Myofascial Massage for Chronic Pain and Decreased Upper Extremity Mobility After Breast Cancer Surgery

Background: Chronic localized pain and decreased upper extremity mobility commonly occur following breast cancer surgery and may persist despite use of pain medication and physical therapy.Purpose: We sought to determine the value of myofascial massage to address these pain and mobility limitations.Setting: The study took place at a clinical massage spa in the U.S. Midwest. The research was overseen by MetroHealth Medical Center’s Institutional Review Board and Case Center for Reducing Health Disparities research staff.Participants: 21 women with persistent pain and mobility limitations 3–18 months following breast surgery.Research Design: We conducted a pilot randomized controlled trial where intervention patients received myofascial massages and control patients received relaxation massages.Intervention: Intervention participants received 16 myofascial massage sessions over eight weeks that focused on the affected breast, chest, and shoulder areas. Control participants received 16 relaxation massage sessions over eight weeks that avoided the affected breast, chest, and shoulder areas. Participants completed a validated questionnaire at the beginning and end of the study that asked about pain, mobility, and quality of life.Main Outcome Measures: Outcome measures include change in self-reported pain, self-reported mobility, and three quality-of-life questions.Results: At baseline, intervention and control participants were similar in demographic and medical characteristics, pain and mobility ratings, and quality of life. Compared to control participants, intervention participants had more favorable changes in pain (-10.7 vs. +0.4, p < .001), mobility (-14.5 vs. -0.8, p < .001), and general health (+29.5 vs. -2.5, p = .002) after eight weeks. All intervention and control participants reported that receiving massage treatments was a positive experience.Conclusions: Myofascial massage is a promising treatment to address chronic pain and mobility limitations following breast cancer surgery. Further work in several areas is needed to confirm and expand on our study findings

Chronic Kidney Disease and Cognitive Function in Older Adults: Findings from the Chronic Renal Insufficiency Cohort Cognitive Study

To investigate cognitive impairment in older, ethnically diverse individuals with a broad range of kidney function, to evaluate a spectrum of cognitive domains, and to determine whether the relationship between chronic kidney disease (CKD) and cognitive function is independent of demographic and clinical factors.Cross-sectional.Chronic Renal Insufficiency Cohort Study.Eight hundred twenty-five adults aged 55 and older with CKD.Estimated glomerular filtration rate (eGFR, mL/min per 1.73 m 2 ) was estimated using the four-variable Modification of Diet in Renal Disease equation. Cognitive scores on six cognitive tests were compared across eGFR strata using linear regression; multivariable logistic regression was used to examine level of CKD and clinically significant cognitive impairment (score ≤1 standard deviations from the mean).Mean age of the participants was 64.9, 50.4% were male, and 44.5% were black. After multivariable adjustment, participants with lower eGFR had lower cognitive scores on most cognitive domains ( P <.05). In addition, participants with advanced CKD (eGFR<30) were more likely to have clinically significant cognitive impairment on global cognition (adjusted odds ratio (AOR) 2.0, 95% CI=1.1–3.9), naming (AOR=1.9, 95% CI=1.0–3.3), attention (AOR=2.4, 95% CI=1.3–4.5), executive function (AOR=2.5, 95% CI=1.9–4.4), and delayed memory (AOR=1.5, 95% CI=0.9–2.6) but not on category fluency (AOR=1.1, 95% CI=0.6–2.0) than those with mild to moderate CKD (eGFR 45–59).In older adults with CKD, lower level of kidney function was associated with lower cognitive function on most domains. These results suggest that older patients with advanced CKD should be screened for cognitive impairment.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/78647/1/j.1532-5415.2009.02670.x.pd

Intradialytic Massage for Leg Cramps Among Hemodialysis Patients: a Pilot Randomized Controlled Trial

Background: Patients on hemodialysis often experience muscle cramps that result in discomfort, shortened treatment times, and inadequate dialysis dose. Cramps have been associated with adversely affecting sleep and health-related quality of life, depression and anxiety. There is limited evidence available about massage in dialysis; however, massage in cancer patients has demonstrated decreases in pain, inflammation, and feelings of anxiety. These correlations indicate massage may be an effective treatment modality for hemodialysis-related lower extremity cramping.Purpose: To determine the effectiveness of intradialytic massage on the frequency of cramping among hemodialysis patients prone to lower extremity cramping.Participants: 26 maintenance hemodialysis patients with frequent lower extremity cramps.Setting: three outpatient hemodialysis centers in Northeast Ohio.Research Design: randomized controlled trial.Intervention: The intervention group received a 20-minute massage of the lower extremities during each treatment (three times per week) for two weeks. The control group received usual care by dialysis center staff.Main Outcome Measure: change in frequency of lower leg cramping.Results: Patient reported cramping at home decreased by 1.3 episodes per week in the intervention group compared to 0.2 episodes per week in the control group (p=.005). Patient reported cramping during dialysis decreased by 0.8 episodesin the intervention group compared to 0.4 episodes in the control group (p=0.44).Conclusion: Intradialytic massage appears to be an effective way to address muscle cramping. Larger studies with longer duration should be conducted to further examine this approach

Spatial access to cooling centers in the city of Boston

Introduction: In the past decade, the City of Boston has experienced a record number of hot days and has implemented measures to help residents stay cool, such as encouraging the use of air-conditioned cooling centers at community centers and public libraries. This study aimed to investigate spatial access to these cooling centers in relation to race, poverty, and heat intensity. Methods: Geospatial analysis was used to estimate the proportion of the population within a 15-minute walk of a cooling center. Data on race, poverty, and urban heat exposure also were analyzed. Results: The analysis showed that 77% of Boston's population is located within a 15-minute walk of a community center or library. There were no large disparities in access by race or poverty status and current cooling centers are located in areas with higher values on an urban heat island index. We estimate the City of Boston would need to construct a minimum of 19 new cooling centers to reach 95% of Boston's population, and 45 new centers to reach all residents. Conclusion: These findings suggest that the majority of Boston's population has good access to cooling centers, but there is still a need for additional centers in certain areas. Further research could explore the effectiveness of these cooling centers in reducing heat-related health impacts

Dialysis Patient Ratings of the Quality of Medical Care

• Dialysis patients receive medical care from a variety of physicians. Little is known about how dialysis patients assess the quality of this care. We sought to determine (1) who dialysis patients receive medical care from, (2) how they rate the quality of such care, and (3) how ratings differ for care provided by generalists, nephrologists, and other specialists. We performed a cross-sectional interview study of 148 patients from four chronic hemodialysis units. Using a structured questionnaire, we asked subjects about each condition for which they received care in the preceding 12 months. For each condition, subjects mentioned the type of physician who provided care and then rated their overall satisfaction with care as well as six components of quality of care (availability of doctor, technical skill, personal manner, explanations provided, amount of time spent, and how much patient was helped). We found that generalists, nephrologists, and other specialists provided care for 14%, 48%, and 38% of conditions for which patients received care. Sixty-nine percent of overall satisfaction ratings were very good or better. Of the six components of quality of care, explanations and amount of time received the lowest ratings. On multivariate analysis, increased patient age, black race, and care for acute illnesses were associated with lower ratings of quality of care. There was no difference in ratings of care provided by generalists, nephrologists, and other specialists. In conclusion, dialysis patients receive most of their medical care from nephrologists and other specialists. Although they generally rate this care highly, we recommend that providers pay special attention to explanations provided, time spent with patients, and care for acute illness. 1998 by the National Kidney Foundation, Inc. INDEX WORDS: Quality of care; nephrology; primary health care; hemodialysis

Clustering of Social Determinants of Health Among Patients

Introduction/Objectives: Many health systems screen patients for social determinants of health and refer patients with social needs to community organizations for assistance. Understanding how social determinants cluster together may help guide assistance programs. Methods: This study examined patients screened by The MetroHealth System in Cleveland, Ohio for 9 social determinants, including food insecurity, financial strain, transportation limitations, inability to pay for housing or utilities, intimate partner violence, social isolation, infrequent physical activity, daily stress, and lack of internet access. Clustering analyses were performed to determine which combination of social determinants occurred together more often than would be expected if each determinant were independent of each other. Results: Among 23 161 screened patients, there were 19 dyads, 13 triads, and one tetrad of social determinants that clustered together. The most prevalent triad of food insecurity, social isolation, and inability to pay for housing or utilities occurred among 1095 patients but would be expected to occur among 284 patients, for an observed/expected ratio of 3.85 (95% confidence interval 3.64-4.07). In multivariate analyses, younger, Black, and lower income patients were 2 to 3 times more likely to have this triad compared to older, White, and wealthier patients. Conclusions: Social determinants of health frequently cluster together, and such clustering is associated with patient demographic characteristics. Further work is needed to determine how social determinant clusters impact health and cost outcomes and to develop programs that can address multiple co-existing social needs