Impact of psychosocial characteristics in neck and low back pain : Long-term outcome and prognosis concerning sick leave

Background: Neck pain (NP) and low back pain (LBP) are common, disabling and extremely costly health issues in the industrial world, and the problem does not seem to be declining. Previously, it was thought that NP/LBP would resolve within three months; however, it is now well established that NP and LBP are both recurrent and episodic in nature. Of even greater concern, back pain seems to first appear in early adolescence to reach the same levels as the adult population already at the age of 18. Psychosocial factors seem to influence the onset of pain. There is also increasing evidence that psychosocial factors may play a crucial role in the transition from acute and sub-acute pain to chronicity. Relevant clinical subgrouping, early identification of individuals suffering from NP/LBP and prevention of chronicity has thus become a principal objective in today’s NP/LBP research. Aims: The overall aim of this thesis was to evaluate two classification methods for individuals with NP and/or LBP. One based on psychosocial factors and one based on pain and pain related sick leave regarding their ability to predict future sickness absence and disability pension among individuals with NP and/or LBP. The primary aim of study I was to evaluate the ability of a classification method based on the Swedish version of the Multidimensional Pain Inventory (MPI-S) to predict rehabilitation outcome (sick leave) among chronic neck and back pain patients for a period of seven years after multidisciplinary rehabilitation. A secondary aim was to use the MPI-subgroup information in conjunction with other clinical data, in this case sickness absence prior to rehabilitation, in order to investigate future sickness absence and disability pension. The third aim was to evaluate the economic outcome of rehabilitation across the defined patient groups. In study II, the overall objective was to evaluate the predictive validity of a subgroup classification based the MPI-S among gainfully employed workers with NP and LBP during follow-up periods of 18 and 36-months. The overall aim in study III was to evaluate the potential interaction between treatment content and MPI-S patient characteristic in the prediction of sickness absence during a 10-year follow-up. The primary aim of study IV was to evaluate a mass screening method to identify individuals with NP/LBP regarded ‘at-risk’ of future long-term sickness absence and disability pension. Results: Individuals with pronounced psychosocial difficulties have more sickness absence compared to patients with less pronounced psychosocial difficulties and better pain coping abilities. Further, subgroups based on psychosocial characteristics had different prognoses with regard to sickness absence during the follow-up periods. Patients with chronic NP/LBP appear to respond better to multidisciplinary rehabilitation compared to its single components and patients with less psychosocial difficulties appear to respond most favourably. Moreover, a classification method based on basic pain characteristics is effective in identifying individuals with an increased risk of future long-term sickness absence and disability pension. Conclusion: Altogether, these studies contribute to research in this area as they add to a better understanding of relevant subgroups. Multidisciplinary rehabilitation appears to be more advantageous compared to its single components in patients with chronic back pain with regard to future sickness absence. Furthermore, early targeting of individuals considered ‘at-risk’ for future sickness absence and in need of further investigation/interventions for their NP/LBP is valuable as it may significantly reduce individual suffering as well as health care costs, which are important objectives for the Swedish health care system

Puberty and asthma in a cohort of Swedish children

VRAstma och allergiförbundetHjärt och lungfondenManuscrip

The influence of childhood asthma on puberty and height in Swedish adolescents

BACKGROUND: Evidence relating to the effect of asthma on puberty or height is inconclusive. We aimed to examine whether the exposure of childhood asthma, including timing and phenotypes, and inhaled corticosteroid (ICS) use is either cross-sectionally or longitudinally associated with the outcomes of pubertal staging or height. METHODS: This study employed data from a longitudinal, population-based cohort of Swedish children (born 1994-1996). At ages 1, 2, 4, 8, and 12 years, parent-reported data on asthma and ICS use in the previous 12 months were collected. At 8 and 12 years, height was ascertained at a clinical visit, and child-reported, respectively. At 12 years, children answered puberty-related questions. RESULTS: Retention through 12 years was 82% (3366/4089). Participants without puberty data (n = 620) were excluded, yielding a study population of 2746 (67%). Asthma at 8 years, including timing of onset and phenotypes, was not statistically significantly associated with pubertal staging in adjusted models. Children with asthma averaged 0.93 cm (95% CI 0.35-1.50) shorter than children without asthma. Children with asthma using ICS were 1.28 (95% CI 0.62-1.95) shorter than those with asthma without using ICS. CONCLUSIONS: We found no consistent association between asthma and pubertal staging. Children with asthma were shorter than those without asthma. Moreover, children with asthma using ICS were shorter than those not using ICS.NoneAccepte

Individual and stable autoantibody repertoires in healthy individuals

In the era towards precision medicine, we here present the individual specific autoantibody signatures of 193 healthy individuals. The self-reactive IgG signatures are stable over time in a way that each individual profile is recognized in longitudinal sampling. The IgG autoantibody reactivity towards an antigen array comprising 335 protein fragments, representing 204 human proteins with potential relevance to autoimmune disorders, was measured in longitudinal plasma samples from 193 healthy individuals. This analysis resulted in unique autoantibody barcodes for each individual that were maintained over one year's time. The reactivity profiles, or signatures, are person specific in regards to the number of reactivities and antigen specificity. Two independent data sets were consistent in that each healthy individual displayed reactivity towards 0-16 antigens, with a median of six. Subsequently, four selected individuals were profiled on in-house produced high-density protein arrays containing 23,000 protein fragments representing 14,000 unique protein coding genes. Based on a unique, broad and deep longitudinal profiling of autoantibody reactivities, our results demonstrate a unique autoreactive profile in each analyzed healthy individual. The need and interest for broad-ranged and high-resolution molecular profiling of healthy individuals is rising. We have here generated and assessed an initial perspective on the global distribution of the self-reactive IgG repertoire in healthy individuals, by investigating 193 well-characterized healthy individuals.Peer reviewe

Maternal health care professionals’ experiences and views on the use of obstetric ultrasound in Rwanda: A cross-sectional study

Background This study, undertaken in Rwanda, aimed to investigate health professionals’ experiences and views on the following topics: current clinical guidelines for ultrasound from second trimester at the clinic, regional and national levels, and adherence to clinical guidelines; medically indicated ultrasound examinations; non-medical use of ultrasound including ultrasounds on maternal request; commercialisation of ultrasound; the value of ultrasound in relation to other clinical examinations in pregnancy; and ultrasound and medicalisation of pregnancy. Methods A cross-sectional design was adopted. Health professionals providing antenatal care and delivery services to pregnant women in 108 health facilities were invited to complete a survey, which was developed based on the results of earlier qualitative studies undertaken as part of the CROss Country Ultrasound Study (CROCUS). Results Nine hundred and seven health professionals participated: obstetricians/gynecologists (3.2%,) other physicians (24.5%), midwives (29.7%) and nurses (42.7%). Few physicians reported the existence of clinical guidelines at clinic, regional or national levels in Rwanda, and guidelines were moderately adhered to. Three obstetric ultrasound examinations were considered medically indicated in an uncomplicated pregnancy. Most participants (73.0%) were positive about obstetric ultrasound examinations on maternal request. Commercialisation was not considered a problem, and the majority (88.5%) agreed that ultrasound had contributed to medicalisation of pregnancy. Conclusions Findings indicate that clinical guidelines for the use of obstetric ultrasound are limited in Rwanda. Non-medically indicated obstetric ultrasound was not considered a current problem at any level of the healthcare system. The positive attitude to obstetric ultrasound examinations on maternal request may contribute to further burden on a maternal health care system with limited resources. It is essential that limited obstetric ultrasound resources are allocated where they are most beneficial, and clearly stated medical indications would likely facilitate this

A modern way to teach and practice manual therapy

Background: Musculoskeletal conditions are the leading contributor to global disability and health burden. Manual therapy (MT) interventions are commonly recommended in clinical guidelines and used in the management of musculoskeletal conditions. Traditional systems of manual therapy (TMT), including physiotherapy, osteopathy, chiropractic, and soft tissue therapy have been built on principles such as clinician-centred assessment, patho-anatomical reasoning, and technique specificity. These historical principles are not supported by current evidence. However, data from clinical trials support the clinical and cost effectiveness of manual therapy as an intervention for musculoskeletal conditions, when used as part of a package of care. Purpose: The purpose of this paper is to propose a modern evidence-guided framework for the teaching and practice of MT which avoids reference to and reliance on the outdated principles of TMT. This framework is based on three fundamental humanistic dimensions common in all aspects of healthcare: safety, comfort, and efficiency. These practical elements are contextualised by positive communication, a collaborative context, and person-centred care. The framework facilitates best-practice, reasoning, and communication and is exemplified here with two case studies. Methods: A literature review stimulated by a new method of teaching manual therapy, reflecting contemporary evidence, being trialled at a United Kingdom education institute. A group of experienced, internationally-based academics, clinicians, and researchers from across the spectrum of manual therapy was convened. Perspectives were elicited through reviews of contemporary literature and discussions in an iterative process. Public presentations were made to multidisciplinary groups and feedback was incorporated. Consensus was achieved through repeated discussion of relevant elements. Conclusions: Manual therapy interventions should include both passive and active, person-empowering interventions such as exercise, education, and lifestyle adaptations. These should be delivered in a contextualised healing environment with a well-developed person-practitioner therapeutic alliance. Teaching manual therapy should follow this model

Misinformation, chiropractic, and the COVID-19 pandemic

Abstract: Background: In March 2020, the World Health Organization elevated the coronavirus disease (COVID-19) epidemic to a pandemic and called for urgent and aggressive action worldwide. Public health experts have communicated clear and emphatic strategies to prevent the spread of COVID-19. Hygiene rules and social distancing practices have been implemented by entire populations, including ‘stay-at-home’ orders in many countries. The long-term health and economic consequences of the COVID-19 pandemic are not yet known. Main text: During this time of crisis, some chiropractors made claims on social media that chiropractic treatment can prevent or impact COVID-19. The rationale for these claims is that spinal manipulation can impact the nervous system and thus improve immunity. These beliefs often stem from nineteenth-century chiropractic concepts. We are aware of no clinically relevant scientific evidence to support such statements. We explored the internet and social media to collect examples of misinformation from Europe, North America, Australia and New Zealand regarding the impact of chiropractic treatment on immune function. We discuss the potential harm resulting from these claims and explore the role of chiropractors, teaching institutions, accrediting agencies, and legislative bodies. Conclusions: Members of the chiropractic profession share a collective responsibility to act in the best interests of patients and public health. We hope that all chiropractic stakeholders will view the COVID-19 pandemic as a call to action to eliminate the unethical and potentially dangerous claims made by chiropractors who practise outside the boundaries of scientific evidence

Facets of individual-specific health signatures determined from longitudinal plasma proteome profiling

Background: Precision medicine approaches aim to tackle diseases on an individual level through molecular profiling. Despite the growing knowledge about diseases and the reported diversity of molecular phenotypes, the descriptions of human health on an individual level have been far less elaborate. Methods: To provide insights into the longitudinal protein signatures of well-being, we profiled blood plasma collected over one year from 101 clinically healthy individuals using multiplexed antibody assays. After applying an antibody validation scheme, we utilized > 700 protein profiles for in-depth analyses of the individuals’ short-term health trajectories. <p<Findings: We found signatures of circulating proteomes to be highly individual-specific. Considering technical and longitudinal variability, we observed that 49% of the protein profiles were stable over one year. We also identified eight networks of proteins in which 11 242 proteins covaried over time. For each participant, there were unique protein profiles of which some could be explained by associations to genetic variants. Interpretation: This observational and non-interventional study identifyed noticeable diversity among clinically healthy subjects, and facets of individual-specific signatures emerged by monitoring the variability of the circulating proteomes over time. To enable more personal hence precise assessments of health states, longitudinal profiling of circulating proteomes can provide a valuable component for precision medicine approaches