Twenty-five years with the biopsychosocial model of low back pain-is it time to celebrate?:A report from the twelfth international forum for primary care research on low back pain

Study Design: An integrated review of current knowledge about the biopsychosocial model of back pain for understanding etiology, prognosis, and interventions, as presented at the plenary sessions of the XII International Forum on LBP Research in Primary Care (Denmark; October 17–19, 2012). Objective: To evaluate the utility of the model in reference to rising rates of back pain-related disability, by identifying (a) the most promising avenues for future research in biological, psychological, and social approaches, (b) promising combinations of all 3 approaches, and (c) obstacles to effective implementation of biopsychosocial-based research and clinical practice. Summary of Background Data: The biopsychosocial model of back pain has become a dominant model in the conceptualization of the etiology and prognosis of back pain, and has led to the development and testing of many interventions. Despite this back pain remains a leading source of disability worldwide. Methods: The review is a synthesis based on the plenary sessions and discussions at the XII International Forum on LBP Research in Primary Care. The presentations included evidence-based reviews of the current state of knowledge in each of the 3 areas (biological, psychological, and social), identification of obstacles to effective implementation and missed opportunities, and identification of the most promising paths for future research. Results: Although there is good evidence for the role of biological, psychological, and social factors in the etiology and prognosis of back pain, synthesis of the 3 in research and clinical practice has been suboptimal. Conclusion: The utility of the biopsychosocial framework cannot be fully assessed until we truly adopt and apply it in research and clinical practice

Understanding the hospital sharps injury reporting pathway

INTRODUCTION: Patient-care workers are frequently exposed to sharps injuries, which can involve the risk of serious illness. Underreporting of these injuries can compromise prevention efforts. MATERIALS AND METHODS: We linked survey responses of 1572 non-physician patient-care workers with the Occupational Health Services (OHS) database at two academic hospitals. We determined whether survey respondents who said they had sharps injuries indicated that they had reported them and whether reported injuries were recorded in the OHS database. RESULTS: Respondents said that they reported 62 of 78 sharps injuries occurring over a 12-month period. Only 28 appeared in the OHS data. Safety practices were positively associated with respondents’ saying they reported sharps injuries but not with whether reported injuries appeared in the OHS data. CONCLUSIONS: Administrators should consider creating reporting mechanisms that are simpler and more direct. Administrators and researchers should attempt to understand how incidents might be lost before they are recorded

Cidofovir for the Treatment of Recurrent Respiratory Papillomatosis: A Review of the Literature

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/90089/1/phco.2005.25.7.977.pd

Language Conflict: A Case Study of National Language Selection in Iran

Iran is a complex nation composed of many nationalities and languages. Through the centuries, it has been plagued by interethnic conflicts, and rapid modernization in this century has exacerbated longstanding differences, especially between the dominant, Farsi speaking group and Iran\u27s numerous non-Farsi speaking minorities. No issue has symbolized Iran\u27s interethnic conflicts in this century more than language problems. Iran\u27s history of language conflict is treated as a case study through which to explore more universal dynamics of language conflict. Emphasis is laid on the historical development of ethnic attitudes, the function of language as a symbol of ethnicity, the necessity of examining the cultural basis of a nation in order to best address the issue of national language choice, and socio-psychological attitudes which inhibit compromise. Some parallels to bilingual issues in this country are drawn

Questionnaire tools for the diagnosis of carpal tunnel syndrome from the patient history

Introduction: There remains no “gold standard” for the diagnosis of carpal tunnel syndrome (CTS). Clinical diagnosis is often held to be paramount but depends on the skills of the individual practitioner. We describe two mathematical approaches to the analysis of a history obtained by questionnaire. Methods: We used two earlier instruments, a conventional logistic regression analysis, and an artificial neural network to analyze data from 5860 patients referred for diagnosis of hand symptoms. We evaluated their ability to predict whether nerve conduction studies would show evidence of CTS using receiver operating characteristic curves. Results: Both new instruments outperformed the existing tools, achieving sensitivity of 88% and specificity of 50% in predicting abnormal median nerve conduction. When combined, 96% sensitivity and 50% specificity were achieved. Conclusion: The combined instrument can be used as a preliminary screening tool for CTS, for self-diagnosis, and as a supplement to diagnosis in primary care

Implementation Science and Employer Disability Practices: Embedding Implementation Factors in Research Designs

Purpose For work disability research to have an impact on employer policies and practices it is important for such research to acknowledge and incorporate relevant aspects of the workplace. The goal of this article is to summarize recent theoretical and methodological advances in the field of Implementation Science, relate these to research of employer disability management practices, and recommend future research priorities. Methods The authors participated in a year-long collaboration culminating in an invited 3-day conference, “Improving Research of Employer Practices to Prevent Disability”, held October 14–16, 2015, in Hopkinton, MA, USA. The collaboration included a topical review of the literature, group conference calls to identify key areas and challenges, drafting of initial documents, review of industry publications, and a conference presentation that included feedback from peer researchers and a question/answer session with a special panel of knowledge experts with direct employer experience. Results A 4-phase implementation model including both outer and inner contexts was adopted as the most appropriate conceptual framework, and aligned well with the set of process evaluation factors described in both the work disability prevention literature and the grey literature. Innovative interventions involving disability risk screening and psychologically-based interventions have been slow to gain traction among employers and insurers. Research recommendations to address this are : (1) to assess organizational culture and readiness for change in addition to individual factors; (2) to conduct process evaluations alongside controlled trials; (3) to analyze decision-making factors among stakeholders; and (4 ) to solicit input from employers and insurers during early phases of study design. Conclusions Future research interventions involving workplace support and involvement to prevent disability may be more feasible for implementation if organizational decision-making factors are imbedded in research designs and interventions are developed to take account of these influences

Management of work-relevant upper limb disorders: a review

Background Upper limb disorders (ULDs) are clinically challenging and responsible for considerable work loss. There is a need to determine effective approaches for their management. Aim To determine evidence-based management strategies for work-relevant ULDs and explore whether a biopsychosocial approach is appropriate. Methods Literature review using a best evidence synthesis. Data from articles identified through systematic searching of electronic databases and citation tracking were extracted into evidence tables. The information was synthesized into high-level evidence statements, which were ordered into themes covering classification/diagnosis, epidemiology, associations/risks and management/treatment, focusing on return to work or work retention and taking account of distinctions between non-specific complaints and specific diagnoses. Results Neither biomedical treatment nor ergonomic workplace interventions alone offer an optimal solution; rather, multimodal interventions show considerable promise, particularly for occupational outcomes. Early return to work, or work retention, is an important goal for most cases and may be facilitated, where necessary, by transitional work arrangements. The emergent evidence indicates that successful management strategies require all the players to be onside and acting in a coordinated fashion; this requires engaging employers and workers to participate. Conclusions The biopsychosocial model applies: biological considerations should not be ignored, but psychosocial factors are more influential for occupational outcomes. Implementation of interventions that address the full range of psychosocial issues will require a cultural shift in the way the relationship between upper limb complaints and work is conceived and handled. Dissemination of evidence-based messages can contribute to the needed cultural shift

Employer Policies and Practices to Manage and Prevent Disability: Foreword to the Special Issue

Purpose Employer policies and practices have been shown to impact workplace disability, but research in this area has waned in recent years despite an aging workforce, a growing prevalence of chronic health conditions, and a larger proportion of working-age adults on permanent work disability in many jurisdictions. The purpose of this article is to describe the background rationale and methodology for an invited conference designed to improve research of employer strategies to curtail work disability. Methods A multidisciplinary team of 26 international researchers with published research in employer-based disability management or related fields were invited to attend a 3-day conference in Hopkinton, Massachusetts, USA. The overall goal was to review the status of current research of workplace disability management and prevention, examine its relevance for employer decision-making, compare conceptual frameworks or theoretical perspectives, and recommend future research directions. Working groups were organized and draft manuscripts were prepared in advance. Conference activities included working group presentations and critiques, discussions with a panel of industry consultants and advisors, group interaction and debate, generation of final recommendations, and manuscript revision. Results/Conclusion Six principal domains were established with respect to future research: (a) further elucidation of the key workplace factors that buffer the disabling effects of injury and illness; (b) more innovative and feasible options for workplace intervention; (c) measurement of workplace-relevant disability outcomes; (d) a stronger theoretical framework for understanding the factors behind employer uptake and implementation; (e) a focus on special clinical populations and occupations where disability risk is most troubling; and (f) better representation of workers and employers that reflect the diverse and changing nature of work. Final comments and recommendations of the working groups are presented in the following six articles in this special issue of the Journal of Occupational Rehabilitation. Conference attendees recommended changes in methodology, collaboration strategies, and theoretical perspectives to improve the practical and scientific impact of future research of employer practices

Pathways to Agroecological Market Inclusion for Peri-Urban Farmers in Berazategui, Argentina

Argentina is home to the largest population of Bolivians outside of Bolivia, the majority of whom have settled within the Buenos Aires Metropolitan Area (AMBA). A high concentration of Bolivian migrants practice diversified horticultural family-scale farming within AMBA’s peri-urban zone (the buffer area between urban and surrounding rural areas). Aside from segmented producer organizations, peri-urban farmers are largely fragmented and excluded from opportunities for market integration. This project was a result of a partnership between Dr. Amanda Crump’s Research Group on Agricultural Equity at the University of California, Davis, Dr. Gustavo Tito at Argentina's National Agricultural Technology Institute (INTA) and Dr. Percy Nugent at Arturo Jauretche National University. Together, we explored avenues for community and political organizations to promote agroecological market integration in Berazategui, Argentina, located in the southern peri-urban zone of AMBA. Using participatory methodologies, we evaluated existing barriers to market expansion for peri-urban farmers and strategized which social alliances would be essential in improving equitable and agroecological market access. This research was conducted with the following objectives: To assess the current realities of producers as they work to commercialize their products and gain access to local market opportunities, to generate a better understanding of the role of social alliances in supporting commercialization for agricultural producers in Berazategui, and to provide space for producers to exchange ideas on how to strengthen and promote local agroecological market inclusion.Findings showed that the municipal and federal government must support farmers with basic needs (such as land tenure) as a prerequisite for engagement with agroecology and improved marketing opportunities. Market intermediaries must also be replaced with either direct marketing opportunities or expanded producer organization roles that populate the entire production chain with producer allies and ensure fair prices for all. Finally, consumers can be educated to serve as allies and advocates for producers. This research collaboration supports the goals of INTA’s ProHuerta family farmer program, which promotes agroecology, food self-sufficiency, farmer inclusivity and market integration, especially for vulnerable farmers. INTA hopes to convert AMBA’s peri-urban zone into a “green belt” of agroecology and food production. This goal is increasingly relevant as the impacts of climate change and COVID stress the need for more localized, diversified, and equitable food systems