A validation study and psychometrical evaluation of the Maastricht Upper Extremity Questionnaire (MUEQ) for the Greek-speaking population.

OBJECTIVES: The Maastricht Upper Extremity Questionnaire (MUEQ) is a tool to examine the physical, psychological and environmental risk factors in the work place that may contribute to the prevalence of complaints of arm, neck and shoulder. The aim of this study was to develop a Greek language version of the MUEQ and to assess its psychosocial parameters. METHODS: The MUEQ was translated into the Greek language and culturally adapted. Exploratory factor analysis was used to analyze interrelations among the questionnaire items and for each of the seven domains two factors were given, thus resulting in the identification of a total of 14 factors. RESULTS: The tool was handed out to 455 computer office workers (179 males, 276 females) with a mean age of 37.4 (SD 9.2). Factor analysis and Cronbach's alpha coefficient indicate that the results are generalizable to the population and the total scale has high internal consistency. The results showed that in the last year, 35.8% of respondents experienced upper extremity pain, specifically in the neck or the shoulders. CONCLUSIONS: The Greek version of the MUEQ appears to be a valid tool for the assessment of risk factors related to pain in the upper extremity among Greek computer office workers.

The burden of caring for patients with dementia and its predictors.

Dementia not only affects patients but also care providers. The assessment of Caregivers' Burden (CB) has grown exponentially in the dementia field, as studies have shown that it is higher in dementia than in other diseases. Dementia care in Greece is different compared to other developed countries, as most of the patients receive care at home from family members. The aim of the present study was to examine the level of burden in Greek caregivers who live in Athens, and its association with patient and caregiver factors. This was a cross-sectional study of 161 primary caregivers of dementia patients living in the community and attending a secondary clinic. CB was assessed with the Zarit Burden Interview (ZBI) and caregivers' depression with the Center for Epidemiological Studies Depression Scale (CES-D). Clinical characteristics of the patients were also assessed using validated scales (cognitive status, functional ability, neuropsychiatric symptoms). In order to find predictors of caregiver Burden, we conducted a 3-step hierarchical regression analysis. Most patients were suffering from Alzheimer's Dementia (n=101; 62.73%) and had moderate and severe dementia according to the MMSE score (mean MMSE=11.50), with patients being unable to perform 2 basic activities of daily living on average. 45 patients (27.95%) had depression according to the CSDD; only 5 patients didn't have any behavioral problem in the NPI, while patients had more than 5 behavioral problems on average. Caregivers were involved in their role for 3.6 years on average and the mean weekly caregiving time was more than 70 hours. Nearly half (n=80; 49.06%) of the 161 caregivers demonstrated high CB (ZBI>40) and nearly one fourth had depression according to the CES-D scale. All blocks of variables entered into the regression model independently predicted caregiver burden's variance (demographics, clinical factors and caregiving characteristics). Lower caregiver's age, high behavioral symptoms of dementia patients and caregivers' depression were found to be independently associated with CB. The final regression model explained 47.2% of the variance in CB. Dementia causes a great burden in caregivers. CB is a complex issue that is associated with several patients and caregivers' factors. The level of CB should be assessed in everyday dementia clinical practice.

Tropisetron in the prevention of acute nausea and vomiting in patients treated with high dose epirubicin.

Tropisetron is a novel selective antagonist of the type-3 serotonin (5-HT3) receptor, with proven efficacy in the control of emesis related to cancer treatment. Epirubicin in doses of > 100 mg/m2 has a high emetogenic potential. This study was designed to determine whether a single intravenous administration of tropisetron could prevent acute nausea and vomiting in patients treated with high dose epirubicin. Forty chemotherapy naive breast cancer patients treated with epirubicin at a dose of 110 mg/m2 on an outpatient basis were enrolled in the study. Tropisetron 5 mg i.v. was used as antiemetic prophylaxis. "On demand" treatment with tropisetron 5 mg p.os was used for the rescue of patients who failed on the initial i.v. dose. Complete control of acute nausea and vomiting had 62.5% (95% C.I. 47.2-77.8), partial control 15% (95% C.I. 3.8-26.2) and 22.5% (95% C.I. 9.3-35.7) insufficient control or failure. Headache was the most common adverse event reported in 3 patients (7.5%) and constipation in 2 patients (5%). Interestingly, patients with a negative experience of nausea and vomiting during pregnancy and those treated for metastatic disease, had a better control of chemotherapy-induced nausea and vomiting. In conclusion, a single 5 mg i.v. dose of tropisetron is safe and effective in preventing acute emesis in patients treated with high dose epirubicin.

Mental pain and suicide risk: application of the Greek version of the Mental Pain and the Tolerance of Mental Pain scale.

According to Shneidman's theory, mental pain or "psychache", which refers to an endopsychic painful experience consisted of excessively felt negative feelings, is a key component to the understanding of suicidal behaviour, as to its psychological features. Shneidman himself supported that 'suicide is caused by psychache', more precisely suicide occurs when a person can no longer tolerate this pain. Findings of previous studies have shown that mental pain is an independent predictive factor for suicidal behaviour. In the present study we evaluated the psychometric properties of the Greek version of the Mental Pain Scale (MPS) and the Tolerance for Mental Pain Scale (TMPS) ina non clinical sample consisted of 112 participants (73 female and 39 male). Moreover, we explore the relationships between mental pain, depression, and suicide risk and for the first time the effect of the tolerance for mental pain on depression and suicide risk. We hypothesized that both the level of mental pain and the degree of tolerance for mental pain would predict suicide risk, independently of the level of depression. Both MPS and TMPS appear to have satisfactory to high levels of internal consistency, test-retest reliability, and concurrent validity. Suicide risk was correlated to mental pain, tolerance for mental pain, and depression. Multiple regression analysis showed that mental pain and tolerance for mental pain have a significant contribution to suicide risk, independently of depression, confirming our hypothesis.Using an additional multivariate regression with the factors extracted from MPS and TMPS as independent variables, we found that especially 'loss of control' of mental pain and the ability to 'contain the pain' contribute uniquely to suicide risk. Our findings offer support to the hypothesis that mental pain is a clinical entity distinct from depression with a specific and important contribution to the suicide risk.Depression alone is not enough to cause suicide. The mental pain construct, although related to depression,could shed light on the comprehension of the human experience that leads to suicide. Relieving mental pain may constitute a distinct and important treatment goal, along with the remission of depression and despair, so that the person can maintain control and contain all the distressing events that comprise the painful experience. Both MPS and TMPS appear to be valid and reliable tools for the assessment of mental pain and its tolerance, respectively. They could also be employed in further investigation on the role of specific aspects of the mental pain experience in suicidal behaviours.

Impact of an anesthesia discharge scoring system on postoperative monitoring after circumcision in children: a randomized trial.

BACKGROUND: Ambulatory surgery in children, combined with new anesthetic methods, leads to shorter hospital stays and an increase in patient and parental satisfaction. AIM: Aim of the study was to determine the feasibility and safety of transferring children directly to the ward without a previous stay in a post anesthesia care unit (PACU), after undergoing circumcision for phimosis under regional anesthesia and non-opioid analgesia. METHODS: 187 healthy children undergoing circumcision were studied in a randomized manner. After surgery, children who met predefined inclusion criteria in the operating room were randomly assigned to one of two groups. Children in the first group (Group A) bypassed the PACU and were admitted directly to the ward, after undergoing assessment using the White and Song scoring system. Children in the second group (Group B) were first transferred to a PACU and then to the ward. The children in Group A who did not meet the criteria of the White and Song scoring system represent the level of risk associated with direct transfer to the ward and no PACU stay. Recovery in the PACU and the ward, parental satisfaction, number of readmissions and the number of parental contacts for medical problems after discharge were recorded and compared between the two study groups. RESULTS: 157 children were randomly assigned into two groups (79 children in Group A and 78 in Group B). Demographic data, the duration of surgery, and recovery in the PACU or the ward were similar for the two groups. No readmissions were observed and most parents were very satisfied with the procedure. CONCLUSION: Children undergoing circumcision do not routinely require admission to a PACU and if the appropriate criteria are met, it is safe to transfer them directly to the ward.