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Background & Purpose: Chronic pain is a prevalent chronic condition for which the best management options rarely provide complete relief. Individuals with chronic pain with neuropathic characteristics (NC) report more severe pain and experience less relief from interventions. Little is known about current self-management practices. The purpose of this dissertation was to inform self-management of chronic pain with and without NC at the individual, health system, and policy levels using the Innovative Care for Chronic Conditions Framework. Methods: The study included a systematic search and review and cross-sectional survey. The review evaluated the evidence for chronic pain self-management interventions and explored the role of health care providers in supporting self-management. The survey was mailed to 8,000 randomly selected Canadians in November 2011, and non-respondents were followed-up in May 2012. Screening questions were included for both chronic pain and NC. The questionnaire captured pain descriptions, self-management strategies, and self-management barriers, and facilitators. Results: Findings of the review suggested that self-management interventions are effective in improving pain and health outcomes. Health care professionals provided self-management advice and referred individuals to self-management interventions. The questionnaire was completed by 1,520 Canadians. Those with chronic pain (n=710) identified primary care physicians as the most helpful pain management professional. Overall, use of non-pharmaceutical medical self-management strategies was low. While use positive emotional self-management strategies was high, individuals with NC were more likely to use negative emotional self-management strategies compared to those without NC. Multiple self-management barriers and facilitators were identified, however those with NC were more likely than those without NC to experience low self-efficacy, depression and severe pain which may impair the ability to self-management. Conclusions: Health care professionals have the opportunity to improve chronic pain outcomes by providing self-management advice, referring to self-management interventions, and addressing self-management barriers and facilitators. Individuals with NC may require additional health services to address their greater self-management challenges, and further research is needed to identify non-pharmaceutical interventions effective in relieving chronic pain with NC. Public policy is needed to facilitate health systems in providing long-term self-management support for individuals with chronic pain. / Thesis (Ph.D, Nursing) -- Queen's University, 2013-09-25 12:57:58.59

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Methods: Three research methodologies were used including a comprehensive literature review, a descriptive study and a qualitative study.  A revised root cause analysis framework (consisting of four major steps) adapted and created by the researcher was also applied as an analytical framework to the whole research programme to facilitate the achievement of the aim and objectives. Results: Antidepressants were the most commonly prescribed drugs followed by a combination of paracetamol and weak opioids.  Drug-drug interactions between antidepressants and opioids were the most common potential MRPs.  Analgesic prescribing was independently associated with cause of pain and health-related quality of life.  Pain level, cause of pain and health-related quality of  life were independent significant factors for adjuvant prescribing.  The poorer the health-related quality of life was, the greater the number of analgesics and adjuvant drugs that were prescribed.  A  model of pain medication taking behaviours was developed, and relationships between MRPs, pain medication taking behaviours and considerations of patients’ perspectives on pain and pain medication taking were identified.  Patient factors were the main root causes of complex MRPs.   A set of recommendations (for both GPs and pharmacists) and evidence-derived questions for primary care pharmacists were proposed to help reduce and prevent MRPs. Conclusion: An intervention based on the findings of this study, and related to the pharmacist’s roles and responsibility could ultimately help to improve pharmaceutical care services for people with chronic pain in primary care.

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ABSTRACT Aim The aim of this study is to compare the degree of severity of chronic periodontitis in HIVseropositive subjects with chronic periodontitis to control subjects with chronic periodontitis, in the Ga-Rankuwa area in South Africa. Methods Two cohorts of subjects with chronic periodontitis were recruited for this study over a period of time: thirty HIV-seropositive subjects; and 30 control subjects presumed to be HIV - seronegative and apparently in good health. Results When all the periodontal indices were compared and evaluated there was no association between HIV-serostatus and the periodontal indices. When periodontal indices were compared between HIV-seropositive subjects using highly active anti-retroviral therapy (HAART), and HAART-naïve subjects, there was no statistical differences regarding gingival recession, plaque index and bleeding index. However, the mean pocket depth in HAARTnaïve seropositive subjects was slightly greater than in HIV-seropositive subjects using HAART. Correlation coefficient of mean pocket depth in relation to log CD4+ T cell count in the HIV-seropositive HAART-naïve group of subjects showed a significant negative correlation (P = -0.947), but there was no correlation between the mean gingival recession values and the log CD4+ T cell counts in the same group (P=0.303). For the HIVseropositive subjects using HAART the correlation coefficient test failed to show significant statistical relationships between log CD4+ T cell count and mean pocket depth (P=0.903) and mean gingival recession (P=0.312) in HIV-seropositive subjects using HAART. Conclusion HIV-seropositive subjects with chronic periodontitis show clinical manifestations of similar degree of their periodontal disease to those of healthy control subjects with chronic periodontitis, with no differences in the mean pocket depth, gingival recession, plaque index and bleeding index.

Faculty of Medicine School of Physiotherapy 82-29610 Tel: 011 452 3175 / Physiotherapists commonly assess head and shoulder posture and correct poor posture on the grounds that there is an association between the patients’ cervical symptoms and their posture. The aims of this study were firstly to compare the sagittal head and shoulder posture and demographic variables of patients with chronic cervical pain to those of “healthy” volunteers. Secondly, to investigate the relationship between the frequency and severity of pain and the sagittal head and shoulder posture of patients with chronic cervical pain. Lateral view photographs were taken of nineteen patients (experimental group) and eighteen “healthy” volunteers (control group) in a supported sitting position. The following five static postural positions were assessed: (1) neutral or natural head and shoulder posture (2) maximum head protraction (3) maximum head retraction (4) maximum shoulder protraction and (5) maximum shoulder retraction. The active range of anteroposterior glide (total excursion) of the participants’ head and shoulders was also assessed. The participants completed a questionnaire that included their demographic variables, medical history and leisure time activities. Differences in head and shoulder posture were observed between the two groups. Some of these differences supported postural relationships that have been described in the literature. The experimental group had a more forward head resting position than the control group. The range of motion (total excursion) of the head and shoulders of the experimental group was less than the control group. In contrast to clinical assumptions that have been described in the literature, a forward resting head posture was not related to a protracted shoulder position or to upper cervical spine extension when measured in the sagittal plane. A relationship was observed between the frequency and severity of pain in certain body regions and selected postural measurements in the experimental group. It is suspected that most of the findings might be the result of poor cervical and scapular muscle control caused by chronic pain. This emphasises the need to assess the influence of tissue and joint extensibility and muscle control on head and shoulder posture. Analysis of the questionnaires demonstrated that the experimental group’s ability to carry out activities of daily living was significantly affected by pain (p=0,001). There was no significant difference in the number of hours worked per week between the experimental and control groups (p=1,000). There was a tendency (p=0,118) for the control group to devote a greater number of hours to “active” leisure time activities. The control group might have been less symptomatic as a result thereof. This highlights the necessity to further investigate the effect of exercise on postural correction and prevention of cervical symptoms.

This research report is submitted to the Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, in partial fulfillment of the requirements for the degree of Master of Medicine in the branch of Psychiatry. / AIM: To describe the demographic and clinical characteristics of a group of patients of Xhosa ethnicity diagnosed with schizophrenia. To also determine the prevalence of their consultations with a traditional healer as well as the factors associated with an increased likelihood of such consultations. METHOD: The study was a review of a database originally compiled as part of an ongoing genetic study. Patients on the database were all of Xhosa ethnicity, with a diagnosis of schizophrenia and had all been recruited from community clinics and psychiatric hospitals in the Cape Town Metropole region. RESULTS: Data was extracted and analysed for 92 patients, who met the criteria for inclusion in this study. The majority of the patients were male (77.2%), single (88%) and unemployed (96%). The mean duration of illness was 20.5 years and the mean number of hospital admissions for their mental illness was 2.4. Close to half (43.5%) of the patients reported being non-compliant on their medication. Ten percent admitted to making one or more suicide attempts in their lifetime. Nicotine was the most commonly used substance (69.6%) followed by alcohol (55.4%), cannabis (37%) and methamphetamines (9.8%). Thirty eight percent of the patients reported having a traditional healer in their family. Twenty two percent had consulted with a traditional healer. In the bivariate analysis the following factors were significantly associated with consulting a traditional healer: having two or less psychiatric admissions (p=0.014); compliance on medication (p=0,012); and having a traditional healer in the family iii (p=0.005). When controlling for age, sex and marital status only having a traditional healer in the family was significantly associated with consulting traditional healer (p=0.011). CONCLUSIONS: This study found that a high proportion of the participants had consulted a traditional healer. This was significantly associated with having a traditional healer as a family member. It is recommended that programmes, to improve the mutual understanding and co-operation between Western practitioners and traditional healers and consequently mental health outcomes, need to be developed and implemented.