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Prehabilitation: the underutilised weapon for chronic pain management
Get PDFObjective
Prehabilitation encompasses preparatory clinical intervention(s) delivered during the period between diagnosis and treatment commencement. Despite widespread successful usage preoperatively, psychological prehabilitation is neglected in outpatient chronic pain management. Although pain management waitlists are associated with treatment attrition and psychological and physical decline, this time window is underutilised in preventing escalation. Waitlists present an under-explored opportunity to ‘prehabilitate’ patients waiting for treatment. This topical review aimed to: (1) examine the effectiveness of psychological prehabilitation for pain services; (2) evaluate the psychological and physical decline associated with waiting for pain management; (3) highlight key psychological prehabilitative targets for increasing treatment engagement; (4) promote pain management psychological prehabilitation within personalised pain medicine, building recommendations for future interventions.
Methods
Studies regarding the impact of waitlists and prehabilitation for chronic pain were reviewed.
Results
Findings demonstrated that the psychological constructs of patient expectations, health locus of control, self-efficacy and pain catastrophizing dynamically influence attrition, treatment engagement and outcomes while waiting. These constructs are amenable to change, emphasising their potential utility within a targeted waitlist intervention.
Conclusions
Prehabilitating chronic pain patients towards treatment engagement could circumvent cycles of failed treatment seeking, preventing psychological and physical decline, and reducing healthcare utilisation. Utilising the waitlist to identify psychosocial risk factors (external health locus of control, low self-efficacy and high pain catastrophizing) would identify who requires additional support to prevent increased risk of treatment failure, enhancing personalised care before prescribed treatment is accessed. This review cements the urgent need for pain services to engage proactively with prehabilitation innovation
Snakebite-induced reversible cerebral vasoconstriction syndrome: report of three cases
Get PDFEnvenomings from Russell’s viper typically result in local tissue damage and bleeding complications, but the bites from common krait and cobra primarily cause neurotoxic effects. While most symptoms can be treated with appropriate antivenom, additional support is necessary for several snakebite victims to tackle a broad range of unusual complications that they develop following bites. Reversible vasoconstriction syndrome (RCVS), characterised by the constriction of cerebral arteries, is a rare but serious issue, presenting with severe headaches and, in extreme cases, haemorrhagic/ischaemic stroke. This report presents three cases of RCVS in snakebite victims following Russell’s viper, krait and cobra bites. The patients were admitted to the hospital with neurological and/or haematological complications, and they were treated with polyvalent antivenom. After two days of antivenom treatment, all the patients developed intense headaches that lasted for several hours and failed to respond to commonly used analgesics. While the physical, laboratory and computed tomography examinations were normal, the RCVS was diagnosed with multimodal magnetic resonance angiography. All patients were successfully treated with oral nimodipine, and during their follow-ups, physical and laboratory examinations were unremarkable, and the magnetic resonance imaging confirmed the reversal of RCVS. To achieve positive outcomes in patients, clinicians must swiftly identify such rare complications and make accurate diagnoses to provide prompt treatments. Overall, this report presents an unusual complication of RCVS in snakebite patients and appropriate diagnosis and treatment approaches to tackle this condition
Role of vector phenotypic plasticity in disease transmission as illustrated by the spread of dengue virus by Aedes albopictus
Get PDFThe incidence of vector-borne disease is on the rise globally, with burdens increasing in endemic countries and outbreaks occurring in new locations. Effective mitigation and intervention strategies require models that accurately predict both spatial and temporal changes in disease dynamics, but this remains challenging due to the complex and interactive relationships between environmental variation and the vector traits that govern the transmission of vector-borne diseases. Predictions of disease risk in the literature typically assume that vector traits vary instantaneously and independently of population density, and therefore do not capture the delayed response of these same traits to past biotic and abiotic environments. We argue here that to produce accurate predictions of disease risk it is necessary to account for environmentally driven and delayed instances of phenotypic plasticity. To show this, we develop a stage and phenotypically structured model for the invasive mosquito vector, Aedes albopictus, and dengue, the second most prevalent human vector-borne disease worldwide. We find that environmental variation drives a dynamic phenotypic structure in the mosquito population, which accurately predicts global patterns of mosquito trait-abundance dynamics. In turn, this interacts with disease transmission to capture historic dengue outbreaks. By comparing the model to a suite of simpler models, we reveal that it is the delayed phenotypic structure that is critical for accurate prediction. Consequently, the incorporation of vector trait relationships into transmission models is critical to improvement of early warning systems that inform mitigation and control strategies
Cadmium and its effect on the physiology of mycorrhizal and saprotrophic fungi
Get PDFCadmium (Cd) is one of the most harmful metals in the environment, because even in a low
concentration they affect human and other organisms. Cd when in the soil impose severe
threats on crop production and food safety. One of the major remediation techniques is
phytoremediation, which is a use of plants to immobilise or extract heavy metal from the soil.
This thesis studies the effect of Cadmium (Cd) in the mycorrhizal system and in saprotrophic
fungi. The main hypothesis tested was common mycorrhizal network increases the amount of
cadmium extracted from the soil and the cadmium uptake dynamics. In order to understand
that system, ectomycorrhizal fungi were tested under Cd along with its effect on carbon cycling
enzymes. The experiments conducted in this project aimed to investigate the potential of
poplars trees (Populus trichocarpa), colonised by the arbuscular mycorrhizal fungus
Rhizophagus irregularis, to improve metal uptake in the host plant as well as in combination
with different species under contaminated soil with Cd. Additional aims were to investigate
common mycorrhizal networks and their potential to transfer Cd between plants, and to
understand the physiological processes by which Cd can affect ectomycorrhizal and
saprotrophic fungi. Results showed that mycorrhizal P. trichocarpa have increased Cd
accumulation in their roots, which supports their use for Cd phytoextraction. Experiments with
common mycorrhizal networks showed that Cd can be transported between P. trichocarpa
trees. This result opens many other opportunities for exploring this complex system and the
likely importance of having neighbouring plants to establish new vegetation in contaminated
soil. Cd contamination increased the production of GSRP (glomalin) in all arbuscular mycorrhizal
plants, but mostly in leeks. Glomalin as known as soil glycoprotein, which apart from being
responsible for stabilization of soil aggregation also act as a soil protector by binding the metal
under Cd contamination. It was also found that Cd can affect mycorrhizal and soil microorganism
producing of carbon enzymes, however there was a wide variation within different species. Cd
was able to reduce soil enzyme activity of xylanase by 50%, demonstrating how Cd can affect
contaminated areas and its dynamics. Some species of saprotrophic fungi showed a potential to
be used for Cd remediation, but there are a wide range of species to be explored in this field.
This thesis offers new opportunities to explore properties of common mycorrhizal networks and
to enhance our knowledge on Cd contamination. The knowledge gathered in this project may
help further research in Cd remediation technique
Reliance on self-reports and estimated food composition data in nutrition research introduces significant bias that can only be addressed with biomarkers
Get PDFThe chemical composition of foods is complex, variable, and dependent on many factors. This has a major impact on nutrition research as it foundationally affects our ability to adequately assess the actual intake of nutrients and other compounds. In spite of this, accurate data on nutrient intake are key for investigating the associations and causal relationships between intake, health, and disease risk at the service of developing evidence-based dietary guidance that enables improvements in population health. Here, we exemplify the importance of this challenge by investigating the impact of food content variability on nutrition research using three bioactives as model: flavan-3-ols, (–)-epicatechin, and nitrate. Our results show that common approaches aimed at addressing the high compositional variability of even the same foods impede the accurate assessment of nutrient intake generally. This suggests that the results of many nutrition studies using food composition data are potentially unreliable and carry greater limitations than commonly appreciated, consequently resulting in dietary recommendations with significant limitations and unreliable impact on public health. Thus, current challenges related to nutrient intake assessments need to be addressed and mitigated by the development of improved dietary assessment methods involving the use of nutritional biomarkers
Advocating law reform or government policy change as valid charitable purposes
Get PDFThis article argues that, contrary to usual statements of the rule against charities for political objects, case law indicates that a charity can exist for the purpose of proposing changes to the law or to government policy – provided informed proposals are to be formulated from a politically neutral starting point
The moneylender as monster: ‘The Jew’ as transformative influence in Bram Stoker’s The Watter’s Mou’
Get PDFRenshaw’s article examines antisemitic narratives in 1890s Europe through the lens of Bram Stoker’s obscure Gothic novel The Watter’s Mou’ (1895). It will argue that racist conceptions of ‘the Jew’, in both the popular literature of the time and the political discourse of contemporary European societies, had shifted to present Jews as a transformative element in the societies they lived in. In this analysis Jews would not just exploit these non-Jewish populations but ultimately irrevocably change their character, corrupt the non-Jewish ‘indigenous’ inhabitants and render them ‘Hebraic’. Drawing on Stoker’s fiction, primarily the portrayal of the moneylender Solomon Mendoza, various elements of this emerging characterization will be considered. First, the development of the medieval antisemitic archetype of the Jewish usurer will be discussed; how this was expanded to incorporate contemporary anxieties surrounding capitalism and colonialism; and how ‘the Jew’ was viewed as financially exploiting ‘native’ peoples (including the British proletariat) and thus meriting retributive violence. Second, the nature of interactions between ‘the Jew’ as exogenous force and the ‘indigenous’ non-Jewish society (in this case the fishing communities of Cruden Bay where the novel is set) are considered in more detail: not solely positioned as a process of economic exploitation, but also of moral debasement, in which elements of the local society are complicit with ‘the Jew’s’ schemes and the blurring of identities. Finally, Stoker’s preoccupations in his fiction with ‘race’ and religion will be placed in wider antisemitic narratives of the ‘place’ of Jews in fin de siècle European societies. The fate that the villain meets at the end of the story will be located as part of an epochal struggle, as posited by racist populism, between ‘Jewish’ and ‘non-Jewish’ elites for control at the end of the nineteenth century
A systematic review of eating disorders and family functioning
No full textThe purpose of the current review was to address four questions: 1) Are there differences in family functioning or family environment among patients with different eating disorder (ED) diagnoses? 2) Are there differences in the perception of family functioning or family environment among different family members? 3) Is family functioning or family environment related to ED symptomatology? 4) Does family functioning or family environment change as a result of ED treatment? and 4a) If so, does this impact ED treatment outcome? Although most studies found no differences among ED diagnostic groups, those that did generally found worse family functioning among those with binge/purge symptoms than among those with the restricting subtype of anorexia nervosa. Differences in perceptions of family functioning among family members were found, with patients generally reporting worse functioning than their parents. Worse family functioning was generally found to be related to worse ED symptoms. The variety of treatment approaches and different assessments of outcome made it somewhat unclear whether family functioning consistently improves with ED treatment. More research is needed on family functioning and EDs, particularly in understudied groups such as males, and those with ED diagnoses other than anorexia nervosa or bulimia nervosa