Self-reported sleep disorders in secondary school students: an epidemiological and risk behavioural analysis.

PURPOSE: To estimate the prevalence of self-reported sleep disorders (SD), to examine associations among demographic characteristics and familiar factors with SD, between SD and daytime sleep-related disorders (DD) and between evening habits and SD. METHODS: An anonymous questionnaire was proposed to 1563 students (aged 14-21 years, mean age 16.5 +/- 1.5; 42.8% males, 57.2% females) attending all classes of two high schools in Verona (North-East of Italy). Data were analyzed by some personal and familial characteristics, by definition of three sleeper groups (non problem, occasional problem or problem-sleepers). Moreover SD were put in relation with DD and with some personal evening attitudes. RESULTS: The 75.5% of the subjects report at least one SD. Difficulty falling asleep is the most frequent SD. The DD concern 91.2% of the sample. Females are more involved than males in SD and DD. All SD result strongly associated with the referred DD, except for sleepiness. Sport is significantly correlated with a minor prevalence of SD. Smoking and studying appear to be associated with SD. CONCLUSIONS: Since SD in youth constitute an important Public Health matter with a severe social impact they would be accurately studied to offer youth appropriate counselling given the importance of lifestyle in determining good sleep.

Endovenous treatment of incompetent anterior accessory saphenous veins with a 1540 nm diode laser.

AIM: Endovenous laser treatment (EVLT) is an accepted form of axial vein ablation for symptomatic venous reflux but its role in the treatment of anterior accessory saphenous vein (AASV) has not been well characterized. The aim of this paper is to show the short-term result of EVLT with a ball-tipped fiber and a 1540 nm diode laser of the AASV with preservation of a competent great saphenous vein (GSV). METHODS: Nine incompetent AASV veins in 8 patients (6 female) were treated. The gravity of chronic venous disease was determined according to the CEAP classification and the severity of symptoms was scored according to the revised Venous Clinical Severity Score. Patient satisfaction was assessed by a 0 to 3 scale. RESULTS: The average linear endovenous energy density was 60.5 J/cm vein (SD: 7.5). Patients returned to daily activities after a mean of 3.8 days (SD: 1.4). 5 patients (63%) have had pain but of mild intensity. No patients developed paresthesia or phlebitis reactions in the treated area. Post-operative ecchymoses are frequent (89%). During the follow-up period (mean 13 months, range: 7-17 months) all the veins were occluded. The VCSS improved drastically from a mean of 3.2 (SD: 1.3) preinterventional to 0 (SD: 0.38) at 17 months. All patients were satisfied or very satisfied with the method. No severe complications occurred. CONCLUSION: EVLT of an incompetent AASV with a 1540 nm diode laser is a safe and efficient therapy option, with a high success rate and with no evidence of GSV neo-reflux or recurrent varicosities during the follow-up period.

Intractable pain: a neglected area of medical education in the UK.

Unease over the previous management of 67 patients referred for treatment to 3 pain relief clinics led us to investigate the current state of education in pain and pain control in the UK. Twenty-seven medical schools provided data which revealed; (i) in 4 schools no teaching whatsoever is given in these subjects; (ii) in the remainder it is accorded an average of 3.5 hours during the 5 year course, with little evidence of multidisciplinary teaching; (iii) only 10 schools (37%) regularly set questions on pain control in formal examinations. A survey of 219 general practitioners revealed a wide-ranging lack of knowledge about the facilities and approach to treatment at their local pain relief clinic. These findings have wide reaching implications for medical education. At the undergraduate level they demonstrate a need for more multidisciplinary teaching and practical experience in specialist units. Thereafter specialists in pain control must enable practising doctors to keep abreast of new developments. This may require them to devote more time writing for a non-specialist audience and devising short, postgraduate courses.

The who and why of pain: analysis by social class.

Physicians with an interest in pain have long suggested that the poor complain more and have a higher prevalence of neuroticism than do higher social groups. This assumption was tested by analysing the pain patterns in 500 consecutive patients attending a pain relief clinic. Results implied that scores for presenting pain, anxiety, and depression were similar to all social groups. After treatment scores for residual pain were significantly lower in all social classes, with greatest reduction in classes III, IV, and V. Almost identical results were obtained in a subgroup of patients with cancer but not in a subgroup with sciatica. That patients from the lower social classes have a higher perception of pain and are more neurotic than other group is a myth, probably resulting from poor communication between clinicians and patients of dissimilar socioeconomic class.

The differential effects of meclofenoxate on memory loss in the elderly.

A double-blind study of the effects of meclofenoxate on memory performance of fit, able, elderly subjects was carried out. A number of performance measures, designed to measure various aspects of memory function were employed. These revealed that meclofenoxate appears to increase the consolidation of new information into long-term memory, but does not affect other aspects of remembering. It was also found that significantly more of the subjects receiving meclofenoxate reported an increased level of mental alertness.

The contribution of the accelerating phase of inspiratory flow to resistive load detection in man.

1. By the use of Signal Detection Theory techniques resistive load detection sensitivity was estimated in ten normal subjects during loading of the whole of inspiration and compared with loading restricted to the initial, accelerating phase of inspiratory air flow. 2. Detection sensitivity during the accelerating-flow phase of inspiration was not significantly different from that in the control conditions. 3. These results suggest that the information for detection is generated in the accelerating phase of inspiratory air flow. 4. We propose that the stimulus for resistive load detection is the ratio of the rate of change of pressure to the rate of change of flow.

The nursing management of pain in the community: a theoretical framework.

This paper is based upon a research project designed to investigate the nursing management of pain in the community. A theoretical framework is described which has been designed to encompass the complexities of different types of pain, individual differences in reaction to pain, and to identify key differences between patients who cope with pain and those who do not. The framework is based on a model of stress, the concept of controllability, and contemporary learning theory. It identifies a unique role for the nurse in pain management and will be used to direct a study into strategies which nurses can use to enhance the coping abilities and resources of elderly patients in the community with pain.

A Signal Detection Theory analysis of the effect of chest cage restriction upon the detection of inspiratory resistive loads.

1. By the use of Signal Detection Theory techniques, resistive load detection sensitivity was estimated in six normal subjects, and compared with detection when the chest cage was strapped in the position of full expiration. 2. With chest cage restriction there was both a decrease in detection sensitivity and an increase in the willingness to report the presence of an added load to breathing. 3. This suggests that the similarity of detection in chest clamping and control previously reported was due partly to increased detection bias with chest clamping. 4. These results have implications concerning the dependence of detection on afferent information from the chest wall.

The nursing management of elderly patients with pain in the community: study and recommendations.

This study is designed to identify factors which influence quality of life for elderly people suffering from painful conditions. It is based upon a theoretical model of control in which mood state is used as the indicator of coping. One hundred and ninety elderly patients took part in semi-structured interviews about their pain and coping experiences, and data were also collected from their nurses in the community. Multivariate statistical analysis revealed that the key determinants of mood were having regrets about the past, being occupied, perceived level of pain control, additional personal problems (notably bereavement) and feeling informed about the painful condition. Active personal coping strategies were identified as more therapeutic than passive strategies. Nurses' data revealed that pain complaints were associated with perceived exaggeration. Few nurses used formal pain assessment. Recommendations for the management of persistent pain in the community are given.

Increased sensitivity to nitrazepam in old age.

The effects of a single 10 mg oral dose of nitrazepam were compared with those of a placebo in healthy young and old people. Both the young and the elderly slept better on three successive nights after nitrazepam but they felt less awake at 12 and 36 hours (P less than 0-01). Elderly people made significantly more mistakes in a psychomotor test than did the young, despite similar plasma concentrations of nitrazepam and half lives in the two groups. This difference in response to psychomotor testing is probably explained by an increased sensitivity of the ageing brain to the action of nitrazepam.

The effects of procaine/haematoporphyrin on age-related decline: a double-blind trial.

A randomized, double-blind study of procaine/haematoporphyrin (KH3) has been carried out over two years in a selected population of healthy elderly subjects. The period of study exceeds 500 patient years. The trial population was weighted to contain a larger proportion of subjects aged over 75 years than a standard population; those receiving active KH3 had similar characteristics on entry to those receiving placebo. Over the course of two years, KH3 was shown to be an active substance in that: (a) decrement in the consolidation of new learning was prevented in the treatment group (less than 1.0%, as against 38% in the placebo group); (b) the prevalence of incontinence increased significantly in the placebo group, but not in the active group (P less than 0.05); (c) there was a significant increase in grip strength in the active treatment group (+22%, P less than 0.01 v. placebo); (d) more adverse reactions were observed on treatment with KH3 (P less than 0.005).