WORK SCHEDULES AND HEALTH IN WOMEN HEALTH PROFESSIONALS
Grant Number: 5R01OH003848-03
PI Name: BARNETT, ROSALIND C.
PI Title:
Project Title: WORK SCHEDULES AND HEALTH IN WOMEN HEALTH PROFESSIONALS

Abstract: Women health-care providers with children at home experience especially heavy distress and are at high risk for such mental health problems as psychological distress and poor marital- and job-role quality and for such stress-related physical health problems as tension headaches. TMJ, hypertension, coronary artery disease (CAD), peptic ulcer disease (PUD) and nonulcer dyspepsia, and fibromyalgia. Alternative career options (e.g., part-time) have been proposed as a means of decreasing distress by increasing flexibility. Whereas such options have already been adopted in such less prestigious health-care occupations as licensed practical nursing, demand for female physicians is prompting the creation of flexible career options in medicine. The aim of the proposed three-year in-depth interview and survey study is to estimate the relationship between full- and part-time work schedules and stress-related mental and physical health outcomes in a random sample of 200 married women ages 25-50 with under-high-school-age children in two-health-care professions that vary in occupational prestige, medicine and licensed practical nursing, and who vary in race/ethnicity. The focus of our proposed study is on one key aspect of flexibility, work scheduling, conceptualized as a complex construct comprising at least two components-- number of work hours (i.e., full-time vs. reduced hours) and work arrangements (e.g., compressed work weeks, weekend or night work, standard work week). We hypothesize that the relationship between work hours and health outcomes varies with work arrangements. We also assess several subjective aspects of work scheduling, including fit, or how well the schedule meets the needs of the health-care professional and her children, spouse, and elderly dependents (if any), and, among reduced-hours workers, the discomfort she experiences over the tradeoff of certain professional activities for more non-work time. These subjective indicators are also thought to mediate or moderate the relationship between work hours and health outcomes. The proposed project addresses four major questions: 1) Are full- time married women with children employed in medicine and licensed practical nursing at higher risk for stress-related mental- and physical-health problems than their reduced-hour counterparts? 2) Do these relationships depend on work arrangements, occupational prestige, race-ethnicity, age, household income, medical setting, number of children at home, elderly dependent care, and, for doctors, area of medical specialization?; 3) Are objective job conditions (e.g., work hours or arrangements) or subjective indicators (e.g., fit, discomfort over tradeoffs) better predictors of stress-related health outcomes; and 4) What are the processes by which schedules affect health outcomes? For example, does the degree to which the health-care professionals are optimizing their work- family preferences (i.e., fit) mediate this relationship?

Thesaurus Terms: health care professional practice, nurse practitioner, occupational health /safety, occupational psychology, physician, women's health age difference, child (0-11), disease /disorder proneness /risk, employment of women, family structure /dynamics, income, marriage /marital status, mother child interaction, outcomes research, population survey, psychological stressor, racial /ethnic difference adult human (19+), behavioral /social science research tag, clinical research, female, health services research tag, human subject, interview

Institution: BRANDEIS UNIVERSITY
Fiscal Year: 2001
Department: NONE
Project Start: 01-JUN-1999
Project End: 31-MAY-2002
ICD: NATIONAL INSTITUTE FOR OCCUPATIONAL SAFETY AND HEALTH
IRG: SOH

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SUBGROUPS OF FMS--SYMPTOMS, BELIEFS & TAILORED TREATMENT
Grant Number: 1R01AR44724-01A1
PI Name: TURK, DENNIS C.
PI Title:
Project Title: SUBGROUPS OF FMS--SYMPTOMS, BELIEFS & TAILORED TREATMENT

Abstract:
Fibromyalgia syndrome (FMS) is a prevalent, chronic musculoskeletal pain disorder. Despite extensive research the etiology and pathophysiologic mechanisms of FMS are not well understood, and no treatment has been shown to be universally effective. In this project, we propose that FMS is a complex disorder involving multiple factors, both physical and psychosocial-behavioral. In our previous research, we have demonstrated that FMS patients are heterogeneous in the psychosocial-behavioral axis and can be classified into 3 distinct subgroups on a basis of their psychosocial adaptation to symptoms. In this application we will extend our previous research and attempt to match treatments to patients psychosocial-behavioral characteristics. Specifically, we will test the efficacy of uniquely tailored treatment for each psychosocial subgroup. Three groups of FMS patients will be treated with one of the 3 treatment protocols with standard physical therapy and varying psychological treatments. A total of 312 FMS patients will undergo a 6 half-day interdisciplinary treatment sessions consisting of physical therapy and psychological treatments. All protocols include a standardized physical therapy but include either cognitive-behavioral pain management therapy, interpersonal skill training, or supportive counseling. In addition to the treatment outcome study, various symptoms of FMS will be assessed prospectively in the patients natural habitats to better understand covariations of FMS symptoms. The repeated daily monitoring using the palm-top computer (ecological momentary assessment) will permit us to evaluate the value of process ratings compared to retrospective reports. Overall, the results of these studies should establish the benefit of matching treatments to subject characteristics, and enhance our understanding of the roles of cognitive-affective-behavioral adaptation of FMS patients.

Thesaurus Terms:
belief, fibromyalgia, human therapy evaluation, physical therapy, psychotherapy, chronic pain, cognition, emotion, group counseling, interpersonal relations, memory, musculoskeletal disorder, outcomes research, patient monitoring device, psychological adaptation, psychological stressor, social adjustment, social psychology, clinical research, data collection methodology /evaluation, human subject

Institution: UNIVERSITY OF WASHINGTON
3935 UNIVERSITY WAY NE
SEATTLE, WA 98195
Fiscal Year: 1998
Department: ANESTHESIOLOGY
Project Start: 20-JUL-98
Project End: 30-JUN-03
ICD: NAT INST OF ARTHRITIS AND MUSCULOSKELETAL AND SKIN DISEASES
IRG: ZRG5

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EFFICACY OF ACUPUNCTURE IN THE TREATMENT OF FIBROMYALGIA
Grant Number: 1R01AT00003-01
PI Name: BUCHWALD, DEDRA S.
PI Title:
Project Title: EFFICACY OF ACUPUNCTURE IN THE TREATMENT OF FIBROMYALGIA

Abstract:
There is no text on file for this abstract.

Thesaurus Terms:
acupressure /acupuncture, fibromyalgia, human therapy evaluation, acetaminophen, clinical trial, fatigue, longitudinal human study, outcomes research, pain threshold, psychological stressor, alternative medicine, clinical research, female, human subject

Institution: UNIVERSITY OF WASHINGTON
3935 UNIVERSITY WAY NE
SEATTLE, WA 98195
Fiscal Year: 1999
Department: MEDICINE
Project Start: 30-SEP-99
Project End: 31-JUL-02
ICD: AGENCY FOR TOXIC SUBSTANCES AND DISEASE REGISTRY
IRG: ZRG7

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FIBROMYALGIA - CENTRAL FACTORS IN ITS ETIOPATHOGENESIS

Grant Number: 5R01AR043136-07
PI Name: BRADLEY, LAURENCE A.
PI Title: PROFESSOR OF CLINICAL IMMUNOLOGY
Project Title: FIBROMYALGIA: CENTRAL FACTORS IN ITS ETIOPATHOGENESIS

Abstract: There is substantial evidence of abnormal pain sensitivity and functional brain activity in patients with fibromyalgia (FM). It has been suggested that FM may be a stress-related disorder, given the evidence of abnormal function of the neuroendocrine axes and the tendency of stress to exacerbate FM symptoms. However, no investigator to date has examined the effects of stress on pain sensitivity or functional brain activity in FM patients and controls. We propose study to test 10 hypotheses derived from our model of abnormal pain perception in FM regarding the effects of stress on pain sensitivity and functional activity in brain structures that process pain. We will assess the effects of noxious thermal stimulation and personally relevant, stressful imagery on pain thresholds and tolerance, magnitude estimates of sensory intensity and unpleasantness, and functional activity of brain structures that process the sensory and affective dimensions of pain. We will perform these evaluation procedures with 120, non- depressed, right-handed women with FM and 60, non-depressed, healthy control women. The patients will be classified in one of two groups according to symptom onset (traumatic vs. insidious). We hypothesize that during noxious thermal stimulation, patients, compared to controls, will (a) produce higher ratings of pain intensity and unpleasantness; and (b) show an abnormal pattern of brain activation characterized by bilateral increases in regional cerebral blood flow (rCBF) in the somatosensory cortices and increases in the ipsilateral anterior cingulate (AC) cortex. We also hypothesize that during exposure to personally relevant, stressful imagery, patients, compared to controls will show (a) smaller increases in salivary cortisol; and (b) greater increases in blood pressure, pulse rate, thermal pain intensity and unpleasantness ratings, and thermal pain-induced change in the contralateral and ipsilateral somatosensory cortices as well as in the ipsilateral AC cortex. This study will allow us to assess the effects of stress on pain perception and functional brain activity in patients with FM independently of the influence of affective disorders. The results will advance our knowledge regarding the effects of stress on abnormal pain sensitivity and the biologic processes that underlie this sensitivity in persons with FM. Thus, the results of the study may eventually lead to improved pharmacologic inteventions that may normalize the central biologic abnormalities that produce painful symptoms in FM.

Thesaurus Terms: brain electrical activity, disease /disorder etiology, fibromyalgia, pain threshold, pathologic process, sensory threshold blood pressure, brain circulation, cingulate gyrus, cortisol, heat stimulus, neuroanatomy, neuroendocrine system, somesthetic sensory cortex, stress clinical research, female, human subject

Institution: UNIVERSITY OF ALABAMA AT BIRMINGHAM
Fiscal Year: 2001
Department: MEDICINE
Project Start: 30-SEP-1994
Project End: 31-MAY-2005
ICD: NATIONAL INSTITUTE OF ARTHRITIS AND MUSCULOSKELETAL AND SKIN DISEASES
IRG: ZRG1

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INHIBITED FUNCTIONAL BRAIN ACTIVITY IN FIBROMYALGIA

Grant Number: 5P60AR020614-240018
PI Name: BRADLEY, LAURENCE A.
PI Title:
Project Title: INHIBITED FUNCTIONAL BRAIN ACTIVITY IN FIBROMYLAGIA

Abstract: We propose two studies with the aim of better understanding the role of inhibited functional brain activity (assessed by regional cerebral blood flow [rCBF]) and abnormal pain perception in the etiopathogenesis of fibromyalgia (FM). To accomplish this aim, we will test six hypotheses based on an etiopathogenetic model of FM developed in our laboratory. Specifically, we wish to determine whether: (a) functional brain activity in the thalamus and caudate nucleus during resting conditions and behavioral indices of pain perception reliably distinguish FM patients from patient with chronic fatigue syndrome (CFS) or major depression and healthy controls; and (b) FM patients differ from the three comparison groups with respect to changes in functional brain activity in the thalamus, caudate nucleus, appropriate somatosensory cortices, and anterior cyngulate gyrus upon exposure to painful dolorimeter stimulation. We will recruit (a) 30 patients with primary FM by American College of Rheumatology (ACR) criteria; (b) 30 patients with CFS by Centers for Disease Control criteria who are pain-free and do not meet ACR criteria for FM; (c) 30 patients with current major depression who are pain-free and do not meet criteria for other current psychiatric diagnoses or criteria for FM or CFS; and (d) 30 healthy controls who are pain-free and do not meet criteria for FM or CFS. Patients will be recruited from appropriate UAB outpatient clinics and controls will be recruited from the Birmingham community. All subjects will be right-handed women. We propose to measure (a) pain thresholds for dolorimeter stimulation of 5 paired ACR tender points as well as behavioral indices of sensory discrimination ability and response bias; (b) rCBF using single photon emission computed tomographic (SPECT) imaging; and (c) responses to questionnaire measures of anxiety, depression, and pain as well as a structured psychiatric interview. The proposed studies represent an advance in the study of FM since they include the use of an experimental manipulation as well as correlational studies to evaluate an etiopathogenetic model of FM. The results also will help us to better understand the mechanisms responsible for inhibited functional brain activity observed in FM patients during resting conditions.

Thesaurus Terms: blood flow, brain circulation, cerebral circulation, fibromyalgia, pain, pathologic process, sensory discrimination chronic fatigue syndrome, major depression, musculoskeletal disorder, pain threshold, rest, sensory mechanism, sensory threshold behavioral /social science research tag, clinical research, functional magnetic resonance imaging, human subject, interview, psychological test, psychometrics, questionnaire, sensory disorder diagnosis, single photon emission computed tomography, statistics /biometry

Institution: UNIVERSITY OF ALABAMA AT BIRMINGHAM
Fiscal Year: 2001
Department:
Project Start:
Project End:
ICD: NATIONAL INSTITUTE OF ARTHRITIS AND MUSCULOSKELETAL AND SKIN DISEASES
IRG:

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HORMONAL RESPONSES TO EXERCISE STRESS TESTING

Grant Number: 5M01RR000334-350549
PI Name: BENNETT, ROBERT M.
PI Title:
Project Title: HORMONAL RESPONSES TO EXERCISE STRESS TESTING

Abstract: This study will address whether patients with fibromyalgia (FM) have a normal endocrine response to the stress of exercise. Subjects will be 12 FM and 12 healthy subjects with low aerobic fitness. Aerobic fitness, growth hormone and cortisol will be measured before and after graded exercise on a treadmill. During a second testing, the same procedures will be used with the addition of pyridostigmine bromide 60 mg (to inhibit somatostatin tone) one hour before treadmill testing.

Thesaurus Terms:
aerobic exercise, endocrine gland /system, fibromyalgia, hormone regulation /control mechanism, physiologic stressor cortisol, drug administration rate /duration, pyridostigmine, somatotropin clinical research, human subject

Institution: OREGON HEALTH SCIENCES UNIVERSITY
Fiscal Year: 2001
Department:
Project Start:
Project End:
ICD: NATIONAL CENTER FOR RESEARCH RESOURCES
IRG:

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COMBINING N OF 1 TRIALS TO ASSESS FIBROMYALGIA THERAPIES
Grant Number: 1R01AR45416-01A1
PI Name: ZUCKER, DEBORAH R.
PI Title:
Project Title: COMBINING N OF 1 TRIALS TO ASSESS FIBROMYALGIA THERAPIES

Abstract:
Fibromyalgia (FM) is a very common rheumatologic condition yet providing an effective treatment for an individual patient remains a challenge. To improve clinical treatment, better understanding of the effectiveness of new drug regimens and the factors effecting patients' responses to these treatments is needed. Anti-depressant medications have been used to treat patients with FM. However, most studies have reported that only about one third of patients show significant improvement with these treatments. A recent study reported that a combination therapy of amitriptyline and fluoxetine (AM + FL) resulted in significantly greater improvement in patients' symptoms as compared with either drug alone. As part of medical practice, physicians and patients often try new, potentially beneficial therapies to assess their effectiveness for the individual. If these studies could be carried out in a scientifically rigorous manner, the collective information could contribute greatly to our understanding of patients' responses to medical treatments. We have developed a method for effectiveness research which uses patient-focused N- of-1 trials and then combines these trials' results to obtain population estimates of treatment effectiveness and to aid in treatment decision-making for an individual patient. This proposal aims to prospectively apply this methodology to compare the effectiveness of the combination therapy AM + FL versus AM alone in the treatment of patients with FM. We propose to carry out N-of-1 trials to compare the effectiveness of AM vs. AM + FL for patients with FM using individual patient (N-of-1) trials. We will analyze the resulting data using the combined N-of-1 methodology to assess overall treatment effectiveness and compare this to results from a prior standard center-based trial. We propose to extend the use of N-of-1 trials into community practices to enable comparison of center-based and practice-based results. Through this broader patient inclusion we will attempt to identify potential patient characteristics which may affect treatment response variation. The results and feedback from both patients and physicians participating in this study will help to develop a framework that will allow transportability of this approach to effectiveness research to the study of other diagnoses and treatments.

Thesaurus Terms:
amitriptyline, antiarthritic agent, arthritis therapy, combination chemotherapy, fibromyalgia, fluoxetine, human therapy evaluation, clinical trial, data collection methodology /evaluation, health care professional practice, longitudinal human study, medical education, outcomes research, patient care management, clinical research, human subject

Institution: NEW ENGLAND MEDICAL CENTER HOSPITALS
750 WASHINGTON ST
BOSTON, MA 02111
Fiscal Year: 1999
Department:
Project Start: 09-SEP-99
Project End: 31-AUG-02
ICD: NAT INST OF ARTHRITIS AND MUSCULOSKELETAL AND SKIN DISEASES
IRG: ZAR1

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PATHOGENESIS OF LYME INDUCED FIBROMYALGIA SYNDROME
Grant Number: 7R01AR43135-04
PI Name: WEINSTEIN, ARTHUR
PI Title:
Project Title: PATHOGENESIS OF LYME INDUCED FIBROMYALGIA SYNDROME

Abstract:
This application proposes to study the pathogenesis of a post Lyme disease syndrome (PLS) which is characterized by chronic musculoskeletal pain, fatigue-and disordered cognition, resembling fibromyalgia (FM). The paradigm of an infection-induced FM syndrome offers the major advantage of conducting prospective studies from disease onset and determining host, infectious or immunologic factors that lead to the development of the condition. This will be a prospective as well as a cross-sectional study. In the prospective arm, l00 patients with the constitutional features of early Lyme disease will have genetic analysis(HLA typing); psychological and neurocognitive testing; SPECT brain scanning; blood and spinal fluid cultures and PCR analysis for Borrelia burgdorferi, and measurement of anti-Borrelial antibodies, anti-Borrelial containing immune complexes and lL-6 and lL-6 complexes. Somatomedin, a growth hormone-related peptide found to be low in FM serum, will also be measured. These patients will be followed after treatment, clinically for the development of PLS and FM and will undergo repeat SPECT scanning, psychological and neurocognitive testing, and blood testing every 8-12 months for 2 more times. In this way, it can be determined if host genetic and psychological factors play a role in predisposition to PLS and FM. Also, the role of B. burgdorferi and the immunological response to it in the development of PLS can be assessed. It may also be possible to correlate changes in cerebral blood flow by SPECT scanning to neurocognitive abnormalities and relate these to infectious or immunological central nervous system injury. In the cross sectional analysis, 25 PLS patients will be compared to age, gender and education matched controls. The control groups are 25 recovered Lyme disease patients, 25 spontaneous FM patients and 25 normal spouse controls. PLS patients and controls will be evaluated using all the above clinical, psychological, neurocognitive, imaging and serological tests. This will relate the abnormal findings in PLS to those in FM and should provide us with insights into the pathogenesis of FM

Thesaurus Terms:
Lyme disease, fibromyalgia, medical complication, pathologic process age difference, antiantibody, antibacterial antibody, bacterial antigen, cognition disorder, fatigue, gender difference, immune complex, interleukin 6, nervous system infection, pain, Borrelia, blood chemistry, brain scanning, enzyme linked immunosorbent assay, histocompatibility typing, human subject, neuropsychological test, polymerase chain reaction, serology /serodiagnosis, single photon emission computed tomography, western blotting

Institution: GEORGE WASHINGTON UNIVERSITY
2121 I ST NW
WASHINGTON, DC 20052
Fiscal Year: 1996
Department: MEDICINE
Project Start: 25-SEP-94
Project End: 30-JUN-99
ICD: NAT INST OF ARTHRITIS AND MUSCULOSKELETAL AND SKIN DISEASES
IRG: AMS

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