Factors in Patient Responsiveness to Directional Preference-Matched Treatment of Neck Pain With or Without Upper Extremity Radiation.

PURPOSE: Patient-related predictive factors in responsiveness to directional preference therapy for neck pain with or without upper extremity radiation (NP/R) have not been reported. A directional preference is any neck movement that, when performed repeatedly to end range, results in centralization and/or alleviation of NP/R. It was hypothesized that patient compliance with a prescribed, directional preference-matched home exercise program would improve positive responsiveness to NP/R treatment. METHODS: Patient-related factors thought to affect responsiveness to care were collected retrospectively from charts and de-identified for patients with NP/R who underwent chiropractic treatment at a multispecialty spine clinic from January 2014 through June 2015. Responsiveness was measured by calculating the percentage change in Neck Bournemouth Questionnaire (NBQ) scores over treatment time. Multiple linear regression was used to identify factors associated with positive responsiveness. RESULTS: Mean percentage change in patient NBQ score from initial intake to discharge was 50% (standard deviation: 32%). Of 104 patients meeting study inclusion criteria, 86 (83%) reported experiencing improvement after the first treatment session. Bivariate analysis of patient characteristics by compliance with directional preference-matched exercise indicated that compliant patients (n=95, 91%) demonstrated significantly greater responsiveness to care than did noncompliant patients, at 55% versus 25% change in NBQ score, respectively (P=0.0041). Four factors were statistically significant predictors of patient responsiveness to directional preference therapy for NP/R: patient compliance with directional preference-matched exercise (P=0.0023), patient age (P=0.0029), condition chronicity (P<0.0001), and whether the patient reported improvement of symptoms following initial treatment session (P=0.0003). CONCLUSIONS: The results of this study suggest that patient compliance with directional preference exercise is associated with patient responsiveness to conservative treatment of NP/R, as are age, chronicity and report of immediate symptom improvement.

Burns in Sierra Leone: a population-based assessment.

PURPOSE: Burns remain disproportionately prevalent in developing countries. This study aims to describe the epidemiology of burns in Sierra Leone to serve as a baseline for future programs. METHODS: A cluster randomized, cross-sectional, countrywide survey was conducted in 2012 in Sierra Leone. With a standardized questionnaire demographics and deaths during the previous 12 months of household members were assessed with the household representative. Thereafter, 2 randomly selected household members were interviewed, elucidating whether participants had ever had a burn in six body regions and determining burn mechanisms and patterns of health care seeking behavior. RESULTS: This study included 1843 households and 3645 individuals. 3.98% (145/3645) of individuals reported at least one burn-injury. The highest proportions of burns were reported in the age groups 0-4 years old (23/426, 5.4%) and 5-14 years old (37/887, 4.17%). The majority of burns (129/145, 89.0%) were caused by a hot liquid/object and the upper, extremities were the most commonly burned body regions, with 36% (53/145) of cases. 21% (30/145) of individuals with burns sought care from a traditional healer. CONCLUSIONS: Burns are highly prevalent in Sierra Leone. Further research and resources should be allocated to the care and prevention of thermal injuries.

Intestinal alkaline phosphatase administration in newborns is protective of gut barrier function in a neonatal necrotizing enterocolitis rat model.

BACKGROUND: Previously, we have shown that supplementation of intestinal alkaline phosphatase (IAP) decreased severity of necrotizing enterocolitis (NEC)-associated intestinal injury. We hypothesized that IAP administration is protective of intestinal epithelial barrier function in a dose-dependent manner. METHODS: Control rat pups were vaginally delivered and breast-fed. Premature rats were divided into 4 groups: formula fed with lipopolysaccharide and hypoxia (NEC) or additional daily bovine IAP 40, 4, or 0.4 U/kg (NEC + IAP 40 U, IAP 4 U, or IAP 0.4 U). RESULTS: Necrotizing enterocolitis is associated with decreased IAP protein expression and activity. Supplemental IAP increases IAP activity in intestinal homogenates and decreased NEC injury score in a dose-dependent manner. Intestinal injury as measured by fluorescein isothiocyanate-dextran flux from ileal loops showed increased permeability vs control, but supplemental IAP reversed this. Tight junction proteins claudin-1, claudin-3, occludin, and zonula occludin 1 were elevated in the NEC and IAP-treated groups with differences in expression patterns. No differences in messenger RNA levels were observed on postinjury day 3. Intestinal alkaline phosphatase administration decreases intestinal NEC injury in a dose-dependent manner. CONCLUSION: Early enteral supplemental IAP may reduce NEC-related injury and may be useful for preserving the intestinal epithelial barrier function.