Changes in Clinical Parameters in Patients with Tension-type Headache Following Massage Therapy: A Pilot Study

Complementary and alternative medicine approaches to treatment for tension-type headache are increasingly popular among patients, but evidence supporting its efficacy is limited. The objective of this study was to assess short term changes on primary and secondary headache pain measures in patients with tension-type headache (TTH) receiving a structured massage therapy program with a focus on myofascial trigger point therapy. Participants were enrolled in an open label trial using a baseline control with four 3-week phases: baseline, massage (two 3-week phases) and follow-up. Twice weekly, 45-minute massage sessions commenced following the baseline phase. A daily headache diary was maintained throughout the study in which participants recorded headache incidence, intensity, and duration. The Headache Disability Index was administered upon study entry and at 3-week intervals thereafter. 18 subjects were enrolled with 16 completing all headache diary, evaluation, and massage assignments. Study participants reported a median of 7.5 years with TTH. Headache frequency decreased from 4.7±0.7 episodes per week during baseline to 3.7±0.9 during treatment period 2 (P<0.001); reduction was also noted during the follow-up phase (3.2±1.0). Secondary measures of headache also decreased across the study phases with headache intensity decreasing by 30% (P<0.01) and headache duration from 4.0±1.3 to 2.8±0.5 hours (P<0.05). A corresponding improvement in Headache Disability Index was found with massage (P<0.001). This pilot study provides preliminary evidence for reduction in headache pain and disability with massage therapy that targets myofascial trigger points, suggesting the need for more rigorously controlled studies.     

Severe neurodevelopmental disability and healthcare needs among survivors of medical and surgical necrotizing enterocolitis: A prospective cohort study

Purpose

This study characterizes neurodevelopmental outcomes and healthcare needs of extremely low birth weight (ELBW) survivors of necrotizing enterocolitis (NEC) compared to ELBW infants without NEC.

Accuracy of a piezoelectric pedometer in persons with and without Down syndrome

BackgroundPiezoelectric pedometers with a tri-axial accelerometer mechanism may effectively monitor physical activity in persons with Down syndrome (DS), but their accuracy has not been determined in this population.AimTo examine the accuracy of a pedometer with a tri-axial accelerometer mechanism in measuring steps at different walking speeds in persons with and without DS.MethodsEighteen persons with DS (8 women; age 25 ± 7 y) and 22 persons without DS (9 women; 26 ± 5 y) participated in this study. Participants completed six over-ground walking trials at the preferred speed and at 0.5, 0.75, 1.0, 1.25, and 1.5 m s⁻¹, each lasting 6 min. The steps taken were measured with hand-tally and with the Walk4Life MVPa piezoelectric pedometer. Pedometer accuracy was assessed with absolute percent error and Bland-Altman plots.ResultsAbsolute percent error did not differ between persons with and without DS across speeds. Error decreased with increased speed (p < 0.001), but leveled off at ≥1.0 m s⁻¹. Pedometers underestimated steps at 0.5 and 0.75 m s⁻¹, but were highly accurate at the preferred walking speed and at speeds ≥1.0 m s⁻¹.ConclusionsA piezoelectric pedometer with a tri-axial accelerometer mechanism measures steps with high accuracy at the preferred walking speed and at speeds ≥1.0 m s⁻¹ in persons with and without DS. Accuracy, however, is compromised at slower speeds. Across speeds, pedometer error is similar between persons with and without DS.     

The generational gap: Mental disorder prevalence and disability amongst first and second generation immigrants in Australia

Despite unprecedented numbers of migrants internationally, little is known about the mental health needs of immigrant groups residing in common countries of resettlement. The majority of studies support the ‘healthy migrant hypothesis’, but few studies have examined: 1) shifts in prevalence patterns across generations; 2) how prevalence relates to disability in immigrant groups. Our study examined the prevalence of common mental disorders and disability in first and second generation migrants to Australia. Twelve-month and lifetime prevalence rates of affective, anxiety, and substance use disorders were obtained from the Australian National Survey of Mental Health and Wellbeing (N = 8841). First generation immigrants (born overseas) and second generation immigrants (both parents overseas) from non-English and English speaking backgrounds were compared to an Australian-born cohort. Disability was indexed by days out of role and the WHO Disability Assessment Schedule (WHODAS12). First generation immigrants with non-English speaking (1G-NE) backgrounds evidenced reduced prevalence of common mental disorders relative to the Australian-born population (adjusted odds ratio 0.5 [95% CI 0.38–0.66]). This lower prevalence was not observed in second generation immigrant cohorts. While overall levels of disability were equal between all groups (p > 0.05), mental health-related disability was elevated in the 1G-NE group relative to the Australian-born group (p = 0.012). The findings challenge the overarching notion of the “healthy migrant” and suggest a dissociation between reduced prevalence and elevated mental health-related disability amongst first generation immigrants with non-English speaking backgrounds. These findings highlight the heterogeneous psychiatric needs of first and second generation immigrants.     

Oral Dimethyl Fumarate in Children With Multiple Sclerosis: A Dual-Center Study

BackgroundFirst-line injectable therapies for multiple sclerosis in children may be ineffective or not well-tolerated. There is therefore an urgent need to explore oral medications for pediatric multiple sclerosis. We review our dual-center experience with oral dimethyl fumarate.MethodsThis study was a retrospective review of children 18 years of age or less with multiple sclerosis treated with dimethyl fumarate at Yale University and the University of Colorado. Clinical, demographic, and magnetic resonance imaging parameters were analyzed.ResultsWe identified 13 children treated with oral dimethyl fumarate for a median of 15.0 months (range, 1 to 25). Dimethyl fumarate was utilized as first-line therapy in five children (38%). Ten children (77%) tolerated dose escalation to the usual adult dose of 240 mg twice daily. Nine children had ≥12 months of follow-up on treatment. Eight of nine (89%) displayed stabilized or reduced relapse rates and disability scores on treatment. Nine children underwent brain magnetic resonance imaging performed after 12 or more months of therapy. New T2 lesions were observed in three children (33%), one of whom had been nonadherent to treatment. Common side effects included facial flushing (8/13, 62%), gastrointestinal discomfort (7/13, 54%), rash (3/13, 23%), and malaise (2/13, 15%). Three children (23%) discontinued treatment because of side effects. No patients displayed laboratory abnormalities including lymphopenia or abnormal liver transaminases. There were no reported infections.ConclusionsOral dimethyl fumarate appears to be safe and generally well tolerated in children with multiple sclerosis. Formal clinical trials to evaluate efficacy are ongoing.     

Changes in health insurance coverage and health care access as teens with disabilities transition to adulthood

BackgroundPre-ACA, less than 6% of children with disabilities were uninsured, compared with more than 42% of young adults with disabilities ages 19–25. Individuals with disabilities face greater barriers to health care access upon transition into adulthood.ObjectivesWe examined whether the ACA dependent coverage provision and Medicaid expansion improved the transition from pediatric to adult healthcare systems by reducing the gap in insurance coverage and access to care between teens and young adults with disabilities.MethodsUsing cross-sectional data from the 2006–2009 and 2011–2015 National Health Interview Survey (n = 10,136), we estimate the change in insurance coverage and access to care from pre-to post-ACA time periods for teens (ages 13–18) and young adults (ages 19–25) with disabilities in a difference-in-differences model. We completed the same analyses for these groups in Medicaid expansion and non-expansion states.ResultsBoth teens and young adults with disabilities made significant gains in insurance coverage (4.55 and 8.96% point gains respectively, p < .001) and access to care (4.01 and 3.14% points decline in delayed care due to cost, p < .05) under the dependent coverage provision and Medicaid expansion.ConclusionsMedicaid expansion had a greater impact on both insurance coverage and on access to care than did the dependent coverage provision. The benefits of these changes flowed primarily to young adults with disabilities, reducing the gaps in insurance coverage between teens and young adults, and expanding access to care for both groups, providing a more seamless transition from pediatric to adult health care systems, post-ACA.     

Internet networks as a source of social support for women with mobility disabilities during pregnancy

BackgroundSocial support during pregnancy is important for the health of mother and baby, yet little is known about social support available to women with disabilities during pregnancy. Internet social networks are one emerging source of social support, and social networks may help connect mothers with similar disabilities.ObjectiveTo examine the perceptions of women with mobility impairments about social support received during pregnancy from three sources: women with similar disabilities and previous pregnancy known in-person, women with similar disabilities and previous pregnancy met via online social networks, and healthcare providers.MethodsFor this cross-sectional study, an online survey of women with mobility impairments examining emotional and informational social support during pregnancy was distributed through email lists, social media and snowball recruitment. Wilcoxon signed-rank tests were conducted to examine differences in social support received by source.ResultsResponses from 63 eligible women were received. The majority of participants (n = 32, 51%) were connected both in-person and online to women with similar disabilities who had been pregnant, but 15 women (24%) were not connected to any women with similar disabilities who had been pregnant. Scores for informational social support from women met online were significantly higher than from women known in-person (p < .01) and from healthcare providers (p < .01). Scores for emotional social support from women met online were significantly higher than from women known in-person (p < .05).ConclusionsInterventions promoting online connections may help leverage an underutilized source of social support for women with mobility impairments seeking social support during pregnancy.