Do medical students believe the back pain myths? A cross-sectional study.

BACKGROUND: Low back pain (LBP) is common, affecting 58-84% of adults at some point. In benign cases, misinformation can lead to harmful coping strategies and prolonged recovery time. Deyo has identified seven 'Myths of Back Pain' as misconceptions commonly seen in clinical practice of which doctors-in-training should be aware. We sought to determine medical students' baseline knowledge of the prognosis and management of LBP compared to the general public and to dispel the 'Myths of Back Pain'. METHODS: We carried out a cross-sectional study of medical students (pre-clinical and clinical) at the National University of Ireland, Galway where students completed a questionnaire outlining the seven 'Myths of Back Pain'. Final year students completed the survey before and after a seminar on LBP. Students' results were compared with a random sample of the public who attended Galway University Hospital. RESULTS: Two hundred nineteen students completed the questionnaire (59% female, 41% male). The mean age was 21 years (17-32). The mean number of correct answers increased according to medical school year (premedical 3/7, first year 4/7, final year 5/7). A personal history of back pain and female sex were associated with higher scores. On average, medical students answered 4/7 questions correctly overall, compared to the public (n = 131) who averaged at 3/7. Final years dispelled one further myth after their LBP seminar. CONCLUSIONS: Common misconceptions around LBP are prevalent among medical students and the general public. It is important that medical school curricula address these issues as part of their musculoskeletal programme.

Do "Myths" of low back pain exist among Irish population? A cross-sectional study.

INTRODUCTION: Low back pain remains major public health problem in the Western industrialized world. The known prevalence of low back pain in Ireland is approximately 13 %. It is one of the leading causes of sickness compensation and disability pension in our justification. We hypothesized that there is a widespread misconception about the perception of low back pain among the Irish population. The aim of this study was to investigate whether the "Myths" of low back pain existed among the Irish population. MATERIALS AND METHODS: We carried out a cross-sectional study in the Republic of Ireland from April 2013 to August 2013. The Irish population who visited Galway University Hospital, Galway, Ireland, was contacted randomly at point of entry to the hospital. During the survey, the authors obtained verbal consent before handing the questionnaire, which contained the Deyo's seven myths. The responders were asked to mark their response in a three-point scale (agree, unsure, disagree) to the seven statements. RESULTS: Out of 500 responders, 59 (11.8 %) people answered none of the questions correctly. Fifty-six (11.2 %) answered one question correctly, 106 (21.2 %) answered two questions correctly, 85 (17 %) people disagreed with three myths, 88 (17.6 %) disagreed with four myths, 55 (11 %) people answered five questions correctly, and 34 (6.8 %) answered six questions correctly. Therefore, only 17 (3.4 %) people disagreed with all the seven myths. CONCLUSION: In conclusion, this cross-sectional study showed that myths of low back pain widely exist among Irish population studied . The level of education played an important role. The findings from this study suggest that public health information regarding low back pain is inadequate and has not affected attitudes to low back pain in an Irish population.

Patterns and Prevalence of Germline BRCA1 and BRCA2 Mutations among High-Risk Breast Cancer Patients in Jordan: A Study of 500 Patients.

PURPOSE: Knowledge of BRCA1 and BRCA2 mutations has a significant clinical impact on the management and prevention of breast cancer. In this study, we evaluate the pattern and prevalence of germline mutations in BRCA1 and BRCA2 among high-risk Jordanian breast cancer patients selected as per international guidelines. METHODS: BRCA1 and BRCA2 testing were performed at a reference genetic lab. Mutations were classified as pathogenic/likely pathogenic and variant of uncertain significance (VUS). RESULTS: A total of 517 patients, median age: 39 (range: 19-78) years, were enrolled. Among the whole group, 72 (13.9%) patients had pathogenic or likely pathogenic BRCA1 (n = 24, 4.6%) or BRCA2 (n = 48, 9.3%) mutations, while 53 (10.3%) others had VUS. Among 333 younger (≤40 years) patients, mutations were observed in 44 (13.2%). Positive mutations were found in 40 (16.5%) patients with one or more close relatives with breast cancer and in 20 (35.1%) of the 57 patients with triple-negative disease. Multivariate analysis showed that a triple-negative status, history of two or more close relatives with breast cancer, and history of one or more close relatives with invasive ovarian cancer were associated with significant high odds ratios (OR) of carrying a pathogenic variant, with an OR (95% CI) of 5.08 (2.66-9.67), 3.24 (1.78-5.89), and 2.97 (1.04-8.52), respectively. CONCLUSIONS: BRCA1 and BRCA2 mutations are not uncommon among Jordanian patients. Young age has the weakest association with positive mutations, while patients with triple-negative disease, especially those with an additional positive family history, have the highest mutation rate.

An analysis of whiplash injury outcomes in an Irish population: a retrospective fifteen-year study of a spine surgeon's experience.

BACKGROUND: Whiplash injuries result from an acceleration-deceleration injury of the cervical spine. The associated symptoms may include neck pain/stiffness; cervicogenic headaches; interscapular pain; upper limb pain, paraesthesia and weakness. Current treatment protocols recommend conservative management of low-grade whiplash. AIMS: To assess changing practices over time in the management of whiplash-associated disorders in the practice of a specialist spine surgeon and to explore the impact of associated litigation on this patient cohort. METHODS AND RESULTS: The private medical records of a specialist spine surgeon over a 15-year period (1996-2011) were reviewed. Three hundred one consecutive patients were identified: 169 females and 132 males with a mean age of 37 years ± 13. All were referred by primary care with potential soft tissue injury of the cervical spine following a road traffic accident. Fifty-eight percent had associated back pain. An initial conservative approach was adopted in all cases. Subsequently, 4 patients underwent surgical intervention. Ninety-three percent reported chronic neck pain > 6 months after their injury. Age was the only significant predictor of chronic neck pain (adjusted OR 1.29 for every 5-year increase, p = 0.03). All were ultimately involved in litigation. The establishment of the Personal Injuries Board did not influence the litigation duration during the study period. CONCLUSION: Whiplash poses a significant societal economic burden in Ireland and was associated with prolonged symptoms including neck pain and upper limb neuropathic symptoms in this cohort. Associated low-back pain was common. Litigation was linked with presentation in all cases.

The rise of metastatic bone disease in Ireland.

To describe the expected rise of metastatic bone disease in Ireland, the relative primary types, and the locations of spread within the skeleton. This was a population-based epidemiological study using cancer registry data. We included patients with known metastatic cancer to bone, within 1 year of the primary diagnosis, during the years 1994 to 2012 inclusive. Our main outcome measures were age-specific, gender-specific and age-standardised incidence rates of bone metastasis, primary types and metastatic location within the skeleton. There were 14,495 recognised cases of bone metastasis in Ireland, 1994-2012 inclusive. Cases consistently rose over the time period, with 108% case increase and 51% age-standardised incidence rise. Annual percentage change increased across both genders and over all age groups. Most of this rise was not due to demographic population change. Breast, prostate and lung accounted for the majority of primary types. GI cancers were the fourth most common primary type. There were proportional increases in breast and lung, with proportional decreases in prostate. The spine was the major metastatic site. Bone metastasis is a significant and rising healthcare concern in Ireland. This rise is disproportionate to demographic changes. Breast, prostate and lung cancers account for the majority. GI cancers are implicated in an unexpectedly high number of cases. Spine is the most common location of bony metastasis, especially at presentation. Prudent healthcare planning is necessitated to prepare for the growing consequences of bone metastasis in cancer patients.

Cellular Plasticity in Prostate Cancer Bone Metastasis.

Purpose. Experimental data suggest that tumour cells can reversibly transition between epithelial and mesenchymal states (EMT and MET), a phenomenon known as cellular plasticity. The aim of this review was to appraise the clinical evidence for the role of cellular plasticity in prostate cancer (PC) bone metastasis. Methods. An electronic search was performed using PubMed for studies that have examined the differential expression of epithelial, mesenchymal, and stem cell markers in human PC bone metastasis tissues. Results. The review included nineteen studies. More than 60% of the studies used ≤20 bone metastasis samples, and there were several sources of heterogeneity between studies. Overall, most stem cell markers analysed, except for CXCR4, were positively expressed in bone metastasis tissues, while the expression of EMT and MET markers was heterogeneous between and within samples. Several EMT and stemness markers that are involved in osteomimicry, such as Notch, Met receptor, and Wnt/ß pathway, were highly expressed in bone metastases. Conclusions. Clinical findings support the role of cellular plasticity in PC bone metastasis and suggest that epithelial and mesenchymal states cannot be taken in isolation when targeting PC bone metastasis. The paper also highlights several challenges in the clinical detection of cellular plasticity.