Joint Intervention Research Articles

A Study to Determine the Clinical Efficacy of Spinal Facet Joint Intervention with Medial Branch Block in Patients of Chronic Low Back Pain with Radiation Associated with Facet Arthropathy

A Study to Determine the Clinical Efficacy of Spinal Facet Joint Intervention with Medial Branch Block in Patients of Chronic Low Back Pain with Radiation Associated with Facet Arthropathy

Effects of aerobic exercise combined with chlorella pyrenoidos of disintegrated cell wall on some indicators of lipid metabolism in rats with high-fat diet

To study the effects of aerobic exercise combined with chlorella pyrenoidos of disintegrated cell wall on the lipid metabolism in rats with high-fat diet. Fifty-five male Wistar rats were subjected to adaptive feeding for 4 days and weight-free swimming training for 3 days, 20 min/d. After eliminating 5 rats that were not suitable for swimming training, the other rats were randomly divided into 5 groups according to their body weight:control group (C group), high fat diet group (H group), high-fat diet + chlorella group(HC group), high fat diet + aerobic exercise group (HM group), high fat diet + chlorella + aerobic exercise group (HMC group), 10 in each group. The HM and HMC group were subjected to 60 min/d swimming training for 6 weeks with non-weight-bearing. Group C were fed regular diet. The other groups were fed with high-fat diet, the rats in group HC and HMC were intragastrically treated with chlorella pyrenoidos of disintegrated cell wall at the dose of 3.9 g/(kg·d), the volume was 5 ml/kg, and the other groups are given equivalent saline. The Lee's index and biochemical indexes of blood and liver were measured after 6 weeks. Compared with group C, Lee's index, serum levels of free fatty acids(FFA), interleukin-6 (IL-6), tumor necrosis factor-α (TNF-α), total cholesterol (TC), triglyceride (TG), low density lipoprotein cholesterol (LDL-c), liver FFA and interleukin-10 (IL-10) were increased significantly (P<0.01), the serum level of high-density lipoprotein cholesterol (HDL-c) was decreased significantly (P<0.01) in group H. Compared with group H, Lee's index, serum FFA, IL-6, TNF-α, TC, TG, LDL-c, liver FFA and IL-10 were decreased significantly (P<0.05 or P<0.01), serum level of HDL-c was increased significantly (P<0.05 or P<0.01) in group HC, HM and HMC. Compared with group HC and HM, Lee's index, serum FFA, IL-6, TNF-α, TC, TG, LDL-c, liver FFA and IL-10 were decreased significantly (P<0.05), serum level of HDL-c was increased significantly (P<0.05) in group HMC. Aerobic exercise and chlorella pyrenoidos of disintegrated cell wall can improve lipid metabolism in rats with high-fat diet and reduce the lipid toxicity caused by obesity. Joint intervention is more effective than single intervention.

In vitro study of joint intervention of E-cad and Bmi-1 mediated by transcription activator-like effector nuclease in nasopharyngeal carcinoma

To explore the effect of intervention of E-cadherin (E-cad) and B-lymphoma Moloney murine leukemia virus insertion region-1 (Bmi-1) mediated by transcription activator-like effector nuclease (TALEN) on the biological behaviors of nasopharyngeal carcinoma cells. Methods: Multi-locus gene targeting vectors pUC-DS1-CMV-E-cad-2A-Neo-DS2 and pUC-DS1-Bmi-1 shRNA-Zeo-DS2 were constructed, and the E-cad and Bmi-1 targeting vectors were transferred with TALEN plasmids to CNE-2 cells individually or simultaneously. The integration of target genes were detected by PCR, the expressions of E-cad and Bmi-1 were detected by Western blot. The changes of cell proliferation were detected by cell counting kit-8 (CCK-8) assay. The cell cycle and apoptosis were detected by flow cytometry. The cell migration and invasion were detected by Transwell assay. Results: The E-cad and Bmi-1 shRNA expression elements were successfully integrated into the genome of CNE-2 cells, the protein expression level of E-cad was up-regulated, and the protein expression level of Bmi-1 was down-regulated. The intervention of E-cad and Bmi-1 didn't affect the proliferation, cell cycle and apoptosis of CNE-2 cells, but it significantly inhibited the migration and invasion ability of CNE-2 cells. Furthermore, the intervention of E-cad and Bmi-1 together significantly inhibited the migration ability of nasopharyngeal carcinoma cells compared with the intervention of E-cad or Bmi-1 alone (all P<0.01). Conclusion: The joint intervention of E-cad and Bmi-1 mediated by TALEN can effectively inhibit the migration and invasion of nasopharyngeal carcinoma cells in vitro, which may lay the preliminary experimental basis for gene therapy of human cancer.

Habilidades favorecedoras del aprendizaje de la lectura en alumnos de 5 y 6 años

Interest in learning to read as well as the ability to predict the acquisition of this linguistic ability in early age has been the subject of numerous investigations in recent years. In the context, the aim of this study was to analyze the effect that the joint intervention in phonemic awareness, alphabetic naming speed and is knowledge about learning reading during the acquisition process of this linguistic skill. A quasiexperimental design compared between groups with pretest posttest measures and was employed. Participants 408 students aged 5 to 6 years. The experimental group had significantly higher scores than the control tests phonological awareness, rapid naming and knowledge of the written code group achieving higher levels in reading assignments. The results support the development of educational models that integrate these variables for both improving learning reader in the early ages, and for the prevention of difficulties in this linguistic ability, which has important educational implications for reading instruction in the classroom.

Prevention and Intervention of Sports Knee Joint Injury in Adolescents

Knee joint sports injuries occur among young people, are very common and harm the physical and mental health of young people. Must cause the main importance of sports management departments, actively reducing exercise prevention of knee joint injury and intervention measures of research and exploration, to avoid juvenile sports injury of knee occurred or knee injuries to a minimum level, enhance physical and mental health of teenagers.

Examining the impacts of health literacy on healthcare costs. An evidence synthesis.

Scholars and practitioners share a significant concern about rising healthcare costs. Health literacy is widely presented as a solution to this momentous issue, paving the way for a more appropriate access to care and therefore, for cost savings. However, to date little is still known about the ultimate effects of better health literacy on healthcare costs. Drawing from the findings of a systematic literature review which ultimately involved 29 papers retrieved from Scopus-Elsevier and PubMed. This manuscript is aimed at shedding light on the relationship between health literacy and healthcare costs. The inadequate ability of patients to understand health information and to navigate the healthcare system was found to be an important predictor of inappropriateness in the access to health care. In addition, people living with problematic health literacy are discouraged to be engaged in the provision of health services and are expected to show poor self-efficacy in dealing with their health-related conditions. From this point of view, poor health literate patients are assumed to be at high risk of exacerbation of their health problems, which in turn contributes in rising healthcare costs. In spite of these findings, both policy makers and practitioners seem to overlook the importance of health literacy. Eventually, the joint intervention on laws, policies, organizational strategies, and practices is crucial to handle the challenges related to limited health literacy.

Violence and depression among men who have sex with men in Tanzania

BackgroundMen who have sex with men (MSM) continue to be at an increased risk of Violence, HIV transmission and Mental Disorders such as depression on top of many other bio-psycho-socio challenges they face as a result of their sexual orientation.MethodsWe recruited 345 MSM using a respondent driven sampling technique. Revised Conflict Tactic Scale, PHQ-9 and questions adapted from the TDHS 2010 were used to assess for violence, depression and HIV-risk behaviors respectively. Continuous and categorical variables were analyzed with student’s t-test and chi-square test respectively. Logistic regression analyses were performed to assess for predictors of depression and HIV-risk behaviors. All tests were two sided and p < 0.05 was taken as significance level.ResultsOverall, 325 (94.2%) of participants experienced any form of violence, with emotional violence constituting the majority (90.1%), while physical and sexual violence were reported by 254 (73.6%) and 250 (72.5%) of participants respectively. Depressive symptoms were present in 245 (70.0%) and participants who experienced violence had a 3 times increased risk of depressive symptoms compared to their violence-free counterparts, p < 0.001. On the other hand, participants who experienced any form of violence displayed an over 11 times increased rate of depressive symptoms compared to their counterparts who were violence free, p < 0.001. Violence experience was found to be the strongest associated factor for depressive symptoms.ConclusionsThe rates of violence, depressive symptoms and HIV risk behaviors amongst MSM are astoundingly high thus necessitating extensive interventions. In view of this, deliberate measures to deal with the reported high rates necessitate joint intervention efforts from the policy makers, health providers and community at large.

Association between joint stiffness and health-related quality of life in community-dwelling older adults

ObjectiveThis study aimed to examine the association between joint stiffness and health-related quality of life (HRQOL) in community-dwelling older adults. MethodsParticipants in this cross-sectional study were 530 Japanese community-dwelling older adults (mean age, 73.9 years; women, 64.3%). Joint stiffness was assessed at the neck, low back, shoulder, elbow, hand or wrist, hip, knee, and ankle or feet; the duration of joint stiffness was also evaluated. We assessed HRQOL using the Short Form-12 (SF-12) and EuroQOL-5 Dimension (EQ-5D) questionnaires. We calculated the physical component summary scores (PCS) and mental component summary scores (MCS) from SF-12 and the EQ-5D index from EQ-5D. ResultsThe prevalence of joint stiffness was 54.0%. Joint stiffness at two or more sites and at each site had a meaningful impact on PCS. Joint stiffness that lasted for 30min or more was meaningfully associated with low PCS and EQ-5D scores (PCS, 30–60min: beta=−6.122, P<0.05; >60min: beta=−5.962, P<0.01; EQ-5D index, 30–60min: beta=−0.068, P<0.01; >60min: beta=−0.070, P<0.01). Further, joint stiffness that lasted over 60min extended over MCS (MCS, >60min: beta=−3.212, P<0.05). ConclusionsJoint stiffness is associated with HRQOL. Assessing joint stiffness and intervention could be beneficial for HRQOL.

The Combined Intervention with Germinated Vigna radiata and Aerobic Interval Training Protocol Is an Effective Strategy for the Treatment of Non-Alcoholic Fatty Liver Disease (NAFLD) and Other Alterations Related to the Metabolic Syndrome in Zucker Rats.

Metabolic syndrome (MetS) is a group of related metabolic alterations that increase the risk of developing non-alcoholic fatty liver disease (NAFLD). Several lifestyle interventions based on dietary treatment with functional ingredients and physical activity are being studied as alternative or reinforcement treatments to the pharmacological ones actually in use. In the present experiment, the combined treatment with mung bean (Vigna radiata), a widely used legume with promising nutritional and health benefits that was included in the experimental diet as raw or 4 day-germinated seed flour, and aerobic interval training protocol (65–85% VO2 max) has been tested in lean and obese Zucker rats following a 2 × 2 × 2 (2 phenotypes, 2 dietary interventions, 2 lifestyles) factorial ANOVA (Analysis of Variance) statistical analysis. Germination of V. radiata over a period of four days originated a significant protein hydrolysis leading to the appearance of low molecular weight peptides. The combination of 4 day-germinated V. radiata and aerobic interval training was more efficient compared to raw V. radiata at improving the aerobic capacity and physical performance, hepatic histology and functionality, and plasma lipid parameters as well as reverting the insulin resistance characteristic of the obese Zucker rat model. In conclusion, the joint intervention with legume sprouts and aerobic interval training protocol is an efficient treatment to improve the alterations of glucose and lipid metabolism as well as hepatic histology and functionality related to the development of NAFLD and the MetS.

Strategic Management in the Relationship between Competitiveness and Organizational Performance in MSMES of the Service Sector in Mexico

The objective of this research is to analyze the influence of strategic management on competitiveness and organizational performance, an issue that is present in micro, small and medium-sized enterprises in the food and beverage preparation industry of the service sector. The study sample was of 200 Mexican organizations from Ciudad Obregón, Sonora. The results indicated that strategic management has a positive, direct and significant effect on competitiveness. The results that were obtained by means of linear regression analysis make it possible to assert that the interaction between both variables (strategic management and competitiveness) establishes significant differences in the levels of organizational performance. It was concluded that the enhancement of strategic management contributes to the increase in organizational performance. Therefore, a joint intervention must take place on strategic management and competitiveness.

Effects of aerobic exercise combined with melatonin on osteoporosis of type II diabetic rats

To investigate the effects of aerobic exercise and melatonin on osteoporosis in type 2 diabetic rats. Sixty fe male SD rats were randomly divided into the control group (n=10) and the diabetic model group (n=50). The rats in the control group(N group) did not receive any intervention, and the rats in the type Ⅱ diabetic group (D) was injected with streptozocin(STZ) at the dose of 35 mg/kg by intraperitoneally. One week later, rats with blood glucose greater than 16.7 mmol/L were successfully modeled for type Ⅱ diabetes. Forty diabetic rats were randomly divided into diabetic control group (D), diabetes + aerobic exercise group(CDE),diabetes + melatonin group (DM), diabetes mellitus + aerobic exercise + melatonin group (DEM), 10 rats in each group. The rats in DE and DEM groups were treated with 20 min aerobic exercise for 6 weeks. The rats in DM group and DEM group were given 40 mg/kg of melatonin per day. The body weight, vertebrae and left and right femur bone mineral density (BMD) of the rats in each group were observed. Malondialdehyde(MDA), superoxide dismutase (SOD), glutathione peroxidase (GSH-Px), serum total calcium (Ca), inorganic phosphate (P) and parathyroid hormone (PTH) were detected. Compared with N group, body weight, serum SOD, GSH-Px levels, blood Ca, lumbar and femoral BMD of rats in group D were decreased significantly (P < 0.05 or P < 0.01). The levels of blood glucose, serum MDA and serum PTH were increased sig-nificantly (P < 0.01), the level of blood P had no changes (P > 0.05); compared with group D, DE group, DM group rats body weight, serum SOD, GSH-Px levels, blood Ca, lumbar spine and femur about BMD were increased significantly (P < 0.05 or P < 0.01). The levels of blood glucose, serum MDA and serum PTH were decreased significantly (P < 0.05 or P < 0.01), the level of blood P had no changes (P > 0.05). The effects in diabetic rats treated with aerobic exercise and melatonin at the same time were much better. Both aero-bic exercise and melatonin can improve diabetic osteoporosis, and the effect of both joint intervention is more significant, it may be associated with oxidative stress by increasing the ability of diabetic rats, regulate glucose metabolism in order to effectively reduce the calcium and PTH, improve BMD to alleviate osteoporosis.

Social work in a Chronic Functional Unit of an acute hospital

Introduction: MútuaTerrassa has designed and developed a model of clinical care, both in prevention and in the treatment of the Chronic Complex Patient (CCP). The Chronic Functional Unit (CFU) was created and implemented in two levels of care: Primary health care (CFU1) and Acute care (CFU2), under a proactive and transversal model.This kind of system was created within the framework of the new models of hospital management in which alternatives are proposed to the conventional hospitalization with the aim of providing better support and health care to the elderly population with chronic complex care needs. The CFU approaches th CCP, from a multidisciplinary point of view, both social and healthcare, setting common objectives, which are specific to each professional, and trying to find the best solution for each patient individually.The role of the social worker (SW) in the chronic patient care is linked to the social risk, the exploration and evaluation of the social resources available to the patient and family and it is based on the continuity of care.Description: In our acute Hospital Universitari MútuaTerrassa, the Social Work intervention is an added value to enhance the well-being and quality of life of patients and their caregivers. Our main goal is to get to know the family profile of patients cared for by Social work Unit (SWU), in order to have an impact on possible points of improvement in attention and coordination after the discharge, since many hospitals readmissions may be associated with inadequate social support and poor accommodation. Likewise we wanted to confirm how many of these patients were previously known by the SWU, through different protocols.Method: The SWU reviewed the list of CCP admitted on a daily basis, and after having identified the previously attended patients, they were proactively monitored. Then, the new admission was discussed by the CFU in the daily session, aiming to draw up the plan of joint intervention of what had been evaluated the previous day. After the initial assessment, social workers inform and advise patients and their families, about possible access to services or specific benefits in the area of Social Welfare, as well as other health or social resources. After the discharge, they make follow-up phone calls at home according to the social situation detected, until the attending social worker takes control so as to promote continuity of care.The data for the descriptive study were collected along 2014.Results: A total of 301 patients were included, median age of 79 years, 58% men. As regards to coexistence: 43% lived with their partner, 18% with children, and 18% lived alone. Primary caregivers were children and partner (79%). Our intervention was due to our own initiative (67%), 12% at the request of the team and 10% of the families. The main requests were social risk assessment (27%) and access to medium and long-term stay unit (17%). Regarding social resources, a 36% had no previous social support. After discharge, 57% returned home, 21% of which with specific health monitoring support, and 12% had moreover some new support. Among other locations, 15% were at a medium and long-term stay unit (15%), 11% returned to their nursing home and 17% were inpatient hospital deaths. Thus 49.5% died throughout the year. The 55% of the coordination was referred to other external social workers. Professionals were not contacted unless the patient died or if they return to their previous nursing home. A relevant 72% had a previous social history.Conclusions- Discussion: It has been confirmed that the Social Work unit already knew the majority of patients evaluated. This fact makes us assume that because they are more fragile, they need advise and support in their daily care. The proactive care has proven effective through the systematic identification, teamwork and networking. It is significant that a large number of patients had no previous social support. Although the cause are not known, we want to remark there should be further research as a new object of study. Another conclusion is that a large percentage of CCP died during the year. Finally, the effort made in terms of the transitional care to ensure the continuity of support to patients and their families has proven necessary.

Association between Epilepsy and Psychogenic Non-Epileptic Seizures: A Case Report

Epilepsy is a very complex disorder of the central nervous system. It is characterized by a sudden, disordered and excessive neuronal shock that causes different clinical evidences with specific related electroencephalogram (EEG). Psychogenic Non-Epileptic Seizures (PNES) can seriously complicate the diagnosis of epilepsy. The separoxysmal events have the same clinical evidences of epilepsy, such as an impairment of the self-control and a range of sensory, motor and mental manifestations, without the typical related electroencephalogram (EEG) because of the absence of an organic cause. The overwhelming majority of Psychogenic Non-Epileptic Seizures are related to psychological factors like dissociation. This is a defense mechanism used to cope stressful events or emotional conflicts. Psychological or psychiatric disorders, like Post Traumatic Stress Disorder (PTSD), are frequently associated to Psychogenic Non-Epileptic Seizures. In this article, we present a case report of epilepsy combined with Psychogenic Non-Epileptic Seizures. A joint intervention is of great significance in this occurrence. The subject received a psychological assessment including psychometric and projective tools. He stood MMPI-2, Wais-R, SCL-90, Rorschach test and graphic tests. A psychological disorder related to defense mechanisms was identified. The subject presents a tendency to convert his fears and emotive pains in rational and more socially acceptable problems, using his body to express his discomfort. Patient with epileptic seizures should receive a psychological assessment to exclude Psychogenic Non-Epileptic Seizures. Further studies should propose guidelines to integrate neurological, psychiatric and psychological intervention.

Implantación de la determinación de hemoglobina glucosilada capilar en un Área de Salud: estudio multicéntrico sobre evolución de pacientes con diabetes mellitus de tipo 2

PurposeThe aim of this study was to evaluate the efficiency of a joint intervention that included educational components, self-assessment, and information to optimise diabetes control through the introduction of instant capillary glycosylated haemoglobin (HbA1c) determination in Primary Care. Materials and methodsA multicentre prospective descriptive study was carried out over 3years in 10Primary Care Centres of the Area VII Murcia East. At the end of the study there were 804 patients with type 2 diabetes (DM2). Patients were divided into 4 groups based on initial values of HbA1c, and if changes in their treatment were needed. HbA1c, body mass index, and blood pressure were monitored. A financial assessment was also performed on the impact of the implementation of a protocol to measure instant capillary ResultsA significant reduction was observed in HbA1c values. The initial HbA1c mean value was 7.4±1.4%, which decreased to a final value of 6.9±1.0% (P<.001). At the end of the study, 71.4% of patients included reached diabetic control objectives. In addition, the financial assessment demonstrated that the implementation of this diabetes control system led to a decrease of the 24.7% in spending on glucose strips after the first year of study in Area VII Murcia Health Service. ConclusionsThe introduction of capillary HbA1c determination in Primary Care has demonstrated to improve diabetes control and the efficiency of the health personnel. Furthermore, a reduction in the health costs of patients with DM2 was also shown.

Research progress of sleep status and intervention strategies in patients with nasopharyngeal carcinoma

Sleep is closely related to the process of treatment and rehabilitation in patients with nasopharyngeal carcinoma (NPC). This paper was summarized from the sleep status and its influencing factors in patients with NPC, adverse effects of sleep disorders, and intervention strategies of sleep for patients with NPC. Intervention strategies were further demonstrated through optimization of nursing strategy, improvement of time management, application of various pharmaceutical nursing, syndrome differentiation based on traditional Chinese medicine, and psychological intervention. In order to improve sleep patterns and enhance quality of life of patients with NPC, several factors such as multidisciplinary joint intervention strategies based on alien breast cancer and prostate cancer abroad; and overall consideration of cultural background, national policy, and expert teams, etc., should be proposed to explore multidisciplinary joint intervention strategies. Key words: Nasopharyngeal carcinoma; Sleep disorder; Strategy; Review

Decreasing Antibiotic use through a Joint Intervention Targeting Physicians and Pharmacists

To decrease population antibiotic use through an educational intervention targeting primary care physicians' and community pharmacists' attitudes and knowledge. We designed a pragmatic cluster-randomized trial covering all National Health System primary care physicians and all community pharmacists' in a region in the north of Portugal. The study protocol was registered on ClinicalTrials.gov (identifier: NCT02173509). After adjustment for baseline values and comparison with the control group, the intervention was associated with a significant reduction in overall antibiotic use in the year following the intervention. The effect was most marked for tetracyclines, macrolides and cephalosporins. No statistically significant differences were observed for fluoroquinolone consumption. Multifaceted interventions involving physicians, pharmacists and general public proved effective in reducing antibiotic consumption in the population.

Effects of phased joint intervention on Rho/ROCK expression levels in patients with portal hypertension.

The current study investigated the effects of phased joint intervention on clinical efficacy and Rho/Rho-associated coil protein kinase (ROCK) expression in patients with portal hypertension complicated by esophageal variceal bleeding (EVB) and hypersplenism. Patients with portal hypertension (n=53) caused by liver cirrhosis complicated by EVB and hypersplenism treated with phased joint intervention were assessed, and portal hemodynamics, blood, liver function, complications, and rebleeding incidence were analyzed. Reverse transcription-quantitative polymerase chain reaction was used to measure Rho, ROCK1 and ROCK2 mRNA expression levels in peripheral blood mononuclear cells prior to and following phased joint intervention, and western blotting was employed to determine the protein expression levels of Rho, ROCK1, ROCK2, phosphorylated (p) myosin phosphatase target subunit 1 (MYPT1) and total-MYPT1. All patients underwent an emergency assessment of hemostasis with a 100% success rate. Varicose veins were alleviated, and portal hemodynamics and liver function improved following intervention. Furthermore, preoperative and postoperative expression levels of Rho, ROCK1 and ROCK2 mRNA were higher compared with the control group. Notably, the mRNA expression levels of Rho, ROCK1 and ROCK2 in the postoperative group were significantly lower when compared with the preoperative group. Protein expression levels of Rho, ROCK1, ROCK2 and pMYPT1 in the postoperative group were lower, as compared with the preoperative group. Concentration levels of transforming growth factor-β1, connective tissue growth factor and platelet-derived growth factor in peripheral blood were significantly reduced following phased joint intervention. Therefore, the present findings demonstrated that phased joint intervention is able to effectively treat EVB and hypersplenism, and improve liver function. The efficacy of phased joint intervention may be associated with its role in the regulation of the Rho-ROCK signaling pathway.

Building inclusive nations in the age of migration

ABSTRACTNation and diversity are often cast in oppositional terms. The present joint intervention explores the limits and possibilities of what we call ‘inclusive nation’, i.e. a nation which embraces rather than expunging diversity. To reflect on this idea, the Loughborough University Nationalism Network (LUNN) organized a symposium, bringing together both academics and relevant stakeholders, to explore both theoretically and practically the feasibility of the inclusive nation. For reason of space, here we present only the theoretical views of academics. While Billig and Yuval-Davis highlight the inherent exclusive thrust of nationalism, Kaufmann and Hearn suggest two distinct ways to move away the traditional understanding of nationalism as a site of singularity, oppression and exclusion. A final rejoinder by Nyhagen pushes the debate further interrogating the boundaries of national belonging.

Joint Mobilization Enhances Mechanisms of Conditioned Pain Modulation in Individuals With Osteoarthritis of the Knee.

An experimental laboratory study with a repeated-measures crossover design. Treatment effects of joint mobilization may occur in part by decreasing excitability of central nociceptive pathways. Impaired conditioned pain modulation (CPM) has been found experimentally in persons with knee and hip osteoarthritis, indicating impaired inhibition of central nociceptive pathways. We hypothesized increased effectiveness of CPM following application of joint mobilization, determined via measures of deep tissue hyperalgesia. To examine the effect of joint mobilization on impaired CPM. An examination of 40 individuals with moderate/severe knee osteoarthritis identified 29 (73%) with impaired CPM. The subjects were randomized to receive 6 minutes of knee joint mobilization (intervention) or manual cutaneous input only, 1 week apart. Deep tissue hyperalgesia was examined via pressure pain thresholds bilaterally at the knee medial joint line and the hand at baseline, postintervention, and post-CPM testing. Further, vibration perception threshold was measured at the medial knee epicondyle at baseline and post-CPM testing. Joint mobilization, but not cutaneous input intervention, resulted in a global increase in pressure pain threshold, indicated by diminished hyperalgesic responses to pressure stimulus. Further, CPM was significantly enhanced following joint mobilization. Diminished baseline vibration perception threshold acuity was enhanced following joint mobilization at the knee that received intervention, but not at the contralateral knee. Resting pain was also significantly lower following the joint intervention. Conditioned pain modulation was enhanced following joint mobilization, demonstrated by a global decrease in deep tissue pressure sensitivity. Joint mobilization may act via enhancement of descending pain mechanisms in patients with painful knee osteoarthritis.

Planejamento de Recursos Humanos de Saúde e Ambiente - aspectos históricos, teóricos e reflexões para políticas públicas em Vigilância em Saúde Ambiental no Brasil.

As relações entre a saúde e o ambiente no âmbito das atribuições do Sistema Único de Saúde é um desafio no cuidado coletivo na perspectiva da identificação, prevenção, controle e das recomendações de processos envolvidos na exposição humana às situações ambientais que possam gerar impacto e consequências negativas para a saúde humana. As reflexões sobre os caminhos da vigilância em saúde ambiental (VSA), seu histórico, conceito, teoria e alternativas metodológicas, que geram informação para tomada de decisão e inclui possibilidades de interpretação e transformação da realidade são os objetivos abordados neste ensaio. A partir de uma pesquisa exploratória sobre a Vigilância em Saúde Ambiental no Brasil, suas práticas e teorias, foi realizada uma revisão sobre a vigilância em saúde ambiental no Brasil, e seu contexto teórico e histórico. O objeto da Vigilância em Saúde Ambiental é a relação sócio ecológica do ambiente, da saúde e da sustentabilidade, e há que se avançar e pensar na análise de situação de saúde ambiental como eixo da discussão do seu objeto produzindo informação qualificada para a intervenção solidária e democrática tendo a saúde como valor que traz a discussão da sustentabilidade, da equidade, com a incorporação de uma política social que interaja condicionando o desenvolvimento econômico e social.