Aim: The aim of this study was to describe experiences of pain and its relationship to daily activities in people with rheumatoid arthritis (RA). Method: Seven semi-structured focus group discussions were conducted with 33 men and women of different ages with RA. Data were analysed with content analysis. Results: Pain affected everyday life and may be a barrier to perform valued activities. Regarding the impact of pain on participation and independence, personal factors and the social environment were found to be important. It could be a struggle to find the right activity balance, since it was easy to be overactive, triggering subsequent elevation of pain levels. However, the participants also described activities as a mediator of pain and a distraction from it. Conclusion: The relationship between pain and daily activities in RA was complex. Pain as an impairment was expressed to be related to activity limitations and participation restrictions, as well as to contextual factors. These findings highlight the clinical importance of paying attention to the complexity of pain and its relation to daily activities and participation.

This overview summarizes the available evidence from systematic reviews of outcomes studies on various assistive technologies (AT) for persons with disabilities. Systematic reviews published between January 2000 and April 2010 were identified by comprehensive literature searches. Study selection, data extraction and methodological quality evaluation were done by two authors independently. The quality of evidence was summarized by explicit methods. Types of disabilities, settings, and AT interventions were recorded. Outcomes were mapped according to the Taxonomy of Assistive Technology Device Outcomes. Forty-four systematic reviews were included in this overview. High-quality evidence was found in single AT (positive effects of providing AT in connection with home assessment and hearing aids, no effects of hip protectors) for limited populations (older people at home, people with hearing loss, and older people in institutional care, respectively). Low-quality or unclear evidence was found for the effectiveness of the other evaluated AT interventions. Current gaps in AT outcomes research were identified. Many frequently used devices have not been systematically reviewed. Well-designed outcomes research to inform clinical decision-making is urgently needed. The systematic review methodology seems to be feasible for summarising AT outcomes research, but methodological development for grading and for primary studies is warranted.

Purpose

Road crash statistics reveal that school children are frequent victims and the most risky situation is when the child is outside the bus. The aim of this pilot study was to explore possible changes in speed, implementation of routines, hazard detection and child security gains from a driver support system integrated with intelligent bus stops and additional technical equipment.

Methods

In total, 130 children with transmitters were using two specially equipped busses and bus stops. Speed of oncoming and overtaking cars, implementation of routines, the possibilities to discover potential hazards and experienced stress in the children were analysed by speed measurements, diary notes, questionnaires and focus group interviews.

Results

This pilot study exploration showed that the speeds of other road users were reduced at one of two bus stops. The driver support system was frequently used in all its parts and was considered useful by the bus drivers. It also raised the level of routines and allowed the drivers to survey the children. Children reported feeling more secure with the system running and experienced less stress as a consequence of it.

Conclusion

This pilot study shows that the evaluated systems may have the ability to reduce speed of other road users, raise the level of routines and make children feel more secure. Further studies are needed that apply a holistic approach on school transportation safety and security.

Background: The number of older people is increasing. Many of them expect to maintain a rich social life and to con- tinue driving at an older age. Objective: The present study investigates the mechanisms behind self-regulation and driving cessation in order to suggest development of support systems to prolong older drivers’ safe mobility. Method: Three focus groups were conducted with 19 older active drivers aged 65+ who were divided according to annual mile- age driven. Results: A content analysis revealed broad self-regulatory behaviour as already reported in the literature, e.g., avoiding driving at rush hour and at night. The participants also reported difficulty in finding the way to their final destination and an increasing need to plan their travelling. Co-piloting was a behaviour applied by couples to cope with difficulties encountered in traffic. A large part of the discussion was focused on emerging feelings of stress, anxiety and fear when driving in recent years, a feeling induced by external factors e.g., other road users’ behaviour, traffic density or high speed. Apart from health problems, high levels of stress could explain driving cessation, especially for women. An increased feeling of safety and comfort could be achieved by an increased use of support systems specifically de- signed to respond to older drivers’ needs. Conclusion: Support systems for older drivers should increase comfort and decrease their stress levels. New systems, such as co-pilot function and more developed Global Positioning System (GPS) supporting of the entire travel from door to door, should be developed to respond to the market needs.

The aim of this study was to describe how speed and accuracy in eye controlled computer performance changed over time for children with severe physical disabilities that used eye tracker controlled system (ETCS) in daily activities as an effect of assistive technology (AT) intervention. Data was collected with diaries and with Compass software. The preliminary results from this study from the first four children indicate that two children improved significantly in eye controlled performance up to 19 months since start of ETCS usage in daily activities.

Background

Incorporating the patient's view on care and treatment has become increasingly important for health care. Patients describe the variety of consequences of their chronic pain conditions as significant pain intensity, depression, and anxiety. We hypothesised that intensities of common symptoms in chronic pain conditions carry important information that can be used to identify clinically relevant subgroups. This study has three aims: 1) to determine the importance of different symptoms with respect to participation and ill-health; 2) to identify subgroups based on data concerning important symptoms; and 3) to determine the secondary consequences for the identified subgroups with respect to participation and health factors.

Methods and Subjects

This study is based on a cohort of patients referred to a multidisciplinary pain centre at a university hospital (n = 4645, participation rate 88%) in Sweden. The patients answered a number of questionnaires concerning symptoms, participation, and health aspects as a part of the Swedish Quality Registry for Pain Rehabilitation (SQRP).

Results

Common symptoms (such as pain intensity, depression, and anxiety) in patients with chronic pain showed great variability across subjects and 60% of the cohort had normal values with respect to depressive and anxiety symptoms. Pain intensity more than psychological symptoms showed stronger relationships with participation and health. It was possible to identify subgroups based on pain intensity, depression, and anxiety. With respect to participation and health, high depressive symptomatology had greater negative consequences than high anxiety.

Conclusions

Common symptoms (such as pain intensity and depressive and anxiety symptoms) in chronic pain conditions carry important information that can be used to identify clinically relevant subgroups.

Purpose: To investigate the presence of subgroups in chronic whiplash-associated disorders (WAD) based on pain thresholds for pressure (PPT), cold (CPT), and heat (HPT) and to compare these subgroups with respect to symptomatology, disability, and health aspects. Methods: Two groups of female subjects – patients with chronic WAD (n = 28) and healthy controls (CON; n = 29) – were investigated. Quantitative sensory testing (QST) for thermal thresholds and algometry for PPT at four sites in the body (over the trapezius and tibialis anterior bilaterally) were determined. Habitual pain intensities, psychological strain, disability, and health aspects were registered using a questionnaire.Results: A cluster analysis based on PPT, CPT, and HPT identified two subgroups of chronic WAD: one sensitive subgroup (s-WAD; n = 21), and one less sensitive subgroup (ls-WAD; n = 6). S-WAD displayed widespread hyperalgesia, whereas ls-WAD had localized hyperalgesia in the neck area, with tendencies to supernormal values in remote areas of the body. Generally, s-WAD had a significantly worse situation than the CON with respect to symptomatology, disability, and health aspects. The ls-WAD group was intermediary between s-WAD and CON in these aspects.Conclusion: Different explanations, eg, severity of the pain condition per se, etiological factors, and pre-trauma differences in pain sensitivity, may exist for the differences in pain thresholds between the two subgroups. Future research should investigate the role of pain thresholds in the chronic stage to determine the efficacy of treatment interventions.

Background: Signs and symptoms of Parkinson’s Disease (PD) include a combination of slowness of movement, increased tone, tremor and loss of postural reflexes. Cognitive changes and dementia can also be found in older people affected by PD. The excessive expenditure of cerebral resources in multitasks can cause cognitive overload resulting in deterioration of functional performance. Previous research has highlighted that the balance of cognitive load is essential for safe driving; however, this has not yet been researched in relation to people with PD. Coupled with mental inflexibility and sluggish reasoning, PD drivers exposed to demanding traffic scenarios may reach dangerous levels of cognitive overload. The present study employed computation of arithmetic sums as secondary task to investigate the effect of cognitive overloading on older PD drivers.

Methodology: A pre-post case-control study design was implemented. Convenience sample of 28 mild to moderate stages of PD drivers and 30 age-matched healthy controls were recruited and their motor and cognitive functions were assessed using the Digit Vigilance Test (DVT), Perdue Pegboard, Symbol Digit Modalities Test (SDMT) and Trail-Making Test- Part A and B. Participants were then assessed twice using a driving simulator: with and without exposure to the secondary task.

Results: When compared with healthy controls, PD drivers scored lower in motor and cognitive psychometric assessments and performed less competently in driving assessments. However, PD drivers drove more cautiously and took more time to complete all the driving tests when compared with the healthy counterparts. With the distraction of the secondary task, both the performance of PD drivers and controls declined, but PD drivers to a greater extent. The Trail-Making Test-B was found to be valuable in predicting the overall performance of PD drivers. The ability of PD participants was observed to have significant deterioration in driving through T-junctions and roundabouts.

Conclusion: PD drivers should avoid cognitive overload caused by, for example, multitasking while driving. Cognitive overload may compound the problem of indecisiveness of the drivers; leading to inconvenience or dangers to other road users. Training of PD drivers should emphasize intersection manoeuvre management.

This study sought to assess burnout and its relation to pain, disability, mood and health-related quality of life in a group of patients with chronic whiplash-associated disorders (WAD). Forty-five patients with chronic WAD (andgt;= 3 months) referred to a multidisciplinary rehabilitation centre were included. A questionnaire covering data on background and lifestyle, the Shirom Melamed Burnout Questionnaire, pain intensity, the Neck Disability Index, the Hospital Anxiety and Depression Scale and the EQ-5D was filled in before the first visit to the clinic. A high proportion of burnout as measured using the Shirom Melamed Burnout Questionnaire was found in the patient group (87%). Burnout correlated moderately with present pain intensity, neck disability, depression and health-related quality of life. The results indicate the possible clinical importance of burnout in relation to chronic WAD and the need for further studies including a larger study population and a longitudinal study design.

The present study focused on the relationship between previous experiences of, and rated susceptibility to, motion sickness and its correlation to subjective measurements and actual performance. Performance was measured in terms of shooting precision among 23 participants from the Swedish amphibious corps after transportation in a small amphibious boat, while sealed off with no reference to the outside world. Self-rating questionnaires were collected regarding perceived performance and presence of motion sickness. The physiological status perceived by each participant was related to factors that generally indicate early stages of motion sickness, which also were correlated to deficits in performance. It was further shown that participants who believed that their performance could be affected by motion sickness also performed less well.

AIMS:

To investigate whether experimental tooth clenching leads to a release of algesic substances in the masseter muscle.

METHODS:

Thirty healthy subjects (16 females, 14 males) participated. During two sessions, separated by at least 1 week, intramuscular microdialysis was performed to collect masseter muscle 5-hydroxytryptamine (5-HT) and glutamate as well as the metabolic markers pyruvate and lactate. Two hours after the start of microdialysis, participants were randomized to a 20-min repetitive experimental tooth-clenching task (50% of maximal voluntary contraction) or a control session (no clenching). Pain and fatigue were measured throughout. The Friedman and Wilcoxon tests were used for statistical analyses.

RESULTS:

No alterations were observed in the concentrations of 5-HT, glutamate, pyruvate, and lactate over time in the clenching or control session, or between sessions at various time points. Pain (P < .01) and fatigue (P < .01) increased significantly over time in the clenching session and were significantly higher after clenching than in the control session (P < .01).

CONCLUSION:

Low levels of pain and fatigue developed with this experimental tooth-clenching model, but they were not associated with an altered release of 5-HT, glutamate, lactate, or pyruvate. More research is required to elucidate the peripheral release of algesic substances in response to tooth clenching.

Background: Acquired resistance to cancer therapy, including targeted therapies such as epidermal growth factor receptor (ErbB) tyrosine kinase inhibitors (TKIs), constitutes a major clinical problem in treating patients with malignant disease. Several drug resistance mechanisms for ErbB1 TKIs involving abnormal activation of growth factor receptors or activation of intracellular signaling pathways have been discovered. ErbB TKIs have recently been shown to inhibit growth in melanoma cells. This study was undertaken to develop a gefitinib-resistant melanoma cell line in order to find any resistance mechanism to gefitinib in melanoma cells lacking activating mutation in BRAF or NRAS.

Material and methods: A malignant melanoma cell line (RaH5) was made resistant to the ErbB1 TKI gefitinib by continuous culture with stepwise increasing concentrations of the drug up to 10 μM. The phosphorylation status of 42 different human receptor tyrosine kinases was screened in a protein array in resistant (RaH5ZDR) and wild-type RaH5 cells treated with or without gefitinib. The PI3K, MAPK and Stat3 signaling pathways were studied in an analogous way by Western blot analysis; 2-D gel electrophoresis was performed to determine other potential proteins involved in gefitinib resistance in RaH5 cells. In addition, the effect of the pan-ErbB TKI canertinib on gefitinib-resistant cells was investigated.

Results: Protein array experiments showed that only Met and the insulin receptor (IR) exhibited substantially increased activation in RaH5ZDR cells as compared to their nonresistant counterparts. Interestingly, following gefitinib treatment ErbB2 and ErbB3 receptor signaling in resistant cells were equally well suppressed as in non-resistant cells. However, downstream Akt and Erk1/2 phosphorylation was inhibited to a greater extent in non-resistant RaH5 cells.

Conclusion: Resistance to gefitinib in RaH5 cells appears to be related to an increased expression of Met and IR and linked to a more persistent signaling through Akt and Erk1/2. However, additional studies are required to further elucidate the resistance to gefitinib in our experimental system.

BACKGROUND:

Animal studies have shown that two repeated intramuscular injections of acidic saline induce mechanical allodynia that lasts for 4 weeks with spread to the contralateral side. In this study, we tested the hypothesis that two repeated intramuscular infusions of acidic saline into the human masseter muscle is associated with pain, mechanical allodynia and release of algesic substances. Eighteen healthy volunteers participated. On day 1, 2.5 mL of acidic saline (pH 3.3) was infused into one of the masseter muscles and isotonic saline (pH 6.0) into the other (randomized and single-blind). Two days later, intramuscular microdialysis was performed to sample serotonin, glutamate, pyruvate, lactate and glucose, during which the saline infusions were repeated. Pain and pressure pain thresholds (PPTs) were recorded before and after infusions on both days.

RESULTS:

Pain intensity induced by the infusions was higher after acidic than that after isotonic saline (p < 0.05). PPTs were decreased on both sides after microdialysis compared with baseline day 1 (p's < 0.05), but there were no differences in PPTs between sides at any time point. The levels of serotonin, glutamate, pyruvate, lactate or glucose did not change significantly during microdialysis.

CONCLUSION:

Infusion of acidic saline caused low levels of muscle pain, but no mechanical allodynia and no increased release of algesic substances. The value of this model appears modest, but future studies could be performed with larger sample size and higher flow rate before definite conclusions about the validity of the model for craniofacial myalgia can be drawn.

Objectives: To examine perceived participation in students with ASC and their classmates in mainstream schools and to investigate correlations between activities the students wanted to do and actually participated in. less thanbrgreater than less thanbrgreater thanMethods: Twenty-two students with ASC and their 382 classmates responded to a 46-item questionnaire regarding perceived participation in mainstream schools. less thanbrgreater than less thanbrgreater thanResults: On 57% of the items, students with ASC perceived lower participation than their classmates. These results emphasize the importance of knowledge about students perceived participation. However, positive correlations between what the students wanted to do and actually did indicate that students with ASC may be participating to the extent that they wanted. less thanbrgreater than less thanbrgreater thanConclusion: Students with ASC perceived lower overall participation in mainstream school than their classmates. The correlations between "I want to" and "I do" statements in students with ASC indicated that aspects of autonomy are important to incorporate when studying, and interpreting, self-rated participation in mainstream schools.

Purpose

SAFEWAY2SCHOOL is a programme based on several systems for the enhancement of school transportation safety for children. The aim of the study was to explore whether children with cognitive disabilities will notice, realise, understand, trust and accept the SAFEWAY2SCHOOL system and act in accordance with its instructions.

Methods

Fourteen children with cognitive disabilities and a control group of 23 children were shown five videos of scenarios involving journeys to and from school. During the first viewing visual scanning patterns were recorded with an eye tracking device. After a second viewing the participant was asked ten questions per scenario. Five questions addressed what the children saw on the video, and the remaining five what they would need to know and/or do within the scenario. Additional ratings of trust, likability, acceptability and usability were also collected.

Results

Very few differences were found in the visual scanning patterns of children with disabilities compared to children who participated in the control group. Of the 50 questions regarding what children saw or needed to know and/or do, only one significant difference between groups was found. No significant differences were found regarding self-reported ratings of trust, acceptability or usability of the system. Despite some significant differences across five of the 11 likability aspects, ratings were consistently high for both groups.

Conclusions

Children with cognitive disabilities proved that the SAFEWAY2SCHOOL system is as useful for them as it was for children in the control group. However, a valid estimation of the full utility of SAFEWAY2SCHOOL requires in situ testing of the system with these children.

Purpose

Occurrence of airway irritation among indoor swimming pool personnel was investigated. The aims of this study were to assess trichloramine exposure levels and exhaled nitric oxide in relation to the prevalence of airway symptoms in swimming pool facilities and to determine protein effects in the upper respiratory tract.

Methods

The presence of airway symptoms related to work was examined in 146 individuals working at 46 indoor swimming pool facilities. Levels of trichloramine, as well as exhaled nitric oxide, were measured in five facilities with high prevalence of airway irritation and four facilities with no airway irritation among the personnel. Nasal lavage fluid was collected, and protein profiles were determined by a proteomic approach.

Results

17 % of the swimming pool personnel reported airway symptoms related to work. The levels of trichloramine in the swimming pool facilities ranged from 0.04 to 0.36 mg/m³. There was no covariance between trichloramine levels, exhaled nitric oxide and prevalence of airway symptoms. Protein profiling of the nasal lavage fluid showed that the levels alpha-1-antitrypsin and lactoferrin were significantly higher, and S100-A8 was significantly lower in swimming pool personnel.

Conclusions

This study confirms the occurrence of airway irritation among indoor swimming pool personnel. Our results indicate altered levels of innate immunity proteins in the upper airways that may pose as potential biomarkers. However, swimming pool facilities with high prevalence of airway irritation could not be explained by higher trichloramine exposure levels. Further studies are needed to clarify the environmental factors in indoor swimming pools that cause airway problems and affect the immune system.

BACKGROUNDS: Occurrence of airway irritation among industrial metal workers was investigated. The aims were to study the association between exposures from water-based metal working fluids (MWF) and the health outcome among the personnel, to assess potential effects on the proteome in nasal mucous membranes, and evaluate preventive actions.

METHODS: The prevalence of airway symptoms related to work were examined among 271 metalworkers exposed to MWF and 24 metal workers not exposed to MWF at the same factory. At the same time, air levels of potentially harmful substances (oil mist, morpholine, monoethanolamine, formaldehyde) generated from MWF was measured. Nasal lavage fluid was collected from 13 workers and 15 controls and protein profiles were determined by a proteomic approach.

RESULTS: Airway symptoms were reported in 39% of the workers exposed to MWF although the measured levels of MWF substances in the work place air were low. Highest prevalence was found among workers handling the MWF machines but also those working in the same hall were affected. Improvement of the ventilation to reduce MWF exposure lowered the prevalence of airway problems. Protein profiling showed significantly higher levels of S100-A9 and lower levels of SPLUNC1, cystatin SN, Ig J and β2-microglobulin among workers with airway symptoms.

CONCLUSIONS: This study confirms that upper airway symptoms among metal workers are a common problem and despite low levels of MWF-generated substances, effects on airway immune proteins are found. Further studies to clarify the role of specific MWF components in connection to airway inflammation and the identified biological markers are warranted.

Purpose: Professional high speed sea navigational procedures are based on turn points, courses, dangers and steering cues in the environment. Since navigational aids have become less expensive and due to the fact that electronic sea charts can be integrated with both radar and transponder information, it may be assumed that traditional navigation by using paper based charts and radar will play a less significant role in the future, especially among less experienced navigators. Possible navigational differences between experienced and non-experienced boat drivers is thus of interest with regards to their use of navigational aids. It may be assumed that less experienced navigators rely too much on the information given by the electronic sea chart, despite the fact that it is based on GPS information that can be questioned, especially in littoral waters close to land.

Method: This eye tracking study investigates gaze behaviour from 16 experi- enced and novice boat drivers during high speed navigation at sea.

Results: The results show that the novice drivers look at objects that are close to themselves, like instrumentation, while the experienced look more at objects far away from the boat. This is in accordance with previous research on car drivers. Further, novice boat drivers used the elec-tronic navigational aids to a larger extent than the experienced, especially during high speed conditions. The experienced drivers focused much of their attention on objects outside the boat.

Conclusions: The findings verify that novice boat drivers tend to rely on electronic navigational aids. Experienced drivers presumably use the navigational aids to verify what they have observed in the surrounding environment and further use the paper based sea chart to a larger extent than the novice drivers.

BACKGROUND AND METHODS:

Fibromyalgia (FMS) has a prevalence of approximately 2% in the population. Central alterations have been described in FMS, but there is not consensus with respect to the role of peripheral factors for the maintenance of FMS. 31P magnetic resonance spectroscopy (31P-MRS) has been used to investigate the metabolism of phosphagens in muscles of FMS patients, but the results in the literature are not in consensus. The aim was to investigate the quantitative content of phosphagens and pH in resting quadriceps muscle of patients with FMS (n = 19) and in healthy controls (Controls; n = 14) using (31) P-MRS. It was also investigated whether the concentrations of these substances correlated with measures of pain and/or physical capacity.

RESULTS:

Significantly lower concentrations of adenosine triphosphate (ATP) and phosphocreatinine (PCr; 28-29% lower) were found in FMS. No significant group differences existed with respect to inorganic phosphate (Pi), Pi/PCr and pH. The quadriceps muscle fat content was significantly higher in FMS than in Controls [FMS: 9.0 ± 0.5% vs. Controls: 6.6 ± 0.6%; (mean ± standard error); P = 0.005]. FMS had significantly lower hand and leg capacity according to specific physical test, but there were no group differences in body mass index, subjective activity level and in aerobic fitness. In FMS, the specific physical capacity in the leg and the hand correlated positively with the concentrations of ATP and PCr; no significant correlations were found with pain intensities.

CONCLUSIONS:

Alterations in intramuscular ATP, PCr and fat content in FMS probably reflect a combination of inactivity related to pain and dysfunction of muscle mitochondria.

The impact of biomarkers in present day health care system, health management and healthy life is enormous. Clinicians need them for diagnosis, prognosis, effect of therapeutic intervention, and most importantly, for early detection of a disease. Pharmaceutical industries need them for new drug discovery and drug efficiency test. Regulatory authorities need them for testing toxicity and environmental impact. Epidemiologists need them for population screening and risk factor determination. In post genomic era biomarkers would have a huge impact in personalized medicine and personalized health management. This scope of this book is not limited to just a few of the most important aspects of biomarkers but covers wide variety of subjects, from biomarkers cancer to neurodegenerative diseases. Chapters cover variety of aspects, from modern cell based technologies to molecular imaging; from drug discovery to critical care prognosis. A great amount of information is also devoted to bioinformatics and statistics. There is an enormous potential for commercial value of biomarkers. The global diagnostic market accounts for only 1-2% of government healthcare expense, however, it influences on 60-70% decisions in healthcare. My sincere thanks go to all the contributors of this book who took the extra effort beyond their busy schedules. Last, but not least I would like to express my gratitude to the publishing group for their tireless support

Inspektionen för socialförsäkringen har utvärderat ­rehabiliteringsgarantin. Rapporten uppvisar stora brister, vilket bekräftas av en granskning av den del som rör multimodal rehabilitering vid långvariga smärtor.

BACKGROUND: Pulmonary Langerhans cell histiocytosis (PLCH) is a rare interstitial lung disease associated with tobacco smoke exposure. New insights into its pathogenesis and how it differs from that of chronic obstructive pulmonary disease (COPD) may be provided by proteomic studies on bronchoalveolar lavage fluid (BALF).

CASE REPORT: We present the BALF proteome in a biopsy-proven case of PLCH and compare it with typical proteomes of COPD and of the healthy lung. The BALF proteins were separated by two-dimensional gel electrophoresis (2-DE) and the protein patterns were analyzed with a computerized 2-DE imaging system. As compared to the healthy subject and the COPD case, the PLCH case showed a strikingly different 2-DE pattern. There was much more IgG (heavy chain) and orosomucoid, and less α1-antitrypsin, surfactant protein-A, haptoglobin, cystatin-S, Clara cell protein 10, transthyretin and gelsolin. Moreover, no apolipoprotein-A1, pro-apolipoprotein-A1, amyloid P, calgranulin A, or calgranulin B was detected at all.

CONCLUSIONS: This case of PLCH presents with an extreme BALF proteome lacking significant amounts of protective and anti-inflammatory proteins. Thus, the intriguing BALF proteome opens up new lines of research into the pathophysiology of PLCH and how its pathogenesis differs from that in COPD.

Chronic widespread pain (CWP) is a complex condition characterized by central hyperexcitability and altered descending control of nociception. However, nociceptive input from deep tissues is suggested to be an important drive. N-Acylethanolamines (NAEs) are endogenous lipid mediators involved in regulation of inflammation and pain. Previously we have reported elevated levels of the 2 NAEs, the peroxisome proliferator-activated receptor type-alpha ligand N-palmitoylethanolamine (PEA) and N-stearoylethanolamine (SEA) in chronic neck/shoulder pain (CNSP). In the present study, the levels of PEA and SEA in women with CWP (n = 18), CNSP (n = 34) and healthy controls (CON, n = 24) were investigated. All subjects went through clinical examination, pressure pain threshold measurements and induction of experimental pain in the tibialis anterior muscle. Microdialysis dialysate of the trapezius was collected before and after subjects performed a repetitive low-force exercise and analyzed by mass spectrometry. The levels of PEA and SEA in CNSP were significantly higher post exercise compared with CWP, and both pre and post exercise compared with CON. Levels of both NAEs decreased significantly pre to post exercise in CWP. Intercorrelations existed between aspects of pain intensity and sensitivity and the level of the 2 NAEs in CWP and CNSP. This is the first study demonstrating that CNSP and CWP differ in levels of NAEs in response to a low-force exercise which induces pain. Increases in pain intensity as a consequence of low-force exercise were associated with low levels of PEA and SEA in CNSP and CWP. These results indicate that PEA and SEA have antinociceptive roles in humans.

Background/aim

Previous research has shown that children with spina bifida use clean intermittent catheterisation for urination, a rather complex procedure that increases the time taken to completion. However, no studies have analysed the factors impacting on the time taken to complete the urination that could inform occupational therapy practice. Therefore, the aim was to identify the variables that predict extended time children with spina bifida take to complete urination.

Methods

Fifty children, aged 5–18 years old with spina bifida using clean intermittent catheterisation, were observed while toileting and responding to a set of assessments tools, among them the Canadian Occupational Performance Measure. A logistic regression was used to identify which variables were independently associated with an extended toileting time.

Results

Children with spina bifida do take long time to urinate. More than half of this study's participants required more than five minutes completing urination, but not all required extended times. Ambulant, independent girls were more likely to perform toileting in less than six minutes compared with other children with spina bifida. However, age, IQ, maintained focus on the task, Canadian Occupational Performance Measure, time processing abilities and self-reported ratings of independence appeared to be of no relevance, to predict extended toileting times.

Conclusion

To minimise occupational disruption caused by extended toileting times, occupational therapists should utilise the relevant predictors: gender, independence and ambulation when they prioritise children for relevant interventions.

The prevalence of chronic trapezius myalgia is high in women with high exposure to awkward working positions, repetitive movements and movements with high precision demands. The mechanisms behind chronic trapezius myalgia are not fully understood. The purpose of this study was to explore the differences in protein content between healthy and myalgic trapezius muscle using proteomics. Muscle biopsies from 12 female cleaners with work-related trapezius myalgia and 12 pain free female cleaners were obtained from the descending part of the trapezius. Proteins were separated with two-dimensional differential gel electrophoresis (2D-DIGE) and selected proteins were identified with mass spectrometry. In order to discriminate the two groups, quantified proteins were fitted to a multivariate analysis: partial least square discriminate analysis. The model separated 28 unique proteins which were related to glycolysis, the tricaboxylic acid cycle, to the contractile apparatus, the cytoskeleton and to acute response proteins. The results suggest altered metabolism, a higher abundance of proteins related to inflammation in myalgic cleaners compared to healthy, and a possible alteration of the contractile apparatus. This explorative proteomic screening of proteins related to chronic pain in the trapezius muscle provides new important aspects of the pathophysiology behind chronic trapezius myalgia.

Questions regarding the use of static or dynamic facial stimuli in experimental studies investigating facial processing of individuals with AS/HFA raises issues of both ecological validity and the applicability of experimental findings to clinical or everyday practice. Children with and without AS/HFA (n = 38) were fitted with a head-mounted eye-tracker and exposed to either static or interactive dynamic facial stimuli. Average fixation duration, the proportion of fixations in areas of interest and a comparative index that was independent of differences in presentation length between stimuli types were calculated. Visual scanning patterns of individuals with AS/HFA were not affected by stimuli type. However, control participants exhibited different scanning patterns between dynamic and static stimuli for certain regions of the face. Visual scanning patterns in children with AS/HFA are consistent regardless of the stimuli being a static photo or dynamic in the form of a real face. Hence, information from experimental studies with static photos of faces provide information that is valid and can be generalised to "real world" interactions.

Background

Clara cell protein (CC16) is ascribed a protective and anti-inflammatory role in airway         inflammation. Lower levels have been observed in asthmatic subjects as well as in         subjects with intermittent allergic rhinitis than in healthy controls. Nasal nitric         oxide (nNO) is present in high concentrations in the upper airways, and considered         a biomarker with beneficial effects, due to inhibition of bacteria and viruses along         with stimulation of ciliary motility. The aim of this study was to evaluate the presumed         anti-inflammatory effects of nasal CC16 and nNO in subjects with allergic rhinitis.     

Methods

The levels of CC16 in nasal lavage fluids, achieved from subjects with persistent         allergic rhinitis (n = 13), intermittent allergic rhinitis in an allergen free interval         (n = 5) and healthy controls (n = 7), were analyzed by Western blot. The levels of         nNO were measured by the subtraction method using NIOX^®. The occurrences of effector cells in allergic inflammation, i.e. metachromatic cells         (MC, mast cells and basophiles) and eosinophils (Eos) were analyzed by light microscopy         in samples achieved by nasal brushing.     

Results

The levels of CC16 correlated with nNO levels (r² = 0.37; p = 0.02) in allergic subjects.     

The levels of both biomarkers showed inverse relationships with MC occurrence, as         higher levels of CC16 (p = 0.03) and nNO (p = 0.05) were found in allergic subjects         with no demonstrable MC compared to the levels in subjects with demonstrable MC. Similar         relationships, but not reaching significance, were observed between the CC16 and nNO         levels and Eos occurrence. The levels of CC16 and nNO did not differ between the allergic         and the control groups.     

Conclusions

The correlation between nasal CC16 and nNO levels in patients with allergic rhinitis,         along with an inverse relationship between their levels and the occurrences of MC         in allergic inflammation, may indicate that both biomarkers have anti-inflammatory         effects by suppression of cell recruitment. The mechanisms behind these observations         warrant further analyses.

Background: The increased vascular permeability seen after burn contribute to morbidity and mortality as it interferes with organ function and the healing process. Large efforts have been made to explore underlying pathophysiological mechanisms that generate increased vascular permeability after burns. Many different substances have been proposed as mediators of which histamine, serotonin and oxygen radicals are claimed most important. However, no specific blocker has convincingly been shown to be clinically effective. Early work has claimed increased histamine plasma-concentrations in humans after burn and data from animal models pointed at histamine as an important mediator. Modern human clinical studies investigating the role of histamine as a mediator of the generalized post burn increase in vascular permeability are lacking. less thanbrgreater than less thanbrgreater thanMethod: We examined histamine turnover by measuring the urinary excretion of histamine and methyl histamine for 48 h after burns in 8 patients (mean total burn surface area 24%). less thanbrgreater than less thanbrgreater thanResults: Over time, in this time frame and compared to healthy controls we found a small increase in the excretion of histamine, but no increase of its metabolite methylhistamine. less thanbrgreater than less thanbrgreater thanConclusion: Our findings do not support that histamine is an important mediator of the increased systemic vascular permeability seen after burn.

Over the years a number of epidemiological studies have shown that PM from combustion sources such as motor vehicles contributes to respiratory and cardiovascular morbidity and mortality.Especially so do the ultra-fine particles (UFPs) with a diameter less than 0.1 micrometer.UFPs from combustion engines are capable to translocate over the alveolar–capillary barrier.  When nano-sized PM (nanoparticles, NP), which are small enough to enter the blood stream, do so they are likely to interact with plasma proteins and this protein-NP interaction will probably affect the fate of and the effects caused by the NPs in the human body. Here, by using a proteomic approach, we present results showing that several proteins indeed are associated to NPs that have in vitro been introduced to human blood plasma.

Chronic widespread pain has limited treatment options and is associated with pronounced negative individual and socioeconomic consequences. Patients with local or regional pain may be at a risk for developing chronic widespread pain. Knowledge of such risk factors can help prevent chronic widespread pain. This study systematically reviews the literature that examines risk factors associated with developing chronic widespread after developing chronic regional pain. We conducted a three-step database search in Medline. Four articles from the authors files formed a core set of articles that were used to validate the search strategy. We conducted a systematic quality assessment of the included studies. Based on risk estimations reported in six prospective population-based studies and one retrospective study on pain, this study identified five risk factors: female sex, higher age, family history of pain, depressed mode and pain sites at baseline. As only a few studies were recovered, the impact of these factors is unclear. Spreading of pain from local or regional pain to widespread pain occurs in a large proportion of the general population. Few studies have addressed similar risk factors and the few risk factors associated with the transition from chronic regional pain to chronic widespread pain are inconsistent. Studies that focus on this transition have included few subjects and few possible risk factors. Future studies should explore more possible risk factors.

BACKGROUND: Current methods of determining licence retainment or cancellation is through on-road driving tests. Previous research has shown that occupational therapists frequently assess drivers' visual attention while sitting in the back seat on the opposite side of the driver. Since the eyes of the driver are not always visible, assessment by eye contact becomes problematic. Such procedural drawbacks may challenge validity and reliability of the visual attention assessments. In terms of correctly classified attention, the aim of the study was to establish the accuracy and the inter-rater reliability of driving assessments of visual attention from the back seat. Furthermore, by establishing eye contact between the assessor and the driver through an additional mirror on the wind screen, the present study aimed to establish how much such an intervention would enhance the accuracy of the visual attention assessment.

METHODS: Two drivers with Parkinson's disease (PD) and six control drivers drove a fixed route in a driving simulator while wearing a head mounted eye tracker. The eye tracker data showed where the foveal visual attention actually was directed. These data were time stamped and compared with the simultaneous manual scoring of the visual attention of the drivers. In four of the drivers, one with Parkinson's disease, a mirror on the windscreen was set up to arrange for eye contact between the driver and the assessor. Inter-rater reliability was performed with one of the Parkinson drivers driving, but without the mirror.

RESULTS: Without mirror, the overall accuracy was 56% when assessing the three control drivers and with mirror 83%. However, for the PD driver without mirror the accuracy was 94%, whereas for the PD driver with a mirror the accuracy was 90%. With respect to the inter-rater reliability, a 73% agreement was found.

CONCLUSION: If the final outcome of a driving assessment is dependent on the subcategory of a protocol assessing visual attention, we suggest the use of an additional mirror to establish eye contact between the assessor and the driver. The clinicians' observations on-road should not be a standalone assessment in driving assessments. Instead, eye trackers should be employed for further analyses and correlation in cases where there is doubt about a driver's attention.

The five volume set LNCS 7663, LNCS 7664, LNCS 7665, LNCS 7666 and LNCS 7667 constitutes the proceedings of the 19th International Conference on Neural Information Processing, ICONIP 2012, held in Doha, Qatar, in November 2012. The 423 regular session papers presented were carefully reviewed and selected from numerous submissions. These papers cover all major topics of theoretical research, empirical study and applications of neural information processing research. The 5 volumes represent 5 topical sections containing articles on theoretical analysis, neural modeling, algorithms, applications, as well as simulation and synthesis.

Objective: Widespread deep tissue pain hyperalgesia was evaluated in women with chronic whiplash associated disorder (n=25) and controls (n=10) using computerized cuff pressure algometry and hypertonic saline infusion. Methods: A pneumatic double-chamber cuff was placed around: (i) the arm and (ii) the leg. Cuff inflation rate was constant and the pain intensity was registered continuously on a visual analogue scale (VAS); thresholds of detection and tolerance were extracted. For assessment of spatial summation the protocol was repeated with a single-chamber cuff inflated around the leg. Temporal summation of pain was assessed from the leg with constant cuff pressure stimulation at 2 different pressure intensities for 10 min. Hypertonic saline was infused in the tibialis anterior muscle. Results: Cuff pressure pain thresholds were lower in subjects with whiplash associated disorder compared with controls (pless than0.05). Tonic pressure stimulation evoked higher maximal VAS and larger areas under the VAS curve in subjects with whiplash associated disorder compared with controls (pless than0.05). The pain threshold and tolerance were higher during single cuff than double cuff stimulation. The area under the VAS curve after intramuscular saline infusion was larger in whiplash associated disorder (pless than0.05). Conclusion: The results indicated widespread hyperalgesia in chronic whiplash associated disorder and facilitated temporal summation outside the primary pain area, suggesting involvement of central sensitization.

Adults with high functioning autism (HFA) and Asperger syndrome (AS) are often less able to identify facially expressed emotions than their matched controls. However, results regarding emotion recognition abilities in children with HFA/AS remain equivocal. Emotion recognition ability and visual search strategies of 26 children with HFA/AS and matched controls were compared. An eye tracker measured the number of fixations and fixation durations as participants were shown 12 pairs of slides, displaying photos of faces expressing anger, happiness or surprise. The first slide of each pair showed a face broken up into puzzle pieces. The eyes in half of the puzzle piece slides were bisected, while those in the remaining half were whole. Participants then identified which of three alternative faces was expressing the same emotion shown in the preceding puzzle piece slide. No differences between the participant groups were found for either emotion recognition ability or number of fixations. Both groups fixated more often on the eyes and performed better when the eyes were whole, suggesting that both children with HFA/AS and controls consider the eyes to be the most important source of information during emotion recognition. Fixation durations were longer in the group with HFA/AS, which indicates that while children with HFA/AS may be able to accurately recognise emotions, they find the task more demanding.

Little is known about how to support a lifestyle change for persons with acquired brain injury (ABI), who have poor health compared with the rest of the population. This study investigates whether the Health Profile Assessment (HPA) combined with individual support in individually adjusted interventions could affect the lifestyle of persons with ABI. This longitudinal prospective and quasi-experimental study has a before and after design. HPA aims to improve health habits, perceived health and physiological measurements. In addition, this study includes interventions based on individual goals and actions decided on by the participants. The intervention process was supported through various communication methods such as Motivational Interviewing (MI) and Transactional Analyses (TA). The studied group (n = 25) included persons with cognitive impairments due to ABI who were considered for outpatient rehabilitation at a specialized facility at a university hospital in south-eastern Sweden. Results at follow-up showed significant improvements in physical activity, perceived health and diet. Significant improvements were also shown in sagittal abdominal diameter, waist circumference, body mass index (BMI) and physical fitness. Consequently, this study describes a method that successfully supported lifestyle changes in persons with ABI.Read

Objective: Study short- and long-term transfer effects of a computerized working memory (WM) training program for patients suffering from working memory deficits after acquired brain injury.

Methods: (Research design: A controlled experimental study with a crossover design.) The study group included a consecutive sample of 21 subjects. Mean age 43.2 years, time since injury/illness onset 37 months (median). The subjects were randomly selected into two groups where one group served as controls. All subjects trained five days a week for five weeks in a computer WM task program. They were followed-up at four and 20 weeks after the training.

Results: The study results showed a significant improvement in the trained WM tasks (p < 0.001), significant improvements in neuropsychological WM-test results at four and twenty weeks after training compared to baseline (p< 0.05). Results also showed a significant improvement in the subjects' rated level of occupational performance and satisfaction with performance in individually pre-defined occupational problems (p<0.05 for occupational performance versus p < 0.001 for satisfaction with performance) . Rated health-related quality of life did not change. However, rated overall health had significantly increased twenty weeks after training (p<0.05).

Conclusions: Structured and intense computerized WM training improves subjects' cognitive functioning as measured by neuropsychological WM-demanding tests, rated occupational performance, satisfaction with performance and rated overall health. The training probably has an impact on the rehabilitation outcome, returning to work, as well as on daily activities for individuals with verified WM impairments. We propose further research with a larger study group, including subgroups with different diagnoses, to confirm our current findings and select for whom this cognitive rehabilitation programme is most suitable.

Primary objective: To study significant factors supporting vocational rehabilitation after acquired brain injury from a patient perspective. less thanbrgreater than less thanbrgreater thanMethods: Two focus group interviews were accomplished with former patients. One focus group interview with professional rehabilitation personnel was performed to review the correspondence between patients and professionals opinion. less thanbrgreater than less thanbrgreater thanSubjects: Fourteen informants with acquired brain injury (ABI) were interviewed. All were working at the time of the focus group interviews. Three occupational therapists and two psychologists participated in the professional group. less thanbrgreater than less thanbrgreater thanResults: Two themes were identified as significant for returning to work: Personal and Society factors. Identified meaningful units could be categorized into sub-categories, which were grouped into six main-and 14 sub-categories. The main categories were: Self-continuity, Coping, Social factors, Rehabilitation intervention, Professionalism and Health insurance. Length of treatment time was described as crucial for the rehabilitation process and for utilizing individual resources. less thanbrgreater than less thanbrgreater thanConclusions: The effects of various synergies and processes form the basis for a successful return to work, which are dependent on, influence and reinforce each other. Society factors support personal factors to be used for returning to work after acquired brain injury. The impact of individual resources and rehabilitation highlights that vocational rehabilitation is inseparable from the individuals capacity, society and the context in which the individual lives.

BACKGROUND:

The microdialysis technique is a method for sampling endogenous molecules from the interstitial compartments of varying tissues and relies on diffusion of molecules between the tissue and a perfusate via a membrane. Such samples do not allow determination of the true interstitial concentration but only a certain percentage. This gives rise to one of the most crucial parameter that needs to be considered for a dependable microdialysis; the relative recovery. Relative recovery states the efficiency of which an analyte is extracted from its external medium. Aim. To investigate the relative recovery of small molecules (< 20 kDa) such as lactate, fluid recovery and the reproducibility of the relative recovery at group and individual level of the microdialysis technique applied in muscle.

MATERIALS AND METHODS:

Using in vivo microdialysis of the trapezius muscle of 65 women from two separate occasions 4-6 months apart. Relative recovery of small molecules was measured from samples collected every 20 min during a period of 220 min.

RESULTS:

Good reproducibility at group level of catheters with cut-offs 100 and 20kDa were found. Furthermore, there was a high and steady relative recovery with an overall good fluid recovery. Poor reproducibility was found at the individual level for both catheters.

CONCLUSIONS:

This study demonstrates that when using microdialysis in skeletal muscle relative recovery is stable over time and is not affected by low-force exercise. Although there is a good reproducibility at group level this is not the case at the individual level. Thus in vivo, the relative recovery should be determined for each test subject and at each test occasion.

Background: Microdialysis (MD) of the trapezius muscle has been an attractive technique to investigating small molecules and metabolites in chronic musculoskeletal pain in human. Large biomolecules such as proteins also cross the dialysis membrane of the catheters. In this study we have applied in vivo MD in combination with two dimensional gel electrophoresis (2-DE) and mass spectrometry to identify proteins in the extracellular fluid of the trapezius muscle. Materials and Methods: Dialysate from women with chronic trapezius myalgia (TM; n = 37), women with chronic wide spread pain (CWP; n = 18) and healthy controls (CON; n = 22) was collected from the trapezius muscle using a catheter with a cut-off point of 100 kDa. Proteins were separated by two-dimensional gel electrophoresis and visualized by silver staining. Detected proteins were identified by nano liquid chromatography in combination with tandem mass spectrometry. Results: Ninety-seven protein spots were identified from the interstitial fluid of the trapezius muscle; 48 proteins in TM and 30 proteins in CWP had concentrations at least two-fold higher or lower than in CON. The identified proteins pertain to several functional classes, e.g., proteins involved in inflammatory responses. Several of the identified proteins are known to be involved in processes of pain such as: creatine kinase, nerve growth factor, carbonic anhydrase, myoglobin, fatty acid binding protein and actin aortic smooth muscle. Conclusions: In this study, by using in vivo microdialysis in combination with proteomics a large number of proteins in muscle interstitium have been identified. Several of the identified proteins were at least two-fold higher or lower in chronic pain patients. The applied techniques open up for the possibility of investigating protein changes associated with nociceptive processes of chronic myalgia. © 2012 Olausson et al.

Objectives

The present study challenges chronic WhiplashAssociatedDisorders (WAD)-subjects to a pharmacological intravenous (i.v.) test with morphine, ketamine, and active placebo (midazolam). The aim was to describe the short-term responses to drugs and the assumed heterogeneity in the patterns of responses. We related the different responder groups to the results from psychometrictests.

Methods

The study includes 95 patients, all with chronic WAD and referred to our departments. They answered a questionnaire including the following psychometric instruments relevant for chronic pain: Beck Depression Inventory, Coping Strategies Questionnaire, Multidimensional Pain Inventory, Life Satisfaction Checklist, SF36 and EuroQol. The subjects also went through sessions with separate infusions of morphine (0.3 mg/kg), ketamine (0.3 mg/kg) and midazolam (0.05 mg/kg). Infusion time was 30 min followed by a 2-h post-infusion assessment. Assessments were made using a Visual Analogue Scale (VAS) for pain intensity and unpleasantness and by statements of per cent pain relieved. A categorical pain rating scale was also used. A positive response was defined as ≥50% decrease of the VAS-level on two consecutive assessment points during the test sessions, anything less was a non response. The placebo responders were defined as those with a positive response to the active placebo infusion.

Results

The tests were completed by 94 subjects and 26% of these were placebo responders. Among the placebo non responders, 47% responded to morphine, 41% to ketamine, 25% to both drugs and 37% to neither morphine nor ketamine (pain intensity assessments). Similar proportions were found in the assessments of pain unpleasantness and per cent pain relieved. Approximately one in four subjects (27%, pain intensity assessment) did not respond to any of the drugs tested. This relatively high proportion of non responders seemed to be worst cases in some aspects of the psychometrictests. Generally, this non responder group had a trend to score worse for most items in the psychometrictests with some reaching significance in a univariate analysis. This result was confirmed in a multivariate context, although the results indicated only small differences between the groups. All three substances showed significant pain relief compared to baseline on all assessment points. On most variables, morphine and ketamine were significantly more effective compared to the active placebo.

Conclusions

There are different subgroups among subjects with chronic WAD with variations in responses to i.v. morphine, ketamine, and midazolam (active placebo). Subjects with chronic WAD who did not respond to any of the drugs tested scored badly in some aspects of the psychometric instruments.

Implications

The present study confirms one aspect of the heterogeneity in the population with chronic WAD. The study does not elucidate precise pain mechanisms but taken together with other studies exploring other aspects, it stresses the importance of individualizing the assessment and treatment of subjects with chronic WAD. A common clinical experience is that depression, anxiety and maladaptive coping strategies often are obstacles for successful medical treatment of chronic pain. The present study supports this experience and emphasizes the need for assessment of psychometric variables when planning the treatment of chronic WAD.

Aim: The aim was to describe the effect of a multidisciplinary pain management program, in terms of patientreported occupational performance and satisfaction with performance.

Methods: The study is a retrospective, case series study. Data from interviews documented routinely in patient medical records were used. Interviews were made at introduction, on conclusion and six months after a pain management program. Data from all participants (n=85) introduced during one year, were analysed. The Canadian Occupational Performance Measure (COPM) was used as the main outcome measure.

Results: Estimated occupational performance as well as satisfaction with performance improved between measures (occupational performance p<0.001; satisfaction with performance p<0.001). The percentage of participants, who improved two or more points on the COPM ten-point scale between baseline and the 6-month follow up, was 27% for occupational performance and 40% for satisfaction with performance.

Conclusion: The findings raise questions regarding what the team might learn from different ways of scrutinizing results; the relevant level of MID in this program; and the overall objective in terms of the proportion of clients who reported a ‘successful’ outcome in occupational performance and satisfaction with performance, based on the identified MID. These questions need to be further analysed and discussed within the professional team.

Background: Effects presented on the use of assistive devices such as prosthesis are often based on laboratory findings (i.e. efficacy). Objectives: To summarise and evaluate findings from studies on effectiveness of lower limb prostheses for adults in real life contexts, primarily in terms of activity, participation, and quality of life (QoL) and secondarily in terms of user satisfaction, use/non-use, and/or cost-effectiveness. Study Design: Systematic review. Methods: We included controlled studies and non-controlled follow-up studies including both baseline and follow-up data. Using 14 different databases supplemented with manual searches, we searched for studies published from 1998 until June 2009. Results: Out of an initial 818 identified publications, eight met the inclusion criteria. Four studies reported on the effectiveness of a microprocessor-controlled knee (MP-knee) compared to a non-microprocessor-controlled knee (NMP-knee). Results were inconsistent except for quality of life and use/non-use, where the authors reported an improvement with the MP-knee compared to the NMP-knee. The remaining four studies included a diversity of prosthetic intervention measures and types of endpoints. Conclusions: Overall, there was an inconsistency in results and study quality. This review highlights the need for high-quality research studies that reflect the effectiveness of different prosthesis interventions in terms of users daily living and QoL.

Purpose: To examine the benefits from a vocational rehabilitation program for patients suffering from Acquired Brain Injury (ABI) in terms of quality of life, and overall health. In addition, to examine the direct societal costs of healthcare interventions related to vocational rehabilitation and indirect societal costs related to production loss. Method: Identified interventions in 45 patients with ABI who were discharged from a vocational rehabilitation program between 2010 and 2011 were documented, classified and translated into costs. Expenses associated with production loss were calculated by comparing sick leave production loss at first contact with the team, with sick leave production loss at discharge. Health related QoL and overall health, was measured at first contact and at discharge by using the EQ5D. Results: For vocational rehabilitation interventions, mean costs were €6303/individual/month. At first contact with the team, mean production loss was estimated to be €4409/individual/month compared; at discharge to be €2446. QoL-ratings increased from first contact to discharge, although estimated health did not change. At discharge, significant correlations were found between QoL ratings and estimated health and the extent of production loss (p < 0.05). Conclusion: Healthcare interventions that help ABI patients resume work are cost effective for society as well as for patients.

Background: Most older drivers continue to drive as they age. To maintain safe and independent transport, mobility is important for all individuals, but especially for older drivers. Objective: The objective of this study was to investigate whether automatic transmission, compared with manual transmission, may improve the driving behavior of older drivers. Method: In total, 31 older drivers (mean age 75.2 years) and 32 younger drivers used as a control group (mean age 39.2 years) were assessed twice on the same fixed route; once in a car with manual transmission and once in a car with automatic transmission. The cars were otherwise identical. The driving behavior was assessed with the Ryd On-Road Assessment driving protocol. Time to completion of left turns (right-hand side driving) and the impact of a distraction task were measured. Results:The older group had more driving errors than the younger group, in both the manual and the automatic transmission car. However, and contrary to the younger drivers, automatic transmission improved the older participants driving behavior as demonstrated by safer speed adjustment in urban areas, greater maneuvering skills, safer lane position and driving in accordance with the speed regulations. Conclusion: Switching to automatic transmission may be recommended for older drivers as a means to maintain safe driving and thereby the quality of their transport mobility.

For combat personnel in urban operations, situational awareness is critical and of major importance for a safe and efficient performance. One way to train situational awareness is to adopt video games. Twenty military and 20 civilian subjects played the game “Close Combat: First to Fight” on two different platforms, Xbox and PC, wearing an eye tracker. The purpose was to investigate if the visual search strategies used in a game correspond to live training, and how military-trained personnel search for visual information in a game environment. A total of 27,081 fixations were generated through a centroid mode algorithm and analyzed frame-by-frame, 48% of them from military personnel. Military personnel’s visual search strategies were different from those of civilians. Fixation durations were, however, equally short, that is, about 170 ms, for both groups. Surprisingly, the military-trained personnel’s fixation patterns were less orientated towards tactical objects and areas of interest than the civilians’; the underlying mechanisms remaining unclear. Military training was apparently not advantageous with respect to playing “Close Combat: First to Fight”. Further research within the area of gaming, military training and visual search strategies is warranted.

This study explores the potential of the health assessment questionnaire (HAQ) score as a clinical indicator that can be used to suggest comprehensive multidisciplinary assessments, by relating it to more general aspects of disability. In a cohort of 132 patients with early RA (mean age 55, 68% women), 28 joint count Disease Activity Scores (DAS-28), HAQ, and Short Form 36 (SF-36) scores were registered at annual follow-up visits 8 years after diagnosis. The patients were tentatively sub-grouped into a high-HAQ group (HAQ ≥1 at the 8-year follow-up) and a low-HAQ group. The high-HAQ group, comprising 36% of the cohort, had a higher mean HAQ score at inclusion and beyond at all visits compared to the low-HAQ group, and 24% of all individual patients in the high-HAQ group had a HAQ score ≥1 at inclusion. Although the DAS-28 improved in both groups, patients in the high-HAQ group also had significantly more persistent disability according to the SF-36: five scales at each follow-up visit and all eight scales at the majority of the visits. Individual RA patients with HAQ ≥1 probably have considerable persistent disabilities according to the SF-36. The HAQ score could be used as a clinical indicator suggesting comprehensive multidisciplinary assessments of the components of disability and corresponding interventions, in addition to the established use of HAQ at group levels and in parallel with the medication strategy based on DAS-28.

This thesis is focused on urodynamic evaluation of variables that are associated with the risk of upper urinary tract dysfunction and autonomic dysreflexia in patients with a reflex urinary bladder after spinal cord injury. The detrusor pressure was measured with suprapubic catheters during 24 or 12 hours of physiological filling (diuresis) and during consecutive cystometries. Within the ftlled volumes the bladder compliance was high. During contractions the maximum detrusor pressure and its duration varied both interand intraindividually. Thus, mean values from a series of contractions seem to be necessary in order to characterize a patient. There was no difference between mean values during physiological filling compared with 10 rnl/min or 50 ml/min fill cystometry and there was no systematic change during a series of four consecutive cystornetries with a 10 min interval. When a closed 12F urethral catheter was added in order to mimick a transurethral urodynamic techrtique, there was an increase of the amplitude and duration of the detrusor pressure and a decrease of the average flow rate, indicating an obstructive effect. In patients with a high level spinal cord injury, the blood pressure was also measured every 30 s, during a series of four consecutive cystometries. In each cystometry there was an elevation of the systolic and diastolic blood pressure. The maximum blood pressure was always observed during the detrusor contraction. The amplitude of the blood pressure response varied intraindividually but did not change in any particular direction during the series of cystometries. When 10 mg rtifedipine was given sublingually, and a series of four cystometries was repeated, there was a sigrtificant decrease of the maximum blood pressure.

Life balance seems subjective, health related, and multidimensional. However, the concept is complex. Exploring what people themselves consider more or less important for their life balance and whether this differs between people would develop new knowledge. Q methodology was chosen for the present study, in which 32 working men and women without recent long-term sick leave participated. They sorted 42 statements regarding life balance according to their importance for each participants life balance. The analysis resulted in four different viewpoints concerning life balance. All four viewpoints considered good relationships with those closest to them, as well as knowing that these people were doing well, as important. Each viewpoint also showed a unique orientation towards what was considered important for life balance: occupational balance (viewpoint 1), self-actualization (viewpoint 2), self-awareness (viewpoint 3), and reciprocal relationships (viewpoint 4). The results. showed support for life balance as being a subjective, multidimensional, and health-related phenomenon. The results demonstrated the importance of relationships for life balance and heterogeneity in what people considered important for their own life balance.

Whiplash-associated disorders (WAD) have been associated with sensory disturbances such as hypersensitivity or hypoesthesia. Different psychological factors seem to be important for prognosis and symptom presentation in WAD. Multivariate correlations between pain thresholds for pressure (PPT), cold and heat (CPT, HPT), detection thresholds for cold and warmth, pain intensity variables, and psychological aspects in women with chronic WAD (n = 28) and in healthy pain-free controls (n = 29) were investigated. Quantitative Sensory Testing (QST) for thermal thresholds and algometry for PPT at various sites in the body were used. Psychological aspects, including catastrophizing, anxiety, and depression were registered using a questionnaire. WAD showed generalized decreased PPT and CPT, altered HPT and cold detection thresholds in the upper part of the body, and a worse psychological situation. Multivariate correlations were found between QST and PPT variables, habitual pain, and psychological factors in WAD. Different psychological variables were generally stronger predictors of CPT and HPT than pain intensity in WAD. Pain intensity aspects were generally the strongest predictors of PPT in WAD. In contrast, no correlations existed between QST and PPT variables and psychological variables in controls. These results indicate the need to consider that a blend of factors influences the pain thresholds in chronic WAD and emphasize the need for a biopsychosocial model when interpreting QST and PPT variables.