Pre-treatment pain predicts outcomes in multimodal treatment for tortured and traumatized refugees: A pilot investigation

Background: Chronic pain is a common comorbid complaint in traumatized refugees seeking treatment for posttraumatic stress disorder (PTSD) and depression. However, the effect of comorbid pain on treatment remains under investigated. Objective: To investigate whether pre-treatment pain (severity/interference) predicts outcomes in a multimodal treatment targeting PTSD, depression, anxiety, somatic complaints, and health-related disability in refugees exposed to torture and organized violence. Additional predictors were gender, age, and number of treatment sessions. Method: Participants were active cases at a specialist outpatient clinic for tortured refugees (n = 276; 170 men, 106 women) who were either on a treatment waitlist (mean length = 7.4 months, SD = 4.5), in treatment (mean length = 12.2 months, SD = 6.5), or who completed treatment and had (or were waiting for) a follow-up assessment. Participants completed symptom measures at referral, pre- and post-treatment, and 9-month follow-up. Multi-level mixed modelling was used to assess whether outcomes at post-treatment and 9-months were predicted by pain, gender, age, or the number of treatment sessions. Results: Treatment yielded significant pre-to-post-treatment reductions in PTSD, depression, anxiety, and number of pain locations, but no reductions in pain severity/interference, or health-related disability, except for societal participation. Gains for PTSD, depression, and societal participation were maintained at the 9-month follow-up. Higher levels of pain interference (but not severity) predicted poorer outcomes (PTSD, depression, and anxiety). Age, gender and number of treatment sessions did not predict outcomes, except for a small negative effect of (older) age on PTSD. Conclusions: A growing body of literature suggests that pain and PTSD symptoms interact in ways to increase the severity and impact of both disorders in refugee and non-refugee populations alike. The present study suggests interference from pain can lessen the effectiveness of standard multi-modal treatments for refugees

Torture survivors’ symptom load compared to chronic pain and psychiatric in-patients

Before their entry into the rehabilitation program at the Rehabilitation and Research Centre for Torture Victims (‘RCT’) in Copenhagen, the degree of symptoms of a group of resettled traumatized refugees was assessed by means of two rating scales: the Disability Rating Index (DRI) (n=197), measuring pain-related functional disability, and the Hospital Anxiety and Depression Scale (HADS) (n=147). The results obtained were compared with other patient populations, which included (1) a large Swedish mixed pain group and (2) various groups of pain patients previously investigated in the validation study of the DRI scale. The DRI scores of the refugee group were comparable to, or higher than, those of the pain groups, except for patients suffering from multiple sclerosis. The degree of anxiety and depression was found to be considerably greater in the refugee group than in the pain groups. Another recently published Danish study comparing traumatized refugees with psychiatric in-patients in terms of Health of Nation Outcome Scores (HoNOS) documented a higher degree of psychiatric disability for refugees. Based on the hypothesis that the observed differences in this study were underestimated due to the exclusion of refugees with psychotic symptoms and substance abuse, a partial re-analysis of the data was carried out by calculating effect sizes with and without the items measuring these symptoms. Controlling for the exclusion of the critical items resulted in a more pronounced difference between the refugees and psychiatric inpatients. Based on the data compared in this study, traumatized refugees are shown to suffer from multiple problems, including chronic pain, at a high symptom-level. This challenges prior clinical assumptions that single factors like PTSD can explain all symptoms

Hur en leverantör till byggindustrin kan bidra till en miljöcertifiering enligt LEED

Syftet med detta examensarbete är att undersöka vad en leverantör till byggindustrin kan göra för att deras kunder ska uppnå en miljöcertifiering enligt LEED. Studien kan delas upp i tre delar. I den första delen har vi fördjupat oss i de miljöstyrmedel som använts i Sverige idag såsom olika miljöcertifieringssystem och miljöledningssystem. Den andra delen beskriver vilka produkter en leverantör till byggindustri kan erbjuda sina kunder med avseende på de bedömningsområden som finns i miljöcertifieringssystemet LEED. Den tredje delen beskriver vilken syn olika aktörer i byggbranschen har på miljöcertifieringssystem. Genom våra undersökningar kom vi fram till att en leverantör till byggindustrin bör inrikta sig på att arbeta med miljöcertifieringssystemen LEED, BREEAM och/eller Miljöbyggnad. De bör inrikta sig på miljödatabaserna BASTA, SundaHus och Byggvarubedömningen. Vi har kommit fram till att en leverantör till byggindustrin bör erbjuda sina kunder följande tjänster: • Rådgivning på byggarbetsplatsen. • Inneha lättillgänglig och uppdaterad dokumentation över relevanta produkter. • Ha svensk information om de produkter de kan erbjuda med avseende på en miljöcertifiering. • Ha en väl utformad och innehållsrik hemsida med avseende på miljöcertifieringssystem. • Ha en direkt kontaktperson som är inriktad på miljöarbete. Slutligen kom vi fram till att en leverantör till byggindustrin bör ha en intern utbildning för att kunna erbjuda de tjänster som punktlistan ovan visar

Acceptability of a physiotherapeutic pain school treatment in trauma-affected populations in the Middle Eastern & Northern African region

Introduction: The aim of this study was to evaluate the acceptability of a physiotherapeutic pain treatment (Pain School), focusing on patient education, physical exercises and self-reliance, and a capacity building program developed for MENA based physiotherapists working with pain and trauma-affected populations.Method: The perceived benefits and challenges of the physiotherapy Pain School treatment were evaluated through qualitative interviews with seven physiotherapists participating in the Pain School training program. The acceptability and feasibility of the treatment manual and training program of the physiotherapists was evaluated. The preliminary results of the Pain School treatment were also analyzed with a paired-sample t-test pre- and post-treatment in 38 patients suffering from persistent pain and trauma-related stress in the MENA region. Results: The qualitative analysis showed good feasibility and high acceptance among the participating physiotherapists of this physiotherapeutic treatment and training program. The pre- to post-treatment evaluation of Pain School, also gave an indication of positive treatment effects. Monitoring and evaluation of treatment was found useful, but indications of mental health status were evaluated to be missing. Due to other limitations, such as author biases (authors carrying out training, interviews and analyzing qualitative results) and no control group, the results from this study do not provide a final conclusion on the training program nor treatment effects. Nevertheless, this study is an important first step to offer evidence-based standardized treatment for pain and trauma-affected populations in the MENA region

CD4(+) CD56(+) natural killer T-like cells secreting interferon-γ are associated with incident coronary events.

CD3(+) CD56(+) natural killer T (NKT)-like cells are a subset of T cells characterized by expression of NK receptors and potent antitumour activity. It has also been suggested that they have a role in autoimmune disease, and levels of NKT-like cells are elevated in patients with coronary disease

Type Ia Supernova Properties as a Function of the Distance to the Host Galaxy in the SDSS-II SN Survey

We use type-Ia supernovae (SNe Ia) discovered by the SDSS-II SN Survey to search for dependencies between SN Ia properties and the projected distance to the host galaxy center, using the distance as a proxy for local galaxy properties (local star-formation rate, local metallicity, etc.). The sample consists of almost 200 spectroscopically or photometrically confirmed SNe Ia at redshifts below 0.25. The sample is split into two groups depending on the morphology of the host galaxy. We fit light-curves using both MLCS2k2 and SALT2, and determine color (AV, c) and light-curve shape (delta, x1) parameters for each SN Ia, as well as its residual in the Hubble diagram. We then correlate these parameters with both the physical and the normalized distances to the center of the host galaxy and look for trends in the mean values and scatters of these parameters with increasing distance. The most significant (at the 4-sigma level) finding is that the average fitted AV from MLCS2k2 and c from SALT2 decrease with the projected distance for SNe Ia in spiral galaxies. We also find indications that SNe in elliptical galaxies tend to have narrower light-curves if they explode at larger distances, although this may be due to selection effects in our sample. We do not find strong correlations between the residuals of the distance moduli with respect to the Hubble flow and the galactocentric distances, which indicates a limited correlation between SN magnitudes after standardization and local host metallicity.Comment: Accepted for publication in The Astrophysical Journal (33 pages, 5 figures, 8 tables

The Effectiveness of Passive Physical Modalities for the Management of Soft Tissue Injuries and Neuropathies of the Wrist and Hand: A Systematic Review by the Ontario Protocol for Traffic Injury Management (OPTIMa) Collaboration

AbstractObjectiveThe purpose of this systematic review was to determine the effectiveness of passive physical modalities compared to other interventions, placebo/sham interventions, or no intervention in improving self-rated recovery, functional recovery, clinical outcomes and/or administrative outcomes (eg, time of disability benefits) in adults and/or children with soft tissue injuries and neuropathies of the wrist and hand.MethodsWe systematically searched MEDLINE, EMBASE, PsycINFO, and the Cochrane Central Register of Controlled Trials, accessed through Ovid Technologies, Inc, and CINAHL Plus with Full Text, accessed through EBSCO host, from 1990 to 2015. Our search strategies combined controlled vocabulary relevant to each database (eg, MeSH for MEDLINE) and text words relevant to our research question and the inclusion criteria. Randomized controlled trials, cohort studies, and case-control studies were eligible. Random pairs of independent reviewers screened studies for relevance and critically appraised relevant studies using the Scottish Intercollegiate Guidelines Network criteria. Studies with low risk of bias were synthesized following best evidence synthesis principles.ResultsWe screened 6618 articles and critically appraised 11 studies. Of those, 7 had low risk of bias: 5 addressed carpal tunnel syndrome (CTS) and 2 addressed de Quervain disease. We found evidence that various types of night splints lead to similar outcomes for the management of CTS. The evidence suggests that a night wrist splint is less effective than surgery in the short term but not in the long term. Furthermore, a night wrist splint and needle electroacupuncture lead to similar outcomes immediately postintervention. Finally, low-level laser therapy and placebo low-level laser therapy lead to similar outcomes. The evidence suggests that kinesio tape or a thumb spica cast offers short-term benefit for the management of de Quervain disease. Our search did not identify any low risk of bias studies examining the effectiveness of passive physical modalities for the management of other soft tissue injuries or neuropathies of the wrist and hand.ConclusionsDifferent night orthoses provided similar outcomes for CTS. Night orthoses offer similar outcomes to electroacupuncture but are less effective than surgery in the short term. This review suggests that kinesio tape or a thumb spica cast may offer short-term benefit for the management of de Quervain disease

Type II-P Supernovae from the SDSS-II Supernova Survey and the Standardized Candle Method

We apply the Standardized Candle Method (SCM) for Type II Plateau supernovae (SNe II-P), which relates the velocity of the ejecta of a SN to its luminosity during the plateau, to 15 SNe II-P discovered over the three season run of the Sloan Digital Sky Survey - II Supernova Survey. The redshifts of these SNe - 0.027 < z < 0.144 - cover a range hitherto sparsely sampled in the literature; in particular, our SNe II-P sample contains nearly as many SNe in the Hubble flow (z > 0.01) as all of the current literature on the SCM combined. We find that the SDSS SNe have a very small intrinsic I-band dispersion (0.22 mag), which can be attributed to selection effects. When the SCM is applied to the combined SDSS-plus-literature set of SNe II-P, the dispersion increases to 0.29 mag, larger than the scatter for either set of SNe separately. We show that the standardization cannot be further improved by eliminating SNe with positive plateau decline rates, as proposed in Poznanski et al. (2009). We thoroughly examine all potential systematic effects and conclude that for the SCM to be useful for cosmology, the methods currently used to determine the Fe II velocity at day 50 must be improved, and spectral templates able to encompass the intrinsic variations of Type II-P SNe will be needed.Comment: Accepted for publication by ApJ; data used in this paper can be downloaded from http://sdssdp47.fnal.gov/sdsssn/photometry/SNIIp.tgz; citation errors correcte