Reducing pain and disability for patients with chronic neck pain : results of a double-blind randomised controlled trial comparing strength to endurance training

Neck pain is a common musculo-skeletal problem in the industrialised world with fifty to ninety percent of people experiencing one or more episodes of neck pain during their lifetime. The majority recover quickly from these episodes, but five percent of all cases persist for more than three months. The recurrence rate is high at sixty-percent. The cost to the individual in terms of reduced earning capacity and personal and family distress is very high. The cost to society in terms of lost productivity and compensation payouts is reported to be substantial. Thus, there are very compelling· reasons for finding the most effective therapies for neck pain. Most whiplash injuries to the neck recover spontaneously within three months, but chronic symptoms develop in some 25% of individuals, where pain persists more than three months after the initial injury. If associated restricted mobility persists for more than a few weeks, joint immobility becomes progressively more complete. Disuse atrophy, with attendant lowered fatigue resistance, also occurs. The link between muscular weakness and chronic low-back pain is well established. Research also suggests a correlation between weak cervical musculature and chronic neck pain. Further, as neck muscle strength is shown to be a controlling factor in the stability of the cervical spine it seems logical to seek safe and effective ways of strengthening it. However, many clinicians feel that strength-training the cervical spine, where the emphasis is on exercising slowly with heavy weights, is unsafe and may even aggravate patients' symptoms . Other clinicians maintain that muscular endurance-training, where the emphasis is on exercising fast with light weights, may be more suitable in the initial stages of training, the theory being that it facilitates maximal blood perfusion thereby maximising healing. Hence, muscular endurance-training is prescribed more often because clinicians believe it is less likely to harm patients, but will still increase their muscular strength. It is also important to establish whether ·physiological changes in muscle size and structure resulting from different training methods impact differently on people's pain and disability. Therefore, the research questions of this thesis are, for patients with chronic neck pain, when compared with muscular endurance-training, (1) does strength training result in a greater increase in muscle strength? (2) Does strength-training result in a greater reduction in pain and disability? The underlying rationale of strength training the cervical muscles, therefore, is that by strengthening the weakened muscles of the neck the symptoms of pain and disability that accompany chronic neck pain will be significantly reduced

Introducing the highlights from: problem solving in court: current practice in FDACs in England.

The FDAC (Family drug and alcohol court) problem-solving approach in court is about hearing cases in a collaborative rather than an adversarial manner. FDAC’s main features are judicial continuity, fortnightly judge-led review hearings without lawyers present where judges use motivational interviewing techniques with parents, encouraging parents to seize every opportunity to turn their lives around for the benefit of their children. In early 2016, expanding on their 2014 research, Lancaster University and Ryan Tunnard Brown undertook a review of FDAC problem-solving court practices. The study consisted of observations of 46 hearings in 10 FDAC courts. The study had two main aims. The first was to test whether FDAC judges are currently using a problem-solving approach during court hearings. The second was to collect the views of judges about differences between FDAC and ordinary care proceedings, local implementation of the FDAC model, and the value of extending its problem-solving approach to other types of care cases. The findings are very positive. The researchers found clear evidence that adherence to the principles and practice of the FDAC problem-solving approach is at the heart of the FDAC courts, and that the judges were unanimous in their support for the FDAC approach which they described as a more compassionate way of responding to the parental difficulties that put children at risk of harm. The study made a strong case for: continuing to roll out and sustain the FDAC model; ensure fidelity to the FDAC model through initial and ongoing training by the FDAC National Unit; and generate local and national discussion about which other types of care proceedings would benefit from the FDAC approach. Their data collection and analysis focused on evidence of the following principles and practice being in place. Problem-solving principles focusing on the FDAC process: 1. Enhanced information (to and from all parties) 2. A collaborative approach (solving problems through joint thinking and action) 3. Fair decision making (using a non-adversarial and an honest, transparent approach) 4. Judicial review and monitoring (by a specially-trained judge) 5. A focus on outcomes (to achieve the changes needed in parental behaviour and lifestyle). Problem-solving activity focusing on Judges practice: 1. talking to parents 2. inviting their views 3. expressing interest in their progress 4. acknowledging family strengths 5. offering praise to parents 6. explaining the aims of FDAC 7. explaining decisions made 8. urging parents to take responsibility for their actions, including the consequences of prioritising their own needs over those of their children, and 9. using time in court to tackle the range of problems faced by parents (that is, using a problem-solving approach)

Preterm‐born individuals: a vulnerable population at risk of cardiovascular morbidity and mortality during thermal extremes?

New Findings: What is the topic of this review? Thermal extremes disproportionately affect populations with cardiovascular conditions. Preterm birth, across all gestational age ranges below 37 weeks, has been identified as a non‐modifiable risk factor for cardiovascular disease. The hypothesis is presented that individuals born preterm are at an increased risk of cardiovascular morbidity and mortality during thermal extremes. What advances does it highlight? Cardiovascular stress tests performed in preterm‐born populations, from infancy through adulthood, highlight a progression of cardiovascular dysfunction accelerating through adolescence and adulthood. This dysfunction has many similarities with populations known to be at risk in thermal extremes. Abstract: Preterm‐born individuals are a uniquely vulnerable population. Preterm exposure to the extrauterine environment and the (mal)adaptations that occur during the transitional period can result in alterations to their macro‐ and micro‐physiological state. The physiological adaptations that increase survival in the short term may place those born preterm on a trajectory of lifelong dysfunction and later‐life decompensation. Cardiovascular compensation in children and adolescents, which masks this trajectory of dysfunction, is overcome under stress, such that the functional cardiovascular capacity is reduced and recovery impaired following physiological stress. This has implications for their response to thermal stress. As the Anthropocene introduces greater changes in our environment, thermal extremes will impact vulnerable populations as yet unidentified in the climate change context. Here, we present the hypothesis that individuals born preterm are a vulnerable population at an increased risk of cardiovascular morbidity and mortality during thermal extremes

Laxative use and incident falls, fractures and change in bone mineral density in postmenopausal women: results from the Women\u27s Health Initiative

BACKGROUND: Laxatives are among the most widely used over-the-counter medications in the United States but studies examining their potential hazardous side effects are sparse. Associations between laxative use and risk for fractures and change in bone mineral density [BMD] have not previously been investigated. METHODS: This prospective analysis included 161,808 postmenopausal women (8907 users and 151,497 nonusers of laxatives) enrolled in the WHI Observational Study and Clinical Trials. Women were recruited from October 1, 1993, to December 31, 1998, at 40 clinical centers in the United States and were eligible if they were 50 to 79 years old and were postmenopausal at the time of enrollment. Medication inventories were obtained during in-person interviews at baseline and at the 3-year follow-up visit on everyone. Data on self-reported falls (\u3e/=2), fractures (hip and total fractures) were used. BMD was determined at baseline and year 3 at 3 of the 40 clinical centers of the WHI. RESULTS: Age-adjusted rates of hip fractures and total fractures, but not for falls were similar between laxative users and non-users regardless of duration of laxative use. The multivariate-adjusted hazard ratios for any laxative use were 1.06 (95% confidence interval [CI], 1.03-1.10) for falls, 1.02 (95% CI, 0.85-1.22) for hip fractures and 1.01 (95% CI, 0.96-1.07) for total fractures. The BMD levels did not statistically differ between laxative users and nonusers at any skeletal site after 3-years intake. CONCLUSION: These findings support a modest association between laxative use and increase in the risk of falls but not for fractures. Its use did not decrease bone mineral density levels in postmenopausal women. Maintaining physical functioning, and providing adequate treatment of comorbidities that predispose individuals for falls should be considered as first measures to avoid potential negative consequences associated with laxative use

Chikungunya virus entry and infectivity is primarily facilitated through cell line dependent attachment factors in mammalian and mosquito cells

Chikungunya virus (CHIKV) is the causative agent of the human disease chikungunya fever, characterized by debilitating acute and chronic arthralgia. No licensed vaccines or antivirals are currently available for CHIKV. Therefore, the prevention of attachment of viral particles to host cells is a potential intervention strategy. As an arbovirus, CHIKV infects a wide variety of cells in both its mammalian and mosquito host. This broad cell tropism might stem from CHIKV’s ability to bind to a variety of entry factors in the host cell including phosphatidylserine receptors (PSRs), glycosaminoglycans (GAGs), and the proteinaceous receptor Mxra8, among others. In this study, we aimed to determine the relevance of each attachment factor during CHIKV entry into a panel of mammalian and mosquito cells. Our data suggest that the importance of particular binding factors during CHIKV infection is highly cell line dependent. Entry into mammalian Vero cells was mediated through attachment to PSRs, mainly T-cell immunoglobulin mucin domain-1 (TIM-1). Conversely, CHIKV infection into HAP1 and NIH3T3 was predominantly mediated by heparan sulfate (HS) and Mxra8, respectively. Entry into mosquito cells was independent of PSRs, HS, and Mxra8. Although entry into mosquito cells remains unclear, our data denotes the importance of careful evaluation of reagents used to identify receptor use in invertebrate cells. While PSRs, GAGs, and Mxra8 all enhance entry in a cell line dependent manner, none of these factors are necessary for CHIKV entry, suggesting additional host factors are involved

Clinical Characteristics of Children Receiving Antipsychotic Medication

This study explored the demographic and diagnostic features of children who were currently receiving antipsychotics compared to children who were receiving other psychotropics in a cohort of children with and without elevated symptoms of mania (ESM). Participants were recruited from 10 child outpatient mental health clinics associated with four universities. Guardians with children between 6–12 years who presented for new clinical evaluations completed the Parent General Behavior Inventory-10 Item Mania Scale (PGBI-10M). All children who scored ≥12 on the PGBI-10M and a select demographically matched comparison group of patients who scored ≤11 were invited to participate. Children were divided into two groups: those receiving at least one antipsychotic medication and those receiving other psychotropic medications. The groups were compared on demographics, diagnoses, psychiatric symptoms, functioning, and past hospitalizations. Of the 707 children enrolled in the Longitudinal Assessment of Manic Symptoms (LAMS) study, 443 (63%) were prescribed psychotropic medication at baseline: 157 (35%) were receiving an antipsychotic and 286 (65%) were prescribed other agents. Multivariate results indicated that being prescribed antipsychotics was related to being white, previous hospitalization, having a psychotic or bipolar 1 disorder and the site where the child was receiving services (

Phenomenology of bipolar disorder not otherwise specified in youth: a comparison of clinical characteristics across the spectrum of manic symptoms

Controversy surrounds the diagnostic categorization of children with episodic moods that cause impairment, but do not meet DSM-IV criteria for bipolar I (BD-I) or bipolar II (BD-II) disorder. This study aims to characterize the degree to which these children, who meet criteria for bipolar disorder not otherwise specified (BD-NOS), are similar to those with full syndromal BD, versus those with no bipolar spectrum diagnosis (no BSD)

Examining the Proposed Disruptive Mood Dysregulation Disorder Diagnosis in Children in the Longitudinal Assessment of Manic Symptoms Study

To examine the proposed disruptive mood dysregulation disorder (DMDD) diagnosis in a child psychiatric outpatient population. Evaluation of DMDD included 4 domains: clinical phenomenology, delimitation from other diagnoses, longitudinal stability, and association with parental psychiatric disorders

Characteristics of Children With Elevated Symptoms of Mania: The Longitudinal Assessment of Manic Symptoms (LAMS) Study

To examine differences in psychiatric symptomatology, diagnoses, demographics, functioning, and psychotropic medication exposure in children with elevated symptoms of mania (ESM+) compared to youth without ESM (ESM−)

The 24-month course of manic symptoms in children

The Longitudinal Assessment of Manic Symptoms (LAMS) study was designed to investigate phenomenology and establish predictors of functional outcomes in children with elevated manic symptoms. The purpose of this series of analyses was to determine whether the participants demonstrated different trajectories of parent-reported manic and biphasic symptoms over the first 24 months of follow-up and to describe the clinical characteristics of the trajectories