Risultati per: Low Back Pain: raccomandazioni

Background
Providing digital mental health interventions online could expand access to help for young people, but requiring parental consent may be a barrier to participation. We therefore need a method that enables young people

Patients with cardiovascular disease can achieve very low levels of low-density lipoprotein (LDL) cholesterol with evolocumab without worrying about cognitive impairment, according to a study published in NEJM Evidence.

Introduction
Postpartum lumbopelvic pain (LPP) is a prevalent condition among women following childbirth. Due to the importance of respiratory muscles in lumbopelvic stability, and the changes they undergo during pregnancy, this study aims to assess the effects of motor control training and breathing exercises on pain, disability and core muscle activity in women suffering from LPP after childbirth.

Methods and analysis
52 women with postpartum LPP will participate in this two-parallel-armed, superiority randomised controlled trial, comprising 24 treatment sessions. The intervention group consists of motor control training and breathing exercises, and the control group includes motor control training. The diaphragm excursion, pelvic floor and abdominal muscle activity, pain and disability will be evaluated using ultrasound imaging, visual analogue scale and Oswestry Disability Index, before and after the intervention, respectively.

Ethics and dissemination
Ethical approval was obtained from the human research ethics committee of the Iran University of Medical Sciences (IR.IUMS.REC.1403.017). The study results will be submitted to a relevant journal and conferences.

Trial registration number
This clinical trial has been registered in the Iranian Registry of Clinical Trials on 21 May 2024 (registration number: IRCT20180916041051N2).

Background
Pain is an unpleasant sensory and emotional experience associated with actual or potential tissue damage. Low back pain (LBP) is a discomfort in the spinal area around the 12th rib and the inferior gluteal folds with or without radiation to the lower extremities. It is a widespread public health problem throughout the world, especially a prominent problem for healthcare providers working in prehospital areas. Now, it is a major problem in low- and middle-income countries, but the magnitude and its determinant factors have not been researched in Ethiopia.

Objective
To assess the prevalence of LBP and associated factors among prehospital healthcare providers in selected ambulance service centres in Addis Ababa, Ethiopia, 2024.

Methods
A cross-sectional study was conducted from a total of 150 prehospital healthcare providers working in Addis Ababa, Ethiopia from 1 to 30 April 2024. A simple random sampling method was used to select the study participants. Data were collected using a standardised self-administered questionnaire by certified degree nursing professionals. The collected data were imported into EpiData V. 3.1 and exported to SPSS V. 25 for analysis. To determine whether there is a significant relationship between the dependent and independent variables, bivariable and multivariable logistic regression was carried out.

Result
The overall prevalence of LBP among prehospital healthcare providers was 80%. Working in a twisting position (AOR: 5.763 (95% CI 1.544 to 21.515)) and several call missions >6 times per week (AOR: 12.437 (95% CI 2.603 to 59.423)) were positive predictors, while using ergonomic manual guidelines (AOR: 0.159 (95% CI 0.032 to 0.787)) was a negative predictor of LBP.

Conclusion
There was a high prevalence of LBP among prehospital healthcare providers. Also, predictors of twisting position, using ergonomic manual guidelines and call missions per week were significantly associated with LBP. Healthcare facilities should be retrofitted with equipment enabling work based on the principles of back ergonomics.

Background
The number of low-acuity emergency department (ED) visits varies across Europe and is often posited as a contributing factor to ED crowding. Many health policy-makers and health professionals assume that these cases are ‘avoidable’ ED visits or could be referred to other ambulatory healthcare providers.

Objectives
This study examines the care-seeking behaviour and the reasoning behind patients with low-acuity ED attendance according to emergency triage.

Design and setting
In a prospective multicentre cross-sectional survey, patients were invited to participate in an anonymised, paper-based survey in the waiting areas of nine EDs in Germany (2018–2020). The survey included questions on sociodemographic characteristics, reasons for using the ED, previous consultations in the outpatient healthcare system, self-rated urgency and knowledge of other emergency care structures. Due to the variance of missing values in the different responses, the valid percentages are shown.

Results
Of the 2752 survey respondents, 41.1% (n=1 120) indicated that ‘pain’ was the primary complaint for their ED attendance. Self-rated urgency was ‘less urgent’ for 58.7% (n=1552), ‘urgent’ for 41.3% (n=1093) and 57.7% reported the first episode of their symptoms (n=1505), with 30.8% (n=830) with symptom onset on the same day. The majority of patients completed the survey on weekdays (94.6%) between 08:00 and 18:00 (82.2%). 80.1% stated that they had a general practitioner (GP) (n=2103) and 55.8% contacted their GP before attending the ED (n=1403). In 77.8% of patients with GP contact, a visit to the ED was recommended by practice members or the GP (n=1068). The on-call service of the statutory health insurance physicians (SHIP) was contacted by 7.0% (n=172); in 64.6% of these cases (n=115), an ED visit was recommended. Of all patients without contact to the SHIP on-call service, 60.6% stated that they were not aware of these services (n=848).

Conclusions
Patients with low-acuity ED attendance stated acute onset and mainly new episodes of symptoms, with pain being the most common chief complaint. A high proportion reported having contacted their GP or SHIP on-call services (if known) but have been referred to the ED. As long as no fundamental changes are made to the provision of timely treatment options in the outpatient care sector, EDs may continue to be the foremost treatment option for these patients.

Objective
We aimed to synthesise existing literature on the health literacy of primary caregivers (PCGs) of children with cerebral palsy (CP) in low- and middle-income countries (LMICs).

Design
Systematic review informed by Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.

Data sources
Ovid MEDLINE, Ovid EMBASE, CINAHL via EBSCO, Scopus and Web of Science were searched from inception to January 2024.

Eligibility criteria
Original studies including observational or experimental data, examining health literacy and/or health literacy proxies using Optimising Health Literacy and Access domains as indicators (eg, education, social support, self-efficacy, health attitudes, reading and writing skills) in primary caregivers of children with CP in LMICs.

Data extraction and synthesis
Data from included studies were systematically recorded using an Excel template, with information extracted independently by two reviewers. We used the Study Quality Assessment Tool developed by the National Health, Lung, and Blood Institute.

Results
The systematic review yielded 2734 articles, with 15 eligible for inclusion. None used health literacy (HL) measurement tools, and there was limited reporting on specific HL domains. Studies spanned 11 LMICs across 5 major regions. PCGs, predominantly mothers, exhibited varying levels of service awareness, service utilisation and social support. Literacy levels significantly impacted HL proficiency, exposing a notable research gap in LMICs.

Conclusions
This study presents the first comprehensive analysis of health literacy among PCGs of children with CP in LMICs. Findings reveal a striking absence of tailored health literacy literature, impacting current considerations of PCGs’ understanding and management of their child’s condition. Additionally, challenges in social support, healthcare navigation and low literacy levels further hinder effective caregiving in LMICs.

Objective
Taking a qualitative approach, we aimed to understand how London’s Ultra Low Emission Zone (ULEZ) might work to change behaviour and improve health in the context of the school journey.

Design
Primary qualitative study embedded within an existing natural experimental study.

Setting
A population-level health intervention implemented across London.

Participants
Purposive sampling was used to recruit children (aged 10–11 years) from ethnically and socioeconomically diverse backgrounds within an existing cohort study, Children’s Health in London and Luton.

Methods
In-person and online interviews were conducted with 21 families and seven teachers from the children’s schools between November 2022 and March 2023. Verbatim transcripts were analysed drawing on Braun and Clarke’s reflexive thematic analysis and guided by realist evaluation principles to identify contexts, mechanisms and outcomes using NVivo.

Results
Common context, mechanism, outcome (CMO) configurations were identified reflecting congruent narratives across children, parents and teachers, for example, current active travellers (context) reported reductions in pollution (mechanism) leading to improvements in health, including alleviated symptoms of asthma (outcome). These CMOs were broadly captured by two themes: (i) how you travelled before the ULEZ matters: the impact of travel mode on experiences of the ULEZ and (ii) your context matters: the role of socioeconomic position in experiences of the ULEZ. Participants highlighted the potential for the ULEZ to positively impact their choice of travel mode to school, experiences of the journey and their health. However, the impact of the ULEZ differed inequitably by journey length, travel mode before implementation and access to reliable and affordable public transport.

Conclusions
The capacity for the ULEZ to both narrow and exacerbate inequities across different travel contexts suggests when developing such schemes, more emphasis needs to be placed on providing accessible and affordable alternatives to driving.

This secondary analysis of the COMET randomized clinical trial examines patient-reported outcomes at baseline and over time in patients with low-risk ductal carcinoma in situ randomized to receive either active monitoring or guideline-concordant care.

This nonrandomized clinical trial reports outcomes for children with low-risk relapsed Hodgkin lymphoma treated with second-line chemotherapy and involved-field radiotherapy without autologous stem cell transplant.

A panel recommends against a group of commonly performed procedures.

New England Journal of Medicine, Volume 392, Issue 9, Page 903-914, February 27, 2025.

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Background
Intralesional corticosteroid injection (ILCSI) has been proven to successfully treat hypertrophic scars (HTSs) and keloids and attain remission in 50% of keloids. Pain is a significant problem with ILCSI, which can affect treatment compliance and effectiveness. To date, many techniques involving ILCSI have been described and used to achieve scar treatment while reducing side effects. The injection technique remains the most widely available method in many healthcare centres.

Objective
This scoping review explores strategies for alleviating pain while administering ILCSIs for hypertrophic scarring and keloid management. ILCSI is a second-line treatment for HTSs and a first-line treatment for keloids.

Eligibility criteria
This scoping review included studies where HTSs and keloids were treated with ILCSI and considered diverse demographics and injection methods. This review excludes other methods of corticosteroid drug delivery where injection is not involved and where the pain assessed is unrelated to injection or infiltration of the scar.

Sources of evidence
This review systematically searched critical databases from inception to December 2023, including ScienceDirect, PubMed and Web of Science, and handpicked articles traced from available review papers. Only English-language publications focused on pain management during ILCSIs for HTSs and keloids were included. All levels of scientific evidence were considered. An in-depth evaluation of the injection technique, type of analgesia or anaesthesia administered, effectiveness of pain management and overall treatment outcomes was conducted.

Charting methods
Citations were compiled in an Excel spreadsheet, with three authors screening the titles and abstracts based on inclusion criteria. Decisions were finalised collaboratively, exclusions were documented and results were presented using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses flow diagram.

Results
16 prospective studies, 2 retrospective studies, 1 case study and 15 journal articles were included. These studies examined ILCSI for hypertrophic scarring and keloid treatment. No differences in pain intensity between HTSs and keloids were reported. 11 studies systematically explored pain reduction methods such as topical analgesia, cryoanaesthesia, mixing triamcinolone acetonide with local analgesics, slow infiltration techniques, vibration analgesia and needle-free injectors.

Conclusion
Pain can significantly impact patient compliance and treatment outcomes. This review offers a foundational reference for healthcare providers and researchers in the field of scar management, providing insights into current practices and highlighting areas for future research and development.

Objectives
The postdischarge period is crucial for vulnerable newborns at risk of morbidity, readmission and mortality in low- and middle-income countries (LMICs). Addressing gaps in care during this period could improve outcomes. This review consolidates evidence on caregiver information needs and relevant information tools used in postdischarge care for vulnerable newborns in LMICs.

Design
Scoping review using the methodological framework developed by Arksey and O’Malley.

Data sources
We searched six databases for relevant articles published in English between 2001 and 2021. Additional articles were identified through citation and reference checking.

Eligibility criteria
Articles on postdischarge care for newborns in LMICs, excluding economic and technical development studies, discharge to other healthcare facilities (rather than to home) and maternal-focused studies.

Data extraction and synthesis
Data extraction followed Arksey and O’Malley’s data charting method. Using a descriptive synthesis approach, heterogeneous data were collated in narrative format.

Results
From 5190 articles, 22 were included. Only a small number of articles discussed caregiver challenges, like receiving insufficient information at discharge which led to uncertainty in caring for vulnerable newborns. Caregivers had a number of needs in relation to maternal and newborn care, including in terms of coordination of follow-up care. Although a number of tools have been used to support relevant needs (for postnatal care in general rather than specifically for postdischarge care of vulnerable newborns), these have shown mixed effectiveness due to challenges with completeness, lack of training and support, supply chain issues and cultural barriers to adoption, such as preference for alternative providers.

Conclusion
Our understanding of postdischarge information needs for those looking after vulnerable newborns in LMICs remains limited. More effective use of information tools could help address some of these needs and contribute towards reducing neonatal mortality rates.

In two small trials, certain FODMAPs were more likely to cause symptoms, and targeted elimination was effective.