Treatment Efficacy, Clinical Utility, and Cost-Effectiveness of Multidisciplinary Biopsychosocial Rehabilitation Treatments for Persistent Low Back Pain: A Systematic Review

Study Design: Systematic review. Objectives: To review the current literature on the treatment efficacy, clinical utility, and cost-effectiveness of multidisciplinary biopsychosocial rehabilitation (MBR) for patients suffering from persistent (nonspecific) lower back pain (LBP) in relation to pain intensity, disability, health-related quality of life, and work ability/sick leave. Methods: We carried out a systematic search of Web of Science, Cochrane Library, PubMed Central, EMBASE, and PsycINFO for English- and German-language literature published between January 2010 and July 2017. Study selection consisted of exclusion and inclusion phases. After screening for duplication, studies were excluded on the basis of criteria covering study design, number of participants, language of publication, and provision of information about the intervention. All the remaining articles dealing with the efficacy, utility, or cost-effectiveness of intensive (more than 25 hours per week) MBR encompassing at least 3 health domains and cognitive behavioral therapy–based psychological education were included. Results: The search retrieved 1199 publications of which 1116 were duplicates or met the exclusion criteria. Seventy of the remaining 83 articles did not meet the inclusion criteria; thus 13 studies were reviewed. All studies reporting changes in pain intensity or disability over 12 months after MBR reported moderate effect sizes and/or p-values for both outcomes. The effects on health-related quality of life were mixed, but MBR substantially reduced costs. Overall MBR produced an enduring improvement in work ability despite controversy and variable results. Conclusions: MBR is an effective treatment for nonspecific LBP, but there is room for improvement in cost-effectiveness and impact on sick leave, where the evidence was less compelling

The α-ketoglutarate dehydrogenase complex in cancer metabolic plasticity

Deregulated metabolism is a well-established hallmark of cancer. At the hub of various metabolic pathways deeply integrated within mitochondrial functions, the α-ketoglutarate dehydrogenase complex represents a major modulator of electron transport chain activity and tricarboxylic acid cycle (TCA) flux, and is a pivotal enzyme in the metabolic reprogramming following a cancer cell’s change in bioenergetic requirements. By contributing to the control of α-ketoglutarate levels, dynamics, and oxidation state, the α-ketoglutarate dehydrogenase is also essential in modulating the epigenetic landscape of cancer cells. In this review, we will discuss the manifold roles that this TCA enzyme and its substrate play in cancer

International students in Australia: Are they food insecure?

Background/Aims: International students are vulnerable to food insecurity, thus impacting upon their ability to study and their international experience. This study investigates the food security levels of international students enrolled at an Australian university and the factors which influence the students' food security status.Methods: A convenience sample of 85 international students were invited to complete a questionnaire and participate in a one-on-one interview. The questionnaire contained pre-validated measures of food security status and hunger (Household Food Security Module), a demographic variable component and the single item instrument from the National Nutrition Survey. Basic statistical and chi-squared analysis was conducted on the survey data and the in-depth interviews thematically analysed.Results: Seventy-five surveys and 11 interviews were completed. Thirty percent of the cohort had experienced food insecurity with half of students who had experienced food insecurity experiencing hunger. Four themes emerged from the interviews: Adaptation and resilience; Quality and availability of traditional food; Student hardship and overcoming obstacles; and Food, health and wellbeing. Cooking and grocery shopping was a new skill for some. Although traditional foods were available, they were found to be expensive resulting in a change of diet.Conclusions: This study highlights the challenges for international students to be food secure. Food insecurity impedes wellbeing and as a result impacts academic success. Further research to understand the impact of food security on the international student experience is recommended, coupled with educational interventions and reinforcing university support services to redress food insecurity amongst international students

School canteens: Parents perceptions on transitioning to healthy canteens

Background/Aims: In the past 10-years school canteens have received bad publicity due to their continued sale of unhealthy foods. Concurrently, many school canteens have moved to improve the type and quality of food available to students. This study, using surveys, investigated stakeholder perceptions and use of school canteens in the Australian Capital Territory (ACT).Methods: Following ethical approval, surveys were conducted in ACT Catholic and Independent schools during February–April 2015. School principals were invited to complete a survey on school canteen demographics; and parent’s a survey on their perceptions of the school canteen and their child’s use of the canteen.Results: In total, 10 school principals and 86 parents participated in the study. Schools were committed to healthy eating, with menus reviewed ‘regularly’. Ninety-four percent of parents reported their children purchased food from the school canteen, with lunch and snacks purchased on a monthly and fortnightly basis. Seventy-one percent of parents provided children with $1-$5 to spend at the canteen, with foods classified under the ‘red’ category such as meat-pies, bacon and egg rolls and full-fat flavoured milks (red-amber) commonly purchased. Parents (56%, total n = 48) believed that it was their responsibility, not the schools, to encourage healthy eating. However, 53% (total n = 47) of parents stated they were not fully aware of canteen practices or the cost of food.Conclusions: While schools are committed to providing healthy foods, more explicit promotion of school canteen practices and encouragement of healthy eating is required

Optimizing Gestational Weight Gain With the Eating4Two Smartphone App:Protocol for a Randomized Controlled Trial

BACKGROUND: Approximately 50% of women gain excessive weight in pregnancy. Optimizing gestational weight gain is important for the short- and long-term health of the childbearing woman and her baby. Despite this, there is no recommendation for routine weighing in pregnancy, and weight is a topic that many maternity care providers avoid. Resource-intensive interventions have mainly targeted overweight and obese women with variable results. Few studies have examined the way that socioeconomic status might influence the effectiveness or acceptability of an intervention to participants. Given the scale of the problem of maternal weight gain, maternity services will be unlikely to sustain resource intensive interventions; therefore, innovative strategies are required to assist women to manage weight gain in pregnancy. OBJECTIVE: The primary aim of the trial was to examine the effectiveness of the Eating4Two smartphone app in assisting women of all body mass index categories to optimize gestational weight gain. Secondary aims include comparing childbirth outcomes and satisfaction with antenatal care and examining the way that relative advantage and disadvantage might influence engagement with and acceptability of the intervention. METHODS: This randomized controlled trial will randomize 1330 women to control or intervention groups in 3 regions of different socioeconomic status. Women will be recruited from clinical and social media sites. The intervention group will be provided with access to the Eating4Two mobile phone app which provides nutrition and dietary information specifically tailored for pregnancy, advice on food serving sizes, and a graph that illustrates women\u27s weight change in relation to the range recommended by the Institute of Medicine. Women will be encouraged to use the app to prompt conversations with their maternity care providers about weight gain in pregnancy. The control group will receive routine antenatal care. RESULTS: Recruitment has commenced though the recruitment rate is slower than expected. Additional funds are required to employ research assistants and promote the study in an advertising campaign. CONCLUSION: Feasibility testing highlighted the inadequacy of the original recruitment strategy and the need to provide the app in both major platforms (Android and iOS). Smartphone technologies may offer an effective alternative to resource intensive strategies for assisting women to optimize weight gain in pregnancy