Current Issue : July - September Volume : 2014 Issue Number : 3 Articles : 5 Articles
Headache is a one of the most common problems encountered in clinical practice. Over 90 per cent of headaches\nfall into one of four diagnostic categories: (1) Tension-type headache; (2) Migraine headache; (3) Cluster headache;\nand (4) Medication overuse headache. The mainstay of diagnosis of these common headaches is the taking of a\ncareful targeted headache history. The physical examination in patients suffering from these common headaches concern. Appropriate use of diagnostic imaging including magnetic resonance imaging of the brain and cervical spine\nis indicated in those patients with a recent onset of headaches and in those patients in whom a previously stable\nheadache pattern has changed. Laboratory testing will also help the clinician rule out co-existent or occult disease\nthat may be contributing to the patient�s headache symptomatology. In most cases, treatment plans should be aimed\nat preventing headache rather than aborting the headache after symptoms have already occurred. Care must be\ntaken to identify overuse or misuse of medications prescribed to treat headache, as many of these medications have\nthe propensity to cause medication overuse headaches....
Objective: People with schizophrenia are at elevated risk of having type 2 diabetes, compared to the general\npopulation. Although there is a growing body of literature on the effectiveness of behavioural interventions to improve\nphysical activity levels and healthy eating habits, there are very few economic evaluations conducted for people\nwith severe mental illness and physical health problems. The aim of this study is to explore the cost-effectiveness\nof group-based lifestyle interventions for middle-aged adults with enduring long-term schizophrenia and co-morbid\ntype 2 diabetes.\nMethods: Deterministic decision analytical modelling techniques are applied to explore cost-effectiveness\nbased on the findings from a systematic review on this population. The intervention refers to a group-based lifestyle\nintervention, which is a combination of exercise, diet and diabetes education over 6 months. The intervention costs\nare estimated to reflect the UK local context.\nResults: From the UK National Health Service perspective, the group-based lifestyle intervention is potentially\ncost-effective, relative to usual care. It costs �£80 to achieve an additional unit of Body Mass Index (BMI) lost and the\nincremental cost-effectiveness ratio is just below �£700 to gain an extra Quality Adjusted Life Year, which lies well\nwithin the conventionally acceptable threshold values in the UK.\nConclusions: Group based life style intervention for this population is effective and can be cost-effective in\nreducing BMI and improving diabetes knowledge, at least in the short-term. More co-ordinated policies among\nrelevant sectors are required to facilitate behavioural change and better maintain an improved lifestyle. An integrated\napproach is needed to make this more sustainable in the long-term....
Context: Studies suggest that yoga is effective for moderate to severe chronic low back pain (cLBP) in diverse\npredominantly lower socioeconomic status populations. However, little is known about factors associated with benefit\nfrom the yoga intervention.\nObjective: Identify factors at baseline independently associated with greater efficacy among participants in a\nstudy of yoga for cLBP.\nDesign: From September-December 2011, a 12-week randomized dosing trial was conducted comparing weekly\nvs. twice-weekly 75-minute hatha yoga classes for 95 predominantly low-income minority adults with nonspecific\ncLBP. Participant characteristics collected at baseline were used to determine factors beyond treatment assignment\n(reported in the initial study) that predicted outcome. We used bivariate testing to identify baseline characteristics\nassociated with improvement in function and pain, and included select factors in a multivariate linear regression.\nSetting: Recruitment and classes occurred in an academic safety-net hospital and five affiliated community\nhealth centers in Boston, Massachusetts.\nParticipants: Ninety-five adults with nonspecific cLBP, ages ranging from 20-64 (mean 48) years; 72 women\nand 23 men.\nOutcome measures: Primary outcomes were changes in back-related function (modified Roland-Morris\nDisability Questionnaire, RMDQ; 0-23) and mean low back pain intensity (0-10) in the previous week, from baseline\nto week 12.\nResults: Adjusting for group assignment, baseline RMDQ, age, and gender, foreign nationality and lower\nbaseline SF36 physical component score (PCS) were independently associated with improvement in RMDQ.\nGreater than high school education level, cLBP less than 1 year, and lower baseline SF36 PCS were independently\nassociated with improvement in pain intensity. Other demographics including race, income, gender, BMI, and use of\npain medications were not associated with either outcome.\nConclusions: Poor physical health at baseline is associated with greater improvement from yoga in backrelated\nfunction and pain. Race, income, and body mass index do not affect the potential for a person with low back\npain to experience benefit from yoga....
Background: Individual barriers to weight loss and physical activity goals in the Diabetes Prevention Program, a\nrandomized trial with 3.2 years average treatment duration, have not been previously reported. Evaluating barriers\nand the lifestyle coaching approaches used to improve adherence in a large, diverse participant cohort can inform\ndissemination efforts.\nMethods: Lifestyle coaches documented barriers and approaches after each session (mean session attendance =\n50.3 �± 21.8). Subjects were 1076 intensive lifestyle participants (mean age = 50.6 years; mean BMI = 33.9 kg/m2; 68%\nfemale, 48% non-Caucasian). Barriers and approaches used to improve adherence were ranked by the percentage\nof the cohort for whom they applied. Barrier groupings were also analyzed in relation to baseline demographic\ncharacteristics.\nResults: Top weight loss barriers reported were problems with self-monitoring (58%); social cues (58%); holidays\n(54%); low activity (48%); and internal cues (thought/mood) (44%). Top activity barriers were holidays (51%); time\nmanagement (50%); internal cues (30%); illness (29%), and motivation (26%). The percentage of the cohort having\nany type of barrier increased over the long-term intervention period. A majority of the weight loss barriers were\nsignificantly associated with younger age, greater obesity, and non-Caucasian race/ethnicity (p-values vary). Physical\nactivity barriers, particularly thought and mood cues, social cues and time management, physical injury or illness\nand access/weather, were most significantly associated with being female and obese (p < 0.001 for all). Lifestyle\ncoaches used problem-solving with most participants (=75% short-term; > 90% long term) and regularly reviewed\nself-monitoring skills. More costly approaches were used infrequently during the first 16 sessions (=10%) but\nincreased over 3.2 years.\nConclusion: Behavioral problem solving approaches have short and long term dissemination potential for many\nkinds of participant barriers. Given minimal resources, increased attention to training lifestyle coaches in the\nconsistent use of these approaches appears warranted....
Background: In total knee arthroplasty (TKA) recipients, losses in quadriceps� strength in the immediate postoperative\nperiod are related to physical function and mobility. Therefore, this period should be a target of rehabilitation\nto prevent strength losses in the short-term. This case report describes the early post-operative changes in muscle\nand physical function associated with a Tai Chi inspired rehabilitation program.\nCase Description: A 62 year-old woman presented with bilateral OA and underwent unilateral TKA surgery in\nher most symptomatic knee. The subject participated in one pre-operative study visit, and a 6-week, Tai Chi inspired\nrehabilitation program from 4 to 10 wks post-operatively. Outcome measures, evaluated at 4 wks, 10 wks, and 6\nmonths post-operatively, included maximum voluntary isometric contraction, lower extremity power, quadriceps force\ncontrol, 6-minute walk test, timed up-and-go test, stair climbing test, gait speed, SF-36 Total Health Status Survey,\nand the lower extremity functional scale.\nOutcomes: In the surgical leg, the subject improved in all muscle and physical function measures from the\npre-operative to 6-month post-operative study visit. Self-report outcome measures also improved from pre- to postoperative\nstudy visits, with the exception of the mental component summary of the SF-36 at 6 months.\nDiscussion: The subject exhibited clinically relevant improvements in muscle and physical function in the\nsurgical leg, suggesting that the Tai Chi inspired rehabilitation program may be an effective and safe addition to\nrange of motion, stretching and gait exercises in the early post-operative period. These results support further\nexploration of this rehabilitation approach in future trials....
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