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Background: Work-related stress (WRS) is associated with musculoskeletal pain (MSP), changes in the autonomic nervous system (ANS) and anxiety. Objective: To determine the feasibility of a follow-up study and treatment efficacy of the Reaset Approach on MSP, ANS and State-Trait anxiety. Methods: 15 subjects with WRS and MSP were assigned into 3 groups (Body, Head-Neck, Head-Neck-Body). Each group received a single 25 minute ‘Reaset Approach’ intervention. Heart rate variability (HRV), electro-dermal activity (EDA), State Trait Anxiety (STAI) and MSP were measured. Results: HRV parameters: SDNN increased in 13 of 15 subjects while SD1 and SD2 increased in 12 of 15 subjects. EDA reduced in 10 of 14 subjects. State Anxiety reduced in all subjects and Trait Anxiety reduced in 14 of 15 subjects. MSP reduced in all subjects after the intervention and were still lower three days afterwards. Conclusions: This pilot study determined that a follow-up study can ensue provided minor modifications are implemented and that the ‘Reaset Approach’ has an influence on the ANS, anxiety and MSP. Results do differ between groups. The intervention groups including the head and neck modalities demonstrated better results. / Hintergrund: Arbeitsbedingter Stress (ABS) ist verbunden mit muskelschmerzen, Veränderungen im autonomen Nervensystem (ANS) und Angst. Ziel: Machbarkeit einer Follow-up-Studie und Wirksamkeit der Behandlung des Reaset Ansatzes auf ANS, Muskelschmerzen und State und Trait- Angst bestimmen. Methoden: 15 Patienten mit ABS und Muskelschmerzen wurden in 3 Gruppen eingeteilt (Körper, Kopf-Hals, Kopf-Hals-Körper). Jede Gruppe erhielt eine einzige 25 Minuten dauernde 'Reaset Approach’-Behandlung. Herzfrequenzvariabilität (HRV), elektro-dermale Aktivität (EDA), State-Trait-Angstsinventar (STAI) und Muskelschmerzen (SF-MPQ) wurden gemessen. Ergebnisse: Die HRV-wert: SDNN ist bei 13 von 15 Probanden erhöht, während SD1 und SD2 bei 12 von 15 Probanden zugenommen hat. EDA war bei 10 von 14 Probanden reduziert. Die State-Angst hat bei allen Probanden und die Trait-Angst bei 14 der 15 Probanden abgenommen. Muskelschmerzen waren bei alle Probanden anschließend an und drei Tage nach der Intervention reduziert. Schlussfolgerung: Diese Pilotstudie hat gezeigt, dass eine Follow-up-Studie fortgesetzt werden kann, sofern kleinere Änderungen durchgeführt werden. Die 'Reaset Approach’ hat einen günstigen Einfluss auf die ANS, State-Trait-Angst und Muskelschmerzen. Ergebnisse zwischen den Gruppen sind unterschiedlich. Die Interventionsgruppen mit einschließlich der Kopf-Hals-Modalitäten zeigten bessere Ergebnisse..

Background: Work-related stress (WRS) is associated with musculoskeletal pain (MSP), changes in the autonomic nervous system (ANS) and anxiety. Objective: To determine the feasibility of a follow-up study and treatment efficacy of the Reaset Approach on MSP, ANS and State-Trait anxiety. Methods: 15 subjects with WRS and MSP were assigned into 3 groups (Body, Head-Neck, Head-Neck-Body). Each group received a single 25 minute ‘Reaset Approach’ intervention. Heart rate variability (HRV), electro-dermal activity (EDA), State Trait Anxiety (STAI) and MSP were measured. Results: HRV parameters: SDNN increased in 13 of 15 subjects while SD1 and SD2 increased in 12 of 15 subjects. EDA reduced in 10 of 14 subjects. State Anxiety reduced in all subjects and Trait Anxiety reduced in 14 of 15 subjects. MSP reduced in all subjects after the intervention and were still lower three days afterwards. Conclusions: This pilot study determined that a follow-up study can ensue provided minor modifications are implemented and that the ‘Reaset Approach’ has an influence on the ANS, anxiety and MSP. Results do differ between groups. The intervention groups including the head and neck modalities demonstrated better results.:I. Abstract (En) III II. Abstract (De) IV III. Table of Contents V IV. Index of figures VIII V. Index of tables IX VI. Index of abbreviations X 1 Introduction 1 2 Background 2 2.1 Work-related musculoskeletal pain 2 2.2 Work-related stress 3 2.3 Osteopathy and the autonomic nervous system 3 2.4 Stress, pain and osteopathy 4 3 Questions 6 3.1 Feasibility 6 3.2 Treatment effect 6 4 Methods 7 4.1 Study design 7 4.2 Participants 8 4.2.1 Inclusion criteria 8 4.2.2 Exclusion criteria 8 4.2.3 Recruitment 8 4.2.4 Randomization 10 4.3 Parameters 11 4.3.1 Heart rate variability 11 4.3.2 Electro-dermal activity 11 4.3.3 State anxiety 11 4.3.4 Trait anxiety 12 4.3.5 Perceived pain 12 4.4 Measuring Instruments 13 4.4.1 Heart rate variability 13 4.4.2 Electro-dermal Activity 13 4.4.3 State-Trait Anxiety Inventory 13 4.4.4 Short-Form McGill Pain Questionnaire 13 4.5 Interventions 14 4.5.1 Intervention ‘B’: Body 14 4.5.2 Intervention ‘HN’: Head and Neck 16 4.5.3 Intervention ‘HNB’: Head, Neck and Body 16 4.6 Study flow 18 4.7 Statistics 20 5 Results 21 5.1 Autonomic nervous system: Heart rate variability 21 5.1.1 SDNN 22 5.1.2 SD1 25 5.1.3 SD2 28 5.2 Autonomic Nervous System: Electro-dermal activity 31 5.3 Anxiety 34 5.3.1 State anxiety 34 5.3.2 Trait anxiety 37 5.4 Musculoskeletal pain 39 5.4.1 Visual analogue scale 40 5.4.2 Total Short-Form McGill Pain Questionnaire 43 6 Discussion 46 6.1 Discussion of the method 46 6.2 Discussion of the results 50 6.2.1 Autonomic nervous system 50 6.2.1.1 Heart rate variability 50 6.2.1.2 Electro-dermal activity 51 6.2.2 Anxiety 51 6.2.2.1 State anxiety 51 6.2.2.2 Trait Anxiety 52 6.2.3 Musculoskeletal pain 52 6.3 Suggestions for future research 53 7 Conclusion 54 8 Literature 55 9 Addendum 63 9.1 Table: SF-MPQ with Sensory, Affective and Evaluative dimension 63 9.2 Patient Information Sheet 64 9.3 Structured telephone interview 70 9.4 Structured pre-treatment interview 72 9.5 SF-MPQ permission 73 9.6 SF-MPQ 74 9.7 STAI License 76 9.8 STAI forms Y-1 and Y-2 77 / Hintergrund: Arbeitsbedingter Stress (ABS) ist verbunden mit muskelschmerzen, Veränderungen im autonomen Nervensystem (ANS) und Angst. Ziel: Machbarkeit einer Follow-up-Studie und Wirksamkeit der Behandlung des Reaset Ansatzes auf ANS, Muskelschmerzen und State und Trait- Angst bestimmen. Methoden: 15 Patienten mit ABS und Muskelschmerzen wurden in 3 Gruppen eingeteilt (Körper, Kopf-Hals, Kopf-Hals-Körper). Jede Gruppe erhielt eine einzige 25 Minuten dauernde 'Reaset Approach’-Behandlung. Herzfrequenzvariabilität (HRV), elektro-dermale Aktivität (EDA), State-Trait-Angstsinventar (STAI) und Muskelschmerzen (SF-MPQ) wurden gemessen. Ergebnisse: Die HRV-wert: SDNN ist bei 13 von 15 Probanden erhöht, während SD1 und SD2 bei 12 von 15 Probanden zugenommen hat. EDA war bei 10 von 14 Probanden reduziert. Die State-Angst hat bei allen Probanden und die Trait-Angst bei 14 der 15 Probanden abgenommen. Muskelschmerzen waren bei alle Probanden anschließend an und drei Tage nach der Intervention reduziert. Schlussfolgerung: Diese Pilotstudie hat gezeigt, dass eine Follow-up-Studie fortgesetzt werden kann, sofern kleinere Änderungen durchgeführt werden. Die 'Reaset Approach’ hat einen günstigen Einfluss auf die ANS, State-Trait-Angst und Muskelschmerzen. Ergebnisse zwischen den Gruppen sind unterschiedlich. Die Interventionsgruppen mit einschließlich der Kopf-Hals-Modalitäten zeigten bessere Ergebnisse..:I. Abstract (En) III II. Abstract (De) IV III. Table of Contents V IV. Index of figures VIII V. Index of tables IX VI. Index of abbreviations X 1 Introduction 1 2 Background 2 2.1 Work-related musculoskeletal pain 2 2.2 Work-related stress 3 2.3 Osteopathy and the autonomic nervous system 3 2.4 Stress, pain and osteopathy 4 3 Questions 6 3.1 Feasibility 6 3.2 Treatment effect 6 4 Methods 7 4.1 Study design 7 4.2 Participants 8 4.2.1 Inclusion criteria 8 4.2.2 Exclusion criteria 8 4.2.3 Recruitment 8 4.2.4 Randomization 10 4.3 Parameters 11 4.3.1 Heart rate variability 11 4.3.2 Electro-dermal activity 11 4.3.3 State anxiety 11 4.3.4 Trait anxiety 12 4.3.5 Perceived pain 12 4.4 Measuring Instruments 13 4.4.1 Heart rate variability 13 4.4.2 Electro-dermal Activity 13 4.4.3 State-Trait Anxiety Inventory 13 4.4.4 Short-Form McGill Pain Questionnaire 13 4.5 Interventions 14 4.5.1 Intervention ‘B’: Body 14 4.5.2 Intervention ‘HN’: Head and Neck 16 4.5.3 Intervention ‘HNB’: Head, Neck and Body 16 4.6 Study flow 18 4.7 Statistics 20 5 Results 21 5.1 Autonomic nervous system: Heart rate variability 21 5.1.1 SDNN 22 5.1.2 SD1 25 5.1.3 SD2 28 5.2 Autonomic Nervous System: Electro-dermal activity 31 5.3 Anxiety 34 5.3.1 State anxiety 34 5.3.2 Trait anxiety 37 5.4 Musculoskeletal pain 39 5.4.1 Visual analogue scale 40 5.4.2 Total Short-Form McGill Pain Questionnaire 43 6 Discussion 46 6.1 Discussion of the method 46 6.2 Discussion of the results 50 6.2.1 Autonomic nervous system 50 6.2.1.1 Heart rate variability 50 6.2.1.2 Electro-dermal activity 51 6.2.2 Anxiety 51 6.2.2.1 State anxiety 51 6.2.2.2 Trait Anxiety 52 6.2.3 Musculoskeletal pain 52 6.3 Suggestions for future research 53 7 Conclusion 54 8 Literature 55 9 Addendum 63 9.1 Table: SF-MPQ with Sensory, Affective and Evaluative dimension 63 9.2 Patient Information Sheet 64 9.3 Structured telephone interview 70 9.4 Structured pre-treatment interview 72 9.5 SF-MPQ permission 73 9.6 SF-MPQ 74 9.7 STAI License 76 9.8 STAI forms Y-1 and Y-2 77

O presente estudo teve como objetivo identificar os padrões de uso de "êxtase" na cidade de São Paulo. Os usuários foram recrutados através da técnica de amostragem snowball, também utilizada para o recrutamento do grupo controle, composto de indivíduos com estilo de vida semelhante aos primeiros mas que nunca haviam experimentado "êxtase" (não usuários). Usuários (52) e não usuários (52) foram entrevistados quanto às características sócio-demográficas e quanto ao uso de drogas psicotrópicas; usuários também responderam questões sobre circunstâncias de uso e efeitos do "êxtase". Através da Escala de Impulsividade de Barratt e dos Inventários de Depressão de Beck e de Ansiedade Traço-Estado (IDATE-traço) foram medidas impulsividade, depressão e ansiedade de ambos os grupos. Os dois grupos apresentaram características sócio-demográficas semelhantes: a maioria pertencia à classe média, era jovem, heterossexual, solteira e com nível superior. Entre os usuários o consumo de outras drogas psicotrópicas foi expressivamente superior. Outras características mais freqüentes no grupo de usuários foram a presença de tatuagens e piercings, a frequência a "raves" e a preferência pela música eletrônica. No Inventário de Depressão de Beck os usuários apresentaram pontuação significativamente menor quanto à depressão. Os resultados das escalas de impulsividade e ansiedade não apresentaram diferenças significativas entre os dois grupos. Os padrões de uso de "êxtase" dos usuários entrevistados são semelhantes aos padrões descritos por pesquisas realizadas na Europa e em Sidney: a maioria dos usuários consome um ou dois comprimidos a cada episódio de uso, apenas nos finais de semana ou férias, mais freqüentemente na companhia de várias pessoas, em ambientes ligados ao lazer noturno, como lugares para dançar, "raves" e festas. Os comprimidos são geralmente adquiridos de amigos ou conhecidos nesses locais. A maioria dos usuários associa "êxtase" a outras drogas psicotrópicas, particularmente maconha. As características sócio-demográficas dos usuários entrevistados e seus padrões de aquisição e consumo de "êxtase" indicam um caráter pouco marginal do uso. São sugeridas estratégias de Redução de Dano caso o uso de "êxtase" se difunda em São Paulo. / The present study was aimed at identifying patterns of ecstasy (MDMA) use in the city of São Paulo. Ecstasy users were recruited through the snowball technique. Using the same technique, a control group of subjects that had never tried the drug (non users) was recruited among individuals sharing with users a similar life style. Users (N=52) and non users (N=52) were interviewed in order to obtain socio-demographic data and data on use of psychoactive drugs; users were also questionned as to the circumstances surrounding their use of the drug. Besides, levels of anxiety, depression and impulsiveness were assessed through Spielberger's IDATE Trace Inventory, Beck's Depression Inventory and Barratt Impulsiveness Scale. Both users and non users revealed similar socio-demographic characteristics: most subjects were middle class young heterosexual single men and women who had a college degree. Multiple drug use was more frequent among users than among non users. Other features that were significantly more accentuated among users than among non users were the presence of tattoos and piercings, the frequency to raves and the preference for electronic music. Beck Inventory results pointed to significantly lower depression scores among users. No differences were observed between groups in anxiety and impulsiveness scores. Ecstasy consumption patterns among users are similar to those reported in Europe and Australia: most subjects take one or two pills per episode, during weekends or vacations, usually with company and in social gatherings such as dancings, raves and parties. The drug is predominantly acquired from friends or acquaintances in these same spots. Most users reported consuming ecstasy in combination with other psychoactive drugs, particularly marihuana. The socio-demographic features of users as well as the way they buy and consume the drug suggest that the present pattern of use is not connected to illegal or marginal activities. Harm reduction strategies are suggested in case of ecstasy's use increases and spreads among the young population of the city.

O presente estudo teve como objetivo identificar os padrões de uso de "êxtase" na cidade de São Paulo. Os usuários foram recrutados através da técnica de amostragem snowball, também utilizada para o recrutamento do grupo controle, composto de indivíduos com estilo de vida semelhante aos primeiros mas que nunca haviam experimentado "êxtase" (não usuários). Usuários (52) e não usuários (52) foram entrevistados quanto às características sócio-demográficas e quanto ao uso de drogas psicotrópicas; usuários também responderam questões sobre circunstâncias de uso e efeitos do "êxtase". Através da Escala de Impulsividade de Barratt e dos Inventários de Depressão de Beck e de Ansiedade Traço-Estado (IDATE-traço) foram medidas impulsividade, depressão e ansiedade de ambos os grupos. Os dois grupos apresentaram características sócio-demográficas semelhantes: a maioria pertencia à classe média, era jovem, heterossexual, solteira e com nível superior. Entre os usuários o consumo de outras drogas psicotrópicas foi expressivamente superior. Outras características mais freqüentes no grupo de usuários foram a presença de tatuagens e piercings, a frequência a "raves" e a preferência pela música eletrônica. No Inventário de Depressão de Beck os usuários apresentaram pontuação significativamente menor quanto à depressão. Os resultados das escalas de impulsividade e ansiedade não apresentaram diferenças significativas entre os dois grupos. Os padrões de uso de "êxtase" dos usuários entrevistados são semelhantes aos padrões descritos por pesquisas realizadas na Europa e em Sidney: a maioria dos usuários consome um ou dois comprimidos a cada episódio de uso, apenas nos finais de semana ou férias, mais freqüentemente na companhia de várias pessoas, em ambientes ligados ao lazer noturno, como lugares para dançar, "raves" e festas. Os comprimidos são geralmente adquiridos de amigos ou conhecidos nesses locais. A maioria dos usuários associa "êxtase" a outras drogas psicotrópicas, particularmente maconha. As características sócio-demográficas dos usuários entrevistados e seus padrões de aquisição e consumo de "êxtase" indicam um caráter pouco marginal do uso. São sugeridas estratégias de Redução de Dano caso o uso de "êxtase" se difunda em São Paulo. / The present study was aimed at identifying patterns of ecstasy (MDMA) use in the city of São Paulo. Ecstasy users were recruited through the snowball technique. Using the same technique, a control group of subjects that had never tried the drug (non users) was recruited among individuals sharing with users a similar life style. Users (N=52) and non users (N=52) were interviewed in order to obtain socio-demographic data and data on use of psychoactive drugs; users were also questionned as to the circumstances surrounding their use of the drug. Besides, levels of anxiety, depression and impulsiveness were assessed through Spielberger's IDATE Trace Inventory, Beck's Depression Inventory and Barratt Impulsiveness Scale. Both users and non users revealed similar socio-demographic characteristics: most subjects were middle class young heterosexual single men and women who had a college degree. Multiple drug use was more frequent among users than among non users. Other features that were significantly more accentuated among users than among non users were the presence of tattoos and piercings, the frequency to raves and the preference for electronic music. Beck Inventory results pointed to significantly lower depression scores among users. No differences were observed between groups in anxiety and impulsiveness scores. Ecstasy consumption patterns among users are similar to those reported in Europe and Australia: most subjects take one or two pills per episode, during weekends or vacations, usually with company and in social gatherings such as dancings, raves and parties. The drug is predominantly acquired from friends or acquaintances in these same spots. Most users reported consuming ecstasy in combination with other psychoactive drugs, particularly marihuana. The socio-demographic features of users as well as the way they buy and consume the drug suggest that the present pattern of use is not connected to illegal or marginal activities. Harm reduction strategies are suggested in case of ecstasy's use increases and spreads among the young population of the city.

Background: Antenatal Psychosocial Assessment (APA) has recently been introduced into routine antenatal care, but the ways in which maternity service providers assess and respond to maternal stress are subject of debate. There is a lack of consensus on the instrument(s) of choice and lack of evidence regarding appropriate interventions. Further, national guidelines have not kept apace with the conceptual shift from ‘postnatal depression’ to ‘perinatal anxiety and depression’. Adopting the Medical Research Council Complex Interventions Framework, the ARMS research aimed to inform the development of interventions that support women who are experiencing, or at risk of, mild-moderate mental health disorder in pregnancy. Methods: A mixed methods approach was adopted. In the quantitative element (Study Part 1) participants (n=191) completed a questionnaire when attending for their first formal antenatal appointment, using a procedure and materials that had been previously tested in a pilot study. Details including mental health assessment and referrals were obtained from their health records, following delivery. In the qualitative element (Study Part 2) a sub-sample of women (n=22) experiencing high levels of maternal stress took part in up to three serial in-depth interviews during pregnancy and the early postnatal period.Findings: Maternal stress was found to be common. Using the Edinburgh Postnatal Depression Scale (EPDS) threshold of ≥10, approximately 1 in 4 women were classed as high depression (halving to 1 in 8 at the more conservative threshold of ≥13). Almost 1 in 3 women were classed as high anxiety, using the state scale of the State-Trait Anxiety Inventory (STAI-S, threshold ≥41), compared with 1 in 5 using the two-item GAD (threshold ≥3). Fewer than half of the women identified as high anxiety were identified by both measures. Factor analyses of the symptom measures were consistent with wider literature suggesting a three-item anxiety component of the EPDS; however, concurrent validation using regression analyses did not indicate that the EPDS could be used as an anxiety case finding instrument. Women reported that maternal stress had significant impact on their lives that may not be captured with existing clinical approaches. Women commonly found it difficult to self-assess severity of maternal stress and the assessment process could itself act as an intervention. The research provided the first validation of the depression case finding questions in UK clinical practice. The Whooley items completed in clinical practice identified only half of the possible cases identified by the EPDS, at both commonly adopted EPDS thresholds. Inclusion of the Arroll 'help' question as a criterion improved specificity of the assessment completed in clinical practice but substantially compromised sensitivity, missing 9 in 10 possible cases. Women’s mental health history and treatment history were similarly under-reported, particularly concerning anxiety. APA was introduced into routine clinical practice without attention to topics of relevance to women, context of disclosure or to provision of adequate resources for consistently responding to identified need. Women experiencing, or at risk of, mild-moderate disorder were thus usually ineligible for further support. Implications: Care pathways are needed that encompass both assessing and responding to maternal stress, where communication with health professionals, subsequent referral and management are addressed. The development, implementation and evaluation of low-cost resources embedded in such pathways are a priority and the research presented in the thesis offers a foundation on which to build.