Implementation of Early Intervention Protocol in Australia for 'High Risk' Injured Workers is Associated with Fewer Lost Work Days Over 2 Years Than Usual (Stepped) Care.

Purpose To evaluate whether a protocol for early intervention addressing the psychosocial risk factors for delayed return to work in workers with soft tissue injuries would achieve better long-term outcomes than usual (stepped) care. Methods The study used a controlled, non-randomised prospective design to compare two case management approaches. For the intervention condition, workers screened within 1-3 weeks of injury as being at high risk of delayed returned to work by the Örebro Musculoskeletal Pain Screening Questionnaire-short version (ÖMPSQ-SF) were offered psychological assessment and a comprehensive protocol to address the identified obstacles for return to work. Similarly identified injured workers in the control condition were managed under usual (stepped) care arrangements. Results At 2-year follow-up, the mean lost work days for the Intervention group was less than half that of the usual care group, their claim costs were 30% lower, as was the growth trajectory of their costs after 11 months. Conclusions The findings supported the hypothesis that brief psychological risk factor screening, combined with a protocol for active collaboration between key stakeholders to address identified psychological and workplace factors for delayed return to work, can achieve better return on investment than usual (stepped) care.

Predicting Return to Work in a Heterogeneous Sample of Recently Injured Workers Using the Brief ÖMPSQ-SF.

Purpose (1) to examine the ability of the Örebro Musculoskeletal Pain Screening Questionnaire-short version (ÖMPSQ-SF) to predict time to return to pre-injury work duties (PID) following a work-related soft tissue injury (regardless of body location); and (2) to examine the appropriateness of 50/100 as a suitable cut-off score for case identification. Methods Injured workers (IW) from six public hospitals in Sydney, Australia, who had taken medically-sanctioned time off work due to their injury, were recruited by insurance case managers within 5-15 days of their injury. Eligible participants (N = 213 in total) were administered the ÖMPSQ-SF over the telephone by the case manager. For objective (1) Cox proportional hazards regression analysis was used to predict days to return to PID using the ÖMPSQ-SF. For objective (2) receiver operator characteristic (ROC) analysis was used to determine the ÖMPSQ-SF total score that optimises sensitivity and specificity in detecting whether or not participants had returned to PID within 2-7 weeks. Results The total ÖMPSQ-SF score significantly predicted number of days to return to PID, such that for every 1-point increase in the total ÖMPSQ-SF score the predicted chance of returning to work reduced by 4% (i.e., hazard ratio = 0.96), p < 0.001. Sensitivity and specificity for the ROC analysis comparing ÖMPSQ-SF total score to return to PID within 2-7 weeks suggested 48 as the optimal cut off (sensitivity = 0.65, specificity = 0.79). Conclusion The results provide strong support for the use of the ÖMPSQ-SF in an applied setting for identifying those IW likely to have delayed RTW when administered within 15 days of the injury. While a score of 48/100 was the optimal cut point for sensitivity and specificity, pragmatically, 50/100 should be acceptable as a cut-off in future studies of this type.

Correction to: Implementation of Early Intervention Protocol in Australia for 'High Risk' Injured Workers is Associated with Fewer Lost Work Days Over 2 Years Than Usual (Stepped) Care.

The original version of this article unfortunately contained a spelling error in one of the co-authors's names. The family name of the co-author was incorrectly displayed as "James McCauley" instead of "James McAuley. The original article has been corrected.

Longitudinal associations between time spent using technology and sleep duration among adolescents.

Technology use has been the focus of much concern for adolescents' sleep health. However, few studies have investigated the bidirectional association between sleep duration and time spent using technology. The aim of this study was to test whether time spent using technology predicted shorter sleep duration, and/or vice versa using cross-lagged analyses over one year. Participants were 1620 high school students in the 8th and 9th grade at baseline from 17 public schools in three middle Sweden communities. Students completed questionnaires at school during the spring of 2015 and 2016. Time spent using technology was self-reported and sleep duration was calculated from reported bed-times, wake-times and sleep onset latency. Time spent using technology significantly predicted shorter subsequent sleep duration and vice versa. Public health advocates educating others about the negative impacts of technology on sleep must also be mindful of the opposite, that many young people may turn to technological devices when experiencing difficulty sleeping.

'Sink or swim': an evaluation of the clinical characteristics of individuals with high bone mass.

SUMMARY: High bone mineral density on routine dual energy X-ray absorptiometry (DXA) may indicate an underlying skeletal dysplasia. Two hundred fifty-eight individuals with unexplained high bone mass (HBM), 236 relatives (41% with HBM) and 58 spouses were studied. Cases could not float, had mandible enlargement, extra bone, broad frames, larger shoe sizes and increased body mass index (BMI). HBM cases may harbour an underlying genetic disorder. INTRODUCTION: High bone mineral density is a sporadic incidental finding on routine DXA scanning of apparently asymptomatic individuals. Such individuals may have an underlying skeletal dysplasia, as seen in LRP5 mutations. We aimed to characterize unexplained HBM and determine the potential for an underlying skeletal dysplasia. METHODS: Two hundred fifty-eight individuals with unexplained HBM (defined as L1 Z-score ≥ +3.2 plus total hip Z-score ≥ +1.2, or total hip Z-score ≥ +3.2) were recruited from 15 UK centres, by screening 335,115 DXA scans. Unexplained HBM affected 0.181% of DXA scans. Next 236 relatives were recruited of whom 94 (41%) had HBM (defined as L1 Z-score + total hip Z-score ≥ +3.2). Fifty-eight spouses were also recruited together with the unaffected relatives as controls. Phenotypes of cases and controls, obtained from clinical assessment, were compared using random-effects linear and logistic regression models, clustered by family, adjusted for confounders, including age and sex. RESULTS: Individuals with unexplained HBM had an excess of sinking when swimming (7.11 [3.65, 13.84], p < 0.001; adjusted odds ratio with 95% confidence interval shown), mandible enlargement (4.16 [2.34, 7.39], p < 0.001), extra bone at tendon/ligament insertions (2.07 [1.13, 3.78], p = 0.018) and broad frame (3.55 [2.12, 5.95], p < 0.001). HBM cases also had a larger shoe size (mean difference 0.4 [0.1, 0.7] UK sizes, p = 0.009) and increased BMI (mean difference 2.2 [1.3, 3.1] kg/m(2), p < 0.001). CONCLUSION: Individuals with unexplained HBM have an excess of clinical characteristics associated with skeletal dysplasia and their relatives are commonly affected, suggesting many may harbour an underlying genetic disorder affecting bone mass.

Exploring theories for the exponential 16-year rise in incidence of necrotising otitis externa in England.

BACKGROUND: Necrotising otitis externa is a severe, life-threatening infection. Epidemiological data demonstrate a dramatic rise in reported cases in England from 2002 to 2017. The reasons for this remain elusive. METHODS: A quantitative descriptive study was undertaken using epidemiological data from the Hospital Episode Statistics database. Cases from 2002 to 2017 were compiled and analysed. Four potential theories were explored to explain the rise in incidence. RESULTS: Within the 16-year period, 7327 necrotising otitis externa cases were reported. Annual necrotising otitis externa incidence increased 1142 per cent within the 16-year period, from 123 recorded cases in 2002 to 1405 cases in 2017. This correlates with an increasing prevalence of diabetes, an ageing population and likely increased physician awareness of necrotising otitis externa. There is insufficient evidence to support antibiotic resistance as a significant associated factor. CONCLUSION: Correlation does not imply causation. It is likely that a combination of factors is contributing to the rise in necrotising otitis externa incidence, including increased physician recognition, diagnosis and accurate clinical coding.

A comparison of the antimicrobial efficacy of two silver-containing wound dressings on burn wound isolates.

OBJECTIVE: To evaluate and compare the efficacy of a silver alginate (SA) dressing and a silver carboxymethyl cellulose (SCMC) dressing on burn isolates grown within the quasi/non-biofilm state and the biofilm phenotypic states. METHOD: Antimicrobial activity was tested using 46 burn wound isolates with a corrected zone of inhibition (CZOI) assay on agar (quasi/non-biofilm) and poloxamer (biofilm). RESULTS: All Gram-negative and positive isolates evaluated were found to be sensitive to both silver containing wound dressings, although superior antimicrobial activity was observed for a select number of specific bacteria when grown in the quasi/non-biofilm phenotypic state, for the SCMC dressing. However, the majority of isolates demonstrated reduced sensitivity to silver when grown as a biofilm, compared with growth in the quasi/non-biofilm phenotypic state. Both dressings demonstrated equivalent antimicrobial activity on Gram-negative isolates grown in the biofilm phenotypic state. For the Gram-positive isolates growing in the biofilm phenotypic state, there appeared to be greater sensitivity to the SA dressing compared with the SCMC dressing, although this result was not statistically significant. CONCLUSION: This study demonstrated the antimicrobial effectiveness of an SA and SCMC dressing in inhibiting the growth of burn isolates residing in both the quasi/non-biofilm and biofilm phenotypic states. It also suggests the SA dressing could be more effective on Gram-positive isolates grown in the biofilm phenotypic state, compared with SCMC dressing.

In vitro antimicrobial efficacy of a silver alginate dressing on burn wound isolates.

OBJECTIVE: To test the antimicrobial effectiveness of a silver alginate dressing on opportunistic pathogens, namely meticillin-sensitive Staphylococcus aureus (MSSA) and meticillin-resistant Staphylococcus aureus (MRSA), Klebsiella spp., Enterococcus faecalis, Enterococcus faecium, Pseudomonas aeruginosa, Escherichia coli, Enterobacter sakazakii, Enterobacter cloacae, Serratia marcescens, Chryseobacterium indologenes, Proteus vulgaris and Acinetobacter baumannii. METHOD: In total, 40 microorganisms were isolated from patients attending three burn centres in the US and evaluated for their susceptibility to a silver alginate wound dressing, employing a corrected zone of inhibition assay, conducted on Mueller Hinton agar (MHA). RESULTS: The sizes of the corrected zones of inhibition varied between and within genera. For example, all Acinetobacter baumannii strains were found to be sensitive to ionic silver at pH 7, with a mean of 2.8mm, compared with 3.5mm at pH 5.5. The silver alginate dressing also demonstrated activity on all strains of Enterobacter and Escherichia coli, with susceptibility to the silver alginate dressing enhanced at pH 5.5. For Enterococcus spp. the average corrected zone of inhibition at pH 7 was 3.6mm, versus 4.9mm at pH 5.5. All strains of Pseudomonas aeruginosa were found to be sensitive to the silver alginate dressing. The average corrected zone of inhibition was 6.9mm at pH 7, compared with 8mm at pH 5.5. For MRSA and Staphylococcus aureus, it ranged from 4.5mm to 7.5mm at pH 7. When the pH was decreased to 5.5, the corrected zone of inhibition increased. CONCLUSION: This study demonstrates the activity of a silver alginate dressing on a wide range of burn isolates, including antibiotic-resistant bacteria, isolated from three different burn centres in the US. It also highlights the possible importance of pH and its potential effects on antimicrobial performance and microbial susceptibility. However, more extensive testing is required to substantiate this. CONFLICT OF INTEREST: SLP is employed by Advanced Medical Solutions Ltd.

Atypical attentional filtering of visual information in youth with chromosome 22q11.2 deletion syndrome as indexed by event-related potentials.

BACKGROUND: Youth with chromosome 22q11.2 deletion syndrome (22q) face one of the highest genetic risk factors for the development of schizophrenia. Previous research suggests impairments in attentional control and potential interactions with elevated anxiety and reduced adaptive functioning may increase the risk for developing psychosis in this population. Here, we examined how variations in attentional control relate to the presence or severity of psychosis-proneness symptoms in these individuals. METHODS: To achieve this, we measured attentional control in youth (12-18 years) with 22q (N = 35) compared to a typically developing group (N = 45), using a flanker task (the Distractor Target task) while measuring neural activity with event-related potentials. RESULTS: Similar to previous findings observed in people with schizophrenia, greater attentional capture by, and reduced suppression of, non-target flanker stimuli characterized participants with 22q and was indexed by the N2pc (N2-posterior-contralateral) and PD (distractor positivity) components. Although we observed no relationships between these components and measures of psychosis-proneness in youth with 22q, these individuals endorsed a relatively low incidence of positive symptoms overall. CONCLUSIONS: Our results provide neural evidence of an attentional control impairment in youth with 22q that suggests these individuals experience sustained attentional focus on irrelevant information and reduced suppression of distracting stimuli in their environment. Impairments in attentional control might be a valid biomarker of the potential to develop attenuated positive symptoms or frank psychosis in high-risk individuals long before the age at which such symptoms typically arise. The evaluation of such a hypothesis, and the preventive potential for the putative biomarker, should be the focus of future studies.

Modulatory effects of ayahuasca on personality structure in a traditional framework.

Ayahuasca is a psychoactive plant brew containing dimethyltryptamine (DMT) and monoamine oxidase inhibitors (MAOIs). It originates from the Amazon basin, where it is used primarily for ceremonial purposes. Ayahuasca tourists are now entering certain communities seeking alternative physical or psychological healing, as well as spiritual growth. RATIONALE: Recent evidence has shown that the similar acting psychedelic compound, psilocybin, facilitated long-term increases in trait openness following a single administration. OBJECTIVES: This paper assesses the impact of ayahuasca on personality in a traditional framework catering for ayahuasca tourists. METHOD: Within a mixed design, we examined the effect of ayahuasca on participants' personality (measured by the NEO Personality Inventory 3 questionnaire) across time (pre- to post-ayahuasca administration, and 6-month follow-up), relative to a comparison group (who did not ingest ayahuasca). RESULTS: The results demonstrated significant increases in agreeableness pre- and post-ayahuasca administration and significant reductions in neuroticism in 24 participants, relative to the comparison group. Both of these changes were sustained at 6-month follow-up, and trait level increases were also observed in openness at this stage. Additionally, greater perceived mystical experience (measured using the Mystical Experience Questionnaire 30) was associated with increased reductions in neuroticism. CONCLUSIONS: These findings, which indicate a positive mediating effect of ayahuasca on personality, support the growing literature suggesting potential therapeutic avenues for serotonergic psychedelics.

Evaluation of work-related psychosocial factors and regional musculoskeletal pain: results from a EULAR Task Force.

OBJECTIVES: To establish whether review articles provide consistent conclusions on associations between workplace psychosocial factors and musculoskeletal pain and, if differences exist, to explore whether this is related to the methods used. METHODS: Reviews, reported up to February 2007, that included consideration of workplace psychosocial factors and upper limb, back or knee pain were identified through searches of multiple databases. The specific work-related psychosocial factors considered were job demands, support, job autonomy and job satisfaction. The conclusions of each review on one or more of the psychosocial/musculoskeletal pain associations were extracted. RESULTS: 15 review articles were identified that considered one or more of the regional pain syndromes included in the study. For back pain, the most consistent conclusions (four reviews positive out of six) were with high job demands and low job satisfaction. The studies of upper limb pain were exclusively related to shoulder and/or neck pain, and the most consistent positive conclusions were with high and low job demands (four reviews positive out of six and two reviews positive out of three, respectively). For knee pain, only a single review was identified. For individual reviews of back and upper limb pain, there were marked differences in the number of associations concluded to be positive between reviews. CONCLUSIONS: The reasons for reviews coming to different conclusions included that they were often evaluating different bodies of evidence (according to their search criteria, the year when the review was conducted, the role that quality assessment played in whether studies contributed to evidence, and the combination of risk factors addressed in individual studies), but more important was whether the review specified explicit criteria for making conclusions on strength of evidence. These conclusions emphasise the importance of developing standardised methods for conducting such evaluations of existing evidence and the importance of new longitudinal studies for clarifying the temporal relationship between psychosocial factors and musculoskeletal pain in the workplace.

A longitudinal view of rumination, poor sleep and psychological distress in adolescents.

BACKGROUND: Given the high prevalence and negative impact of psychological problems during adolescence, examining transdiagnostic factors that may have scope to positively influence a variety of psychological problems is imperative. The main purpose of this study was to investigate the longitudinal relationship between rumination and psychological distress and whether sleep mediated this relationship over a 2 year period. METHODS: Participants were 1620 high school students in the 7th and 8th grade at baseline from 17 public schools in three middle Sweden communities. Students completed questionnaires at school during the spring of 2014, 2015 and 2016. Rumination and psychological distress were self-reported, and sleep duration was calculated from reported bed-times, wake-times and sleep onset latencies. RESULTS: Sleep duration declined with age, whereas rumination and psychological distress increased. Rumination was predictive of future psychological distress and distress at a given time was predictive of concurrent rumination. Sleep duration did not consistently mediate the reciprocal relationships between rumination and psychological distress over time. LIMITATIONS: Stronger longitudinal associations may have been obtained by using smaller measurement intervals or further delineation of outcome constructs. CONCLUSIONS: Reducing rumination, rather than targeting sleep patterns, may work towards preventing the development of a number of psychological problems and is a strategy anticipated to function across disorders to improve young people's mental wellbeing.

Avoiding or enduring painful sex? A prospective study of coping and psychosexual function in vulvovaginal pain.

BACKGROUND: Recurring vulvovaginal pain is common, with evident effects on affected women's lives. Little is known about how affected women cope with painful sexual activities and how coping relates to pain intensity and psychosexual functioning over time. This prospective study explored the impact of avoidance and endurance on sexual function over time. Additionally, patterns of coping were studied on an individual level to increase knowledge about coping and its relation to psychosexual functioning. METHODS: One hundred and seventeen women, 18-35 years old, with recurring vulvovaginal pain answered questionnaires at two measurement points, five months apart, assessing avoidance and endurance coping, pain intensity and psychosexual functioning. A multiple regression model explored the predictive value of avoidance and endurance on sexual function over time. Cluster analyses investigated patterns of coping and stability within the clusters. These subgroups were compared on psychosexual outcomes. RESULTS: Avoidance at baseline was the only significant predictor of sexual function five months later. Distinct and stable subgroups with different patterns of coping were identified, where avoidance and endurance coping were used both separately and combined. Women who both avoided and endured had the most unfavourable outcomes in terms of psychosexual functioning. CONCLUSIONS: Avoidance of sexual activities was related to reduced sexual function over time, which calls for attention and clinical interventions targeting avoidance. Additionally, women who both avoid and endure sexual activities despite pain possibly need tailored interventions, as women with this coping pattern reported the lowest levels of psychosexual functioning. SIGNIFICANCE: In this prospective study, avoidance of sexual activities predicted sexual function over time, when controlling for pain intensity. Subgroups of women using distinct patterns of coping were identified. Those who both avoided and endured had the lowest levels of psychosexual functioning.

Quality of life and maintenance of improvements after early multimodal rehabilitation: a 5-year follow-up.

PURPOSE: There is a paucity of long-term evaluations on rehabilitation of musculoskeletal disorders, e.g., neck, shoulder or back pain. The aim of this study was to assess quality of life and the effect of early multimodal rehabilitation on 91 patients with musculoskeletal pain and disability at a 5-year follow-up. METHOD: The follow-up assessment, which included questions on pain, function, quality of life, perceived health, sick leave and psychosomatic symptoms, was performed 5 years after the assessment of baseline status. RESULTS: Improvements in pain, perceived health and psychosomatic symptoms were maintained at the 5-year follow-up. In addition, improvements in function, quality of life, and level of acceptable pain were significant in comparison to baseline. At the time of the baseline assessment all patients were on sick leave (13% were on partial sick leave). At the 5-year follow-up, 58% of the patients were at work part or full time. The results show that those working differed significantly from those not working at the 5-year follow-up on almost all variables, indicating that those working enjoy better health. The most salient prognostic factors for return to work were perceived health and educational level at the time of the baseline evaluation. CONCLUSIONS: These results show that treatment improved quality of life and the effects were basically maintained at 5 years. Work capacity as reflected in return to work increased greatly (81%) at a 1-year follow-up and was substantial (58%) at the 5-year follow-up. Moreover, perceived health and educational levels were important prognostic factors. Finally, the fact that patients working reported better health underscores the probable importance of return to work. Our results imply that it may be feasible to obtain long-term benefits from such a primary care-based intervention.

Sleep duration and patterns in adolescents: correlates and the role of daily stressors.

OBJECTIVES: The first aim of this study was to assess the prevalence of sleep deficit in a large sample of adolescents. Second, the study aimed to assess whether short sleep duration in the sample was associated with emotional and behavioral problems. Lastly, the study aimed to investigate the association between daily stressors--bedtime activities and sleep duration. DESIGN: Cross-sectional survey. SETTING: The questionnaires were completed during school hours in 17 municipal junior high schools in Sweden. PARTICIPANTS: A total of 2767 adolescents aged 12 to 16 years, 48% girls. MEASUREMENTS AND RESULTS: Sleep measures included total sleep time (TST) for schooldays and weekends, obtained as combined measures of self-reported bed-time, wake-time, and sleep onset latency. We used the new National Sleep Foundation's guidelines to operationalize sleep duration. Overall 12% of younger adolescents (age 12-13 years) and 18% of older adolescents (14-16 years) slept less than recommended (TST < 7 hours). Adolescents reporting nonrecommended TST also reported more behavioral (ie, norm-breaking behaviors) and emotional problems (ie, depression, anxiety, and anger), with effects in the small-medium range. Finally, adolescents reporting bedtime arousal and use of information and communication technology in bed were more likely to report TST < 7 hours. Stress at home (for younger adolescents) and stress of school performance (for older adolescents) were also associated with TST less than 7 hours. CONCLUSIONS: The new National Sleep Foundation's recommendations were informative in this context. Future sleep interventions need to target barriers to good sleep practices, such as use of information and communication technology, stress, and worry that may contribute to arousal at bedtime.

Treating youth in pain: Comparing tailored behavioural medicine treatment provided by physical therapists in primary care with physical exercises.

OBJECTIVES: To study the efficacy of tailored behavioural medicine treatment within a physical therapy framework. METHODS: The study was a randomized controlled study (RCT): tailored behavioural medicine treatment (EXT) delivered by physical therapists (PTs) was compared with exercise-based treatment (CT). Thirty-two adolescents (mean age 14.3 years) with persistent pain participated. Data on pain-related disability and school attendance (primary outcomes), pain intensity, catastrophizing, fear of movement and self-efficacy were collected. RESULTS: The pain-related disability measured by the Functional Disability Inventory (FDI) resulted in mean score change of EXT = -18 and CT = -11, respectively. A significant change within both groups was found (EXT p = 0.003, CT p = 0.001), and a large effect size for FDI between the conditions was demonstrated (AUC of 0.77). For school attendance post-treatment, no difference was found between conditions. For secondary outcomes, a significant improvement in pain intensity and pain catastrophizing was found for the EXT and self-efficacy for the CT groups but no statistically significant difference between the two conditions was detected. Caution should be given to the small sample size, as it may affect the interpretation and generalizability of the results. CONCLUSION: In this study, differences between tailored behavioural medicine treatment delivered by PTs and exercise-based treatment could not be demonstrated, although the effect size was large. Patients who received either treatment demonstrated significant changes over time in pain-related disability. The low number of participants and suboptimal tailoring of the psychological components may partly explain the failure to demonstrate differences between groups, and future studies are warranted.

Behavioural treatment for chronic low-back pain.

BACKGROUND: Behavioural treatment, commonly used in the treatment of chronic low-back pain (CLBP), is primarily focused at reducing disability through the modification of environmental contingencies and cognitive processes. In general, three behavioural treatment approaches are distinguished: operant, cognitive and respondent. OBJECTIVES: To determine if behavioural therapy is more effective than reference treatments for CLBP, and which type of behavioural treatment is most effective. SEARCH STRATEGY: We searched the CENTRAL, MEDLINE, EMBASE, and PsycLIT databases up to October 2003. References of identified randomised trials and relevant systematic reviews were screened. SELECTION CRITERIA: Only randomised trials on behavioural treatment for non-specific CLBP were included. DATA COLLECTION AND ANALYSIS: Two reviewers independently assessed the methodological quality and extracted the data. The magnitude of effect was assessed by computing a pooled effect size for post-treatment and long-term results for each comparison, for each domain (i.e., behavioural outcomes, overall improvement, back pain specific and generic functional status, return to work, and pain intensity) using the random effects model. MAIN RESULTS: Seven studies (33%) were considered high quality. Comparing behavioural treatment to waiting list control (WLC) revealed strong evidence (4 trials, 134 people) in favour of a combined respondent-cognitive therapy for a medium positive effect on pain, and moderate evidence (2 trials, 39 people) in favour of progressive relaxation for a large positive effect on pain and behavioural outcomes (short-term only). When comparing operant treatment to WLC no significant differences could be detected on general functional status (strong evidence: 2 trials, 87 people) or on behavioural outcomes (moderate evidence; 3 trials, 153 people) (short-term only). There is limited evidence (1 trial, 98 people) that a graded activity program in an industrial setting is more effective than usual care for early return to work and reduced long-term sick leave. There is limited evidence (1 trail, 39 people) that there are no differences between behavioural treatment and exercises. Finally, there is moderate evidence (6 trials, 210 people) that there are no significant differences in short-term and long-term effectiveness when behavioural components are added to usual treatment programs for CLBP (i.e. physiotherapy, back education) on pain, generic functional status and behavioural outcomes. AUTHORS' CONCLUSIONS: Combined respondent-cognitive therapy and progressive relaxation therapy are more effective than WLC on short-term pain relief. However, it is unknown whether these results sustain in the long term. No significant differences could be detected between behavioural treatment and exercise therapy. Whether clinicians should refer patients with CLBP to behavioural treatment programs or to active conservative treatment cannot be concluded from this review.

Complement activation and inhibition in experimental models of arthritis.

Complement activation has been implicated as a pathological process in a number of inflammatory and autoimmune disorders including chronic rheumatoid arthritis (RA). Animal models of experimental arthritis have been widely used to investigate the pathogenesis of RA and also in the development of novel therapies. Many of these models are complement-dependent and both incidence and progression of disease can be influenced by complement inhibition. In certain situations, local inhibition is of greater therapeutic benefit than systemic decomplementation. An increasing awareness and availability of a wide range of naturally occurring complement regulatory proteins can now offer a more targeted approach to complement inhibition while the availability of novel engineering strategies has also improved the efficiency of this process. The success of complement inhibition in the experimental models described should offer a novel therapeutic approach to the treatment of human inflammatory arthritis.

Too tired for school? The effects of insomnia on absenteeism in adolescence.

OBJECTIVES: Sleep has important consequences for a person's daytime functioning. Numerous studies have shown that insomnia predicts work absenteeism and work disability in adults, but only a few studies have examined this association in adolescents. This study aims to explore whether symptoms of insomnia in adolescents predict school absenteeism 1 year later, over and above known psychological risk factors for absenteeism. DESIGN: The study used a longitudinal design with 2 measurement points over 1 year. SETTING: The students completed questionnaires during school hours at baseline and again at follow-up. PARTICIPANTS: Students in the 10th to 12th grades in a Swedish upper secondary school were followed prospectively for 1 year (age, 16-20 years; N = 353; 48.1% girls). MEASUREMENTS AND RESULTS: We used logistic regression analyses, controlling for the known effects of psychological factors, and arrived at a model elucidating the role of insomnia. That is, besides symptoms of insomnia, the model included previous absenteeism, alcohol intoxication, school-related social phobia, social anxiety, depressive symptoms, somatic symptoms, and bully victimization. Symptoms of insomnia predicted school absenteeism 1 year later, over and above known risk factors for absenteeism. Adolescents reporting severe symptoms of insomnia were almost 3 times more likely than adolescents reporting no or low symptoms to report problematic absenteeism 1 year later. We did not find any gender difference. CONCLUSIONS: Our findings underscore the importance of sleep problems on adolescents' daytime functioning as measured by school absenteeism. Therefore, sleep may be an important target for preventive interventions with adolescents.

A population-based study of the relationship between sexual abuse and back pain: establishing a link.

The aim of the present study was to investigate the prevalence of physical and sexual abuse in the general population as well as to investigate the link between abuse and pain. From a pool of randomly selected people 35-45-years-old, three groups were selected based on their reports of their musculoskeletal pain. These were the No Pain Group (n = 449), the Mild Pain Group (n = 229), and the Pronounced Pain Group (n = 271). A group of 142 consecutive patients with chronic musculoskeletal pain was used as a clinical reference group. A standardized questionnaire was employed to determine self-reported physical and sexual abuse. Sexual abuse was more frequently reported than physical abuse and women tended to report more sexual abuse than did men. For women the prevalence of physical abuse ranged from 2% in the No Pain Group to 8% in the Pronounced Pain Group. The total amount of self-reported sexual abuse ranged from 23% in the No Pain Group to 46% in the Pronounced Pain Group. The prevalence of self-reported abuse for the Patient Group differed little from the Pronounced Pain Group and was 35%. For females only, there was a clear link between self-reported abuse and pain as physical abuse increased the risk of pronounced pain by five-fold and sexual abuse increased this risk by four-fold. These data provide the prevalence of self-reported abuse in a 'normal' population base and moreover demonstrate an important link between self-reported abuse and pain for women. The findings show that self-reported abuse may be an important predictor for chronic pain and provide support for the idea that abuse may indirectly or directly be implicated in the chronification of pain.