Barriers against incorporating evidence-based practice in physical therapy in Colombia: current state and factors associated

Background

Evidence-based practice (EBP) has been widely implemented in differing areas of physiotherapy. Nevertheless, few studies have investigated EBP-related barriers amongst Latin-American physical therapists working in primary care. The primary objective of this study was to describe the current state concerning perceived barriers engagement in EBP among physical therapy in Colombia. A secondary objective was to identify factors associated with barriers to implementation EBP.

Methods

A cross-sectional online survey was conducted. The study involved physical therapists working in public and private hospital who were contacted through professional networks (Email, Facebook_®, ResearchGate_® and Linked-In_®) and invited to participate. Multiple logistic regression (MLR) and multiple correspondence analysis (MCA) were used for examining factors associated with perceived barriers to including EBP in their work.

Results

The final sample size was 1064 (77.2 % female). Forty-one percent of the respondents indicated that a “lack of research skills” was the most important barrier to evidence being used in practice. MLR analysis suggested that several variables were associated with perceived barriers to including EBP: i.e. hours of work per week, current main role in therapy center and undergraduate degree. The MCA model established two groups of similarities regarding the different barriers; the "lack of understanding of statistical analysis", "insufficient time" and "understanding of the English in which articles are written" barriers were weighted more heavily regarding in the first group (the second factor on MCA) and the rest barriers on the second group (first factor on the MCA).

Conclusions

Although most physiotherapists had a positive opinion regarding EBP, they considered that they needed to improve their knowledge, skills and attitudes towards EBP. Initiatives to advance EBP in Colombia with no academic or research tradition should primarily target practitioner-level factors.

     

Examining the Associations Between Overeating,Disinhibition, and Hunger in a Nonclinical Sample of College Women

Background

Binge eating (BE) has long been identified as a correlate of overweight and obesity. However, less empirical attention has been given to overeating with and without loss of control (LOC) in nonclinical samples.

Purpose

The goal of the present study was to examine the association of (1) established correlates of BE, namely, weight and shape concerns, dietary restraint, and negative affect, and (2) three additional correlates, disinhibition, hunger, and interoceptive awareness (IA), to overeating in a nonclinical sample of college women.

Method

Female students (n?=?1,447) aged 18 to 21 years recruited from colleges in three Canadian metropolitan areas completed self-report questionnaires in class to assess sociodemographic and anthropomorphic characteristics, overeating, LOC, dietary restraint, negative affect, weight and shape concerns, IA, disinhibition, and hunger.

Results

The established correlates of BE were significant correlates of all types of overeating and explained 33 % of the variance. Disinhibition was the most strongly associated correlate of overeating.

Conclusions

Findings suggest that established correlates of BE are associated with other types of overeating such as objective overeating (OOE), as are disinhibition and hunger.

     

Lack of MMP-9 expression is a marker for poor prognosis in Dukes’ B colorectal cancer

Background

Matrix metalloproteinases (MMPs) play a role in cancer progression by degrading extracellular matrix and basement membranes, assisting in tumour neovascularization and in supporting immune response in cancer.

Methods

We studied the prognostic value of immunohistochemical expression of MMP-2, MMP-8, and MMP-9 in a series of 619 colorectal cancer patients using tissue microarray specimens.

Results

Of the samples, 56% were positive for MMP-2, 78% for MMP-8, and 60% for MMP-9. MMP-9 associated with low WHO grade (p?<?0.001). In univariate analysis of Dukes’ B tumours, MMP-9 negativity associated with poor survival (p?=?0.018), and MMP-9 positivity was an independent prognostic marker in multivariate analysis of these tumours (p?=?0.034).

Conclusion

Negative MMP-9 expression can predict poor prognosis in Dukes’ B colorectal tumours and may prove useful for identifying patients, who should be offered adjuvant treatment.

     

Histamine intolerance: a metabolic disease?

Objective

To evaluate the evidence regarding the disease concept of histamine intolerance as a state of inadequate histamine inactivation.

Methods

Keyword-based systematic screening of the scientific literature and of public websites focusing on diagnostic and therapeutic procedures.

Results

Histamine intolerance is commonly diagnosed based solely on subjective reporting of symptoms instead of following systematic diagnostic procedures based on objective laboratory and physical parameters. The only effective long-term therapy is avoidance of histamine-containing food.

Conclusions

The concept of histamine intolerance as a metabolic disease is in need of more experimental and clinical evidence and affected patients will benefit from a clear, evidence-based diagnostic and therapeutic regime.

     

Stressful Parental-Bonding Exaggerates the Functional and Emotional Disturbances of Primary Dysmenorrhea

Background

Some evidence suggests that women with primary dysmenorrhea (or painful period) often have traumatic experience with parental attachments, but the exact relationship is still unclear.

Purpose

This study aims to investigate associations between styles of the parental bonding and the detailed aspects of the disorder in Chinese university-student women.

Methods

From university-student women, we have invited 50 primary dysmenorrhea patients and 111 healthy volunteers, to undergo tests of the Functional and Emotional Measure of Dysmenorrhea (FEMD), the Family Relationship Questionnaire (FRQ), and the visual analogue scale for the pain intensity experienced.

Results

Besides the high scores of the FEMD Functional and Emotional scales, the dysmenorrhea patients also scored significantly higher than the healthy controls on the FRQ scales of Paternal Dominance and Maternal Abuse. In patients, the FEMD Emotional scale was negatively predicted by the Paternal Freedom Release scale, and the FEMD Functional scale was positively predicted by the Maternal Dominance scale.

Conclusions

Inappropriate parental bonding or chronic traumatic attachment styles have respective relationships with the functional and emotional disturbances experienced by the primary dysmenorrhea patients.

     

Bridging the gap - planning Lifestyle Medicine fellowship curricula: A cross sectional study

Background

The emerging field, Lifestyle Medicine (LM), is the evidence-based practice of assisting individuals and families to adopt and sustain behaviors that can improve health. While competencies for LM education have been defined, and undergraduate curricula have been published, there are no published reports that address graduate level fellowship in LM. This paper describes the process of planning a LM fellowship curriculum at a major, academic teaching institution.

Methods

In September 2012 Harvard Medical School Department of Physical Medicine and Rehabilitation approved a “Research Fellowship in Lifestyle Medicine”. A Likert scale questionnaire was created and disseminated to forty LM stakeholders worldwide, which measured perceived relative importance of six domains and eight educational experiences to include in a one-year LM fellowship. Statistical procedures included analysis of variance and the Wilcoxon signed-rank test.

Results

Thirty-five stakeholders (87.5%) completed the survey. All domains except smoking cessation were graded at 4 or 5 by at least 85% of the respondents. After excluding smoking cessation, nutrition, physical activity, behavioral change techniques, stress resiliency, and personal health behaviors were rated as equally important components of a LM fellowship curriculum (average M?=?4.69, SD?=?0.15, p?=?0.12). All educational experiences, with the exception of completing certification programs, research experience and fund raising, were graded at 4 or 5 by at least 82% of the responders. The remaining educational experiences, i.e. clinical practice, teaching physicians and medical students, teaching other health care providers, developing lifestyle interventions and developing health promotion programs were ranked as equally important in a LM fellowship program (average M?=?4.23, SD?=?0.11, p?=?0.07).

Conclusions

Lifestyle fellowship curricula components were defined based on LM stakeholders’ input. These domains and educational experiences represent the range of competencies previously noted as important in the practice of LM. As the foundation of an inaugural physician fellowship, they inform the educational objectives and future evaluation of this fellowship.

     

The role and prognostic value of apoptosis in colorectal carcinoma

Background

Alterations to apoptosis are a common occurrence in human tumours. The aim of our study was to determine the influence of apoptotic variations on the carcinogenesis and prognosis of colorectal carcinomas (CRCs).

Methods

A TUNEL assay was performed on archival material from 103 colorectal carcinomas, 26 adenomas and 20 samples of normal epithelia.

Results

The number of apoptotic cells was higher in CRCs (1.09?±?0.13) than in adenomas (0.38?±?0.23, p?=?0.059) and normal epithelium (0.06?±?0.04, p?=?0.001). In addition, the apoptotic index (AI) was greater in metastatic disease (stage IV) than in other stages (p?=?0.017). No relationship was found between apoptotic rates and age, gender or tumour grade. However, patients with tumours that showed higher AI values had a significantly lower disease-free survival (DFS) and overall survival (OS) than those with tumours that had lower AIs (p?=?0.020 and p?=?0.027). In a multivariate Cox proportional hazards model, AI remained a significant independent predictor of survival.

Conclusions

We conclude that disregulated apoptosis is an important event during CRC development and progression. Higher AIs are associated with more aggressive tumours and a poorer prognosis for patients with CRC.

     

Preliminary estimation of the prevalence of chemotherapy-induced dysgeusia in Japanese patients with cancer

Background

Although dysgeusia is a common adverse event in chemotherapy patients; it has not been evaluated using objective methods, and its prevalence and frequency have not been quantified.

Methods

Salt-impregnated taste strips were used to objectively assess dysgeusia in patients receiving chemotherapy at Akita University (n?=?38) and those off chemotherapy (n?=?9). Participant characteristics, and ongoing and previous chemotherapies were evaluated, and their associations with dysgeusia analyzed.

Results

Dysgeusia developed in 38.8% (14/38) of chemotherapy patients, and was most prevalent in patients receiving 5-fluorouracil (5-FU) or its oral analogs (48.1%, 13/27). Particularly, dysgeusia developed in 55.6% (10/18) of patients receiving oral 5-FU analogs; however, prevalence in patients receiving and off chemotherapy was not significantly different. Patients aged ≥70 years also tended to experience dysgeusia (75.0%, 6/8).

Conclusions

Association with dysgeusia may be higher for some chemotherapeutic drugs. Dysgeusia should be routinely assessed in chemotherapy patients with objective methods such as paper strips; interventions for its prevention may be required.

     

Type D Personality and Sleep Quality in Coronary Artery Disease Patients With and Without Obstructive Sleep Apnea: Mediating Effects of Anxiety and Depression

Purpose

The study aimed to examine the association between type D personality trait and sleep quality in coronary artery disease (CAD) patients with and without obstructive sleep apnea (OSA) and to explore the mediating effects of anxiety and depression symptoms.

Method

A cross-sectional study was performed in 879 CAD patients attending cardiac rehabilitation program (mean age 57.8 years; SD?=?9.0; 75% men). Participants underwent full-night polysomnography and were classified in OSA (n?=?349) and no OSA (n?=?530) groups. Patients were evaluated for type D personality, subjective sleep quality (Pittsburgh sleep quality index), and symptoms of anxiety and depression (hospital anxiety and depression scale).

Results

Patients with type D personality reported poorer subjective sleep quality than non-type D patients irrespective of the presence of OSA. Type D and negative affectivity (NA) were associated with worse subjective sleep quality in patients with OSA and without OSA. The mediational analysis revealed that type D and NA were indirectly associated with Pittsburgh sleep quality index through anxiety and depression symptoms in no OSA and OSA patients.

Conclusion

In CAD patients, type D personality and NA are associated with worse subjective sleep quality and this association is mediated by depression and anxiety symptoms irrespective of OSA presence.

     

Independent and Combined Associations of Physical Activity and Sedentary Behavior with Depressive Symptoms Among Japanese Adults

Background

Associations between levels of sedentary behavior and depressive symptoms independently and in combination with different levels of physical activity remain unclear.

Purpose

This study aimed to examine independent and combined associations of physical activity (PA) and sedentary behavior (SB) with depressive symptoms among Japanese adults.

Method

An Internet-based survey collected data on depression levels (Center for Epidemiologic Studies Depression Scale), self-reported time spent in PA and SB (Japanese short version of the International Physical Activity Questionnaire), and sociodemographic variables from 2,914 adults in 2009. Binary logistic regression analyses were conducted to examine the odds ratios (ORs) for being depressed (depression scores ≥16) according to independent PA levels (none, insufficient, sufficient), SB levels (low, moderate, high), and nine combinations of PA and SB categories.

Results

After adjusting for potential confounders, sufficient PA level was found to be related to lower risk of depressive symptoms independently (OR?=?0.61), whereas no significant associations were observed between SB levels and depression. In the combined associations, adults in the sufficient PA/high SB (OR?=?0.44), sufficient PA/moderate SB (OR?=?0.56), and sufficient PA/low SB (OR?=?0.57) categories were significantly less likely to have depressive symptoms in comparison with the no PA/high SB category.

Conclusion

Meeting physical activity recommendations is associated with a lower risk of depressive symptoms, regardless of time spent in total sedentary behavior. These results suggest that promoting physical activity may be an effective strategy against depressive symptoms among Japanese adults.

     

HIV Prevention Among Transgender Populations: Knowledge Gaps and Evidence for Action

Purpose of Review

The purpose of this review is to summarize the available evidence-based HIV prevention interventions tailored for transgender people.

Recent Findings

A limited number of evidence-based HIV prevention interventions have been tested with transgender populations. Most existing interventions target behavior change among transgender women, with only one HIV prevention program evaluated for transgender men. Studies addressing biomedical interventions for transgender women are ongoing. Few interventions address social and structural barriers to HIV prevention, such as stigma, discrimination, and poverty.

Summary

Evidence-based multi-level interventions that address the structural, biomedical, and behavioral risks for HIV among transgender populations, including transgender men, are needed to address disparities in HIV prevalence. Future research should address not only pre-exposure prophylaxis uptake and condom use but also structural barriers that limit access to these prevention strategies.

     

Psychological Treatments for Chronic Pain in East and Southeast Asia: A Systematic Review

Background

Psychological treatments are recognised as generally effective for chronic pain. However, little is known about the evidence for psychological treatments for chronic pain in Asia.

Purpose

This study aimed (1) to identify all treatment outcome studies in the area of psychological approaches to chronic pain in adult populations of East Asia and Southeast Asia and (2) to evaluate the treatment types, the evidence for treatment outcomes and research design quality with regard to these studies.

Methods

We identified all psychologically based treatment outcome studies for chronic pain in East and Southeast Asia by searching CENTRAL, EMBASE, PsycINFO, MEDLINE (via Ovid), Global Health and Web of Science from the beginning of each abstracting service until December 2014 (week 4).

Results

Seventeen studies met inclusion criteria including a total of N?=?1,890 participants. Four were randomised controlled trials (RCTs), five controlled clinical trials (CCTs) and eight cohort studies. Treatment outcomes included pain, disability, depression and anxiety. Overall, the studies included in this review showed small to medium within-group effect sizes for all four outcomes. A majority of the studies were rated as weak in design quality. Three RCTs were found to be of strong quality, one of moderate quality and only one CCT of moderate quality.

Conclusion

The current available literature on psychological treatments for chronic pain in East and Southeast Asia is generally small in scale, mostly preliminary and lags behind on some developments occurring in North America and Europe. Further development of treatment methods and research designs is warranted.

     

Association between quantitative varicella-zoster virus antibody levels and zoster reactivation in HIV-infected persons

Background

Varicella-zoster virus (VZV) reactivation is common but difficult to predict in HIV-infected persons.

Objective

Since qualitative VZV antibodies can determine past VZV disease or vaccination, we evaluated whether quantitative VZV antibody levels over time can predict future zoster.

Study design

US Military HIV Natural History (NHS) participants with a zoster diagnosis at least 5 years after HIV diagnosis (n?=?100) were included. Zoster-negative controls (n?=?200) were matched by age, race, gender, and CD4 count at HIV diagnosis. Repository plasma specimens collected at baseline and prior to zoster diagnosis were evaluated using a quantitative anti-VZV ELISA assay. Differences in quantitative VZV levels were analyzed by Wilcoxon Mann–Whitney and Fisher’s exact tests.

Results

Median CD4 count at HIV diagnosis was similar for cases and controls (535 [IQR 384–666] vs. 523 [IQR 377–690] cells/μL; p?=?0.940), but lower for cases at zoster diagnosis (436 [IQR 277–631] vs. 527 [IQR 367–744] cells/μL; p?=?0.007). Antiretroviral therapy (ART) use prior to zoster diagnosis was lower for cases (52.0%) compared to controls (64.5%; p?=?0.025). Cases had similar mean VZV antibody levels prior to zoster diagnosis compared to controls [2.25?±?0.85 vs. 2.44?±?0.96 index value/optical density (OD) ratio; p?=?0.151] with no difference in the change in antibody levels over time (0.08?±?0.71 vs. 0.01?±?0.94 index value/OD per year; p?=?0.276).

Conclusion

Quantitative VZV antibody levels are stable in HIV-infected persons and do not predict zoster reactivation. Low CD4 count and lack of ART use appear to be better predictors of future zoster diagnosis.

     

Stress Underestimation and Mental Health Outcomes in Male Japanese Workers: a 1-Year Prospective Study

Purpose

Being appropriately aware of the extent of stress experienced in daily life is essential in motivating stress management behaviours. Excessive stress underestimation obstructs this process, which is expected to exert adverse effects on health. We prospectively examined associations between stress underestimation and mental health outcomes in Japanese workers.

Methods

Web-based surveys were conducted twice with an interval of 1 year on 2359 Japanese male workers. Participants were asked to complete survey items concerning stress underestimation, depressive symptoms, sickness absence, and antidepressant use.

Results

Multiple logistic regression analysis revealed that high baseline levels of ‘overgeneralization of stress’ and ‘insensitivity to stress’ were significantly associated with new-onset depressive symptoms (OR?=?2.66 [95 % CI, 1.54–4.59], p?<?.01) and antidepressant use (OR?=?4.91 [95 % CI, 1.22–19.74], p?<?.05), respectively, during the 1-year follow-up period.

Conclusions

This study clearly demonstrated that stress underestimation, including stress insensitivity and the overgeneralization of stress, could exert adverse effects on mental health.

     

Tinnitus,Traumatic Brain Injury,and Posttraumatic Stress Disorder in the Military

Purpose

Acoustic trauma is more prevalent in military settings, especially among individuals with combat-related military occupational specialties. Gunfire, improvised explosive devices, and mortar explosions are a few examples that may cause hearing degradation and tinnitus. It is possible that the same events that are associated with auditory problems can cause traumatic brain injury (TBI) and posttraumatic stress disorder (PTSD).

Method

This paper reviews the distinct and overlapping symptoms of tinnitus, TBI, and PTSD, and how these disorders interact to synergistically promote negative outcomes.

Results

Tinnitus may serve as a significant contributor to symptoms of TBI and PTSD. Therefore, tinnitus subtypes could be identified as physiologically or psychologically based, or both.

Conclusions

Additional research is warranted to determine the common and unique symptoms and associated neurological pathways of tinnitus, TBI, and PTSD. Brief treatment recommendations are provided, including a multidisciplinary approach for the physical and psychological distress associated with tinnitus.

     

Through thick and thin?

Background

A good romantic relationship quality increases resilience against mental and physical health problems. Regarding correlates of relationship quality, research has focused mostly on attachment style and personality traits such as the Big Five.

Objective

The current study aims to find further predictors of a good relationship quality, such as sleep, demographics, and the boundary concept.

Materials and methods

For the study, 336 subjects were recruited, most of them women (79.76%). Only participants who were in a relationship were included in the analyses (N?=?216). The effects of sleep (Pittsburgh Sleep Quality Index, PSQI), demographics, and thin or thick boundaries (Boundary Personality Questionnaire, BPQ) on relationship quality (Partnerschaftsfragebogen—Kurzversion, PFB-K) were assessed using multiple regression.

Results

Age and thickness of boundaries were significantly connected with relationship quality. Sleep quality, gender, body mass index, and accommodation were not related to relationship quality.

Conclusion

The current study confirms the importance of age and provides new insight into the effects of boundaries in terms of relationship quality. Methodological limitations (e.g., homogenous and healthy sample) might compromise the findings regarding sleep. Future studies should include a more diverse sample and investigate further correlates of the boundary concept.

     

<Emphasis Type="Italic">Helicobacter bilis</Emphasis>-Associated Suppurative Cholangitis in a Patient with X-Linked Agammaglobulinemia

?

Helicobacter bilis is a commensal bacterium causing chronic hepatitis and colitis in mice. In humans, enterohepatic Helicobacter spp. are associated with chronic hepatobiliary diseases.

Purpose

We aimed at understanding the microbial etiology in a patient with X-linked agammaglobulinemia presenting with suppurative cholangitis.

Methods

16S rDNA PCR directly performed on a liver biopsy retrieved DNA of H. bilis.

Results

Clinical outcome resulted in the normalization of clinical and biological parameters under antibiotic treatment by a combination of ceftriaxone, metronidazole, and doxycyclin followed by a 2-week treatment with moxifloxacin and a 2-month treatment with azithromycin.

Conclusion

In conclusion, these data suggest a specific clinical and microbiological approach in patients with humoral deficiency in order to detect H. bilis hepatobiliary diseases.