Daily pain variations among patients with hand, hip, and knee osteoarthritis.

OBJECTIVE: This study examined within-day osteoarthritis (OA)-related pain patterns and associated patient characteristics. METHODS: Participants with physician diagnoses and self-reported symptoms of hand (N=40), hip (N=32), and knee (N=85) OA recorded pain using a handheld computer on one weekday and one weekend day, with ratings beginning immediately after waking, then approximately every 2h following. Pain was rated on a sliding visual analog scale with hidden coding of 1-100. Multivariable linear mixed models examined associations of patient demographic characteristics, enrollment site (Durham VA Medical Center vs Duke University Medical Center), joint site, body mass index, and pain medication use with within-day pain range (maximum minus minimum pain rating) and area under the curve (AUC) of pain ratings, which incorporates the magnitude of all pain measurements. RESULTS: Pain patterns differed substantially across individuals. The sample means of the average, maximum, and minimum weekday pain scores were 35.3, 54.4, and 17.9, respectively. The mean pain range was 36.4, and the mean pain AUC was 564.3 (possible range: 16-1600). Pain scores were similar on weekends. In multivariable mixed models, both knee and hip OA were associated with a greater within-day pain range than hand OA. Only VA enrollment site was associated with a significantly greater pain AUC. CONCLUSION: There is substantial within-day range in OA-related pain. Both pain range and overall within-day magnitude vary according to patient characteristics. Patients' records of within-day pain patterns could be used in clinical encounters to tailor recommendations for the timing of medication use and behavioral strategies.

Comorbid posttraumatic stress disorder is associated with suicidality in male veterans with schizophrenia or schizoaffective disorder.

The purpose of this study was to determine if patients with schizophrenia or schizoaffective disorders and comorbid posttraumatic stress disorder (PTSD) are at higher risk for suicidality than patients without comorbid PTSD. Participants were 165 male veterans with primary diagnoses of schizophrenia or schizoaffective disorder. Those with comorbid PTSD reported higher rates of suicidal ideation and suicidal behaviors compared to those without comorbid PTSD. These findings suggest that patients with comorbid PTSD are at higher risk for suicidality. Enhanced screening and targeted interventions may be warranted to address comorbid PTSD and increased suicide risk in this population.

The relationship between self-rated health and health care service use among women veterans in a primary care clinic.

This study examined whether self-rated health predicted health service use among women in an equal access primary care clinic setting. Women veterans (n = 139), 23-76 years of age were administered the PRIME-MD questionnaire at their outpatient clinic (OPC) visit which included a self-rated health item and assessment of symptoms. Number of prospective OPC visits was the outcome variable. Women who had poor/fair health were significantly more likely (OR = 3.25) to have more (>12) OPC visits than women who reported excellent/very good health. We conclude that poor perception of one's health is an important predictor of health care use among women veterans.

Racial variation in wanting and obtaining mental health services among women veterans in a primary care clinic.

Epidemiologic studies suggest that African-American women may be less likely to obtain mental health services. Racial differences were explored in wanting and obtaining mental health services among women in an equal access primary care clinic setting after adjusting for demographics, mental disorder symptoms, and a history of sexual trauma. Participating in the study were women veterans at a primary care clinic at the Durham Veterans Affairs Medical Center. Consecutive women patients (n = 526) between the ages of 20 and 49 years were screened for a desire to obtain mental health services. Patients were given the Primary Care Evaluation of Mental Disorders questionnaire (PRIME-MD) and a sexual trauma questionnaire. Mental health service utilization was monitored for 12 months. The median age of the women was 35.8 years; 54.4% of them were African-American. African-American women expressed a greater desire for mental health services than whites, yet mental health resources at the clinic were similarly used by both racial groups. African-American women may want more mental health services; however, given an equal access system, there were no racial differences in mental health use.

Reliability and accuracy of dermatologists' clinic-based and digital image consultations.

BACKGROUND: Telemedicine technology holds great promise for dermatologic health care delivery. However, the clinical outcomes of digital image consultations (teledermatology) must be compared with traditional clinic-based consultations. OBJECTIVE: Our purpose was to assess and compare the reliability and accuracy of dermatologists' diagnoses and management recommendations for clinic-based and digital image consultations. METHODS: One hundred sixty-eight lesions found among 129 patients were independently examined by 2 clinic-based dermatologists and 3 different digital image dermatologist consultants. The reliability and accuracy of the examiners' diagnoses and the reliability of their management recommendations were compared. RESULTS: Proportion agreement among clinic-based examiners for their single most likely diagnosis was 0. 54 (95% confidence interval [CI], 0.46-0.61) and was 0.92 (95% CI, 0. 88-0.96) when ratings included differential diagnoses. Digital image consultants provided diagnoses that were comparably reliable to the clinic-based examiners. Agreement on management recommendations was variable. Digital image and clinic-based consultants displayed similar diagnostic accuracy. CONCLUSION: Digital image consultations result in reliable and accurate diagnostic outcomes when compared with traditional clinic-based consultations.

Validation of a Trauma Questionnaire in veteran women.

The Trauma Questionnaire (TQ) assesses a woman's history of childhood and adult sexual trauma, sexual harassment, and domestic violence. The TQ is used widely at Veterans Affairs Medical Centers, but its validity has not been thoroughly examined. In a prospective study of 127 women, we found the TQ to have good to excellent agreement with a semistructured clinician interview and good sensitivity and specificity. The TQ can be used as a valid alternative to the clinician interview in the initial elicitation of trauma history among women veterans in the primary care setting.

The domain of hypertrophic chondrocytes in growth plates growing at different rates.

In this study, we tested the hypotheses that (a) both the domain volume (volume of the cell and the matrix it has formed) and matrix volume of juxtametaphyseal hypertrophic chondrocytes in the growth plate is tightly controlled, and that (b) the domain volume of juxtametaphyseal hypertrophic chondrocytes is a strong determinant of the rate of bone length growth. We analyzed the rate of bone length growth (oxytetracycline labeling techniques) and nine stereologic and kinetic parameters related to the juxtametaphyseal chondrocytic domain in the proximal and distal radial and tibial growth plates of 21- and 35-day-old rats. The domain volume increased with increasing growth rates, independent of the location of the growth plate and the age of the animal. Within age groups, the matrix volume per cell increased with increasing growth rates, but an identical growth plate had the same matrix volume per cell in 21- and 35-day-old rats. The most suitable regression model (R2 = 0.992) to describe the rate of bone length growth included the mean volume of juxtametaphyseal hypertrophic chondrocytes and the mean rate of cell loss/cell proliferation. This relationship was independent of the location of the growth plate and the age of the animal. The data suggest that the domain volume of juxtametaphyseal hypertrophic chondrocytes, as well as the matrix volume produced per cell, may be tightly regulated. In addition, the volume of juxtametaphyseal hypertrophic chondrocytes and the rate of cell loss/rate of cell proliferation may play the most important role in the determination of the rate of bone length growth.