Perceptions Of Global Change Research Articles

Usual light touch osteopathic treatment versus simple light touch without intent in the reduction of infantile colic crying time: A randomised controlled trial

BackgroundMany parents seek osteopathic care for their infants with colic. Our aim was to test the effectiveness of usual light touch osteopathic treatment on crying time for infants with ‘colic’. MethodsA superiority, two arm, single blinded (parent) multi-centre (UK, Australia and Switzerland), randomised controlled trial, included healthy infants between 1 and 69 days of age who excessively cried, fussed, or were distressed and difficult to console. The Test intervention consisted of usual light touch osteopathic treatment, the Control intervention simple light touch to random body locations with no treatment intent. Both groups received best practice advice and guidance. The primary outcome was the daily crying time, reported hourly by parents in a diary, for two-weeks. Secondary outcomes were parenting confidence, global change, satisfaction, and experience of care. ResultsSixty-six infants were recruited (32 Test: 34 Control group). Mean average daily crying time in the Test group was 124 min (SD = 69, n = 26) and in the Control 115 min (SD = 49, n = 29). After adjustment, infants in the Test group cried 2.2 min more per day than those in the Control group (CI95 % −20 to 25 min, p = 0.849). Parents’ perceptions of global change in symptoms, satisfaction with, and experience of care were high and similar in both groups. There were no serious adverse events related to the treatments or the trial. ConclusionUsual light touch osteopathic treatment was not superior to simple light touch without treatment intent. The biomechanical explanatory models and underpinning assumptions about the mechanisms of osteopathic intentional light touch care may require reconsideration. Trial registrationACTRN12620000047998 (January 22, 2020).

Investigating the efficacy of transcranial direct current stimulation on chronic pain management in endometriosis patients: A randomized controlled trial protocol.

Similar to chronic pain conditions, individuals with endometriosis can be affected by central sensitization syndrome (CSS), which is characterized by a loss of analgesia and central amplification of pain. Transcranial direct current stimulation (tDCS) has shown potential as an effective intervention to improve pain generated by other chronic pain conditions impacted by CSS, such as fibromyalgia and chronic pelvic issues. This study aims to evaluate the effectiveness of tDCS on pain, fatigue, and quality of life among patients affected by endometriosis. This is a single-center, parallel, double-blinded, randomized, controlled clinical trial protocol study. We aim to recruit 40 participants affected by endometriosis (active group, n = 20; sham group, n = 20). Anodal tDCS will be delivered at an intensity of 2mA, applied over the primary motor cortex for 20 minutes per day for 10 consecutive days. There will be four assessment times: 1 week before beginning the intervention; on the 10th day following the last tDCS session; and 1 and 2 months after the last tDCS session. Pain evaluated by the algometry will be the primary outcome. Pain intensity, quality of life, fatigue, and global perception of change will be the secondary outcomes. We will calculate the effects of the active versus sham stimulation on primary and secondary outcomes by using generalized estimated equations or mixed model analysis. The effect size calculation will represent the effect measure. We expect that only the active group show reductions in pain, fatigue, and quality of life. The results of this trial will produce an important first step in providing evidence on the effectiveness of neuromodulation for the management of pain and will provide data to support new studies on tDCS. Brazilian Clinical Trials Registry (RBR-4q69573).

Fishers’ perceptions of global change to inform coastal planning in a data-poor socio-ecological system

Global change has a significant impact on coastal populations and their reliance on coastal ecosystems and resources. This is particularly true for small-scale fisheries (SSF) in Brazil, where limited data exacerbates their vulnerability. Acquiring local user knowledge is crucial to enhancing the sustainability of SSF. In Rio Formoso, Northeast Brazil, a fisher's association plays a vital role in conserving coastal ecosystems and raising awareness about anthropogenic activities. This study examines various social, governance, economic, and ecological aspects of Rio Formoso fisheries, focusing on fishers' perceptions of global change. We carried out individual and collective interviews, participatory mapping, and discourse analysis. Rio Formoso fisheries stood out by the diversity of their activities (gears, species, habitats), women's leading role, and the intense involvement of the association in coastal management initiatives. Fishers reported decreased abundance and biodiversity, and increased demand for their products. They perceived the threats to their fishing activities posed by the consequences of global change, including temperature and rainfall modifications, pollution generated by anthropogenic activities, and conflicts with tourism. Social challenges, such as gender discrimination against fisherwomen and the ongoing struggle for fishers to be included in policy-making decisions, further hinder fisheries' sustainability. This study demonstrates the valuable insights gained from fishers' perceptions in a data-poor system, enabling a preliminary global assessment to identify conflicts, social challenges, ecological concerns, and suitable actors to lead feasible and acceptable policies. As conflicts and community concerns can provide opportunities for co-management, it is imperative to operationalise community-based management tools, particularly in Brazil, to alleviate fishers' struggles in meaningful decision-making involvement.

Lian Gong for Treatment in Fibromyalgia: Case Study

In this case study the patients was diagnosed with fibromyalgia at 29 years ago and sought care in memory of discontent with previous treatments. Intensity was assessed with a visual analog scale (VAS), quality of life with SF-36 and the pressure pain threshold algometer (PPT). There were 16 visits with two weekly 60-minute sessions, when the patient was re-evaluated, a Global Perception of Change (GPC) scale was added to assess general health.

Lian Gong for treatment of fibromyalgia – a case study

Introduction. As a Complementary Integrative Practices (CIPs), Lian Gong has been increasingly used in the practice of Physiotherapy. Aim. This study aims to verify the effects of Lian Gong in a patient with fibromyalgia. Description of the case. In this case study the patient (one patient is evaluated) was diagnosed with fibromyalgia 29 years ago and sought care following discontent with previous treatments. Pain intensity was assessed with a visual analog scale (VAS), quality of life with SF-36, and the pressure pain threshold algometer (PPT). There were 16 visits with two weekly 60-minute sessions. When the patient was reevaluated, a Global Perception of Change (GPC) scale was added to assess general health. A folder was submitted to the patient for follow-up of exercises at home and asked to return after 4 weeks (follow-up period). Conclusion. The results indicate improvement in pain, functional capacity and general health. As a first therapy treatment, Lian Gong proved promising results in one case of fibromyalgia. The possible benefits when combined with other forms of care should be explored by clinical trials to expand knowledge of health benefit potential.

Prognostic indicators for poor outcomes in low back pain patients consulted in primary care

BackgroundNon-specific low back pain (NSLBP) is the most prevalent musculoskeletal condition in western countries and is associated with persistent disability and high consumption of health care resources. NSLBP patients first seek primary health care services but the outcomes are often uncertain. This study aimed to examine the clinical course of the outcomes and to identify prognostic indicators for poor outcomes in NSLBP patients who consulted primary care.MethodsA prospective cohort study of 115 patients seeking treatment for NSLBP in primary care was conducted. Participants were consecutively recruited by their General Practitioners (GPs) and then assessed at baseline and 2 and 6 months later. Baseline assessment included socio-demographic and clinical data, psychosocial factors, pain, disability, and health related quality of life (HRQoL). Pain, disability, HRQoL and global perception of change were also assessed at 2 and 6-months’ follow-up. In addition, information regarding the GP’ practice was collected. Poor outcomes were determined according to the cut-off point used to define a persistent disabling condition and the minimal important change established for disability, pain and for global perception of change. The relationship between variables on baseline and poor outcomes was modulated through binary logistic regression analysis. The significance of associations was evaluated at ≤ 0.05 p-value with 95% confidence intervals (CI) and adjusted odds ratios (AOR).Results110 (94.8%) and 104 (89.7%) participants completed the follow-up assessment at 2 and 6 months, respectively. The mean age (±SD) was 48.06 ± 11.41, with 53.9%, (N = 62) reporting an acute presentation of NSLBP. Six months after GP consultation, 53.8% (N = 56) of the participants reported a persistent disabling condition. An “LBP episode of less than 12 weeks” [AOR: 0.26; 95% CI (0.10, 0.65); AOR: 0.34; 95% CI (0.14, 0.81); AOR: 0.21; 95% CI (0.09, 0.53)],”maladaptive psychosocial factors” [AOR: 2.06; 95% CI (1.40, 3.04); AOR: 1.82; 95% CI (1.27, 2.59); AOR: 1.72; 95% CI (1.20, 2.47)] were significantly associated with poor outcomes on disability, pain and global perception of change, respectively. Besides these factors, being employed reduces the chances of poor outcomes on disability [AOR 0.31; 95% CI (0.11, 0.92)].ConclusionsA large proportion of LBP patients seeking primary health care reported poor outcomes 6 months after GP consultation. Patients who report chronic LBP, maladaptive psychosocial factors and are unemployed have a significant increase in the risk of poor outcome. These findings suggest the need of implementing effective models of care able to provide early screening and appropriate treatment to those at greatest risk of a poor outcome.Trial registrationCurrent Controlled Trials NCT04046874 (August 6, 2019). Retrospectively registered.

Cross-cultural adaptation and psychometric properties of the European Portuguese version of the Global Perceived Effect Scale in patients with chronic low back pain

Purpose To cross-culturally adapt the Global Perceived Effect Scale (GPES) into Portuguese and investigate its psychometric properties in patients with chronic low back pain. Methods Cross-cultural adaptation was carried out according to published guidelines. Along with measures for pain and disability, GPES was administered at baseline, 48-h later and post-intervention. To estimate test-retest reliability, the intraclass correlation coefficient was used. The validity was examined through the correlation between the GPES and the Patient Global Improvement Change Scale and the contribution of baseline status to GPES scores. Responsiveness was assessed by analyzing hypotheses regarding areas under the curve and correlations with changes in other measures. Results The test-retest reliability, the convergent validity and the contribution of the baseline status to GPES scores were demonstrated. The EPES correlated strongly with global perception of change (r = 0.677), and moderately with pain and disability changes (r = 0.457 and r = 0.452, respectively). Areas under the curve values of 0.71(95% CI = 0.607–0.825) and 0.83 (95% CI = 0.749–922) were found. Conclusion The GPES demonstrated adequate psychometric properties. This study’s findings supported its use in clinical and research studies with patients with chronic low back pain. IMPLICATIONS FOR REHABILITATION The European Portuguese version of the Global Perceived Effect Scale demonstrated adequate reliability, validity and responsiveness. This instrument is suitable to evaluate meaningful changes in patients with chronic low back pain. The contribution of baseline status to GPES scores was confirmed by specific and recommended methods. The use of the GPES as external criterion of change in clinimetric studies was supported. The minimum important change was 2.5 points out of 11 of the GPES. Only improvements above this point should be considered as relevant to patients with chronic low back pain undergoing physiotherapy.

Acute effects of whole-body vibration on spinal excitability level and ankle plantar flexion spasticity in post-stroke individuals: A randomized controlled trial

IntroductionThis study aimed to evaluate the acute effects (up to 30 min) of whole-body vibration (WBV) on spinal excitability level and ankle plantar flexion spasticity in chronic stroke subjects. MethodsTwenty-one subjects (age 30–70 years old) with chronic stroke and ankle plantar flexion spasticity were randomly assigned to the vibration group (VG, n = 11) or the control group (CG, n = 10). Subjects in the VG underwent 10 minutes of WBV with a frequency of 35 Hz and amplitude of 2 mm. Subjects in the CG remained on the platform for 10 min without receiving vibratory stimulus. The spinal excitability level was estimated by the Hmax/Mmax ratio extracted from the H-reflex with simple stimulus examination. The value of the second/first wave ratio (H2/H1 ratio) at the peak of the first facilitation was also considered through the recovery curve with double stimulation. Spasticity was estimated by the Modified Ashworth Scale (MAS) and global perception of change. All outcomes were assessed before and at 10, 20, and 30 min after the WBV, except for MAS, which was evaluated only 10 min after WBV. ResultsNo between-group differences were found in either the spinal excitability level or plantar flexor spasticity at the three evaluated moments after WBV. ConclusionThese results suggest that WBV does not reduce spinal excitability level or spasticity of the plantar flexor muscles in chronic stroke patients in the first 30 min after vibratory stimulus.

Contract-relax technique compared to static stretching in treating migraine in women: A randomized pilot trial

IntroductionPhysical therapy is often used by patients with headache, including modalities such as muscle stretching exercises. ObjectivesTo evaluate the feasibility of a pilot trial aimed at determining the efficacy of the proprioceptive neuromuscular facilitation (PNF) contract-relax technique compared to static stretching for treating migraineurs. MethodsThis pilot trial allocated 30 migraineur women (23 ± 4 years) into PNF (n = 15) and static stretching groups (n = 15). The interventions were performed twice a week (16 sessions, 8 weeks). The feasibility outcomes included successful random allocation of 30 patients during a 12-month period, the proportion of eligible patients randomly assigned to each group, and the proportion of those who completed the 30-day follow-up. The outcomes of headache characteristics; medication intake; severity of migraine-related disability; neck disability; cervical mobility; pressure pain threshold; adverse effects and global perception of change were evaluated at baseline, after the end of treatment and after 30-day follow-up. ResultsThe recruitment rate was 4.66% participants/month. The proportion of eligible patients randomly assigned to each group and for those who completed the 30-day follow-up was 88.23% and 100%, respectively. Both groups improved in headache-related outcomes. The perception of change was important for 67% of the PNF group and 47% of the static stretching group. No differences were found between groups regarding the studied outcomes. ConclusionThis is a feasible pilot trial. The PNF contract-relax technique was no more effective than static stretching for treating migraine, but both techniques improved the headache, the severity of migraine-related disability and the satisfaction after treatment.

Characterizing Clinically Meaningful Changes in Lower Urinary Tract Symptoms Using the American Urological Association Symptom Index

To correlate patients' perception of changes in their lower urinary tract symptoms with changes in their American Urological Association Symptom Index (AUA-SI) scores with the goal of improving the ability of patients and clinicians to assess the clinical meaningfulness of changes in the AUA-SI score. Men were asked to complete an AUA-SI survey and answer a symmetrical response framework question to evaluate their global perception of change in lower urinary tract symptoms at each interval, namely, "Are your urinary symptoms much better, slightly better, the same, slightly worse, or much worse compared to your prior visit?" Median changes and interquartile ranges (IQRs) in the AUA-SI scores were compared with the global evaluation response for the entire cohort. Additionally, outcomes were stratified by baseline AUA-SI severity classification (mild, moderate, or severe). The median changes and IQRs in AUA-SI scores of patients rating themselves as much better, slightly better, the same, slightly worse, and much worse compared with their symptoms at the time of their last AUA-SI were -2 (IQR -6 to 0), -1 (IQR -5 to 1), 0 (IQR -2 to 2), 5 (IQR 0-9), and 11 (IQR 5-18), respectively. There was a significant difference in AUA-SI score change between each rating category (P <.001). These results demonstrate that the patients require only a small decrease in their AUA-SI scores to report they are slightly better or much better, whereas a larger increase in their AUA-SI scores is required for patients to report their symptoms are slightly worse or much worse.

China's “One Belt, One Road” initiative - the perspective of the European Union

The idea of the “One Belt, One Road” will promote the China as a soft power and attractive player in the global market. It is related to China’s perception of global changes brought about by financial crisis, and growing world-wide interdependence. Beijing’s initiative aims on the potential for increased economic exchanges between China and Europe. In fact, the One Belt, One Road (OBOR) can be called a comprehensive domestic and foreign policy concept. Historically, the concept of the “Silk Road” was not only about trade, but also had significant cultural meaning. The OBOR initiative could serve as a cultural bridge between Europe and China, which should not only be understood as “two markets” and “two forces,” but also as “two civilizations”. This concept might be especially profitable for Central and Eastern European countries which focus on strengthening relations with the PRC after years of mutual insignificance and strive for balancing huge trade deficit and attracting Chinese investments.

What are the major global threats and impacts in marine environments? Investigating the contours of a shared perception among marine scientists from the bottom-up.

Marine scientists broadly agree on which major processes influence the sustainability of marine environments worldwide. Recent studies argue that such shared perceptions crucially shape scientific agendas and are subject to a confirmation bias. Based on these findings a more explicit engagement with scientists’ (shared) perceptions of global change in marine environments is called for. This paper takes stock of the shared understanding in marine science of the most pertinent, worldwide threats and impacts that currently affect marine environments. Using results from an email survey among leading academics in marine science this article explores if a shared research agenda in relation to global change in marine environments exists. The analysis demonstrates that marine scientists across disciplines are largely in agreement on some common features of global marine change. Nevertheless, the analysis also highlights where natural and social scientists diverge in their assessment. The article ends discussing what these findings imply for further improvement of interdisciplinary marine science.

Comparative Evaluation of Pregabaline, Gabapentine, Sertraline and Duloxetine in Painful Diabetic Non Insulin-dependent Neuropathy

There are numerous studies that compare different drugs in painful diabetic neuropathy (Bansal et al., 2009; Goldstein et al., 2005; Morello, et al,1999; Wernicke et al., 2007) but our study tries to make a comparison between all four drugs and evaluate the associated depression. The study shows the results of drug therapy for painful diabetic non-insulin-dependent neuropathy after 6 months. Four drugs are compared for their efficiency and also the global perception of change by the patients. Another aspect is the reduction in depression symptoms caused by unsuccessful therapy before using the drugs used in this study. The study shows how the drugs are similar in efficiency in pairs of two, one pair of drugs being more efficient than the other.

Benefits of Thoracic Thrust Manipulation when Applied with a Multi-Modal Treatment Approach in Individuals with Mechanical Neck Pain: A Pilot Randomized Trial

Objectives: Mechanical neck pain is generally treated with a multimodal approach that includes electro/thermal modalities, exercise and non-thrust manual therapy to the neck. Recent studies reported beneficial effects of thoracic thrust manipulation (TTM) but evidence for additive effects of TTM over multimodal neck program (MNP) is limited. The purpose of this pilot study was to assess the supplementary effects of TTM on pain and disability when applied in addition to a MNP to treat mechanical neck pain. Methods: Twenty-two eligible subjects (age: 38 ± 11 years, BMI: 25 ± 5 Kg/m2, 68% female) were randomized to receive MNP only or MNP+TTM for a maximum of 12 sessions. Outcomes were assessed at baseline and at 6 weeks follow up, and consisted of the numeric pain rating scale (NPS), Neck Disability Index (NDI), Global Rating of Change, duration of care, and neck active range of motion (AROM). Results: At 6 weeks both groups showed similar improvement in pain and disability that were clinically important. The NPS improved 2.9 points in the MNP+TTM group and 2.7 points in MNP group. The NDI reduced 14.6% in MNP+TTM and 11.8% in MNP. Increases in neck range of motion were small and similar in both groups. The percentage of subjects who improved in the global rating of change was 60%. Both groups reported similar duration of care (40 and 33 days in the MNP and MNP+TTM respectively). Conclusion: TTM does not appear to provide additional benefits over the MNP on the outcomes of pain, disability, neck range of motion, duration of care or global perception of change.