Faculty Bibliography

After a survey in 1986, a primary educational prevention program for low back pain (LBP) was implemented over a 3 year period in a primary school setting in Switzerland. In 1989 a second survey was carried out to evaluate the effect of the intervention. One thousand seven hundred and fifty-five (1755) children received a questionnaire, 1716 (97.7%) were returned. Recollection of participation in the prevention program was significantly associated with reported increased prevalence of LBP (p 0.000). Simultaneously, there was a significant reduction in the utilization of medical care for LBP (p < 0.05)

1. In fifteen healthy volunteers, muscle nerve sympathetic activity (MSA) was recorded from the peroneal nerve using microneurography. Blood pressure and electrocardiogram were also recorded. 2. Painful stimuli, adjusted to the subject's tolerance level, were delivered over 30-60 s via (a) pressure to the nail-bed of different digits, and to the trigeminal region, (b) electrical stimulation (5 Hz) of digital nerves and of the supraorbital nerve, or (c) instillation of soap solution into one eye. Non-painful ocular pressure was also applied. 3. All procedures except electrical stimulation of digital nerves caused a marked increase in MSA (mean, 160-248%) with preserved pulse synchrony and a rise in blood pressure. Stimulation of digits induced tachycardia, whereas stimulation of the trigeminal region tended to cause bradycardia. 4. Despite similar pain ratings, electrical stimulation of digital nerves caused a smaller MSA response than the other stimuli (mean increase, 40%). 5. It is concluded that sustained noxious stimulation in awake humans evokes a generalized MSA increase; the activity is still under baroreflex control, but the inhibitory level is reset. Both spinal and brainstem reflexes may contribute; a defence reaction is an unlikely explanation. It is suggested that the number of afferent C fibres activated by electrical stimulation of digital nerves was insufficient to induce any marked MSA response. 6. The non-painful oculo-cardiac reflex is associated with a strong increase in MSA

OBJECTIVE: This study examines the extent to which preventive and promotive advice is integrated into the clinical practice of doctors. STUDY DESIGN: Using a cross-sectional descriptive survey design, the study compares the performance of doctors in giving healthy lifestyle advice for five clinical conditions, their perceived practice and their rating on the importance of disseminating selected key lifestyle messages. DATA EXTRACTION METHODS: A total of 28 volunteers were trained to simulate the five clinical conditions which required related health advice and to rate the doctors' performance with the use of a prepared checklist. Simulated patient ratings of 343 doctor-patient encounters provided the data on doctors' health promotion efforts for the selected clinical conditions. A post-visit self-administered questionnaire survey of a sub-sample of 100 doctors gave an insight into their opinions and perceived practice. PRINCIPAL FINDINGS: Only in 49% of the instances was a health promotion message given. The doctors' encouraging interest in health education and health promotion and their positive perceptions of their volume of healthy lifestyle counselling were not borne out in actual clinical practice. CONCLUSIONS: The results indicate that the extent of preventive and promotive health education in both the public and private health sectors is unacceptably low. The matter needs to be addressed through training programmes as well as the formulation of clear health promotion priorities and strategies in Malaysia

Education for the patient with back pain is currently being discussed and reassessed. In the 1970s and 1980s, the clinical and scientific communities were convinced that patient education as a sole treatment for back pain was most beneficial. In the 1990s outcome studies, randomized controlled trials, meta analysis and best synthesis evidence have moderated this view. This brief overview summarizes important aspects put forward in recently published articles about the education of patients with non-specific, low back pain in industrialized societies

This paper reports the results of a statistical analysis of injuries to the clients and the employees of a state facility for people with developmental disabilities, as recorded in the respective databases of the institution. The goal of the analysis was to identify the characteristics and patterns of injuries in order to identify priorities for technological intervention. Databases for 2000 client injuries and for 900 direct care staff injuries between 1988 and 1991 were analyzed retrospectively. Most of the injuries were sustained by the direct care staff and involved their backs. The injuries occurred in the institution's bedrooms (approximately 25%) and bathrooms (approximately 15%) and took place mainly during the early morning (approximately 30%) and evening rush (20%). The time of day and location of the injuries of clients coincided with those of the injuries of employees. These findings direct the focus of technological based interventions.