Pain-catastrophizing and fear-avoidance beliefs as mediators between post-traumatic stress symptoms and pain following whiplash injury - A prospective cohort study.

BACKGROUND: Knowledge about the course of recovery after whiplash injury is important. Most valuable is identification of prognostic factors that may be reversed by intervention. The mutual maintenance model outlines how post-traumatic stress symptoms (PTSS) and pain may be mutually maintained by attention bias, fear, negative affect and avoidance behaviours. In a similar vein, the fear-avoidance model describes how pain-catastrophizing (PCS), fear-avoidance beliefs (FA) and depression may result in persistent pain. These mechanisms still need to be investigated longitudinally in a whiplash cohort. METHODS: A longitudinal cohort design was used to assess patients for pain intensity and psychological distress after whiplash injury. Consecutive patients were all contacted within 3 weeks after their whiplash injury (n = 198). Follow-up questionnaires were sent 3 and 6 months post-injury. Latent Growth Mixture Modelling was used to identify distinct trajectories of recovery from pain. RESULTS: Five distinct trajectories were identified. Six months post-injury, 64.6% could be classified as recovered and 35.4% as non-recovered. The non-recovered (the medium stable, high stable and very high stable trajectories) displayed significantly higher levels of PTSS, PCS, FA and depression at all time points compared to the recovered trajectories. Importantly, PCS and FA mediated the effect of PTSS on pain intensity. CONCLUSIONS: The present study adds important knowledge about the development of psychological distress and pain after whiplash injury. The finding, that PCS and FA mediated the effect of PTSS on pain intensity is a novel finding with important implications for prevention and management of whiplash-associated disorders. WHAT DOES THIS STUDY ADD?: The study confirms the mechanisms as outlined in the fear-avoidance model and the mutual maintenance model. The study adds important knowledge of pain-catastrophizing and fear-avoidance beliefs as mediating mechanisms in the effect of post-traumatic stress on pain intensity. Hence, cognitive behavioural techniques targeting avoidance behaviour and catastrophizing may be beneficial preventing the development of chronic pain.

Comparison of nurse practice environments in Denmark and the USA.

AIMS: The aims were to translate, validate and test the reliability of the Practice Environment Scale of the Nursing Work Index in a Danish context; and to compare Danish nurses' ratings of their nurse work environments with the highest rated work environments, USA magnet hospitals. BACKGROUND: Patient quality and safety are priorities for managers, administrators and policy makers worldwide. A supportive work environment is an important factor to improve quality and safety. The most used scale to measure the nurse work environment is Practice Environment Scale of the Nursing Work Index. There is no Danish translation of the scale or a comparison of nurse work environment between Denmark and other countries. METHODS: The translation and cultural adaption followed the steps recommended by the World Health Organization. Content validity was evaluated using cognitive interviewing in-person and through surveys. The reliability was tested using Cronbach's alpha. Finally, Practice Environment Scale of the Nursing Work Index ratings from 127 nurses were compared with results from Magnet and non-Magnet hospitals using t-tests. FINDINGS: The Danish translation of Practice Environment Scale of the Nursing Work Index had a high validity and reliability. Danish nurses rated their nurse work environment more favourable than nurses in non-Magnet hospitals and at the same level as Magnet hospitals. Lowest Danish scores were found in the two hospital-level subscales in items related to staff nurses' involvement in discussions on daily problems, the visibility of the chief nursing officer and importance of up-to-date nursing documentation. CONCLUSION: Danish nurses report a supportive nurse work environment with overall scores at the same level as Magnet hospitals. Opportunities for improvement were identified in the subscales. IMPLICATIONS FOR NURSING AND HEALTH POLICY: A first step to improve patient quality and safety is addressing factors that influence quality and safety. Using the Danish Practice Environment Scale of the Nursing Work Index, interventions to improve specific areas can be planned, implemented and evaluated. Further, Practice Environment Scale of the Nursing Work Index is a nursing quality indicator that can be included in quality databases in Denmark.

The effect of shortening and varus collapse of the femoral neck on function after fixation of intracapsular fracture of the hip: a multi-centre cohort study.

We have studied the effect of shortening of the femoral neck and varus collapse on the functional capacity and quality of life of patients who had undergone fixation of an isolated intracapsular fracture of the hip with cancellous screws. After screening 660 patients at four university medical centres, 70 patients with a mean age of 71 years (20 to 90) met the inclusion criteria. Overall, 66% (46 of 70) of the fractures healed with > 5 mm of shortening and 39% (27 of 70) with > 5 degrees of varus. Patients with severe shortening of the femoral neck had significantly lower short form-36 questionnaire (SF-36) physical functioning scores (no/mild (<5 mm) vs severe shortening (> 10 mm); 74 vs 42 points, p < 0.001). A similar effect was noted with moderate shortening, suggesting a gradient effect (no/mild (< 5 mm) vs moderate shortening (5 to 10 mm); 74 vs 53 points, p = 0.011). Varus collapse correlated moderately with the occurrence of shortening (r = 0.66, p < 0.001). Shortening also resulted in a significantly lower EuroQol questionnaire (EQ5D) index scores (p = 0.05). In a regression analysis shortening of the femoral neck was the only significant variable predictive of a low SF-36 physical functioning score (p < 0.001).

Similar therapeutic serum levels attained with emulsified and oil-based preparations of coenzyme Q10.

Studies of the therapeutic efficacy of coenzyme Q10 (CoQ10) have been confounded by the variable bioavailability of numerous CoQ10 preparations. The aims of the present study were to determine the early serum levels attained by two different preparations of CoQ10, a soybean oil-based preparation and a complex micelle emulsion and to assess whether these preparations of oral CoQ10 influence plasma lipid profiles. Twelve healthy individuals received 300 mg CoQ10 daily of either preparation for 7 days in a double-blind cross-over design with a 21-day washout period. Blood samples to determine serum levels of CoQ10 and lipids were taken at baseline, after 24 h and 7 days. Both preparations induced significant increases in serum CoQ10 levels at 24 h and 7 days. These were for soy oil: baseline 0.27 +/- 0.03 mol/L, 24 h 0.50 +/- 0.04 mol/L (180%) and 7 days 0.80 +/- 0.05 mol/L (291%), mean +/- SEM: for emulsion: baseline 0.29 +/- 0.03 mol/L, 24 h 0.45 +/- 0.03 mol/L (150%) and 7 days 0.79 +/- 0.06 mol/L (270%). There were no significant differences between CoQ10 levels for the two preparations at either time point. There was no change in any of the serum lipids following the 7 days treatment. We conclude that administration of either a soy oil suspension or a complex emulsion of CoQ10 increases serum levels to the therapeutic range within 1 week.

Matrix-assisted laser desorption/ionization Fourier transform mass spectrometric analysis of oxygenated triglycerides and phosphatidylcholines in egg tempera paint dosimeters used for environmental monitoring of museum display conditions.

Oxidative changes in triacylglycerols and diacylphosphatidylcholines in egg tempera paint strips are used for chemical dosimetry of the quality of the museum environment. High-resolution matrix-assisted laser desorption/ionization Fourier transform mass spectrometry (MALDI-FTMS) was used as a rapid method for the determination of the exact elemental composition of the alteration products from diacylphosphatidylcholines and triacylglycerols. Light exposure of the egg tempera paints yields oxygenated diacylphosphatidylcholines and triacylglycerols. In the latter multiple incorporation of oxygen was observed as a recurring mass difference of 15.995, the exact atomic mass of oxygen. Owing to the high resolution of the FTMS data (routinely 20 000 at m/z 1000 in broadband mode), oxidation products with different elemental compositions but identical nominal mass could be distinguished. Products of oxidative cleavage of triacylglycerols were observed in samples exposed for longer times. The relative intensities of the peaks of singly and multiply oxygenated triacylglycerols were used to derive the degree of oxygenation of the egg lipids in the tempera paint dosimeters. The degree of oxygenation was found to be directly related to the light exposure time. Exposure to elevated temperature (60 degrees C) for a period of 21 days did not lead to oxygenation of the triacylglycerols and diacylphosphatidylcholines. Exposure to NO(x) and SO(2) in the dark greatly increased the degree of oxygenation. Addition of lead- or copper-containing pigments to the egg binding medium (and subsequent storage for 6 months in the dark) led to accelerated conversion of egg lipids to oxidised products.

[Late sequelae of violence seen from victims' perspective]. / Voldens senfølger set fra offerets synsvinkel.

Hospital accident and emergency (A&E) departments frequently treat victims of interpersonal violence. This study of 1,451 victims treated at the A&E departments of Aarhus University Hospital during a one-year period (1993-94) aims at illuminating some of the sequelae of victims. A questionnaire survey was carried out two years later to obtain information on medical after-treatment, the extent of sick leaves, and the victims' personal costs. One in two assault victims needed further medical treatment. 7.5% were admitted to hospital and 20% were referred to the out-patient clinic in the hospital or to follow-up treatment in general practice. The median sick leave period was eight days. Two years after the violence took place, 21.8% of all assault victims claimed that they had cosmetic sequelae, 14.7% had persistent pain. 38.1% said they were afraid to enter certain neighbourhoods or places; 41.2% had frequently or occasionally thought about the assault. The study has revealed some aspects of the personal costs, discomfort and trouble that victims of violence experience.

[Domestic violence]. / Vold i familien.

The purpose of this study was to analyze the development in the incidence of violence against women committed by husband/spouse and violence against children committed by parents. This study is based on a prospective registration during a one year period (1993-94) of women and children who attended the casualty wards and/or the Department of Forensic Medicine because of exposure to violence. The results were compared with similar studies from 1981-82 and 1987-88. The incidence of domestic violence within the age group of 25-34 years (the major group) was in 1993-94 1.9 per 1000 per year, in 1981-82 1.7 and in 1987-88 2.9. Twelve percent of the women had been exposed to violence characterized as severe. Twenty (6.6%) women were registered more than once. Thirty-eight percent of Danish women and 25.8% of foreign women reported the incident to the police. The incidence of violence against children remained unchanged at 0.3 per 1000 per year during the three registration periods.

Perioperative myocardial ischaemia in patients undergoing surgery for fractured hip randomized to incremental spinal, single-dose spinal or general anaesthesia.

Quantitative assessment of myocardial ischaemia during incremental spinal, single-dose spinal and general anaesthesia may provide guidelines for the choice of anaesthetic technique for osteosynthesis of hip fractures in the elderly atherosclerotic individual. Forty-three patients with coronary artery disease were allocated to receive either incremental spinal anaesthesia (bupivacaine 0.5% plain) (A), single-dose spinal anaesthesia (2.5 mL of bupivacaine 0.5% plain) (B) or general anaesthesia (fentanyl, thiopentone, atracurium, enflurane, N2O/O2) (C) for hip surgery. ST segment monitoring was performed from the induction of anaesthesia and for the following 48 h, and perioperative hypotension, blood loss and fluid therapy were recorded. ST depression developed in two out of 14 (A), seven out of 15 (B) and six out of 14 (C) patients (P = 0.14). In (A), a total of seven ST depressions occurred in the observation period as opposed to 125 in (B) and 16 in (C) (P < 0.05). Intra-operative ST depression only occurred in (B). Three (A), 33 (B) and 40 (C) hypotensive events were recorded (P < 0.002). Altogether, 56% of hypotensive patients developed ST depression compared with 10% of normotensive patients (P < 0.003). In (A), 1.6 mL of 0.5% bupivacaine were used as opposed to the fixed 2.5 mL dose in (B) (P < 0.001). In the first post-operative week, mortality was higher in (B) (P < 0.05) but, after 1 month, there was no significant difference in mortality between the three groups. The incidence of hypotension and myocardial ischaemia was lowest in the group receiving incremental spinal anaesthesia.

Pattern of injuries due to interpersonal violence.

The specific aim of this study was to find characteristics of violence-related injuries, its anatomic distribution and the mechanisms. During a one-year period 1481 consecutive assault victims were interviewed and examined at the Accident and Emergency departments or the Department of Forensic Medicine in Aarhus, Denmark. Information about 2432 violence-related injuries was analysed. The results showed significant differences in injury location, type of injury and injury mechanisms between male and female victims. 69% of all injuries were craniofacial. The injury mechanism was mostly blunt trauma by fist or feet. Cases with penetrating trauma, were predominantly caused by broken drinking glasses. Weapons such as knives and guns only caused 3.7% of all injuries. The results are similar to other studies.

The epidemiology of violence in Denmark.

A 1-year prospective study was carried out to describe the epidemiological changes in interpersonal violence in Aarhus (Denmark) over a 12-year period. Data was collected from the Accident & Emergency department, the Department of Forensic Medicine, the local police and compared to previous studies carried out in 1981-1982 and 1987-1988. The incidence of violence was found to have declined significantly over the study period, but severity of violence remained unchanged. The composition of pubs, discotheques and cafes might be an important factor in reducing inner city violence. Police statistics alone may give a false picture of the assault rate. All of these factors are discussed.

Stable lateral malleolar fractures treated with aircast ankle brace and DonJoy R.O.M.-Walker brace: a prospective randomized study.

Stable lateral malleolar fractures can be treated with dynamic braces and early mobilization. In a randomized clinical trial, 66 patients with supination-eversion stage II fractures were treated with Aircast Air-Stirrup ankle braces or DonJoy R.O.M.-Walker braces. Average bracing time was 5 weeks, and average time until return to work was 6 weeks. At 4 weeks, 70% to 80% of patients were able to walk without pain. Subjective satisfaction with comfort and ease of use was significantly higher with Aircast, although it was high in both groups. Pain relief and an inflammatory score were significantly better in the R.O.M.-Walker group after 4 weeks. Three months after injury, no differences were observed in grade of ambulation, pain, swelling, range of motion, or inflammatory score. Both braces can be recommended.

[Decline of violence in ]rhus. Violence registered in ]rhus hospital during a period of 12 years]. / Faldende vold i Arhus.

The aim of this study was to describe the changes in frequency and character of interpersonal violence in Aarhus during a twelve year period. A one year (1993-1994) prospective registration of all persons exposed to violence and attending the casualty wards or the Department of Forensic Medicine was performed. The results were compared with similar studies performed in 1981-1982 and 1987-1988. The incidence in the last one year period had decreased significantly to 5.5 cases/1000 inhabitants compared to 6.5 in 1981-1982 and 7.5 in 1987-1988. The decrease was most distinct among men between 15-24 years of age. Ninety percent of the lesions were minor and the severity did not differ from the former study. Among risk factors associated to severe violence were men between 25-49 years of age, foreigners, use of knives and domestic violence. Firearms were only involved in 0.8% of the cases. Significantly higher proportion of the victims reported the incidence to the police in 1993-1994 than previously.

Benzoolysis of diacylglycerophosphocholines: dephosphorylation and sequential formation of isomeric reaction products.

Benzoolysis experiments are reported in which diacylglycerophosphocholine is heated at 100 degrees C with benzoic anhydride for variable periods of time. It is shown that more than 90% of the phospholipid is dephosphorylated after 5 h of heating. Lipid extracts of the reaction mixture contained 1,2- and 1,3-diacylglycerobenzoate and 1,2- and 1,3-diacylglycerol in nearly constant isomer ratios of about 3:1 and 1:2, respectively, independent of the heating and extraction time. The total amount of isomeric diacylglycerobenzoates increased more slowly with increasing heating time that corresponded with the dephosphorylation rate, complete benzoylation being attained only after a 15 h heating period. The total amount of isomeric diacylglycerols went through a maximum after about 4 h and vanished after 15 h of heating. Addition of 4-dimethylaminopyridine subsequent to the heating period resulted in rapid and complete benzoylation of dephosphorylated phospholipid. However, the ratio of 1,2- to 1,3-diacylglycerobenzoate then found in the lipid extract depended on heating time, changing from less than 1:1 to about 3:1 upon an increase of heating time from 1 to 15 h. The results are interpreted in terms of two consecutive reactions. In a relatively fast first step, a dephosphorylated intermediate is formed, which in the molten benzoic anhydride, is slowly benzoylated. The intermediate yields diacylglycerols upon extraction in the absence of 4-dimethylaminopyridine and diacylglycerobenzoates upon extraction in the presence of 4-dimethylaminopyridine.

[Waiting lists--how valid are the official numbers? Evaluation of a waiting list at a department of orthopedic surgery]. / Ventende til indlaeggelse--er de officielle tal reelle? Ventelisteopgørelse på en ortopoedkirurgisk afdeling.

With increasing waiting lists for admission to hospital, the aim of this study was to investigate the reliability of an orthopaedic waiting list. Questionnaires were sent to every patient listed as waiting for more than three months. The questionnaire addressed the current symptoms and the current need for surgical treatment. In case of no reply, a further evaluation was done before eventual removal from the waiting list. Of 809 questionnaires mailed, replies were received from 409. A total of 376 were removed from the list, including 111 due to registration errors in the central data base. This study has shown how the indication for operation changes during the waiting period but also that information from data bases can be most unreliable. We find the reasons so general, that we recommend a corresponding evaluation of other waiting lists. Altogether, today's waiting list is faulty and thus provides a wrong basis for management.

A voice accumulation--validation and application.

Studies of vocal behavior under natural conditions require suitable techniques for obtaining records of voice use. We describe the operation of a newly designed voice accumulator that allows registration of fundamental frequency and phonation time during a 12-hour period. The device is based on microprocessors and allows accumulation of the voice fundamental frequency within 60-600 Hz. The voice signal is picked up by a contact microphone attached to the front part of the neck. Analysis of fundamental frequency distribution and phonation time is made on a personal computer. Validation of the device shows it to provide accurate measurements of fundamental frequency, although it tends to underestimate phonation time. In a field test, the accumulator was used to analyze vocal behavior during two work-days in a group of nurses and a group of speech pathologists. Overall, the speech pathologists had a lower fundamental frequency level and higher values of phonation time than the nurses. These field results confirm the validation of the voice accumulator.