Healthcare

197 KiB

Open AccessArticle

Differences in the Association between Depression and Opioid Misuse in Chronic Low Back Pain versus Chronic Pain at Other Locations

by Arpana Jaiswal, Jeffrey F. Scherrer, Joanne Salas, Carissa Van den Berk-Clark, Sheran Fernando and Christopher M. Herndon

Healthcare 2016, 4(2), 34; https://doi.org/10.3390/healthcare4020034 - 16 Jun 2016

Cited by 6 | Viewed by 4352

Abstract

Patients with chronic pain and depression are more likely to develop opioid abuse compared to patients without depression. It is not known if this association differs by pain location. We compared the strength of association between depression and opioid misuse in patients with [...] Read more.

Patients with chronic pain and depression are more likely to develop opioid abuse compared to patients without depression. It is not known if this association differs by pain location. We compared the strength of association between depression and opioid misuse in patients with chronic low back pain (CLBP) vs. chronic pain of other location (CPOL). Chart abstracted data was obtained from 166 patients seeking care in a family medicine clinic. Depression was measured by the PHQ-9 and opioid misuse was measured using the Current Opioid Misuse Measure. Pain severity and interference questions came from the Brief Pain Inventory. Cross-tabulations were computed to measure the association between depression and opioid misuse stratified on pain location. Exploratory logistic regression modeled the association between depression and opioid misuse after adjusting for pain location and pain severity and interference. Depression was significantly associated with opioid misuse in CPOL but not in CLBP. Regression results indicate pain interference partly accounts for the depression–opioid misuse association. These preliminary results from a small patient sample suggest depression may co-occur with opioid misuse more often in CPOL than in CLBP. Further research is needed to compare this comorbidity in specific pain diagnoses such as arthritis, fibromyalgia and CLBP. Full article

(This article belongs to the Special Issue Low Back Pain: Recent Advances And Perspectives)

221 KiB

Open AccessArticle

Getting “Unstuck”: A Multi-Site Evaluation of the Efficacy of an Interdisciplinary Pain Intervention Program for Chronic Low Back Pain

by Timothy Clark, Jean Claude Wakim and Carl Noe

Healthcare 2016, 4(2), 33; https://doi.org/10.3390/healthcare4020033 - 14 Jun 2016

Cited by 13 | Viewed by 5203

Abstract

Chronic low back pain is one of the major health problems in the U.S., resulting in a large number of years of disability. To address the biopsychosocial nature of pain, interdisciplinary pain programs provide integrated interventions by an interdisciplinary team in a unified [...] Read more.

Chronic low back pain is one of the major health problems in the U.S., resulting in a large number of years of disability. To address the biopsychosocial nature of pain, interdisciplinary pain programs provide integrated interventions by an interdisciplinary team in a unified setting with unified goals. This study examined outcomes of an interdisciplinary program located at two sites with different staff, yet with a unified model of treatment and documentation. Efficacy at the combined sites was examined by comparing standard measures obtained upon admission to the program with measures at completion of a 3–4 week long program for 393 patients with chronic low back pain (CLBP). Repeated measures included pain severity, pain interference, efficacy of self-management strategies, hours of activity, depression, ability to do ADLs, and physical endurance. All repeated measures differed at the p < 0.001 level, with large effect sizes (0.66–0.85). Eighty-two percent of graduates reported being “very much improved” or “much improved”. A second analyses provided evidence that treatment effects were robust across sites with no differences (<0.001) found on five of seven selected outcome measures. A third analysis found that number of days of treatment was correlated on three of seven measures at the <0.01 level. However, the amount of variance explained by days of treatment was under 5% on even the most highly correlated measure. These finding are consistent with previous research and explore short-term effectiveness of treatment across treatment sites and with variable duration of treatment. Full article

(This article belongs to the Special Issue Low Back Pain: Recent Advances And Perspectives)

597 KiB

Open AccessReview

The Impact of Antenatal Psychological Group Interventions on Psychological Well-Being: A Systematic Review of the Qualitative and Quantitative Evidence

by Franziska Wadephul, Catriona Jones and Julie Jomeen

Healthcare 2016, 4(2), 32; https://doi.org/10.3390/healthcare4020032 - 08 Jun 2016

Cited by 10 | Viewed by 6964

Abstract

Depression, anxiety and stress in the perinatal period can have serious, long-term consequences for women, their babies and their families. Over the last two decades, an increasing number of group interventions with a psychological approach have been developed to improve the psychological well-being [...] Read more.

Depression, anxiety and stress in the perinatal period can have serious, long-term consequences for women, their babies and their families. Over the last two decades, an increasing number of group interventions with a psychological approach have been developed to improve the psychological well-being of pregnant women. This systematic review examines interventions targeting women with elevated symptoms of, or at risk of developing, perinatal mental health problems, with the aim of understanding the successful and unsuccessful features of these interventions. We systematically searched online databases to retrieve qualitative and quantitative studies on psychological antenatal group interventions. A total number of 19 papers describing 15 studies were identified; these included interventions based on cognitive behavioural therapy, interpersonal therapy and mindfulness. Quantitative findings suggested beneficial effects in some studies, particularly for women with high baseline symptoms. However, overall there is insufficient quantitative evidence to make a general recommendation for antenatal group interventions. Qualitative findings suggest that women and their partners experience these interventions positively in terms of psychological wellbeing and providing reassurance of their ‘normality’. This review suggests that there are some benefits to attending group interventions, but further research is required to fully understand their successful and unsuccessful features. Full article

(This article belongs to the Special Issue Health Psychology in Healthcare Settings)

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1401 KiB

Open AccessArticle

StopApp: Using the Behaviour Change Wheel to Develop an App to Increase Uptake and Attendance at NHS Stop Smoking Services

by Emily Anne Fulton, Katherine E. Brown, Kayleigh L. Kwah and Sue Wild

Healthcare 2016, 4(2), 31; https://doi.org/10.3390/healthcare4020031 - 08 Jun 2016

Cited by 58 | Viewed by 13832

Abstract

Smokers who attend NHS Stop Smoking Services (SSS) are four times more likely to stop smoking; however, uptake has been in decline. We report the development of an intervention designed to increase uptake of SSS, from a more motivated self-selected sample of smokers. [...] Read more.

Smokers who attend NHS Stop Smoking Services (SSS) are four times more likely to stop smoking; however, uptake has been in decline. We report the development of an intervention designed to increase uptake of SSS, from a more motivated self-selected sample of smokers. In Phase 1 we collected data to explore the barriers and facilitators to people using SSS. In Phase 2, data from extant literature and Phase 1 were subject to behavioural analysis, as outlined by the Behaviour Change Wheel (BCW) framework. Relevant Behaviour Change Techniques (BCTs) were identified in order to address these, informing the content of the StopApp intervention. In Phase 3 we assessed the acceptability of the StopApp. Smokers and ex-smokers identified a number of barriers to attending SSS, including a lack of knowledge about what happens at SSS (Capability); the belief that SSS is not easy to access (Opportunity); that there would be ’scare tactics’ or ‘nagging’; and not knowing anyone who had been and successfully quit (Motivation). The ‘StopApp’ is in development and will link in with the commissioned SSS booking system. Examples of the content and functionality of the app are outlined. The next phase will involve a full trial to test effectiveness. Full article

(This article belongs to the Special Issue Health Psychology in Healthcare Settings)

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Open AccessReview

Population Health and Paid Parental Leave: What the United States Can Learn from Two Decades of Research

by Adam Burtle and Stephen Bezruchka

Healthcare 2016, 4(2), 30; https://doi.org/10.3390/healthcare4020030 - 01 Jun 2016

Cited by 60 | Viewed by 25798

Abstract

Over the last two decades, numerous studies have suggested that dedicated time for parents to be with their children in the earliest months of life offers significant benefits to child health. The United States (US) is the only wealthy nation without a formalized [...] Read more.

Over the last two decades, numerous studies have suggested that dedicated time for parents to be with their children in the earliest months of life offers significant benefits to child health. The United States (US) is the only wealthy nation without a formalized policy guaranteeing workers paid time off when they become new parents. As individual US states consider enacting parental leave policies, there is a significant opportunity to decrease health inequities and build a healthier American population. This document is intended as a critical review of the present evidence for the association between paid parental leave and population health. Full article

(This article belongs to the Special Issue Developmental Origins of Health and Disease (DOHaD): Implications for Health Policy and Health Promotion)

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Open AccessReview

Who Benefits from Chronic Opioid Therapy? Rethinking the Question of Opioid Misuse Risk

by Elizabeth Huber, Richard C. Robinson, Carl E. Noe and Olivia Van Ness

Healthcare 2016, 4(2), 29; https://doi.org/10.3390/healthcare4020029 - 25 May 2016

Cited by 12 | Viewed by 6279

Abstract

Beginning in the late 1990s, a movement began within the pain management field focused upon the underutilization of opioids, thought to be a potentially safe and effective class of pain medication. Concern for addiction and misuse were present at the start of this [...] Read more.

Beginning in the late 1990s, a movement began within the pain management field focused upon the underutilization of opioids, thought to be a potentially safe and effective class of pain medication. Concern for addiction and misuse were present at the start of this shift within pain medicine, and an emphasis was placed on developing reliable and valid methods and measures of identifying those at risk for opioid misuse. Since that time, the evidence for the safety and effectiveness of chronic opioid therapy (COT) has not been established. Rather, the harmful, dose-dependent deleterious effects have become clearer, including addiction, increased risk of injuries, respiratory depression, opioid induced hyperalgesia, and death. Still, many individuals on low doses of opioids for long periods of time appear to have good pain control and retain social and occupational functioning. Therefore, we propose that the question, “Who is at risk of opioid misuse?” should evolve to, “Who may benefit from COT?” in light of the current evidence. Full article

(This article belongs to the Special Issue Low Back Pain: Recent Advances And Perspectives)

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Open AccessArticle

Person-Centered, Physical Activity for Patients with Low Back Pain: Piloting Service Delivery

by Saul Bloxham, Phil Barter, Slafka Scragg, Charles Peers, Ben Jane and Joe Layden

Healthcare 2016, 4(2), 28; https://doi.org/10.3390/healthcare4020028 - 18 May 2016

Cited by 5 | Viewed by 5192

Abstract

Low back pain (LBP) is one of the most common and costly conditions in industrialized countries. Exercise therapy has been used to treat LBP, although typically using only one mode of exercise. This paper describes the method and initial findings of a person-centered, [...] Read more.

Low back pain (LBP) is one of the most common and costly conditions in industrialized countries. Exercise therapy has been used to treat LBP, although typically using only one mode of exercise. This paper describes the method and initial findings of a person-centered, group physical activity programme which featured as part of a multidisciplinary approach to treating LBP. Six participants (aged 50.7 ± 17 years) completed a six-week physical activity programme lasting two hours per week. A multicomponent approach to physical activity was adopted which included aerobic fitness, core activation, muscular strength and endurance, Nordic Walking, flexibility and exercise gaming. In addition, participants were required to use diary sheets to record physical activity completed at home. Results revealed significant (p < 0.05) improvements in back strength (23%), aerobic fitness (23%), negative wellbeing (32%) and disability (16%). Person’s Correlation Coefficient analysis revealed significant (p < 0.05) relationships between improvement in perceived pain and aerobic fitness (r = 0.93). It was concluded that a person-centered, multicomponent approach to physical activity may be optimal for supporting patients who self-manage LBP. Full article

(This article belongs to the Special Issue Low Back Pain: Recent Advances And Perspectives)

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186 KiB

Open AccessReview

Surface Electromyographic (SEMG) Biofeedback for Chronic Low Back Pain

by Randy Neblett

Healthcare 2016, 4(2), 27; https://doi.org/10.3390/healthcare4020027 - 17 May 2016

Cited by 44 | Viewed by 7919

Abstract

Biofeedback is a process in which biological information is measured and fed back to a patient and clinician for the purpose of gaining increased awareness and control over physiological domains. Surface electromyography (SEMG), a measure of muscle activity, allows both a patient and [...] Read more.

Biofeedback is a process in which biological information is measured and fed back to a patient and clinician for the purpose of gaining increased awareness and control over physiological domains. Surface electromyography (SEMG), a measure of muscle activity, allows both a patient and clinician to have direct and immediate access to muscle functioning that is not possible with manual palpation or visual observation. SEMG biofeedback can be used to help “down-train” elevated muscle activity or to “up-train” weak, inhibited, or paretic muscles. This article presents a historical and clinical overview of SEMG and its use in chronic low back pain assessment and biofeedback training. Full article

(This article belongs to the Special Issue Low Back Pain: Recent Advances And Perspectives)

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Open AccessConcept Paper

Preeclampsia-Eclampsia Adverse Outcomes Reduction: The Preeclampsia-Eclampsia Checklist

by Oroma B. Nwanodi

Healthcare 2016, 4(2), 26; https://doi.org/10.3390/healthcare4020026 - 13 May 2016

Cited by 10 | Viewed by 5240

Abstract

Globally, preeclampsia-eclampsia (PE-E) is a major cause of puerperal intensive care unit admission, accounting for up to 10% of maternal deaths. PE-E primary prevention is possible. Antepartum low-dose aspirin prophylaxis, costing USD $10–24 can cut the incidence of PE-E in half. Antepartum low [...] Read more.

Globally, preeclampsia-eclampsia (PE-E) is a major cause of puerperal intensive care unit admission, accounting for up to 10% of maternal deaths. PE-E primary prevention is possible. Antepartum low-dose aspirin prophylaxis, costing USD $10–24 can cut the incidence of PE-E in half. Antepartum low molecular weight heparin combined with low-dose aspirin prophylaxis can cut the incidence of early onset PE-E and fetuses that are small for their gestational age in half. Despite predictive antepartum models for PE-E prophylaxis, said prophylaxis is not routinely provided. Therefore, magnesium sulfate secondary prevention of eclampsia remains the globally recommended intervention. Implementation of a PE-E checklist is a continuous quality improvement (CQI) tool facilitating appropriate antepartum PE-E prophylaxis and maternal care from the first trimester through the postpartum fourth trimester inter-partum interval. A novel clinical PE-E checklist and implementation strategy are presented below. CQI PE-E checklist implementation and appropriate PE-E prophylaxis provides clinicians and healthcare systems an opportunity to achieve Millennium Development Goals 4 and 5, reducing child mortality and improving maternal health. While CQI checklist implementation may be a tedious ongoing process requiring healthcare team resiliency, improved healthcare outcomes are well worth the effort. Full article

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Open AccessArticle

Perceptions of Self-Testing for Chlamydia: Understanding and Predicting Self-Test Use

by Rachael Powell, Helen M. Pattison and John F. Marriott

Healthcare 2016, 4(2), 25; https://doi.org/10.3390/healthcare4020025 - 10 May 2016

Cited by 1 | Viewed by 5389

Abstract

Background: Self-testing technology allows people to test themselves for chlamydia without professional support. This may result in reassurance and wider access to chlamydia testing, but anxiety could occur on receipt of positive results. This study aimed to identify factors important in understanding self-testing [...] Read more.

Background: Self-testing technology allows people to test themselves for chlamydia without professional support. This may result in reassurance and wider access to chlamydia testing, but anxiety could occur on receipt of positive results. This study aimed to identify factors important in understanding self-testing for chlamydia outside formal screening contexts, to explore the potential impacts of self-testing on individuals, and to identify theoretical constructs to form a Framework for future research and intervention development. Methods: Eighteen university students participated in semi-structured interviews; eleven had self-tested for chlamydia. Data were analysed thematically usingaFrameworkapproach. Results: Perceivedbeneﬁtsofself-testingincludeditsbeingconvenient, anonymousandnotrequiringphysicalexamination. Therewasconcernabouttestaccuracyandsome participants lacked conﬁdence in using vulvo-vaginal swabs. While some participants expressed concern about the absence of professional support, all said they would seek help on receiving a positive result. Factors identiﬁed in Protection Motivation Theory and the Theory of Planned Behaviour, such as response efﬁcacy and self-efﬁcacy, were found to be highly salient to participants in thinking about self-testing. Conclusions: These exploratory ﬁndings suggest that self-testing independentlyofformalhealthcaresystemsmaynomorenegativelyimpactpeoplethanbeingtested by health care professionals. Participants’ perceptions about self-testing behaviour were consistent with psychological theories. Findings suggest that interventions which increase conﬁdence in using self-tests and that provide reassurance of test accuracy may increase self-test intentions. Full article

(This article belongs to the Special Issue Health Psychology in Healthcare Settings)

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Open AccessReview

Ethical Issues Surrounding End-of-Life Care: A Narrative Review

by Sameera Karnik and Amar Kanekar

Healthcare 2016, 4(2), 24; https://doi.org/10.3390/healthcare4020024 - 05 May 2016

Cited by 37 | Viewed by 26153

Abstract

End-of-life care decision making carries paramount importance due to the advancements in medical sciences. Since medical science has evolved over the time and now has a potentiality to reshape the circumstances during death and in turn prolong lives, various ethical issues surround end-of-life [...] Read more.

End-of-life care decision making carries paramount importance due to the advancements in medical sciences. Since medical science has evolved over the time and now has a potentiality to reshape the circumstances during death and in turn prolong lives, various ethical issues surround end-of-life care. The purpose of this narrative review is to discuss issues such as autonomous decision making, importance of advance directives, rationing of care in futile treatments and costs involved in providing end-of-life care. Even though much progress has been made in this area continued advancement in medical science demands further research into this topic. Full article

(This article belongs to the Special Issue Ethics, Health, and Natural Resources)

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Open AccessArticle

A Controlled and Retrospective Study of 144 Chronic Low Back Pain Patients to Evaluate the Effectiveness of an Intensive Functional Restoration Program in France

by Isabelle Caby, Nicolas Olivier, Frédérick Janik, Jacques Vanvelcenaher and Patrick Pelayo

Healthcare 2016, 4(2), 23; https://doi.org/10.3390/healthcare4020023 - 27 Apr 2016

Cited by 20 | Viewed by 5344

Abstract

Study Design: A controlled and retrospective study of 144 chronic low back pain patients to evaluate the effectiveness of an intensive functional restoration program in France. Objective: Evaluating the efficiency of an intensive, dynamic and multidisciplinary functional restoration program in patients [...] Read more.

Study Design: A controlled and retrospective study of 144 chronic low back pain patients to evaluate the effectiveness of an intensive functional restoration program in France. Objective: Evaluating the efficiency of an intensive, dynamic and multidisciplinary functional restoration program in patients with chronic low back pain (LBP), during 6 and 12 months follow up. Summary of background data: Chronic low back pain disease has a multifactor nature, involving physical, psychological professional and social factors. A functional restoration program (FRP) has been included in a multidisciplinary training program which provides an efficient therapeutic solution. However, the effectiveness of an FRP has not been yet established. Methods: 144 subjects (71 males, 73 females) with chronic low back pain were included in a functional restoration program. The FRP includes physiotherapy and occupational therapy interventions together with psychological counselling. Patients participated as in- or outpatients 6 h per day, 5 days a week over 5 weeks. Pain intensity, trunk flexibility, trunk strength, lifting ability, quality of life and return to work were recorded before, immediately after, and at 6 months and 12 months after the treatment period. Results: All outcome measures were significantly higher just after the FRP (144 patients) and at 6 and 12 months (from available data in 31 subjects) compared to pre-treatment values. This FRP for chronic low back pain maintained its benefits whatever the patient’s activities. Conclusions: The effects reflected on all outcome measures, both on short and long term follow-up. The multidisciplinary FRP for chronic low back pain patients durably stopped the de-conditioning syndrome and involved new life-style habits for the patient, daily pain management and a return to work. Full article

(This article belongs to the Special Issue Low Back Pain: Recent Advances And Perspectives)

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Open AccessReview

A Systematic Review of the Effects of Exercise and Physical Activity on Non-Specific Chronic Low Back Pain

by Rebecca Gordon and Saul Bloxham

Healthcare 2016, 4(2), 22; https://doi.org/10.3390/healthcare4020022 - 25 Apr 2016

Cited by 212 | Viewed by 41723

Abstract

Back pain is a major health issue in Western countries and 60%–80% of adults are likely to experience low back pain. This paper explores the impact of back pain on society and the role of physical activity for treatment of non-specific low back [...] Read more.

Back pain is a major health issue in Western countries and 60%–80% of adults are likely to experience low back pain. This paper explores the impact of back pain on society and the role of physical activity for treatment of non-specific low back pain. A review of the literature was carried out using the databases SPORTDiscuss, Medline and Google Scholar. A general exercise programme that combines muscular strength, flexibility and aerobic fitness is beneficial for rehabilitation of non-specific chronic low back pain. Increasing core muscular strength can assist in supporting the lumbar spine. Improving the flexibility of the muscle-tendons and ligaments in the back increases the range of motion and assists with the patient’s functional movement. Aerobic exercise increases the blood flow and nutrients to the soft tissues in the back, improving the healing process and reducing stiffness that can result in back pain. Full article

(This article belongs to the Special Issue Low Back Pain: Recent Advances And Perspectives)

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Open AccessArticle

Oral Health Behavior and Lifestyle Factors among Overweight and Non-Overweight Young Adults in Europe: A Cross-Sectional Questionnaire Study

by Annamari Nihtila, Nicola West, Adrian Lussi, Philippe Bouchard, Livia Ottolenghi, Egita Senekola, Juan Carlos Llodra, Stephane Viennot and Denis Bourgeois

Healthcare 2016, 4(2), 21; https://doi.org/10.3390/healthcare4020021 - 06 Apr 2016

Cited by 20 | Viewed by 6170

Abstract

Being overweight is a risk factor for many chronic diseases including oral diseases. Our aim was to study the associations between oral health behavior, lifestyle factors and being overweight among young European adults, 2011–2012. The subjects constituted a representative sample of adult population [...] Read more.

Being overweight is a risk factor for many chronic diseases including oral diseases. Our aim was to study the associations between oral health behavior, lifestyle factors and being overweight among young European adults, 2011–2012. The subjects constituted a representative sample of adult population aged 18–35 years from eight European countries participating in the Escarcel study. The participants completed a self-administered questionnaire on dietary habits, oral health behavior, smoking, exercise, height, and weight. Overweight was defined as body mass index (BMI) ≥ 25 kg/m² using the World Health Organization criteria. Mean BMI was 23.2 (SD 3.48) and 24.3% of the study population were overweight. Those who were overweight drank more soft drinks (p = 0.005) and energy drinks (p = 0.006) compared with those who were non-overweight. Brushing once a day (OR 1.6; 95% CI 1.3-2.0), emergency treatment as the reason for last dental visit (OR 1.6; 95% CI 1.3–1.9) and having seven or more eating or drinking occasions daily (OR 1.4; 95% CI 1.1–1.7) were statistically significantly associated with overweight. Associations were found between oral health behavior, lifestyle and overweight. A greater awareness of the detrimental lifestyle factors including inadequate oral health habits among overweight young adults is important for all healthcare providers, including oral health care professionals. Full article

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