The prevalence of primary headache disorders and their associated factors among nursing staff in North China.

BACKGROUND: Epidemiological data on the prevalence of headache in nursing staff in Mainland China are lacking. We therefore performed a study to assess the prevalence of headache, and factors associated with headaches, in nursing staff in three hospitals in North China. METHODS: Stratified random cluster sampling was used to select 1102 nurses from various departments in three hospitals. A structured questionnaire was used to collect epidemiological data, headache characteristics and associated factors. RESULTS: The response rate was 93.0%. Among nursing staff, the 1-year prevalence of primary headache disorders was 45.3%, of migraine 14.8% (migraine with aura 3.4%, migraine without aura 11.4%), of tension-type headache (TTH) 26.2%, of chronic daily headache (CDH) 2.7%. Multivariate analysis showed that seniority (≥5 years) was a risk factor for migraine (OR 2.280), obesity (BMI ≥ 25) was a risk factor for TTH and CDH (OR 1.684 and 3.184), and age (≥40 years) was a risk factor for CDH (OR 8.455). Nurses working in internal medicine were more likely to suffer CDH than those in other departments. Working a greater number of night shifts was also associated with increased prevalence of headache. CONCLUSION: The prevalence of primary headache disorders in nurses is higher than that in the general population in China, and occupational factors may play an important role. Therefore, the prevalence of headache in nurses should be a focus of attention, and coping strategies should be provided. Such measures could contribute to improving patient care.

The second to fourth digit ratio (2D:4D): a risk factor of migraine and tension-type headache.

BACKGROUND: Migraine and Tension-type headache (TTH) are common and disabling primary headache disorders. They are more prevalent in females. The second to fourth digit ratio (2D:4D) is sexually dimorphic in humans and is considered to be a marker for the balance of prenatal testosterone and estrogen exposure. Therefore, we investigated the hypothesis that prenatal sex steroids constitute an independent risk factor for adult headaches later in life. METHODS: A total of 891 individuals (303 males, 588 females) of 18-68 years in age (a mean of 37.0 ± 10.1 years), including 279 migraine, 300 TTH, and 312 healthy subjects were enrolled. The 2D:4D ratio was measured by a single investigator using a digital Vernier caliper. RESULTS: The females in the migraine group had lower 2D:4D ratios than those in the control group (left hand: 0.947 ± 0.034 vs. 0.955 ± 0.038, p = 0.048; right hand: 0.952 ± 0.035 vs. 0.965 ± 0.037, p = 0.001). There was a similar relationship between the TTH group and the control group (left hand: 0.946 ± 0.034 vs. 0.955 ± 0.038, p = 0.034; right hand: 0.954 ± 0.035 vs. 0.965 ± 0.037, p = 0.005), although this was not observed in males. Males showed lower 2D:4D ratios than females for the right hand in the control group (0.954 ± 0.039 vs. 0.965 ± 0.037, p = 0.015). No significant difference was found in the left hand. CONCLUSIONS: These results suggested that the 2D:4D ratio is a risk factor of migraine and TTH and that the balance of prenatal estrogen and testosterone in utero may impact adult primary headache disorders.

Comorbidity of poor sleep and primary headaches among nursing staff in north China.

BACKGROUND: Sleep disorders and primary headaches are both more prevalent among nursing staff than in the general population. However, there have been no reports about the comorbidity of poor sleep and primary headaches among nursing staff. METHODS: Stratified random cluster sampling was used to select 1102 nurses from various departments in three hospitals in north China. Sleep quality was assessed with the Pittsburgh Sleep Quality Index (PSQI). The diagnosis of primary headaches including migraine, tension-type headache (TTH), and chronic daily headache (CDH) was based on the International Classification of Headache Disorders, 3rd edition (beta version) (ICHD-3-beta). RESULTS: The response rate was 93 %. Among 1023 nurses, the prevalence of poor sleep was 56.7 %. Of these, 315 nurses (34.13 %) had poor sleep comorbid with primary headaches. The prevalence of poor sleep in the groups with CDH (82.1 %), migraine (78.9 %), and TTH (59.0 %) was significantly higher than that in the group without headaches (47.3 %) (all P < 0.05). Multivariate logistic regression revealed that rotating shifts and suffering headache were independent risk factors for poor sleep. Also, the 1-year prevalence of the three types of primary headache was significantly increased in the poor sleep group (migraine: 21.2 % vs. 7.2 %; TTH: 27.9 % vs. 24.9 %; CDH: 4.1 % vs. 1.1 %; P < 0.05). Compared with normal sleepers, nurses with poor sleep were 1.72 times more likely to have severe headache (OR: 1.72, 95 % CI: 1.14-2.57). CONCLUSION: Comorbidity of poor sleep and primary headaches among nursing staff is common. Therefore, sleep quality should be carefully evaluated in nurses with primary headaches.

The Influence of Medical Professional Knowledge on Empathy for Pain: Evidence From fNIRS.

Empathy is a mental ability that allows one person to understand the mental and emotional state of another and determines how to effectively respond to that person. When a person receives cues that another person is in pain, neural pain circuits within the brain are activated. Studies have shown that compared with non-medical staff, medical practitioners present lower empathy for pain in medical scenarios, but the mechanism of this phenomenon remains in dispute. This work investigates whether the neural correlates of empathic processes of pain are altered by professional medical knowledge. The participants were 16 medical students who were enrolled at a Chinese medical college and 16 non-medical students who were enrolled at a normal university. Participants were scanned by functional near-infrared spectroscopy while watching pictures of medical scenarios that were either painful or neutral situations. Subjects were asked to evaluate the pain intensity supposedly felt by the model in the stimulus displays, and the Interpersonal Reactivity Index-C (IRI-C) questionnaire was used to measure the empathic ability of participants. The results showed that there is no significant difference between medical professional and non-medical professional subjects in IRI-C questionnaire scores. The subjects of medical professions rated the pain degree of medical pictures significantly lower than those of non-medical professions. The activation areas in non-medical subjects were mainly located in the dorsolateral prefrontal cortex, frontal polar regions, posterior part of the inferior frontal gyrus, supramarginal gyrus, supplementary somatosensory cortex and angular gyrus, whereas there was a wide range of activation in the prefrontal lobe region in addition to the somatosensory cortex in medical professionals. These results indicate that the process of pain empathy in medical settings is influenced by medical professional knowledge.

Positive and negative relationship between anxiety and depression of patients in pain: a bifactor model analysis.

BACKGROUND: The relationship between anxiety and depression in pain patients has not been clarified comprehensively. Previous research has identified a common factor in anxiety and depression, which may explain why depression and anxiety are strongly correlated. However, the specific clinical features of anxiety and depression seem to pull in opposite directions. OBJECTIVE: The purpose of this study is to develop a statistical model of depression and anxiety, based on data from pain patients using Hospital Anxiety and Depression Scale (HADS). This model should account for the positive correlation between depression and anxiety in terms of a general factor and also demonstrate a latent negative correlation between the specific factors underlying depression and anxiety. METHODS: The anxiety and depression symptoms of pain patients were evaluated using the HADS and the severity of their pain was assessed with the visual analogue scale (VAS). We developed a hierarchical model of the data using an IRT method called bifactor analysis. In addition, we tested this hierarchical model with model fit comparisons with unidimensional, bidimensional, and tridimensional models. The correlations among anxiety, depression, and pain severity were compared, based on both the bidimensional model and our hierarchical model. RESULTS: The bidimensional model analysis found that there was a large positive correlation between anxiety and depression (r = 0.638), and both scores were significantly positively correlated with pain severity. After extracting general factor of distress using bifactor analysis, the specific factors underlying anxiety and depression were weakly but significantly negatively correlated (r = -0.245) and only the general factor was significantly correlated with pain severity. Compared with the three first-order models, the bifactor hierarchical model had the best model fit. CONCLUSION: Our results support the hypothesis that apart from distress, anxiety and depression are inversely correlated. This finding has not been convincingly demonstrated in previous research.