Negative experiences of pain and withdrawal create barriers to abscess care for people who inject heroin. A mixed methods analysis.

BACKGROUND: Skin and soft tissue infections (SSTIs) are prevalent among people who inject heroin (PWIH). Delays in seeking health care lead to increased costs and potential mortality, yet the barriers to accessing care among PWIHs are poorly understood. METHODS: We administered a quantitative survey (N = 145) and conducted qualitative interviews (N = 12) with PWIH seeking syringe exchange services in two U.S. cities. RESULTS: 66% of participants had experienced at least one SSTI. 38% reported waiting two weeks or more to seek care, and 57% reported leaving the hospital against medical advice. 54% reported undergoing a drainage procedure performed by a non-medical professional, and 32% reported taking antibiotics that were not prescribed to them. Two of the most common reasons for these behaviors were fear of withdrawal symptoms and inadequate pain control, and these reasons emerged as prominent themes in the qualitative findings. These issues are often predicated on previous negative experiences and exacerbated by stigma and an asymmetrical power dynamic with providers, resulting in perceived barriers to seeking and completing care for SSTIs. CONCLUSIONS: For PWIH, unaddressed pain and withdrawal symptoms contribute to profoundly negative health care experiences, which then generate motivation for delaying care SSTI seeking and for discharge against medical advice. Health care providers and hospitals should develop policies to improve pain control, manage opioid withdrawal, minimize prejudice and stigma, and optimize communication with PWIH. These barriers should also be addressed by providing medical care in accessible and acceptable venues, such as safe injection facilities, street outreach, and other harm reduction venues.

[The Continued Breastfeeding Experiences of Women Who Suffer From Breast Abscess].

BACKGROUND: Up to 11% of women with mastitis develop a breast abscess, which obviously affects breastfeeding. Therefore, this is a potentially significant issue for women's health. Women with breast abscesses suffer from severe pain. Pain is the most significant factor causing the termination of breastfeeding. The experience of women with breast abscesses who continued to breastfeed may provide valuable insights/guidance to women who are currently in the same or similar situations. PURPOSE: This study explores the continuous breastfeeding experience of women with breast abscesses. METHODS: We collected qualitative data from 10 qualified female participants using 60-90 minute, in-depth interviews that were conducted between April 2012 and June 2012 in a central medical center. All interviews were recorded and transcribed verbatim. Content analysis was used to analyze and categorize the major themes. RESULTS: Results were generalized into the following seven themes: (1) experiencing uncomfortable breast pain; (2) feeling helpless to manage the abnormal breast symptoms; (3) relying on the concept of motherhood to support continued breastfeeding; (4) feeling shocked about the process of diagnosis and treatment; (5) facing the doubts and difficulties regarding continuing to breastfeed; (6) experiencing the assistance of the support system for breastfeeding; (7) returning to a normal pattern of life. CONCLUSIONS/IMPLICATIONS FOR PRACTICE: The findings provide nurses with a deeper understanding of the biological and psychological behaviors and social support system experiences of women with breast abscesses who continue to breastfeed. Study results may serve as a reference for nurses in providing mother-centered breastfeeding care.

Influence of oral mucosal lesions and oral symptoms on oral health related quality of life in dermatological patients: a cross sectional study in Sudan.

BACKGROUND: There are only few studies considering the impact of oral mucosal lesions (OML) on the oral quality of life of patients with different dermatological conditions. This study aimed to assess the relationship between oral health-related quality of life (OHRQoL) and OML and reported oral symptoms, perceived general and oral health condition and caries experience in adult skin diseased patients attending an outpatient dermatologic clinic in Sudan. METHODS: A cross-sectional survey was carried out with 544 diagnosed skin diseased patients (mean age 37.1 years, 50% females), during the period October 2008 to January 2009. The patients were orally examined and OML and caries experience was recorded. The patients were interviewed using the Sudanese Arabic version of the OIDP. OHRQoL was evaluated by socio-demographic and clinical correlates according to number of types of OML diagnosed (no OML, one type of OML, > one type of OML) and number and types of oral symptoms. RESULTS: An oral impact (OIDP > 0) was reported by 190 patients (35.6%) (mean OIDP total score 11.6, sd=6.7). The prevalence of any oral impact was 30.5%, 36.7% and 44.1%, in patients with no OML, one type of OML and more than one type of OML, respectively. Number of types of OML and number and types of oral symptoms were consistently associated with the OIDP scores. Patients who reported bad oral health, patients with ≥ 1 dental attendance, patients with>1 type of OML, and patients with ≥ 1 type of oral symptoms were more likely than their counterparts in the opposite groups to report any OIDP. The odds ratios (OR) were respectively; 2.9 (95% CI 1.9-4.5), 2.3 (95% CI 1.5-3.5), 1.8 (95% CI 1.1-3.2) and 6.7 (95% CI 2.6-17.5). Vesiculobullous and ulcerative lesions of OML disease groups associated statistically significantly with OIDP. CONCLUSION: OIDP was more frequently affected among skin diseased patients with than without OML. The frequency of the impacts differed according to the number of type of OML, oral symptoms, and OML disease groups. Dentists and dermatologists should pay special attention to skin diseased patients because they are likely to experience oral impacts on daily performances.

Sickness behavior in mice deficient in interleukin-6 during turpentine abscess and influenza pneumonitis.

Interleukin-6 (IL-6), among other cytokines, is thought to be involved in the regulation of sickness behavior (e.g., anorexia, cachexia, fever, and lethargy) induced by infections bacterial and viral origin) and sterile tissue necrosis (burns and surgical traumas). Mice deficient in IL-6 (IL-6 KO) were generated by gene targeting. Homozygous IL-6 KO male and female mice and their appropriate controls were implanted with biotelemeters to monitor body temperature (Tb) and motor activity (Act). Normal circadian rhythms in Tb and Act as well as rates of food intake and weight gain did not differ significantly between sex-matched IL-6 KO and control groups at 30 degrees C in a 12:12-h light-dark cycle. Sterile tissue damage was induced in mice by subcutaneous injection of turpentine (0.1 ml, left hindlimb). Influenza pneumonitis was induced by intranasal inoculation of mouse-adapted influenza A virus (17.5 plaque-forming units). Lack of IL-6 completely prevented fever, anorexia, and cachexia because of turpentine abscess in both sexes. It did not prevent lethargy, although IL-6 KO mice recovered to normal Act significantly sooner than wild-type mice. Symptoms of sickness were only slightly modified during influenza virus infection in IL-6 KO mice. Attenuation of sickness behavior was more pronounced in IL-6 KO female than in male mice. We conclude that, although IL-6 is induced during both turpentine abscess and influenza infection, this cytokine appears to be more critical in induction of the symptoms of sickness behavior during sterile tissue abscess than during influenza infection.

[Artificially induced suppurative diseases]. / Iskusstvenno vyzvannye gnoinye zabolevaniia.

128 cases of artificially caused purulent diseases have been analysed. All the cases were masked as chronic septicemia, recurrent abscesses, nonhealing wounds and fever of the unclear origin. The specific features of artificial diseases have been pointed out: social status, occupation, provoking factors, specific clinical signs--multiple hospitalizations, dominating location of postoperative scars and abscesses. Diagnostic principles, including psychological ang psychiatric testing are discussed. The neuro-psychiatric disorders were detected in most cases. Prevention of such diseases is analysed.

Minor procedures in the accident and emergency department: can Entonox help?

The efficacy of Entonox as a supplement to local anaesthesia for minor surgical procedures was studied. Eighty-five patients undergoing surgery for the incision and drainage of a subcutaneous abscess using a local anaesthetic were involved in a trial to ascertain the level of pain associated with such procedures and to investigate the possibility of using on-demand Entonox to supplement the local anaesthesia provided. Patients received either the standard local anaesthesia, or, alternatively, the local anaesthesia was supplemented with oxygen or Entonox via on-demand apparatus. Patients indicated on three linear visual analogue scales their pain, anxiety and total discomfort, and also on a cartoon pain rating scale, at different stages during the operation. Results showed that there was no statistically significant reduction in pain provided by the Entonox, despite general patient approval. Both oxygen and Entonox showed some anxiolytic properties. Pure oxygen was also seen to produce a rise in heart rate, while both gases (pure oxygen and Entonox) caused an increase in diastolic blood pressure. It was also seen that the patient's short term memory of the pain experienced was unaffected by pure oxygen or Entonox.

Telltale mouth flora: a clue to the diagnosis of factitious recurrent thigh abscesses.

A 27-year-old man had recurrent abscesses of the thigh caused by organisms typical of mouth flora. The unusual identity of these organisms from a thigh abscess led to the recognition that the illness was induced by self-injection with saliva, and that the patient had many of the characteristics of Münchausen's syndrome.