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[Abstract] Risk factors for low back pain (LBP) flares have been considered about self-reported measures. This case–crossover study aimed to investigate whether (1) objective measures of physical activity and sleep were associated with the risk of experiencing LBP flares and (2) these associations differed for flares defined as pain 2 or more points greater than average pain over the period using an 11-point Numerical rating scale (0-no pain and 10-worst pain imaginable) (pain-defined flare: PDF) and flares identified by participants according to a broader definition that considered emotions or coping (self-reported flare [SRF]). We included 126 participants who had experienced LBP for >3 months. Physical activity and sleep were monitored for 28 days using wearable sensors. Occurrence of flares (PDF or SRF) was assessed daily using a smartphone application. Data on exposure to risk factors 1, 2, and 3 days preceding PDF or SRF were compared with nonflare control periods. Conditional logistic regression determined association between each factor and flares. Data show that day-to-day variation in physical activity and in-bed time are associated with the risk of LBP flares, but associations differ depending on how flare is defined. Longer in-bed time increased the risk of PDF but not SRF. Although physical activity was not associated with the risk of PDF, greater sedentary behaviour increased the risk of SRF and being more physically active decreased the risk for SRF. These results highlight the potential role of targeting sleep and physical activity in interventions to prevent LBP flares and indicate that risk factors differ depending on how LBP flares are defined.

Background: Patellofemoral pain (PFP) affects one-quarter of adolescents, yet there are few evidence-informed recommendations to treat PFP in this population. HAPPi Kneecaps! is a randomised, controlled, participant- and assessor-blind, parallel-group feasibility trial of shoe inserts for adolescents with PFP. The aim of this qualitative study was to explore adolescents’ perspectives of participating in HAPPi Kneecaps!. Methods: All 36 adolescents with PFP from the HAPPi Kneecaps! study were invited to participate in semi-structured interviews. We used a descriptive qualitative methodology underpinned by a relativist framework to investigate adolescents’ perspectives on participating in the trial. Inductive thematic analysis was used to examine patterns regarding how each adolescent experienced the HAPPi Kneecaps! study within their social, cultural, and historical contexts. Results: 14 out of 36 HAPPi Kneecaps! participants provided consent and participated in interviews (12 females; mean [SD] age 14.9 [2.4] years). Overall, most adolescents responded positively when discussing their experience, such as improvements in their knee pain and satisfaction with how the study was run. Major themes that were generated from the analysis and feedback were: (1) shoe inserts require little effort to use; (2) perceptions of the program were generally positive; (3) participation in the trial could be made easier; (4) warm weather matters; and (5) life happens. Conclusion: Adolescents with PFP who participated in the HAPPi Kneecaps! study found that shoe inserts were easy to wear. Most adolescents experienced an improvement in their symptoms and enhanced participation in sport and exercise. Adolescents with PFP prefer an option for warmer climates (e.g. flip flops or sandals), access to online logbooks, and clinicians who are easily accessible.

[Abstract] Objective. Understanding sleeping behaviours could improve prevention and treatment of sleep problems and associated health conditions. This study aimed to evaluate a method to assess body posture and movement during sleep using trunk-worn accelerometers for 28 nights. Approach. Participants (50 adults with low back pain (66% female); aged 32(±9) years) wore two activPAL-micro sensors (thigh, trunk) during their normal daily life for 28 consecutive days. Parameters related to body posture (e.g. time spent lying supine or prone) and movement (e.g. number of turns) during sleep were calculated for each night. Average values for each parameter were identified for different periods, the Spearman–Brown Prophecy Formula was used to estimate the minimum number of nights required to obtain a reliable estimate of each parameter, and repeatability of measures between different weeks was calculated. Main results. Participants spent 8.1(±0.8) h asleep and most time (44%) was spent in a supine posture. The minimum number of nights required for reliable estimates varied between sleep parameters, range 4–21 nights. The most stable parameters (i.e. requiring less than seven nights) were 'average activity', 'no. of turns', 'time spent prone', and 'posture changes in the first hour'. Some measures differed substantially between weeks. Significance. Most sleep parameters related to body posture and movement require a week or more of monitoring to provide reliable estimates of behaviour over one month. Notably, one week may not reflect behaviour in another week, and the time varying nature of sleep needs to be considered.

Background: Patellofemoral pain (PFP) affects one-third of adolescents and can persist into adulthood, negatively impacting health and quality of life. Foot orthoses are a recommended treatment for adults with PFP, but have not been evaluated in adolescents. The primary objective was to determine the feasibility of conducting a full-scale randomised controlled trial (RCT) evaluating effects of contoured, prefabricated foot orthoses on knee pain severity and patient-perceived global change, compared to flat insoles. The secondary objective was to describe outcomes on a range of patient-reported outcome measures. Methods: We recruited adolescents aged 12–18 years with PFP of ≥2 months duration into a double-blind, randomised, parallel-group feasibility trial. Participants were randomised to receive prefabricated contoured foot orthoses or flat shoe insoles, and followed for 3 months. Participants and outcome assessors were blinded to group allocation. Primary outcomes were feasibility of a full-scale RCT (number of eligible/enrolled volunteers; recruitment rate; adherence with the intervention and logbook completion; adverse effects; success of blinding; drop-out rate), and credibility and expectancy of interventions. Secondary outcomes were patient-reported measures of pain, symptoms, function, quality of life, global rating of change, patient acceptable symptom state, and use of co-interventions. Results: 36 out of 279 (12.9%) volunteers (27 female, mean (SD) age 15 (2) years, body mass 60 (13) kg) were eligible and enrolled, at a recruitment rate of 1.2 participants/week. 17 participants were randomised to receive foot orthoses, and 19 to flat insoles. 15 participants returned logbooks; 7/15 (47%) adhered to the intervention. No serious adverse events were reported. 28% (10/36, 4 pandemic-related) of participants dropped out before 3 months. Blinding was successful. Both groups found the inserts to be credible. Conclusions: Based on a priori criteria for feasibi

Low back pain (LBP) varies over time. Consumers, clinicians, and researchers use various terms to describe LBP fluctuations, such as episodes, recurrences and flares. Although “flare” is use commonly, there is no consensus on how it is defined. This study aimed to obtain consensus for a LBP flare definition using a mixed-method approach. Step 1 involved the derivation of a preliminary candidate flare definition based on thematic analysis of views of 130 consumers in consultation with an expert consumer writer. In step 2, a workshop was conducted to incorporate perspectives of 19 LBP experts into the preliminary flare definition, which resulted in 2 alternative LBP flare definitions. Step 3 refined the definition using a 2-round Delphi consensus with 50 experts in musculoskeletal conditions. The definition favored by experts was further tested with 16 individuals with LBP in step 4, using the definition in three scenarios. This multiphase study produced a definition of LBP flare that distinguishes it from other LBP fluctuations, represents consumers’ views, involves expert consensus, and is understandable by consumers in clinical and research contexts: “A flare-up is a worsening of your condition that lasts from hours to weeks that is difficult to tolerate and generally impacts your usual activities and/or emotions.” Perspective: A multiphase process, incorporating consumers’ views and expert consensus, produced a definition of LBP flare that distinguishes it from other LBP fluctuations.

Low back pain (LBP) varies over time. Consumers, clinicians, and researchers use various terms to describe LBP fluctuations, such as episodes, recurrences and flares. Although “flare” is use commonly, there is no consensus on how it is defined. This study aimed to obtain consensus for a LBP flare definition using a mixed-method approach. Step 1 involved the derivation of a preliminary candidate flare definition based on thematic analysis of views of 130 consumers in consultation with an expert consumer writer. In step 2, a workshop was conducted to incorporate perspectives of 19 LBP experts into the preliminary flare definition, which resulted in 2 alternative LBP flare definitions. Step 3 refined the definition using a 2-round Delphi consensus with 50 experts in musculoskeletal conditions. The definition favored by experts was further tested with 16 individuals with LBP in step 4, using the definition in three scenarios. This multiphase study produced a definition of LBP flare that distinguishes it from other LBP fluctuations, represents consumers’ views, involves expert consensus, and is understandable by consumers in clinical and research contexts: “A flare-up is a worsening of your condition that lasts from hours to weeks that is difficult to tolerate and generally impacts your usual activities and/or emotions.” Perspective: A multiphase process, incorporating consumers’ views and expert consensus, produced a definition of LBP flare that distinguishes it from other LBP fluctuations.

Low back pain (LBP) varies over time. Consumers, clinicians, and researchers use various terms to describe LBP fluctuations, such as episodes, recurrences and flares. Although "flare" is use commonly, there is no consensus on how it is defined. This study aimed to obtain consensus for a LBP flare definition using a mixed-method approach. Step 1 involved the derivation of a preliminary candidate flare definition based on thematic analysis of views of 130 consumers in consultation with an expert consumer writer. In step 2, a workshop was conducted to incorporate perspectives of 19 LBP experts into the preliminary flare definition, which resulted in 2 alternative LBP flare definitions. Step 3 refined the definition using a 2-round Delphi consensus with 50 experts in musculoskeletal conditions. The definition favored by experts was further tested with 16 individuals with LBP in step 4, using the definition in three scenarios. This multiphase study produced a definition of LBP flare that distinguishes it from other LBP fluctuations, represents consumers views, involves expert consensus, and is understandable by consumers in clinical and research contexts: "A flare-up is a worsening of your condition that lasts from hours to weeks that is difficult to tolerate and generally impacts your usual activities and/or emotions." Perspective: A multiphase process, incorporating consumers views and expert consensus, produced a definition of LBP flare that distinguishes it from other LBP fluctuations. (C) 2019 by the American Pain Society, Funding Agencies|National Health and Medical Research Council (NHMRC) of AustraliaNational Health and Medical Research Council of Australia [APP1091302, PH APP1102905, MLF APP1143593, DJH -APP632922]; Centre of Research Excellence grant from the National Health and Medical Research Council (NHMRC) of AustraliaNational Health and Medical Research Council of Australia [APP1079078]

Raising issues of struggles for democratization of the media, seek to demonstrate the influences that these vehicles can bear fruit, as we noted some of the genealogy of Michel Foucault. Therefore, we try to give the clues to an investigation of the effects of power produced by reports of these institutions regarding the rights of children and adolescents; associating the ways the media articulates, the struggles that are waged and its implications on these subjects. Finally, we conclude that the Brazilian media is still very resistant and tariff duties and forge relations of knowledge and power that crystallize in processes of domination, in Brazil, even today., Soulever les questions de la lutte pour la démocratisation des médias et le discours des médias, nous cherchons à démontrer les influences que ces véhicules peuvent porter leurs fruits, comme en témoignent certains de la génération de Michel Foucault. De cette façon, nous essayons de donner les indices à une enquête sur les effets de l'électricité produite par les pratiques des médias avant les droits des enfants et des adolescents, reliant les façons dont le support est articulé, les luttes que se livrent et ses implications sur leur corps. Enfin, nous concluons que les médias brésiliens est toujours agenda des droits très résistant et forger des relations de connaissance et de pouvoir qui se cristallisent dans les processus de domination au Brésil aujourd'hui., Suscitando os temas das lutas por democratização da mídia e os discursos dos meios de comunicação, procuramos demonstrar as influências que esses veículos podem surtir, assim como evidenciamos um pouco da genealogia de Michel Foucault. Dessa maneira, tentamos dar as pistas para uma investigação dos efeitos de poder produzidos pelas práticas midiáticas frente aos direitos de crianças e adolescentes, associando as formas como a mídia se articula, as lutas que estão sendo travadas e as suas implicações sobre seus corpos. Por fim, concluímos que a mídia brasileira ainda é muito resistente à pauta de direitos e forja relações de saber e poder que se cristalizam em processos de dominação, no Brasil, ainda hoje., Desde los temas de inspiración de las luchas por la democratización de los medios de comunicación y los discursos de los medios de comunicación, buscamos demostrar las influencias que estos vehículos pueden ocurrir, así como un poco de genealogia de Michel Foucault. De esta manera, tratamos de dar las claves para una investigación de los efectos de la energía producida por las prácticas de medios impulsado a los derechos de los niños y adolescentes, asociando las formas en que los medios de comunicación está articulado, las batallas que se libran y las consecuencias en sus cuerpos. Por último, podemos concluir que los medios brasileños es aún muy resistentes y derechos arancelarios y forjar relaciones de poder y saber que cristalizan en los procesos de dominación, en Brasil, incluso hoy en día.

Raising issues of struggles for democratization of the media, seek to demonstrate the influences that these vehicles can bear fruit, as we noted some of the genealogy of Michel Foucault. Therefore, we try to give the clues to an investigation of the effects of power produced by reports of these institutions regarding the rights of children and adolescents; associating the ways the media articulates, the struggles that are waged and its implications on these subjects. Finally, we conclude that the Brazilian media is still very resistant and tariff duties and forge relations of knowledge and power that crystallize in processes of domination, in Brazil, even today., Soulever les questions de la lutte pour la démocratisation des médias et le discours des médias, nous cherchons à démontrer les influences que ces véhicules peuvent porter leurs fruits, comme en témoignent certains de la génération de Michel Foucault. De cette façon, nous essayons de donner les indices à une enquête sur les effets de l'électricité produite par les pratiques des médias avant les droits des enfants et des adolescents, reliant les façons dont le support est articulé, les luttes que se livrent et ses implications sur leur corps. Enfin, nous concluons que les médias brésiliens est toujours agenda des droits très résistant et forger des relations de connaissance et de pouvoir qui se cristallisent dans les processus de domination au Brésil aujourd'hui., Suscitando os temas das lutas por democratização da mídia e os discursos dos meios de comunicação, procuramos demonstrar as influências que esses veículos podem surtir, assim como evidenciamos um pouco da genealogia de Michel Foucault. Dessa maneira, tentamos dar as pistas para uma investigação dos efeitos de poder produzidos pelas práticas midiáticas frente aos direitos de crianças e adolescentes, associando as formas como a mídia se articula, as lutas que estão sendo travadas e as suas implicações sobre seus corpos. Por fim, concluímos que a mídia brasileira ainda é muito resistente à pauta de direitos e forja relações de saber e poder que se cristalizam em processos de dominação, no Brasil, ainda hoje., Desde los temas de inspiración de las luchas por la democratización de los medios de comunicación y los discursos de los medios de comunicación, buscamos demostrar las influencias que estos vehículos pueden ocurrir, así como un poco de genealogia de Michel Foucault. De esta manera, tratamos de dar las claves para una investigación de los efectos de la energía producida por las prácticas de medios impulsado a los derechos de los niños y adolescentes, asociando las formas en que los medios de comunicación está articulado, las batallas que se libran y las consecuencias en sus cuerpos. Por último, podemos concluir que los medios brasileños es aún muy resistentes y derechos arancelarios y forjar relaciones de poder y saber que cristalizan en los procesos de dominación, en Brasil, incluso hoy en día.

A study to evaluate the safety and effectiveness of CIMAvax EGF therapeutic vaccine in patients with lung cancer non-small cell stage IIIB or IV treated in primary health care in the province is done during the year Guantánamo, 2011. It was important the insertion of patients with cytohistological confirmation of non-small cell carcinoma of lung in advanced stages who were not candidates for oncospecific therapies because lesions were progressing after receiving supportive care or palliative. 35 patients were evaluated, only 11 of these completed the inclusion and exclusion criteria. Adverse events were registered such as: fever, injection site pain and vomiting. The death rate in the study was 54. 5 %. The survival time was 3. 1 month and survival at inclusion, 1.8 months. The quality of life the patients improved significantly, with low dyspnea and incorporation of patients to their families., Se realiza un estudio con el objetivo de evaluar la seguridad y efectividad de la vacuna terapéutica CIMAvax EGF en pacientes con cáncer de pulmón de células no pequeñas en estadio IIIB ó IV tratados en la Atención Primaria de Salud, en la provincia Guantánamo durante el año 2011. Se trata de un ensayo clínico fase IV, multicéntrico, abierto, no controlado, donde se incluyen pacientes con confirmación citohistológica de carcinoma de células no pequeñas de pulmón en estadios avanzados que no fueran candidatos a las terapias oncoespecíficas o porque las lesiones progresaron con posterioridad a recibir las mismas y solo estuvieran recibiendo los cuidados de soporte o paliativos. Se evaluaron 35 pacientes, de estos, 11, cumplieron con los criterios de inclusión y exclusión. Los eventos adversos que con mayor frecuencia se registraron fueron: fiebre, dolor en sitio de inyección y vómitos. La tasa de fallecimiento en el estudio fue del 54.5 %. El tiempo global de supervivencia fue de 3.1 meses y la supervivencia a la inclusión, 1.8 meses. La calidad de vida de vida de los pacientes mejoró notablemente, con disminución de la disnea e incorporación de los pacientes a su medio familiar.

BACKGROUND:An association between CYP2D6 variation and clinical outcomes among women with breast cancer treated with tamoxifen (TAM) has been demonstrated, such that the presence of 2 functional CYP2D6 alleles was associated with better clinical outcomes. This association is mainly due to the CYP2D6-mediated hydroxylation of N-desmethyltamoxifen (NDT) to yield endoxifen (EDF), which because of its high antiestrogenic potency, is mainly responsible for the therapeutic efficacy of TAM. The aim of this study was to evaluate the relation of CYP2D6 genotyping and phenotyping with EDF levels and [NDT]/[EDF] metabolic ratio in breast cancer patients from South of Brazil under TAM therapy. METHODS:Trough blood samples were collected from 97 patients. CYP2D6 genotyping was performed with a luminex assay and calculation of genotypic activity scores. Tamoxifen and metabolites EDF, NDT, and 4-hydroxy-TAM were measured in plasma by high performance liquid chromatography with photo diode array detector. CYP2D6 phenotyping was performed by the determination of dextromethorphan (DMT) and dextrorphan (DTF) by high-performance liquid chromatography with fluorescence detection at plasma collected 3 hours after oral administration of 33 mg of DMF. Phenotypes were given according to [DMT]/[DTF] metabolic ratio. RESULTS:CYP2D6 genotyping indicated a prevalence of 4.1% poor metabolizer, 4.1% intermediate metabolizer, 49.5% extensive metabolizer slow activity, 39.2% extensive metabolizer fast activity, and 3.1% ultrarapid metabolizer. Genotype (genotypic activity scores) was significantly correlated with phenotype ([DMT]/[DTF]), with a moderate association (rs = -0.463; P < 0.001). Median plasma concentrations (nanograms per milliliter; N = 97) were TAM 57.17; 4-hydroxy-TAM 1.01; EDF 6.21; NDT 125.50. EDF levels were lower in poor metabolizers than that in extensive metabolizers (P < 0.05). Phenotype showed stronger, but still moderate, association with EDF and [NDT]/[EDF] than genotype (r