Prognosis of Patients With Nonspecific Neck Pain Development and External Validation of a Prediction Rule for Persistence of Complaints

Study Design. Reanalysis of data from 3 randomized controlled trials. Objective. Development and validation of a prediction rule that estimates the probability of complaints persisting for at least 6 months in patients presenting with nonspecific neck pain in primary care. Summary of Background Data. A substantial proportion of the neck pain patients will develop chronic neck pain. An important question is whether we can identify patients at risk of persistent complaints at the first consultation with the physician, based on their personal characteristics? A prediction model that quantifies prognosis in patients with nonspecific neck pain is not available. Methods. The study population consisted of a sample (n = 468) from the adult primary care population (18-70 years) in The Netherlands presenting with nonspecific neck pain. The primary outcome measure was global perceived recovery measured at 6 months of follow-up. Seventeen baseline characteristics of the patients were included in the analysis. Significant predictors were identified by multivariable backward stepwise logistic regression analysis. A score chart was constructed by using the regression coefficient estimates. The score chart was externally validated in a cohort of patients with nonspecific neck pain (n = 315), who participated in a randomized controlled trial in the United Kingdom (PANTHER-trial). Results. The multivariable analysis resulted in a set of 9 predictors. The score chart has a discriminative ability of 0.66. External validation of the score chart showed a discriminative ability of 0.65, an adequate calibration, a good fit, and a low explained variation. Conclusion. We developed a score chart, estimating the probability of persistent complaints at 6 months follow-up for patients with nonspecific neck pain. This chart performed well in the study population and external validation population. The prediction which patients are more likely to develop persistent complaints is significantly improved by the score chart

Do whiplash patients differ from other patients with non-specific neck pain regarding pain, function or prognosis?

We evaluated whether patients with self-reported whiplash differed in perceived pain, functional limitation and prognosis from patients with other painful neck complaints. Data from three Dutch trials and an English trial were used all evaluating conservative treatment in neck pain patients in primary care. All patients had non-specific neck pain. Information on any trauma or injury came from self-report at baseline. We compared frequencies of baseline variables and outcome at short-term and long term for whiplash and non-trauma neck pain patients separately. The total study population consisted of 804 neck pain patients. Of these patients 133 reported (16.5%) that an injury was the cause of their neck pain. In all trials there were 17-18% more male patients in the whiplash group. At follow-up pain decreased between 12 and 28%, function 10%, and 25-50% of patients recovered in all trials. Post-treatment improvements in pain, function and recovery were comparable between whiplash and non-trauma patients. We also found no different prognostic factors between whiplash and non-trauma patients. Overall we found in a population with mild to moderate pain no clinically relevant differences between patients with self-reported whiplash and patients with other painful neck complaints. The findings suggest that whiplash patients with mild to moderate pain should not be considered a specific subgroup of patients with non-specific neck pain. (C) 2011 Elsevier Ltd. All rights reserved

The first integrated speed management program benefitting vulnerable road users in Bangladesh : results and implications for LMICS

Over 20,000 people are killed due to road traffic crashes in Bangladesh annually. The country has over 100 road traffic deaths per 10,000 motor vehicles, one of the highest rates in the world. 70% of crash fatalities occur in rural areas. In 2014, Safe Crossings (Netherlands) and CIPRB (Bangladesh) received permission from the government of Bangladesh to design and implement an integrated speed management program to prevent road traffic injuries at three locations on a national highway that passes through villages. The study goal was to understand and quantify the improvement in road safety as a result of small-scale infrastructural adaptations combined with active community involvement and road user education. We had a specific interest in the effects on VRUs. Prior to installing the interventions, the three intervention locations combined had, on average, per year: 110 serious accidents, 12 deaths, and 240 injured people. Pedestrians accounted for 63% of all fatalities in the Before Period. In an ideal world one would like to use accident statistics as the ultimate measure of road safety. In reality, this was not possible as the accident statistics were neither sufficiently accurate nor complete. Hence we had to design an alternative monitoring & evaluation approach. The basic research design is a Before and After study using three methods: i) speed measurement (also in control locations), ii) an accident recording system using local record keepers that we set up ourselves, and iii) conflict observation using the DOCTOR method with video recording. Implementation of all infrastructural interventions was completed in April 2015. The integrated speed management for three locations in Bangladesh has resulted a reduction in road traffic injuries and fatalities of around 60%. The net speed effect is a reduction on average of 13,3 km/h (or 20% in relative terms), suggesting a reduction in the number of people killed of 59% using Nilsson’s power law. Our accident recording system shows a 66% reduction in the number of serious accidents (significant at p < 0.01), a 73% reduction in the number of injured people (significant at p < 0.01), and a 67% reduction in the number of road traffic deaths (significant at p < 0.10).Analysis of the conflict data revealed a 54% reduction in relative terms (52% reduction when taking the traffic volumes into account) in the number of serious conflicts. In addition, no conflicts of the highest severity category occurred in the after period. An additional advantage of the integrated speed management program is that it can be implemented relatively quickly (in 6 to 12 months) and the cost-effectiveness is very high. Our calculation suggests a ‘cost per DALY saved’ of below USD 100. We would like to suggest three specific areas of future research based on this study: i) traffic calming in city environments in LMICs, ii) interventions to further reduce the speed of fast-moving traffic in general and buses in particular and iii) investigating the potential of an integrated speed management program in a large number of locations in LMICs with the joint aim of significantly improving road safety and generating valuable road safety data on (cost-) effectiveness and implementation challenges and solutions

Enhancing phosphorus removal of photogranules by incorporating polyphosphate accumulating organisms

Photogranules are a novel wastewater treatment technology that can utilize the sun's energy to treat water with lower energy input and have great potential for nutrient recovery applications. They have been proven to efficiently remove nitrogen and carbon but show lower conversion rates for phosphorus compared to established treatment systems, such as aerobic granular sludge. In this study, we successfully introduced polyphosphate accumulating organisms (PAOs) to an established photogranular culture. We operated photobioreactors in sequencing batch mode with six cycles per day and alternating anaerobic (dark) and aerobic (light) phases. We were able to increase phosphorus removal/recovery by 6 times from 5.4 to 30 mg/L/d while maintaining similar nitrogen and carbon removal compared to photogranules without PAOs. To maintain PAOs activity, alternating anaerobic feast and aerobic famine conditions were required. In future applications, where aerobic conditions are dependent on in-situ oxygenation via photosynthesis, the process will rely on sunlight availability. Therefore, we investigated the feasibility of the process under diurnal cycles with a 12-h anaerobic phase during nighttime and six short cycles during the 12 h daytime. The 12-h anaerobic phase had no adverse effect on the PAOs and phototrophs. Due to the extension of one anaerobic phase to 12 h the six aerobic phases were shortened by 47% and consequently decreased the light hours per day. This resulted in a decrease of phototrophs, which reduced nitrogen removal and biomass productivity up to 30%. Finally, we discuss and suggest strategies to apply PAO-enriched photogranules at large-scale.</p

Influência climática no uso e ocupação do solo do município de Poço Verde/SE

Climatic elements such as precipitation and temperature are essential in agriculture, especially in semi-arid, where is specifically the city of Poço Verde/Se, besides other factors such as economic, social, political and technological. Edaphic constraints represented by pedological composition, comprising the Inceptisols, and Entisols Planosols are conducive to farming, though, need to be corrected, using fertilizer. There, in the city, due to inappropriate areas of outcropping rocks as a result of erosion, resulting from human activities and natural processes. The climate is conceived as dynamic qualitative analysis based on reading Monteiro, and Mendonça Pinto and Oliveira. The dynamic environment is scored on the association between nature and society. In this sense, this paper aims to analyze the relationship between climate conditions and anthropogenic lead in the semiarid area of Poço Verde/ SE, proposing understand the behavior climatic variations of precipitation and extreme events likely, specifically drought, not only a natural phenomenon, but its aspects, political and economic, that affect quality of life. This research method is based on the GTP-geosystem, Planning and Landscape, qualitative and quantitative in nature, the idea of having a holistic view of the paid up space. The methodological procedures outlined that this work were: bibliographic and documentary; fieldwork through secondary and primary data through semi-structured interviews and questionnaires with social actors in thematic mapping system Georeferenced Information Processing in ArcGIS version 9.3. Construction of the water balance method of Thornthwaite & Mather (1955). Quantification and data tabulation, analysis, interpretation and description. It is thus understandable that the precipitation variability is striking and irregular, spatially; presents water deficit. ENOS events play a significant role in the dynamics of rain, the genetic character of climatic anomalies producer, overlapping to human actions, wide effect on the local scale. The occupation of agricultural land dominates the local economy, with the agrarian structure of small farms with maize and beans as main crops, directly linked to rainfall distribution and adapted to the small thermal variation of the Poço Verde tropicality itself. The vegetation consists of the savanna biome and amended its origin. The urban population has more than rural, composed of 21,968 inhabitants. The welfare state develops actions, building wells freshwater and brackish water, dams and water distribution pipes for cars. Drought is one of climatic hazards in the city, classified as seasonal and contingent, which interferes with the local farming and has impact on urban life. There are reports of hail. Thus sertanejos poçoverdenses suffer in the dry season and drought, reflected both in the field and in the city, and there are real correlation between the physical, productive, economic, labor relations and social and public policies.Elementos climáticos, como precipitação e temperatura são essenciais na agricultura, sobretudo no semiárido, onde se localiza especificamente o município de Poço Verde, além de outros fatores como o econômico, social, político e tecnológico. Condicionantes edáficos representados pela composição pedológica, constituída pelos Cambissolos, Planossolos e Neossolos, são propícios para o cultivo agrícola, embora, precisem ser corrigidos, utilizando-se adubação. Existem, no município, áreas impróprias devido ao afloramento das rochas em decorrência, da erosão, resultante de atividades antrópicas e de processos naturais. O clima é concebido como dinâmico na análise qualitativa fundada na leitura de Monteiro, Pinto e Mendonça e Oliveira. A dinâmica ambiental é pontuada na associação entre natureza e sociedade. Nesse sentido, esta dissertação tem como objetivo analisar a relação entre os condicionantes climáticos e as derivações antropogênicas no espaço Semiárido de Poço Verde/SE, propondo compreender, o comportamento climático, suas variações de precipitação e os prováveis eventos extremos, especificamente a seca, não somente como fenômeno natural, mas, em seus aspectos, político e econômico, que interferem na qualidade de vida. Esta pesquisa está fundamentada no método GTP- Geossistema, Território e Paisagem, de natureza quali-quantitativa, pela ideia de se ter uma visão holística integralizada do espaço. Os procedimentos metodológicos que delinearam este trabalho foram: levantamento bibliográfico e documental; pesquisa de campo mediante dados secundários e primários, através de entrevistas semi-estruturadas e questionários com atores sociais; elaboração de mapas temáticos no Sistema de Processamento de Informações Georreferenciadas na versão do ArcGis 9.3. Construção do balanço hídrico pelo método de Thornthwaite & Mather (1955). Quantificação e tabulação de dados, análise, interpretação e descrição. Compreende-se assim, que a variabilidade de precipitação é marcante e irregular, espacialmente; apresenta déficit hídrico. Eventos de ENOS exercem papel significativo na dinâmica pluvial, pelo caráter genético produtor de anomalias climáticas, sobrepondo-se às ações antrópicas, de efeito amplo na escala local. A ocupação do solo agrícola domina a economia local, com estrutura fundiária de minifúndios, tendo o milho e o feijão como principais cultivos, vinculados diretamente à distribuição pluvial e adaptados à pequena variação térmica da tropicalidade de Poço Verde-SE. A cobertura vegetal é constituída pelo bioma caatinga, bem alterado em sua origem. O espaço urbano apresenta população superior a rural, composta de 21.968 habitantes. O Estado desenvolve ações assistencialistas, construindo poços tubulares de água doce e de água salobra, barragens e distribuição de água por carros pipas. A seca é um dos azares climáticos no município, classificada como sazonal e contingente, que interfere na agropecuária local e tem repercussão na vida urbana. Há registro de chuva de granizo. Assim, os sertanejos poçoverdenses sofrem no período de estiagem e seca, com reflexos tanto no campo quanto na cidade, sendo que há correlação real entre os elementos físicos, produtivos, econômicos, relações de trabalho e sociais e as políticas públicas

Measurement properties of disease-specific questionnaires in patients with neck pain: a systematic review

Purpose: To critically appraise and compare the measurement properties of the original versions of neck-specific questionnaires. Methods: Bibliographic databases were searched for articles concerning the development or evaluation of the measurement properties of an original version of a self-reported questionnaire, evaluating pain and/or disability, which was specifically developed or adapted for patients with neck pain. The methodological quality of the selected studies and the results of the measurement properties were critically appraised and rated using a checklist, specifically designed for evaluating studies on measurement properties. Results: The search strategy resulted in a total of 3,641 unique hits, of which 25 articles, evaluating 8 different questionnaires, were included in our study. The Neck Disability Index is the most frequently evaluated questionnaire and shows positive results for internal consistency, content validity, structural validity, hypothesis testing, and responsiveness, but a negative result for reliability. The other questionnaires show positive results, but the evidence for each measurement property is mostly limited, and at least 50% of the information on measurement properties per questionnaire is lacking. Conclusions: Our findings imply that studies of high methodological quality are needed to properly assess the measurement properties of the currently available questionnaires. Until high quality studies are available, we recommend using these questionnaires with caution. There is no need for the development of new neck-specific questionnaires until the current questionnaires have been adequately assessed

Measurement properties of translated versions of neck-specific questionnaires: a systematic review

<p>Abstract</p> <p>Background</p> <p>Several disease-specific questionnaires to measure pain and disability in patients with neck pain have been translated. However, a simple translation of the original version doesn't guarantee similar measurement properties. The objective of this study is to critically appraise the quality of the translation process, cross-cultural validation and the measurement properties of translated versions of neck-specific questionnaires.</p> <p>Methods</p> <p>Bibliographic databases were searched for articles concerning the translation or evaluation of the measurement properties of a translated version of a neck-specific questionnaire. The methodological quality of the selected studies and the results of the measurement properties were critically appraised and rated using the COSMIN checklist and criteria for measurement properties.</p> <p>Results</p> <p>The search strategy resulted in a total of 3641 unique hits, of which 27 articles, evaluating 6 different questionnaires in 15 different languages, were included in this study. Generally the methodological quality of the translation process is poor and none of the included studies performed a cross-cultural adaptation. A substantial amount of information regarding the measurement properties of translated versions of the different neck-specific questionnaires is lacking. Moreover, the evidence for the quality of measurement properties of the translated versions is mostly limited or assessed in studies of poor methodological quality.</p> <p>Conclusions</p> <p>Until results from high quality studies are available, we advise to use the Catalan, Dutch, English, Iranian, Korean, Spanish and Turkish version of the NDI, the Chinese version of the NPQ, and the Finnish, German and Italian version of the NPDS. The Greek NDI needs cross-cultural validation and there is no methodologically sound information for the Swedish NDI. For all other languages we advise to translate the original version of the NDI.</p