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Malvin N Janal

Publications and source records attributed to Malvin N Janal.

17 recordsLinked to original sources
PubMed2006

Psychiatric comorbidities in a community sample of women with fibromyalgia.

Prior studies of careseeking fibromyalgia (FM) patients often report that they have an elevated risk of psychiatric disorders, but biased sampling may distort true risk. The current investigation utilizes state-of-the-art diagnostic procedures for both FM and psychiatric disorders to estimate prevalence rates of FM and the comorbidity of FM and specific psychiatric disorders in a diverse community sample of women. Participants were screened by telephone for FM and MDD, by randomly selecting telephone numbers from a list of households with women in the NY/NJ metropolitan area. Eligible women were invited to complete physical examinations for FM and clinician-administered psychiatric interviews. Data were weighted to adjust for sampling procedures and population demographics. The estimated overall prevalence of FM among women in the NY/NJ metropolitan area was 3.7% (95% CI=3.2, 4.4), with higher rates among racial minorities. Although risk of current MDD was nearly 3-fold higher in community women with than without FM, the groups had similar risk of lifetime MDD. Risk of lifetime anxiety disorders, particularly obsessive compulsive disorder and post-traumatic stress disorder, was approximately 5-fold higher among women with FM. Overall, this study found a community prevalence for FM among women that replicates prior North American studies, and revealed that FM may be even more prevalent among racial minority women. These community-based data also indicate that the relationship between MDD and FM may be more complicated than previously thought, and call for an increased focus on anxiety disorders in FM.

Chi-Square Distribution↗
PubMed2006

Sub-typing CFS patients on the basis of 'minor' symptoms.

The diagnosis of chronic fatigue syndrome (CFS), an illness characterized by medically unexplained fatigue, depends on a clinical case definition representing one or more pathophysiological mechanisms. To prepare for studies of these mechanisms, this study sought to identify subtypes of CFS. In 161 women meeting 1994 criteria for CFS, principal components analysis of the 10 'minor' symptoms of CFS produced three factors interpreted to indicate musculoskeletal, infectious and neurological subtypes. Extreme scores on one or more of these factors characterized about 2/3 of the sample. Those characterized by the neurological factor were at increased risk of reduced scores on cognitive tests requiring attention, working memory, long-term memory or rapid performance. In addition, the neurological subtype was associated with reduced levels of function. Those characterized by the musculoskeletal factor were at increased risk for the diagnosis of fibromyalgia (chronic widespread pain and mechanical allodynia) and reduced physical function. Those characterized by the infectious factor were less likely to evidence co-occurring fibromyalgia, and showed lesser risk of functional impairment. The prevalence of disability was increased in those with the highest scores on any of the subtypes, as well as in those with high scores on multiple factors. Depression and anxiety, while frequently present, were not more prevalent in any particular subtype, and did not increase with the severity of specific symptom reports. Results suggest that subtypes of CFS may be identified from reports of the minor diagnostic symptoms, and that these subtypes demonstrate construct validity.

Adult↗
PubMed2006

Outcome assessment of inferior alveolar nerve microsurgery: a retrospective review.

PURPOSE: This retrospective study was performed to assess the clinical outcome of patients who have undergone trigeminal nerve microsurgical repair of the inferior alveolar nerve. MATERIALS AND METHODS: This study includes all patients who underwent microsurgical repair of the inferior alveolar nerve at the University of Medicine and Dentistry of New Jersey from July 1, 1998 through June 30, 2003. Each patient underwent a thorough evaluation of sensory nerve function that included the type of injury, date of injury, and neurosensory testing. The evaluation was performed pre- and postoperatively to assess sensory improvement. Through chart review and quantitative statistical analysis, the outcome of inferior alveolar nerve microsurgical repair was assessed to ascertain which sensory variables were statistically significant in showing improvement from microsurgical procedures. RESULTS: Thirty-two patients underwent microsurgical repair of their inferior alveolar nerve injury by the same surgeon. The average period of time from initial nerve injury until primary surgical repair was 6.6 months. Four patients did not follow-up postoperatively and were excluded from the final data. Of the remaining 28 patients, mean follow-up period was 9.5 months. It was determined that 26 patients (92.9%) had statistically significant neurosensory improvement, with 14 reporting (50%) significant improvement, 12 patients (42.9%) with slight improvement, and 2 patients (7.1%) demonstrating no improvement. No statistical evidence was found to support that a decrease in time from injury to surgery had improved results in this limited patient population. CONCLUSION: Microsurgical repair provides an improvement in neurosensory function in patients that present with an inferior alveolar nerve injury.

Adolescent↗
PubMed2006

Oral health promotion among older persons and their care providers in a nursing home facility.

OBJECTIVES: To assess oral health status and oral health-related quality of life (OHRQoL) of residents in an extended care facility and to assess the care providers' oral health attitudes and knowledge. METHODS: Participants included 137 residents (58.1% female, age range 32-94 years, 91% African-American) and 22 care providers. Residents received an oral examination and completed the Oral Health Impact Profile (OHIP-14), an OHRQoL questionnaire. Care providers completed an oral health knowledge (OHK) questionnaire before and after the on-site geriatric oral health education and training programme. RESULTS: Oral examinations showed that 58% of the residents had extensive oral health needs. On the OHIP-14, the mean severity was 9.2 (SD=12.0), extent (number of items rated as 'fairly often' or 'often') was 1.2 (SD=2.6) and prevalence (participants rating at least one item at least 'fairly often') was 37.8%. Most prevalent negative impact items were about 'oral pain', 'appearance' and 'self-consciousness'. Regarding OHK, caregivers' knowledge improved following instruction from 65% correct on the pre-test to 90% correct on the post-test (p<0.05). Subsequent to the eight in-service workshops, providers reported that physical limitations, fear of getting bitten and time constraints were barriers to providing oral hygiene to their residents. CONCLUSION: Examination data showed a high level of dental needs among the majority of residents, accompanied by significantly reduced OHRQoL. Although care providers' OHK improved following the geriatric service programme, they reported specific barriers regarding their provision of oral hygiene care to the residents.

Adult↗
PubMed2006

Oral health, related behaviors and oral health impacts among homeless adults.

OBJECTIVE: To assess the oral health needs, related behavior and oral health impact among homeless persons in Newark, New Jersey. METHODS: Participants represented a convenience sample of adults (n=46) participating in Homeless Services Day, an annual event sponsored by the Homeless Services Division of the Newark, NJ Department of Health and Human Services. Their mean age was 40.4 yr (SD=10.0), and 51.1% were female. The majority (76%) reported African-American ethnicity; remaining participants self-identified as Hispanic, White or Asian. Participants reported being homeless for a median of 11 months, with a range of 1 to 108 months. RESULTS: The 46 participants had 745 teeth (averaged 16.2 per person) that were either missing, had fillings or had untreated decay. Diseased teeth averaged 3.8 per person; missing teeth averaged 8.6 per person; and filled teeth averaged 3.7 per person. Only 28.3% had a dental visit in the past year. Approximately 87% reported negative oral health impacts impact: over half (55.6%) had current oral facial pain and two-thirds of our participants reported having dental-related face pain during the past year. Additional oral health impacts included: eating (42%), smiling (33%), concentrating (18%) and talking (16%). CONCLUSIONS: Consistent with other studies, this homeless sample presented with considerable oral health needs. Newark's homeless, like other homeless cohorts, face access to care and negative oral health impacts. This study informs the need for future research that can provide substantive evidence for care providers and policy makers.

Adult↗
PubMed2005

Long-term outcome assessment for lingual nerve microsurgery.

OBJECTIVE: A retrospective study was undertaken to investigate the clinical outcomes resulting from the microsurgical repair of lingual nerve injuries. The study was based on patient chart review. PATIENTS AND METHODS: A total of 20 patients referred to the principal investigator (V.B.Z.), with a diagnosis of lingual nerve injury who underwent trigeminal nerve microsurgery during a 3-year period (1999 to 2002), were entered in this study. All patients received a complete history and physical examination, and thorough preoperative and postoperative neurosensory testing to evaluate clinical response to hot, cold, cotton wisp, vibration, 2-point discrimination, directional stroke, and fine touch as determined by Von-Frey filaments. RESULTS: All patients underwent an external neurolysis procedure in combination with an internal neurolysis, neuroma excision, or primary neurorrhaphy under microscopic guidance depending on the intraoperative findings. The average time from injury to surgery was 8 months. The patients were followed for an average of 9 months after surgery, and assessment was based on the patients subjective experience as well as standardized neurosensory testing. Eighteen patients (90%) had some improvement in neurosensory function and 2 patients (10%) reported no improvement. One of the patients exhibiting no clinical improvement had a prolonged delay in seeking treatment, and the distal nerve could not be localized intraoperatively. Most patients were operated on between 2.5 and 7 months after injury, and there was no statistical difference in outcome as a function of the time from injury to repair in this group of patients. This subgroup of responding patients averaged at least 50% improvement in neurosensory function. CONCLUSION: Microsurgical repair of lingual nerves provides moderate to significant improvements in clinical sensory function and is a useful option in treating affected individuals, especially when implemented soon after injury.

Adolescent↗
PubMed2005

Removing carious dentin using a polymer instrument without anesthesia versus a carbide bur with anesthesia.

BACKGROUND: The authors describe a new rotary polymer instrument that selectively removes infected dentin. This instrument has the potential to prepare selected cavities without the need for local anesthesia (LA). Patient acceptance has not been investigated in a clinical trial. METHODS: In this open-label clinical study, the authors enrolled 20 subjects with two Class I carious lesions and randomly assigned them to receive one restoration with the polymer instrument and no LA and the second restoration with a carbide bur and LA. Both procedures were completed in one appointment. Subjects completed dental history, dental anxiety and situational pain questionnaires. At specific points during the procedure, subjects rated their perception of the intensity of cold, heat, pain, pressure, vibration, fear and anxiety. On completion of the restorative procedures and at 48-hour and one-week telephone contacts, subjects indicated which procedure they preferred. RESULTS: During treatment with the polymer instrument, subjects indicated that they experienced slightly more pain, pressure, vibration and anxiety, but not more heat, cold or fear. Immediately after the procedure, 14 (70 percent) of 20 respondents (binomial test; P = .11) said that they would prefer having no LA and use of the polymer instrument for future dental work. The number of subjects indicating this preference increased to 15 (P < .05) at both the 48-hour and one-week contacts. One subject requested rescue LA during the polymer instrument treatment. CONCLUSIONS: A significant number of subjects preferred the rotary polymer instrumentation with no LA to the carbide bur instrumentation with LA. They held this preference despite experiencing slightly, but reliably, more pain and pressure when treated with the polymer instrument. CLINICAL IMPLICATIONS: A polymer (bur-like) rotary instrument with cutting ability limited to infected dentin can be used in Class I cavity preparations without the need for LA.

Adult↗
PubMed2004

Familial aggregation of depression in fibromyalgia: a community-based test of alternate hypotheses.

Numerous studies report that fibromyalgia (FM), a syndrome characterized by widespread pain and generalized tender points, is comorbid with major depressive disorder (MDD). The current study tests two alternate explanations for their comorbidity using a family study methodology. The first is that FM is a depression spectrum disorder. The second is that depression is a consequence of living with FM. We recruited potential probands by initially screening by telephone for FM and MDD among women in the NY/NJ metropolitan area, randomly selecting telephone numbers from a list of households with women. Eligible women were invited for second stage physical examinations for FM diagnosis and psychiatric interviews for MDD diagnosis. All available adult, first-degree relatives received psychiatric interviews. Relatives of probands were divided into four groups on the basis of the probands' FM and MDD diagnoses (FM+/MDD+ (n = 156), FM+/MDD- (n = 51), FM-/MDD+ (n = 351) and FM-/MDD- (n = 101)). Results indicated that rates of MDD in the relatives of probands with FM but without personal histories of MDD were virtually identical to rates of MDD in relatives of probands with MDD themselves. This outcome is consistent with the hypothesis that FM is a depression spectrum disorder, in which FM and MDD are characterized by shared, familially mediated risk factors. The implications of these findings for a stress-vulnerability model of FM are discussed.

Adolescent↗
PubMed2004

Comorbidity of fibromyalgia and posttraumatic stress disorder symptoms in a community sample of women.

OBJECTIVE: To test alternative explanations for the comorbidity between fibromyalgia (FM), a medically unexplained syndrome involving widespread pain, and posttraumatic stress disorder (PTSD). In contrast to a default "risk factor" hypothesis, tested hypotheses were that: A) The association is due to a sampling bias introduced by the study of care-seeking individuals; B) FM is an additive burden that strains coping resources when confronting life stress; and C) Arousal symptoms of PTSD and FM are confounded. DESIGN: Community-dwelling women in the New York/New Jersey metropolitan area (N=1,312) completed a telephone survey regarding FM-like symptoms prior to September 11, 2001. Approximately 6 months after the World Trade Center terrorist attacks, they again completed the survey, to which questions regarding PTSD symptoms were added. RESULTS: The odds of probable PTSD were more than three times greater in women with FM-like symptoms, both assessed after 9/11. The odds ratio was not reduced by controlling for FM-like symptoms before 9/11 or for the potentially confounded symptoms of PTSD specifically related to arousal. CONCLUSIONS: These findings lead us to reject alternate explanations for the comorbidity between FM and PTSD. Speculations that FM and PTSD share psychobiological risk factors remain plausible.

Adult↗
PubMed2002

A community-based survey of fibromyalgia-like pain complaints following the World Trade Center terrorist attacks.

A purported pathogenic mechanism for the development of fibromyalgia, a medically unexplained syndrome involving widespread pain, is stress and associated psychiatric disorder. The major stressor of recent World Trade Center terrorist attacks provides a natural experiment for evaluating this mechanism. This study sought to determine whether symptoms consistent with fibromyalgia increased post-September 11 and whether exposure to specific terrorism-related events or prior depression predicted symptom increase. In a large community sample of women in the New York/New Jersey metropolitan area (n=1,312), a cohort initially surveyed for pain and psychiatric symptoms before September 11th were recontacted approximately 6 months after the attacks to assess current symptoms and specific terrorism-related exposures. 'Fibromyalgia-like' (FM-L) four-quadrant pain reports consistent with a diagnosis of fibromyalgia were compared at baseline and follow-up. Result showed that FM-L rates did not increase significantly between baseline and post-attack follow-up. Event exposure did not relate to FM-L onset at follow-up, nor did depressive symptoms at baseline interact with event exposure. Depressive symptoms did not predict new onsets better than the extent of their comorbidity with FM-L at baseline. The failure to detect a significant increase in symptoms consistent with a diagnosis of fibromyalgia and the failure of new onsets of such symptoms to be accounted for by exposure to major stressors or prior depressive symptoms suggests that these hypothesized risk factors are unlikely to be of major importance in the pathogenesis of fibromyalgia.

Adult↗
PubMed1996

Concerning the homology of painful experiences and pain descriptors: a multidimensional scaling analysis.

How is the sensory (or other) experience of pain related to the words used to describe such experiences? Answering this question would not only improve our general understanding of the relationship between the experience of pain and the report of pain, but also would allow one to quantify inaccuracies or idiosyncracies in this regard. A continuous multidimensional scaling model was used to examine the similarity between noxious electrocutaneous stimuli and the words used to describe them. If these two types of stimulus objects were homologous, one would expect that physical and verbal stimuli with the same meaning would be scaled with similar values along a single dimension; if not, the two types of stimuli would be scaled at opposite poles of a dimension which distinguished between them. Twenty-five subjects rated the similarity of all pairs of 16 stimulus objects: 8 electrocutaneous stimuli (3-235 mW) and 8 verbal descriptors of such stimulation (from Slight Sensation to Severe Pain). A single dimension in the group stimulus space scaled both physical and verbal stimulus objects from least to greatest intensity. Since this (or any higher) dimension failed to segregate verbal from physical stimuli, the words appear to be homologous with experience. While conclusions are limited to these specific stimuli, results suggest that the INDSCAL model offers a valuable method for exploring the relationship between pain report and pain experience.

Adolescent↗
PubMed1996

Pain sensitivity in silent myocardial ischemia.

Although the cause of silent myocardial ischemia (SMI) is unknown, several theories have been advanced to explain the disorder. Most prominent among these are the suggestions that attribute the condition to generalized impaired pain sensitivity and/or enhanced endorphin activity. The present study examined both hypotheses. It was carried out in 33 patients with myocardial ischemia: 13 with silent myocardial ischemia (silents) and 20 with symptomatic ischemia (symptomatics). Pain sensitivity was determined with thermal, electrical, and ischemic pain tests using signal detection theory (SDT) and conventional threshold procedures. To evaluate the significance of endorphin mechanisms naloxone (6 mg i.v.) and placebo were administered on alternate days in a double-blind, cross-over procedure before the pain tests and again before a treadmill exercise test (TET). Somatic pain sensitivity was found not to be impaired in patients with SMI, and no evidence was found to support a causal role for endorphins in the disorder.

Angina Pectoris↗
PubMed1994

Are runners stoical? An examination of pain sensitivity in habitual runners and normally active controls.

Anecdotal and clinical reports suggest that athletes are stoical. However, there are few studies comparing persons who exercise regularly with those who do not. This study compared two independent samples of regular runners and normally active controls, both without recent exercise, on cold pressor, cutaneous heat, and tourniquet ischemic pain tests. Results demonstrated that the runners' threshold for noxious cold was significantly higher than that of controls. The heart rate and blood pressure responses to cold were similar in the 2 groups, suggesting that differences in cold pain report did not result from differences in autonomic reactivity to cold. Signal detection theory measures demonstrated that runners discriminated among noxious thermal stimuli significantly better than controls, but neither noxious nor innocuous thermal report criteria differed between groups. The cohorts also did not differ in their report of ischemic pain sensations. Thus, these data do not generally support the hypothesis of pain insensitivity or stoicism in habitual runners. Rather, insensitivity occurs only in their response to noxious cold, which is suggested to be an adaptation to regular training.

Adult↗
PubMed1989

The dimensions of pain: a multidimensional scaling comparison of cancer patients and healthy volunteers.

This paper presents a new approach to the measurement and understanding of clinical pain. A multidimensional scaling (MDS) procedure was used to analyze pairwise similarity judgments made to 9 pain descriptors by 24 cancer pain patients and 24 healthy volunteers. The question was whether the dimensions of the global pain space differed between the 2 groups. The Pain Intensity dimension was found to be primary for the patients, but much less important for the volunteers. Otherwise, the group stimulus space revealed broadly similar 3-dimensional solutions. The Pain Intensity dimension placed Mild Pain and Annoying at one pole and Intense and Unbearable Pain at the other. The Emotional Quality dimension grouped the descriptors Sickening and Miserable (and, in part, Intense Pain and Unbearable Pain) at the strong negative affect pole for both groups; they differed, however, with respect to the moderate affect pole. The Somatosensory dimension ranged from Burning to Cramping. The subject weight space revealed that the Pain Intensity dimension was the most important dimension for the patients, while Emotional Quality was more salient for the volunteers. Wide differences were found in the salience of the various dimensions to different individuals; this information may prove useful for tailoring patient treatment. The study demonstrates that MDS procedures such as INDSCAL, in which the subjects (rather than the researcher) determine the number and characteristics of the global pain dimensions, will improve our understanding and treatment of pain.

Adult↗
PubMed1984

Pain sensitivity, mood and plasma endocrine levels in man following long-distance running: effects of naloxone.

The effects of intense exercise on pain perception, mood, and plasma endocrine levels in man were studied under naloxone and saline conditions. Twelve long-distance runners (mean weekly mileage = 41.5) were evaluated on thermal, ischemic, and cold pressor pain tests and on mood visual analogue scales (VAS). Blood was drawn for determination of plasma levels of beta-endorphin-like immunoreactivity (BEir), growth hormone (GH), adrenocorticotrophic hormone (ACTH), and prolactin (PRL). These procedures were undertaken before and after a 6.3 mile run at 85% of maximal aerobic capacity. Subjects participated on two occasions in a double-blind procedure counterbalanced for drug order: on one day they received 2 i.v. injections of naloxone (0.8 mg in 2 ml vehicle each) at 20 min intervals following the run; on the other day, 2 equal volume injections of normal saline (2 ml). Sensory decision theory analysis of the responses to thermal stimulation showed that discriminability, P(A), was significantly reduced post-run under the saline condition, a hypoalgesic effect; response bias, B, was unaffected. Ischemic pain reports were significantly reduced post-run on the saline day, also a hypoalgesic effect. Naloxone reversed the post-run ischemic but not thermal hypoalgesic effects. Joy, euphoria, cooperation, and conscientiousness VAS ratings were elevated post-run; naloxone attenuated the elevation of joy and euphoria ratings only. Plasma levels of BEir, ACTH, GH, and PRL were significantly increased post-run. The results show that long-distance running produces hypoalgesia and mood elevation in man. The effects of naloxone implicate endogenous opioid neural systems as mechanisms of some but not all of the run-induced alterations in mood and pain perception.

Adrenocorticotropic Hormone↗
PubMedDate not supplied

An in vitro evaluation of the effect of sealant characteristics on laser fluorescence for caries detection.

PURPOSE: The purposes of this study were to: (1) evaluate the ability of a laser fluorescence (LF) unit to detect simulated caries under pit and fissure sealants; (2) determine the effect of an opacifying agent in sealants on LF values; and (3) determine interexaminer reproducibility values of the unit in a highly controlled, laboratory setting. Sealant characteristics specifically considered were: (1) filler content; (2) opacity; and (3) intrinsic fluorescence. METHODS: Three sealants were used in this study: 2 unfilled and 1 filled. To evaluate the effect of an opacifying agent, titanium dioxide powder was added to both filled and unfilled sealants. 0.5-mm thick sealant discs were prepared for all samples. The sealant discs were individually placed on top of 3 wells filled with varying amounts of protoporphyrin IX, a fluorescent material that mimicked dental caries. A total of 270 readings were made through the different sealant discs to evaluate signal attenuation of the laser fluorescence unit. RESULTS: Clear sealants, without an added opacifying agent, attenuated LF readings. At baseline protoporphyrin IX levels yielding DIAGNOdent readouts of 20 and 60, there was a significant difference in the LF readings between the baseline protoporphyrin (uncovered) and with sealant disc covered in all 3 sealant types (P<.001). Furthermore, the filled sealant attenuated LF signals significantly more than the unfilled sealant (P<.001). Sealants with titanium dioxide added had variable levels of intrinsic fluorescence. Titanium dioxide added to the sealants also had a profound effect on fluorescence transmission of the underlying simulated caries. As the concentration of titanium dioxide approached 0.5%, the fluorescence signal was almost fully attenuated. CONCLUSION: Clinical detection of caries under dental sealants with the use of laser fluorescence units is unreliable and not recommended due to a high likelihood of inaccurate readings caused by: (1) intrinsic fluorescence of sealant material; and (2) attenuation of fluorescence signals by the sealant.

Bisphenol A-Glycidyl Methacrylate↗