Jeffrey E. Holm

A multi-center evaluation of the McGill Pain Questionnaire: results from more than 1700 chronic pain patients

&NA; We argue that the conflicting results reported in previous studies examining the factor structure of the McGill Pain Questionnaire Pain Rating Index (PRI) can be explained by differences in the patient samples and statistical analyses used across studies. In an effort to clarify the factor structure of the PRI, 3 different factor models were compared using confirmatory factor analysis in 2 samples of low‐back pain patients (N = 1372) and in a third sample of patients suffering from other chronic pain problems (N = 423). A 4‐factor model, similar to those obtained in previous studies where multiple criteria were used to determine the number of factors extracted, best explained covariation among PRI subclasses. However, relatively high interfactor correlations (approximately two‐thirds of the variance explained by the best fitting factor structure was common variance) cast doubt on the discriminant validity of PRI subscales; examination of relationships between the PRI and MMPI subscales also failed to provide evidence of the discriminant validity or clinical utility of PRI subscales. Reducing the information from the 10 PRI sensory subclasses to a single subscale score may seriously limit the usefulness of the PRI. Alternate methods of using PRI data are suggested.

The Role of Stress in Recurrent Tension Headache

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Migraine and stress : A daily examination of temporal relationships in women migraineurs

This study examined daily temporal relationships between stress, cognitive appraisal, coping, and migraine in a group of young women migraineurs sampled from a general population. Participants (N=20) meeting International Headache Society 1 criteria for migraine with or migraine without aura provided headache activity, perceived stress, cognitive appraisal, and coping strategy data across 2 months of data collection. A time‐series analytic approach was used to cross‐correlate daily stress, appraisal, and coping data with daily headache data controlling for factors that can inflate correlations in data collected across time. Analyses revealed that between 50% and 70% of subjects showed significant, substantial, and meaningful temporal correlations between their daily stress and their daily migraine activity. Furthermore, these data support the hypothesis that stress and migraine are reciprocally related (ie, cyclically influencing each other across time). In addition, despite some measurement concerns, our data suggest that cognitive appraisal and coping are also related to migraine activity in a reciprocal fashion.

Behavioral assessment of relaxation: The validity of a Behavioral Rating Scale

Poppen (Behavior Relaxation Training and Assessment, 1988) has developed an observational method of assessing the degree to which individuals show a relaxation response. Although promising, this method, the Behavioral Rating Scale (BRS), has yet to be thoroughly investigated. Subjects in this study were randomly assigned to a progressive relaxation training group or an attention-control group. Following a training period, subjects participated in a laboratory session in which self-report measures of relaxation were obtained, physiological measures were monitored, and behavioral observations were made using the BRS. Results supported the use of the BRS as a valid, observable measure of an individuals relaxation response. Discriminant validity was demonstrated by between-group differences on the BRS and construct validity was shown by significant correlations between changes on the BRS and changes on self-report and physiological measures. It is argued that, though alternative explanations are feasible, this studys results support the use of the BRS as an effective assessment tool when measuring an individuals response to progressive muscle relaxation.

Attitudes, knowledge, and intentions related to breastfeeding among university undergraduate women and men.

The purpose of the current study was to examine university undergraduate womens and mens attitudes and knowledge toward breastfeeding. Data were gathered for 111 women and 50 men. Data showed a significant relationship between positive attitudes toward breastfeeding and exposure to breastfeeding. Women and participants older than 20 years scored higher on measures of knowledge and attitudes. Results indicated that positive attitude toward breastfeeding was a significant predictor of intention to breastfeed among women and men. In conclusion, the results suggest that understanding attitudes among young adults is an important line of research. Further studies are needed to develop and evaluate interventions aimed at improving attitudes about breastfeeding and increasing initiation of breastfeeding among this population. J Hum Lact. 24(2):186-192. El propósito de este estudio fue examinar actitudes y conocimientos sobre lactancia materna de las mujeres y hombres cursando estudios universitarios. Los datos se tomaron de 111 mujeres y 50 hombres. Los datos mostraron una relación significativa entre las actitudes positivas hacia la lactancia materna y exposición a lactancia materna. Las mujeres y participantes mayores de 20 años tenían puntajes más altos en la medición de conocimiento y actitudes. Los resultados indican que una actitud positiva hacia la lactancia materna fue un factor significativo precursor de la intención de lactancia materna entre hombres y mujeres. En conclusión, los resultados sugieren que el entendimiento de las actitudes de los adultos jóvenes es un área importante de investigación. Se necesitan más estudios para desarrollar y evaluar intervenciones dirigidas a mejorar las actitudes sobre lactancia materna e incrementar la iniciación de la lactancia materna en esta población.

Assessing Health Status, Behavioral Risks, and Health Disparities in American Indians Living on the Northern Plains of the U.S.

Objective. We assessed health status and behavioral risks in American Indians (AIs) from rural, northern plains reservation communities. Methods. AI interviewers from the communities administered the core and optional modules of the Behavioral Risk Factor Surveillance System (BRFSS) to 404 AI adults randomly selected from housing lists from four AI tribal communities located on the northern plains of the U.S. The BRFSS interview assessed several health functioning areas including medical conditions, preventive screenings, and behavioral risks. We measured health disparities by comparing the AI sample data with a northern plains statewide (North Dakota) sample and a U.S. national sample. We compared outcomes with BRFSS statewide (North Dakota) and U.S. national data from telephone-based interviews. Results. AI participants showed a significantly greater prevalence of diabetes, coronary heart disease, myocardial infarction, smoking, obesity, and heavy alcohol use than either the regional or national samples. They also reported being less likely to engage in leisure-time physical activity and to have had age-appropriate preventive screenings for several diseases including colorectal cancer, prostate cancer, breast cancer, and cardiovascular disease. Conclusions. Face-to-face interviews conducted by AI community members are an effective means of gathering health information about AIs living in rural, reservation communities. AIs living in these communities on the northern plains have a much higher prevalence of many health-risk behaviors and some medical conditions than are found in the general population. Improved health-care access, better preventive screenings, and culturally appropriate community-based health promotion programs and policies should be examined as possible ways to reduce health disparities.

The role of family structure, functioning, and pain modeling in headache.

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Correlates of Overweight and Obesity in American Indian Children

OBJECTIVE To identify risk factors that may contribute to the development and/or maintenance of overweight and obesity in American Indian children. METHODS The sample consisted of 291 tribally enrolled American Indian children. Body mass index (BMI) was measured by a tribal program and children completed self-report measures during health class. Hierarchical multiple regression analyses were conducted for 232 children and included three blocks of predictor variables (diet and physical activity, weight-related attitudes, and psychosocial variables). RESULTS Thirty-three percent of children were obese and 20% were overweight. Diet and physical activity (7.6%) and weight-related attitudes (31.9%) made significant contributions, explaining 39.5% of the variance in BMI. CONCLUSIONS Greater BMI scores were related to healthier food choice intentions, more hours of television viewing, greater body dissatisfaction, higher negative attitudes toward body size, and more weight loss attempts.

Carbohydrate antigens in nipple aspirate fluid predict the presence of atypia and cancer in women requiring diagnostic breast biopsy

BackgroundThe goal of this prospective study was to determine (a) concentrations of the carbohydrate biomarkers Thomsen Friedenreich (TF) antigen and its precursor, Tn antigen, in nipple discharge (ND) collected from women requiring biopsy because of a suspicious breast lesion; and (b) if concentration levels predicted pathologic diagnosis.MethodsAdult women requiring biopsy to exclude breast cancer were enrolled and ND obtained. The samples from 124 women were analyzed using an anti-TF and anti-Tn monoclonal antibodies in direct immunoassay.ResultsThe highest median concentration in ND for TF and Tn was in women with ductal carcinoma in situ (DCIS). TF was higher in women with 1) cancer (DCIS or invasive) vs. either no cancer (atypia or benign pathology, p = .048), or benign pathology (p = .018); and 2) abnormal (atypia or cancer) versus benign pathology (p = .016); and was more predictive of atypia or cancer in post- compared to premenopausal women. Tn was not predictive of disease. High TF concentration and age were independent predictors of disease, correctly classifying either cancer or abnormal vs. benign pathology 83% of the time in postmenopausal women.ConclusionsTF concentrations in ND were higher in women with precancer and cancer compared to women with benign disease, and TF was an independent predictor of breast atypia and cancer. TF may prove useful in early breast cancer detection.

The Influence of Pain State on Physiological Reactivity of Tension Headache Sufferers

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