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Hintergrund
Lumbale Ruckenschmerzen und ihre Neigung zur Chronifizierung stellen nicht nur in der Allgemeinbevolkerung, sondern auch im Leistungssport ein bedeutendes Gesundheitsproblem dar. Im Gegensatz zu Nichtathleten ist die Erforschung psychosozialer Risikofaktoren sowie von Screeningfragebogen, die moglichst fruhzeitig die Entwicklung chronischer Schmerzen erkennen und vorhersagen konnen, im Leistungssport noch in den Anfangen. Das vorliegende systematische Review gibt einen uberblick uber den Stand der Risikofaktorenforschung in beiden Feldern und untersucht die pradiktive Qualitat verschiedener Screeningfragebogen bei Nichtathleten.
Methodik
Die Literatursuche erfolgte zwischen Marz und Juni 2016 in den Datenbanken MEDLINE, PubMed und PsycINFO mit den Suchbegriffen psychosocial screening, low back pain, sciatica und prognosis, athletes. Eingeschlossen wurden prospektive Studien an Patienten mit lumbalen Ruckenschmerzen mit und ohne Ausstrahlung in das Bein, 18Jahre und mit einem Follow-up von mindestens 3-monatiger Dauer.
Ergebnisse
In das Review zu Screeninginstrumenten wurden 16Studien einbezogen. Alle waren an klinischen Stichproben der Allgemeingesellschaft durchgefuhrt worden. Zu den am haufigsten publizierten Screeningfragebogen gehoren der orebro Musculoskeletal Pain Screening Questionnaire (oMPSQ) mit einer zufriedenstellenden Fruherkennung der Wiederherstellung der Arbeitsfahigkeit sowie das STarT Back Screening Tool (SBT) mit guter Vorhersage schmerzbedingter Beeintrachtigung. Fur die Vorhersage kunftiger Schmerzen eignen sich die Risikoanalyse der Schmerzchronifizierung (RISC-R) und der Heidelberger Kurzfragebogen (HKF).
Schlussfolgerungen
Psychosoziale Risikofaktoren fur chronische Ruckenschmerzen, wie z.B. chronischer Stress, ungunstige Schmerzverarbeitung und depressive Stimmungslagen, werden zunehmend auch im Leistungssport erkannt. Screeninginstrumente, die sich in der Allgemeingesellschaft als hinreichend vorhersagestark erwiesen haben, werden aktuell im MiSpEx-Forschungsverbund auf ihre Eignung uberpruft.
Psychosocial risk factors for chronic back pain in the general population and in competitive sports
(2018)
Lumbar back pain and the high risk of chronic complaints is not only an important health concern in the general population but also in high performance athletes. In contrast to non-athletes, there is a lack of research into psychosocial risk factors in athletes. Moreover, the development of psychosocial screening questionnaires that would be qualified to detect athletes with a high risk of chronicity is in the early stages. The purpose of this review is to give an overview of research into psychosocial risk factors in both populations and to evaluate the performance of screening instruments in non-athletes. The databases MEDLINE, PubMed, and PsycINFO were searched from March to June 2016 using the keywords "psychosocial screening", "low back pain", "sciatica" and "prognosis", "athletes". We included prospective studies conducted in patients with low back pain with and without radiation to the legs, aged ae<yen>18 years and a follow-up of at least 3 months. We identified 16 eligible studies, all of them conducted in samples of non-athletes. Among the most frequently published screening questionnaires, the A-rebro Musculoskeletal Pain Screening Questionnaire (A-MPSQ) demonstrated a sufficient early prediction of return to work and the STarT Back Screening Tool (SBT) revealed acceptable performance predicting pain-related impairment. The prediction of future pain was sufficient with the Risk Analysis of Back Pain Chronification (RISC-BP) and the Heidelberg Short Questionnaire (HKF). Psychosocial risk factors of chronic back pain, such as chronic stress, depressive mood, and maladaptive pain processing are becoming increasingly more recognized in competitive sports. Screening instruments that have been shown to be predictive in the general population are currently being tested for suitability in the German MiSpEx research consortium.
Der gemeinsame Wandel der inselkeltischen Sprachen wie auch des Englischen vom vorwiegend synthetischen Typus zum vorwiegend analytischen Typus läßt sich vermutlich auf einen ca. 1500 Jahre dauernden intensiven Sprachenkontakt zwischen diesen Sprachen zurückführen. Heute ist das Englische die analytischste Sprache der Britischen Inseln und Irlands, gefolgt vom Walisischen, Bretonischen und Irischen. Letzteres ist von den genannten Sprachen noch am weitesten morphologisch komplex.
Background
Communicating a diagnosis is highly important, yet complex, especially in the context of cancer and mental disorders. The aim was to explore the communication style of an oncologist vs. psychotherapist in an online study.
Methods
Patients (N = 136: 65 cancer, 71 depression) were randomly assigned to watch a standardized video vignette with one of two communication styles (empathic vs. unempathic). Outcome measures of affectivity, information recall, communication skills, empathy and trust were applied.
Results
Regardless of diagnosis, empathic communication was associated with the perception of a significantly more empathic (p < 0.001, η2partial = 0.08) and trustworthy practitioner (p = 0.014, η2partial = 0.04) with better communication skills (p = 0.013, η2partial = 0.05). Cancer patients reported a larger decrease in positive affect (p < 0.001, η2partial = 0.15) and a larger increase in negative affect (p < 0.001, η2partial = 0.14) from pre- to post-video than depressive patients. Highly relevant information was recalled better in both groups (p < 0.001, d = 0.61–1.06).
Conclusions
The results highlight the importance of empathy while communicating both a diagnosis of cancer and a mental disorder. Further research should focus on the communication of a mental disorder in association with cancer.
We report on the detection of very high energy (VHE; E > 100 GeV) gamma-ray emission from the BL Lac objects KUV 00311-1938 and PKS 1440-389 with the High Energy Stereoscopic System (H.E.S.S.). H.E.S.S. observations were accompanied or preceded by multiwavelength observations with Fermi/LAT, XRT and UVOT onboard the Swift satellite, and ATOM. Based on an extrapolation of the Fermi/LAT spectrum towards the VHE gamma-ray regime, we deduce a 95 per cent confidence level upper limit on the unknown redshift of KUV 00311-1938 of z < 0.98 and of PKS 1440-389 of z < 0.53. When combined with previous spectroscopy results, the redshift of KUV 00311-1938 is constrained to 0.51 <= z < 0.98 and of PKS 1440-389 to 0.14 (sic) z < 0.53.
We study a transition to hyperchaos in the two-dimensional incompressible Navier-Stokes equations with periodic boundary conditions and an external forcing term. Bifurcation diagrams are constructed by varying the Reynolds number, and a transition to hyperchaos (HC) is identified. Before the onset of HC, there is coexistence of two chaotic attractors and a hyperchaotic saddle. After the transition to HC, the two chaotic attractors merge with the hyperchaotic saddle, generating random switching between chaos and hyperchaos, which is responsible for intermittent bursts in the time series of energy and enstrophy. The chaotic mixing properties of the flow are characterized by detecting Lagrangian coherent structures. After the transition to HC, the flow displays complex Lagrangian patterns and an increase in the level of Lagrangian chaoticity during the bursty periods that can be predicted statistically by the hyperchaotic saddle prior to HC transition.
Based on joint consideration of S receiver functions and surface-wave anisotropy we present evidence for the existence of a thick and layered lithosphere beneath the Kalahari Craton. Our results show that frozen-in anisotropy and compositional changes can generate sharp Mid-Lithospheric Discontinuities (MLD) at depths of 85 and 150-200 km, respectively. We found that a 50 km thick anisotropic layer, containing 3% S wave anisotropy and with a fast-velocity axis different from that in the layer beneath, can account for the first MLD at about 85 km depth. Significant correlation between the depths of an apparent boundary separating the depleted and metasomatised lithosphere, as inferred from chemical tomography, and those of our second MLD led us to characterize it as a compositional boundary, most likely due to the modification of the cratonic mantle lithosphere by magma infiltration. The deepening of this boundary from 150 to 200 km is spatially correlated with the surficial expression of the Thabazimbi-Murchison Lineament (TML), implying that the TML isolates the lithosphere of the Limpopo terrane from that of the ancient Kaapvaal terrane. The largest velocity contrast (3.6-4.7%) is observed at a boundary located at depths of 260-280 km beneath the Archean domains and the older Proterozoic belt. This boundary most likely represents the lithosphere-asthenosphere boundary, which shallows to about 200 km beneath the younger Proterozoic belt. Thus, the Kalahari lithosphere may have survived multiple episodes of intense magmatism and collisional rifting during the billions of years of its history, which left their imprint in its internal layering.