Barriers and Facilitators to Effective Implementation of the NAMWEZA Intervention in Dar es Salaam,Tanzania

Prevention Science - The NAMWEZA intervention was implemented, using a ten-session group format, to build skills targeting psychosocial vulnerabilities and enhancing HIV prevention among people...     

Cervico-cephalalgiaphobia: a subtype of phobia in patients with cervicogenic headache and neck pain? A pilot study

Objectives: The term ‘cephalalgiaphobia’ was introduced in the mid-1980s and defined as fear of migraine (attacks). We hypothesized that a specific subtype of cephalalgiaphobia affects patients with cervicogenic headache (CEH). This study aimed to: (1) define the term ‘cervico-cephalalgiaphobia’; (2) develop a set of indicators for phobia relevant to patients with CEH; and (3) apply this set to a practice test in order to estimate the frequency of cervico-cephalalgiaphobia in the Dutch primary care practice of manual physical therapy.

Methods: A systematic approach was used to develop a definition and potential indicators for cervico-cephalalgiaphobia. An expert group appraised the definition and the set of indicators (score per indicator: never; sometimes; often/always). An invitation to participate in the practice test was sent to Dutch manual physical therapy practices (n?=?56) representing 134 manual physical therapists (MPTs). The cut-off point for percentages of scores for coverage of the indicators was set at ≥?60%.

Results: The expert group agreed with the proposed definition of cervico-cephalalgiaphobia. A set of eight indicators for cervico-cephalalgiaphobia was selected from 10 initial indicators. Thirty-six MPTs provided data from 46 patients diagnosed with CEH. The coverage of ‘often/always’ was substantial for the indicators, ‘Short-term positive results in previous manual physical therapeutic treatment’, ‘Shorter interval between treatment sessions’, ‘Fear of “locked facet joints” of the neck’, ‘More frequent manipulation’, and ‘Fear of increase in headaches’. Coverage was also substantial for ‘never’ regarding ‘Long-term positive results in previous manual physical therapeutic treatment’. ‘Confirmation of “locked facet joints” of the cervical spine by MPT as a cause for increase of CEH’ scored ‘often/always’ in all patients. Coverage for ‘Increased use of medication with insufficient effect’ was substantial, scoring as ‘sometimes’ in 39 (84.8%) patients.

Discussion: Cervico-cephalalgiaphobia was defined and a set of eight indicators formulated based on the literature and clinical expertise. The practice test provides valuable information on the frequency of indicators for cervico-cephalalgiaphobia in the Dutch manual physical therapy practice, suggesting that cervico-cephalalgiaphobia is common in patients with CEH.     

Treating Palliative Care Patients with Pain with the Body Tambura: A Prospective Case Study at St. Joseph's Hospice for Dying destitute in Dindigul South India

Background:

The Body Tambura is a recently invented stringed instrument that is used for receptive music therapy designed to be placed and attached on the human body. The aim of this study was to record perceived effects of a treatment with the Body Tambura on palliative care patients with special reference to pain.

Materials and Methods:

A prospective case study was carried out with patients of St. Joseph''s Hospice for Dying Destitute in Dindigul/South India. Patients were treated with a treatment after baseline assessment and also on the next day. Outcomes were measured quantitatively by using a numeric rating scale (0–10, 10 maximum intensity of pain felt) at baseline, directly after treatment, and the day after the treatment to determine the intensity of the pain.

Results:

Ten patients (five women and five men) participated in the study. The majority described the therapy as a pleasant experience. The pain intensity at baseline was reduced from 8.3 ± standard deviation (SD) 1.16 to 4.6 ± 1.52 at day 1 and from 4.6 ± 2.07 to 2.4 ± 1.58 at day 2.

Conclusion:

A clinically relevant pain reduction was described as short time outcome; the therapy was received and perceived well. Forthcoming research should include a control group, randomization, a larger number of participants, and a longer period of treatment.     

Multidisciplinary allocation of chronic pain treatment: Effects and cognitive‐behavioural predictors of outcome

Objectives . Multidisciplinary treatment approaches have been found to be effective for chronic pain patients although there are large individual differences in outcomes. To increase overall treatment effects, tools are needed to identify patients most likely to benefit from tailored, comprehensive modular treatment schemes. Design . The present study evaluates the effects of a multidisciplinary pain treatment allocation protocol in chronic pain patients and seeks to identify cognitive‐behavioural predictors of outcome. Pain intensity, functional disability, depression, and use of medication in an intervention group of 110 chronic pain patients were compared to the outcomes of a 110 strong control group. Results . Paired pre‐ and post‐treatment t tests showed that all primary outcomes had significantly decreased in the intervention group with ANCOVAs revealing a main group effect for post‐treatment pain intensity levels and functional disability. Paired t tests demonstrated both variables to have significantly reduced after treatment relative to the levels reported by the control group. Predictor analyses further showed higher levels of acceptance to significantly predict larger reductions in pain intensity in the intervention but not in the control group. Conclusion . The tested multidisciplinary allocation scheme for out‐patient treatment of chronic pain complaints was effective in reducing pain intensity and functional disability. Findings also showed that especially those patients that are able to accept their condition are likely to profit most from the treatment in terms of pain reduction.     

Antimicrobial resistance predicts death in Tanzanian children with bloodstream infections: a prospective cohort study

Background

Bloodstream infection is a common cause of hospitalization, morbidity and death in children. The impact of antimicrobial resistance and HIV infection on outcome is not firmly established.

Methods

We assessed the incidence of bloodstream infection and risk factors for fatal outcome in a prospective cohort study of 1828 consecutive admissions of children aged zero to seven years with signs of systemic infection. Blood was obtained for culture, malaria microscopy, HIV antibody test and, when necessary, HIV PCR. We recorded data on clinical features, underlying diseases, antimicrobial drug use and patients' outcome.

Results

The incidence of laboratory-confirmed bloodstream infection was 13.9% (255/1828) of admissions, despite two thirds of the study population having received antimicrobial therapy prior to blood culture. The most frequent isolates were klebsiella, salmonellae, Escherichia coli, enterococci and Staphylococcus aureus. Furthermore, 21.6% had malaria and 16.8% HIV infection. One third (34.9%) of the children with laboratory-confirmed bloodstream infection died. The mortality rate from Gram-negative bloodstream infection (43.5%) was more than double that of malaria (20.2%) and Gram-positive bloodstream infection (16.7%). Significant risk factors for death by logistic regression modeling were inappropriate treatment due to antimicrobial resistance, HIV infection, other underlying infectious diseases, malnutrition and bloodstream infection caused by Enterobacteriaceae, other Gram-negatives and candida.

Conclusion

Bloodstream infection was less common than malaria, but caused more deaths. The frequent use of antimicrobials prior to blood culture may have hampered the detection of organisms susceptible to commonly used antimicrobials, including pneumococci, and thus the study probably underestimates the incidence of bloodstream infection. The finding that antimicrobial resistance, HIV-infection and malnutrition predict fatal outcome calls for renewed efforts to curb the further emergence of resistance, improve HIV care and nutrition for children.     

The effect of AIDS defining conditions on immunological recovery among patients initiating antiretroviral therapy at Joint Clinical Research Centre, Uganda

Background  

Many HIV-infected patients only access health care once they have developed advanced symptomatic disease resulting from AIDS Defining Conditions (ADCs). We carried out a study to establish the effect of ADCs on immunological recovery among patients initiated on antiretroviral therapy (ART).     

The role of fear-avoidance and helplessness in explaining functional disability in chronic pain: a prospective study

Objective: Based on the fear-avoidance and helplessness models, the relative contribution of fear of pain, avoidance behavior, worrying, and helplessness were examined in relation to fluctuations in functional disability in chronic-pain patients. Methods: A cohort of 181 chronic-pain patients first completed various questionnaires and kept a 7-day pain journal during a standard 3-month waiting-list period prior to their scheduled treatment at an Interdisciplinary Pain Centre and did so again immediately preceding the intervention. Results: At baseline, fear of pain, avoidance behavior, and helplessness all predicted functional disability after 3 months. Stepwise regression analyses showed avoidance behavior to be the strongest predictor of change in functional disability followed by helplessness, thus both ahead of fear of pain. Conclusion: The current findings support the roles of both fear-avoidance factors and helplessness in the functional disability in chronic-pain patients awaiting treatment but revealed a central role for avoidance behavior.     

The role of helplessness, fear of pain, and passive pain-coping in chronic pain patients

OBJECTIVES: The goal of this study was to examine the relative contribution of helplessness, fear of pain, and passive pain-coping to pain level, disability, and depression in chronic pain patients attending an interdisciplinary pain center. METHODS: One hundred sixty-nine chronic pain patients who had entered treatment at an interdisciplinary pain center completed various questionnaires and a pain diary. RESULTS: Helplessness, fear of pain, and passive pain-coping strategies were all related to the pain level, disability, and depression. When comparing the contribution of the predictors in multiple regression analyses, helplessness was the only significant predictor for pain level. Helplessness and the passive behavioral pain-coping strategies of resting significantly predicted disability. The passive cognitive pain-coping strategy of worrying significantly predicted depression. CONCLUSIONS: These findings indicate a role for helplessness and passive pain-coping in chronic pain patients and suggest that both may be relevant in the treatment of pain level, disability, and/or depression.