Massage for low-back pain.

BACKGROUND: Low-back pain (LBP) is one of the most common and costly musculoskeletal problems in modern society. It is experienced by 70% to 80% of adults at some time in their lives. Massage therapy has the potential to minimize pain and speed return to normal function. OBJECTIVES: To assess the effects of massage therapy for people with non-specific LBP. SEARCH METHODS: We searched PubMed to August 2014, and the following databases to July 2014: MEDLINE, EMBASE, CENTRAL, CINAHL, LILACS, Index to Chiropractic Literature, and Proquest Dissertation Abstracts. We also checked reference lists. There were no language restrictions used. SELECTION CRITERIA: We included only randomized controlled trials of adults with non-specific LBP classified as acute, sub-acute or chronic. Massage was defined as soft-tissue manipulation using the hands or a mechanical device. We grouped the comparison groups into two types: inactive controls (sham therapy, waiting list, or no treatment), and active controls (manipulation, mobilization, TENS, acupuncture, traction, relaxation, physical therapy, exercises or self-care education). DATA COLLECTION AND ANALYSIS: We used standard Cochrane methodological procedures and followed CBN guidelines. Two independent authors performed article selection, data extraction and critical appraisal. MAIN RESULTS: In total we included 25 trials (3096 participants) in this review update. The majority was funded by not-for-profit organizations. One trial included participants with acute LBP, and the remaining trials included people with sub-acute or chronic LBP (CLBP). In three trials massage was done with a mechanical device, and the remaining trials used only the hands. The most common type of bias in these studies was performance and measurement bias because it is difficult to blind participants, massage therapists and the measuring outcomes. We judged the quality of the evidence to be "low" to "very low", and the main reasons for downgrading the evidence were risk of bias and imprecision. There was no suggestion of publication bias. For acute LBP, massage was found to be better than inactive controls for pain ((SMD -1.24, 95% CI -1.85 to -0.64; participants = 51; studies = 1)) in the short-term, but not for function ((SMD -0.50, 95% CI -1.06 to 0.06; participants = 51; studies = 1)). For sub-acute and chronic LBP, massage was better than inactive controls for pain ((SMD -0.75, 95% CI -0.90 to -0.60; participants = 761; studies = 7)) and function (SMD -0.72, 95% CI -1.05 to -0.39; 725 participants; 6 studies; ) in the short-term, but not in the long-term; however, when compared to active controls, massage was better for pain, both in the short ((SMD -0.37, 95% CI -0.62 to -0.13; participants = 964; studies = 12)) and long-term follow-up ((SMD -0.40, 95% CI -0.80 to -0.01; participants = 757; studies = 5)), but no differences were found for function (both in the short and long-term). There were no reports of serious adverse events in any of these trials. Increased pain intensity was the most common adverse event reported in 1.5% to 25% of the participants. AUTHORS' CONCLUSIONS: We have very little confidence that massage is an effective treatment for LBP. Acute, sub-acute and chronic LBP had improvements in pain outcomes with massage only in the short-term follow-up. Functional improvement was observed in participants with sub-acute and chronic LBP when compared with inactive controls, but only for the short-term follow-up. There were only minor adverse effects with massage.

Facilitators and hinderers for designing augmented reality for ecotourism SME's experiences: A service Design approach.

Designing Augmented Reality (AR) throughout service experiences remains under studied in several industries, despite the fact of growing consumer interest and use through different platforms and applications globally. Consequently, there is growing interest in understanding the what, the why and the how for designing AR applications in practice to boost ecotourism experiences, with the purpose of enhancing customer value creation and organizations differentiation. Consequently, the authors conducted an eleven-month practical theoretical study in 10 ecotourism SMEs purposefully recruited in Latin America, adopting service design as a main research framework. Using interviews, contextual analyses, buyer personas, observation, storytelling creation sessions, prototyping sessions and accompaniment sessions as research methods, researchers studied, (1) what were the key facilitators and hinderers for designing AR in practice at the SMEs ecotourism context following a service design lens and, (2) how the inherent principles of service design influence ecotourism SME's for the strategically adoption of AR in their service experiences. The study suggests key elements that can facilitate or hinder designing AR at ecotourism SME's Experiences in practice. Furthermore, the authors suggest a practical protocol for designing AR for ecotourism SMEs from the lens of service design (SD), User Experience (UX), and Augmented Reality (AR). Finally, the study also contributes to shade light on the marketing role and potential adoption of Augmented Reality (AR) in practice in SME's through a service design lens.

Electropneumatic system for the simulation of the pulmonary viscoelastic effect in a mechanical ventilation scenario.

The viscoelastic properties of the lung have important implications during respiratory mechanics in terms of lung movement or work of breathing, for example. However, this property has not been well characterized due to several reasons, such as the complex nature of the lung, difficulty accessing its tissues, and the lack of physical simulators that represent viscoelastic effects. This research proposes an electropneumatic system and a method to simulate the viscoelastic effect from temporary forces generated by the opposition of magnetic poles. The study was tested in a mechanical ventilation scenario with inspiratory pause, using a Hamilton-S1 mechanical ventilator (Hamilton Medical) and a simulator of the human respiratory system (SAMI-SII). The implemented system was able to simulate the stress relaxation response of a Standard Linear Solid model in the Maxwell form and showed the capacity to control elastic and viscous parameters independently. To the best of our knowledge, this is the first system incorporated into a physical lung simulator that represents the viscoelastic effect in a mechanical ventilation scenario.

Land-use and land-cover assessment for the study of lifestyle change in a rural Mexican community: the Maycoba project.

BACKGROUND: In 1995, a study was conducted to identify the effects of traditional and westernized environments on the prevalence of type 2 diabetes in Pima Indians (Pimas) in Mexico and the United States. The study concluded that the more traditional lifestyle in Mexico had a protective effect against this metabolic disorder. In the ensuing 15 years, the environmental circumstances of the Mexican Pimas changed, and a follow-up study was conducted to determine the role environmental change plays in the development of diabetes in this genetically susceptible population. A major element of environmental transition relates to land-use and land-cover (LULC) changes that could affect physical activity and promote an obesogenic environment. This study examined changes in the region's LULC to determine whether there have been transitions in agricultural land use and urbanization that would be consistent with a more sedentary lifestyle. Changes were assessed from 1994 aerial photographs and 2007 satellite images. RESULTS: The land-cover analysis showed that mixed vegetation and dense trees cover most of the study area. It suggested a rural environment that includes a low percentage of impermeable areas, and it indicated that the area experiencing human intervention covers 7% of the total area. The land-use-change findings showed a decrease or no change in agricultural or ranching areas and a decrease in farmland due to reforestation or revegetation. Three variables from the land-use-change analysis were examined as proxies for lifestyle change: urban development, dwelling-unit density, and variation in the road network. Two of the measures -the amount of urbanization and the number and density of dwelling units-showed increases, most notably in the town of Maycoba. There were only minor changes in the road network: most of the road segments are short and concentrated in Maycoba where most of the buildings, points of interest (e.g., church, stores), and cars are located. CONCLUSIONS: The LULC in Maycoba and surrounding settlements had changed during the study period. LULC change was used as a proxy to examine lifestyle changes that can affect levels of physical activity.

A randomized clinical trial of lipid metabolism modulation with fenofibrate for acute coronavirus disease 2019.

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) cytotoxicity may involve inhibition of peroxisome proliferator-activated receptor alpha. Fenofibrate activates peroxisome proliferator-activated receptor alpha and inhibits SARS-CoV-2 replication in vitro. Whether fenofibrate can be used to treat coronavirus disease 2019 (COVID-19) infection in humans remains unknown. Here, we randomly assigned inpatients and outpatients with COVID-19 within 14 d of symptom onset to 145 mg of oral fenofibrate nanocrystal formulation versus placebo for 10 d, in a double-blinded fashion. The primary endpoint was a severity score whereby participants were ranked across hierarchical tiers incorporating time to death, mechanical ventilation duration, oxygenation, hospitalization and symptom severity and duration. In total, 701 participants were randomized to fenofibrate (n = 351) or placebo (n = 350). The mean age of participants was 49 ± 16 years, 330 (47%) were female, mean body mass index was 28 ± 6 kg/m2 and 102 (15%) had diabetes. Death occurred in 41 participants. Compared with placebo, fenofibrate had no effect on the primary endpoint. The median (interquartile range) rank in the placebo arm was 347 (172, 453) versus 345 (175, 453) in the fenofibrate arm (P = 0.819). There was no difference in secondary and exploratory endpoints, including all-cause death, across arms. There were 61 (17%) adverse events in the placebo arm compared with 46 (13%) in the fenofibrate arm, with slightly higher incidence of gastrointestinal side effects in the fenofibrate group. Overall, among patients with COVID-19, fenofibrate has no significant effect on various clinically relevant outcomes ( NCT04517396 ).

A Randomized Trial of Lipid Metabolism Modulation with Fenofibrate for Acute Coronavirus Disease 2019.

Background Abnormal cellular lipid metabolism appears to underlie SARS-CoV-2 cytotoxicity and may involve inhibition of peroxisome proliferator activated receptor alpha (PPARα). Fenofibrate, a PPAR-α activator, modulates cellular lipid metabolism. Fenofibric acid has also been shown to affect the dimerization of angiotensin-converting enzyme 2, the cellular receptor for SARS-CoV-2. Fenofibrate and fenofibric acid have been shown to inhibit SARS-CoV-2 replication in cell culture systems in vitro . Methods We randomly assigned 701 participants with COVID-19 within 14 days of symptom onset to 145 mg of fenofibrate (nanocrystal formulation with dose adjustment for renal function or dose-equivalent preparations of micronized fenofibrate or fenofibric acid) vs. placebo for 10 days, in a double-blinded fashion. The primary endpoint was a ranked severity score in which participants were ranked across hierarchical tiers incorporating time to death, duration of mechanical ventilation, oxygenation parameters, subsequent hospitalizations and symptom severity and duration. ClinicalTrials.gov registration: NCT04517396. Findings: Mean age of participants was 49 ± 16 years, 330 (47%) were female, mean BMI was 28 ± 6 kg/m 2 , and 102 (15%) had diabetes mellitus. A total of 41 deaths occurred. Compared with placebo, fenofibrate administration had no effect on the primary endpoint. The median (interquartile range [IQR]) rank in the placebo arm was 347 (172, 453) vs. 345 (175, 453) in the fenofibrate arm (P = 0.819). There was no difference in various secondary and exploratory endpoints, including all-cause death, across randomization arms. These results were highly consistent across pre-specified sensitivity and subgroup analyses. Conclusion Among patients with COVID-19, fenofibrate has no significant effect on various clinically relevant outcomes.

Study design of the Maycoba Project: obesity and diabetes in Mexican Pimas.

OBJECTIVE: To focus on the rationale and methods of the Maycoba Project. METHODS: Study population included Mexican Pima Indians (MPI) and Blancos aged ≥20-years, living in the village of Maycoba and surrounding area. Surveys in 1995 and 2010 included a medical history, biochemical and anthropomet- ric measurements. Additionally, socio- economic, physical activity, and dietary interviews were conducted. The 2010 study incorporated investigations on type 2 diabetes (T2D) and obesity-associated genetic alleles and human-envi- ronment changes. RESULTS: The study results are limited to demographic data and description of the eligible and ex- amined sample. CONCLUSIONS: This study may yield important information on T2D and obesity etiology in a traditional population exposed to environmental changes.

Primer reporte de enfermedad sistémica por arañazo de gato (Bartonella henselae) en el Perú / First case report of systemic cat-scratch disease (Bartonella henselae) in Peru

Introducción: la enfermedad por arañazo de gato(EAG) en la mayoría de las veces es descrita en su forma típica, las formas sistémicas son raras y de escaso reporte. La EAG puede tener una gran variedad de presentaciones, siendo algunas de ellas poco frecuentes. Es la primera vez que se reporta esta forma de presentación en el Perú. Caso clínico: presentamos aquí dos niñas de cinco y seis años de edad, hospitalizadas en el Servicio de Pediatría del HNCASE EsSalud Arequipa. Con formas sistémicas de enfermedad por arañazo de gato. Las niñas fueron arañadas por gatos cachorros sin reacción local, las cuales presentaron fiebre prolongada, malestar general, anorexia, cefalea, dolor abdominal, compromiso de ganglios, hepatomegalia y esplenomegalia, velocidad de eritrosedimentación globular (VSG) acelerada, proteína C reactiva (PCR) elevada, leucocitosis, desviación izquierda, transaminasas hepáticas discretamente elevadas o normales, en ambas se confirma el diagnóstico con la reacción serológica positiva (IgG e IgM) para Bartonella henselae y microabscesos hepatoesplénicos en la TAC abdominal. En ambas el tratamiento antibiótico combinado con macrólido más rifampicina por un mes tuvo eficacia terapéutica.

Introduction: Cat-scratch disease most of the times is described reporting its typical form; systemic forms are rare and they are seldom reported. Cat-scratch disease may have a great variety of presentations, and some of them are quite unusual. This is the very first time that the systemic form is reported in Peru. Clinical case: We present two girls, 5 and 6 years old, hospitalized in the pediatric ward of Hospital Nacional Carlos Alberto Seguin, EsSalud, Arequipa, Peru, who presented with the systemic form of cat scratch disease. Both girls were scratched by kittens without developing a characteristic local reaction, and they presented with prolonged fever, malaise, anorexia, headache, abdominal pain, lymph node enlargement, liver and spleen involvement, accelerated erythrocyte sedimentation rate, high levels of C-reactive protein, leukocytosis, left shift, slightly elevated or normal liver enzymes; and in both girls the diagnosis was confirmed with a positive result in serological testing (IgG and IgM) for Bartonella henselae. Also, some splenic microabscesses were found in the CT scan. Both girls responded to antimicrobial therapy using a macrolide combined with rifampin for one month.

Propiedades linüüísticas de los trastornos específicos del desarrollo del lenguaje / Linguistic prperrties of specific language impairmnnt

This study reviews the main approaches of the functional alterations that may explain language alterations in children with Specific Language Impairment (SLI). It is estimated that at least 7.4% of the children have difficulties in their language development and most of them do not have other developmental delay. Although the linguistic difficulties could apparently be resolved in children with SLI, there is a group of children for whom the impairment persists across time and throughout their school age, mostly related with reading and writing difficulties; as a consequence, several barriers in their social and academic achievement may appear. Two theoretical positions pretend to explain functional alterations in the language of children who suffer the Specific Language Impairment: the processing and the linguistic approaches. The processing view suggests that the core disturbance is related to the working memory, while the lingüistic view proposes that the inherited grammar abilities explain the language difficulties. Lastly it is possible to conclude that children with Specific Language Impairment may show difficulties as in non word repetition tests as in grammatical language abilities that may explain the processing and the linguistic marker views, respectively. The understanding of the functional alterations in Specific Language Impairment may lead to design the therapeutic and educational strategies in this group of children.

Este estudio revisa los principales enfoques de las alteraciones que pueden explicar las alteraciones del lenguaje en los niños con Trastornos Específicos del Desarrollo del Lenguaje (TEDL). Se estima que en por lo menos en un 7.4% de los niños tienen dificultades en su desarrollo del lenguaje y la mayoría de ellos no tienen otro retraso en el desarrollo. Aunque las dificultades lingüísticas aparentemente podrían ser resultas en niños con TEDL, hay un grupo de niños en los que el daño persiste a través del tiempo y a través de la edad escolar y la mayoría está relacionado con las dificultades de la lectura y la escritura; como consecuencia, pueden aparecer algunas barreras en su logro social y académico. Dos posiciones teóricas pretenden explicar las alteraciones funcionales del lenguaje de los niños que sufren Trastornos Específicos del Desarrollo del Lenguaje: el enfoque de procesamiento y el lingüístico. La visión del procesamiento sugiere que el principal problema está relacionado con la memoria operativa, mientras la visión lingüística propone que las habilidades gramaticales heredadas explican las dificultades del lenguaje. Por último, es posible concluir que los niños con Trastornos Específicos del Desarrollo del Lenguaje pueden mostrar dificultades tanto en las pruebas de repetición tanto en las habilidades gramaticales del lenguaje que puedan explicar los marcadores de las visiones del procesamiento y lingüísticas, respectivamente. La comprensión de las alteraciones en los Trastornos Específicos del Desarrollo del Lenguaje puede llevar al diseño de Estrategias Terapéuticas y educativas en los grupos de niños.

Respuesta inmunologica con el ejercicio / Imnunologic state induced by exercise

El ejercicio genera respuestas inmunológicas dependientes de la intensidad y duración con la que se realice la actividad física. El número de linfocitos circulantes, la actividad citotóxica, la actividad antiviral de monocitos, la concentración de citoquinas y la producción de anticuerpos tienen un comportamiento alterado cuando se realiza una sesión de actividad física extenuante y estos cambios parecen acompañar una mayor susceptibilidad a la infección viral. Por otra parte, el entrenamiento físico y el sedentarismo inducen respuestas diferentes en la concentración de cortisol, las catecolaminas plasmáticas y esplénicas que generan respuestas neuroendocrinas y reacciones celulares y humorales de diferente calidad. La presencia de apoptosis en músculo-esquelético y cardiaco asociadas a disminución en la capacidad aeróbica, y la modificación de los niveles plasmáticos de citoquinas proapoptóticas con el entrenamiento físico en humanos, además de cambios en el número de miocitos apoptóticos en animales, parecen indicar que la muerte celular espontánea puede ser modificada con la actividad física regular. El ejercicio requiere una dosificación apropiada de acuerdo con la capacidad aeróbica de cada persona conforme a su edad, enfermedades subyacentes y grado de acondicionamiento físico para que se realice a intensidades que generen cambios positivos inmunológicos