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Binge drinking (BD) is a common practice among college students. Alcohol consumption has been related to depressive symptoms and certain personality factors, although less is known about the relationship of these variables with BD. The aim of this study was to analyze the relationship of BD with depressive symptoms and personality in university students. We performed a cross-sectional study among students (aged 18–30 years) enrolled in the academic year 2018–2019 at the Faculty of Nursing of the University of Cantabria (Spain). Sociodemographic, academic, and alcohol and other drug use information was collected by means of a semi-structured questionnaire. The Beck Depression Inventory-II was used to measure depressive symptomatology and the Neo Five-Factor Inventory was used for personality. A total of 142 participants were included, 88.03% of which were women. Up to 38.03% were classified as BD. Concerning depressive symptoms, 7.41% of BD were at the moderate-severe level compared to 3.41% of non-BD (p = 0.7096). Regarding personality, the median score for extraversion of BD was 35 (Q1 = 29, Q3 = 40), 32 (Q1 = 28, Q3 = 36) in non-BD (p = 0.0062), conscientiousness scored 34 (Q1 = 30.5, Q3 = 38) points in non-BD, 31.50 (Q1 = 27, Q3 = 37) in BD (p = 0.0224). In conclusion, BD students have higher levels of extraversion and lower levels of responsibility than non-BD students. No significant differences were found between the level of depressive symptomatology between BD and non-BD students.

Background People with carpal tunnel syndrome (CTS) exhibit widespread pressure pain and thermal pain hypersensitivity as a manifestation of central sensitization. The aim of our study was to compare the effectiveness of manual therapy versus surgery for improving pain and nociceptive gain processing in people with CTS. Methods The trial was conducted at a local regional Hospital in Madrid, Spain from August 2014 to February 2015. In this randomized parallel-group, blinded, clinical trial, 100 women with CTS were randomly allocated to either manual therapy (n = 50), who received three sessions (once/week) of manual therapies including desensitization manoeuvres of the central nervous system, or surgical intervention (n = 50) group. Outcomes including pressure pain thresholds (PPT), thermal pain thresholds (HPT or CPT), and pain intensity which were assessed at baseline, and 3, 6, 9 and 12 months after the intervention by an assessor unaware of group assignment. Analysis was by intention to treat with mixed ANCOVAs adjusted for baseline scores. Results At 12 months, 95 women completed the follow-up. Patients receiving manual therapy exhibited higher increases in PPT over the carpal tunnel at 3, 6 and 9 months (all, p

Study Design Randomized parallel-group trial. Background Carpal tunnel syndrome (CTS) is a common pain condition that can be managed surgically or conservatively. Objective To compare the effectiveness of manual therapy versus surgery for improving self-reported function, cervical range of motion, and pinch-tip grip force in women with CTS. Methods In this randomized clinical trial, 100 women with CTS were randomly allocated to either a manual therapy (n = 50) or a surgery (n = 50) group. The primary outcome was self-rated hand function, assessed with the Boston Carpal Tunnel Questionnaire. Secondary outcomes included active cervical range of motion, pinch-tip grip force, and the symptom severity subscale of the Boston Carpal Tunnel Questionnaire. Patients were assessed at baseline and 1, 3, 6, and 12 months after the last treatment by an assessor unaware of group assignment. Analysis was by intention to treat, with mixed analyses of covariance adjusted for baseline scores. Results At 12 months, 94 women completed the follow-up. Analyses showed statistically significant differences in favor of manual therapy at 1 month for self-reported function (mean change, -0.8; 95% confidence interval [CI]: -1.1, -0.5) and pinch-tip grip force on the symptomatic side (thumb-index finger: mean change, 2.0; 95% CI: 1.1, 2.9 and thumb-little finger: mean change, 1.0; 95% CI: 0.5, 1.5). Improvements in self-reported function and pinch grip force were similar between the groups at 3, 6, and 12 months. Both groups reported improvements in symptom severity that were not significantly different at all follow-up periods. No significant changes were observed in pinch-tip grip force on the less symptomatic side and in cervical range of motion in either group. Conclusion Manual therapy and surgery had similar effectiveness for improving self-reported function, symptom severity, and pinch-tip grip force on the symptomatic hand in women with CTS. Neither manual therapy nor surgery resulted in changes in cervical range of motion. Level of Evidence Therapy, level 1b. Prospectively registered September 3, 2014 at www.clinicaltrials.gov (NCT02233660). J Orthop Sports Phys Ther 2017;47(3):151-161. Epub 3 Feb 2017. doi:10.2519/jospt.2017.7090.

Alcohol consumption is common among young people. We performed a preliminary cross-sectional study among students (aged 18&ndash, 30 years) enrolled for the academic year 2018&ndash, 2019 at the Faculty of Nursing, University of Cantabria (Spain). We collected information on psychological and sociographic factors, tobacco and cannabis uses, and levels of physical activity by AUDIT questionnaires and in person interviews. The aim of our study was to assess the potential of binge drinking (BD) to adversely affect memory and executive function. We recruited 103 students, of whom 85% were female. The alcohol use pattern of slightly more than one-half of the total population was classified as BD. Among BD students, one-fourth were smokers, and nearly one-third had tried cannabis. The mean onset for alcohol use was 15.11 years. Despite our relatively small sample size, our results show that there are strong relationships between BD and both smoking and cannabis use.

Background: Urinary incontinence represents a complex problem which commonly affects women and influences their physical, mental and social wellbeing. The objective was to determine the effect of pelvic floor muscle training using a tampon as visual biofeedback. Methods: A non-randomized clinical trial involving 60 women &gt, 18 years of age, both with, and without, urinary incontinence. All women exercised with a program involving visual biofeedback using disposable tampons at home for three months. The compliance rate was 76.8 &plusmn, 24.1 An electromyographic assessment of the pelvic floor was performed and assessments of the impact of the exercise program. Results: 54.5% of women without incontinence and 81.6% of women incontinence reported improvements (p = 0.041). In both groups, there was increased quality life (p &gt, 0.05). The women without incontinence experienced greater improvement in the quality of their sexual relations (Pre 6.8 &plusmn, 1.4&ndash, Post 7.2 &plusmn, 1.0). Conclusions: After the intervention, a high percentage of women showed a statistically significant improvement in their symptoms. The participants reported an increase in quality of life and the women without incontinence reported an improvement in quality of their sexual relations. Our findings suggest that visual BFB for training the PFM may be beneficial for women with or without incontinence.

Background: Cancer patients often suffer from emotional distress as a result of the oncological process. The purpose of our study was to determine whether practice of Jacobson?s relaxation technique reduced consumption of psychotropic and analgesic drugs in a sample of cancer patients. Methods: This was a multicenter pre?post intervention design. Participants were 272 patients aged over 18 years attending 10 Spanish public hospitals with oncological pathologies and anxiety symptoms. The intervention consisted of a protocol of abbreviated progressive muscle relaxation training developed by Bernstein and Borkovec. This was followed up by telephone calls over a 1-month period. The intervention was performed between November 2014 and October 2015. Sociodemographic variables related to the oncological process, mental health variables, and intervention characteristics were measured. Results: A reduction in the consumption of psychotropic and analgesic drugs was observed throughout the follow-up period. Improvement was observed throughout the 4-week follow-up for all the parameters assessed: anxiety, relaxation, concentration, and mastery of the relaxation technique. Conclusions: The practice of abbreviated Jacobson?s relaxation technique can help to decrease the consumption of psychotropic and analgesic drugs. Patients experienced positive changes in all the evaluated parameters, at least during the 1-month follow-up. To confirm these findings, additional long-term studies are needed that include control groups. Trial registration: ISRCTN 81335752, DOI 10.1186/ISRCTN81335752 17. Date of registration: 22/11/2016 (retrospectively registered).

Introduction Pain is a common symptom in cancer patients, and its control and management are complex. Despite the high concomitant use of psychotropic drugs among such patients, the association among pain, inadequate pain control, and psychotropic drug use has not been fully determined. This study examined the prevalence of cancer pain and inadequate pain control and the association with psychotropic drug use. Materials and methods In this cross-sectional study, we investigated 402 medical records obtained by simple random sampling of oncology patients at a hospital in northern Spain from July 2012 to July 2014. Adjusted odds ratios (ORs) were estimated together with their 95% confidence intervals (95% CIs) by unconditional logistic regression for each type of psychotropic drug (anxiolytics, hypnotics, and antidepressants). Results The mean patient age was 61.17 (standard deviation ± 13.14) years; 57.5% were women, 42.5% men. Pain was present in 18.4% of patients and inadequate pain control in 54.2%. We found a statistically significant association between the presence of cancer pain and anxiolytic use (adjusted OR, 3.15; 95% CI, 1.49–6.68) and hypnotic use (adjusted OR, 5.19; 95% CI, 1.77–15.25). Inadequate pain control was associated to a greater extent with the use of those drugs: adjusted OR for anxiolytic use, 4.74 (95% CI, 1.91–11.80); adjusted OR for hypnotic use, 6.09 (95% CI, 1.74–21.32). By contrast, no association was found between pain and antidepressant use (adjusted OR, 0.99). Conclusion The presence of pain and (to a greater extent) poor pain control were associated with increased use of certain psychotropic drugs, such as anxiolytics and hypnotics. There appeared to be no association between pain and antidepressant use.

Introduction Patients with cancer frequently suffer from emotional distress, characterized by psychological symptoms such as anxiety or depression. The presence of psychological symptoms combined with the complex nature of oncology processes can negatively impact patients’ quality of life. We aimed to determine the impact of a relaxation protocol on improving quality of life in a sample of oncological patients treated in the Spanish National Public Health System. Materials and methods We conducted a multicenter interventional study without a control group. In total, 272 patients with different oncologic pathologies and showing symptoms of anxiety were recruited from 10 Spanish public hospitals. The intervention comprised abbreviated progressive muscle relaxation training, according to Bernstein and Borkovec. This was followed by weekly telephone calls to each patient over a 1-month period. We collected sociodemographic variables related to the disease process, including information about mental health and the intervention. Patients’ quality of life was assessed using the Functional Assessment of Cancer Therapy-General (FACT-G) questionnaire. Bivariate and univariate analyses were performed, along with an analysis of multiple correspondences to identify subgroups of patients with similar variations on the FACT-G. Results Patients showed statistically significant improvements on the FACT-G overall score (W = 16806; p

Purpose: To compare the prevalence of migraine headaches in the Romany population with the prevalence in the general Spanish population and to describe its association with demographic and clinical risk factors. Method: A cross-sectional study using data from the 2006 Spanish National Health Survey ( n = 16,079) and the National Health Survey in the Romany Population ( n = 993). Inclusion criteria were migraine headache diagnosed by a neurologist, suffered over the preceding 2 weeks that reduced work or leisure activity by half a day or more. Results: The prevalence of migraine in the Romany population (29.4%, 95% confidence interval [CI] = 26.48-32.53) was significantly higher than in the general Spanish population (12.52%, 95% CI = 11.85-13.22). Females (odds ratio [OR] = 1.56, 95% CI = 1.10-2.21), those ≤40 years old (OR = 4.17, 95% CI = 1.78-9.62), those sleeping ≤8 hours/day or less (OR = 1.85, 95% CI = 1.32-2.59), those with body mass index >30 kg/m2 (OR = 1.75, 95% CI = 1.15-2.65), those suffering from osteoarthritis (OR = 2.59, 95% CI = 1.54-4.36), and those suffering from allergy (OR = 1.69, CI = 1.05-2.71) were associated with higher incidence of migraines. Romanies with migraines reported worse self-perceived health status (OR = 2.11, 95% CI = 1.41-3.15) and higher incidence of depression (OR = 2.09 95% CI = 1.32-3.30) than those without. Discussion: Prevalence of migraines is greater in the Romany living in Spain than in the general Spanish population. Implication for practice: Public health systems should focus prevention campaigns specifically on this population and concentrate on those factors that are potentially modifiable.

Cross sectional cohort study.To analyze the differences in the prevalence of trigger points (TrPs) between patients with acute whiplash-associated disorders (WADs) and healthy controls, and to determine if widespread pressure hypersensitivity and reduced cervical range of motion are related to the presence of TrPs in patients with acute WADs.The relationship between active TrPs and central sensitization is not well understood in patients with acute WADs.Twenty individuals with a high level of disability related to acute WAD and 20 age- and sex-matched controls participated in the study. TrPs in the temporalis, masseter, upper trapezius, levator scapulae, sternocleidomastoid, suboccipital, and scalene muscles were examined. TrPs are defined as hypersensitive spots in a palpable taut band, producing a local twitch response and referred pain when palpated. Pressure pain threshold (PPT) was assessed bilaterally over the C5-6 zygapophyseal joints, second metacarpal, and tibialis anterior muscle. Active cervical range of motion, neck pain, and self-rated disability using the Neck Disability Index were also assessed.The mean ± SD number of TrPs for the patients with acute WAD was 7.3 ± 2.8 (3.4 ± 2.7 were latent TrPs; 3.9 ± 2.5 were active TrPs). In comparison, healthy controls had 1.7 ± 2.2 latent and no active TrPs (P0.01). In patients with acute WAD, the most prevalent sites for active TrPs were the levator scapulae and upper trapezius muscles. The number of active TrPs increased with higher neck pain intensity (P0.001) and a higher number of days since the accident (P=.003). Patients had significantly lower PPTs in all tested locations and less active cervical range of motion than controls (P.001). In the patient group, there were significant negative correlations between the number of active TrPs and PPT over the C5-C6 joints and cervical range of motion in flexion, extension, and rotation in both directions: the greater the number of active TrPs, the lower the bilateral PPT over the neck and the greater the cervical range of motion limitation.The local and referred pain elicited from active TrPs reproduced neck and shoulder pain patterns in individuals with acute WADs with higher levels of disability. Patients with acute WADs exhibited widespread pressure hypersensitivity and reduced cervical mobility. The number of active TrPs was related to higher neck pain intensity, the number of days since the accident, higher pressure pain hypersensitivity over the cervical spine, and reduced active cervical range of motion.

Objectives The main objectives of the current study were (1) to describe the prevalence of disability according to sociodemographic features, self-perceived health status, comorbidity, and lifestyle habits; (2) to determine factors associated with disability in men and women; and (3) to study the time trends prevalence of disability in the period 2000 to 2007. Methods We analyzed data taken from the Spanish National Health Surveys conducted in 2001 (n = 21,058), 2003 (n = 21,650), and 2006 (n = 29,478). For the current study, we included answers from adults aged 65 years and older. The main variable was disability including basic activities of daily living (ADLs), instrumental ADLs (IADLs), and mobility disability. We stratified the adjusted models by the main variables. We analyzed sociodemographic characteristics, self-perceived health status, lifestyle habits, and comorbid conditions using multivariate logistic regression models. Results The total number of individuals aged 65 years and older was 18,325 (11,346 women, 6,979 men). Women were significantly older than men in all the surveys (P < .001). Women showed higher prevalence of disability (ADL, IADL, and mobility) as compared with men in all surveys. Time trends in the total disability prevalence and whole age range showed a significant increase from 2000 to 2007 in both men and women (OR 1.13, 95% CI 1.1–1.7), particularly in individuals with older age. The variables significantly associated with a higher likelihood of reporting ADL and IADL disability were age older than 84, lower educational level, 2 or more comorbid chronic conditions, obesity (only in women), sleeping more than 8 hours per day, and not practicing physical exercise. Finally, variables that increased the probability of having mobility disability were age older than 84 years, lower educational level, 2 or more comorbid chronic conditions, and not practicing physical exercise. In addition, subjects with disability had a worse self-reported health status. Conclusions The current study revealed an increase in disability from 2000 to 2007 in the older Spanish population. We found that age older than 84 years, lower education levels, obesity, not practicing physical activity and sleeping more than 8 hours per day were associated with higher disability. Individuals with disability reported a worse self-perceived health status and a greater number of comorbid conditions.

The Spanish National Sexual Health Survey (SNSHS) is designed to examine sexual activity, sexual behaviors, and sexual health among the Spanish population.To describe sexual activity and behaviors of Spaniards aged ≥ 65 years old focusing on gender differences.A population-based descriptive study was conducted using individual data from the SNSHS. The number of subjects aged ≥ 65 years included was 1,939 (1,118 women, 821 men).Sexual activity, frequency, sexual behaviors, sexual practices, and reasons for lack of sexual activity were assessed from questions included in the survey. Subjects who reported having any sexual practice including giving or receiving kissing and hugging, vaginal intercourse, oral sex, or masturbation, with at least one partner in the previous 12 months were considered as sexually active. We analyzed sociodemographic characteristics, self-rated physical and sexual health, comorbid conditions, and medications using multivariate logistic regression models.Overall, 62.3% of men and 37.4% of elderly women were sexually active (P0.01). The prevalence of sexual inactivity significantly increased with age (P0.01, odds ratio [OR] 5.8, 95% confidence interval 3.8-9.05 men; 6.37, 3.9-10.4 women). Not having a partner was a predictor of sexual inactivity (OR 5.79, 3.98-8.42 men; OR 12.0, 8.4-17.2 women). Worse self-rated sexual health, suffering ≥ 2 comorbid conditions, and taking ≥ 2 medications were associated with higher probability of reporting no sexual activity in both men and women. The most common sexual practices were kissing, hugging, and vaginal intercourse. The most common reasons for sexual inactivity were: partner was physically ill (23%), lack of interest (21%), and the man was a widower (23%).This study provided data on sexual activity in older Spanish adults and has identified potential factors that appear to influence sexuality in the elderly with some gender differences. Current results can have implications for healthcare providers for addressing these concerns in an effective manner.

ObjectivesTo analyze psychological distress, comorbidity, and medication consumption among subjects suffering from disabling migraine compared to non-migraineurs controls and to identify those factors associated with psychological distress in migraine adults.MethodsA case–control study was conducted with data obtained from adults aged 16 years or older [N = 29,478] who participated in the 2006 Spanish National Health Survey. We analyzed socio-demographic characteristics, self-perceived health status, lifestyle habits, presence of concomitant chronic disease, and medication consumption in subjects with disabling migraine the previous two weeks. The 12-item Global Health Questionnaire was used to assess psychological distress.ResultsThe prevalence of disabling migraine among Spanish adults was 2.2 percent [95 percent confidence interval [CI] 2.04–2.37]. Migraine was more prevalent in women [77.5 percent] than men [22.5 percent]. Migraine sufferers showed 1.57 [95 percent CI 1.12–2.19] and 3.68 [95 percent C...

ObjectivesTo describe the association and those factors associated with psychological distress and invalidating musculoskeletal pain [IMP] within Spanish adults.MethodsA case–control study based on data from the 2006 Spanish National Health Survey [N = 29,478] was performed. We identified 1331 subjects with and 1331 subjects without IMP matched by age, gender, and province of residence. Subjects with depression, anxiety, or other mental problems were excluded. The General Health Questionnaire was used to assess psychological distress. Socio-demographic features and health-related variables were also recruited and included in the multivariate logistic regression models.ResultsForty-two percent [95 percent confidence interval [95 percent CI] 39.8–45.2] of IMP sufferers had psychological distress as compared with 18 percent [95 percent CI 16.0–20.2] of those without pain [P

Cross-sectional epidemiological study.To determine the 1-year prevalence of neck pain and low back pain in the Spanish population and their association with sociodemographic and lifestyle habits, self-reported health status and comorbidity with other chronic disorders.No recent population-based epidemiological studies have estimated the prevalence of neck and low back pain in Spain.We analyzed data obtained from adults aged 16 years or older (n = 29,478) who participated in the 2006 Spanish National Health Survey, an ongoing, home-based personal interview which examines a nation-wide representative sample of civilian noninstitutionalized population residing in main family dwellings (household) of Spain. We analyzed prevalence data of neck and low back pain and their relationship with socio-demographic characteristics (sex, age, marital status, educational level, occupational status, or monetary income), self-perceived health status, lifestyle habits (smoking habit, alcohol consumption, sleep habit, physical exercise, or obesity), and the presence of concomitant chronic diseases or symptoms.The 1-year prevalence was 19.5% (95% CI: 18.9-20.1) for neck pain and 19.9% (95% CI: 19.3-20.5) for low back pain. Both neck pain and low back pain were higher among female (26.4% and 24.5%) than male (12.3% and 15.1%). Subjects in the 31 to 50 years group were 1.5 times (95% CI: 1.3-1.8) more likely to report low back pain than participants in the 16 to 30 years group. Individuals reporting neck or low back pain showed worse self-reported health status (OR: 4.9, 95% CI: 4.5-5.3 for neck pain; OR: 4.7, 95% CI: 4.3-5.1 for low back pain) and were more likely to complain of depression (OR: 4.3, 95% CI: 3.9-4.7 or OR: 3.6, 95% CI: 3.3-3.9, respectively). Further, a strong association between neck and low back pain was found (OR: 15.6, 95% CI: 14.2-17.1). Finally, neck pain and low back pain were also associated with several other chronic conditions, particularly arthrosis (OR: 6.5, 95% CI: 6.0-7.0), and headaches (OR: 4.3, 95% CI: 3.9-4.8) for neck pain, and both arthrosis (OR: 5.7, 95% CI: 5.3-6.2), and osteoporosis (OR: 6.3, 95% CI: 5.6-7.2), for low back pain.This Spanish population-based survey showed that neck and low back pain are prevalent and highly associated between them, more frequent in female (particularly neck pain) and associated to worse self-reported health status. Individuals with neck and low back pain were more likely than those without pain to have depression and other painful conditions, including headache and osteoporosis.

Aim An implantable cardioverter-defibrillator is the treatment of choice for ventricular arrhythmias and sudden death. Clinical trials and qualitative studies normally exclude elderly patients. The aim of this study was to describe the experience of elderly Spanish men with an implantable cardioverter-defibrillator. Methods This was a qualitative phenomenological study. Sampling was purposeful and used the snowball technique. Unstructured interviews and recipients' personal accounts were collected. Data collection finished with information saturation. Analysis was performed using the Giorgi proposal with triangulation between research-team members. Data were audited by an external researcher. Results The change and the need to adapt to the new situation can be perceived as a loss of independence by the elderly. The significance of the partner in the Spanish context is particularly relevant during the narration. Also, their view of the world is transformed, they experience an internal change. Additionally, the elderly patient may become confined to their home and shut off from their surroundings, accompanied by a sensation of being "stuck" and "imprisoned" by their own process. Conclusion Elderly recipients can end up "clinging on" to customs as they are felt to define the recipient's identity and utility within their social and personal context. Their partner is of huge significance for elderly recipients. The geriatric health personnel must contribute to promote and maintain activities of daily living in elderly. Future qualitative studies taking an in-depth look at the experience and readjustment process of elderly recipients and the relationship among older people and technological equipment should be further conducted.

Our aim was to analyze the differences in the referred pain patterns and size of the areas of those myofascial trigger points (TrPs) involved in chronic tension type headache (CTTH) including a number of muscles not investigated in previous studies. Thirteen right handed women with CTTH (mean age: 38 ± 6 years) were included. TrPs were bilaterally searched in upper trapezius, sternocleidomastoid, splenius capitis, masseter, levator scapulae, superior oblique (extra-ocular), and suboccipital muscles. TrPs were considered active when both local and referred pain evoked by manual palpation reproduced total or partial pattern similar to a headache attack. The size of the referred pain area of TrPs of each muscle was calculated. The mean number of active TrPs within each CTTH patient was 7 (95% CI 6.2-8.0). A greater number (T = 2.79; p = 0.016) of active TrPs was found at the right side (4.2 ± 1.5) when compared to the left side (2.9 ± 1.0). TrPs in the suboccipital muscles were most prevalent (n = 12; 92%), followed by the superior oblique muscle (n =11/n = 9 right/left side), the upper trapezius muscle (n = 11/n = 6) and the masseter muscle (n = 9/n=7). The ANOVA showed significant differences in the size of the referred pain area between muscles (F = 4.7, p = 0.001), but not between sides (F = 1.1; p = 0.3): as determined by a Bonferroni post hoc analysis the referred pain area elicited by levator scapulae TrPs was significantly greater than the area from the sternocleidomastoid (p = 0.02), masseter (p = 0.003) and superior oblique (p = 0.001) muscles. Multiple active TrPs exist in head, neck and shoulder muscles in women with CTTH. The referred pain areas of TrPs located in neck muscles were larger than the referred pain areas of head muscles. Spatial summation of nociceptive inputs from multiple active TrPs may contribute to clinical manifestations of CTTH.

Background Pain is a common symptom in cancer patients, and its control and management are complex. Despite the high concomitant prevalence of psychotropic drugs in these individuals, the association between pain, inadequate pain control and psychotropic drug use is not well determined. This study aims to determine the prevalence of cancer pain, inadequate pain control and its association with psychotropic drug use. Materials and methods Cross-sectional study. A total of 402 medical records obtained by simple random sampling among all oncology patients in a hospital in northern Spain, seen between 2012 and 2014, were reviewed. Adjusted odds ratios were estimated together with their 95% confidence intervals (95% CI) by unconditional logistic regression for each type of psychotropic drug (anxiolytics, hypnotics and antidepressants). Results Mean patient age was 61.17 (standard deviation [SD] ± 13.14) years; 57.5% were women and 42.5% were men. The prevalence of existence of pain was 18.4% and inadequate pain control was 54.2%. A statistically significant association was found between existence of cancer pain and anxiolytic use (adjusted OR: 3.15; 95% CI: 1.49–6.68) and hypnotic use (adjusted OR: 5.19; 95% CI: 1.77–15.25). Inadequate pain control was associated to a greater extent with the use of these drugs: adjusted OR for anxiolytic use 4.74 (95% CI: 1.91–11.80), adjusted OR for hypnotic use 6.09 (95% CI: 1.74–21.32). In contrast, no association was found between pain and antidepressant use (adjusted OR: 0.99). Conclusion The existence of pain and, to a greater extent, poor pain control, were associated with increased use of certain psychotropic drugs, such as anxiolytics and hypnotics. There appears to be no association between pain and antidepressant use.

Resumen Objetivo Conocer la experiencia diaria de los pacientes con un desfibrilador automatico implantado y los cambios adaptativos que se producen en estos pacientes. Metodo Estudio cualitativo y fenomenologico. Recogida de datos a traves de entrevistas no estructuradas a la mitad de los informantes y, posteriormente, entrevistas semiestructuradas a traves de una guia de preguntas abiertas construida tras las primeras entrevistas no estructuradas y la utilizacion de documentos escritos y narraciones personales de los informantes. Analisis de los datos a traves de la propuesta de Van Manen. Resultados Se analizaron las entrevistas de 10 participantes. Se recogieron variables sociodemograficas y se identificaron los siguientes temas que responden a la pregunta ?como es vivir con un desfibrilador automatico?: es vivir «con las dos caras de la moneda», vivir en una constante espera e incertidumbre, aceptar el cambio, desarrollar estrategias de adaptacion, renegociar la relacion de pareja y la sexualidad, y vivir transformado. Conclusiones Los resultados de este estudio pueden integrarse en la practica clinica de las enfermeras en aspectos como la valoracion tras el alta de cambios en habitos, control del tratamiento, notificacion de descargas, deteccion de ocultacion de sintomas y de estrategias que puedan poner en riesgo al portador. Es preciso desarrollar lineas de investigacion que profundicen en la influencia de otros dispositivos tecnologicos en las personas.

Objective: The aim of this study was to develop a preliminary clinical prediction rule to identify the potential predictors for identifying patients presenting with ankylosing spondylitis who are likely to respond to a specific exercise program. Design: Consecutive patients with ankylosing spondylitis underwent a standardized examination and then received eight physical therapy sessions during a 2-mo period, which included an exercise program based on the treatment of the shortened muscle chains, following the guideline described by the global posture re-education method. Patients were classified as having experienced a successful outcome at 1 mo after discharge based on a 20% reduction on Bath Ankylosing Spondylitis Functional Index and self-report perceived recovery. Potential predictor variables were entered into a stepwise logistic regression model to determine the most accurate set of variables for identifying treatment success. Results: Data from 35 patients were included, of which 16 (46%) experienced a successful outcome. A clinical prediction rule with three variables (physical role >37, bodily pain >27, and Bath Ankylosing Spondylitis Disease Activity Index >31) was identified. The most accurate predictor of success was if the patient exhibited two of the three variables, and the positive likelihood ratio was 1 1.2 (95% confidence interval, 1.7―76.0) and the posttest probability of success increased to 91 %. The accuracy of prediction declined if either 1 /3 (+likelihood ratio = 7.7; 95% confidence interval, 0.52―113.5) or 3/3 (+like-lihood ratio = 2.6, 95% confidence interval, 1.6―4.0) variables were present. Conclusions: The present preliminary clinical prediction rule provides the potential to identify patients with ankylosing spondylitis who are likely to experience short-term follow-up success with a specific exercise program. Future studies are necessary to validate the clinical prediction rule.

The relationship between the changes in forward head posture (FHP), neck mobility and headache parameters was analysed in 25 patients with chronic tension-type headache (CTTH) undergoing a physical therapy programme. Side-view pictures were taken to measure the cranio-vertebral angle in the sitting and standing positions. A cervical goniometer was employed to measure the range of all cervical motions. A headache diary was kept to assess headache intensity, frequency and duration. All patients received six sessions of physical therapy over 3 weeks. Outcomes were assessed at baseline, after treatment and 1 month later. Neck mobility and headache parameters showed a significant improvement after the intervention, whereas posture changes did not reach statistical significance. No correlations were found between FHP, neck mobility and headache parameters at any stage. Changes in these outcomes throughout the study were not correlated either. FHP and neck mobility appear not to be related to headache intensity, duration or frequency in patients suffering from CTTH. Although patients showed a reduction in the range of motion in the neck, it is uncertain whether this is consistent with TTH.

Objective: This paper describes differences in both the presence of trigger points [TrPs] in the masticatory muscles and active mouth opening between subjects with ankylosing spondylitis [AS] and normal healthy control [HNC] subjects. In addition, we assessed the possible correlations between TrPs in the masticatory muscles, active mouth opening, cervical flexion-extension motion, and occiput-to-wall distance.Methods: Twenty subject with AS and 20 matched HNCs participated in this study. One clinician, blinded to the subjects' condition, examined first for TrPs. Trigger points were identified by eliciting referred pain with palpation and increased referred pain with muscle contraction. A second clinician assessed the active mouth opening, the cervical motion in flexion-extension, and the occiput-to-wall distance measurements.Results: Ankylosing spondylitis subjects showed a greater number of TrPs than HNCs [P < 0.001]. Patients showed a more reduced mouth opening and cervical mobility than HNCs [P < 0.001...

A relationship between muscle and joint impairments has been proposed in the literature; however, the prevalence and the extent of a possible correlation between these disorders in a patient population with mechanical neck pain have been documented in only a few papers. Our aims for this cross-sectional study were to assess the prevalence of myofascial trigger points (TrPs) in the upper trapezius, sternocleidomastoid, and levators capulae muscles; the prevalence of posterior-anterior (PA) joint hypomobility in the mid-cervical spine (C3-C6); and the correlation of these impairments in patients presenting with mechanical neck pain. Thirty patients with neck pain were examined for the presence of TrPs, according to the diagnostic criteria described by Simons et al and Gerwin et al, and for the presence of mid-cervical spine join thypomobility as described by Maitland. One clinician first examined for TrPs. A second clinician blinded to the TrP results then examined the patients for PA joint hypomobi...

Objective.—To assess the presence of trigger points (TrPs) in the suboccipital muscles and forward head posture (FHP) in subjects with chronic tension-type headache (CTTH) and in healthy subjects, and to evaluate the relationship of TrPs and FHP with headache intensity, duration, and frequency. Background.—Tension-type headache (TTH) is a prototypical headache in which myofascial TrPs in the cervical and pericranial musculature can play an important role. Design.—A blinded, controlled pilot study. Methods.—Twenty CTTH subjects and 20 matched controls without headache participated. TrPs were identified by eliciting referred pain with palpation, and increased referred pain with muscle contraction. Side-view pictures of each subject were taken in sitting and standing positions, in order to assess FHP by measuring the craniovertebral angle. Both measures were taken by a blinded assessor. A headache diary was kept for 4 weeks in order to assess headache intensity, frequency, and duration. Results.—Sixty-five percent (13/20) CTTH subjects showed active TrPs and 35% (7/20) had latent TrPs in the suboccipital muscles. Six (30%) controls also had latent TrPs. Differences in the presence of suboccipital muscle TrPs between both the groups were significant for active TrPs (P .5). CTTH subjects with active TrPs reported a greater headache intensity and frequency than those with latent TrPs (P < .05). The degree of FHP was greater in CTTH subjects than in controls in both sitting and standing positions (P < .01). Within the CTTH group, there was a negative correlation between the craniovertebral angle and the frequency of headache (rs=−0.6, P < .01, in sitting position; rs=−0.5, P < .05, in standing position). CTTH subjects with active TrPs had a greater FHP than those with latent TrPs, though this difference was not significant. Conclusions.—Suboccipital active TrPs and FHP were associated with CTTH. CCTH subjects with active TrPs reported a greater headache intensity and frequency than those with latent TrPs. The degree of FHP correlated positively with headache duration, headache frequency, and the presence of suboccipital active TrPs.

Literature review of quality of clinical trials.To determine the methodological quality of published randomized controlled trials that used spinal manipulation and/or mobilization to treat patients with tension-type headache (TTH), cervicogenic headache (CeH), and migraine (M) in the last decade.TTH, CeH, and M are the most prevalent types of headaches seen in adults. Individuals who have headaches frequently use physical therapy, manual therapy, or chiropractic care. Randomized controlled trials are considered an optimal method with which to assess the efficacy of any intervention.Computerized literature searches were performed in MEDLINE, EMBASE, COCHRANE, AMED, MANTIS, CINHAL, and PEDro databases. Randomized controlled trials in which spinal manipulation and/or mobilization had been used for TTH, CeH, and M published in a peer-reviewed journal as full text, and with at least 1 clinically relevant outcome measure (ie, headache intensity, duration, or frequency) were reviewed. The methodological quality of the studies was assessed independently by 2 reviewers using a set of predefined criteria.Only 8 studies met all the inclusion criteria. One clinical trial evaluated spinal manipulation and mobilization together, and the remaining 7 assessed spinal manipulative therapy. No controlled trials analyzing exclusively the effects of spinal mobilization were found. Methodological scores ranged from 35 to 56 points out of a theoretical maximum of 100 points, indicating an overall poor methodology of the studies. Only 2 studies obtained a high-quality score (greater than 50 points). No significant differences in quality scores were found based on the type of headache investigated. Methodological quality was not associated with the year of publication (before 2000, or later) nor with the results (positive, neutral, negative) reported in the studies. The most common flaws were a small sample size, the absence of a placebo control group, lack of blinded patients, and no description of the manipulative procedure.There are few published randomized controlled trials analyzing the effectiveness of spinal manipulation and/or mobilization for TTH, CeH, and M in the last decade. In addition, the methodological quality of these papers is typically low. Clearly, there is a need for high-quality randomized controlled trials assessing the effectiveness of these interventions in these headache disorders.

Summary The aim of this pilot study was to compare the effects of a single treatment of the ischemic compression technique with transverse friction massage for myofascial trigger point (MTrP) tenderness. Forty subjects, 17 men and 23 women, aged 19–38 years old, presenting with mechanical neck pain and diagnosed with MTrPs in the upper trapezius muscle, according to the diagnostic criteria described by Simons and by Gerwin, participated in this pilot study. Subjects were divided randomly into two groups: group A which was treated with the ischemic compression technique, and group B which was treated with a transverse friction massage. The outcome measures were the pressure pain threshold (PPT) in the MTrP, and a visual analogue scale assessing local pain evoked by a second application of 2.5kg/cm 2 of pressure on the MTrP. These outcomes were assessed pre-treatment and 2min post-treatment by an assessor blinded to the treatment allocation of the subject. The results showed a significant improvement in the PPT ( P = 0.03 ), and a significant decrease in the visual analogue scores ( P = 0.04 ) within each group. No differences were found between the improvement in both groups ( P = 0.4 ). Ischemic compression technique and transverse friction massage were equally effective in reducing tenderness in MTrPs.

Resumen La osteogenesis imperfecta (OI) constituye, dentro del grupo de las displasias oseas, un conjunto de trastornos congenitos de las fibras de colageno tipo I. Estas mutaciones generan un defecto bioquimico que se traduce en un complejo cuadro clinico: talla baja, deformidades oseas, osteopenia, problemas respiratorios y cardiovasculares, y dentinogenesis imperfecta. Las 3 lineas principales de tratamiento de la OI sobre las que se desarrollan los cuidados de enfermeria son: a) prevenir y controlar las manifestaciones clinicas de la enfermedad, de manera que se favorezca el desarrollo normal del nino; b) promover la maxima independencia fisica, emocional y social del afectado, evitando la aparicion de complicaciones, como fracturas y deformidades, y c) realizar educacion sanitaria al afectado y su entorno, en particular los padres. El objetivo de este trabajo es proporcionar, a traves del estudio de un caso clinico, los conocimientos basicos sobre esta patologia de gran relevancia terapeutica debido a las graves deformidades y discapacidades asociadas.

Patients suffering from cervicogenic headache (CeH) are commonly treated with spinal manipulative therapy. We have analyzed the quality and the outcomes of published, randomized, controlled trials assessing the effectiveness of spinal manipulation in CeH. Among 121 relevant articles, only two met all the inclusion criteria. Methodological quality scores were 8/10 and 7/10 points. Only one of the trials made use of a headache diary. Both the trials reported positive (+) results on headache intensity, headache duration, and medication intake, so that spinal manipulative therapy obtained strong evidence of effectiveness (level 1) with regard to these outcomes. Conversely, spinal manipulation obtained no more than limited evidence (level 3) in reducing headache frequency, as it was analyzed only in one study with positive (+) results. A greater number of well-designed, randomized, controlled trials are required to confirm or refute the effectiveness of spinal manipulation in the management of CeH.

The purpose of this clinical trial was to evaluate the impact of a 4-month comprehensive protocol of strengthening and flexibility exercises developed by our research group versus conventional exercises for patients with Ankylosing Spondylitis (AS) on functional and mobility outcomes.Randomized controlled trial. Forty-five patients diagnosed with AS according to the modified criteria of New York were allocated to control or experimental groups using a random numbers table. The control group was treated with a conventional protocol of physical therapy in AS, whereas the experimental group was treated with the protocol suggested by our research group. The conventional intervention consisted of 20 exercises: motion and flexibility exercises of the cervical, thoracic, and lumbar spine; stretching of the shortened muscles; and chest expansion exercises. The experimental protocol is based on the postural affectation of the AS and the treatment of the shortened muscle chains in these patients according to the Global Posture Reeducation (GPR) method. This intervention employs specific strengthening and flexibility exercises in which the shortened muscle chains are stretched and strengthened. The study lasted 4 mos. During this period, patients received a weekly group session managed by an experienced physiotherapist. Each session lasted an hour, and there were 15 total sessions. Changes in activity, mobility, and functional capacity were evaluated by an assessor blinded to the intervention, using the following previously validated scores from the Bath group: BASMI (tragus to wall distance, modified Schober test, cervical rotation, lumbar side flexion, and intermalleolar distance), BASDAI (The Bath Ankylosing Spondylitis Disease Activity Index), and BASFI (The Bath Ankylosing Spondylitis Functional Index).Both groups showed an improvement (prepost scores) in all the outcome measures, mobility measures of the BASMI index, as well as in BASFI and BASDAI indexes. In the control group, the improvement in tragus to wall distance (P=0.009) and in lumbar side flexion (P=0.02) was statistically significant. Although the rest of the outcomes also improved, they did not reach a significant level (P0.05). In the experimental group, the improvement in all the clinical measures of the BASMI index (P0.01) and in the BASFI index (P=0.003) was statistically significant. The intergroup comparison between the improvement (prepost scores) in both groups showed that the experimental group obtained a greater improvement than the control group in all the clinical measures of the BASMI index, except in tragus to wall distance, as well as in the BASFI index.The experimental protocol developed by our research group, based on the GPR method and specific strengthening and flexibility exercises of the muscle chains, offers promising results in the management of patients suffering from AS. Further trials on this topic are required.

To estimate time trends in the prevalence of neck (NP) and low back pain (LBP) from 2009 to 2012; and to determine the socio-demographic features, self-rated health status, co-morbidity, lifestyle-related habits, and health care service associated with NP and LBP in Spanish adults.The European Health Interview Survey for Spain (2009) and the Spanish National Health Survey (2011).A total of 43,072 subjects were included. We analyzed data collected from the European Health Interview Survey for Spain conducted in 2009 (n = 22,188), and the Spanish National Health Survey in 2011 (n = 20,884). We considered the presence of isolated NP, LBP and both (NPLBP). We analyzed socio-demographic features; self-perceived health status; lifestyle habits; comorbid diseases, and professional treatment using logistic regression models.The prevalence of isolated NP, LBP and NPLBP increased from 2008/9 to 2011/12 (7.86 vs. 8.56 %; 5.18 vs.5.44 %; 10.61 vs.11.12 %, respectively). Being female, increased the probability of isolated NP and NPLBP, but decreased the probability of LBP. The prevalence of all pain localizations increased with older age, lower education level, poor self-rated health, smoker, comorbidities, psychological distress (anxiety or depression), hospital and physiotherapist visits and consumed drugs for pain, in 2008/9 as compared to 2011/12. Moreover, LBP, and NPLBP were associated with obesity, whereas NPLBP was associated with being married.The prevalence of LBP, NP and NPLBP had increased in the last 3 years in Spain.

Objective To assess the trend in prevalence of Spanish adults who engaged in sports activities from 2000 to 2010. Design Retrospective analysis of three population-based cross-sectional surveys conducted on a representative sample of Spanish adults: 2000 (N=5160), 2005 (N=8170) and 2010 (N=8925). Results The overall prevalence of sport-active men increased from 45.8% to 52.12% between 2000 and 2010. Among women the prevalence also increased from 27.26% to 33.27% (adjusted OR 1.03 95% CI 1.02 to 1.04). A significant decrease in the prevalence of sport-active subjects was found as the age increases. Adjusted time trends analysis showed that the prevalence of sport-active women and men increased over time in all age groups, with exception of women aged 15–25 years (adjusted OR 0.99, 0.97 to 1.01). Higher educational level was associated with more sport activity. The first reason for not practising sport was ‘I have no time due to working or studying’. Less than 10% of women and men reported health problems as the reason for not practising any sport. Conclusions Sports participation in Spain has increased between 2000 and 2010 among young-aged and middle-aged adults and decreased among older people. Women showed lower prevalence of sport activity as compared to men.

No study has determined time trends of neck pain and low back pain (NPLBP) in the 20th century in Spain.To estimate current 1-year prevalence of NPLBP using data from the 2009 European Health Survey and to analyze the time trends in the prevalence of NPLBP from 2005 to 2010.Population-based national study.A total of 51,666 subjects were finally included.The 2006 Spanish National Health Survey (SNHS) and the 2009 European Health Interview Survey for Spain (EHISS).We analyzed data from the 2006 SNHS (n=29,478) and the 2009 EHISS (n=22,188). We considered the presence of NP, LBP, and both NPLBP. We analyzed sociodemographic features, self-perceived health status, lifestyle habits, and comorbid diseases using logistic regression models.In 2009, the 1-year prevalence was 5.2% (95% confidence interval 4.8-5.5) for NP, 7.9% (7.4-8.3) for LBP, and 10.6% (10.2-11.1) for NPLBP. Women increased the probability of NP and NPLBP but decreased the probability of LBP. The prevalence of all pain localizations increased with age. Not practicing exercise or being obese was associated with lower NP and higher NPLBP. One-year prevalence of NP decreased from 2006 (7.57%) to 2009 (5.18%) (prevalence ratio [PR] 0.66, 0.60-0.72; men: 0.68, 0.61-0.75; women: 0.66, 0.60-0.72). The prevalence of LBP did not change (PR 0.93, 0.86-101) from 2006 (8.34%) to 2009 (7.86%). The prevalence of NPLBP decreased from 12.53% in 2006 to 10.61% in 2009 (PR 0.81, 0.75-0.86; men: 7.73% to 6.36%, PR 0.80, 0.70-0.90; women: 17.15% to 14.69%, PR 0.81, 0.74-0.87).The prevalence of NP and NPLBP, but not LBP, has decreased in the last years in Spain. NPLBP were associated with similar sociodemographic and lifestyle habits in 2009 compared with 2006.

The purpose of this study is to describe differences in the presence of masseter and temporalis muscle trigger points (TrPs) and jaw opening between individuals with mechanical neck pain and healthy controls.Twenty patients with mechanical neck pain (60% women) without symptoms in the orofacial region, aged 20 to 37 years old, and 20 matched controls participated. Temporalis and masseter muscles were examined for the presence of TrPs in a blinded design. Trigger points were considered active if the subject recognized the pain as a familiar symptom, whereas the TrPs was considered latent if the pain was not recognized as a symptom. Jaw opening was assessed with a ruler.A greater number (P.001) of TrPs in the masticatory muscles were found in patients than in controls. None of the patients or healthy controls recognized the referred pain as familiar; thus, latent rather than active TrPs were found. The distribution of TrPs between groups was different for the masseter (left odds ratio [OR], 3.4; right OR, 8.1; P.001) and temporalis (left OR, 2.8; right OR, 5.7; P.001) muscles. Patients with neck pain had smaller jaw opening than controls (P.001). A negative correlation between active jaw opening and the number of TrPs within the masticatory muscles (r(s) = -0.6; P.001) was found: the greater the number of TrPs, the smaller the jaw opening.For the subjects in this study, those with mechanical chronic neck pain had more latent TrPs in the masticatory muscles and reduced jaw opening compared to healthy controls. These findings may suggest the spread of sensitization from the cervical segment to the trigeminal brain stem sensory nuclear complex.

Background: To estimate trends in leisure time physical activity and physical fitness between 1987-2006 in older Spanish people. Methods: We analyzed data collected from the Spanish National Health Surveys conducted in 1987 (n = 29,647), 1993 (n = 20,707), 1995-1997 (n = 12,800), 2001 (n = 21,058), 2003 (n = 21,650), and 2006 (n = 29,478). The number of subjects aged ¿ 65 years included in the current study was 29,263 (1987: n = 4,958-16.7%; 1993: n = 3,751- 17.8%; 1995-97: n = 2,229-17.4%; 2001: n = 4,356-20.7%; 2003: 6,134-28.3%; 2006: 7,835-26.5%). Main variables included leisure-time physical activity and physical fitness. We analyzed socio-demographic characteristics, self-rated health status, lifestyle habit and co-morbid conditions using multivariate logistic regression models. Results: Women exhibited lower prevalence of leisure time physical activity and physical fitness compared to men (P < 0.05). The multivariate analysis for time trends found that practising leisure time physical activity increased from 1987 to 2006 (P < 0.001). Variables associated with a lower likelihood of practicing leisure time physical activity were: age ¿ 80 years old, ¿ 2 co-morbid chronic conditions, and obesity. Variables associated with lower physical fitness included: age ¿ 80 years, worse self rated health; ¿ 2 medications (only for walking), and obesity. Conclusions: We found an increase in leisure time physical activity in the older Spanish population. Older age, married status, co-morbid conditions, obesity, and worse self-perceived health status were associated with lower activity. Identification of these factors can help to identify individuals at risk for physical inactivity. Fisioterapia, Terapia Ocupacional, Rehabilitación y Medicina Física

The aim of this study was to describe the differences in the presence of myofascial trigger points (TrPs) in the upper trapezius,sternocleidomastoid, levator scapulae and suboccipital muscles between patients presenting with mechanical neck pain and control healthy subjects. Twenty subjects with mechanical neck pain and 20 matched healthy controls participated in this study. TrPs were identified, by an assessor blinded to the subjects' condition, when there was a hypersensible tender spot in a palpable taut band, local twitch response elicited by the snapping palpation of the taut band, and reproduction of the referred pain typical of each TrP. The mean number of TrPs present on each neck pain patient was 4.3 (SD: 0.9), of which 2.5 (SD: 1.3) were latent and 1.8 (SD: 0.8) were active TrPs. Control subjects also exhibited TrPs (mean: 2; SD: 0.8). All were latent TrPs. Differences in the number of TrPs between both study groups were significant for active TrPs (P0.001), but not for latent TrPs (P0.5). Moreover, differences in the distribution of TrPs within the analysed cervical muscles were also significant (P0.01) for all muscles except for both levators capulae. All the examined muscles evoked referred pain patterns contributing to patients' symptoms. Active TrPs were more frequent in patients presenting with mechanical neck pain than in healthy subjects.

Objetivo Comparar la prevalencia de dolor cronico de cabeza, cervical y lumbar en la Comunidad de Madrid analizando diferencias de sexo, y estudiar factores asociados con la presencia de cada uno de estos dolores en las mujeres. Metodos Se analizaron los datos de los sujetos de 16 anos o mas de edad (n = 12,190) que participaron en la Encuesta Regional de Salud de Madrid en el ano 2007. La encuesta incluye los datos recogidos de una poblacion representativa de la region de Madrid que vive en su domicilio. Se analizo la presencia de dolor cronico de cabeza (DC), cervical (DCv) y lumbar (DL). Se investigaron caracteristicas sociodemograficas, percepcion de salud, habitos de vida, estres psicologico, consumo de farmacos, uso de servicios sanitarios, uso de terapias alternativas y patologias cronicas asociadas mediante analisis multivariado. Resultados La prevalencia de DC, DCv y DL fue significativamente mayor (p

An implantable cardioverter-defibrillator is the treatment of choice for ventricular arrhythmias and sudden death. Clinical trials and qualitative studies normally exclude elderly patients. The aim of this study was to describe the experience of elderly Spanish men with an implantable cardioverter-defibrillator.This was a qualitative phenomenological study. Sampling was purposeful and used the snowball technique. Unstructured interviews and recipients' personal accounts were collected. Data collection finished with information saturation. Analysis was performed using the Giorgi proposal with triangulation between research-team members. Data were audited by an external researcher.The change and the need to adapt to the new situation can be perceived as a loss of independence by the elderly. The significance of the partner in the Spanish context is particularly relevant during the narration. Also, their view of the world is transformed, they experience an internal change. Additionally, the elderly patient may become confined to their home and shut off from their surroundings, accompanied by a sensation of being "stuck" and "imprisoned" by their own process.Elderly recipients can end up "clinging on" to customs as they are felt to define the recipient's identity and utility within their social and personal context. Their partner is of huge significance for elderly recipients. The geriatric health personnel must contribute to promote and maintain activities of daily living in elderly. Future qualitative studies taking an in-depth look at the experience and readjustment process of elderly recipients and the relationship among older people and technological equipment should be further conducted.

To determine the differences in widespread pressure pain and thermal hypersensitivity in women with minimal, moderate, and severe carpal tunnel syndrome (CTS) and healthy controls.A total of 72 women with CTS (19 with minimal, 18 with moderate, and 35 with severe) and 19 healthy age-matched women participated. Pressure pain thresholds were bilaterally assessed over the median, ulnar, and radial nerves, the C5 to C6 zygapophyseal joint, the carpal tunnel, and the tibialis anterior muscle. In addition, warm and cold detection thresholds and heat and cold pain thresholds were bilaterally assessed over the carpal tunnel and the thenar eminence. All outcome parameters were assessed by an assessor blinded to the participant's condition.No significant differences in pain parameters among patients with minimal, moderate, and severe CTS were found. The results showed that PPT were significantly decreased bilaterally over the median, ulnar, and radial nerve trunks, the carpal tunnel, C5 to C6 zygapophyseal joint, and the tibialis anterior muscle in patients with minimal, moderate, or severe CTS as compared with healthy controls (all, P0.001). In addition, patients with CTS also showed lower heat pain threshold and reduced cold pain threshold compared with controls (P0.001). No significant sensory differences between minimal, moderate, or severe CTS were found.The similar widespread pressure and thermal hypersensitivity in patients with minimal, moderate, or severe CTS and pain intensity suggests that increased pain sensitivity is not related to electrodiagnostic findings.

Objectives: To determine whether the local and referred pain from active myofascial trigger points (MTrPs) reproduce the overall spontaneous fibromyalgia syndrome (FMS) pain pattern and whether widespread pressure hypersensitivity is related to the presence of widespread active MTrPs in FMS. Methods: Forty-four women with FMS (mean age: 47 ± 8 y) and 50 comparable healthy women (age: 48 ± 7 y) participated in the study. MTrPs in the temporalis, masseter, upper trapezius, splenius capitis, sternocleidomastoid, suboccipital, levator scapulae, scalene, pectoralis major, extensor carpi radialis brevis, extensor digitorum communis, gluteus maximus, piriformis, vastus medialis, and tibialis anterior muscles were explored. Pressure pain thresholds over 18 tender points specified in the 1990 American College of Rheumatology for FMS were also assessed by an assessor blinded to the condition of the participants. Results: The mean ± SD number of MTrPs for each woman with FMS was 11 ± 3, of which 10 ± were active MTrPs and the remaining 1 ± 1 were latent. Healthy controls only had latent MTrPs (mean±SD: 2 ± 1). The combination of the referred pain patterns from active MTrPs fully reproduced the overall spontaneous clinical pain area in patients with FMS. Patients with FMS had significant lower PPT compared with controls (P < 0.001). Within FMS, a significant positive correlation was found between the number of active MTrPs and spontaneous pain intensity (r s = 0.455; P = 0.002). Conclusions: The local and referred pain elicited from widespread active MTrPs fully reproduced the overall spontaneous clinical pain area in patients with FMS. Widespread mechanical pain hypersensitivity was related to a greater number of active MTrPs. This study suggests that nociceptive inputs from active MTrPs may contribute to central sensitization in FMS.

Objective. To compare differences in the prevalence and the anatomical localization of the referred pain areas of active trigger points (TrPs) in head and neck musculature between adults and children with chronic tension-type headache (CTTH). Design. A cross-sectional study. Setting. Some studies had found that referred pain from active TrPs reproduce the head pain pattern in adults. No study has compared clinical differences between referred pain patterns elicited by active TrPs between adults and children with CTTH. Patients. Twenty adults (10 men, 10 women, mean age: 41 ± 11 years) and 20 children (10 boys, 10 girls, mean age: 8 ± 2 years) with CTTH were included. Outcome Measures. Bilateral temporalis, sternocleidomastoid, upper trapezius, and suboccipital muscles were examined for TrPs. TrPs were identified by palpation and considered active when local and referred pains reproduce the headache pain attacks. The referred pain areas were drawn on anatomical maps, digitalized, and also measured. An analysis technique based on a center of gravity (COG) method was used to provide a quantitative estimate of the localization of the TrP referred pain areas. Results. Adults with CTTH exhibited a greater years with headache, higher intensity, and longer headache duration (P

Our aim was to describe the referred pain patterns and size of areas of trigger points (TrPs) in the masticatory and neck-shoulder muscles of women with myofascial temporomandibular disorders (TMD). Twenty-five women with myofascial TMD and 25 healthy matched women participated. Bilateral temporalis, deep masseter, superficial masseter, sternocleidomastoid, upper trapezius and suboccipital muscles were examined for TrPs by an assessor blinded to the subjects' condition. TrPs were identified with manual palpation and categorized into active and latent according to proposed criteria. The referred pain areas were drawn on anatomical maps, digitalized, and measured. The occurrence of active (P < .001) and latent TrPs (P = .04) were different between groups. In all muscles, there were significantly more active and latent TrP in patients than controls (P < .001). Significant differences in referred pain areas between groups (P < .001) and muscles (P < .001) were found: the referred pain areas were larger in patients (P < .001), and the referred pain area elicited by suboccipital TrPs was greater than the referred pain from other TrPs (P < .001). Referred pain areas from neck TrPs were greater than the pain areas from masticatory muscle TrPs (P < .01). Referred pain areas of masticatory TrPs were not different (P > .703). The local and referred pain elicited from active TrPs in the masticatory and neck-shoulder muscles shared similar pain pattern as spontaneous TMD, which supports the concept of peripheral and central sensitization mechanisms in myofascial TMD. PERSPECTIVE: The current study showed the existence of multiple active muscle TrPs in the masticatory and neck-shoulder muscles in women with myofascial TMD pain. The local and referred pain elicited from active TrPs reproduced pain complaints in these patients. Further, referred pain areas were larger in TMD pain patients than in healthy controls. The results are also in accordance with the notion of peripheral and central sensitization mechanisms in patients with myofascial TMD.

Our aim was to describe the differences in the presence of trigger points (TrPs) in the shoulder muscles and to investigate the presence of mechanical hypersensitivity in patients with unilateral shoulder impingement and healthy controls. Twelve patients with strictly unilateral shoulder impingement and 10 matched controls were recruited. TrPs in the levator scapula, supraspinatus, infraspinatus, subscapularis, pectoralis major, and biceps brachii muscles were explored. TrPs were considered active if the local and referred pain reproduced the pain symptoms and the patient recognized the pain as a familiar pain. Pressure pain thresholds (PPT) were assessed over the levator scapulae, supraspinatus, infraspinatus, pectoralis major, biceps brachii, and tibialis anterior muscles. Both explorations were randomly done by an assessor blinded to the subjects' condition. Patients with shoulder impingement have a greater number of active (mean +/- SD: 2.5 +/- 1; P < 0.001) and latent (mean +/- SD: 2 +/- 1; P = 0.003) TrPs when compared to controls (only latent TrPs, mean +/- SD: 1 +/- 1). Active TrPs in the supraspinatus (67%), infraspinatus (42%), and subscapularis (42%) muscles were the most prevalent in the patient group. Patients showed a significant lower PPT in all muscles when compared to controls (P < 0.001). Within the patient group a significant positive correlation between the number of TrPs and pain intensity (r (s) = 0.578; P = 0.045) was found. Active TrPs in some muscles were associated to greater pain intensity and lower PPTs when compared to those with latent TrPs in the same muscles (P < 0.05). Significant negative correlations between pain intensity and PPT levels were found. Patients with shoulder impingement showed widespread pressure hypersensitivity and active TrPs in the shoulder muscles, which reproduce their clinical pain symptoms. Our results suggest both peripheral and central sensitisation mechanisms in patients with shoulder impingement syndrome.

This article features an individual example describing the multifactorial interventions of community nursing and a multidisciplinary team as they assess an older man’s progressive functional decline, changes in behavior, and loss of previous social habits after being discharged from the hospital for the treatment of community-acquired pneumonia. Such nursing evaluation should include the following aspects: social environment, home environment, neighborhood characteristics, architectural barriers, capacity to perform activities of daily living, walking difficulties, risk of falling, changes in behavior and social habits, cognitive-affective state, pharmacological management, and the existence of nearby social organizations. The different approaches of community nursing and the multidisciplinary team are discussed.