Obesity impedes functional improvement in youth with chronic pain: An initial investigation.

BACKGROUND: Youth with chronic pain are at higher risk for obesity than the general population. In youth with chronic pain, obesity exacerbates pain-specific activity limitations, and in adults with chronic pain, obesity perpetuates a cycle of disability. The current study examined whether weight status predicts functional disability outcomes over time in youth with chronic pain. METHODS: Data were obtained from a retrospective chart review of patients who consented to participate in a longitudinal outcomes study. The Child Activity Limitations Questionnaire was used to assess functional disability at intake, 1-, and 3-month follow-up. Height and weight were measured at intake. A linear mixed model was used to test whether weight status and time predicted functional disability. Trend analysis with polynomial contrasts was used to test whether improvements in functional disability showed a linear trend over time. RESULTS: The linear mixed model analysis showed a main effect of weight, suggesting that youth with higher BMI demonstrated less improvement in functional disability over time. The trend analysis suggested that improvements in functional disability were consistent with a linear trend for both healthy weight and overweight participants, but not for obese participants. CONCLUSION: These findings demonstrate that obesity impedes improvement in functioning for youth with chronic pain. Despite multidisciplinary pain treatment, youth with comorbid chronic pain and obesity demonstrate greater functional disability at follow-up and little improvement over time. These results support the need for interventions specifically tailored to the unique challenges faced by youth with comorbid chronic pain and obesity. SIGNIFICANCE: This study shows that obesity impedes improvement in functioning for youth with chronic pain. On the basis of these findings, interventions should be tailored to the unique challenges of this population.

Carcinoid metastasis to extraocular muscles: case reports and review of the literature.

Carcinoid tumors are slow growing, low-grade malignant neoplasms that are believed to originate from neuroendocrine cells, usually in the gastrointestinal mucosa. Metastasis of carcinoid tumor to the orbit is a rare occurrence. When metastasis does occur, the choroid is the most common ocular structure involved. We report two cases of unique involvement of extraocular muscles.

Spectral restoration of speech: intelligibility is increased by inserting noise in spectral gaps.

In order to function effectively as a means of communication, speech must be intelligible under the noisy conditions encountered in everyday life. Two types of perceptual synthesis have been reported that can reduce or cancel the effects of masking by extraneous sounds: Phonemic restoration can enhance intelligibility when segments are replaced or masked by noise, and contralateral induction can prevent mislateralization by effectively restoring speech masked at one ear when it is heard in the other. The present study reports a third type of perceptual synthesis induced by noise: enhancement of intelligibility produced by adding noise to spectral gaps. In most of the experiments, the speech stimuli consisted of two widely separated narrow bands of speech (center frequencies of 370 and 6,000 Hz, each band having high-pass and low-pass slopes of 115 dB/octave meeting at the center frequency). These very narrow bands effectively reduced the available information to frequency-limited patterns of amplitude fluctuation lacking information concerning formant structure and frequency transitions. When stochastic noise was introduced into the gap separating the two speech bands, intelligibility increased for "everyday" sentences, for sentences that varied in the transitional probability of keywords, and for monosyllabic word lists. Effects produced by systematically varying noise amplitude and noise bandwidth are reported, and the implications of some of the novel effects observed are discussed.