A randomised controlled trial to assess the effectiveness of a single session of nurse administered massage for short term relief of chronic non-malignant pain

Background: Massage is increasingly used to manage chronic pain but its benefit has not been clearly established. The aim of the study is to determine the effectiveness of a single session of nurse-administered massage for the short term relief of chronic non-malignant pain and anxiety. Methods: A randomised controlled trial design was used, in which the patients were assigned to a massage or control group. The massage group received a 15 minute manual massage and the control group a 15 minute visit to talk about their pain. Adult patients attending a pain relief unit with a diagnosis of chronic pain whose pain was described as moderate or severe were eligible for the study. An observer blind to the patients' treatment group carried out assessments immediately before (baseline), after treatment and 1, 2, 3 and 4 hours later. Pain was assessed using 100 mm visual analogue scale and the McGill Pain Questionnaire. Pain Relief was assessed using a five point verbal rating scale. Anxiety was assessed with the Spielberger short form State-Trait Anxiety Inventory. Results: 101 patients were randomised and evaluated, 50 in the massage and 51 in the control group. There were no statistically significant differences between the groups at baseline interview. Patients in the massage but not the control group had significantly less pain compared to baseline immediately after and one hour post treatment. 95% confidence interval for the difference in mean pain reduction at one hour post treatment between the massage and control groups is 5.47 mm to 24.70 mm. Patients in the massage but not the control group had a statistically significant reduction in anxiety compared to baseline immediately after and at 1 hour post treatment. Conclusion: Massage is effective in the short term for chronic pain of moderate to severe intensity

Promover a partir do interior: o papel do facilitador no apoio a formas dialógicas e reflexivas de auto-avaliação

Resumo Este artigo apresenta uma abordagem reflexiva e dialógica para a avaliação que tem sido desenvolvida ao longo de cerca de vinte anos por um grupo de pesquisa em educação na Universidade de Pavia e que foi testado em campo em várias experiências e pesquisas realizadas na Itália, em que educadores de creches e escolas de educação infantil estiveram diretamente envolvidos. A abordagem, inspirada na avaliação de quarta geração de Guba e Lincoln e na teoria do pensamento reflexivo de Dewey, considera a avaliação como um processo pelo qual as pessoas que trabalham em uma instituição de ensino podem refletir em grupo sobre suas crenças e práticas educacionais, a fim de planejar e implementar ações de melhora. Depois de delinear brevemente os principais benefícios da abordagem, vou me concentrar no papel desempenhado nela pela figura dofacilitador, alguém de fora da realidade educacional objeto de avaliação, cuja principal tarefa é ajudar os participantes a reconstruir uma imagem compartilhada da realidade em que operam, o que torna possível prever o futuro, pensando em por que você faz o que você faz e como você pode melhorar isso. O principal objetivo dessa figura é “promover a partir de dentro” provocando, através da reflexão, o “empoderamento” de grupos de educadores e professores. Com base em uma pesquisa recente, as estratégias comunicativas e maiêuticas utilizadas por essa figura na promoção de processos de auto-avaliação em grupos de educadores e professores também serão apresentados

Genetic and environmental contributions to loneliness in adults: the Netherlands Twin Register study

Heritability estimates based on two small studies in children indicate that the genetic contribution to individual differences in loneliness is approximately 50%. Heritability estimates of complex traits such as loneliness may change across the lifespan, however, as the frequency, duration, and range of exposure to environmental influences accrues, or as the expression of genetic factors changes. We examined data on loneliness from 8,387 young adult and adult Dutch twins who had participated in longitudinal survey studies. A measure of loneliness was developed based on factor analyses of items of the YASR (Achenbach, (1990) The Young Adult Self Report, University of Vermont, Department of Psychiatry, Burlington, VT). Variation in loneliness was analyzed with genetic structural equation models. The estimate of genetic contributions to variation in loneliness in adults was 48%, which is similar to the heritability estimates found previously in children. There was no evidence for sex or age differences in genetic architecture. Sex differences in prevalence were significant, but we did not see an association with age or birth cohort. All resemblance between twin relatives was explained by shared genes, without any suggestion of a contribution of shared environmental factors. ©2005 Springer Science+Business Media, Inc

Herbal supplements in the print media: communicating benefits and risks

Background The rise in use of food supplements based on botanical ingredients (herbal supplements) is depicted as part of a trend empowering consumers to manage their day-to-day health needs, which presupposes access to clear and accurate information to make effective choices. Evidence regarding herbal supplement efficacy is extremely variable so recent regulations eliminating unsubstantiated claims about potential effects leave producers able to provide very little information about their products. Medical practitioners are rarely educated about herbal supplements and most users learn about them via word-of-mouth, allowing dangerous misconceptions to thrive, chief among them the assumption that natural products are inherently safe. Print media is prolific among the information channels still able to freely discuss herbal supplements. Method This study thematically analyses how 76 newspaper/magazine articles from the UK, Romania and Italy portray the potential risks and benefits of herbal supplements. Results Most articles referenced both risks and benefits and were factually accurate but often lacked context and impartiality. More telling was how the risks and benefits were framed in service of a chosen narrative, the paucity of authoritative information allowing journalists leeway to recontextualise herbal supplements in ways that serviced the goals and values of their specific publications and readerships. Conclusion Providing sufficient information to empower consumers should not be the responsibility of print media, instead an accessible source of objective information is required.</p

Magnet therapy for the relief of pain and inflammation in rheumatoid arthritis (CAMBRA): A randomised placebo-controlled crossover trial

<p>Abstract</p> <p>Background</p> <p>Rheumatoid arthritis is a common inflammatory autoimmune disease. Although disease activity may be managed effectively with prescription drugs, unproven treatments such as magnet therapy are sometimes used as an adjunct for pain control. Therapeutic devices incorporating permanent magnets are widely available and easy to use. Magnets may also be perceived as a more natural and less harmful alternative to analgesic compounds. Of interest to health service researchers is the possibility that magnet therapy might help to reduce the economic burden of managing chronic musculoskeletal disorders. Magnets are extremely cheap to manufacture and prolonged treatment involves a single cost. Despite this, good quality scientific evidence concerning the safety, effectiveness and cost-effectiveness of magnet therapy is scarce. The primary aim of the CAMBRA trial is to investigate the effectiveness of magnet therapy for relieving pain and inflammation in rheumatoid arthritis.</p> <p>Methods/Design</p> <p>The CAMBRA trial employs a randomised double-blind placebo-controlled crossover design. Participant will each wear four devices: a commercially available magnetic wrist strap; an attenuated wrist strap; a demagnetised wrist strap; and a copper bracelet. Device will be allocated in a randomised sequence and each worn for five weeks. The four treatment phases will be separated by wash out periods lasting one week. Both participants and researchers will be blind, as far as feasible, to the allocation of experimental and control devices. In total 69 participants will be recruited from general practices within the UK. Eligible patients will have a verified diagnosis of rheumatoid arthritis that is being managed using drugs, and will be experiencing chronic pain. Outcomes measured will include pain, inflammation, disease activity, physical function, medication use, affect, and health related costs. Data will be collected using questionnaires, diaries, manual pill counts and blood tests.</p> <p>Discussion</p> <p>Magnetism is an inherent property of experimental devices which is hard to conceal. The use of multiple control devices, including a copper bracelet, represents a concerted attempt to overcome methodological limitations associated with trials in this field. The trial began in July 2007. At the time of submission (August 2008) recruitment has finished, with 70 trial participants, and data collection is almost complete.</p> <p>Trial Registration</p> <p>Current Controlled Trials ISRCTN51459023</p

The Local Economic Impact of Shale Gas Extraction

Advocates of UK shale gas expansion have focused upon predicted national economic benefits, but local and/or regional impact has been largely neglected. This paper seeks to address this deficit by creating a unique dataset, combining industry data with consumer and supply chain surveys, thereby overcoming the current absence of suitable secondary data. Local economic impact in the Bowland field is estimated via a simple Keynesian local income multiplier model. Results emphasize the importance of facilitating local employment opportunities, through skills initiatives, and development of regional supply chain clusters, to anchor economic benefits within the local economy. Policy implications are discussed

Comment letters to the National Commission on Commission on Fraudulent Financial Reporting, 1987 (Treadway Commission) Vol. 2

https://egrove.olemiss.edu/aicpa_sop/1662/thumbnail.jp

International Consensus Statement on Rhinology and Allergy: Rhinosinusitis

Background: The 5 years since the publication of the first International Consensus Statement on Allergy and Rhinology: Rhinosinusitis (ICAR‐RS) has witnessed foundational progress in our understanding and treatment of rhinologic disease. These advances are reflected within the more than 40 new topics covered within the ICAR‐RS‐2021 as well as updates to the original 140 topics. This executive summary consolidates the evidence‐based findings of the document. Methods: ICAR‐RS presents over 180 topics in the forms of evidence‐based reviews with recommendations (EBRRs), evidence‐based reviews, and literature reviews. The highest grade structured recommendations of the EBRR sections are summarized in this executive summary. Results: ICAR‐RS‐2021 covers 22 topics regarding the medical management of RS, which are grade A/B and are presented in the executive summary. Additionally, 4 topics regarding the surgical management of RS are grade A/B and are presented in the executive summary. Finally, a comprehensive evidence‐based management algorithm is provided. Conclusion: This ICAR‐RS‐2021 executive summary provides a compilation of the evidence‐based recommendations for medical and surgical treatment of the most common forms of RS