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Using Multivariate Statistics

Study design The Oswestry Disability Index (ODI) has become one of the principal condition-specific outcome measures used in the management of spinal disorders. This review is based on publications using the ODI identified from the authors' personal databases, the Science Citation Index, and hand searches of Spine and current textbooks of spinal disorders. Objectives To review the versions of this instrument, document methods by which it has been validated, collate data from scores found in normal and back pain populations, provide curves for power calculations in studies using the ODI, and maintain the ODI as a gold standard outcome measure. Summary of background data It has now been 20 years since its original publication. More than 200 citations exist in the Science Citation Index. The authors have a large correspondence file relating to the ODI, that is cited in most of the large textbooks related to spinal disorders. Methods All the published versions of the questionnaire were identified. A systematic review of this literature was made. The various reports of validation were collated and related to a version. Results Four versions of the ODI are available in English and nine in other languages. Some published versions contain misprints, and many omit the scoring system. At least 114 studies contain usable data. These data provide both validation and standards for other users and indicate the power of the instrument for detecting change in sample populations. Conclusions The ODI remains a valid and vigorous measure and has been a worthwhile outcome measure. The process of using the ODI is reviewed and should be the subject of further research. The receiver operating characteristics should be explored in a population with higher self-report disabilities. The behavior of the instrument is incompletely understood, particularly in sensitivity to real change.

https://womenshealthapta.org/wp-content/uploads/2013/12/oswestry-fairbanks.pdf

The Oswestry Disability Index.

Perceived discrimination has been studied with regard to its impact on several types of health effects. This meta-analysis provides a comprehensive account of the relationships between multiple forms of perceived discrimination and both mental and physical health outcomes. In addition, this meta-analysis examines potential mechanisms by which perceiving discrimination may affect health, including through psychological and physiological stress responses and health behaviors. Analysis of 134 samples suggests that when weighting each study's contribution by sample size, perceived discrimination has a significant negative effect on both mental and physical health. Perceived discrimination also produces significantly heightened stress responses and is related to participation in unhealthy and nonparticipation in healthy behaviors. These findings suggest potential pathways linking perceived discrimination to negative health outcomes.

/pdf/perceived-discrimination-and-health-a-meta-analytic-review-4aai112ban.pdf

Perceived discrimination and health: a meta-analytic review.

Naturally occurring variations in maternal care alter the expression of genes that regulate behavioral and endocrine responses to stress, as well as hippocampal synaptic development. These effects form the basis for the development of stable, individual differences in stress reactivity and certain forms of cognition. Maternal care also influences the maternal behavior of female offspring, an effect that appears to be related to oxytocin receptor gene expression, and which forms the basis for the intergenerational transmission of individual differences in stress reactivity. Patterns of maternal care that increase stress reactivity in offspring are enhanced by stressors imposed on the mother. These findings provide evidence for the importance of parental care as a mediator of the effects of environmental adversity on neural development.

Maternal care, gene expression, and the transmission of individual differences in stress reactivity across generations.

www.mobilehealthmap.org 617‐442‐3200 New research shows that mobile health clinics improve health outcomes for hard to reach populations in cost‐effective and culturally competent ways . A Harvard Medical School study determined that for every dollar invested in a mobile health clinic, the US healthcare system saves $30 on average. Mobile health clinics, which offer a range of services from preventive screenings to asthma treatment, leverage their mobility to treat people in the convenience of their own communities. For example, a mobile health clinic in Baltimore, MD, has documented savings of $3,500 per child seen due to reduced asthma‐related hospitalizations. The estimated 2,000 mobile health clinics across the country are providing similarly cost‐effective access to healthcare for a wide range of populations. Many successful mobile health clinics cite their ability to foster trusting relationships. Qualitative research in such mobile health clinics has found that patients value the informal, familiar environment in a convenient location, with staff who “are easy to talk to,” and that the staff’s “marriage of professional and personal discourses” provides patients the space to disclose information themselves. A communications academic argued that mobile health clinics’ unique use of space is important in facilitating these relationships. Mobile health clinics park in the heart of the community in familiar spaces, like shopping centers or bus stations, which lend themselves to the local community atmosphere.

Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care

Metabolic syndrome (MetS) comprises a constellation of metabolic abnormalities that substantially increase risk for chronic illnesses. Autonomic dysregulation is closely linked to MetS, and while pathophysiological models often address chronic stress exposure, none have examined how such physiological contributions operate situationally, in a clinical setting. We used ambulatory impedance cardiography to examine indicators of cardiac autonomic control (CAC) in a sample of 50 adult primary care patients with and without MetS. Indices of independent sympathetic and parasympathetic cardiovascular control in primary care outpatients were measured during a brief stress reactivity assessment. We compared interdependent CAC features, including cardiac autonomic balance (i.e., sympathovagal reciprocity) and cardiac autonomic regulation (i.e., sympathovagal coactivation) and found significant differences among MetS participants as compared to healthy controls. In particular, cardiac autonomic regulation scores were higher among MetS patients when discussing medication concerns, and cardiac autonomic balance scores were lower among MetS patients when discussing daily stressors. These results suggest that patients meeting criteria for MetS demonstrate momentary variations in CAC depending on personally relevant health topics. The potential for future research is discussed with a focus on prospective data collection to enhance diagnostic procedures and treatment monitoring.

Maladaptive Cardiac Autonomic Control during a Stress Reactivity Assessment Among Primary Care Patients with Metabolic Syndrome

High prevalence rates for depression, anxiety, and gastrointestinal (GI) symptoms are found in emerging adults. However, the consequences of mood, anxiety, and GI health on health-related quality o...

https://journals.sagepub.com/doi/pdf/10.1177/2055102920974524

Gastrointestinal health: An investigation of mediating effects on mood and quality of life.

Okeson and others have proposed that statistical comparisons between groups of treated and untreated patients be used to evaluate the effectiveness of occlusal splint therapy. This article argues that valid between-groups comparisons cannot be made by most clinicians and that such comparisons do not satisfactorily guide the treatment of individual patients. An intrasubject replication design strategy is then offered as a model for clinicians to use in evaluating splint-therapy effects in individual cases.

An intrasubject replication strategy for evaluating occlusal splint therapy.

The Medical Tattoo Assistant: Guidelines for an Emerging Profession.

Objective Tinnitus is a common and sometimes severely debilitating condition. It has been estimated that approximately 7% of Americans experience tinnitus daily. Hearing difficulties, sleep problems, concentration difficulties, and anxiety are commonly reported associated concerns. Cognitive behavior therapy (CBT) is often recommended to address the psychosocial impact of burdensome tinnitus, as CBT interventions have been shown to be efficacious in reducing tinnitus burden. The presented case demonstrates that a brief (4-session) adapted CBT treatment in an integrated primary care (IPC) setting can result in notable improvements in functioning. Method Tinnitus severity was monitored with the Tinnitus Handicap Inventory (THI) and the Tinnitus Functional Index (TFI). Results The patient reported increased self-efficacy in coping with his tinnitus symptoms. The subjective volume of his tinnitus remained similar over time, but the emotional impact of his symptoms decreased dramatically. Overall THI score decreased from a 48 (moderate impairment) at baseline to a 20 (mild impairment) at discharge. Overall TFI score decreased from a 40 (moderate problem) during first administration to a 9.6 (not a problem) at discharge. Conclusions Brief CBT treatment for tinnitus can be delivered in an IPC setting, consistent with a population-health approach. Such treatment may result in improved quality of life for patients, and the brief approach has the potential to reduce overall cost of care. This case encourages increased identification and treatment of tinnitus within IPC settings, in order to increase access of care for patients with this burdensome condition. (PsycINFO Database Record

Jeffrey E. Cassisi

Papers

Maladaptive Cardiac Autonomic Control during a Stress Reactivity Assessment Among Primary Care Patients with Metabolic Syndrome

Gastrointestinal health: An investigation of mediating effects on mood and quality of life.

An intrasubject replication strategy for evaluating occlusal splint therapy.

The Medical Tattoo Assistant: Guidelines for an Emerging Profession.

Cognitive behavior therapy for tinnitus in integrated primary care: A case example.