptophan delays gastric emptying in the dog at molar concentrations below those required to stimulate duodenal osmoreceptors. In healthy volunteers, we have shown that neither tryptophan nor the small neutral amino acid glycine delayed gastric emptying when given in concentrations similar to those of levodopa which produce gastric stasis. The study suggests that levodopa does not inhibit gastric emptying by an effect on duodenal amino acid receptors or via osmoreceptors.