Chronic non-specific low back pain - sub-groups or a single mechanism?

Copyright 2008 Wand and O'Connell; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.Background: Low back pain is a substantial health problem and has subsequently attracted a considerable amount of research. Clinical trials evaluating the efficacy of a variety of interventions for chronic non-specific low back pain indicate limited effectiveness for most commonly applied interventions and approaches. Discussion: Many clinicians challenge the results of clinical trials as they feel that this lack of effectiveness is at odds with their clinical experience of managing patients with back pain. A common explanation for this discrepancy is the perceived heterogeneity of patients with chronic non-specific low back pain. It is felt that the effects of treatment may be diluted by the application of a single intervention to a complex, heterogeneous group with diverse treatment needs. This argument presupposes that current treatment is effective when applied to the correct patient. An alternative perspective is that the clinical trials are correct and current treatments have limited efficacy. Preoccupation with sub-grouping may stifle engagement with this view and it is important that the sub-grouping paradigm is closely examined. This paper argues that there are numerous problems with the sub-grouping approach and that it may not be an important reason for the disappointing results of clinical trials. We propose instead that current treatment may be ineffective because it has been misdirected. Recent evidence that demonstrates changes within the brain in chronic low back pain sufferers raises the possibility that persistent back pain may be a problem of cortical reorganisation and degeneration. This perspective offers interesting insights into the chronic low back pain experience and suggests alternative models of intervention. Summary: The disappointing results of clinical research are commonly explained by the failure of researchers to adequately attend to sub-grouping of the chronic non-specific low back pain population. Alternatively, current approaches may be ineffective and clinicians and researchers may need to radically rethink the nature of the problem and how it should best be managed

Effect of exacerbations on health status in subjects with chronic obstructive pulmonary disease

<p>Abstract</p> <p>Background</p> <p>Acute exacerbations may cause deteriorations in the health status of subjects with chronic obstructive pulmonary disease (COPD). The present study prospectively evaluated the effects of such exacerbations on the health status and pulmonary function of subjects with COPD over a 6-month period, and examined whether those subjects showed a steeper decline in their health status versus those subjects without exacerbations.</p> <p>Methods</p> <p>A total of 156 subjects with COPD (mean age 71.4 ± 6.3 years) were included in the analysis. At baseline and after 6 months, their pulmonary function and health status were evaluated using the Chronic Respiratory Disease Questionnaire (CRQ) and the St. George's Respiratory Questionnaire (SGRQ). An acute exacerbation was defined as a worsening of respiratory symptoms requiring the administration of systemic corticosteroids or antibiotics, or both.</p> <p>Results</p> <p>Forty-eight subjects experienced one or more exacerbations during the 6-month study period, and showed a statistically and clinically significant decline in Symptom scores on the SGRQ, whereas subjects without exacerbations did not show a clinically significant decline. Logistic multiple regression analyses confirmed that the exacerbations significantly influenced the Fatigue and Mastery domains of the CRQ, and the Symptoms in the SGRQ. Twelve subjects with frequent exacerbations demonstrated a more apparent decline in health status.</p> <p>Conclusion</p> <p>Although pulmonary function did not significantly decline during the 6-month period, acute exacerbations were responsible for a decline in health status. To minimize deteriorations in health status, one must prevent recurrent acute exacerbations and reduce the exacerbation frequencies in COPD subjects.</p

Self-Reported Drink Driving and Deterrence

The use of Random Breath Testing (RBT) to deter individuals from drink driving is seen as one of the major initiatives in Australian Road Safety. Viewed with the genre of general deterrence models, RBT enters the decision to drink and drive through increasing the perceived risk of being apprehended. Although long term crash statistics point to a possible link between the introduction of RBT and a reduction in drink driving, a number of researchers have questioned the stability of RBT as a counter measure. This paper analyses the deterrence effect of RBT in regional Queensland; an area where the rate of fatal crashes attributed to alcohol is high. The significant finding reported is that of itself the perceived threat of being apprehended does not significantly deter drink driving

Boundary-Crossing in Perceptual Deterrence

Severe punishments have historically been the bedrock of criminal deterrence, but criminologists have long documented that such threats are often ineffective. Instead, it has been the certainty of sanctions that has been most emphasized and that has garnered empirical support. In a departure from prior research, the question motivating this study is whether increases in the threatened severity of sanction threats alter the perceived certainty of detection irrespective of any objective changes in detection certainty, and then how such perceptions relate to offending. To the authors' knowledge, scant attention has been paid to examining the possibility of this "boundary-crossing," or the extent to which two core dimensions of deterrence, objective and perceptual certainty, cross, intersect, or interact with one another. Using data from a sample of young adults, the authors find mixed support for "boundary-crossing": Although combinations of objective certainty and severity did not necessarily result in substantive differences in perceptions of certainty and severity, an individual's own perceived certainty and severity related to offending differently depending on the information provided to them about the objective certainty and severity of punishment.No Full Tex