Sex, Gender, and Pain: A Review of Recent Clinical and Experimental Findings

One in 7 US children and adolescents is obese, yet little is known about their health-related quality of life (QOL) This study was a cross-sectional study of 106 children and adolescents (57 males) between the ages of 5 and 18 years, who had been referred to an academic children's hospital for evaluation of obesity between January and June 2002 Children and adolescents had a mean (SD) body mass index (BMI) of 347 (93) The main outcome measures were child self-report and parent proxy report using a pediatric QOL inventory generic core scale (range, 0-100) The inventory was administered by an interviewer for children aged 5 through 7 years Scores were compared with previously published scores for healthy children and adolescents and children and adolescents diagnosed as having cancer Compared with healthy children and adolescents, obese children and adolescents reported significantly lower health-related QOL in all domains  Obese children and adolescents were more likely to have impaired health-related QOL than healthy children and adolescents and were similar to children and adolescents diagnosed as having cancer Children and adolescents with obstructive sleep apnea reported a significantly lower health-related QOL total score than obese children and adolescents without obstructive sleep apnea Overall it is clear that physicians, parents, and teachers need to be informed of the risk for impaired health-related QOL among obese children and adolescents to target interventions that could enhance health outcomes

http://web.mit.edu/kilroi/Public/text/jama-obese-children.pdf

Health-related quality of life of severely obese children and adolescents.

This review is a critical summary of research examining gender variations in clinical pain experience. Gender-comparative pain research was identified through Medline and Psychlit searches and references obtained from bibliographies of pertinent papers and books. Review of this research demonstrates that women are more likely than men to experience a variety of recurrent pains. In addition, many women have moderate or severe pains from menstruation, pregnancy and childbirth. In most studies, women report more severe levels of pain, more frequent pain and pain of longer duration than do men. Women may be at greater risk for pain-related disability than men but women also respond more aggressively to pain through health related activities. Women may be more vulnerable than men to unwarranted psychogenic attributions by health care providers for pain. Underlying biological mechanisms of pain and the contribution of psychological and social factors as they contribute to the meaning of pain for women and men warrant greater attention in pain research.

Gender variations in clinical pain experience.

National High Blood Pressure Education Program.

Summary The prevalence of overweight among children has doubled within the past two decades. Increases in the rate of childhood overweight are of particular concern due to the negative health and psychological effects noted among overweight children. As shown by previous research, the development of childhood overweight involves a complex set of factors from multiple contexts that interact with each other to place a child at risk of overweight. This multifaceted system can be conceptualized using Ecological Systems Theory (EST). EST highlights the importance of considering the context(s), or ecological niche, in which a person is located in order to understand the emergence of a particular characteristic. In the case of a child, the ecological niche includes the family and the school, which are in turn embedded in larger social contexts including the community and society at large. In this review, EST is used as a framework with which to summarize research assessing predictors of childhood overweight. Specifically, child characteristics that place children at risk of the development of overweight (including dietary intake, physical activity, and sedentary behaviour) will be reviewed while taking into consideration the influence of the familial environment, the school environment, and the community and larger social environments. It is concluded that future research needs to adopt a broader contextual approach in order to understand and intervene against the processes leading to the development of overweight among children and that the use of theories or paradigms such as EST will facilitate developing and testing models of causal processes.

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Childhood overweight: a contextual model and recommendations for future research

Assessment of children's distress during painful medical procedures.

Cognitive-behavioral and pharmacologic interventions for childrens' distress during painful medical procedures.

Behavioral management of children's distress during painful medical procedures.

The current state-of-the-art in the area of assessing pain and anxiety experienced by children undergoing painful medical procedures remains at a rudimentary level. Early studies in the preparation literature included global Likert-type rating scales of children’s distress and cooperative behaviors (Visintainer & Wolfer, 1975; Wolfer & Visintainer, 1979). More recent studies have focused on the development of more objective and operationalized behavioral observation scales which have been used specifically to measure distress in pediatric cancer patients undergoing bone marrow aspirations (BMAs) and lumbar punctures (LPs) (Jay, in press; Jay & Elliott, 1984; Jay, Ozolins, Elliott, & Caldwell, 1983; Katz, Kellerman, & Siegel, 1980; LeBaron & Zeltzer, 1984). For example, Katz et al. (1980) developed the Procedure Behavior Rating Scale (PBRS) which consisted of 13 operationally defined behaviors that were recorded as present or absent during bone marrow aspirations. The PBRS was found to be a reliable instrument and preliminary validity data (i.e., nurse ratings) were also encouraging. LeBaron and Zeltzer (1984) presented additional validity data on an eight-item version of the PBRS which they labeled the Procedure Behavior Check List.

An Observation Scale for Measuring Children's Distress During Medical Procedures

Summary The psychological and social adjustment of 30 obese children and their families was examined. Mothers completed the Child Behaviour Checklist and the Family Environment Scale; children completed the Self-Perception Profile for Children. The results consistently indicate that the obese children were less socially competent, had more behaviour problems, and had poorer self-perceptions than the non-obese normative samples. Families of obese children differed significantly from families in the non-distressed normative sample in that they interacted in a more negative way. The findings are discussed in terms of an ‘at risk profile’ and the implications for the behavioural treatment of obese children.

Susan M. Jay

Papers

Assessment of children's distress during painful medical procedures.

Cognitive-behavioral and pharmacologic interventions for childrens' distress during painful medical procedures.

Behavioral management of children's distress during painful medical procedures.

An Observation Scale for Measuring Children's Distress During Medical Procedures

Psychological and social adjustment of obese children and their families.