Kinematics of fast cervical rotations in persons with chronic neck pain: a cross-sectional and reliability study

Background  

Assessment of sensorimotor function is useful for classification and treatment evaluation of neck pain disorders. Several studies have investigated various aspects of cervical motor functions. Most of these have involved slow or self-paced movements, while few have investigated fast cervical movements. Moreover, the reliability of assessment of fast cervical axial rotation has, to our knowledge, not been evaluated before.     

Prevalence of neck pain in subjects with metabolic syndrome - a cross-sectional population-based study

Background  

Metabolic syndrome (MetS) is increasingly common. Obesity has been suggested to associate with neck pain but prevalence of neck pain in subjects with MetS has not been studied. Aim of this study was to analyse the association between MetS and neck pain.     

Predictors of unsuccessful pessary fitting in women with prolapse: a cross-sectional study in general practice

Introduction and hypothesis

Pelvic organ prolapse is a common condition. There is inconsistency between predictors of unsuccessful pessary fitting in urological/gynaecological clinics. Research in general practice is scarce. The aim was to estimate the proportion of women in general practice with a symptomatic pelvic organ prolapse and unsuccessful pessary fitting, and to identify characteristics associated with unsuccessful pessary fitting.

Methods

A cross-sectional study in general practice (n?=?20) was carried out among women (≥55 years) with symptomatic prolapse (n?=?78). Multivariate logistic regression analysis was used to identify predictors of unsuccessful pessary fitting.

Results

In total, 33 women (42 %) had unsuccessful pessary fitting. Factors associated with unsuccessful pessary fitting were age (per year, OR 0.93 [95 % CI 0.87–1.00]), body mass index (per kg/m², OR 1.14 [95 % CI 1.00–1.30]), and having underactive pelvic floor muscles (OR 2.60 [95 % CI 0.81–8.36]).

Conclusions

Pessary fitting was successful in 58 %, indicating that pessary treatment may be suitable for many, but not for all women in general practice with symptomatic prolapse. The condition of the pelvic floor probably plays a role in the success of pessary fitting, as demonstrated by the association with underactive pelvic floor muscles, and body mass index. The association with age may reflect the higher acceptance of conservative treatments for prolapse in older women. This is the first study on predictive factors for unsuccessful pessary fitting in general practice. Therefore, further research should seek to confirm these associations before we can recommend the use of this information in patient counselling.

     

Depression and anxiety in adolescents and adults with cystic fibrosis in the UK: A cross-sectional study

BackgroundThe International Depression/anxiety Epidemiological Study (TIDES) in the UK aimed: (i) to establish the prevalence of anxiety and depression amongst people with CF compared to a normative sample; (ii) to establish the association between mood, demographic and clinical variables; and (iii) to provide guidance for specialist-referral decision-making.MethodsPatients (≥ 12 years) completed the Hospital Anxiety and Depression Scale (HADS). CF-HADS scores, expressed as percentiles, were compared with a normative sample. Multiple-regression analysis explored associations between demographic, clinical and mood variables.ResultsThirty-nine CF centres recruited 2065 patients. Adults with CF were similar in terms of anxiety and depression to the general population. Adolescents with CF were less anxious and depressed. For adult patients, older age, unemployment for health reasons and poor lung function were associated with disordered mood. Gender-specific CF-percentile scores were calculated.ConclusionSurveillance, with attention to gender and risk factors is advocated. This work provides unique benchmark scores to aid referral decision-making.     

Lower back and neck pain among dentistry students: a cross-sectional study in dentistry students in Northern Greece

Introduction

Dentistry students and dentists comprise a unique group of professionals, whose everyday professional activity requires long hours of standing and working in a position considered unhealthy for the lower back and neck. Our aim was to explore the factors involved in the appearance of low back and neck pain in dentistry students as well as the impact of the pain on the students’ professional and everyday activities.

Materials and methods

A questionnaire was given to all dentistry students of the 4th and 5th year of our university. The questionnaire included 43 questions regarding demographic data, history (spinal injury, other comorbidities), daily activities (exercise, smoking, alcohol and caffeine consumption, use of cell phone), professional activities (length and type of dental work), pattern and intensity of pain, and personal pain evaluation. A statistical analysis of the gathered data was performed.

Results

All students having suffered a spinal trauma or indicating any other comorbidity that could cause severe pain of the spine were excluded from the study. Fifty-five students (21 male, 34 female) were included. Our data showed that increased alcohol consumption and prolonged use of cell phone were connected to increased levels of pain. The students reported that the most frequent onset of pain was 1 h after starting to work in a standing position, while the majority believed that their working habits were involved in the appearance and the intensity of neck and low-back pain.

Conclusion

Our findings indicate that among dentistry students appears to be a causative relationship between their professional activities and the experienced spinal pain. These findings may be useful in a possible future restructuring of the educational program in dental schools, as well as in improving the ergonomics of dentistry working units.

     

Prostate-specific antigen testing rates remain low in UK general practice: a cross-sectional study in six English cities

Study Type – Practice patterns (retrospective cohort) Level of Evidence 2b What is known on the subject? and what does the study add? There is no organized screening programme for prostate cancer in the UK, although men can request a PSA test at their general practice. The testing rate had been estimated at 6% per year among 45–84 year old men during 2001 to 2007. Our study estimated the annual practice‐based PSA testing rate for men aged 45–89 years with no previous diagnosis of prostate cancer at 6.2% during 2007. This is very similar to the rate found in the earlier study. Older men and men at general practices situated in more affluent areas were found to be most likely to undergo a PSA test, suggesting that uptake of the test is not reflecting clinical need. OBJECTIVE ? To estimate rates of prostate‐specific antigen (PSA) testing in UK general practices by age, deprivation index and geographical location. SUBJECTS AND METHODS ? Practice‐based, retrospective data on PSA testing patterns in 2007 were collected from a random sample of 87 general practices using EMIS LV computer systems within the passively observed non‐intervention arm of a cluster‐randomized controlled trial. ? Information for a total of 126 716 men aged 45–89 years with no recorded diagnosis of prostate cancer prior to 1 January 2007 was collected. RESULTS ? In all, 7902 (6.2%) of 126 716 men aged 45–89 without a prior diagnosis of prostate cancer underwent at least one PSA test from their general practitioner during 2007 [95% confidence interval (CI) 5.6–7.0%; practice‐based inter‐quartile range 3.6–8.4%]. ? PSA testing rates were 1.4% (95% CI 1.1–1.6%) in men aged 45–49, rising to 11.3% (95% CI 10.0–12.9%) at age 75–79 years (P for trend <0.001). ? Testing rates were lowest in the three northern centres (3.5–5.7%) vs the three more southern centres (7.1–8.9%; P < 0.001). ? For every 20 points increase in the index of multiple deprivation score, the proportion of men tested fell by 1.7% (95% CI ?2.5 to ?0.8%; P < 0.001). ? Lower proportions of men were subsequently diagnosed with prostate cancer in practices testing more men (odds ratio for a one unit increase in the natural log of testing 0.76; 95% CI 0.60–0.97; P= 0.025). CONCLUSION ? Overall levels of PSA testing in UK general practice remain low, but for those tested there are important variations by age, deprivation and geographical location that do not appear to reflect clinical need or the intention of current policy. ? PSA testing in general practice is currently skewed towards older men, and current policy enabling all men to make an informed choice about PSA testing is not being effectively implemented as uptake clearly varies by socioeconomic status. ? This reinforces the need for robust evidence regarding the costs and benefits of using the PSA test for the detection of localized prostate cancer in the UK, a full assessment of the health economic implications and a revision of the current policy.     

Muscle strength and soccer practice as major determinants of bone mineral density in adolescents

ObjectivesTo analyse the relationship between isokinetic strength of the lower limb muscles and bone mineral density and content (BMD, BMC) of adolescent male soccer players and age-matched controls not involved in sport (12–15 years).MethodsA random sample of 151 young males was divided into soccer players (SG; n = 117) and control subjects (CG; n = 34). Peak torque of knee extensors (PTE) and flexors (PTF) was measured during isokinetic knee joint movement (90°/s) of the dominant and non-dominant lower limbs. BMD and BMC of the whole-body, lumbar spine, dominant/non-dominant lower limb were determined by dual-energy X-ray absorptiometry. Physical activity was monitored with accelerometers during 5 days. Estimated maturity offset was used as an indicator of biological maturity status.ResultsWhole-body BMD (1.03 ± 0.01 vs. 0.98 ± 0.01 g/cm², P = 0.003) and dominant (1.09 ± 0.01 vs. 1.02 ± 0.01 g/cm², P < 0.001) and non-dominant (1.09 ± 0.01 vs. 1.01 ± 0.01 g/cm², P < 0.001) lower limb BMD was greater in SG compared to CG. No significant differences were found for BMC. Compared to CG, SG performed better in the YY-IE2 test (780 ± 40 vs. 625 ± 31 m), exhibited higher PTE (dominant limb: 155.2 ± 30.3 vs. 123.4 ± 37.0 N m; non-dominant limb: 156.2 ± 36.1 vs. 120.4 ± 41.1 N m) and PTF muscles (dominant limb: 79.0 ± 25.3 vs. 57.1 ± 25.3 Nm; non-dominant limb: 73.3 ± 20.7 vs. 57.0 ± 24.2 N m). Moreover, the PTE, soccer participation and maturity status were positively associated with the BMD at all body sites (r² = 0.57–0.73, P < 0.05).ConclusionsMuscle strength of knee extensors is associated with BMD and BMC at all body sites. Muscle-skeletal structures respond positively to the weight-bearing and impact-loading imposed by soccer practice. Soccer seemed to be a multilateral balanced sport activity.     

Stages of chronicity in fibromyalgia and pain catastrophising: a cross-sectional study

Background  

Fibromyalgia (FM) is a prevalent and disabling disorder characterised by widespread pain and other symptoms such as insomnia, fatigue and depression. Catastrophisation is considered to be a key clinical symptom in FM; however, few studies have investigated how contextual factors, such as catastrophisation, might contribute to the duration of the pain. The present research examined the relationship among pain, catastrophic thinking and FM impact, as a function of stage of chronicity.     

Rates of prostate-specific antigen testing in general practice in England and Wales in asymptomatic and symptomatic patients: a cross-sectional study

OBJECTIVE: To assess the rate of prostate-specific antigen (PSA) testing for prostate cancer in general practice in asymptomatic and symptomatic patients. SUBJECTS AND METHODS: The cross-sectional study took place in England and Wales, was population-based and covered 469 159 men aged 45-84 years. Pathology data on PSA tests requested between 19 November 1999 and 31 May 2002 by general practitioners (GPs) were provided by 28 pathology laboratories. The practices recorded reasons for the tests between 1 December 2001 and 31 May 2002. In all, 391 practices in which all GP partners participated were included in the analyses. RESULTS: The overall annual rate of testing in men with no previous diagnosis of prostate cancer was estimated to be 6%, of which the annual rates of asymptomatic, symptomatic and re-testing were 2.0%, 2.8% and 1.2%, respectively, after adjusting for missing values. The rate decreased with increasing social deprivation, and with increasing proportions of black and Asian populations. The overall rate of PSA testing increased significantly from 1999 to 2002. CONCLUSIONS: If the recommendations of the National Health Service Prostate Cancer Risk Management Programme were applied, 14% of asymptomatic tests and 23% of symptomatic tests would have led to a referral. As the rate of PSA testing is increasing and there are uncertainties about the benefit of screening, the workload and costs in general practice and hospitals should be monitored.     

The association between prevalent neck pain and health-related quality of life: a cross-sectional analysis

The aim of this study was to examine the association between grades of neck pain severity and health-related quality of life (HRQoL), using a population-based, cross-sectional mailed survey. The literature suggests that physical and mental HRQoL is worse for individuals with neck pain compared to those without neck pain. However, the strength of the association varies across studies. Discrepancies in study results may be attributed to the use of different definitions and measures of neck pain and differences in the selection of covariates used as control variables in the analyses. The Saskatchewan Health and Back Pain Survey was mailed to 2,184 randomly selected Saskatchewan adults of whom 1,131 returned the questionnaire. Neck pain was measured with the Chronic Pain Questionnaire and categorized into four increasing grades of severity. We measured HRQoL with the SF-36 Health Survey and computed the physical and mental component summary scores. We built separate multiple linear regression models to examine the association between grades of neck pain and physical and mental summary scores while controlling for sociodemographic, general health and comorbidity covariates. Our crude analysis suggests that a gradient exists between the severity of neck pain and HRQoL. Compared to individuals without neck pain, those with Grades III–IV neck pain have significantly lower physical (mean difference = −13.9/100; 95% CI = −16.4, −11.3) and mental (mean difference = −10.8/100; 95% CI = −13.6, −8.1) HRQoL. Controlling for covariates greatly reduced the strength of association between neck pain and physical HRQoL and accounted for the observed association between neck pain and mental HRQoL. In the comorbidity model, the strength of association between Grades III–IV neck pain and PCS decreased by more than 50% (mean difference = −4.5/100; 95% CI = −6.9, −2.0). In the final PCS model, Grades III–IV neck pain coefficients changed only slightly from the comorbidity model (mean difference = −4.4/100; 95% CI = −6.9, −1.9). This suggests that comorbid conditions account for most of the association between neck pain and PCS score. It was concluded that prevalent neck pain is weakly associated with physical HRQoL, and that it is not associated with mental HRQoL. Our cross-sectional analysis suggests that most of the observed association between prevalent neck pain and HRQoL is attributable to comorbidities.     

Kinesiophobia in patients with non-traumatic arm,neck and shoulder complaints: a prospective cohort study in general practice

Background  

Complaints of arm, neck and shoulder are common in Western societies. Of those consulting a general practitioner (GP) with non-traumatic arm, neck or shoulder complaints, about 50% do not recover within 6 months.     

Implementation barriers for general practice guidelines on low back pain a qualitative study

STUDY DESIGN: Qualitative study design, using semi-structured interviews. OBJECTIVE: To explore factors that determine non-adherence to the guidelines for low back pain. SUMMARY OF BACKGROUND DATA: Guidelines for low back pain have been published in the past decade in various countries. In the Netherlands, general practitioners adhere to them to a fair extent, and it is unclear whether room for improvement remains. METHODS: Forty semistructured, in-depth interviews were conducted with twenty patients who consulted for low back pain, and with their general practitioners. The interviews were fully transcribed and analyzed qualitatively. RESULTS: Patients often had limited expectations of the consultation. They wanted to hear a diagnosis or expected to receive simple advice. The general practitioners said they were well informed about the guideline and mostly agreed with its content. Reasons for non-adherence were mainly related to patients' experiences in the past and general practitioners' interpretations of their preferences. General practitioners stated that they were inclined to give in to patients' demands, for example the request for radiographic films or a referral to a physical therapist. In general, patients and their general practitioners were satisfied with the chosen management. CONCLUSIONS: Improvement of the quality of back pain care may still be possible. Implementation strategies should aim at training physicians in communication skills, especially about subjects for debate, where patients' beliefs and experiences color their expectations.     

Management of osteoporosis in general practice: a cross-sectional survey of primary care practitioners in Spain

A cross-sectional survey was conducted to determine the current situation in Spain regarding diagnosis and care of patients with osteoporosis in the primary care setting. A total of 2,500 primary care physicians who were homogeneously grouped in autonomous communities throughout the country received a postal 30-item anonymous self-administered questionnaire. The questionnaire covered demographics and personal characteristics of the physicians, conditions in everyday consultation, and degree of knowledge with regard to risk factors, diagnosis, treatment, and follow-up of the disease. The overall response was 850 (34%). The mean age of physicians surveyed was 43 years (range 23–66 years). The percentage of physicians specialized in community and family medicine was 46.7%. In 55.2% of cases, years of practice ranged between 11 and 20, and 55.7% of physicians visited between 31 and 50 patients per day. Age and years of practice were not associated with daily number of visits. Only 4% of physicians stated that there were specific programs for osteoporosis implemented in their primary care center. Diagnostic complementary investigations that could be ordered included plain radiographs in 96.2% of cases and bone densitometry in 27.8%. Laboratory tests included serum hormones in 61.6% of cases, PTH in 50.2%, and bone alkaline phosphatase in 33.4%. The diagnosis of osteoporosis was made always personally in 25.2% of cases. Personal diagnosis and follow-up, as well as actions directed to detection of osteoporosis were significantly higher among physicians working in centers with specific programs for osteoporosis. With regard to knowledge about osteoporosis, the mean percentage of correct responses was 63%. The percentage of correct responses was inversely associated with age and years of practice, and positively associated with speciality of community and family medicine. Primary care providers are in a good position to assess risk factors and recommend prevention strategies, as well as to play an active role in the diagnosis, care, and follow-up of patients with osteoporosis. Practitioners of younger age and relatively few years of practice were those with more up-to-date information regarding the disease, and the existence of a specific program for osteoporosis seems to improve the management of this condition.