Elderly users of fall-risk-increasing drug perceptions of fall risk and the relation to their drug use – a qualitative study

Objective: The aim of the study was to explore how home-dwelling elderly who use fall-risk-increasing drugs (FRIDs) perceive their fall risk and how they relate this to their drug use.

Design, setting and subjects: A qualitative study with 14 home-dwelling elderly FRID users between 65 and 97 years in Central Norway participating in semi-structured individual interviews. The data were analyzed thematically by using systematic text condensation.

Results: The main finding was that the informants did not necessarily perceive the use of FRIDs to be a prominent risk factor for falls. Some informants said they did not reflect upon drug use whatsoever and said they fully trusted their physician’s choices. When either experiencing dizziness, fall episodes or by reading the patient information leaflet the informants said to either adjust their drug use or to contact their physician. Some felt rejected due to not getting their point across or their wish to alter the drug was not granted by the physician.

Conclusions: Elderly FRID users did not necessarily relate their drug use to fall risk or struggled to present their perceived drug-related problems. Physicians need to regularly inform, monitor and assess the drug treatment when treating elderly with FRIDs.     

Changes in patients visiting a homeopathic clinic in Norway from 1994 to 2004

AIM: There are a few examining changes in patient groups seeking homeopathic care. This study describes changes in complaints and characteristics of patients visiting a homeopathic clinic in Norway from 1994/1995 to 2003/2004. METHODS: Two surveys were conducted, each including data for 700 patients who had visited the same homeopathic clinic, with five (1995) and seven (2004) homeopaths, respectively. Data on patients' gender, age, occupation, reason for encounter and where they had heard about homeopathy and the homeopathic clinic were registered by the homeopaths. In 2004, the patients also answered questions on the previous use of conventional treatment and how long it took them to decide to consult a homeopath. RESULTS: There are no changes in the reason for encounter and gender proportions between 1995 and 2004. Over 36% of patients were under the age of 16 in 2004, compared to 26% in 1995. Most patients still consult homeopaths through a lay referral network. In 2004, more than 60% made an appointment with a homeopath within the first month of first considering it. CONCLUSION: There are few changes in the characteristics of this homeopathic patient population. There is a need for studies that explore the 'why question'; Why an increasing percentage of patients are children? Why people with higher education and why certain age groups visit homeopaths more frequently than others?     

Twelve-month effect of chronic pain self-management intervention delivered in an easily accessible primary healthcare service - a randomised controlled trial

Background

To investigate the effects after twelve months related to patient activation and a range of secondary outcomes on persons with chronic pain of a chronic pain self-management course compared to a low-impact outdoor physical activity, delivered in an easily accessible healthcare service in public primary care.

Methods

An open, pragmatic, parallel group randomised controlled trial was conducted. The intervention group was offered a group-based chronic pain self-management course with 2.5-h weekly sessions for a period of six weeks comprising education that included cognitive and behavioural strategies for pain management, movement exercises, group discussions and sharing of experiences among participants. The control group was offered a drop-in, low-impact, outdoor physical activity in groups in one-hour weekly sessions that included walking and simple strength exercises for a period of six weeks. The primary outcome was patient activation assessed using the Patient Activation Measure (PAM-13). Secondary outcomes included assessments of pain, anxiety and depression, pain self-efficacy, sense of coherence, health-related quality of life, well-being and the 30-s Chair to Stand Test. Analyses were performed using a linear mixed model.

Results

After twelve months, there were no statistically significant differences between the intervention group (n?=?60) and the control group (n?=?61) for the primary or the secondary outcomes. The estimated mean difference between the groups for the primary outcome PAM was 4.0 (CI 95% -0.6 to 8.6, p?=?0.085). Within both of the groups, there were statistically significant improvements in pain experienced during the previous week, the global self-rated health measure and the 30-s Chair to Stand Test.

Conclusions

No long-term effect of the chronic pain self-management course was found in comparison with a low-impact physical activity intervention for the primary outcome patient activation or for any secondary outcome.

Trial registration

ClinicalTrials.gov: NCT02531282. Registered on August 212,015

     

Primary irritant dermatitis from topical clioquinol

During the 2-year period 1976--1977, seven patients were studied with primary irritant dermatitis from topical preparations containing clioquinol. During the same period contact hypersensitivity to the compound was recorded in 35 eczema patients. Six of the seven patients with clioquinol irritancy had used creams containing 3% large crystal clioquinol and fluorinated steroids. One patient had used 6% small crystal clioquinol cream. Challenge tests with 3% small crystal and large crystal clioquinol creams showed that crystal size did not affect the appearance of irritant dermatitis.     

PARTICIPATION AND QUALITY OF LIFE IN PERSONS LIVING WITH SPINAL CORD INJURY IN NORWAY

ObjectivesTo describe the association between sociodemographic and spinal cord injury characteristics, of people living with spinal cord injury, and participation and quality of life, and to study the association between participation and quality of life in this group of people.DesignPersons registered in the Norwegian Spinal Cord Injury Registry after post-acute rehabilitation between 2011 and 2017 were invited to participate in a survey in 2019 when they were in a community setting.SubjectsA total of 339 people living with spinal cord injury.MethodsThe Frequency scale and Restrictions scale of the Utrecht Scale for Evaluation of Rehabilitation-Participation were used to measure participation. Quality of life was measured as life satisfaction with the World Health Organization Quality of life assessment (WHOQoL-5) and mental health was measured using the Mental Health subscale (MHI-5).ResultsOverall, sociodemographic characteristics were more prominently associated with quality of life and participation than were spinal cord injury characteristics. Currently working as main activity and having a family income in the highest quartile were associated with higher scores on all 4 measures of participation and quality of life. There was a strong gradient between higher level of participation (frequency and restrictions) and better quality of life.ConclusionParticipation was strongly associated with life satisfaction and mental health in people living with spinal cord injury. This indicates that participation issues should be given greater priority during post-acute rehabilitation, follow-up and subsequent care efforts provided in the community.LAY ABSTRACTHaving paid work, leisure-time activities and good relationships with other people is important for one’s quality of life. For people living with spinal cord injury, it may be more difficult to participate in such activities than it is for people without health problems. A survey on participation problems was carried out among Norwegians living with spinal cord injury. Sociodemographic factors, such as family income and education, were found to have a greater impact on quality of life and participation, than the severity of the injury itself. Participation was strongly associated with life satisfaction and mental health. This indicates that participation issues should be given greater priority.Key words: spinal cord injuries, participation, quality of life, Norway

Participation provides opportunities for the fulfilment of basic human needs and can be an important determinant of quality of life (QoL) (1). Persons living with spinal cord injury (SCI) may, however, experience restrictions or barriers to participation in different domains, including employment or social-recreational activities (2). Research on issues related to participation problems among persons with SCI is, however, limited. In a critical systematic review on social and community participation following SCI (3), the authors emphasized that the samples in the reviewed studies were relatively small, that the instruments used were often developed before the introduction of the International Classification of Functioning, Disability and Health (ICF), and that the use of the term ”participation” varied. In addition, knowledge about the impact of injury characteristics on participation is underdeveloped (2). Furthermore, limited attention has been given in the literature to how clinical practice can be adapted to improve participation in persons with SCI. To do so, more knowledge of factors influencing participation is needed.In the ICF, ”participation” refers to the involvement of an individual in a life situation and represents the social perspective on functioning (4). To measure participation, it has been recommended to measure participation both as the so-called objective state and subjective experience (5). Objective participation can be measured as self-reported frequencies of behaviour, while subjective participation concerns self-reported experienced restrictions in participation in society. It has been commented that the ICF definition of participation does not adequately capture this (6).QoL is a broad concept, and has been defined by the World Health Organization (WHO) as the individuals’ perceptions of their position in life in the context of the culture and value systems in which they live and in relation to their goals, expectations, standards and concerns. It can be operationalized to distinguish between the cognitive component that refers to life satisfaction and the emotional component that refers to a person’s affect or mental health (8).People with SCI experience lower QoL, as shown by higher levels of distress, worse mental health and lower levels of life satisfaction compared with the general population (9, 10). Studies have indicated that decreased mobility (11, 12), having secondary impairments (11, 12), pain (11, 13) and unemployment (14) are associated with lower QoL. Increased QoL has been associated with psychosocial characteristics, such as higher self-efficacy (15), good social skills (15), more social support (9) and a feeling of acceptance (16). The associations between QoL and age, sex, education, injury level and injury duration are inconsistent (9, 12, 17). However, there is variation in study design, inclusion criteria, and measure instruments, and cohort studies with a representative sample and sufficient sample size have been requested (9).Studies exploring the association between participation and QoL indicate that participation is related to higher life satisfaction (1, 18). However, little is known about risk groups for poor participation and poor QoL and knowledge about risk profiles can help in intervention planning.The objectives of this study were therefore to assess participation and QoL with validated generic measurement instruments in a representative sample. Specific aims were: (i) to describe the association between sociodemographic and SCI characteristics with participation and QoL; (ii) to detect groups at risk for low participation/poor QoL; and (iii) to study the association between participation and QoL.     

Both sides of the story: Exploring how improved and less-improved participants experience mindfulness-based stress reduction for social anxiety disorder

Objective: What works for whom in mindfulness-based group interventions for social anxiety disorder (SAD)? The present article compared the experiences of 14 participants in a clinical study of mindfulness-based stress reduction (MBSR) for young adults with SAD. Methods: A two-staged mixed methods design was used to identify the participants who reported the highest (n?=?7) and lowest (n?=?7) levels of symptomatic change on outcome measures after treatment, and analyze qualitative in-depth interviews to explore what they experienced as helpful and unhelpful during the MBSR program. The qualitative interviews were analyzed using a thematic analysis methodology. Results: We identified the global theme of (i) Discovering agency to change or not feeling empowered through the MBSR program, and four sub-themes: (ii) Forming an active commitment or feeling ambivalence toward learning mindfulness, (iii) Engaging with others or avoiding contact with the group, (iv) Using the mindfulness exercises to approach or resigning when facing unpleasant experiences, and (v) Using the course to break interpersonal patterns or remaining stuck in everyday life. Conclusions: MBSR may be helpful for young adults with SAD, although it may be important to match clients to their preferred form of treatment.     

Homeopathic care for the prevention of upper respiratory tract infections in children: a pragmatic, randomised, controlled trial comparing individualised homeopathic care and waiting-list controls

OBJECTIVE: To investigate whether individualised treatment by homeopaths is effective in preventing childhood upper respiratory tract infection (URTI). METHODS: Open, pragmatic, randomised parallel-group trial with waiting-list group as control. One hundred and sixty-nine children below the age of 10 years, recruited by post from children previously diagnosed with URTI, were randomly assigned to receive either pragmatic homeopathic care from one of five homeopaths for 12 weeks or to a waiting-list control using self-selected, conventional health care. RESULT: There was a significant difference in median total symptom score in favour of homeopathic care (24 points) compared to the control group (44 points) (p = 0.026). The difference in the median number of days with URTI symptoms was statistically significant with 8 days in the homeopathic group and 13 days in the control group (p = 0.006). There was no statistical difference in the use of conventional medication or care between the two groups. CONCLUSION: In this study, there was a clinically relevant effect of individualised homeopathic care in the prevention of URTI in children.     

An exploratory study of the contextual effect of homeopathic care. A randomised controlled trial of homeopathic care vs. self-prescribed homeopathic medicine in the prevention of upper respiratory tract infections in children

OBJECTIVES: The aim of this study was to explore the contextual effect of homeopathic consultation by investigating the effect of homeopathic care compared to self-treatment with self prescribed homeopathic medicine in the prevention of childhood upper respiratory tract infections (URTI). METHODS: Randomised parallel group trial with 208 children below the age of 10. The children were randomly assigned to receive either homeopathic care (HC: individual homeopathic consultations with any homeopathic medicine in any potency being prescribed) or one of three self-prescribed homeopathic medicines (SPH) in C-30 administered twice weekly, for 12 weeks. RESULTS: There were no significant differences in clinical effects between SPH and HC for primary outcomes. Mean URTI scores over 12 weeks were 39.0 in the HC group and 43.9 in the SPH group (p=0.782, difference -5.0 points (95% C.I.; -20.5 to +10.5)). The mean number of days where the parents rated their child as 'ill with URTI' was 10.0 in the HC group and 13.7 in the SPH group (p=0.394). There was a trend in favour of HC for other outcomes. CONCLUSIONS: In this innovative and exploratory study, there was no evidence for a clinically relevant effect of homeopathic care vs. a homeopathic medicine given by the child's parents and based on a pre-agreed homeopathic treatment protocol.