Alejandra Cano

The Influence of Psychological Factors on Low Back Pain‐Related Disability in Community Dwelling Older Persons

OBJECTIVES To assess the influence of fear avoidance beliefs (FAB) and catastrophizing on low back pain (LBP)-related disability in Spanish community dwelling retirees. DESIGN Correlation between variables measured with previously validated instruments. SETTING Majorca, Spain. PATIENTS 1,044 community dwelling subjects attending conferences for retired persons. OUTCOME MEASURES Visual analog scales for LBP and pain referred to the leg (LP), Roland Morris Questionnaire (RMQ) for disability, FAB-Phys questionnaire (FABQ) for FAB, and the Coping Strategies Questionnaire (CSQ) for catastrophizing. RESULTS In subjects without clinically relevant LBP, FAB correlated moderately with catastrophizing (r = 0.535) and disability (r = 0.390), and weakly with LP (r = 0.119) and LBP (r = 0.197). In subjects with LBP, FAB correlated moderately with catastrophizing (r = 0.418) and disability (r = 0.408), and weakly with LP (0.152), but not with LBP. Correlations among CSQ, FABQ, and RMQ were similar in subjects with and without current LBP. In regression models, the coefficient for effect of FAB on disability was 0.14 for participants with no LBP, and 0.28 for those with pain. Corresponding values for catastrophizing were 0.17 and 0.19. CONCLUSION In Spanish community dwelling retirees, the influence of FAB and catastrophizing on LBP-related disability is clinically small.

Fear avoidance beliefs do not influence disability and quality of life in Spanish elderly subjects with low back pain.

Study Design. Correlation between previously validated questionnaires. Objective. To assess the association of fear avoidance beliefs (FAB) with disability and quality of life in elderly Spanish subjects. Summary of Background Data. As opposed to Anglo-Saxon and Northern European patients, in Spanish low back pain (LBP) patients of working age, the influence of FAB on disability and quality of life is sparse and much less than that of pain. The influence of FAB on LBP-related disability and quality of life in the elderly is unknown. Methods. A visual analogue scale (VAS), the Roland Morris Questionnaire (RMQ), the FAB-Phys questionnaire (FABQ), and the SF-12 questionnaire were used to assess LBP, disability, fear avoidance beliefs, and quality of life in 661 institutionalized elderly in Spain, 439 of whom had LBP. Results. In all subjects, FAB correlated with LBP (r = 0.477), disability (r = 0.458), the Physical Component Summary of SF-12 (PCS SF-12) (r = −0.389), and the Mental Component Summary of SF-12 (MCS SF-12) (r = −0.165). In subjects with LBP, FABs only correlated weakly with disability (r = −0.110). The stronger correlations were found between LBP and disability, both in all subjects (r = 0.803) and LBP patients (r = 0.445). Regression models including all the participants showed that the influence of FABs on physical quality of life was sparse and that FABs were not associated with either disability or mental quality of life. In elderly subjects with LBP, FABs were not associated with either disability or quality of life. Conclusion. In Spanish institutionalized elderly subjects, FABs only have a minor influence on physical quality of life, and none on disability or mental quality of life. In elderly subjects with LBP, differences in FABs are not associated with differences in disability or quality of life. Further studies should explore the potential value of FABs in the elderly in other settings.

Reporting quality of survival analyses in medical journals still needs improvement. A minimal requirements proposal

OBJECTIVES We reviewed publications with two main objectives: to describe how survival analyses are reported across medical journal specialties and to evaluate changes in reporting across periods and journal specialties. STUDY DESIGN AND SETTING Systematic review of clinical research articles published in 1991 and 2007, in 13 high-impact medical journals. RESULTS The number of articles performing survival analysis published in 1991 (104) and 2007 (240) doubled (17% vs. 33.5%; P = 0.000), although not uniformly across specialties. The percentage of studies using regression models and the number of patients included also increased. The presentation of results improved, although only the reporting of precision of effect estimates reached satisfactory levels (53.1% in 1991 vs. 94.2% in 2007; P = 0.000). Quality of reporting also varied across specialties; for example, cardiology articles were less likely than oncology ones to discuss sample size estimation (odds ratio = 0.12; 95% confidence interval: 0.05, 0.30). We also detected an interaction effect between period and specialty regarding the likelihood of reporting precision of curves and precision of effect estimates. CONCLUSION The application of survival analysis to medical research data is increasing, whereas improvement in reporting quality is slow. We propose a list of minimum requirements for improved application and description of survival analysis.

Validation of the French translation-adaptation of the impact of cancer questionnaire version 2 (IOCv2) in a breast cancer survivor population

BackgroundThe Impact of Cancer version 2 (IOCv2) was designed to assess the physical and psychosocial health experience of cancer survivors through its positive and negative impacts. Although the IOCv2 is available in English and Dutch, it has not yet been validated for use in French-speaking populations. The current study was undertaken to provide a comprehensive assessment of the reliability and validity of the French language version of the IOCv2 in a sample of breast cancer survivors.MethodsAn adapted French version of the IOCv2 as well as demographic and medical information were completed by 243 women to validate the factor structure divergent/divergent validities and reliability. Concurrent validity was assessed by correlating the IOCv2 scales with measures from the SF-12, PostTraumatic Growth Inventory and Fear of Cancer Recurrence Inventory.ResultsThe French version of the IOCv2 supports the structure of the original version, with four positive impact dimensions and four negative impact dimensions. This result was suggested by the good fit of the confirmatory factor analysis and the adequate reliability revealed by Cronbachs alpha coefficients and other psychometric indices. The concurrent validity analysis revealed patterns of association between IOCv2 scale scores and other measures.Unlike the original version, a structure with a Positive Impact domain consisting in the IOCv2 positive dimensions and a Negative Impact domain consisting in the negative ones has not been clearly evidenced in this study. The limited practical use of the conditional dimensions Employment Concerns and Relationship Concerns, whether the patient is partnered or not, did not make possible to provide evidence of validity and reliability of these dimensions as the subsets of sample to work with were not large enough. The scores of these conditional dimensions have to be used with full knowledge of the facts of this limitation of the study.ConclusionsIntegrating IOCv2 into studies will contribute to evaluate the psychosocial health experience of the growing population of cancer survivors, enabling better understanding of the multi-dimensional impact of cancer.

Relevancia clínica de las interacciones medicamentosas entre antiinflamatorios no esteroideos y antihipertensivos

OBJECTIVE To establish the clinical relevance of drug interactions between nonsteroidal antiinflammatory drugs (NSAIDs) and antihypertensives, based on the interaction severity and probability of occurrence. DESIGN Systematic review. DATA SOURCES A PubMed/Medline search was made using the MeSH terms: NSAIDs, Antihypertensive drugs, and Drug interactions. DATA EXTRACTION Articles between 2002 and 2012, human studies, in Spanish and English and full text access were included. Found articles were included and some of the references used in this works. Studies with in vitro methods, effects on ocular hypertension and those who do not consider the interaction NSAIDs, antihypertensives were excluded. For the selection of the papers included three independent reviewers were involved. We used a tool for data extraction and for assess of the interaction clinical relevance. RESULTS Nineteen of 50 papers found were included. There were identified 21 interactions with pharmacodynamic mechanism, classified by their clinical relevance in level-2 high risk (76.2%) and level-3 medium risk (23.8%). In addition, evidence of 16 combinations of no interaction were found. CONCLUSIONS Some NSAIDs may attenuate the effectiveness of antihypertensive drugs when used concurrently, especially with angiotensin converting enzyme inhibitors, diuretics, beta blockers and angiotensin receptorsii blockers. There was no evidence of effect modification of calcium channel antagonists, especially dihydropyridine, by concurrent use of NSAIDs.

The perceptions of people with low back pain treated in the Spanish National Health, and their experience while undergoing a new evidence-based treatment. A focus group study

Abstract Purpose: To explore the perceptions of people with low back pain (LBP) treated within the Spanish National Health Service, and their experience while undergoing a new evidence-based treatment (“neuroreflexotherapy”). Methods: A focus group (FG) study was conducted. Participants were divided into five groups according to whether they: suffered from subacute versus chronic LBP; had undergone one versus several neuroreflexotherapy procedures; showed a clinically relevant improvement in pain and disability according to validated measuring instruments, and reported it. Thirty-two patients were selected by purposive sampling. Content analysis was undertaken by two researchers who had no contact with the clinicians. Results: Subacute and chronic LBP curtails daily activities, reduces quality of life (QoL) and self-esteem, and is experienced as a stigma. Patients want to be treated with respect and empathy by clinicians who refrain from judging them. New treatments trigger hope, but also fear and mistrust. Most patients experiencing a clinically relevant improvement resume daily activities, and report improvement in QoL, self-esteem and emotional wellbeing. Conclusion: Southern European LBP patients have similar perceptions to those in other cultural settings. LBP jeopardizes patients’ QoL and self-esteem. When pain improves significantly, patients are happy to acknowledge it and resume their normal life. Implications for Rehabilitation People with low back pain (LBP) want to be treated with respect and empathy by clinicians who inspire confidence and refrain from judging them. When faced with a new evidence based treatment, people with subacute and chronic LBP are hopeful, but apprehensive. Most of those who experience a clinically meaningful improvement after treatment are happy to acknowledge it and resume an active and fulfilling life. People who report no improvements after being treated, should be believed.

Patient-Centered Care in Breast Cancer Genetic Clinics

With advances in breast cancer (BC) gene panel testing, risk counseling has become increasingly complex, potentially leading to unmet psychosocial needs. We assessed psychosocial needs and correlates in women initiating testing for high genetic BC risk in clinics in France and Germany, and compared these results with data from a literature review. Among the 442 counselees consecutively approached, 212 (83%) in France and 180 (97%) in Germany, mostly BC patients (81% and 92%, respectively), returned the ‘Psychosocial Assessment in Hereditary Cancer’ questionnaire. Based on the Breast and Ovarian Analysis of Disease Incidence and Carrier Estimation Algorithm (BOADICEA) BC risk estimation model, the mean BC lifetime risk estimates were 19% and 18% in France and Germany, respectively. In both countries, the most prevalent needs clustered around the “living with cancer” and “children-related issues” domains. In multivariate analyses, a higher number of psychosocial needs were significantly associated with younger age (b = −0.05), higher anxiety (b = 0.78), and having children (b = 1.51), but not with country, educational level, marital status, depression, or loss of a family member due to hereditary cancer. These results are in line with the literature review data. However, this review identified only seven studies that quantitatively addressed psychosocial needs in the BC genetic counseling setting. Current data lack understandings of how cancer risk counseling affects psychosocial needs, and improves patient-centered care in that setting.

Evaluation of the impact of the recommendations of the Conference for the Development of Nursing Research in Salamanca

In 2001, Investen-isciii (Unit for Coordination and Development of Nursing Research) carried out a questionnaire survey among 13 European countries the aim of which was to assess the degree of progress concerning the recommendations of the 1999 Euroconference entitled ‘Building a European Nursing Research Strategy’, held in Salamanca, Spain. Aim:To evaluate the level of dissemination and the impact of these recommendations and assess which actions to stimulate nursing research had been subsequently undertaken in each country, after the Salamanca Euroconference. Method:The study used a descriptive approach. A total of 23 questionnaires with 70 questions were distributed, 13 of which were returned. The questionnaire used a multiple-choice format with some space for explanations. The questionnaire covered the impact at national, regional and local level and the degree of dissemination of the recommendations of the conference in each country. Results:At the national level, the countries where the impact and acceptance of the conference findings were highest were Finland, Denmark and the UK. In Germany, the Netherlands and Spain, impact and acceptance had been good. At regional and local levels, the best rated countries were the UK, Denmark, Germany and Spain. Conclusions:The major difficulty for nursing research is lack of funds and the lack of nursing research infrastructure in some of the countries studied. National and regional support are also very limited in some countries.