Use of complementary alternative medicine for low back pain consulting in general practice: a cohort study

<p>Abstract</p> <p>Background</p> <p>Although back pain is considered one of the most frequent reasons why patients seek complementary and alternative medical (CAM) therapies little is known on the extent patients are actually using CAM for back pain.</p> <p>Methods</p> <p>This is a post hoc analysis of a longitudinal prospective cohort study embedded in a RCT. General practitioners (GPs) recruited consecutively adult patients presenting with LBP. Data on physical function, on subjective mood, and on utilization of health services was collected at the first consultation and at follow-up telephone interviews for a period of twelve months</p> <p>Results</p> <p>A total of 691 (51%) respectively 928 (69%) out of 1,342 patients received one form of CAM depending on the definition. Local heat, massage, and spinal manipulation were the forms of CAM most commonly offered. Using CAM was associated with specialist care, chronic LBP and treatment in a rehabilitation facility. Receiving spinal manipulation, acupuncture or TENS was associated with consulting a GP providing these services. Apart from chronicity disease related factors like functional capacity or pain only showed weak or no association with receiving CAM.</p> <p>Conclusion</p> <p>The frequent use of CAM for LBP demonstrates that CAM is popular in patients and doctors alike. The observed association with a treatment in a rehabilitation facility or with specialist consultations rather reflects professional preferences of the physicians than a clear medical indication. The observed dependence on providers and provider related services, as well as a significant proportion receiving CAM that did not meet the so far established selection criteria suggests some arbitrary use of CAM.</p

The impact of regional and neighbourhood deprivation on physical health in Germany: a multilevel study

Voigtländer S, Berger U, Razum O. The impact of regional and neighbourhood deprivation on physical health in Germany: a multilevel study. BMC Public Health. 2010;10(1): 403.Background There is increasing evidence that individual health is at least partly determined by neighbourhood and regional factors. Mechanisms, however, remain poorly understood, and evidence from Germany is scant. This study explores whether regional as well as neighbourhood deprivation are associated with physical health and to what extent this association can be explained by specific neighbourhood exposures. Methods Using 2004 data from the German Socio-Economic Panel Study (SOEP) merged with regional and neighbourhood characteristics, we fitted multilevel linear regression models with subjective physical health, as measured by the SF-12, as the dependent variable. The models include regional and neighbourhood proxies of deprivation (i.e. regional unemployment quota, average purchasing power of the street section) as well as specific neighbourhood exposures (i.e. perceived air pollution). Individual characteristics including socioeconomic status and health behaviour have been controlled for. Results This study finds a significant association between area deprivation and physical health which is independent of compositional factors and consistent across different spatial scales. Furthermore the association between neighbourhood deprivation and physical health can be partly explained by specific features of the neighbourhood environment. Among these perceived air pollution shows the strongest association with physical health (-2.4 points for very strong and -1.5 points for strong disturbance by air pollution, standard error (SE) = 0.8 and 0.4, respectively). Beta coefficients for perceived air pollution, perceived noise and the perceived distance to recreational resources do not diminish when including individual health behaviour in the models. Conclusions This study highlights the difference regional and in particular neighbourhood deprivation make to the physical health of individuals in Germany. The results support the argument that specific neighbourhood exposures serve as an intermediary step between deprivation and health. As people with a low socioeconomic status were more likely to be exposed to unfavourable neighbourhood characteristics these conditions plausibly contribute towards generating health inequalities

Nutritional behaviour of nurses working night shifts

Hintergrund Schicht- und Nachtarbeit beeinflussen das Ernährungsverhalten. Dies kann zur Entstehung von ernährungsmitbedingten Erkrankungen führen. Dennoch liegen für Gesundheits- und Krankenpfleger, als größte von Schichtarbeit betroffene Berufsgruppe, im Gesundheitswesen bisher kaum Daten vor. Ziel ist es daher, das Ernährungsverhaltens von Gesundheits- und Krankenpflegern (GKP) während des Nachtdienstes zu erfassen. Methode Das Ernährungsverhalten von 19 GKP wurde mithilfe eines „doubly labelled water“ validierten, offenen 3?Tage-Ernährungsprotokolls erfasst. Die ermittelte tägliche Zufuhr verschiedener Lebensmittelgruppen wurde mit den gesundheitsförderlichen Orientierungswerten verglichen. Ergebnisse GKP weisen Defizite bei der Umsetzung der Ernährungsempfehlungen auf. Dies betrifft insbesondere den zu geringen Konsum von Gemüse (1,43?±?0,88 Portionen [P]/Tag), Obst (1,54?±?1,21?P/Tag) und Getreideprodukten (2,36?±?0,93?P/Tag). Diskussion Hinsichtlich des Lebensmittelverzehrs wurden keine Unterschiede zwischen den GKP und der deutschen Bevölkerung erfasst. Stattdessen wurden während der Schichtarbeit eine Umverteilung der Mahlzeiten von Tag zu Nacht, ungewöhnliche und unregelmäßige Essenszeiten sowie ein geringer Verzehr warmer Mahlzeiten beobachtet. Aufgrund dieser Defizite sollten gesundheitsförderliche Maßnahmen auf Verhaltens- und Verhältnisebene in den Klinikalltag integriert werden