The stigmatisation of people with chronic back pain

This study responded to the need for better theoretical understanding of experiences that shape the beliefs, attitudes and needs of chronic back patients attending pain clinics. The aim was explore and conceptualise the experiences of people of working age who seek help from pain clinics for chronic back pain. Methods. This was a qualitative study, based on an interpretative phenomenological approach (IPA). During in-depth interviews in their homes, participants were invited to 'tell their story' from the time their pain began. Participants were twelve male and six female patients, aged between 28 and 62 years, diagnosed as having chronic benign back pain. All had recently attended one of two pain clinics as new referrals. The interview transcripts were analysed thematically. Findings. Stigmatisation emerged as a key theme from the narrative accounts of participants. The findings expose subtle as well as overt stigmatising responses by family, friends, health professionals and the general public which appeared to have a profound effect on the perceptions, self esteem and behaviours of those interviewed. Conclusions. The findings suggest that patients with chronic back pain feel stigmatised by the time they attend pain clinics and this may affect their attitudes and behaviours towards those offering professional help. Theories of chronic pain need to accommodate these responses, while pain management programmes need to address the realities and practicalities of dealing with stigma in everyday life

M & L Jaargang 13/5

GeneriekHedwig Van Den Bossche Het Metselaarshuis te Gent, bericht van een omstreden restauratie. [The Metselaarshuis in Ghent, report of a controversial restoration.]Drie jaar terug en ruim 15 jaar na een eerste slopingsaanvraag, werd met de oplevering van de restauratiewerken aan het Gentse Metselaershuis het laatste hoofdstuk afgesloten van een onvoorspelbaar suspense-verhaal. Het hybried ogende hoekgebouw bleef sindsdien geenszins onbesproken, noch onbespreekbaar voor de monumentenzorger. Hedwig Van den Bossche, die de hele operatie van nabij meemaakte, tracht hierbij op verhelderende wijze het weinig evidente samengaan van nieuwbouw, reconstructie en conservering te toetsen aan het zo veraf lijkende Charter van Venetië.Guido Jan Bral m.m.v. E. Denekens en Sander Peters Sint-Jozef, De Duivels en Het Paradijs. De restauratie van drie huizen aan de Haverwerf te Mechelen. [Sint-Jozef, De Duivels and Het Paradijs the restoration of three houses at the Haverwerf in Mechelen.]Het herstel, zoniet de reconstructie van gevelpolychromieën blijft bij historische gebouwen nog meer uitzondering dan regel.Bij dit schilderachtige Mechelse triool zag Guido Jan Bral de kans schoon om de conclusies van zijn voorafgaandelijk kleurenonderzoek ook in werkelijkheid om te zetten. Om deze en andere redenen een \u27harde\u27 maar boeiende restauratie, waarvoor een omzichtige en zorgvuldige argumentatie wordt opgebouwd.Anne Malliet Antwerpen-Dam. Een station op het spoor gezet. [Antwerpen-Dam, a station on the right track.]Een ten top gedreven vorm van conservering overkwam in 1907 het spoorwegstation Antwerpen-Dam, met de integrale verplaatsing naar een meer geschikte standplaats.Grotendeels de verdienste van de onverstoorbare ingenieurs Morglia en Weiss, bleef de krachtproef vereeuwigd in een reeks sprekende prentbriefkaarten. Nu dit oudste Antwerpse reizigersstation opnieuw het verder uitdeinende treinverkeer blijkt te hinderen, blikt Anne Malliet even terug op het toenmalig spectaculair gebeuren.SummaryM&L Binnenkran

Every-Other-Day Versus Once-a-Week Urethra-Sparing Prostate Stereotactic Body Radiation Therapy: 5-Year Results of a Randomized Phase 2 Trial

Purpose: The objective of this study was to present the 5-year results from a prospective, multicenter, phase 2 randomized trial of every-other-day (EOD) versus once-a-week (QW) urethra-sparing stereotactic body radiation therapy for localized prostate cancer. Methods and Materials: Between 2012 and 2015, 170 patients with cT1c-3aN0M0 prostate cancer from 9 European institutions were randomized to 36.25 Gy in 5 fractions (6.5 Gy/fraction to the urethra) delivered either EOD (arm A, n = 84) or QW (arm B, n = 86). The median follow-up was 78 months (interquartile range, 66-89 months) and 77 months (interquartile range, 66-82 months) for arms A and B, respectively. Results: Among the 165 patients treated and retained for the final analysis (arm A, n = 82; arm B, n = 83), acute toxicity (National Cancer Institute Common Terminology Criteria for Adverse Events version 4.03 scale) was mild or absent, with no differences between arms. The 5-year grade 2 or greater genitourinary toxicity-free survival was 75.9% and 76.1% for arms A and B, respectively (P =.945), whereas the 5-year grade 2 or greater gastrointestinal toxicity-free survival was 89% and 92% for arms A and B, respectively (P =.596). No changes in European Organisation for Research and Treatment of Cancer QLQ-PR25 scores were observed in both arms for genitourinary, gastrointestinal, and sexual domains at 5-year follow-up compared with baseline. At the last follow-up, biochemical failure was observed in 14 patients in the EOD arm and in 7 patients in the QW arm, with a 5-year biochemical relapse-free survival rate of 92.2% and 93% for arms A and B, respectively (P =.13). Conclusions: Stereotactic body radiation therapy for prostate cancer with a 10% dose reduction to urethra was associated with a minimal effect on urinary function and quality of life regardless of an EOD or QW fractionation schedule. Biochemical control so far has been encouraging and much alike in both study arms, although longer follow-up is probably needed to assess the true value of overall treatment time on disease outcome

Antiaging Glycopeptide Protects Human Islets Against Tacrolimus-Related Injury and Facilitates Engraftment in Mice

Clinical islet transplantation has become an established treatment modality for selected patients with type 1 diabetes. However, a large proportion of transplanted islets is lost through multiple factors, including immunosuppressant-related toxicity, often requiring more than one donor to achieve insulin independence. On the basis of the cytoprotective capabilities of antifreeze proteins (AFPs), we hypothesized that supplementation of islets with synthetic AFP analog antiaging glycopeptide (AAGP) would enhance posttransplant engraftment and function and protect against tacrolimus (Tac) toxicity. In vitro and in vivo islet Tac exposure elicited significant but reversible reduction in insulin secretion in both mouse and human islets. Supplementation with AAGP resulted in improvement of islet survival (Tac+ vs. Tac+AAGP, 31.5% vs. 67.6%, P &amp;lt; 0.01) coupled with better insulin secretion (area under the curve: Tac+ vs. Tac+AAGP, 7.3 vs. 129.2 mmol/L/60 min, P &amp;lt; 0.001). The addition of AAGP reduced oxidative stress, enhanced insulin exocytosis, improved apoptosis, and improved engraftment in mice by decreasing expression of interleukin (IL)-1β, IL-6, keratinocyte chemokine, and tumor necrosis factor-α. Finally, transplant efficacy was superior in the Tac+AAGP group and was similar to islets not exposed to Tac, despite receiving continuous treatment for a limited time. Thus, supplementation with AAGP during culture improves islet potency and attenuates long-term Tac-induced graft dysfunction.</jats:p