Managing low back pain in active adolescents.

Adolescent low back pain has received limited research attention despite its potentially considerable impact on quality of life. The role of diagnostic triage to identify serious or specific pathology and/or order relevant investigations is considered. An overview of contemporary pain mechanisms is provided, with specific reference to the wide range of risk factors for persistent low back pain. Education and exercise framed within a biopsychosocial framework are the cornerstones of treatment. There is a lack of data on more comprehensive personalized treatment approaches among adolescents. One such approach - Cognitive Functional Therapy - which has shown promise in adults and active adolescents with low back pain, is described and illustrated using a case study. The most promising avenues, in practice and research, may be those that view adolescent low back pain as less of a local structural spinal issue and more of an indication of the general health of the adolescent.

Can a low-resource-use blood pressure device impact on global maternal mortality?

BACKGROUND: Hypertension in pregnancy in the developing world is largely underreported, misdiagnosed, and untreated, especially in rural settings, though it contributes significantly to maternal and perinatal morbidity and mortality. To reduce general global cardiovascular and cerebrovascular morbidity and mortality, the World Health Organization aims to develop and validate low-resource-use blood pressure devices for use in developing nations. OBJECTIVE AND METHODS: To describe how existing antenatal care systems provide a useful and relevant model through which to evaluate the potential for this initiative to be applied in low-resource settings and to offer opportunities for much needed further research.

Validation of the Nissei DS-400 in a low-resource setting.

OBJECTIVE: Hypertension affects approximately one billion individuals worldwide. The effective management of hypertension requires accurate measurement and monitoring of blood pressure. We evaluated the accuracy of a low cost self-measurement oscillometric device, with features suitable for use in a low-resource setting, in an adult population in the developing world according to the International Protocol of the European Society of Hypertension. METHODS: Trained observers using a double-headed stethoscope took nine sequential same arm measurements from 33 participants, alternating between mercury sphygmomanometry and the test device. Anyone with an arrhythmia or unclear Korotkoff sounds was excluded. Data were analyzed according to the protocol guidelines. RESULTS: The device passed all the criteria of the International Protocol with 78/95/99 and 80/95/99 of systolic and diastolic differences, respectively, within 5/10/15 mmHg of the mercury standard. It also achieved the Association for the Advancement of Medical Instrumentation criteria with a mean difference (standard deviation) of 0.8 (4.4) mmHg and -0.9 (4.5) mmHg for systolic blood pressure and diastolic blood pressure, respectively. CONCLUSION: The Nissei DS-400 can be recommended for use in the adult population, particularly in the developing world. Its impressive performance may be related to theoretical factors within the patient population and environment (e.g. temperature, humidity and altitude) that could influence the device's performance.