Risultati per: Low Back Pain: raccomandazioni

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.

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).

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.

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.

Muhler P, AkuamoaBoateng D, Rosenbrock J, et al. Cost–utility analysis of MR imaging-guided transurethral ultrasound ablation for the treatment of low- to intermediate-risk localised prostate cancer. BMJ Open 2025;15:e088495. doi:10.1136/bmjopen-2024–0 88 495 This article has been corrected since it was published online. Page 1 ‘BACKGROUND […] Among all prostate cancer patients, those with low or favourable intermediate risk of prostate cancer who have a low risk of tumour & page 2 ‘[…] To evaluate the clinical and economic long-term consequences of applying MR-TULSA in low or favourable intermediate-risk prostate cancer in Germany’ We found inconsistencies in punctuation: Please correct them into ‘low- and favourable intermediate-risk (of) prostate cancer. Page 5: ‘Table 2 Cost calculation […] Salvage ADT withleuprorelinn for 2 years’ The typing mistake mentioned above, needs to be corrected in ‘with leuprorelin for 2 years’ Page 5: ‘Table 2 Cost calculation […] RARP, radical prostatectomy’ Please correct to ‘RARP, robot-assisted…

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.

Introduction
Both physical adaptations (e.g., altered neck kinematics and muscle coordination) and psychological features are common in people presenting with neck pain (NP). Additionally, both physical and psychological features may be relevant for the development of persistent or recurrent NP. Although a number of original studies have reported this, currently there is no available systematic review reporting physical and psychological predictors for the recurrence of non-specific NP.

Methods and analysis
The report of this systematic review protocol follows the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols. Studies will be searched from PubMed, MEDLINE, EMBASE, CINAHL Plus, PsycINFO and grey literature. Title, abstract and full-text screening, data extraction and risk of bias assessment will be conducted by two independent reviewers. Studies investigating the prediction of persistent or recurrent NP from physical or psychological predictors will be included. Physical predictors will be commonly reported objective measures including neck kinematics, measures of muscle activity and sensory function. Psychological predictors will include variables such as kinesiophobia, self-efficacy, pain coping strategies and quality of life. The main outcomes of interest are the Neck Disability Index, presence of pain recurrence, as well as pain intensity and frequency during a persistent or recurrent NP episode. Observational cohort studies will be included, and studies on both single-factor and multifactor predictions or associations will be investigated. Risk of bias will be assessed using the Quality in Prognosis Studies (QUIPS) tool. The certainty of evidence will be rated using Grading of Recommendations Assessment, Development and Evaluation (GRADE). A random-effect meta-analysis will be conducted if methodological and clinical homogeneity is deemed satisfactory.

Ethics and dissemination
Ethical approval will not be required for this review as there is no primary data collection involving humans. The findings will be published in peer-reviewed journals.

PROSPERO registration number
CRD42024596844.

A 58-year-old woman with no allergies or rheumatic disease had a 2-year history of spontaneous wheals that occurred daily, accompanied by pruritus, arthralgia, and intermittent fevers; the wheals resolved after several hours without residual hyperpigmentation or bruising. C-reactive protein level was elevated, and skin biopsy showed dermal neutrophilic infiltration. What is the diagnosis and what would you do next?

Objectives
The aim of this study was to gather insights from a diverse group of stakeholders, identify existing challenges and explore associated solutions to develop a conceptual framework that assists in the development of a chronic low back pain (CLBP) self-management app.

Design
Codesign workshop methodology.

Setting
The study was conducted online, allowing for the participation of a diverse group of stakeholders.

Participants
Participants were recruited through social media platforms and professional networks, including individuals with LBP for at least 3 months, healthcare professionals experienced in CLBP management and app developers with a background in digital health applications.

Interventions
The study used codesign workshops focused on brainstorming, communication and reflection exercises designed to foster collaboration and gather insights from stakeholders.

Outcome measures
Identification of key challenges and potential solutions for mobile health (mHealth) apps targeting CLBP.

Results
Nine stakeholders identified four primary challenges in current back pain apps: belief and trust, motivation, safety and usability. The group also collaboratively developed and proposed practical solutions to these challenges.

Conclusions
This study illustrated the utility of the codesign workshop approach in generating critical insights for the development of a mHealth solution for CLBP. The insights gathered from these workshops can be used to inform future app development, potentially improving user engagement.

The footprint of cervical cancer mirrors the impact of global inequity and inequality on the right to health for girls and women. While today, cervical cancer is a relatively rare cause of death in Europe, North America, and Australia, almost 94% of deaths in 2022 occurred in low- and middle-income countries (LMICs). Governments adopted the WHO global strategy to eliminate cervical cancer. Still, the stark reality is that many countries may not reach the 90:70:90 targets by 2030 without political commitment and a sense of urgency.

Introduction
Acute pain levels following orthopaedic injury (eg, fracture) are a predictor of the onset of chronic pain, which affects nearly 50% of fracture patients and impairs functional recovery. Among current pharmacological treatments for acute pain, non-steroidal anti-inflammatory drugs have been associated with delayed bone healing, while opioids inhibit effective bone remodelling, increase the risk of pseudarthrosis and carry a high risk of addiction. In light of this, the development of new pain treatments is essential. Cannabidiol (CBD), a non-addictive and non-psychotropic cannabis component stands out as a potential therapeutic agent, given its analgesic and anti-inflammatory properties as well as its potential benefits for bone healing. This randomised controlled trial aims to investigate the effect of acute CBD treatment, compared with placebo, on patients’ self-reported pain, inflammation and well-being following a fracture injury.

Methods and analysis
This is a triple-blind, randomised, placebo-controlled clinical trial. A total of 225 adults aged 18–70 years, who have suffered a long bone fracture and were treated at the Hôpital du Sacré-Coeur de Montréal, will be randomly assigned within 1 week to one of three treatment arms (25 mg or 50 mg of CBD or placebo) for 1 month. The primary outcome will be the difference in the pain score between groups at 1-month follow-up. Secondary outcomes will include measures of persistent pain, inflammation, opioid usage, quality of life, sleep quality, depression, anxiety, cognition and orthopaedic function. Data will be collected at baseline, 1-month and 3-month follow-ups.

Ethics and dissemination
This study obtained a Health Canada licence for use of cannabis products. It has also been approved by Health Canada and the Research Ethics Board of the CIUSSS du Nord-de-l’Île-de-Montréal (Project ID 2025-2105). The findings will be published in a peer-reviewed journal and presented at local, national and international conferences. The trial’s results will be made publicly available on the ClinicalTrials.gov database.

Trial registration number
NCT06448923.