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1.
Prev Med ; 182: 107940, 2024 May.
Artigo em Inglês | MEDLINE | ID: mdl-38513839

RESUMO

OBJECTIVES: Relevant knowledge is essential for informed choices about (non)participation in population-based cancer screening. Many instruments have been proposed to assess residents' knowledge about cancer screening programmes but their measurement properties are unknown. This systematic review aims to identify and critically evaluate the measurement properties of instruments to measure knowledge about cancer screening in individuals eligible for population-based screening. METHODS: A literature search was undertaken in PubMed, PsycINFO, Embase, CINAHL, Scopus and Web of Science in August 2023. The review included any study reporting one or more measurement properties of the questionnaire or sub-scale used measuring knowledge of cancer screening including breast, colorectal and/or cervical cancer screening. Studies including males aged 45 or older and females aged 20 or older were included. Two independent reviewers screened the articles and assessed the included articles using the COnsensus-based Standards for the selection of health Measurement Instruments (COSMIN). RESULTS: We included 24 instruments, which varied in number and characteristics of items. All instruments were assessed as having an inadequate instrument development. The results of structural validity, internal consistency, criterion validity and reliability were assessed as indeterminate, while construct validity and responsiveness were assessed as sufficient. CONCLUSION: This systematic review identified no instruments to measure knowledge about cancer screening where the measurement properties were sufficiently evaluated. There is a lack of focus on content validity and structural validity, and further validation of the instruments is needed. The results indicate a lack of shared understanding or agreement of what constitutes relevant knowledge about cancer screening.

2.
BMC Health Serv Res ; 24(1): 117, 2024 Jan 22.
Artigo em Inglês | MEDLINE | ID: mdl-38254059

RESUMO

BACKGROUND: The number of people living with chronic conditions is increasing worldwide, and with that, the need for multiple long-term complex care across care settings. Undergoing transitions across healthcare settings is both challenging and perilous for patients. Nevertheless, knowledge of what facilitates quality during transitions in healthcare settings from the lifeworld perspective of patients is still lacking. Therefore, we aimed to explore the lived experience in healthcare quality for Danish adult patients during healthcare pathways including transitions across settings. METHODS: Within a hermeneutic-phenomenological approach, interviews were conducted with three women and five men with various diagnoses and care paths between 30 and 75 years of age. Data underwent a three phased thematic analysis leading to three themes. RESULTS: Patients with various illnesses' experiences of quality of care is described in the themes being powerless in the face of illness; burdensome access and navigation; and being in need of mercy and striving for kindness. This highlights that patients' experiences of quality in healthcare pathways across settings interweaves with an overall understanding of being powerless at the initial encounter. Access and navigation are burdensome, and system inflexibility adds to the burden and enhances powerlessness. However, caring care provided through the kindness of healthcare professionals supports patients in regaining control of their condition. CONCLUSIONS: This hermeneutical-phenomenological study sheds light on the lived experiences of people who are at various stages in their care paths with transitions across healthcare settings. Although our findings are based on the lived experiences of 8 people in a Danish context, in light of the discussion with nursing theory and other research, the results can be reflected in two main aspects: I) kind and merciful professional relationships and II) system flexibility including access and navigation, were essential for their experiences of care quality during healthcare transitions. This is important knowledge when striving to provide patients with a clear voice regarding quality in care pathways stretching across settings.


Assuntos
Transição para Assistência do Adulto , Adulto , Masculino , Humanos , Feminino , Hermenêutica , Procedimentos Clínicos , Emoções , Instalações de Saúde
3.
BMC Health Serv Res ; 24(1): 828, 2024 Jul 22.
Artigo em Inglês | MEDLINE | ID: mdl-39039533

RESUMO

No reviews so far have been conducted to define the constructs of patient-experienced quality in healthcare transitions or to identify existing generic measures of patients' experience of the quality within healthcare transitions. Our aim was to identify domains relevant for people experiencing healthcare transitions when evaluating the quality of care they have received, map the comprehensiveness of existing patient-reported experience measures (PREM), and evaluate the PREMs' content validity. The method was guided by the Joanna Briggs Institutes' guidance for scoping reviews. The search was performed on 07 December 2021 and updated 27 May 2024, in the electronic databases Medline (Ovid), Embase (Ovid), and Cinahl (EBSCO). The search identified 20,422 publications, and 190 studies were included for review. We identified 30 PREMs assessing at least one aspect of adults' experience of transitions in healthcare. Summarising the content, we consider a model with two domains, organisational and human-relational, likely to be adequate. However, a more comprehensive analysis and adequate definition of the construct is needed. None of the PREMs were considered content valid.


Assuntos
Medidas de Resultados Relatados pelo Paciente , Qualidade da Assistência à Saúde , Humanos , Qualidade da Assistência à Saúde/normas , Reprodutibilidade dos Testes , Satisfação do Paciente
4.
J Occup Rehabil ; 34(3): 669-682, 2024 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-38102368

RESUMO

PURPOSE: Assessing work functioning in patients with persistent low back pain (LBP) is important for understanding their ability to engage in work-related activities. This study aims to evaluate the item characteristics, factor structure, and internal consistency of the Work Rehabilitation Questionnaire (WORQ) in patients with persistent LBP. METHODS: Four hundred and twenty-five individuals with LBP completed the WORQ. Item characteristics, exploratory factor analysis (EFA), and consistency were performed to identify the underlying factors. RESULTS: Missing responses were < 2% for each item. The analysis revealed three factors: psychological wellbeing, physical functioning, and cognitive ability. The factors demonstrated strong internal consistency, with Cronbach's alpha values ranging from 0.88 to 0.93 and McDonald's Omega from 0.92 to 0.96. Fifteen items did not fit into any identified factors, suggesting their potential value in screening functioning levels beyond the factors. CONCLUSIONS: The WORQ is a valid instrument for evaluating work limitations in individuals with persistent LBP. Further research should assess its responsiveness to changes from interventions that target workability. Advancing this knowledge has the potential to promote work rehabilitation and improve the quality of life for patients with persistent LBP.


Assuntos
Dor Lombar , Humanos , Dor Lombar/reabilitação , Dor Lombar/psicologia , Masculino , Feminino , Inquéritos e Questionários/normas , Pessoa de Meia-Idade , Adulto , Reprodutibilidade dos Testes , Análise Fatorial , Avaliação da Capacidade de Trabalho , Qualidade de Vida , Psicometria
5.
Clin Anat ; 37(4): 440-454, 2024 May.
Artigo em Inglês | MEDLINE | ID: mdl-38217386

RESUMO

An intricate meshwork of trabeculations lines the luminal side of cardiac ventricles. Compaction, a developmental process, is thought to reduce trabeculations by adding them to the neighboring compact wall which is then enlarged. When pig, a plausible cardiac donor for xenotransplantation, is compared to human, the ventricular walls appear to have fewer trabeculations. We hypothesized the trabecular volume is proportionally smaller in pig than in human. Macroscopically, we observed in 16 pig hearts that the ventricular walls harbor few but large trabeculations. Close inspection revealed a high number of tiny trabeculations, a few hundred, within the recesses of the large trabeculations. While tiny, these were still larger than embryonic trabeculations and even when considering their number, the total tally of trabeculations in pig was much fewer than in human. Volumetrics based on high-resolution MRI of additional six pig hearts compared to six human hearts, revealed the left ventricles were not significantly differently trabeculated (21.5 versus 22.8%, respectively), and the porcine right ventricles were only slightly less trabeculated (42.1 vs 49.3%, respectively). We then analyzed volumetrically 10 pig embryonic hearts from gestational day 14-35. The trabecular and compact layer always grew, as did the intertrabecular recesses, in contrast to what compaction predicts. The proportions of the trabecular and compact layers changed substantially, nonetheless, due to differences in their growth rate rather than compaction. In conclusion, processes that affect the trabecular morphology do not necessarily affect the proportion of trabecular-to-compact myocardium and they are then distinct from compaction.


Assuntos
Ventrículos do Coração , Coração , Humanos , Animais , Suínos , Ventrículos do Coração/diagnóstico por imagem , Ventrículos do Coração/anatomia & histologia , Coração/anatomia & histologia , Miocárdio
6.
Proc Biol Sci ; 290(2006): 20231353, 2023 09 13.
Artigo em Inglês | MEDLINE | ID: mdl-37700647

RESUMO

In hypoxia, air-breathing fish obtain O2 from the air but continue to excrete CO2 into the water. Consequently, it is believed that some O2 obtained by air-breathing is lost at the gills in hypoxic water. Pangasionodon hypophthalmus is an air-breathing catfish with very large gills from the Mekong River basin where it is cultured in hypoxic ponds. To understand how P. hypophthalmus can maintain high growth in hypoxia with the presumed O2 loss, we quantified respiratory gas exchange in air and water. In severe hypoxia (PO2: ≈ 1.5 mmHg), it lost a mere 4.9% of its aerial O2 uptake, while maintaining aquatic CO2 excretion at 91% of the total. Further, even small elevations in water PO2 rapidly reduced this minor loss. Charting the cardiovascular bauplan across the branchial basket showed four ventral aortas leaving the bulbus arteriosus, with the first and second gill arches draining into the dorsal aorta while the third and fourth gill arches drain into the coeliacomesenteric artery supplying the gut and the highly trabeculated respiratory swim-bladder. Substantial flow changes across these two arterial systems from normoxic to hypoxic water were not found. We conclude that the proposed branchial oxygen loss in air-breathing fish is likely only a minor inefficiency.


Assuntos
Peixes-Gato , Oxigênio , Animais , Dióxido de Carbono , Hipóxia/veterinária , Transporte Biológico
7.
BMC Biol ; 20(1): 180, 2022 08 19.
Artigo em Inglês | MEDLINE | ID: mdl-35982432

RESUMO

BACKGROUND: Buoyancy and balance are important parameters for slow-moving, low-metabolic, aquatic organisms. The extant coelacanths have among the lowest metabolic rates of any living vertebrate and can afford little energy to keep station. Previous observations on living coelacanths support the hypothesis that the coelacanth is neutrally buoyant and in close-to-perfect hydrostatic balance. However, precise measurements of buoyancy and balance at different depths have never been made.  RESULTS: Here we show, using non-invasive imaging, that buoyancy of the coelacanth closely matches its depth distribution. We found that the lipid-filled fatty organ is well suited to support neutral buoyancy, and due to a close-to-perfect hydrostatic balance, simple maneuvers of fins can cause a considerable shift in torque around the pitch axis allowing the coelacanth to assume different body orientations with little physical effort. CONCLUSIONS: Our results demonstrate a close match between tissue composition, depth range and behavior, and our collection-based approach could be used to predict depth range of less well-studied coelacanth life stages as well as of deep sea fishes in general.


Assuntos
Peixes , Animais , Oceano Índico
8.
Scand J Caring Sci ; 37(2): 534-548, 2023 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-36522835

RESUMO

INTRODUCTION: QUALIDEM is a dementia-specific QoL instrument that allows a proxy-based Quality of Life rating in all stages of dementia. It was originally developed in The Netherlands and has later been translated into English and German. This study endeavoured to translate, cross-culturally adapt and test important psychometric properties of a Danish version in a cross-sectional validation study with a nested test-retest design. METHOD: All items underwent forward and backward translation by bilingual academics. Persons with dementia were recruited from 28 healthcare units in a Danish municipality. The severity of dementia was determined using a pragmatic approach allowing the site team to trichotomise the disease (mild, moderate-severe and very severe) before scoring the QUALIDEM. Psychometric properties for QUALIDEM were determined for item characteristics, construct validity, internal consistency, test-retest reliability, measurement error and floor and ceiling effects. The study was approved by The Danish Data Protection Agency. RESULTS: A total of 169 persons with dementia, aged 51-103, were included. The construct validity testing showed that the overall proportion of correctly hypothesised correlations was 83%. Testing for internal consistency, Cronbach's α ranged from 0.65 to 0.85 in mild-severe dementia with three out of nine subscales having values below 0.7. For very severe dementia, Cronbach's α ranged from 0.44 to 0.81, with three out of six subscales having insufficient values. For test-retest reliability, the intra-class correlation coefficients ranged from 0.56 to 0.86. The 'scale width' method revealed a marked ceiling effect in all subscales ranging from 30.6% to 87.7%. DISCUSSION: The QUALIDEM was successfully translated and cross-culturally adapted into Danish. Most subscales show acceptable internal consistency and test-retest reliability. However, a substantial measurement error and ceiling effect was present in most subscales. CONCLUSION: With few exceptions, the subscales of the Danish version of QUALIDEM have acceptable validity and reliability. Future research should address the limitations of the ceiling effects.


Assuntos
Demência , Qualidade de Vida , Humanos , Reprodutibilidade dos Testes , Estudos Transversais , Inquéritos e Questionários , Psicometria/métodos , Dinamarca , Comparação Transcultural
9.
J Anat ; 241(2): 535-544, 2022 08.
Artigo em Inglês | MEDLINE | ID: mdl-35412658

RESUMO

Non-crocodylian reptiles have hearts with a single ventricle, which is partially separated by a muscular ridge that provides some separation of blood flows. An exceptional situation exists in monitor lizards and pythons, where the ventricular left side generates a much higher systolic blood pressure than the right side, thus resembling mammals and birds. This functional division of the ventricle depends on a large muscular ridge and may relate to high metabolic demand. The large leatherback turtle (<1000 kg), with its extensive migrations and elevated body temperatures, may have similar adaptations. We report on the anatomy of the hearts of two leatherback turtles. One stranded in Ballum, Denmark in 2020, and was examined in detail, supplemented by observations and photos of an additional stranding specimen from Canada. The external morphology of the leatherback heart resembles that of other turtles, but it is large. We made morphometric measurements of the Ballum heart and created an interactive 3D model using high-resolution MRI. The volume of the ventricle was 950 ml, from a turtle of 300 kg, which is proportionally almost twice as large as in other reptiles. The Ballum heart was compared to MRI scans of the hearts of a tortoise, a python, and a monitor lizard. Internally, the leatherback heart is typical of non-crocodylian reptiles and did not contain the well-developed septation found in pythons and monitor lizards. We conclude that if leatherback turtles have exceptional circulation needs, they are sustained with a relatively large but otherwise typical non-crocodylian reptile heart.


Assuntos
Lagartos , Tartarugas , Animais , Coração/anatomia & histologia , Ventrículos do Coração , Hemodinâmica , Mamíferos
10.
J Exp Biol ; 225(6)2022 03 15.
Artigo em Inglês | MEDLINE | ID: mdl-35262176

RESUMO

Hagfish represent the oldest extant connection to the ancestral vertebrates, but their physiology is not well understood. Using behavioural (video), physiological (respirometry, flow measurements), classical morphological (dissection, silicone injection) and modern imaging approaches (micro-MRI, DICE micro-CT), we examined the interface between feeding and the unique breathing mechanism (nostril opening, high-frequency velum contraction, low-frequency gill pouch contraction and pharyngo-cutaneous duct contraction) in the Pacific hagfish, Eptatretus stoutii. A video tour via micro-MRI is presented through the breathing and feeding passages. We have reconciled an earlier disagreement as to the position of the velum chamber, which powers inhalation through the nostril, placing it downstream of the merging point of the food and water passage, such that the oronasal septum terminates at the anterior end of the velum chamber. When feeding occurs by engulfment of large chunks by the dental plates, food movement through the chamber may transiently interfere with breathing. Swallowing is accelerated by peristaltic body undulation involving the ventral musculature, and is complete within 5 s. After a large meal (anchovy, 20% body mass), hagfish remain motionless, defaecating bones and scales at 1.7 days and an intestinal peritrophic membrane at 5 days. O2 consumption rate approximately doubles within 1 h of feeding, remaining elevated for 12-24 h. This is achieved by combinations of elevated O2 utilization and ventilatory flow, the latter caused by varying increases in velar contraction frequency and stroke volume. Additional imaging casts light on the reasons for the trend for greater O2 utilization by more posterior pouches and the pharyngo-cutaneous duct in fasted hagfish.


Assuntos
Feiticeiras (Peixe) , Animais , Brânquias/fisiologia , Feiticeiras (Peixe)/fisiologia , Oxigênio , Consumo de Oxigênio , Respiração
11.
Bioessays ; 42(11): e2000054, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-32914411

RESUMO

The heart has a high-metabolic rate, and its "around-the-clock" vital role to sustain life sets it apart in a regenerative setting from other organs and appendages. The landscape of vertebrate species known to perform intrinsic heart regeneration is strongly biased toward ectotherms-for example, fish, salamanders, and embryonic/neonatal ectothermic mammals. It is hypothesized that intrinsic heart regeneration is exclusively limited to the low-metabolic hearts of ectotherms. The biomedical field of regenerative medicine seeks to devise biologically inspired regenerative therapies to diseased human hearts. Falsification of the ectothermy dependency for heart regeneration hypothesis may be a crucial prerequisite to meaningfully seek inspiration in established ectothermic regenerative animal models. Otherwise, engineering approaches to construct artificial heart components may constitute a more viable path toward regenerative therapies. A more strict definition of regenerative phenomena is generated and several testable sub-hypotheses and experimental avenues are put forward to elucidate the link between heart regeneration and metabolism. Also see the video abstract here https://youtu.be/fZcanaOT5z8.


Assuntos
Coração , Vertebrados , Adulto , Animais , Humanos , Mamíferos , Modelos Animais , Medicina Regenerativa
12.
Int Psychogeriatr ; 33(4): 405-417, 2021 04.
Artigo em Inglês | MEDLINE | ID: mdl-32880256

RESUMO

OBJECTIVES: Caring for a person with dementia is associated with poor mental, physical, and social health, which makes it important to consider how carers are best supported in their caring role to preserve both their and the person with dementia's well-being. At present, a robust instrument to assess carers' support needs does not exist. This study aimed to develop a self-reported questionnaire to assess the support needs of carers of people with dementia. The objectives were to: (1) generate items, (2) pilot test, and (3) field-test the questionnaire. DESIGN: Development and field-testing of a new questionnaire. SETTINGS: Primary and secondary health and social care of informal carers and people with dementia in nine municipalities and one dementia clinic in a hospital in Denmark. PARTICIPANTS: Eight experts, 12 carers, and 7 digital users participated in pilot testing. 301 carers participated in field-testing. MEASUREMENTS: Items for inclusion were generated based on interviews and literature review. An iterative process of data collection was applied to establish face and content validity of the Dementia Carer Assessment of Support Needs Tool (DeCANT) using Content Validity Index among experts and cognitive interviews with carers. Field-testing of DeCANT among carers included using the 12-item Short Form Health Survey, the Barthel-20 Index, and the Neuropsychiatric Inventory. RESULTS: Initially, an item pool of 63 items was generated, and pilot testing reduced this to 42 items. Subsequent field-testing resulted in a 25-item version of DeCANT, and confirmatory factor analysis of three hypothesized models demonstrated a marginally better fit to a four-factor model with fit indices of: χ2 = 775.170 (p < 0.001), root mean square error of approximation = 0.073, Comparative Fit Index = 0.946, the Tucker-Lewis Index = 0.938, and weighted root mean residual (WRMR) = 1.265. CONCLUSIONS: DeCANT is a 25-item carer-reported questionnaire that can be used to help identify their support needs when caring for a person with dementia to enable supportive interventions and improve carers' health and well-being.


Assuntos
Sobrecarga do Cuidador , Cuidadores/psicologia , Demência , Apoio Social , Inquéritos e Questionários , Feminino , Necessidades e Demandas de Serviços de Saúde , Humanos , Masculino , Pessoa de Meia-Idade
13.
Scand J Caring Sci ; 35(3): 685-700, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32781496

RESUMO

BACKGROUND: Informal carers of people with dementia report having unmet needs for support and few supportive interventions have been shown to be effective. There is a need to develop needs assessment instruments and supportive interventions with a holistic and person-centred approach to meet the various and complex needs of carers. The aim of this study was to provide an overview of carers' support needs when caring for people with dementia with the objectives to map and synthesise knowledge on key concepts of carers' support needs. METHODS: A scoping review methodology was used. A literature search was conducted in PsycINFO, CINAHL, PubMed and EMBASE between January 2007 and October 2019. Three authors independently selected articles meeting the inclusion criteria, and data were extracted using a matrix developed for that purpose. Inductive content analysis was used to synthesise key concepts of carers' support needs. RESULTS: The search identified 2748 articles after removing duplicates, and 122 articles were included in the mapping of carers' support needs. Synthesising carers' support needs indicated that the full extent of support needs emerges in the interaction between the carer and the person cared for and that it is possible to categorise support needs into four key concepts related to: 1) the carer as a person, 2) managing being a carer, 3) providing care, and 4) knowledge of dementia. CONCLUSION: The findings of this study help to map a framework describing carers' support needs that may guide the development of future needs assessment instruments and supportive interventions.


Assuntos
Cuidadores , Demência , Humanos
14.
Scand J Caring Sci ; 35(2): 586-599, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32410395

RESUMO

BACKGROUND: Caring for a person with dementia predisposes informal carers (carers) to mental and physical disability. Carers tend to focus on the needs of the person with dementia and have difficulties expressing their own needs for support. No instrument has yet been developed to directly assess carers' support needs. The aim of this study is to clarify the main categories of carers' support needs to inform future development of an instrument to assess carers' support needs. METHODS: A qualitative approach combining focus group interviews with carers and professionals and individual interviews were used. RESULTS: Carers' support needs were categorised into four areas: (i) daily life when caring for a person with dementia, (ii) focus on themselves, (iii) maintain own well-being, and (iv) communicate and interact with surroundings. DISCUSSION: Carers have support needs in common regardless of the relation to the person with dementia. Carers tend to focus on the needs of the person with dementia, thus not knowing their own needs. The four main categories clarified in this study may inform the foundation of developing an instrument to facilitate dialogue between carers and professionals with the purpose of assessing carers' support needs.


Assuntos
Surdez , Demência , Pessoas com Deficiência , Cuidadores , Grupos Focais , Humanos , Pesquisa Qualitativa
15.
BMC Biol ; 17(1): 103, 2019 12 12.
Artigo em Inglês | MEDLINE | ID: mdl-31831016

RESUMO

BACKGROUND: Videographic material of animals can contain inapparent signals, such as color changes or motion that hold information about physiological functions, such as heart and respiration rate, pulse wave velocity, and vocalization. Eulerian video magnification allows the enhancement of such signals to enable their detection. The purpose of this study is to demonstrate how signals relevant to experimental physiology can be extracted from non-contact videographic material of animals. RESULTS: We applied Eulerian video magnification to detect physiological signals in a range of experimental models and in captive and free ranging wildlife. Neotenic Mexican axolotls were studied to demonstrate the extraction of heart rate signal of non-embryonic animals from dedicated videographic material. Heart rate could be acquired both in single and multiple animal setups of leucistic and normally colored animals under different physiological conditions (resting, exercised, or anesthetized) using a wide range of video qualities. Pulse wave velocity could also be measured in the low blood pressure system of the axolotl as well as in the high-pressure system of the human being. Heart rate extraction was also possible from videos of conscious, unconstrained zebrafish and from non-dedicated videographic material of sand lizard and giraffe. This technique also allowed for heart rate detection in embryonic chickens in ovo through the eggshell and in embryonic mice in utero and could be used as a gating signal to acquire two-phase volumetric micro-CT data of the beating embryonic chicken heart. Additionally, Eulerian video magnification was used to demonstrate how vocalization-induced vibrations can be detected in infrasound-producing Asian elephants. CONCLUSIONS: Eulerian video magnification provides a technique to extract inapparent temporal signals from videographic material of animals. This can be applied in experimental and comparative physiology where contact-based recordings (e.g., heart rate) cannot be acquired.


Assuntos
Ambystoma mexicanum/fisiologia , Frequência Cardíaca , Fisiologia/métodos , Gravação de Videoteipe/métodos , Peixe-Zebra/fisiologia , Animais , Embrião de Galinha , Humanos , Camundongos , Pulso Arterial/instrumentação , Análise de Onda de Pulso/instrumentação
16.
Eur Spine J ; 26(9): 2242-2257, 2017 09.
Artigo em Inglês | MEDLINE | ID: mdl-28523381

RESUMO

PURPOSE: To summarise recommendations about 21 selected non-surgical interventions for recent onset (<12 weeks) non-specific neck pain (NP) and cervical radiculopathy (CR) based on two guidelines from the Danish Health Authority. METHODS: Two multidisciplinary working groups formulated recommendations based on the GRADE approach. RESULTS: Twelve recommendations were based on evidence and nine on consensus. Management should include information about prognosis, warning signs, and advise to remain active. For treatment, guidelines suggest different types of supervised exercise and manual therapy; combinations of exercise and manual therapy before medicine for NP; acupuncture for NP but not CR; traction for CR; and oral NSAID (oral or topical) and Tramadol after careful consideration for NP and CR. CONCLUSION: Recommendations are based on low-quality evidence or on consensus, but are well aligned with recommendations from guidelines from North America. The working groups recommend intensifying research relating to all aspects of management of NP and CR.


Assuntos
Cervicalgia/terapia , Guias de Prática Clínica como Assunto , Radiculopatia/diagnóstico , Terapia por Acupuntura/métodos , Dinamarca , Terapia por Exercício/métodos , Humanos , Massagem/métodos , Manipulações Musculoesqueléticas/métodos , Manejo da Dor/métodos , Educação de Pacientes como Assunto/métodos , Tração
17.
Pain Pract ; 17(4): 480-493, 2017 04.
Artigo em Inglês | MEDLINE | ID: mdl-27440225

RESUMO

OBJECTIVE: To (1) translate and culturally adapt and (2) determine the clinimetric properties of the Danish 8-item Neck Disability Index (NDI-8) in primary sector patients (PSPs) and secondary sector patients (SSPs). METHODS: Analyses included 326 patients with neck pain. Validity and reliability were assessed using a cross-validation factor analytical design, hypothesis testing, internal consistency, measurement error, the smallest detectable change (SDC), and a generalizability study. Criterion and construct responsiveness, minimal important change (MIC), and floor and ceiling effects were determined. RESULTS: The original Danish version of the NDI was not unidimensional. Omitting 2 items (pain, headache) revealed a 1-factor structure (NDI-8). Construct validity correctly predicted 88% of the hypotheses. Internal consistency (Cronbach's α) ranged between 0.88 and 0.89, and generalizability was high (Φ = 0.90). The SDC was 6.8 in PSPs and 5.9 in SSPs. Criterion responsiveness revealed poor areas under the curve for SSPs (0.58 to 0.64), and construct responsiveness was poor for PSPs (43% correctly predicted hypothesis). A floor effect of 26.5% was found in PSPs, with a change of 4 points representing the MIC. CONCLUSION: The modified Danish 8-item NDI was unidimensional, had construct validity, and was reproducible with a large but acceptable measurement error. However, responsiveness was poor and a significant floor effect was found in PSPs. A change score representing the MIC is proposed for PSPs.


Assuntos
Comparação Transcultural , Avaliação da Deficiência , Cervicalgia/diagnóstico , Cervicalgia/epidemiologia , Medição da Dor/métodos , Medição da Dor/normas , Adulto , Estudos Transversais , Dinamarca/epidemiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Reprodutibilidade dos Testes , Inquéritos e Questionários
18.
Acta Orthop ; 87(sup363): 1-5, 2016 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-28271925

RESUMO

The combination of modern interventional and preventive medicine has led to an epidemic of ageing. While this phenomenon is a positive consequence of an improved lifestyle and achievements in a society, the longer life expectancy is often accompanied by decline in quality of life due to musculoskeletal pain and disability. The Aarhus Regenerative Orthopaedics Symposium (AROS) 2015 was motivated by the need to address regenerative challenges in an ageing population by engaging clinicians, basic scientists, and engineers. In this position paper, we review our contemporary understanding of societal, patient-related, and basic science-related challenges in order to provide a reasoned roadmap for the future to deal with this compelling and urgent healthcare problem.


Assuntos
Envelhecimento/fisiologia , Sistema Musculoesquelético/fisiopatologia , Medicina Regenerativa/métodos , Animais , Comorbidade , Modelos Animais de Doenças , Humanos , Regeneração/fisiologia
19.
Proc Biol Sci ; 282(1802)2015 Mar 07.
Artigo em Inglês | MEDLINE | ID: mdl-25652830

RESUMO

Early tetrapods faced an auditory challenge from the impedance mismatch between air and tissue in the transition from aquatic to terrestrial lifestyles during the Early Carboniferous (350 Ma). Consequently, tetrapods may have been deaf to airborne sounds for up to 100 Myr until tympanic middle ears evolved during the Triassic. The middle ear morphology of recent urodeles is similar to that of early 'lepospondyl' microsaur tetrapods, and experimental studies on their hearing capabilities are therefore useful to understand the evolutionary and functional drivers behind the shift from aquatic to aerial hearing in early tetrapods. Here, we combine imaging techniques with neurophysiological measurements to resolve how the change from aquatic larvae to terrestrial adult affects the ear morphology and sensory capabilities of salamanders. We show that air-induced pressure detection enhances underwater hearing sensitivity of salamanders at frequencies above 120 Hz, and that both terrestrial adults and fully aquatic juvenile salamanders can detect airborne sound. Collectively, these findings suggest that early atympanic tetrapods may have been pre-equipped to aerial hearing and are able to hear airborne sound better than fish on land. When selected for, this rudimentary hearing could have led to the evolution of tympanic middle ears.


Assuntos
Ambystoma/fisiologia , Metamorfose Biológica , Ambystoma/anatomia & histologia , Ambystoma/crescimento & desenvolvimento , Animais , Orelha Média/anatomia & histologia , Orelha Média/fisiologia , Potenciais Evocados Auditivos , Audição/fisiologia , Larva/anatomia & histologia , Larva/fisiologia
20.
Vet Ophthalmol ; 18 Suppl 1: 23-9, 2015 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-25132530

RESUMO

OBJECTIVE: To provide morphological descriptions of microphthalmia or anophthalmia in eight pythons using microcomputerized tomography (µCT), magnetic resonance imaging (MRI), and histopathology. ANIMALS STUDIED: Seven Burmese pythons (Python bivittatus) and one ball python (P. regius) with clinically normal right eyes and an abnormal or missing left eye. PROCEDURE: At the time of euthanasia, four of the eight snakes underwent necropsy. Hereafter, the heads of two Burmese pythons and one ball python were examined using µCT, and another Burmese python was subjected to MRI. Following these procedures, the heads of these four pythons along with the heads of an additional three Burmese pythons were prepared for histology. RESULTS: All eight snakes had left ocular openings seen as dermal invaginations between 0.2 and 2.0 mm in diameter. They also had varying degrees of malformations of the orbital bones and a limited presence of nervous, glandular, and muscle tissue in the posterior orbit. Two individuals had small but identifiable eyes. Furthermore, remnants of the pigmented embryonic framework of the hyaloid vessels were found in the anophthalmic snakes. Necropsies revealed no other macroscopic anomalies. CONCLUSIONS: Eight pythons with unilateral left-sided microphthalmia or anophthalmia had one normal eye and a left orbit with malformed or incompletely developed ocular structures along with remnants of fetal structures. These cases lend further information to a condition that is often seen in snakes, but infrequently described.


Assuntos
Anoftalmia/veterinária , Microftalmia/veterinária , Serpentes , Animais , Imageamento por Ressonância Magnética/veterinária , Tomografia Computadorizada por Raios X/veterinária
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