Objectives: Chronic pain is associated with substantial direct and indirect costs in adulthood. Chronic pain problems are also common in childhood, but little is known about the costs of pédiatrie chronic pain and its treatment. The objectives of this study were to examine and describe healthcare utilization and indirect burden among pédiatrie chronic pain patients and their families.Methods: Participants were parents of 75 pédiatrie patients with daily or almost daily pain for at least three months, seen at a multidisciplinary pédiatrie pain outpatient elinie. Information about healtheare use and indireet familial burden was obtained during a semi-structured interview at the patients' first visit to the pain clinic. A financial analyst extracted cost data regarding hospital 155 156 JOURNAL OF MUSCULOSKELETAL PAIN charges. To assess change over time, the same information was gathered from parents and the hospital financial analyst six months after their initial visit.Results: Parents reported numerous healthcare visits related to their child's pain condition [e.g., visits to specialists, physical therapy visits], high financial costs [e.g., charges for outpatient visits], and substantial indirect burden [e.g., time spent in medical appointments and missed workdays]. Parents reported lower healthcare utilization and decreased burden on families at the six-month follow-up assessment.Conclusions: Our results suggest that pédiatrie chronic pain is associated with considerable direct financial costs and indirect familial costs. Preliminary evidence suggests that involvement in a multidisciplinary program may be associated with decreased health care use and indirect burden.
The incidence of cervical cancer is high among Southeast Asian American women, but their participation in preventive cervical cancer screening is alarmingly low. This paper reviews the literature on factors associated with participation in cervical cancer screening among women of Vietnamese, Cambodian and Hmong descent in the United States. These factors include acculturation, age, marital status, knowledge about cervical cancer, apprehension about cervical cancer screening, financial concerns, access to health care, and physician characteristics and recommendation. Suggestions for future research include the need to investigate the role of physicians treating Southeast Asian American women, the need for more extensive up-to-date studies on the current generation of young Southeast Asian American women, and the use of more advanced assessments of acculturation. Overall, much more work is needed in order to deepen our understanding of the various ways to improve the rate of cervical cancer screening among Southeast Asian American women.
Fibromyalgia is a stress-related disorder characterized by chronic pain, memory impairment, and neuroendocrine aberrations. With the hypothesis that biological and psychological symptoms may underlie the cognitive problems, the relative influences of neuroendocrine function and psychological factors on declarative memory were examined among 50 women with fibromyalgia. This within-group analysis controlled for age, education, pain, and relevant medications. Neuroendocrine function and depression had significant independent associations with memory function. Higher log-transformed mean salivary cortisol levels were associated with better performance on both immediate and delayed visual recall and with delayed verbal recall. Depressive symptoms were negatively associated with verbal recall. These findings suggest that a basic disorder of endocrine stress responses may contribute to the cognitive symptoms experienced by fibromyalgia patients.
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