Chronic Low Back Pain Beliefs and Management Practices in Africa: Time for a Re-think?

Background: Chronic low back pain (CLBP) beliefs are important psychosocial risk factors affecting the occurrence and progression of CLBP. To address pain beliefs and implement recommended biopsychosocial approaches for CLBP management, an understanding of the beliefs of patients and healthcare professionals (HCPs), and also CLBP management practices, is necessary. A narrative review was conducted to explore CLBP beliefs and practices in African countries. Methods: Two systematic searches were conducted using seven databases (MEDLINE, Embase, PsychInfo, CINAHL Plus, AMED, PubMed and Web of Science) with combined variations of the terms “Management”, “Guidelines”, “Chronic Low Back Pain”, “Beliefs”, “Patients”, “Healthcare Professionals” and “Africa”. Results: Five studies and one standard treatment guideline document were included. No systematically developed African CLBP treatment guideline was found, although CLBP practices were identified in two African countries. CLBP management in African countries appears to be biomedically orientated. Only three research articles investigated the CLBP beliefs of patients in Africa, with none assessing HCP beliefs. Unhelpful CLBP beliefs (catastrophizing and fear avoidance) and biomedical thoughts about the causes of CLBP were identified. Unhelpful CLBP beliefs were associated with increased disability. Conclusions: Management practices for CLBP in African countries appear to contradict recommended biopsychosocial management guidelines by developed countries and are not sufficiently documented. Research on CLBP beliefs and CLBP management practices in Africa is lacking. To enhance the uptake of biopsychosocial approach in Africa, research around CLBP beliefs in African CLBP patients and HCPs is required

Understanding how patients' pain beliefs influence chronic low back pain management in Ghana: a grounded theory approach.

Chronic low back pain (CLBP) is associated with negative consequences in high and low/middle-income countries. Pain beliefs are important psychosocial factors that affect the occurrence and progression of CLBP and may be influenced by the sociocultural context and interactions with healthcare professionals (HCPs). The pain beliefs of Ghanaian patients with CLBP are unknown and the factors influencing pain beliefs in African contexts are unclear. To explore the pain beliefs of Ghanaian patients with CLBP, how they influence CLBP management/coping and to identify the mechanisms influencing them. Qualitative study using individual semistructured face-to-face interviews, situated within Straussian grounded theory principles and critical realist philosophy. Thirty patients with CLBP accessing physiotherapy at two teaching hospitals in Ghana. Participants suggested dominant biomedical/mechanical beliefs (related to CLBP causes, posture and activity, and the belief of an endpoint/cure for CLBP). Maladaptive beliefs and practices, in particular fear-avoidance beliefs, and dependence on passive management and coping, were common among participants. These beliefs and practices were mostly influenced by HCPs and sociocultural expectations/norms. Although spirituality, pacing activity and prescribed exercises were commonly mentioned by participants, other active strategies and positive beliefs were expressed by a few participants and influenced by patients' themselves. Limited physiotherapy involvement, knowledge and awareness were also reported by participants, and this appeared to be influenced by the limited physiotherapy visibility in Ghana. Participants' narratives suggested the dominant influence of HCPs and the sociocultural environment on their biomedical/mechanical beliefs. These facilitated maladaptive beliefs and adoption of passive coping and management practices. Therefore, incorporation of more positive beliefs and holistic/active strategies by Ghanaian patients and HCPs may be beneficial. Furthermore, patient empowerment and health literacy opportunities to address unhelpful CLBP/sociocultural beliefs and equip patients with management options for CLBP could be beneficial. [Abstract copyright: © Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.

Nonlinear dynamo action in a precessing cylindrical container

It is numerically demonstrated by means of a magnetohydrodynamics (MHD) code that precession can trigger the dynamo effect in a cylindrical container. This result adds credit to the hypothesis that precession can be strong enough to be one of the sources of the dynamo action in some astrophysical bodies.Comment: 5 pages, 5 figures including subfigure

A Qualitative Investigation of the Psychosocial Impact of Chronic Low Back Pain in Ghana

Introduction: Chronic low back pain (CLBP) is a global health concern associated with multidimensional/biopsychosocial levels of affectation in developed countries, with holistic management requiring consideration of these factors. There has been minimal research exploring the psychosocial impact of CLBP, and the factors influencing it, in African contexts, with none in Ghana. Objectives: To explore the psychosocial impact of CLBP among patients with CLBP in Ghana. Design: Qualitative study using individual semistructured face-to-face interviews, underpinned by Straussian grounded theory principles and critical realist philosophy. Participants: Thirty patients with CLBP attending physiotherapy at two hospitals in Ghana. Results: Five categories: loss of self and roles, emotional distress, fear, stigmatisation and marginalisation, financial burden, and social support and three mechanisms: acquired biomedical/mechanical beliefs from healthcare professionals (HCPs), sociocultural beliefs and the socioeconomic impact of CLBP were derived. Conclusion: CLBP adversely affects multidimensional/biopsychosocial aspects of individuals experiencing CLBP in Ghana. This delineates the need for a biopsychosocial approach to care. There is the need for HCPs in Ghana to reassess current CLBP management strategies to address the influence of adverse HCPs biomedical inclinations on patients’ psychosocial consequences. Population-based education strategies and consideration of formal support systems for persons with disabling CLBP may also be beneficial

A numerical model of the VKS experiment

We present numerical simulations of the magnetic field generated by the flow of liquid sodium driven by two counter-rotating impellers (VKS experiment). Using a dynamo kinematic code in cylindrical geometry, it is shown that different magnetic modes can be generated depending on the flow configuration. While the time averaged axisymmetric mean flow generates an equatorial dipole, our simulations show that an axial field of either dipolar or quadrupolar symmetry can be generated by taking into account non-axisymmetric components of the flow. Moreover, we show that by breaking a symmetry of the flow, the magnetic field becomes oscillatory. This leads to reversals of the axial dipole polarity, involving a competition with the quadrupolar component.Comment: 6 pages, 5 figure

Creation and evolution of magnetic helicity

Projecting a non-Abelian SU(2) vacuum gauge field - a pure gauge constructed from the group element U - onto a fixed (electromagnetic) direction in isospace gives rise to a nontrivial magnetic field, with nonvanishing magnetic helicity, which coincides with the winding number of U. Although the helicity is not conserved under Maxwell (vacuum) evolution, it retains one-half its initial value at infinite time.Comment: Clarifying remarks and references added; 12 pages, 1 figure using BoxedEPSF, REVTeX macros; submitted to Phys Rev D; email to [email protected]

Magnetohydrodynamic activity inside a sphere

We present a computational method to solve the magnetohydrodynamic equations in spherical geometry. The technique is fully nonlinear and wholly spectral, and uses an expansion basis that is adapted to the geometry: Chandrasekhar-Kendall vector eigenfunctions of the curl. The resulting lower spatial resolution is somewhat offset by being able to build all the boundary conditions into each of the orthogonal expansion functions and by the disappearance of any difficulties caused by singularities at the center of the sphere. The results reported here are for mechanically and magnetically isolated spheres, although different boundary conditions could be studied by adapting the same method. The intent is to be able to study the nonlinear dynamical evolution of those aspects that are peculiar to the spherical geometry at only moderate Reynolds numbers. The code is parallelized, and will preserve to high accuracy the ideal magnetohydrodynamic (MHD) invariants of the system (global energy, magnetic helicity, cross helicity). Examples of results for selective decay and mechanically-driven dynamo simulations are discussed. In the dynamo cases, spontaneous flips of the dipole orientation are observed.Comment: 15 pages, 19 figures. Improved figures, in press in Physics of Fluid

Connecting communities: A qualitative investigation of the challenges in delivering a national social prescribing service to reduce loneliness

Loneliness is a global public health concern linked to a range of negative health outcomes (Cacioppo & Cacioppo, 2018. The Lancet. 391(10119), 426). Internationally, this has led to the development of a number of interventions, but these are rarely implemented or evaluated on a large scale. This paper is one of the first of its kind to describe elements of an evaluation of a large‐scale national social prescribing scheme to reduce loneliness, deploying individual link workers to signpost people to community activities. Reporting on findings from interviews with staff (n = 25 of which 6 were repeat interviews) and volunteers (n = 9) between October 2017 and December 2018 in localities across the United Kingdom. We reflect on the complexities of the link worker role, the challenges of service delivery and the importance of community infrastructure. There was evidence that highly skilled link workers who had developed positive relationships with providers and service‐users were key to the success of the intervention. As well as providing an effective liaison and signposting function, successful link workers tailored the national programme to local need to proactively address specific gaps in existing service provision. For social prescribing services to be successful and sustainable, commissioners must consider additional funding of community infrastructure

Large-Scale Magnetic-Field Generation by Randomly Forced Shearing Waves

A rigorous theory for the generation of a large-scale magnetic field by random non-helically forced motions of a conducting fluid combined with a linear shear is presented in the analytically tractable limit of low Rm and weak shear. The dynamo is kinematic and due to fluctuations in the net (volume-averaged) electromotive force. This is a minimal proof-of-concept quasilinear calculation aiming to put the shear dynamo, a new effect recently found in numerical experiments, on a firm theoretical footing. Numerically observed scalings of the wavenumber and growth rate of the fastest growing mode, previously not understood, are derived analytically. The simplicity of the model suggests that shear dynamo action may be a generic property of sheared magnetohydrodynamic turbulence.Comment: Paper substantially rewritten, results changed (relative to v1). Revised versio

Measurement Of Quasiparticle Transport In Aluminum Films Using Tungsten Transition-Edge Sensors

We report new experimental studies to understand the physics of phonon sensors which utilize quasiparticle diffusion in thin aluminum films into tungsten transition-edge-sensors (TESs) operated at 35 mK. We show that basic TES physics and a simple physical model of the overlap region between the W and Al films in our devices enables us to accurately reproduce the experimentally observed pulse shapes from x-rays absorbed in the Al films. We further estimate quasiparticle loss in Al films using a simple diffusion equation approach.Comment: 5 pages, 6 figures, PRA