Neuropathic pain in low back-related leg pain patients: What is the evidence of prevalence, characteristics, and prognosis in primary care? A systematic review of the literature.

This systematic review synthesizes literature describing prevalence, characteristics and prognosis of low back-related leg pain (LBLP) patients with neuropathic pain in primary care and/or similar settings. Inclusion and exclusion criteria were developed and used by independent reviewers to screen citations for eligibility. The initial search yielded 24,948 citations; after screening 12 studies were included. Neuropathic pain was identified by case ascertainment tools (n=5), by clinical history with examination (n=4), and by LBLP samples assumed neuropathic (n=3). Neuropathic pain prevalence varied from 19% to 80%. There was consistent evidence for higher back-related disability (n=3), poorer health-related quality of life (n=2) and some evidence for more severe depression (n=2), anxiety (n=3) and pain intensity (n=4) in patients with neuropathic pain. Results were less consistent when cases were identified through clinical history plus examination than those identified using case ascertainment tools. Prognosis (n=1) of LBLP patients with neuropathic pain was worse compared to those without, in all outcomes (leg pain intensity, leg and back-related disability, self-reported general health) except back pain intensity. No studies described prognostic factors. This systematic review highlights the evidence gap in neuropathic pain in LBLP in primary care, especially with respect to prognosis. PERSPECTIVE: Patients with low back-related leg pain may have neuropathic pain. This systematic review emphasises the paucity of evidence describing the characteristics and prognosis of neuropathic pain in this patient population. Future research investigating prognosis of these patients with neuropathic pain is likely to contribute to better understanding and management

Prevalence, Characteristics and Clinical Course of Neuropathic Pain in Primary Care Patients Consulting with Low Back-related Leg Pain.

OBJECTIVES: Little is known about the epidemiology of neuropathic pain in primary care patients consulting with low back-related leg pain. We aimed to describe prevalence, characteristics and clinical course of low back-related leg pain patients with and without neuropathic pain, consulting with their family doctor in the UK. METHODS: This was a prospective cohort study. Data were collected using a standardised baseline clinical examination and self-report questionnaires at baseline, 4, 12 and 36-months. We identified cases of neuropathic pain using three definitions: two based on clinical diagnosis (sciatica, with and without evidence of nerve root compression on MRI), one on the self-report version of Leeds Assessment for Neurological Symptoms and Signs (S-LANSS). Differences between patients with and without neuropathic pain were analysed comparing each definition. Clinical course (mean pain intensity measured as the highest of leg or back pain intensity: mean of three Numerical Rating Scales, each 0-10) was investigated using linear mixed models over 36-months. RESULTS: Prevalence of neuropathic pain varied from 48% to 74% according to definition used. At baseline, patients with neuropathic pain had more severe leg pain intensity, lower pain self-efficacy, more patients had sensory loss than those without. Distinct profiles were apparent depending on neuropathic pain definition. Mean pain intensity reduced after 4-months (6.1 to 3.9 (sciatica)), most rapidly in cases defined by clinical diagnosis. DISCUSSION: This research provides new information on the clinical course of neuropathic pain and a better understanding of neuropathic pain in low back-related leg pain patients consulting in primary care

Trends in gabapentinoid prescribing in UK primary care using the Clinical Practice Research Datalink: an observational study

Background The UK government reclassified gabapentin and pregabalin as ‘controlled drugs’ from April 2019. This study aimed to describe the trends in gabapentinoid prescribing before and immediately after reclassification, in the UK Clinical Practice Research Datalink, an electronic primary care health record broadly representative of the UK. Methods Separately for gabapentin and pregabalin, we calculated annual incident and prevalent prescribing rates from year of UK approval (April 1997 and 2004 respectively) to September 2019, and monthly incident and prevalent prescribing rates (October 2017–September 2019). Significant changes in temporal trends were determined using joinpoint regression. We also described potential prescribing indications, prior pain-related prescribing, and co-prescribing with potentially interacting medicines. Findings Incident gabapentin prescribing increased annually, peaking in 2016–17, at 625/100,000 patient years before falling steadily to 2019. Incident pregabalin prescribing peaked at 329/100,000 patient years in 2017–18 and did not fall significantly until 2019. Prevalent gabapentin and pregabalin prescribing increased annually to 2017–18 and 2018–19 respectively, before plateauing. Gabapentinoids were commonly co-prescribed with opioids (60%), antidepressants (52%), benzodiazepines (19%), and Z-drugs (10%). Interpretation Following a dramatic rise, incident gabapentinoid prescribing has started to fall but the specific impact of reclassification on prescribing rates remains unclear. Limited change in prevalent gabapentinoid prescribing during the 6 months following their reclassification as controlled drugs suggests little immediate impact on continued gabapentinoid prescribing for existing users. Funding National Institute for Health and Care Research (NIHR) Research for Patient Benefit Programme. NIHR Applied Research Collaboration West Midlands. NIHR School for Primary Care Research

First integrative trend analysis for a great ape species in Borneo

For many threatened species the rate and drivers of population decline are difficult to assess accurately: species’ surveys are typically restricted to small geographic areas, are conducted over short time periods, and employ a wide range of survey protocols. We addressed methodological challenges for assessing change in the abundance of an endangered species. We applied novel methods for integrating field and interview survey data for the critically endangered Bornean orangutan (Pongo pygmaeus), allowing a deeper understanding of the species’ persistence through time. Our analysis revealed that Bornean orangutan populations have declined at a rate of 25% over the last 10 years. Survival rates of the species are lowest in areas with intermediate rainfall, where complex interrelations between soil fertility, agricultural productivity, and human settlement patterns influence persistence. These areas also have highest threats from human-wildlife conflict. Survival rates are further positively associated with forest extent, but are lower in areas where surrounding forest has been recently converted to industrial agriculture. Our study highlights the urgency of determining specific management interventions needed in different locations to counter the trend of decline and its associated drivers

Recent Surveys in the Forests of Ulu Segama Malua, Sabah, Malaysia, Show That Orang-utans (P. p. morio) Can Be Maintained in Slightly Logged Forests

BACKGROUND: Today the majority of wild great ape populations are found outside of the network of protected areas in both Africa and Asia, therefore determining if these populations are able to survive in forests that are exploited for timber or other extractive uses and how this is managed, is paramount for their conservation. METHODOLOGY/PRINCIPAL FINDINGS: In 2007, the "Kinabatangan Orang-utan Conservation Project" (KOCP) conducted aerial and ground surveys of orang-utan (Pongo pygmaeus morio) nests in the commercial forest reserves of Ulu Segama Malua (USM) in eastern Sabah, Malaysian Borneo. Compared with previous estimates obtained in 2002, our recent data clearly shows that orang-utan populations can be maintained in forests that have been lightly and sustainably logged. However, forests that are heavily logged or subjected to fast, successive coupes that follow conventional extraction methods, exhibit a decline in orang-utan numbers which will eventually result in localized extinction (the rapid extraction of more than 100 m(3) ha(-1) of timber led to the crash of one of the surveyed sub-populations). Nest distribution in the forests of USM indicates that orang-utans leave areas undergoing active disturbance and take momentarily refuge in surrounding forests that are free of human activity, even if these forests are located above 500 m asl. Displaced individuals will then recolonize the old-logged areas after a period of time, depending on availability of food sources in the regenerating areas. CONCLUSION/SIGNIFICANCE: These results indicate that diligent planning prior to timber extraction and the implementation of reduced-impact logging practices can potentially be compatible with great ape conservation

Status and determinants of intra-household food allocation in rural Nepal.

BACKGROUND/OBJECTIVES: Understanding of the patterns and predictors of intra-household food allocation could enable nutrition programmes to better target nutritionally vulnerable individuals. This study aims to characterise the status and determinants of intra-household food and nutrient allocation in Nepal. SUBJECTS/METHODS: Pregnant women, their mothers-in-law and male household heads from Dhanusha and Mahottari districts in Nepal responded to 24-h dietary recalls, thrice repeated on non-consecutive days (n = 150 households; 1278 individual recalls). Intra-household inequity was measured using ratios between household members in food intakes (food shares); food-energy intake proportions ('food shares-to-energy shares', FS:ES); calorie-requirement proportions ('relative dietary energy adequacy ratios', RDEARs) and mean probability of adequacy for 11 micronutrients (MPA ratios). Hypothesised determinants were collected during the recalls, and their associations with the outcomes were tested using multivariable mixed-effects linear regression models. RESULTS: Women's diets (pregnant women and mothers-in-law) consisted of larger FS:ES of starchy foods, pulses, fruits and vegetables than male household heads, whereas men had larger FS:ES of animal-source foods. Pregnant women had the lowest MPA (37%) followed by their mothers-in-law (52%), and male household heads (57%). RDEARs between pregnant women and household heads were 31% higher (log-RDEAR coeff=0.27 (95% CI 0.12, 0.42), P < 0.001) when pregnant women earned more or the same as their spouse, and log-MPA ratios between pregnant women and mothers-in-law were positively associated with household-level calorie intakes (coeff=0.43 (0.23, 0.63), P < 0.001, per 1000 kcal). CONCLUSIONS: Pregnant women receive inequitably lower shares of food and nutrients, but this could be improved by increasing pregnant women's cash earnings and household food security

Modificações vocais acústicas produzidas pela fonação reversa Acoustic vocal modifications produced by reverse phonation

OBJETIVO: Descrever as modificações vocais acústicas e as sensações ocorridas após a técnica vocal de fonação reversa em mulheres adultas jovens, sem queixas vocais e com laringe normal. MÉTODOS: Trinta e duas mulheres adultas jovens submeteram-se à avaliação otorrinolaringológica e triagem fonoaudiológica para descartar possíveis alterações que pudessem interferir nos resultados da pesquisa; tiveram amostras vocais coletadas antes e após realizarem três séries de 15 repetições de fonação reversa, em tempo máximo de fonação com tom e intensidade habituais, e 30 segundos de repouso passivo entre cada série. Após, responderam a um questionário referente às sensações percebidas. A análise vocal acústica foi realizada através do software Praat (versão 4.6.10) e os dados analisados por meio da estatística descritiva e pelo teste de Wilcoxon, com nível de significância de 5%. RESULTADOS: Aumento estatisticamente significativo da frequência fundamental e da frequência máxima; diminuição da frequência mínima; aumento das medidas de Jitter, exceto da medida de Jitter local-absoluto que diminuiu; diminuição das medidas de Shimmer, relação ruído/harmônico (NHR) e relação harmônico/ruído (HNR); e predomínio das sensações positivas. CONCLUSÃO: A fonação reversa pareceu promover efeito positivo sobre a vibração da mucosa das pregas vocais e sobre o seu alongamento. Sugere efeito sobre a musculatura, favorecendo mudanças de frequência fundamental; e sobre sua homogeneização e modificação da camada de muco. Além disso, promoveu melhora global do sinal vocal e das sensações durante sua produção.<br>PURPOSE: To describe the acoustic vocal modifications and the sensations occurred after the reverse phonation technique in young adult women without vocal complaints and with normal larynx. METHODS: Thirty-two young adult women were submitted to otorhinolaryngologic and speech-language pathology screening to discard possible alterations that could interfere with the results of the research; had vocal samples collected before and after carrying out three series of 15 repetitions of reverse phonation, in maximum time of phonation with the habitual tone and intensity, and 30 seconds of passive rest between series. After that, they answered a questionnaire regarding their sensations. Vocal acoustic analysis was carried out using the software Praat (version 4.6.10), and the data were analyzed using descriptive statistics and the Wilcoxon test, with a 5% level of significance. RESULTS: Statistically significant increase of the fundamental frequency and the maximum frequency; decrease of the minimum frequency; increase of the measures of Jitter, except for the local-absolute Jitter, which diminished; decrease of Shimmer, noise-to-harmonic ratio, and harmonic-to-noise ratio measures; and predominance of positive sensations. CONCLUSION: Reverse phonation promoted a positive effect over the vibration of the mucosa of the vocal folds and over their stretching. This result suggests an effect over the vocal muscles, favoring changes of fundamental frequency; and over the homogenization and modification of mucus layer. Moreover, it promoted a global improvement of the vocal signal and of the sensations during its production