Avoidable costs of physical treatments for chronic back, neck and shoulder pain within the Spanish National Health Service: a cross-sectional study

<p>Abstract</p> <p>Background</p> <p>Back, neck and shoulder pain are the most common causes of occupational disability. They reduce health-related quality of life and have a significant economic impact. Many different forms of physical treatment are routinely used. The objective of this study was to estimate the cost of physical treatments which, despite the absence of evidence supporting their effectiveness, were used between 2004 and 2007 for chronic and non-specific neck pain (NP), back pain (BP) and shoulder pain (SP), within the Spanish National Health Service in the Canary Islands (SNHSCI).</p> <p>Methods</p> <p>Chronic patients referred from the SNHSCI to private physical therapy centres for NP, BP or SP, between 2004 and 2007, were identified. The cost of providing physical therapies to these patients was estimated. Systematic reviews (SRs) and clinical practice guidelines (CPGs) for NP, BP and SP available in the same period were searched for and rated according to the Oxman and AGREE criteria, respectively. Those rated positively for ≥70% of the criteria, were used to categorise physical therapies as Effective; Ineffective; Inconclusive; and Insufficiently Assessed. The main outcome was the cost of physical therapies included in each of these categories.</p> <p>Results</p> <p>8,308 chronic cases of NP, 4,693 of BP and 5,035 of SP, were included in this study. Among prescribed treatments, 39.88% were considered Effective (physical exercise and manual therapy with mobilization); 23.06% Ineffective; 13.38% Inconclusive, and 23.66% Insufficiently Assessed. The total cost of treatments was € 5,107,720. Effective therapies accounted for € 2,069,932.</p> <p>Conclusions</p> <p>Sixty percent of the resources allocated by the SNHSCI to fund physical treatment for NP, BP and SP in private practices are spent on forms of treatment proven to be ineffective, or for which there is no evidence of effectiveness.</p

A detailed Hapmap of the Sitosterolemia locus spanning 69 kb; differences between Caucasians and African-Americans

BACKGROUND: Sitosterolemia is an autosomal recessive disorder that maps to the sitosterolemia locus, STSL, on human chromosome 2p21. Two genes, ABCG5 and ABCG8, comprise the STSL and mutations in either cause sitosterolemia. ABCG5 and ABCG8 are thought to have evolved by gene duplication event and are arranged in a head-to-head configuration. We report here a detailed characterization of the STSL in Caucasian and African-American cohorts. METHODS: Caucasian and African-American DNA samples were genotypes for polymorphisms at the STSL locus and haplotype structures determined for this locus RESULTS: In the Caucasian population, 13 variant single nucleotide polymorphisms (SNPs) were identified and resulting in 24 different haplotypes, compared to 11 SNPs in African-Americans resulting in 40 haplotypes. Three polymorphisms in ABCG8 were unique to the Caucasian population (E238L, INT10-50 and G575R), whereas one variant (A259V) was unique to the African-American population. Allele frequencies of SNPs varied also between these populations. CONCLUSION: We confirmed that despite their close proximity to each other, significantly more variations are present in ABCG8 compared to ABCG5. Pairwise D' values showed wide ranges of variation, indicating some of the SNPs were in strong linkage disequilibrium (LD) and some were not. LD was more prevalent in Caucasians than in African-Americans, as would be expected. These data will be useful in analyzing the proposed role of STSL in processes ranging from responsiveness to cholesterol-lowering drugs to selective sterol absorption

Monkeys and Humans Share a Common Computation for Face/Voice Integration

Speech production involves the movement of the mouth and other regions of the face resulting in visual motion cues. These visual cues enhance intelligibility and detection of auditory speech. As such, face-to-face speech is fundamentally a multisensory phenomenon. If speech is fundamentally multisensory, it should be reflected in the evolution of vocal communication: similar behavioral effects should be observed in other primates. Old World monkeys share with humans vocal production biomechanics and communicate face-to-face with vocalizations. It is unknown, however, if they, too, combine faces and voices to enhance their perception of vocalizations. We show that they do: monkeys combine faces and voices in noisy environments to enhance their detection of vocalizations. Their behavior parallels that of humans performing an identical task. We explored what common computational mechanism(s) could explain the pattern of results we observed across species. Standard explanations or models such as the principle of inverse effectiveness and a “race” model failed to account for their behavior patterns. Conversely, a “superposition model”, positing the linear summation of activity patterns in response to visual and auditory components of vocalizations, served as a straightforward but powerful explanatory mechanism for the observed behaviors in both species. As such, it represents a putative homologous mechanism for integrating faces and voices across primates

Failed suppression of direct visuomotor activation in Parkinson's disease

Abstract The response times in choice-reaction tasks are faster when the relative spatial positions of stimulus and response match than when they do not match, even when the spatial relation is irrelevant to response choice. This spatial stimulus—response (S-R) compatibility effect (i.e., the Simon effect) is attributed in part to the automatic activation of spatially corresponding responses, which need to be suppressed when the spatial location of stimulus and correct response do not correspond. The present study tested patients with Parkinson's disease and healthy control subjects in a spatial S-R compatibility task in order to investigate whether basal ganglia dysfunction in Parkinson's disease leads to disinhibition of direct visuomotor activation. High-density event-related brain potential recordings were used to chart the cortical activity accompanying attentional orientation and response selection. Response time measures demonstrated a failure to inhibit automatic response activation in Parkinson patients, which was revealed by taking into account a sequence-dependent modulation of the Simon effect. Event-related potential (ERP) recordings demonstrated that visuospatial orientation to target stimuli was accompanied by signal-locked activity above motor areas of the cortex, with similar latencies but an enhanced amplitude in patients compared to control subjects. The results suggest that inhibitory modulation of automatic, stimulus-driven, visuomotor activation occurs after the initial sensory activation of motor cortical areas. The failed inhibition in Parkinson's disease appears therefore related to a disturbance in processes that prevent early attention-related visuomotor activation, within motor areas, from actually evoking a response.</jats:p

Alterações na distribuição de potência cortical em função da consolidação da memória no aprendizado de datilografia Changes in cortical power distribution produced by memory consolidation as a function of a typewriting skill

O objetivo do presente estudo foi investigar alterações nos padrões eletroencefalográficos de sujeitos normais e destros durante o aprendizado de uma tarefa motora (datilografia). Estudos têm demonstrado que o córtex cerebral é susceptível a modificações durante a aprendizagem e que alterações nos padrões elétricos corticais ocorrem em função da aquisição de uma habilidade motora e da consolidação da memória. Assim, a atividade elétrica cortical dos sujeitos foi analisada antes e depois da prática motora. Os dados foram captados pelo "Braintech" 3000 e analisados pelo programa "Neurometrics". Para a análise estatística, variáveis comportamentais tais como tempo e erro, foram analisadas através do teste ANOVA "one-way" (diferenças entre blocos). Em seguida, foi utilizado um Teste-t pareado para os pares de eletrodos CZ-C3/CZ-C4, nas bandas de freqüência teta e alfa. Os resultados principais demonstraram mudança na performance através das variáveis comportamentais "tempo" e "número de erros". Concomitantemente, não foram observadas alterações na variável neurofisiológica "Potência Absoluta" na banda teta. Em contrapartida, houve um aumento significativo na banda alfa em áreas centrais (CZ-C3/CZ-C4). Tais resultados sugerem uma adaptação do córtex sensório-motor em função do treinamento de datilografia.<br>The present study aimed to investigate alterations in EEG patterns in normal, right-handed individuals, during the process of learning a specific motor skill (typewriting). Recent studies have shown that the cerebral cortex is susceptible to several changes during a learning process and that alterations in the brain's electrical patterns take place as a result of the acquisition of a motor skill and memory consolidation. In this context, subjects' brain electrical activity was analyzed before and after the motor task. EEG data were collected by a Braintech 3000 and analyzed by Neurometrics. For the statistical analysis, the behavioral variables "time" and "number of errors" were assessed by a one-way ANOVA. For the neurophysiological variable "Absolute Power", a paired t-Test was performed for each pair of electrodes CZ-C3/CZ-C4, in the theta and alpha frequency bands. The main results demonstrated a change in performance, through both behavioral variables ("time" and "number of errors"). At the same time, no changes were observed for the neurophysiological variable ("Absolute Power") in the theta band. On the other hand, a significant increase was observed in the alpha band in central areas (CZ-C3/CZ-C4). These results suggest an adaptation of the sensory-motor cortex, as a consequence of the typewriting training

Clinimetric quality of the fire fighting simulation test as part of the Dutch fire fighters Workers' Health Surveillance

<p>Abstract</p> <p>Background</p> <p>Clinimetric data for the fire fighting simulation test (FFST), a new test proposed for the Workers' Health Surveillance (WHS) of Dutch fire fighters, were evaluated.</p> <p>Methods</p> <p>Twenty-one fire fighters took the FFST three times with one and three weeks between testing. Clinimetric quality was determined by means of reliability, agreement and validity. For reliability and agreement, the intraclass correlation coefficient (ICC), and standard error of measurement (SEM), were analysed. For construct validity, the tests from 45 fire fighters were correlated with their own and their supervisors' rated work ability.</p> <p>Results</p> <p>The ICCs were 0.56 and 0.79 at the one-week and three-week test-retest periods, respectively. Testing times ranged from 9 to 17 minutes; the SEMs were 70 s at the one-week and 40 s at the three-week test-retest periods. The construct validity was moderate (-0.47 ≤ r ≤ -0.33; p < 0.05).</p> <p>Conclusions</p> <p>The FFST was reliable with acceptable agreement after three weeks. Construct validity was moderate. We recommend using FFST as a part of the WHS for Dutch fire fighters. It is advised that fire fighters should perform the FFST once as a trial before judging their performance in testing time during the second performance.</p

Diet of Lontra longicaudis (Olfers, 1818) (Carnivora: Mustelidae) in three limnic systems in Southern Rio Grande do Sul State, Brazil

The aim of the present work was to study the diet of Lontra longicaudis in three limnic systems (anthropogenic shallow lakes, pluvial channel and coastal stream) in Rio Grande do Sul State coastal plain, southern Brazil. Fishes were the most consumed item in all the three systems, being Mugilidae the most representative family in the pluvial channel and coastal stream and Cichlidae in the shallow lakes. Other identified items were mollusks, insects, crustaceans, amphibians, reptiles, birds and mammals and vegetal fragments. The high frequency of birds in the shallow lakes was remarkable, considering the lower frequencies of this item in previous investigations on the species diet. There was a high frequency of swamp eels (Synbranchidae, Synbranchus marmoratus) in the pluvial channel and shallow lakes, which were usually absent or found in low frequencies in previous studies