‘On their own’: social isolation, loneliness and chronic musculoskeletal pain in older adults

Purpose: In this paper, the concepts of social isolation and loneliness will be explored in relation to people with chronic musculoskeletal pain. Through this, biological, psychological and social factors will be examined to consider how we can identified people at risk of social isolation and loneliness who have chronic musculoskeletal pain and secondly how health professionals may intervene to reduce their effects. Design/methodology/approach: Conceptual paper. Findings: Social isolation and loneliness is evident in people with chronic musculoskeletal diseases. This may be bi-directional where both pain may lead to social isolation and loneliness, or social isolation and loneliness may exacerbate pain. Interventions to improve the symptoms of chronic musculoskeletal pain, and approaches around social participation and engagement should be adopted in combination to ameliorate this potentially disabling scenario. Originality/value: There remains limited evidence around the prevalence and management of social isolation and loneliness for people with chronic musculoskeletal pain. By raising awareness of social isolation and loneliness in this population, people with chronic musculoskeletal pain may be better supported to reduce the negative impact that social isolation and loneliness can have on their health and well-being

Nilhilism in Nietzsche, Heidegger and Levinas

This thesis presents an account of nihilism in the philosophy of Friedrich Nietzsche, and a critical response to it using the philosophies of Martin Heidegger and Emmanuel Levinas. Chapter one gives an account of the three different types of nihilism in Nietzsche’s writings, and of how the latest outbreak of nihilism, modern European, came about. Chapter two presents Nietzsche's own responses to modern European nihilism, focusing on the overman, the will to power, the eternal recurrence and his view of truth, and points out the disturbing ethical implications of Nietzsche's responses to nihilism. Chapter three places Nietzsche’s philosophy within the context of Heidegger's account of nihilism as 'forgetfulness of Being', and considers Heidegger's critique of Nietzsche and the notion of 'values', Heidegger's account of the philosophical tradition since Plato, and his reflection on our ‘technological' understanding of Being as an inevitable result of the 'forgetfulness of Being’. Chapter four discusses how Being and Time and its critique of Descartes and the subject-object distinction can be seen as a response to nihilism as the 'forgetfulness of Being՝, and as an implicit part of Heidegger's critique of Nietzsche. Chapter five considers Heidegger’s response to nihilism in terms of his writings on authenticity, art, language, and thinking, and shows how all of these features of Heidegger's thought aim to attune us to Being as the mysterious 'source' of all particular understandings of being, a source to which we are beholden for the sense we are able to make in our lives. The potentially dangerous features of this picture of human life are then addressed, as is the lack of an explicitly ethical dimension to Heidegger's response to Nietzsche's explicitly ethical account of nihilism. Chapter six gives an account of Levinas's phenomenology of ethics and his critique of Heidegger and the philosophical tradition as 'philosophies of the Same'. It presents Levinas's theses concerning the importance of the other person in giving philosophical accounts of language, truth, and objectivity, and the heteronomous nature of the moral subject, as a way of making good the lack of an explicitly ethical response to Nietzschean nihilism in Heidegger’s philosophy

Investigations on the physiotherapy management of people following first-time patellar dislocation

Background: First-time patellar dislocation (FTPD) is a disabling musculoskeletal disorder. Whilst physiotherapy is considered the cornerstone treatment in FTPD, its evidence-base is limited. Three studies were undertaken to develop knowledge on this area. Study 1: All 306 National Health Service acute hospitals with an accident and emergency and/or an orthopaedic department were sent a fourteen-item questionnaire pertaining to the management of FTPD. Physiotherapists reported they most commonly assessed this population for reduced quadriceps or vastus medialis oblique (VMO) capacity, patellar maltracking and excessive patellar glide. Reassurance, proprioceptive, knee mobility, quadriceps and VMO-specific exercises were the most commonly cited treatments. Study 2: Ninety people who had experienced recurrent patellar instability completed a questionnaire which assessed the frequency with which they perceived patellar instability during various activities. Sporting and multidirectional activities were frequently associated with patellar instability. Females and those without a family history of patellar instability reported more frequent patellar instability symptoms compared to males, or those with a family history of this disorder. The results were used to construct the Norwich Patellar Instability Score. Study 3: A pragmatic multi-centre randomised controlled trial was conducted to compare the prescription of a general quadriceps exercise and rehabilitation programme (n=15) to a VMO-specific exercise and rehabilitation regime (n=12). Whilst Lysholm Knee Score was statistically different between the groups (p=0.02) this was not clinically significant. The general quadriceps exercise group reported a statistically significantly greater Tegner Level of Activity Score at six weeks (p=0.03) but not at six months (p=0.42). There was no significant difference between the groups for isometric knee extension, Short Form-12 or recurrent patellar dislocation at either follow-up (p>0.05). Conclusions: The studies undertaken have significantly developed the evidence-base in this field. Further investigations are recommended to further inform the clinical decision-making of physiotherapists who manage people following FTPD

Association between osteoarthritis and cardiovascular disease: systematic review and meta-analysis

Background: To examine for a possible relationship between osteoarthritis and cardiovascular disease (CVD). Design: A systematic review and meta-analysis Methods: Published and unpublished literature from: MEDLINE, EMBASE, CINAHL, the Cochrane Library, OpenGrey and clinical trial registers. Search to 22nd November 2014. Cohort, case-control, randomised and non-randomised controlled trial papers reporting the prevalence of CVD in osteoarthritis were included. Results: Fifteen studies with 32,278,744 individuals were eligible. Pooled prevalence for overall CVD pathology in people with osteoarthritis was 38.4% (95% Confidence interval (CI): 37.2% to 39.6%). Individuals with osteoarthritis were almost three times as likely to have heart failure (Relative Risk (RR): 2.80; 95% CI: 2.25 to 3.49) or ischaemic heart disease (RR: 1.78; 95% CI: 1.18 to 2.69) compared to matched non-osteoarthritis cohorts. No significant difference was detected between the two groups for the risk of experiencing myocardial infarction or stroke. There was a three-fold decrease in the risk of experiencing a transient ischaemic attack in the osteoarthritis cohort compared to the non-osteoarthritis group. Conclusions: Prevalence of CVD in patients with OA is significant. There was an observed increased risk of incident heart failure and ischaemic heart disease in people with OA compared to matched controls. However the relationship between OA and CVD is not straight-forward and there is a need to better understand the potential common pathways linking pathophysiological mechanisms

Medical morbidities in people following hip and knee arthroplasty: data from the Osteoarthritis Initiative

Background: Total hip (THA) and knee (TKA) arthroplasty are common orthopaedic procedures most frequently for older people. Whilst it is known that this older population frequently present with medical morbidities, no studies have previously documented the prevalence of such morbidities in people who have undergone THA or TKA. The purpose of this study was to determine the prevalence and what factors are in association with the presentation of medical morbidities in these populations. Methods: Data from the Osteoarthritis Initiative, a population-based observational study, was assessed. In total 419 people who had undergone a THA or TKA were assessed to determine the prevalence of recorded morbidities within 12 months post-arthroplasty. All medical morbidities were then assessed using univariate and then multivariate logistic regression analysis to identify factors influencing the presentation of specific morbidities at 12 months following THA or TKA. Results: The most common medical morbidities included: osteoporosis (16%), mild to moderate depression (8%), cancer (8%), diabetes (6%), history of stroke or TIA (6%) and asthma (5%). The medical morbidities demonstrated are similar between those who undergo THA and TKA. Only gender and ethnic origin were identified as statistically significant predictors of medical morbidities in these populations. Gender was a predictor of history of heart failure, whilst ethnic origin significantly predicted depression. Conclusions: People who undergo THA or TKA may present with a variety of medical morbidities. Accordingly consideration should be made on how to encourage the adoption and maintenance of physical activity and healthy lifestyle choices for this population

Barriers to uptake of the hip fracture core outcome set: an international survey of 80 hip fracture trialists.

Background: Core outcome sets are an agreed recommendation to inform the selection of outcome measures in clinical trials. There has been low uptake of the 2014 hip fracture core outcome set. The reasons for this remain unclear. The aim of this study was to understand the reasons for the non-adoption and approaches to increase adoption of the hip fracture core outcome set. Methods: Randomised controlled trials from PubMed (2017–2019) and ClinicalTrials.gov (2015–2019) were identified. Corresponding authors for each identified trial (n = 302) were surveyed using five questions on awareness of the hip fracture core outcome set, reasons for non-adoption and approaches to increase adoption. Data were analysed descriptively using frequencies, mean values and standard deviations. Results: Fifty-four percent of the respondents (n = 43) were aware of the concept of core outcome set. Only 15% (n = 12) based the outcome measure selection on the 2014 hip fracture core outcome set. Key reasons for non-adoption included the following: authors being unaware and perceived inappropriateness to their trial design. Eighty-six percent (n = 69) of respondents agreed to the need for increased awareness of core outcome sets through research training, academic and clinical journal requirements, and funding or publication stipulations. Eighty-eight percent (n = 70) of respondents indicated the current core outcome set required revision to focus on trials investigating people with cognitive impairment, caregivers, rehabilitation, surgical interventions and anaesthetic trial designs. Conclusion: Barriers to the adoption of the hip fracture core outcome set centre on education, awareness of the core outcome sets and applicability to the breath of hip fracture trial designs. Further consideration should be made to address these, to improve the harmonisation of outcome measures across hip fracture trials

Trajectory of Psychosocial Measures amongst Informal Caregivers: Case-Controlled Study of 1375 Informal Caregivers from the English Longitudinal Study of Ageing.

Informal caregivers provide vital support for older adults living in the community with chronic illnesses. The purpose of this study was to assess the psychosocial status of informal caregivers of community-dwelling adults over an eight-year period. Informal caregivers of adult care-recipients were identified from Wave 1 of the English Longitudinal Study of Ageing (ELSA) cohort. Multivariate regression analysis models were constructed to assess the association between participant's psychosocial characteristics and informal caregiving. Multilevel modelling explored the psychosocial changes between caregivers and non-caregivers over eight years. 1375 informal caregivers and 2750 age-matched non-caregivers were analyzed. Self-reported loneliness (Odd Ratio (OR): 0.26; 95% confidence intervals (CI): 0.01-0.51) and relationship status (OR: 0.36; 95% CI: 0.16-0.46) were independently associated with caregiving. Caregivers were more socially isolated with less holidaying abroad (OR: 0.51; 95% CI: 0.35-0.66), attendance to church (OR: 0.30; 95% CI: 0.11-0.49), or charity groups (OR: 0.35; 95% CI: 0.14-0.55). On multilevel analysis, over time (eight-years), caregivers reported greater loneliness (p < 0.01), change in relationship status (p = 0.01) and reduced control, autonomy, and pleasure (p ≤ 0.01) compared to non-caregivers. Given the deleterious effects caregiving can place on health and wellbeing, further interventions are required to improve these psychosocial factors

Entanglement can completely defeat quantum noise

We describe two quantum channels that individually cannot send any information, even classical, without some chance of decoding error. But together a single use of each channel can send quantum information perfectly reliably. This proves that the zero-error classical capacity exhibits superactivation, the extreme form of the superadditivity phenomenon in which entangled inputs allow communication over zero capacity channels. But our result is stronger still, as it even allows zero-error quantum communication when the two channels are combined. Thus our result shows a new remarkable way in which entanglement across two systems can be used to resist noise, in this case perfectly. We also show a new form of superactivation by entanglement shared between sender and receiver.Comment: 4 pages, 1 figur