The Prevalence of Post-Traumatic Stress Disorder Symptoms in Chronic Pain Patients in a Tertiary Care Setting: A Cross-Sectional Study.

BACKGROUND: There is limited research regarding the prevalence of post-traumatic stress disorder (PTSD) in civilian multidisciplinary pain clinics. Controlled studies have only examined specific patient populations, such as those with motor vehicle accidents, war veterans, work-related injuries, back pain, and headache. OBJECTIVE: The purpose of this study was to estimate the prevalence of PTSD symptoms in patients with chronic pain at a large multidisciplinary pain clinic. METHODS: Three hundred consecutive new or newly referred patients with a self-reported history of chronic pain were recruited to complete an in-person screen for PTSD symptoms, which included the Brief Trauma Questionnaire and the PTSD Symptom-Scale Self-Report. Two hundred and sixty-five were eligible for the study. RESULTS: Seventy-four (28%) screened positive for PTSD symptoms, a value higher than the lifetime prevalence of PTSD in the general population (6.8%). Those who screened positive for PTSD symptoms were significantly younger (p = 0.007) and had higher levels of pain intensity (p = 0.0005) compared to those who screened negative for PTSD symptoms. CONCLUSIONS: The prevalence of PTSD symptoms in our chronic pain population (28%) exceeded the prevalence of PTSD in the general population (7%). Patients with chronic pain who screened positive for PTSD reported higher pain severity and were younger. This emphasizes the need for PTSD screening in the chronic pain population, as early identification and treatment may be effective in reducing the mounting health care costs and disease burden of comorbid chronic pain and PTSD.

Thermal biology mediates responses of amphibians and reptiles to habitat modification.

Human activities often replace native forests with warmer, modified habitats that represent novel thermal environments for biodiversity. Reducing biodiversity loss hinges upon identifying which species are most sensitive to the environmental conditions that result from habitat modification. Drawing on case studies and a meta-analysis, we examined whether observed and modelled thermal traits, including heat tolerances, variation in body temperatures, and evaporative water loss, explained variation in sensitivity of ectotherms to habitat modification. Low heat tolerances of lizards and amphibians and high evaporative water loss of amphibians were associated with increased sensitivity to habitat modification, often explaining more variation than non-thermal traits. Heat tolerances alone explained 24-66% (mean = 38%) of the variation in species responses, and these trends were largely consistent across geographic locations and spatial scales. As habitat modification alters local microclimates, the thermal biology of species will likely play a key role in the reassembly of terrestrial communities.

Miositis necrotizante autoinmune: reporte de caso y revisión de literatura

Introducción: la miositis necrotizante autoinmune es una enfermedad rara en nuestro medio, pero constituye una de las formas de miopatías inflamatorias autoinmunes en un 20 % aproximadamente de casos. Reporte de caso: En este trabajo se presenta el caso de un paciente que se hospitalizo en el servicio de medicina interna el cual tuvo un desenlace favorable luego de su diagnóstico. Conclusión: La miositis necrotizante autoinmune es una miopatía inflamatoria de difícil diagnóstico, pero cada vez más prevalente dentro de las miopatías.

Summary Introduction: autoimmune necrotizing myositis is a rare disease in our environment, but it constitutes one of the forms of autoimmune inflammatory myopathies in approximately 20% of cases. Case report: This paper presents the case of a patient who was hospitalized in the internal medicine service who had a favorable outcome after his diagnosis. Conclusion: Autoimmune necrotizing myositis is an inflammatory myopathy that is difficult to diagnose, but is increasingly prevalent among myopathies.

Quality of monitoring for metabolic effects associated with second generation antipsychotics in patients with schizophrenia on public insurance.

Second generation antipsychotics (SGA) are associated with new onset diabetes, dyslipidemia and significant weight gain. Patients with schizophrenia are also at an increase risk of developing metabolic disorders, making routine metabolic monitoring important in patients with schizophrenia. The objective of our study was to identify glucose and lipid monitoring rates in Kansas Medicaid beneficiaries with schizophrenia who received long-term SGA therapy both before and after metabolic concerns of SGA had been introduced in the medical literature and after publication of metabolic monitoring guidelines from professional organizations in 2004. A retrospective cohort study was conducted using health care claims of Kansas Medicaid enrollees (age 18-64 years) with a diagnosis of schizophrenia and receiving long-term SGA. Proportions of these patients receiving annual blood glucose and serum lipid laboratory tests were calculated for two periods: 2002-2003 and 2005-2007. Bivariate and multivariate analyses were conducted to determine associations between demographic characteristics and monitoring outcomes. Among 2204 persons in the 2002 cohort, 23% received annual blood glucose monitoring and 10.1% received lipid monitoring. Among 1646 persons in the 2006 cohort, 75.3% received blood glucose monitoring and 52.5% received lipid monitoring. Our findings showed significant increases in blood glucose and lipid monitoring rates observed across a 4-year period in Kansas Medicaid enrollees with schizophrenia receiving SGA. The large rise in monitoring over time may be due to increase awareness of metabolic concerns by mental health care specialists, whom patients with schizophrenia are likely to receive their care from.

Pharmacy students' knowledge of black box warnings.

OBJECTIVE: To evaluate the progression of pharmacy students' knowledge of black box warnings across 3 years of didactic training, and to determine how they stay current with new warnings. METHODS: A cross-sectional survey instrument was administered to pharmacy students in their first (P1), second (P2), and third (P3) professional years. The survey assessed student awareness of medications possessing a black box warning and familiarity with the warning content for 20 medications (15 with and 5 without warnings). RESULTS: Mean number of correct responses identifying the presence or absence of a black box warning among the 20 medications were 5.8 +/- 3.3, 9.6 +/- 4.0, and 14.8 +/- 2.8 for the P1, P2, and P3 students, respectively. Knowledge of black box warning content was variable. Students were least aware of the warning content for stavudine and enoxaparin. Students were most familiar with the warning content for paroxetine and estrogen. CONCLUSION: Students' awareness and understanding of black box warnings was proportional to their educational progression, but their knowledge level was inconsistent across drug groups.