Comparisons of lumbosacral kinematics among non-specific chronic low back pain subgroups and healthy during prolonged sitting: A cross-sectional observational study.

BACKGROUND: The literature has suggested a variety of postural changes of the spine that possibly contribute to the increase in back pain during sitting in persons with non-specific chronic low back pain (NS-CLBP). However, the heterogeneity of NS-CLBP persons has made the ability to attribute pain increase to a particular sitting posture very difficult. Therefore, the purpose of this study was to compare lumbosacral kinematics and their roles in pain increase among homogenous NS-CLBP subgroups and healthy controls over a 1-h sitting period. METHODS: Twenty NS-CLBP subjects with motor control impairment [10 classified as having flexion pattern (FP) disorder, and 10 with active extension pattern (AEP) disorder], and 10 healthy controls participated in the study. Subjects underwent a 1-h sitting protocol on a standard office chair. Lumbosacral postures including sacral tilt, third lumbar vertebrae (L3) position, and relative lower lumbar angle were recorded using two-dimensional inclinometers over the 1-h period. Perceived back-pain intensity was measured using a visual analog scale every 10 min throughout the sitting period. RESULTS: All study groups (FP, AEP and healthy controls) significantly differed from each other in the measured lumbosacral kinematics at the beginning as well as at the end of the sitting period (p ≤ 0.05). Only the NS-CLBP subgroups showed significant changes in the lumbosacral kinematics across the 1-h sitting period (p < 0.01), and that the directions of change occurred toward end spinal postures (lumbar kyphosis for FP subgroup and lumbar lordosis for the AEP subgroup). In addition, both NS-CLBP subgroups reported a similarly significant increase in pain through mid-sitting (p < 0.001). However, after mid-sitting, the AEP subgroup reported much less increase in pain level that was accompanied by a significant decrease in the lumbar lordotic postures (p = 0.001) compared to FP subgroup. CONCLUSION: The present study's findings suggest that each NS-CLBP subgroup presented with differently inherent sitting postures. These inherently dysfunctional postures coupled with the directional changes in the lumbosacral kinematics toward the extreme ranges across the 1-h sitting period, might explain the significant increase in pain among subgroups.

Detailing the organic matter in suspended sediments as a tool to assess the impact of land occupation in water bodies: a case of Barigui Watershed (Southern Brazil).

Suspended sediments were collected to examine the organic carbon content and n-alkanes in order to assess the impact on water bodies caused by soil and land occupation. For this, samples from distinct areas based on the level of land occupation of the Barigui Watershed and different areas under the influence of human activities were examined. The number of industries increasing along the river was also considered. Twenty-two sediment samples were collected using a time-integrated sediment sampler. Samples were extracted with dichloromethane:methanol (DCM:methanol) (2:1) in an ultrasound bath, treated and injected using gas chromatography coupled with mass spectrometry (GC-MS) for separation and quantification. Twenty-one n-alkanes were identified and were used to track both biogenic and anthropogenic inputs. The concentration of total n-alkanes varied from 38.72 to 222.76 µg g-1, due to the impact of urbanization. Diagnostic indexes indicated high numbers of plants, bacteria and petroleum as n-alkanes sources. The following results were obtained using: carbon preference index (CPI), 1.96-2.22 (rainy season) and 2.12-5.80 (summer season); average chain length (ACL), 30.37-31.17 (rainy season) and 30.05-30.50 (summer season) and terrigenous aquatic ratio (TAR), 0.39-5.47 (rainy season) and 2.98-5.06 (summer season); n-alkanes had two main sources: terrestrial plant and petroleum. It is clear that the source of n-alkanes is different in each season (rainy and dry) demonstrated by n-alkanes occurrence. During the rainy season, there was an increase in organic matter of oil origin which was mainly associated with the increased runoff and rain drainage. Finally, the input of organic matter associated with land occupation and erosion can be distinguished by higher concentration in the most urbanized site (PB).

Validation of Five Facets Mindfulness Questionnaire - Short form, in Spanish, general health care services patients sample: Prediction of depression through mindfulness scale.

The validation of Five Facets Mindfulness Questionnaire (FFMQ)-short version was performed in a general population of a city in a region of Galicia (Spain), the sample was composed of randomly selected Spanish Health Care patients (N = 845). The results on the goodness of fit of the non-hierarchical, five-dimensional factorial model met the criteria for good and acceptable model adjustment (after eliminating item 18 and despite the correlations detected among the errors included in the model), explaining a 55.5%.of the variance. As the second objective has been analysed the association between the scores obtained in the different facets of the FFMQ-SF and the risk of suffering an episode of depression. (The Odd Ratio, the Hosmer-Lemeshow test and the ROC curve were calculated.) Participants who were currently suffering from an episode of depression were more likely to have low scores in "describing" facet of Mindfulness (adjusted OR = 1.58, 95% CI = 1.04-2.40, linear trend: χ2 = 3.74, df = 1, p = 0.053) as well as low scores on "acting with awareness" (adjusted OR = 2.19, 95% CI = 1.461-3.30, linear trend: χ2 = 9.52, df = 1; = 0.002) and "non judging" (adjusted OR = 2.05, 95% CI = 1.36-3.09, linear trend: χ2 = 143.21, df = 1; p <0.001). Participants with a previous episode of depression were more likely to have low scores on the subscale "acting with awareness" (adjusted OR = 2.37, 95% CI = 1.43-3.93, linear trend: χ2 = 9.62, df = 1, p = 0.002) and "non-reactivity" (adjusted OR = 2.14, 95% CI = 1.28-3.56, linear trend: χ2 = 8.30; df = 1; p = 0.004. Questionnaire FFMQ-SF is an adequate questionnaire for the evaluation of mindfulness in non-clinical multi- occupational population.

Relation of the Psychological Constructs of Resilience, Mindfulness, and Self-Compassion on the Perception of Physical and Mental Health.

PURPOSE: Health factors that enhance an individual's ability to perceive and maintain health and well-being are referred to as "health assets". Of these assets, resilience, mindfulness and self-compassion are considered to be of special importance. The objective of this study was to analyze the association between these psychological constructs on the perception of physical and mental health in a general population. PATIENTS AND METHODS: A descriptive and analytical cross-sectional study was conducted with 845 participating subjects. The outcome variable was the individual´s perception of physical and mental health, measured using the SF-36 questionnaire. The independent variables were: sociodemographic variables, medical information, physical activity performance (using the International Physical Activity Questionnaire), tobacco and alcohol consumption, anxiety and/or depression (using the Goldberg Anxiety and Depression Scale), resilience (using the Connor-Davidson Resilience Scale), mindfulness (with the Five Facets of Mindfulness Questionnaire Short Form) and self-compassion (using the Self-compassion scale-short form). A correlation analysis, simple linear regression and multiple linear regression were carried out, controlling for the influence of the distinct independent variables. RESULTS: The constructs of resilience, mindfulness and self-compassion are significant, in the perception of both physical and mental health. Other factors appearing in the multiple regression are gender, age, educational level, physical activity and tobacco consumption, in a positive or negative sense. CONCLUSION: The study of these associations is fundamental for the understanding of underlying regulation processes of healthy lifestyles in the general population.

Health-care users, key community informants and primary health care workers' views on health, health promotion, health assets and deficits: qualitative study in seven Spanish regions.

BACKGROUND: Although some articles have analysed the definitions of health and health promotion from the perspective of health-care users and health care professionals, no published studies include the simultaneous participation of health-care users, primary health care professionals and key community informants. Understanding the perception of health and health promotion amongst these different stakeholders is crucial for the design and implementation of successful, equitable and sustainable measures that improve the health and wellbeing of populations. Furthermore, the identification of different health assets and deficits by the different informants will generate new evidence to promote healthy behaviours, improve community health and wellbeing and reduce preventable inequalities. The objective of this study is to explore the concept of health and health promotion and to compare health assets and deficits as identified by health-care users, key community informants and primary health care workers with the ultimate purpose to collect the necessary data for the design and implementation of a successful health promotion intervention. METHODS: A descriptive-interpretive qualitative research was conducted with 276 participants from 14 primary care centres of 7 Spanish regions. Theoretical sampling was used for selection. We organized 11 discussion groups and 2 triangular groups with health-care users; 30 semi-structured interviews with key community informants; and 14 discussion groups with primary health care workers. A thematic content analysis was carried out. RESULTS: Health-care users and key community informants agree that health is a complex, broad, multifactorial concept that encompasses several interrelated dimensions (physical, psychological-emotional, social, occupational, intellectual, spiritual and environmental). The three participants' profiles consider health promotion indispensable despite defining it as complex and vague. In fact, most health-care users admit to having implemented some change to promote their health. The most powerful motivators to change lifestyles are having a disease, fear of becoming ill and taking care of oneself to maintain health. Health-care users believe that the main difficulties are associated with the physical, social, working and family environment, as well as lack of determination and motivation. They also highlight the need for more information. In relation to the assets and deficits of the neighbourhood, each group identifies those closer to their role. CONCLUSIONS: Generally, participants showed a holistic and positive concept of health and a more traditional, individual approach to health promotion. We consider therefore crucial to depart from the model of health services that focuses on the individual and the disease toward a socio-ecological health model that substantially increases the participation of health-care users and emphasizes health promotion, wellbeing and community participation.

Embolia aérea cerebral secundaria a colangiopancreatografía endoscópica retrógrada / Cerebral artery air embolism secondary to endoscopic retrograde cholangiopancreatography

El ictus cerebral secundario a embolias aéreas es una rara complicación de una endoscopia digestiva. Se presenta un caso de un paciente que desarrolló una embolia arterial cerebral durante la realización de una colangiopancreatografía retrógrada endoscópica. A pesar de su diagnóstico y tratamiento, el paciente falleció como consecuencia del grave daño cerebral isquémico. Las embolias aéreas cerebrales han representado, hasta ahora, una causa de ictus cerebral prácticamente anecdótica. Cada vez son más frecuentes y variadas las complicaciones secundarias a la realización de técnicas endoscópicas debido al gran aumento que este tipo de procedimientos ha experimentado en los hospitales españoles.El mejor conocimiento de esta rara complicación permite alcanzar un rápido diagnóstico, clave a la hora de aplicar su tratamiento específico y salvar la vida al paciente(AU)

Stroke secondary to an air embolism is an uncommon complication of gastrointestinal endoscopy. We report the case of a patient who developed a cerebral artery air embolism during endoscopic retrograde cholangiopancreatography. Despite diagnosis and treatment, the patient died from severe ischemic brain damage. To date, cerebral artery air embolisms as a cause of stroke have only been reported anecdotally. The complications of endoscopic techniques are increasingly frequent and varied, due to the major increase in the use of these procedures in our hospitals.Greater knowledge of this infrequent complication would allow rapid diagnosis, which is essential to provide specific treatment and prevent fatal outcome(AU)

El principio de proporcionalidad terapéutica y el rechazo a los tratamientos médicos / The principle of the therapeutic proportionality and the rejection to the medical treatments

La relación entre el médico y el paciente ha evolucionado desde una vinculación de carácter paternalista, eminentemente ética, personalizada y fundada en los principios de beneficencia y no maleficencia, hasta una vinculación paritaria dotada de derechos y deberes recíprocos, pertenecientes al catálogo de las prerrogativas de tercera generación, exigibles y vinculantes, referidos a prestaciones y contraprestaciones subjetivamente valoradas, basadas en el principio de autonomía. Este replanteamiento ha implicado la reformulación de la relación médico-paciente, llevando a que se le apliquen reglas contractuales en aspectos tan importantes como el consentimiento, el papel que a las partes compete - prestador de servicios y usuario- y la evaluación de la satisfacción del paciente frente al servicio prestado. En dicho contexto, el derecho ha propuesto diversos criterios que relevando al médico de sus responsabilidades éticas, penales y civiles, permitan al paciente rechazar tratamientos médicos y que, a la vez, resulten objetivos y claros. Primero y al efecto se intentó la distinción entre tratamientos ordinarios y extraordinarios, pero ese criterio se ha ido desechando por depender fundamentalmente de los recursos disponibles y de las usanzas en materia médica más que del propio paciente, por lo cual, en la actualidad se prefiere distinguir entre tratamientos proporcionados y desproporcionados, porque este criterio considera la situación particular del paciente y respeta su decisión siempre que no vulnere los principios de no maleficencia y justicia. Si bien se critica del principio de proporcionalidad propuesto su fuerte subjetividad, el difuso límite que lo separa de la eutanasia pasiva y el predominio de la autonomía del sujeto, su mayor ventaja consiste en entregar la decisión de aceptar o no un tratamiento médico a la razón ejercida para el bien del individuo