Use of complementary alternative medicine for low back pain consulting in general practice: a cohort study

<p>Abstract</p> <p>Background</p> <p>Although back pain is considered one of the most frequent reasons why patients seek complementary and alternative medical (CAM) therapies little is known on the extent patients are actually using CAM for back pain.</p> <p>Methods</p> <p>This is a post hoc analysis of a longitudinal prospective cohort study embedded in a RCT. General practitioners (GPs) recruited consecutively adult patients presenting with LBP. Data on physical function, on subjective mood, and on utilization of health services was collected at the first consultation and at follow-up telephone interviews for a period of twelve months</p> <p>Results</p> <p>A total of 691 (51%) respectively 928 (69%) out of 1,342 patients received one form of CAM depending on the definition. Local heat, massage, and spinal manipulation were the forms of CAM most commonly offered. Using CAM was associated with specialist care, chronic LBP and treatment in a rehabilitation facility. Receiving spinal manipulation, acupuncture or TENS was associated with consulting a GP providing these services. Apart from chronicity disease related factors like functional capacity or pain only showed weak or no association with receiving CAM.</p> <p>Conclusion</p> <p>The frequent use of CAM for LBP demonstrates that CAM is popular in patients and doctors alike. The observed association with a treatment in a rehabilitation facility or with specialist consultations rather reflects professional preferences of the physicians than a clear medical indication. The observed dependence on providers and provider related services, as well as a significant proportion receiving CAM that did not meet the so far established selection criteria suggests some arbitrary use of CAM.</p

Teaching: Natural or Cultural?

In this chapter I argue that teaching, as we now understand the term, is historically and cross-culturally very rare. It appears to be unnecessary to transmit culture or to socialize children. Children are, on the other hand, primed by evolution to be avid observers, imitators, players and helpers—roles that reveal the profoundly autonomous and self-directed nature of culture acquisition (Lancy in press a). And yet, teaching is ubiquitous throughout the modern world—at least among the middle to upper class segment of the population. This ubiquity has led numerous scholars to argue for the universality and uniqueness of teaching as a characteristically human behavior. The theme of this chapter is that this proposition is unsustainable. Teaching is largely a result of recent cultural changes and the emergence of modern economies, not evolution

A probabilistic approach for determining submarine landslide tsunami hazard along the upper east coast of the United States

Tsunami hazard assessment is critical for coastal communities, emergency services, and industry, to develop regional risk and response management plans, for catastrophic tsunami events (such as the recent 1998 Papua New Guinea (PNG) and 2004 Indian Ocean tsunamis). Along the northeastern United States coastline, tsunami hazard assessment is in its infancy, mostly due to the lack of historical tsunami record and the uncertainty regarding the return periods of potential large-scale events. The latter includes large transoceanic tsunamis, such as could be caused by a collapse of the Cumbre Vieja volcano in the Canary Islands or a large co-seismic tsunami initiated in the Puerto Rican trench, as well as large local tsunamis, such as could be caused by a Submarine Mass Failure (SMF) occurring on the nearby continental slope. In this region, considerable geologic and some historical (e.g., the 1929 Grand Bank landslide tsunami) evidence suggests that the largest tsunami hazard may arise from tsunamigenic SMFs, triggered by moderate seismic activity. The coastal impact of SMF (or landslide) tsunamis, indeed, can potentially be narrowly focused and affect specific communities. This research presents the development, validation, and results of a probabilistic geomechanical and coastal tsunami impact analysis, of tsunami hazard on the upper northeast coast of the United States. Results are presented in terms of nearshore breaking wave height and runup, caused by seismically induced tsunamigenic SMF, with a given return period. A Monte Carlo approach is employed, in which distributions of relevant parameters (seismicity, sediment properties, type and location, volume, and dimensions of slide, water depth, etc.) are used to perform large numbers of stochastic stability analyses of submerged slopes (along actual shelf transects), based on standard pseudo-static limit equilibrium methods. The distribution of predicted slope failures along the upper U.S. East Coast is found to match published data quite well. For slopes that are deemed unstable for a specified ground acceleration (with given return period), the tsunami source characteristic height is found using empirical equations (based on earlier numerical simulation work), and corresponding breaking height and runup are estimated on the nearest coastline. For a 0.2% annual-probability ground acceleration, for instance, simulations yield a return period of tsunamigenic SMFs of 3350-yr (i.e., a 0.03% annual probability of occurrence). The resulting estimate of the overall coastal hazard, from 100 and 500-yr SMF tsunami events, is found to be quite low at most locations, as compared to the typical 100 yr hurricane storm surge in the region (~ 4-5 m). Specifically, for the 100 yr event, SMF tsunami hazard is quite low with no coastal region exceeding a 1 m runup. For the 500 yr event, however, two regions of relatively elevated hazard are found: (1) near Long Island, NY, with a peak runup of 3 m; and (2) near the New Jersey coast, with a peak runup of 4 m. It should be stressed that these are only first-order estimates and detailed tsunami inundation modeling is required to fully quantify tsunami runup (and inundation) at these sites. This will be the object of more detailed studies in future work. © 2009 Elsevier B.V. All rights reserved