Beyond activity patterns: The complex process of activity management among individuals with chronic musculoskeletal pain after an orthopaedic trauma.

CONTEXT: Individuals must change the way they perform activities in response to chronic pain. In the literature, three activity patterns are commonly described: avoidance, pacing, and persistence. Many studies have explored these activity patterns. However, little research has delved into the factors that lead people to adopt a particular activity behaviour. This study aimed to explore the relationship that people with chronic musculoskeletal pain have with activity and highlight the factors underlying their practices. METHODS: The qualitative study was conducted by researchers in the social sciences, physiotherapy, psychology, and rehabilitation medicine. Observations of vocational workshops and semi-structured interviews were conducted with 33 persons undergoing rehabilitation for chronic musculoskeletal pain after an accident. RESULTS: Patients' declarations and actions show that any one patient will alternate between activity patterns: the same person may adopt a strategy of avoidance, pacing or persistence depending on the context, the importance of the activity, personal objectives, and representations of self, pain, and activity. The decision to engage in a particular behaviour is based on a process of self-negotiation weighted by the circumstances, the nature of the activity, the importance attached to it, and the individual's perceived ability. CONCLUSION: Our study emphasized the complexity of physical, social, and contextual factors that intervene in the relationship toward activity. Rather than favouring pacing, the therapist's role in rehabilitation might be to reinforce the reflexive process and the patient's adaptability in approaching the activity, to foster the capacity to find flexible solutions. SIGNIFICANCE: Patients choose an activity pattern (avoidance, pacing, persistence) according to the challenges they face in their daily lives. Context, representations of self and activity, as well as goals sought influence these choices. Some patients report having learned to adapt their activity management strategies. Therefore, therapeutic approaches in the rehabilitation context could focus on these adaptive capacities to offer patients optimal pain and activity management and develop their ability to use different strategies according to the circumstance.

Inter-group violence among early Holocene hunter-gatherers of West Turkana, Kenya.

The nature of inter-group relations among prehistoric hunter-gatherers remains disputed, with arguments in favour and against the existence of warfare before the development of sedentary societies. Here we report on a case of inter-group violence towards a group of hunter-gatherers from Nataruk, west of Lake Turkana, which during the late Pleistocene/early Holocene period extended about 30 km beyond its present-day shore. Ten of the twelve articulated skeletons found at Nataruk show evidence of having died violently at the edge of a lagoon, into which some of the bodies fell. The remains from Nataruk are unique, preserved by the particular conditions of the lagoon with no evidence of deliberate burial. They offer a rare glimpse into the life and death of past foraging people, and evidence that warfare was part of the repertoire of inter-group relations among prehistoric hunter-gatherers.

French Swiss physicians' attitude toward palliative sedation: Influence of prognosis and type of suffering.

OBJECTIVE: Palliative sedation is a last resort medical act aimed at relieving intolerable suffering induced by intractable symptoms in patients at the end-of-life. This act is generally accepted as being medically indicated under certain circumstances. A controversy remains in the literature as to its ethical validity. There is a certain vagueness in the literature regarding the legitimacy of palliative sedation in cases of non-physical refractory symptoms, especially "existential suffering." This pilot study aims to measure the influence of two independent variables (short/long prognosis and physical/existential suffering) on the physicians' attitudes toward palliative sedation (dependent variable). METHODS: We used a 2 × 2 experimental design as described by Blondeau et al. Four clinical vignettes were developed (vignette 1: short prognosis/existential suffering; vignette 2: long prognosis/existential suffering; vignette 3: short prognosis/physical suffering; vignette 4: long prognosis/physical suffering). Each vignette presented a terminally ill patient with a summary description of his physical and psychological condition, medication, and family situation. The respondents' attitude towards sedation was assessed with a six-point Likert scale. A total of 240 vignettes were sent to selected Swiss physicians. RESULTS: 74 vignettes were completed (36%). The means scores for attitudes were 2.62 ± 2.06 (v1), 1.88 ± 1.54 (v2), 4.54 ± 1.67 (v3), and 4.75 ± 1.71 (v4). General linear model analyses indicated that only the type of suffering had a significant impact on the attitude towards sedation (F = 33.92, df = 1, p = 0.000). Significance of the results: The French Swiss physicians' attitude toward palliative sedation is more favorable in case of physical suffering than in existential suffering. These results are in line with those found in the study of Blondeau et al. with Canadian physicians and will be discussed in light of the arguments given by physicians to explain their decisions.

The evolution of the diversity of cultures.

The abundant evidence that Homo sapiens evolved in Africa within the past 200,000 years, and dispersed across the world only within the past 100,000 years, provides us with a strong framework in which to consider the evolution of human diversity. While there is evidence that the human capacity for culture has a deeper history, going beyond the origin of the hominin clade, the tendency for humans to form cultures as part of being distinct communities and populations changed markedly with the evolution of H. sapiens. In this paper, we investigate 'cultures' as opposed to 'culture', and the question of how and why, compared to biological diversity, human communities and populations are so culturally diverse. We consider the way in which the diversity of human cultures has developed since 100,000 years ago, and how its rate was subject to environmental factors. We argue that the causes of this diversity lie in the distribution of resources and the way in which human communities reproduce over several generations, leading to fissioning of kin groups. We discuss the consequences of boundary formation through culture in their broader ecological and evolutionary contexts.

The phylogeography of Y chromosome binary haplotypes and the origins of modern human populations.

Although molecular genetic evidence continues to accumulate that is consistent with a recent common African ancestry of modern humans, its ability to illuminate regional histories remains incomplete. A set of unique event polymorphisms associated with the non-recombining portion of the Y-chromosome (NRY) addresses this issue by providing evidence concerning successful migrations originating from Africa, which can be interpreted as subsequent colonizations, differentiations and migrations overlaid upon previous population ranges. A total of 205 markers identified by denaturing high performance liquid chromatography (DHPLC), together with 13 taken from the literature, were used to construct a parsimonious genealogy. Ancestral allelic states were deduced from orthologous great ape sequences. A total of 131 unique haplotypes were defined which trace the microevolutionary trajectory of global modern human genetic diversification. The genealogy provides a detailed phylogeographic portrait of contemporary global population structure that is emblematic of human origins, divergence and population history that is consistent with climatic, paleoanthropological and other genetic knowledge.

Towards a theory of modern human origins: geography, demography, and diversity in recent human evolution.

The origins of modern humans have been the central debate in palaeoanthropology during the last decade. We examine the problem in the context of the history of anthropology, the accumulating evidence for a recent African origin, and evolutionary mechanisms. Using a historical perspective, we show that the current controversy is a continuation of older conflicts and as such relates to questions of both origins and diversity. However, a better fossil sample, improved dates, and genetic data have introduced new perspectives, and we argue that evolutionary geography, which uses spatial distributions of populations as the basis for integrating contingent, adaptive, and demographic aspects of microevolutionary change, provides an appropriate theoretical framework. Evolutionary geography is used to explore two events: the evolution of the Neanderthal lineage and the relationship between an ancestral bottleneck with the evolution of anatomically modern humans and their diversity. We argue that the Neanderthal and modern lineages share a common ancestor in an African population between 350,000 and 250,000 years ago rather than in the earlier Middle Pleistocene; this ancestral population, which developed mode 3 technology (Levallois/Middle Stone Age), dispersed across Africa and western Eurasia in a warmer period prior to independent evolution towards Neanderthals and modern humans in stage 6. Both lineages would thus share a common large-brained ancestry, a technology, and a history of dispersal. They differ in the conditions under which they subsequently evolved and their ultimate evolutionary fate. Both lineages illustrate the repeated interactions of the glacial cycles, the role of cold-arid periods in producing fragmentation of populations, bottlenecks, and isolation, and the role of warmer periods in producing trans-African dispersals.

Ecology and energetics of encephalization in hominid evolution.

Hominid evolution is marked by very significant increase in relative brain size. Because relative brain size has been linked to energetic requirements it is possible to look at the pattern of encephalization as a factor in the evolution of human foraging and dietary strategies. Major expansion of the brain is associated with Homo rather than the Hominidae as a whole, and the energetic costs are likely to have forced a prolongation of growth rates and secondary altriciality. It is calculated here that modern human infants have energetic requirements approximately 9% greater than similar size apes due to their large brains. Consideration of energetic costs of brain allow the prediction of growth rates in hominid taxa and an examination of the implications for life-history strategy and foraging behaviour.

Finite social space, evolutionary pathways, and reconstructing hominid behavior.

Changes in social behavior were a key aspect of human evolution, and yet it is notoriously difficult for paleobiologists to determine patterns of social evolution. By defining the limited number of distributional strategies available to members of each sex of any species and investigating the conditions under which they may occur and change, the social behavior of different hominid taxa may be reconstructed.