Risultati per: LBP (Low Back Pain): Cosa dicono le linee guida del mal di schiena

Objective
To support evidence informed decision-making, we systematically examine the effectiveness and cost-effectiveness of community engagement interventions on routine childhood immunisation outcomes in low-income and middle-income countries (LMICs) and identify contextual, design and implementation features associated with effectiveness.

Design
Mixed-methods systematic review and meta-analysis.

Data sources
21 databases of academic and grey literature and 12 additional websites were searched in May 2019 and May 2020.

Eligibility criteria for selecting studies
We included experimental and quasi-experimental impact evaluations of community engagement interventions considering outcomes related to routine child immunisation in LMICs. No language, publication type, or date restrictions were imposed.

Data extraction and synthesis
Two independent researchers extracted summary data from published reports and appraised quantitative risk of bias using adapted Cochrane tools. Random effects meta-analysis was used to examine effects on the primary outcome, full immunisation coverage.

Results
Our search identified over 43 000 studies and 61 were eligible for analysis. The average pooled effect of community engagement interventions on full immunisation coverage was standardised mean difference 0.14 (95% CI 0.06 to 0.23, I2=94.46). The most common source of risk to the quality of evidence (risk of bias) was outcome reporting bias: most studies used caregiver-reported measures of vaccinations received by a child in the absence or incompleteness of immunisation cards. Reasons consistently cited for intervention success include appropriate intervention design, including building in community engagement features; addressing common contextual barriers of immunisation and leveraging facilitators; and accounting for existing implementation constraints. The median intervention cost per treated child per vaccine dose (excluding the cost of vaccines) to increase absolute immunisation coverage by one percent was US$3.68.

Conclusion
Community engagement interventions are successful in improving outcomes related to routine child immunisation. The findings are robust to exclusion of studies assessed as high risk of bias.

Introduction
Persistent heel pain is a prevalent complaint affecting up to 10% of the population. Insoles adapted in flip-flop sandals are an alternative treatment for pain and function of individuals with persistent heel pain, showing improvement within 12 weeks of treatment. Most studies considered foot posture and biomechanics to prescribe insoles for persistent heel pain, but few verified the effects of a 12-week treatment on pain catastrophising. This study will investigate the effects of insoles adapted in flip-flop sandals on pain intensity, function, functional walking capacity and pain catastrophising of individuals with persistent heel pain.

Methods and analysis
This is a protocol for a sham-controlled randomised trial. Eighty individuals with persistent heel pain will be assessed and randomised into two intervention groups: insoles adapted in flip-flop sandals and flip-flop sandals with sham (ie, flat) insoles. Assessments will be conducted at baseline (T0), after 6 weeks (T6), 12 weeks postintervention (T12) and after a 4-week follow-up (T16). The primary outcome will be the pain intensity, and secondary outcomes will be foot function, functional walking capacity and pain catastrophising. Analysis of variance with mixed design (if normal distribution) or Friedman’s test (if not normal distribution) will verify intergroup and intragroup differences. Bonferroni post hoc tests will be performed in case of significant group or time interaction. Intent-to-treat analysis will be used, and a significance level of 5% and 95% CIs will be considered.

Ethics and dissemination
This study was approved by the research ethics committee of the Federal University of Rio Grande do Norte (registry no. 4,018,821). Results will be disseminated to individuals, submitted to a peer-reviewed journal and disclosed in scientific meetings.

Trial registration number
NCT04784598.

In Gut, Olesen et al present the first comprehensive multicentre cross-sectional study of pain in prospectively enrolled chronic pancreatitis (CP) patients.1 It is demonstrated that pain-related factors are often overlapping in these patients and have a cumulative detrimental effect on patient-reported outcomes. One might argue that the results of this study are lacking novelty, but there are several reasons why such studies are urgently warranted. Pain, may it be acute, recurring or chronic, is one of the cardinal symptoms of CP and impacts patients’ well-being significantly.2 Thus far, several efforts have been conducted to improve the treatment of painful CP, with variable outcome. At first it is interesting to note, that the methodology to quantify pain for most of the published efforts was not validated in CP patients before and as such results obtained in these studies might not truly reflect the patients’ situation.

Objective
Several factors have been suggested to mediate pain in patients with chronic pancreatitis. However, it is unknown whether these factors are overlapping and if they have cumulative effects on patient-reported outcomes (PROs).

Design
We performed a multicentre cross-sectional study of 201 prospectively enrolled subjects with definitive chronic pancreatitis. All subjects underwent evaluation for pancreatic duct obstruction, abnormalities in pain processing using quantitative sensory testing, and screening for psychological distress (anxiety, depression and pain catastrophising) based on validated questionnaires. Abnormality was defined by normal reference values. PROs included pain symptom severity (Brief Pain Inventory short form) and quality of life (EORTC-QLQ-C30 questionnaire). Associations between pain-related factors and PROs were investigated by linear trend analyses, multiple regression models and mediation analyses.

Results
Clinical evaluation suggestive of pancreatic duct obstruction was observed in 29%, abnormal pain processing in 23%, anxiety in 47%, depression in 39% and pain catastrophising in 28%; each of these factors was associated with severity of at least one PRO. Two or more factors were present in 51% of subjects. With an increasing number of factors, there was an increase in pain severity scores (p

Objective
This study aimed to identify the associated factors of low and medium household (HH) dietary diversity (DD) compared with high DD among marginalised households in rural Bangladesh.

Methods
Through the Suchana baseline survey, data on 5440 households from Sylhet and Moulvibazar districts of Bangladesh was collected between November 2016 and February 2017. Household DD was categorised as low, medium or high based on number of food groups consumed during the last 24 hours. Primary outcome measure was household DD; multinomial logistic regression was to determine independent correlations between outcome and independent variables.

Results
Of the households examined, 0.72%, 31.8% and 67.5% had low, medium and high DD, respectively. Around 99% and 97% of households consumed cereals and vegetables. Cereals, fruits and legumes accounted for 36%, 18% and 16% of total food expenditure; vegetables only represented 8% of total expenditure; 70% of total monthly expenditure was on food items. Compared with high DD, low DD was significantly associated with severe food insecurity, not receiving remittance, not being supported by social safety-net programs, household size of 6–10, household income and expenditure on food below-median. Severe food insecurity was the strongest predictor of low DD. Age, occupation and educational status of the household head, amount of land owned and presence of a homestead garden, fish production and domestic violence were not significantly associated with DD.

Conclusion
Our findings suggest that nine out of ten households were food insecure, and nearly two-thirds of households had high DD. Severe food insecurity was significantly associated with low DD. Expenditure on food items amounted to nearly two-thirds of total household expenditure. Diversification of income-generating activities would provide more sources of income to the households, allowing the households to spend more on non-cereal food items and increase the household dietary diversity.

New England Journal of Medicine, Ahead of Print.

Objectives
The aim of the study was to evaluate recovery of participation in post-COVID-19 patients during the first year after intensive care unit (ICU) discharge. The secondary aim was to identify the early determinants associated with recovery of participation.

Design
Prospective cohort study.

Setting
COVID-19 post-ICU inpatient rehabilitation in the Netherlands, during the first epidemic wave between April and July 2020, with 1-year follow-up.

Participants
COVID-19 ICU survivors ≥18 years of age needing inpatient rehabilitation.

Main outcome measures
Participation in society was assessed by the ‘Utrecht Scale for Evaluation of Rehabilitation-Participation’ (USER-P) restrictions scale. Secondary measures of body function impairments (muscle force, pulmonary function, fatigue (Multidimensional Fatigue Inventory), breathlessness (Medical Research Council (MRC) breathlessness scale), pain (Numerical Rating Scale)), activity limitations (6-minute walking test, Patient reported outcomes measurement information system (PROMIS) 8b), personal factors (coping (Utrecht Proactive Coping Scale), anxiety and depression (Hospital Anxiety and Depression Scale), post-traumatic stress (Global Psychotrauma Screen—Post Traumatic Stress Disorder), cognitive functioning (Checklist for Cognitive Consequences after an ICU-admission)) and social factors were used. Statistical analyses: linear mixed-effects model, with recovery of participation levels as dependent variable. Patient characteristics in domains of body function, activity limitations, personal and social factors were added as independent variables.

Results
This study included 67 COVID-19 ICU survivors (mean age 62 years, 78% male). Mean USER-P restrictions scores increased over time; mean participation levels increasing from 62.0, 76.5 to 86.1 at 1, 3 and 12 months, respectively. After 1 year, 50% had not fully resumed work and restrictions were reported in physical exercise (51%), household duties (46%) and leisure activities (29%). Self-reported complaints of breathlessness and fatigue, more perceived limitations in daily life, as well as personal factors (less proactive coping style and anxiety/depression complaints) were associated with delayed recovery of participation (all p value

Annals of Internal Medicine, Ahead of Print.

This review of current literature evaluates whether ERBB2 (formerly HER2) offers a potential therapeutic target in patients with ERBB2-low breast cancer.

This prospective clinical trial examines if expanded size/growth parameters for patients with low-risk thyroid cancer are viable.

A 66-year-old woman with chronic hepatitis B infection and hepatocellular carcinoma presented with moderate radiating epigastric pain with nausea, anorexia, and water brash without emesis. What is your diagnosis?

This case report describes a patient in their 40s who presented to the emergency department with acute chest pain.

This randomized clinical trial compares the short-term efficacy of laparoscopic surgery vs open surgery for treatment of low rectal cancer.