Open AccessArticle
Effectiveness of a Lifestyle Intervention in Patients with Type 2 Diabetes: The Physical Activity and Nutrition for Diabetes in Alberta (PANDA) Trial
Healthcare 2016, 4(4), 73; doi:10.3390/healthcare4040073 -
Abstract
Type 2 diabetes (T2D) patients often find integrating a new dietary pattern into their lifestyle challenging; therefore, the PANDA (Physical Activity and Nutrition for Diabetes in Alberta) menu plan intervention was developed to help people incorporate the Canadian Diabetes Association (CDA) nutrition [...] Read more.
Type 2 diabetes (T2D) patients often find integrating a new dietary pattern into their lifestyle challenging; therefore, the PANDA (Physical Activity and Nutrition for Diabetes in Alberta) menu plan intervention was developed to help people incorporate the Canadian Diabetes Association (CDA) nutrition therapy guidelines into their daily lives. The menu plan focused on recipes and foods that were accessible, available and acceptable to Albertans. The objective was to evaluate the effectiveness of the intervention on blood glucose control and dietary adherence and quality among patients with T2D. Participants with T2D (n = 73) enrolled in a single-arm incorporating interactive education based on a four-week menu plan that incorporated the recommendations of the CDA nutrition therapy guidelines. Post-intervention follow-up was conducted at three and six months. After three months, there were beneficial changes in A1c (−0.7%), body mass index (BMI, −0.6 kg/m2), diastolic blood pressure (−4 mmHg), total cholesterol (−63 mg/dL), HDL- (+28 mg/dL) and LDL-cholesterol (−89 mg/dL), Healthy Eating Index (+2.1 score) and perceived dietary adherence (+8.5 score) (all p < 0.05). The significant improvements in A1c, BMI and lipids were maintained at six months. The PANDA menu plan intervention was effective in improving glycemic control and diet quality. The results suggest that a dietary intervention incorporating interactive education sessions focused on menu planning with familiar, accessible foods may be effective for diabetes management. Full article
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Open AccessReview
Symptom Management in Patients with Stage 5 CKD Opting for Conservative Management
Healthcare 2016, 4(4), 72; doi:10.3390/healthcare4040072 -
Abstract
Chronic kidney disease (CKD) stages 3–5 now affects 8.5% of adults in the United Kingdom; with 4% of patients expected to reach stage 5 CKD. Increasing numbers of older patients are contributing to the growth of demand of kidney services. With the [...] Read more.
Chronic kidney disease (CKD) stages 3–5 now affects 8.5% of adults in the United Kingdom; with 4% of patients expected to reach stage 5 CKD. Increasing numbers of older patients are contributing to the growth of demand of kidney services. With the exception of transplantation, dialysis has been the main form of renal replacement therapy (RRT) for advanced CKD. This elderly population is usually too frail and has many other co-existing medical complaints or co morbidities to undergo transplantation. Dialysis is an invasive treatment, and some frail elderly patients can experience many dialysis related symptoms. An alternative option for these patients is to choose conservative management (CM) of their stage 5 CKD. These patients often have complex supportive and palliative care needs. The frequency, severity and distress caused by symptoms related to stage 5 CKD are often under recognized and under treated. There is a need for early identification and management of symptoms as they present in patients with stage 5 CKD being managed conservatively. Symptom assessment should be focused on anticipating, identifying and alleviating any symptoms. This needs to be incorporated into the regular practice of those managing CM patients. Full article
Open AccessArticle
Comparison of Very Low Energy Diet Products Available in Australia and How to Tailor Them to Optimise Protein Content for Younger and Older Adult Men and Women
Healthcare 2016, 4(3), 71; doi:10.3390/healthcare4030071 -
Abstract
Very low energy diets (VLED) are efficacious in inducing rapid weight loss but may not contain adequate macronutrients or micronutrients for individuals with varying nutritional requirements. Adequate protein intake during weight loss appears particularly important to help preserve fat free mass and [...] Read more.
Very low energy diets (VLED) are efficacious in inducing rapid weight loss but may not contain adequate macronutrients or micronutrients for individuals with varying nutritional requirements. Adequate protein intake during weight loss appears particularly important to help preserve fat free mass and control appetite, and low energy and carbohydrate content also contributes to appetite control. Therefore, the purpose of this study was to compare the nutritional content (with a focus on protein), nutritional adequacy and cost of all commercially-available VLED brands in Australia. Nutritional content and cost were extracted and compared between brands and to the Recommended Dietary Intake (RDI) or adequate intake (AI) of macronutrients and micronutrients for men and women aged 19–70 years or >70 years. There was wide variability in the nutritional content, nutritional adequacy and cost of VLED brands. Most notably, even brands with the highest daily protein content, based on consuming three products/day (KicStart™ and Optislim®, ~60 g/day), only met estimated protein requirements of the smallest and youngest women for whom a VLED would be indicated. Considering multiple options to optimise protein content, we propose that adding pure powdered protein is the most suitable option because it minimizes additional energy, carbohydrate and cost of VLEDs. Full article
Open AccessArticle
Associations between Trunk Extension Endurance and Isolated Lumbar Extension Strength in Both Asymptomatic Participants and Those with Chronic Low Back Pain
Healthcare 2016, 4(3), 70; doi:10.3390/healthcare4030070 -
Abstract
Background: Strength and endurance tests are important for both clinical practice and research due to the key role they play in musculoskeletal function. In particular, deconditioning of the lumbar extensor musculature has been associated with low back pain (LBP). Due to the [...] Read more.
Background: Strength and endurance tests are important for both clinical practice and research due to the key role they play in musculoskeletal function. In particular, deconditioning of the lumbar extensor musculature has been associated with low back pain (LBP). Due to the relationship between strength and absolute endurance, it is possible that trunk extension (TEX) endurance tests could provide a proxy measure of isolated lumbar extension (ILEX) strength and thus represent a simple, practical alternative to ILEX measurements. Though, the comparability of TEX endurance and ILEX strength is presently unclear and so the aim of the present study was to examine this relationship. Methods: Thirty eight healthy participants and nineteen participants with non-specific chronic LBP and no previous lumbar surgery participated in this cross-sectional study design. TEX endurance was measured using the Biering–Sorensen test. A maximal ILEX strength test was performed on the MedX lumbar-extension machine. Results: A Pearson’s correlation revealed no relationship between TEX endurance and ILEX strength in the combined group (r = 0.035, p = 0.793), the chronic LBP group (r = 0.120, p = 0.623) or the asymptomatic group (r = −0.060, p = 0.720). Conclusions: The results suggest that TEX is not a good indicator of ILEX and cannot be used to infer results regarding ILEX strength. However, a combination of TEX and ILEX interpreted together likely offers the greatest and most comprehensive information regarding lumbo-pelvic function during extension. Full article
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Open AccessReview
Effect of Flavonoids on Oxidative Stress and Inflammation in Adults at Risk of Cardiovascular Disease: A Systematic Review
Healthcare 2016, 4(3), 69; doi:10.3390/healthcare4030069 -
Abstract
Oxidative stress (OS) and inflammatory processes initiate the first stage of cardiovascular disease (CVD). Flavonoid consumption has been related to significantly improved flow-mediated dilation and blood pressure. Antioxidant and anti-inflammatory mechanisms are thought to be involved. The effect of flavonoids on markers [...] Read more.
Oxidative stress (OS) and inflammatory processes initiate the first stage of cardiovascular disease (CVD). Flavonoid consumption has been related to significantly improved flow-mediated dilation and blood pressure. Antioxidant and anti-inflammatory mechanisms are thought to be involved. The effect of flavonoids on markers of oxidative stress and inflammation, in at risk individuals is yet to be reviewed. Systematic literature searches were conducted in MEDLINE, Cochrane Library, CINAHL and SCOPUS databases. Randomised controlled trials in a Western country providing a food-based flavonoid intervention to participants with one or two modifiable risk factors for CVD measuring a marker of OS and/or inflammation, were included. Reference lists were hand-searched. The Cochrane Collaboration Risk of Bias Tool was used to assess study quality. The search strategy retrieved 1248 articles. Nineteen articles meeting the inclusion criteria were reviewed. Eight studies were considered at low risk of bias. Cocoa flavonoids provided to Type 2 diabetics and olive oil flavonoids to mildly-hypertensive women reduced OS and inflammation. Other food sources had weaker effects. No consistent effect on OS and inflammation across patients with varied CVD risk factors was observed. Study heterogeneity posed a challenge for inter-study comparisons. Rigorously designed studies will assist in determining the effectiveness of flavonoid interventions for reducing OS and inflammation in patients at risk of CVD. Full article
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Open AccessArticle
Increasing Incidence Rate of Cervical Cerclage in Pregnancy in Australia: A Population-Based Study
Healthcare 2016, 4(3), 68; doi:10.3390/healthcare4030068 -
Abstract
Objective: Data published from the United States have demonstrated that the use of cervical cerclage has fallen in the period 1998–2013. This is in contrast to recommendations in Australia. We examined this trend using data from the Australian Institute of Health and [...] Read more.
Objective: Data published from the United States have demonstrated that the use of cervical cerclage has fallen in the period 1998–2013. This is in contrast to recommendations in Australia. We examined this trend using data from the Australian Institute of Health and Welfare (AIHW). Study design: Retrospective population-based study. Methods: Data from the Australian Institute of Health and Welfare procedural database were used to determine the total number of cervical cerclage sutures inserted during the period 2004 to 2013. Population datasets were used to calculate age-stratified incidence rates of cerclage. Findings: There was a significant increase in the rate of cervical cerclage in women aged 25 to 34 years and in the 35 years and older age group. The incidence of preterm birth was stable for gestations of 32 to 36 weeks, but slightly increased in the 20 to 27 week and 28 to 31 week gestational age groups. Further research into cervical cerclage and the use of vaginal progesterone for the prevention of preterm birth would be valuable. Full article
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Open AccessReview
Revisiting the Corticomotor Plasticity in Low Back Pain: Challenges and Perspectives
Healthcare 2016, 4(3), 67; doi:10.3390/healthcare4030067 -
Abstract
Chronic low back pain (CLBP) is a recurrent debilitating condition that costs billions to society. Refractoriness to conventional treatment, lack of improvement, and associated movement disorders could be related to the extensive brain plasticity present in this condition, especially in the sensorimotor [...] Read more.
Chronic low back pain (CLBP) is a recurrent debilitating condition that costs billions to society. Refractoriness to conventional treatment, lack of improvement, and associated movement disorders could be related to the extensive brain plasticity present in this condition, especially in the sensorimotor cortices. This narrative review on corticomotor plasticity in CLBP will try to delineate how interventions such as training and neuromodulation can improve the condition. The review recommends subgrouping classification in CLBP owing to brain plasticity markers with a view of better understanding and treating this complex condition. Full article
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Open AccessArticle
Early Workplace Intervention to Improve the Work Ability of Employees with Musculoskeletal Disorders in a German University Hospital—Results of a Pilot Study
Healthcare 2016, 4(3), 64; doi:10.3390/healthcare4030064 -
Abstract
Health promotion is becoming increasingly important in work life. Healthcare workers seem to be at special risk, experiencing musculoskeletal disorders (MSD); their situation is strongly influenced by demographic changes. The aim of this study is to evaluate the feasibility and outcome of [...] Read more.
Health promotion is becoming increasingly important in work life. Healthcare workers seem to be at special risk, experiencing musculoskeletal disorders (MSD); their situation is strongly influenced by demographic changes. The aim of this study is to evaluate the feasibility and outcome of a worksite intervention. In a one-group pretest-posttest design, 118 employees of a hospital were recruited from 2010 to 2011. The raised parameters were satisfaction with the program, work ability (Work Ability Index), and sickness absence (provided by human resource management). Patient-reported questionnaire data was raised at baseline (t1) and after three months (t2). Sickness leave was evaluated in the period six months prior to and six months after the intervention. Means, frequencies, standardized effect sizes (SES), analysis of variance, and regression analysis were carried out. Participants were found to be highly satisfied. Work ability increased with moderate effects (SES = 0.34; p < 0.001) and prognosis of gainful employment (SES = −0.19; p ≤ 0.047) with small effects. Days of MSD-related sickness absence were reduced by 38.5% after six months. The worksite intervention program is transferable to a hospital setting and integration in occupational health management is recommended. The use of a control group is necessary to demonstrate the effectiveness. Full article
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Open AccessArticle
Justice and Equity Implications of Climate Change Adaptation: A Theoretical Evaluation Framework
Healthcare 2016, 4(3), 65; doi:10.3390/healthcare4030065 -
Abstract
Climate change affects human health, and climate change adaptation aims to reduce these risks through infrastructural, behavioral, and technological measures. However, attributing direct human health effects to climate change adaptation is difficult, causing an ethical dilemma between the need for evidence of [...] Read more.
Climate change affects human health, and climate change adaptation aims to reduce these risks through infrastructural, behavioral, and technological measures. However, attributing direct human health effects to climate change adaptation is difficult, causing an ethical dilemma between the need for evidence of strategies and their precautionary implementation before such evidence has been generated. In the absence of conclusive evidence for individual adaptation strategies, alternative approaches to the measurement of adaptation effectiveness need to be developed. This article proposes a theoretical framework and a set of guiding questions to assess effects of adaptation strategies on seven domains of health determinants, including social, economic, infrastructure, institutional, community, environmental, and cultural determinants of health. Its focus on advancing gender equity and environmental justice concurrently with the implementation of health-related adaptation could serve as a template for policymakers and researchers. Full article
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Open AccessReview
Review of Positive Psychology Applications in Clinical Medical Populations
Healthcare 2016, 4(3), 66; doi:10.3390/healthcare4030066 -
Abstract
This review examines the application of positive psychology concepts in physical health care contexts. Positive psychology aims to promote well-being in the general population. Studies identifying character strengths associated with well-being in healthy populations are numerous. Such strengths have been classified and [...] Read more.
This review examines the application of positive psychology concepts in physical health care contexts. Positive psychology aims to promote well-being in the general population. Studies identifying character strengths associated with well-being in healthy populations are numerous. Such strengths have been classified and Positive Psychology Interventions (PPIs) have been created to further develop these strengths in individuals. Positive psychology research is increasingly being undertaken in health care contexts. The review identified that most of this research involves measuring character strengths and their association with health outcomes in patients with a range of different conditions, similar to the position in positive psychology research on non-clinical populations. More recently, PPIs are beginning to be applied to clinical populations with physical health problems and this research, although relatively scarce, is reviewed here for cancer, coronary heart disease, and diabetes. In common with PPIs being evaluated in the general population, high quality studies are scarce. Applying PPIs to patients with serious health conditions presents significant challenges to health psychologists. They must ensure that patients are dealt with appropriately and ethically, given that exaggerated claims for PPIs are made on the internet quite frequently. This is discussed along with the need for more high quality research. Full article
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Open AccessReview
Core Outcome Sets and Multidimensional Assessment Tools for Harmonizing Outcome Measure in Chronic Pain and Back Pain
Healthcare 2016, 4(3), 63; doi:10.3390/healthcare4030063 -
Abstract
Core Outcome Sets (COSs) are a set of domains and measurement instruments recommended for application in any clinical trial to ensure comparable outcome assessment (both domains and instruments). COSs are not exclusively recommended for clinical trials, but also for daily record keeping [...] Read more.
Core Outcome Sets (COSs) are a set of domains and measurement instruments recommended for application in any clinical trial to ensure comparable outcome assessment (both domains and instruments). COSs are not exclusively recommended for clinical trials, but also for daily record keeping in routine care. There are several COS recommendations considering clinical trials as well as multidimensional assessment tools to support daily record keeping in low back pain. In this article, relevant initiatives will be described, and implications for research in COS development in chronic pain and back pain will be discussed. Full article
Open AccessArticle
Concerns about Breast Cancer, Pain, and Fatigue in Non-Metastatic Breast Cancer Patients Undergoing Primary Treatment
Healthcare 2016, 4(3), 62; doi:10.3390/healthcare4030062 -
Abstract
Women diagnosed with breast cancer often endorse psychosocial concerns prior to treatment, which may influence symptom experiences. Among these, low perceived social support relates to elevated fatigue. Those with low social support perceptions may also experience a greater sense of rejection. We [...] Read more.
Women diagnosed with breast cancer often endorse psychosocial concerns prior to treatment, which may influence symptom experiences. Among these, low perceived social support relates to elevated fatigue. Those with low social support perceptions may also experience a greater sense of rejection. We sought to determine if social rejection concerns post-surgery predict fatigue interference 12 months later in women with non-metastatic breast cancer. Depressive symptoms and pain severity after completion of adjuvant therapy (six months post-surgery) were examined as potential mediators. Women (N = 240) with non-metastatic breast cancer were recruited 2–10 weeks post-surgery. Multiple regression analyses examined relationships among variables adjusting for relevant covariates. Greater rejection concerns at study entry predicted greater fatigue interference 12 months later (p < 0.01). Pain severity after adjuvant therapy partially mediated the relationship between social rejection concerns and fatigue interference, with significant indirect (β = 0.06, 95% CI (0.009, 0.176)) and direct effects (β = 0.18, SE = 0.07, t(146) = 2.78, p < 0.01, 95% CI (0.053, 0.311)). Therefore, pain levels post-treatment may affect how concerns of social rejection relate to subsequent fatigue interference. Interventions targeting fears of social rejection and interpersonal skills early in treatment may reduce physical symptom burden during treatment and into survivorship. Full article
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Open AccessReview
Suppression of NADPH Oxidase Activity May Slow the Expansion of Osteolytic Bone Metastases
Healthcare 2016, 4(3), 60; doi:10.3390/healthcare4030060 -
Abstract
Lysophosphatidic acid (LPA), generated in the microenvironment of cancer cells, can drive the proliferation, invasion, and migration of cancer cells by activating G protein-coupled LPA receptors. Moreover, in cancer cells that have metastasized to bone, LPA signaling can promote osteolysis by inducing [...] Read more.
Lysophosphatidic acid (LPA), generated in the microenvironment of cancer cells, can drive the proliferation, invasion, and migration of cancer cells by activating G protein-coupled LPA receptors. Moreover, in cancer cells that have metastasized to bone, LPA signaling can promote osteolysis by inducing cancer cell production of cytokines, such as IL-6 and IL-8, which can stimulate osteoblasts to secrete RANKL, a key promoter of osteoclastogenesis. Indeed, in cancers prone to metastasize to bone, LPA appears to be a major driver of the expansion of osteolytic bone metastases. Activation of NADPH oxidase has been shown to play a mediating role in the signaling pathways by which LPA, as well as RANKL, promote osteolysis. In addition, there is reason to suspect that Nox4 activation is a mediator of the feed-forward mechanism whereby release of TGF-beta from bone matrix by osteolysis promotes expression of PTHrP in cancer cells, and thereby induces further osteolysis. Hence, measures which can down-regulate NADPH oxidase activity may have potential for slowing the expansion of osteolytic bone metastases in cancer patients. Phycocyanin and high-dose statins may have utility in this regard, and could be contemplated as complements to bisphosphonates or denosumab for the prevention and control of osteolytic lesions. Ingestion of omega-3-rich flaxseed or fish oil may also have potential for controlling osteolysis in cancer patients. Full article
Open AccessConcept Paper
Finding Common Ground: Environmental Ethics, Social Justice, and a Sustainable Path for Nature-Based Health Promotion
Healthcare 2016, 4(3), 61; doi:10.3390/healthcare4030061 -
Abstract
Decades of research have documented continuous tension between anthropocentric needs and the environment’s capacity to accommodate those needs and support basic human welfare. The way in which society perceives, manages, and ultimately utilizes natural resources can be influenced by underlying environmental ethics, [...] Read more.
Decades of research have documented continuous tension between anthropocentric needs and the environment’s capacity to accommodate those needs and support basic human welfare. The way in which society perceives, manages, and ultimately utilizes natural resources can be influenced by underlying environmental ethics, or the moral relationship that humans share with the natural world. This discourse often centers on the complex interplay between the tangible and intangible benefits associated with nonhuman nature (e.g., green space), both of which are relevant to public health. When ecosystem degradation is coupled with socio-demographic transitions, additional concerns related to distributional equity and justice can arise. In this commentary, we explore how environmental ethics can inform the connection between the ecosystem services from green space and socially just strategies of health promotion. Full article
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Open AccessArticle
Biopsychosocial Characteristics, Using a New Functional Measure of Balance, of an Elderly Population with CLBP
Healthcare 2016, 4(3), 59; doi:10.3390/healthcare4030059 -
Abstract
This study examined the biopsychosocial characteristics of chronic low back pain (CLBP) in an understudied but increasingly larger part of the population: the elderly (i.e., 65 years and older). A new innovative physical functioning measure (postural control, which is a proxy for [...] Read more.
This study examined the biopsychosocial characteristics of chronic low back pain (CLBP) in an understudied but increasingly larger part of the population: the elderly (i.e., 65 years and older). A new innovative physical functioning measure (postural control, which is a proxy for the common problem of slips and falls in the elderly) was part of this biopsychosocial evaluation. Also, the National Institutes of Health (NIH)-developed Patient-Reported Outcome Measurement Information System (PROMIS) was also part of this comprehensive evaluation. Two demographically-matched groups of elderly participants were evaluated: one with CLBP (n = 24); and the other without (NCLBP, n = 24). Results revealed significant differences in most of these measures between the two groups, further confirming the importance of using a biopsychosocial approach for future studies of pain and postural control in the elderly. Full article
Open AccessArticle
Associations between Unhealthy Diet and Lifestyle Behaviours and Increased Cardiovascular Disease Risk in Young Overweight and Obese Women
Healthcare 2016, 4(3), 57; doi:10.3390/healthcare4030057 -
Abstract
Unhealthy lifestyle behaviours are known modifiable risk factors for cardiovascular disease (CVD). This cross-sectional analysis aimed to describe lifestyle behaviours and CVD risk markers in young overweight and obese Australian women and explore associations between individual and combined lifestyle behaviours with CVD [...] Read more.
Unhealthy lifestyle behaviours are known modifiable risk factors for cardiovascular disease (CVD). This cross-sectional analysis aimed to describe lifestyle behaviours and CVD risk markers in young overweight and obese Australian women and explore associations between individual and combined lifestyle behaviours with CVD risk markers. Lifestyle behaviours assessed were diet quality, alcohol intake, physical activity, sitting time and smoking status, and were combined to generate a Healthy Lifestyle Score (HLS) (0–5). Objectively measured CVD risk markers were body mass index (BMI), %body fat, waist circumference, blood pressure, and plasma cholesterol and triglycerides. Analysis included 49 women aged 18–35 years, with BMI 25.0 to 34.9 kg/m2. The mean ± SD Australian Recommended Food Score was 33.5 ± 9.3 points, alcohol 3.3 ± 2.4 standard drinks/day, physical activity 207 ± 225 min/week and sitting time 578 ± 213 min/day. All participants were non-smokers. The proportion of participants outside normal reference ranges was 83.7% for waist circumference (n = 41), blood pressure 0% (n = 0), total cholesterol 26.2% (n = 11), HDL cholesterol 38.6% (n = 17), LDL cholesterol 22.7% (n = 10), and triglycerides 4.2% (n = 2). Physical activity was inversely associated with body fat (β = −0.011%, p = 0.005), diastolic blood pressure (β = −0.010 mmHg, p = 0.031) and waist circumference (β = −0.013 cm, p = 0.029). Most participants (59.2%, n = 29) had a HLS ≤ 2. No significant associations were found between HLS and CVD risk markers. Insufficient physical activity was the primary lifestyle factor associated with increased CVD risk markers, which suggests interventions targeting physical activity in young women may potentially improve cardiovascular health. Full article
Open AccessArticle
The Relationship between Pain Beliefs and Physical and Mental Health Outcome Measures in Chronic Low Back Pain: Direct and Indirect Effects
Healthcare 2016, 4(3), 58; doi:10.3390/healthcare4030058 -
Abstract
Low back pain remains a major health problem with huge societal cost. Biomedical models fail to explain the disability seen in response to reported back pain and therefore patients’ beliefs, cognitions and related behaviours have become a focus for both research and [...] Read more.
Low back pain remains a major health problem with huge societal cost. Biomedical models fail to explain the disability seen in response to reported back pain and therefore patients’ beliefs, cognitions and related behaviours have become a focus for both research and practice. This study used the Pain Beliefs Questionnaire and had two aims: To examine the extent to which pain beliefs are related to disability, anxiety and depression; and to assess whether those relationships are mediated by pain self-efficacy and locus of control. In a sample of 341 chronic low back pain patients, organic and psychological pain beliefs were related to disability, anxiety and depression. However, organic pain beliefs were more strongly related to disability and depression than psychological pain beliefs. Regression analyses revealed that these relationships were in part independent of pain self-efficacy and locus of control. Further, mediation analyses revealed indirect pathways involving self-efficacy and, to a lesser extent chance locus of control, between organic pain beliefs, on the one hand, and disability, anxiety and depression, on the other. In contrast, psychological pain beliefs were only directly related to disability, anxiety and depression. Although longitudinal data are needed to corroborate our findings, this study illustrates the importance of beliefs about the nature of pain and beliefs in one’s ability to cope with pain in determining both physical and mental health outcomes in chronic low back pain patients. Full article
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Open AccessArticle
Enhanced Brain Responses to Pain-Related Words in Chronic Back Pain Patients and Their Modulation by Current Pain
Healthcare 2016, 4(3), 54; doi:10.3390/healthcare4030054 -
Abstract
Previous functional magnetic resonance imaging (fMRI) studies in healthy controls (HC) and pain-free migraine patients found activations to pain-related words in brain regions known to be activated while subjects experience pain. The aim of the present study was to identify neural activations [...] Read more.
Previous functional magnetic resonance imaging (fMRI) studies in healthy controls (HC) and pain-free migraine patients found activations to pain-related words in brain regions known to be activated while subjects experience pain. The aim of the present study was to identify neural activations induced by pain-related words in a sample of chronic back pain (CBP) patients experiencing current chronic pain compared to HC. In particular, we were interested in how current pain influences brain activations induced by pain-related adjectives. Subjects viewed pain-related, negative, positive, and neutral words; subjects were asked to generate mental images related to these words during fMRI scanning. Brain activation was compared between CBP patients and HC in response to the different word categories and examined in relation to current pain in CBP patients. Pain-related words vs. neutral words activated a network of brain regions including cingulate cortex and insula in subjects and patients. There was stronger activation in medial and dorsolateral prefrontal cortex (DLPFC) and anterior midcingulate cortex in CPB patients than in HC. The magnitude of activation for pain-related vs. negative words showed a negative linear relationship to CBP patients’ current pain. Our findings confirm earlier observations showing that pain-related words activate brain networks similar to noxious stimulation. Importantly, CBP patients show even stronger activation of these structures while merely processing pain-related words. Current pain directly influences on this activation. Full article
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Open AccessArticle
Addressing Younger Workers’ Needs: The Promoting U through Safety and Health (PUSH) Trial Outcomes
Healthcare 2016, 4(3), 55; doi:10.3390/healthcare4030055 -
Abstract
Most younger workers, less than 25 years old, receive no training in worker safety. We report the feasibility and outcomes of a randomized controlled trial of an electronically delivered safety and health curriculum for younger workers entitled, PUSH (Promoting U through Safety [...] Read more.
Most younger workers, less than 25 years old, receive no training in worker safety. We report the feasibility and outcomes of a randomized controlled trial of an electronically delivered safety and health curriculum for younger workers entitled, PUSH (Promoting U through Safety and Health). All younger workers (14–24 years old) hired for summer work at a large parks and recreation organization were invited to participate in an evaluation of an online training and randomized into an intervention or control condition. Baseline and end-of-summer online instruments assessed acceptability, knowledge, and self-reported attitudes and behaviors. One-hundred and forty participants (mean age 17.9 years) completed the study. The innovative training was feasible and acceptable to participants and the organization. Durable increases in safety and health knowledge were achieved by intervention workers (p < 0.001, effect size (Cohen’s d) 0.4). However, self-reported safety and health attitudes did not improve with this one-time training. These results indicate the potential utility of online training for younger workers and underscore the limitations of a single training interaction to change behaviors. Interventions may need to be delivered over a longer period of time and/or include environmental components to effectively alter behavior. Full article
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Open AccessReview
Emotions and Emotion Regulation in Breast Cancer Survivorship
Healthcare 2016, 4(3), 56; doi:10.3390/healthcare4030056 -
Abstract
Emotional distress in cancer patients is an important outcome; however, emotional experience does not begin and end with emotion generation. Attempts to regulate emotions may lessen their potentially negative effects on physical and psychological well-being. Researchers have called for the study of [...] Read more.
Emotional distress in cancer patients is an important outcome; however, emotional experience does not begin and end with emotion generation. Attempts to regulate emotions may lessen their potentially negative effects on physical and psychological well-being. Researchers have called for the study of emotion regulation (ER) in health psychology and psycho-oncology. Thus, this review has three aims. First, we discuss current understandings of emotion and ER across the cancer trajectory, including the principles of ER and methods for its assessment. Second, we present a model for examining the mediating effects of ER on psychosocial outcomes. Third, we “round out” the discussion with an example: new data on the role of ER in recurrent breast cancer. Taken together, these aims illustrate the impact of affective regulatory processes on cancer patients’ long-term outcomes. As survival rates increase, long-term follow-up studies are needed to characterize the dynamic, reciprocal effects of emotion and ER for cancer survivors. Further research on ER may help women with breast cancer better manage the challenges associated with diagnosis and treatment. Full article
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