Slacklining:An explanatory multi-dimensional model considering classical mechanics,biopsychosocial health and time

This paper aims to overcome slacklining’s limited formulated explanatory models.Slacklining is an activity with increasing recreational use,but also has progressive adoption into prehabilitation and rehabilitation.Slacklining is achieved through self-learned strategies that optimize energy expenditure without conceding dynamic stability,during the neuromechanical action of balance retention on a tightened band.Evolved from rope-walking or‘Funambulus’,slacklining has an extensive history,yet limited and only recent published research,particularly for clinical interventions and in-depth hypothesized multi-dimensional models describing the neuromechanical control strategies.These‘knowledge-gaps’can be overcome by providing an,explanatory model,that evolves and progresses existing standards,and explains the broader circumstances of slacklining’s use.This model details the individual’s capacity to employ control strategies that achieve stability,functional movement and progressive technical ability.The model considers contributing entities derived from:Self-learned control of movement patterns;subjected to classical mechanical forces governed by Newton’s physical laws;influenced by biopsychosocial health factors;and within time’s multi-faceted perspectives,including as a quantified unit and as a spatial and cortical experience.Consequently,specific patient and situational uses may be initiated within the framework of evidence based medicine that ensures a multi-tiered context of slacklining applications in movement,balance and stability.Further research is required to investigate and mathematically define this proposed model and potentially enable an improved understanding of human functional movement.This will include its application in other diverse constructed and mechanical applications in varied environments,automation levels,robotics,mechatronics and artificial-intelligence factors,including machine learning related to movement phenotypes and applications.

The Status of the “Biopsychosocial” Model in Health Psychology: Towards an Integrated Approach and a Critique of Cultural Conceptions

The current status of the “Biopsychosocial” Model in health psychology is contested and arguably exists in a stage of infancy. Despite original goals, medical researchers have developed theoretical and empirical integrations across bio-psycho-social domains only to a limited extent. This review article addresses this issue by making connections across research findings in health psychology and related medical fields in order to strengthen the associations across bio-psycho-social domains. In particular, research in sociosomatics, neuroplasticity and psychosocial genomics are introduced and explored. The role of “culture” as conceived of within the Biopsychosocial Model is also ambiguous and somewhat problematic. Arthur Klienman’s conceptions of culture as what is at stake for individuals in their local social and moral worlds is adopted to offer a critique of previous perspectives of culture and question its role amidst bio-psycho-social domains. Overall, a multilevel integrative or ‘holistic’ perspective is advanced to strengthen the Biopsychosocial Model for use within health psychology and biomedical research. In the end, some clinical implications are discussed.

The Impact of Psychosocial Influences on Chronic Wound Healing

This comprehensive review explores the intricate dynamics between psychosocial factors and chronic wound healing processes, specifically focusing on prevalent conditions such as pressure ulcers, diabetic foot ulcers, and venous leg ulcers. By examining the roles of psychiatric conditions, including depression, anxiety, and post-traumatic stress disorder (PTSD), this paper illuminates how these factors intricately influence wound healing dynamics, including mechanisms of pain perception and inflammatory responses. Furthermore, we evaluate the effectiveness of integrated biopsychosocial interventions, which encompass a holistic approach to wound care, thereby enhancing healing outcomes for dermatology patients. Future studies should focus on investigating the specific psychosocial determinants that significantly influence wound healing, exploring novel therapeutic strategies, and implementing personalized interventions to meet the unique needs of each patient. Such endeavors hold promise in advancing the fields of psychodermatology and wound management, fostering a deeper understanding and application of psychosocial considerations in dermatological care.

Irritable bowel syndrome:A clinical review

Irritable bowel syndrome (IBS) remains a clinical challenge in the 21st century. It’s the most commonly diagnosed gastrointestinal condition and also the most common reason for referral to gastroenterology clinics. Its can affect up to one in five people at some point in their lives, and has a significantly impact of life quality and health care utilization. The prevalence varies according to country and criteria used to define IBS. Various mechanisms and theories have been proposed about its etiology, but the biopsychosocial model is the most currently accepted for IBS. The complex of symptoms would be the result of the interaction between psychological, behavioral, psychosocial and environmental factors. The diagnosis of IBS is not confirmed by a specific test or structural abnormality. It is made using criteria based on clinical symptoms such as Rome criteria, unless the symptoms are thought to be atypical. Today the Rome Criteria III is the current gold-standard for the diagnoses of IBS. Secure positive evidence of IBS by means of specific disease marker is currently not possible and cannot be currently recommended for routine diagnosis. There is still no clinical evidence to recommend the use of biomarkers in blood to diagnose IBS. However, a number of different changes in IBS patients were demonstrated in recent years, some of which can be used in the future as a diagnostic support. IBS has no definitive treatment but could be controlled by non-pharmacologic management eliminating of some exacerbating factors such certain drugs, stressor conditions and changes in dietary habits.The traditional pharmacologic management of IBS has been symptom based and several drugs have been used. However, the cornerstone of its therapy is a solid patient physician relationship. This review will provide a summary of pathophysiology, diagnostic criteria and current and emerging therapies for IBS.

Irritable bowel syndrome:The evolution of multi-dimensional looking and multidisciplinary treatments

Irritable bowel syndrome(IBS)is common in the society.Among the putative pathogeneses,gut dysmotility results in pain and disturbed defecation.The latter is probably caused by the effect of abnormal gut water secretion.The interaction between abnormal gas accumulation,abdominal pain and bloating remains controversial.Visceral hypersensitivity and its modification along with the central transmission are the characteristics of IBS patients.The identification of biologic markers based on genetic polymorphisms is undetermined.Imbalanced gut microbiota may alter epithelial permeability to activate nociceptive sensory pathways which in turn lead to IBS.Certain food constituents may exacerbate bowel symptoms.The impact of adult and childhood abuses on IBS is underestimated.Using the concept of biopsychosocial dysfunction can integrate multidimensional pathogeneses.Antispasmodics plus stool consistency modifiers to treat the major symptoms and defecation are the first-line drug treatment.New drugs targeting receptors governing bowel motility,sensation and secretion can be considered,but clinicians must be aware of their potential serious side effects.Psychiatric drugs and modalities may be the final options for treating intractable subjects.Probiotics of multi-species preparations are safe and worth to be considered for the treatment.Antibiotics are promising but their longterm safety and effectiveness are unknown.Diet therapy including exclusion of certain food constituents is an economic measure.Using relatively safe complementary and alternative medicines(CAMs)may be optional to those patients who failed classical treatment.In conclusion,IBS is a heterogeneous disorder with multidimensional pathogeneses.Personalized medicines with multidisciplinary approaches using different classes of drugs,psychiatric measures,probiotics and antibiotics,dietary therapy,and finally CAMs,can be considered.

Irritable bowel syndrome in children: Pathogenesis, diagnosis and evidence-based treatment

Irritable bowel syndrome (IBS) is the commonest cause of recurrent abdominal pain (RAP) in children in both more developed and developing parts of the world. It is defined by the Rome III criteria for functional gastrointestinal disorders. It is characterized by abdominal pain that is improved by defecation and whose onset is associated with a change in stool form and or frequency and is not explained by structural or biochemical abnormalities. It is estimated that 10%-15% of older children and adolescents suffer from IBS. IBS can be considered to be a brain-gut disorder possibly due to complex interaction between environmental and hereditary factors. The diagnosis of IBS is made based on the Rome III criteria together with ruling out organic causes of RAP in children such as inflammatory bowel disease and celiac disease. Once the diagnosis of IBS is made, it is important to explain to the parents (and children) that there is no serious underlying disease. This reassurance may be effective treatment in a large number of cases. Lifestyle modifications, stress management, dietary interventions and probiotics may be beneficial in some cases. Although there is limited evidence for efficacy of pharmacological therapies such as antispasmodics and antidiarrheals; these have a role in severe cases. Biopsychosocial therapies have shown encouraging results in initial trials but are beset by limited availability. Further research is necessary to understand the pathophysiology and provide specific focused therapies.

Health measurement

Jamaicans are not atypical in how they conceptualize health and/or how they address patient care as the antithesis of diseases or dysfunctions (i.e. health conditions). In the 1900s and earlier, Western Societies were using the biomedical model in the measurement and trea- tment of health, health attitudes and the utilization of health services. This approach emphasizes sickness, dysfunction, and the identification of symptomology or medical disorders to evaluate health and health care. Such an approach places significance on the end (i.e. genetic and physical conditions), instead of the multiplicity of factors that are likely to result in the existing state, or issues outside of the space of dysfunctions. Notwithstanding the limitations of the biomedical approach, it is still practiced by many Caribbean societies, and this is fundamentally the case in Jamaica. The current paper is an examination of health measurement, and provides at the same time a rationale for the need to have a more representative model as opposed to the one-dimensional approach of using pathogens in measuring health. Owing to the importance of health in development, patient care and its significance for other areas in society, this paper seeks to broaden more than just the construct, as it goes to the core of modern societies in helping them to understand the constitution of health and how patient care should be treated. Thus, it provides a platform for the adoption of the biopsychosocial model, which integrates biological, social, cultural, psychological and environmental conditions in the assessment of health and the outcome of research, by using observational survey data.

The Modernisation of Manipulative Therapy

Research indicates that, despite physiotherapists’ comprehensive training in the basic sciences, manipulative (currently “musculoskeletal”) therapy is still dominated in the clinical setting by its original, now obsolete, structure-based “biomedical” model. This is further inexplicable in the light of evidence that not only the underlying “philosophy” but also several of the fundamental requirements of the clinical process itself which has the structural-mechanical model as its basis, have been shown to be flawed or at least irrelevant. The apparent inability of the profession to fully abandon outmoded “concepts” (and embrace the acknowledged science-based “best practice” biopsychosocial model) may have potentially undesirable consequences for both patients and therapists engaged in the management of (chronic) musculoskeletal pain and disability.

Strategies for Managing Chronic Pain: Case of a Skilled Orthopaedic Physician and Mini-Review

Epidemiological surveys have recently revealed a high prevalence of chronic musculoskeletal pain in Japan;however, 30% of the patients in the survey were not satisfied with their pain treatment. This indicates that standard strategies in the management of chronic pain are poorly shared among physicians in Japan. Herein we report a case of a patient with intractable chronic pain who is a skilled orthopaedic physician. A 43-year-old man who was a skilled orthopaedic surgeon presented at our center complaining of severe buttock pain especially around the right hip region for more than three years. At begging of pain onset, he was diagnosed with femoacetabular impingement syndrome (FAI) with labral tear. Despite biophysical interventions including twice surgeries and alternative conservative treatment, his pain persisted, and he occasionally had to take a day off work due to the severe pain. Therefore we had to evaluate his pathological condition using a multidimensional approach based on a biopsychosocial model. We had provided him with cognitive behavioral therapy (CBT) approach, and simultaneously suggestion for short leaving from work. Three months after the start of CBT training, his disabilities had begun to improve. About six months later, he could continue to do his work. Finally, 19 months have passed since we started implementing the CBT approach;he has regained both his previous work-life balance and his health, although the pain has not completely subsided. In conclusion, we think it is important for physicians treating chronic pain to learn the management strategies for chronic pain and to re-consider their management policy when conventional biomedical interventions were not succeeded, even in cases where medication and surgical intervention are warranted.

Daily Life and Planning for the Future of Ageing People with Down Syndrome: Results from a National Study on Caregivers

Background: Limited research concerns the study of continuity in the future of the physical and social status of elderly people with DS that is when people who take care of them will not be there anymore (“after we have gone”). Objective: From a biopsychosocial perspective, to investigate the daily life of ageing people with Down Syndrome over 45 years old in order to identify the most important issues in better planning for their future. Methods: A cross-sectional Italian national study was carried out. An ad hoc questionnaire was administered to formal and informal caregivers of aging people with Down Syndrome. Results: 136 family members and health professionals were involved. Most of the people with Down Syndrome live at home, attend a daily center and do many activities. Most of them had never worked and she/he is not at all autonomous. 25% of caregivers declared that, nowadays, there is not planning for the future, and 30.9% of participants who planned their future collected information when it occurred (e.g. when the parents pass away). Conclusions: The aging of people with DS requires attention to the planning of their future. In order to better plan, it is necessary to avoid programming “in emergency”, but for time, keeping in mind of the activities developed by the people, their abilities and all of the elements that have allowed them to live well up to a point of their life.

Delusional disorder with depression and history of early trauma: A case report

BACKGROUND The case report supports the recent findings regarding the correlation of posttraumatic stress disorder(PTSD)and schizophrenia.The report accomplished the following objectives:(1)To present a case of an adult female manifesting with somatic type of delusion(foul body odor)and history of PTSD;(2)To discuss the biopsychosocial factors,psychodynamics and management of the patient;and(3)To differentiate delusional disorder from schizophrenia according to recent studies.Schizophrenia and delusional disorder have certain defining features that separate the two.However,at times it may be difficult to actually classify one from the other.A psychiatrist must be able to carefully examine and assess the history of the patient,helping them share early life experiences of past traumatic events.The early past traumatic experiences and life events greatly influence the predisposition of a patient to develop schizophrenia.However,people with schizophrenia were known to underreport their trauma experience.CASE SUMMARY This is a case of a young adult female diagnosed with delusional disorder with a history of PTSD and associated depression.The patient manifested with somatic type of delusion with a fixed false belief that a foul body odor was coming from her underarms.CONCLUSION Developing a therapeutic alliance is vital in achieving therapy goals through empathy,support and warmth between the patient and physician.History of PTSD predisposes patients with schizophrenia to develop depressive disorders as a comorbidity.

Management of Geriatric Low Back Pain with Tai Chi

Introduction:Chronic low back pain(cLBP)among older adults is a complex,biopsychosocial condition that despite research efforts and innovative interventions remains a prevalent,disabling and costly condition.This case highlights the use of tai chi(TC)for persistent geriatric LBP.Case Presentation:A 68-year-old Caucasian female with cLBP,neuromuscular imbalances,leg weakness and fall risk was treated with a walking program(aerobic),manual therapy(mobility),lumbar stabilization(strength)and group TC class(neuromuscular function).Discussion:Research validates TC for a variety of older adult health conditions,but few studies demonstrated effectiveness for cLBP.This case outlines the use of a simplified Yang-style TC for management of persistent geriatric LBP.Conclusion:The addition of group TC to standard treatment for cLBP resulted in improved functional outcomes,decreased pain ratings and improved leg strength,flexibility and balance as compared to standard treatment for cLBP.Following the group TC class the client reported significant self-perception of recovery,and these functional and confidence gains eliminated the need for physiotherapy services for cLBP for three subsequent years.Level of Evidence:Therapy,level 4.

Health care in light of different theories of health——A proposed framework for integrating a social humanistic perspective into health care

The objective of this paper is to provide an overview of the biomedical,the biopsychosocial, and the social humanistic theories of health and to propose a framework for integrating the latter into health care. In summary, the definitions of health, illness and disease are essential to the practice of health care and play fundamental roles in how patients’ experiences of being ill are valued and assessed within health care systems. Principally, the biomedical perspective proceeds from pathoanatomical deficiencies defining disease and malfunction;the addition of psychosocial components forms a biopsychosocial perspective.In addition, the social humanistic perspective extends from a person’s will, their ability to act, and the possibility to fulfill wanted actions. Thus, health care that does not address the social humanistic perspective may lack the power to describe how these entities are related to the patient on a personal level;thus,the will of the patient is not always fully addressed. Importantly, by targeting the will of the patient and the patient’s ability to act, the proposed framework of integrating a social humanistic perspective into health care may further emphasize and strengthen the interrelatedness of medical perspectives. A framework for integrating a social humanistic perspective into health care is proposed and its potential impact on health care is discussed.

Stress reduction via neuro-emotional technique to achieve the simultaneous resolution of chronic low back pain with multiple inflammatory and biobehavioural indicators:A randomized,double-blinded,placebo-controlled trial

Background:Beginning with the concepts of stress developed by Selye,an approach to stress and pain management,known as neuro-emotional technique(NET),has been developed.It is a treatment approach based on the principle that the stressor effects of dormant and/or current unresolved issues or trauma are what determine one’s bodily responses.These responses are relatively personalized to the conditioned,experiential and emotional reality of the individual.Objective:To determine the effect of NET on patients with chronic low back pain(CLBP)over time.Design,setting,participants,and interventions:In a randomized,double-blinded,placebo-controlled study conducted in a single clinic,NET or control treatments were given twice weekly for 4 weeks in a population of 112 patients.Main outcome measures:Outcome measures,including Oswestry Disability Index,Quadruple Visual Analogue Scale,the psychoneuroimmunology markers of blood serum levels of C-reactive protein,tumour necrosis factor-a,interleukin-1(IL-1),IL-6,and IL-10,and 10 dimensions of the Short Form Health Survey scale,were assessed at baseline and at 1,3 and 6 months following the intervention period.Results:Compared to placebo,NET produced clinical and statistical significance(P<0.001)via declines of virtually all physiological,pain and disability markers,accompanied by gains in quality-of-life indicators at 0(baseline),1,3 and 6 months.Reductions of the percentages of patients whose 5 biomarkers lay outside the normative range were achieved at 1,3 and 6 months by NET but not control interventions.Conclusion:A randomized,controlled trial of CLBP patients indicated that 8 NET interventions,compared to placebo,produced clinically and statistically significant reductions in pain,disability and inflammatory biomarkers,and improvements in quality-of-life measures.