The Impact of Age on the Outcomes of Minimally Invasive Lumbar Decompression for Lumbar Spinal Stenosis.

BACKGROUND AND PURPOSE: Minimally invasive lumbar decompression (mild ®) is an effective long-term therapy for patients with symptomatic lumbar spinal stenosis (LSS) resulting primarily from hypertrophic ligamentum flavum (HLF). Most subjects in clinical studies of the mild procedure have been older adults (age≥65). While the incidence of LSS increases with age, a substantial number of adults (age<65) also suffer from neurogenic claudication secondary to HLF. In this report, outcomes of mild were compared between adults and older adults. PATIENTS AND METHODS: All prospective studies of the mild procedure with a 1-year follow-up completed since the beginning of 2012 that allowed the inclusion of adult patients of all ages were reviewed. Outcomes of visual analog scale (VAS), Oswestry Disability Index (ODI), Pain Disability Index (PDI), Roland Morris Low Back Pain and Disability Questionnaire (RMQ), standing time and walking distance were compared for adults and older adults. RESULTS: Four studies met the inclusion criteria, resulting in an analysis of 49 adults and 160 older adults. Patients in both age groups experienced significant mean improvements in all but one outcome measure at 6- and 12-month follow-up. Differences between the two age groups in all scores at 6 and 12 months were not statistically significant. CONCLUSION: Analysis of the four studies indicated that symptom improvements for adults and older adults were significant from baseline, and no statistically significant difference was observed between the two age groups. These results illustrate that mild can be an effective treatment for LSS due primarily to HLF, regardless of the adult patient age.

College Students' Perceived Differences Between the Terms Real Meal, Meal, and Snack.

OBJECTIVE: To assess qualitatively and quantitatively college students' perceived differences between a real meal, meal, and snack. DESIGN: A descriptive study design was used to administer an 11-item online survey to college students. SETTING: Two university campuses in the western US. PARTICIPANTS: Pilot testing was conducted with 20 students. The final survey was completed by 628 ethnically diverse students. MAIN OUTCOME MEASURES: Students' perceptions of the terms real meal, meal, and snack. ANALYSIS: Three researchers coded the data independently, reconciled differences via conference calls, and agreed on a final coding scheme. Data were reevaluated based on the coding scheme. Means, frequencies, Pearson chi-square, and t test statistics were used. RESULTS: More than half of students perceived a difference between the terms real meal and meal. Most (97.6%) perceived a difference between the terms meal and snack. A marked difference in the way students defined these terms was evident, with a real meal deemed nutritious and healthy and meeting dietary recommendations, compared with meals, which were considered anything to eat. CONCLUSIONS AND IMPLICATIONS: These findings suggest that the term real meal may provide nutrition educators with a simple phrase to use in educational campaigns to promote healthful food intake among college students.

Developing a Questionnaire to Evaluate College Students' Knowledge, Attitude, Behavior, Self-efficacy, and Environmental Factors Related to Canned Foods.

OBJECTIVE: Develop a questionnaire to measure students' knowledge, attitude, behavior, self-efficacy, and environmental factors related to the use of canned foods. METHODS: The Knowledge-Attitude-Behavior Model, Social Cognitive Theory, and Canned Foods Alliance survey were used as frameworks for questionnaire development. Cognitive interviews were conducted with college students (n = 8). Nutrition and survey experts assessed content validity. Reliability was measured via Cronbach α and 2 rounds (1, n = 81; 2, n = 65) of test-retest statistics. Means and frequencies were used. RESULTS: The 65-item questionnaire had a test-retest reliability of .69. Cronbach α scores were .87 for knowledge (9 items), .86 for attitude (30 items), .80 for self-efficacy (12 items), .68 for canned foods use (8 items), and .30 for environment (6 items). CONCLUSIONS AND IMPLICATIONS: A reliable questionnaire was developed to measure perceptions and use of canned foods. Nutrition educators may find this questionnaire useful to evaluate pretest-posttest changes from canned foods-based interventions among college students.

Novel 10-kHz High-frequency Therapy (HF10 Therapy) Is Superior to Traditional Low-frequency Spinal Cord Stimulation for the Treatment of Chronic Back and Leg Pain: The SENZA-RCT Randomized Controlled Trial.

BACKGROUND: Current treatments for chronic pain have limited effectiveness and commonly known side effects. Given the prevalence and burden of intractable pain, additional therapeutic approaches are desired. Spinal cord stimulation (SCS) delivered at 10 kHz (as in HF10 therapy) may provide pain relief without the paresthesias typical of traditional low-frequency SCS. The objective of this randomized, parallel-arm, noninferiority study was to compare long-term safety and efficacy of SCS therapies in patients with back and leg pain. METHODS: A total of 198 subjects with both back and leg pain were randomized in a 1:1 ratio to a treatment group across 10 comprehensive pain treatment centers. Of these, 171 passed a temporary trial and were implanted with an SCS system. Responders (the primary outcome) were defined as having 50% or greater back pain reduction with no stimulation-related neurological deficit. RESULTS: At 3 months, 84.5% of implanted HF10 therapy subjects were responders for back pain and 83.1% for leg pain, and 43.8% of traditional SCS subjects were responders for back pain and 55.5% for leg pain (P < 0.001 for both back and leg pain comparisons). The relative ratio for responders was 1.9 (95% CI, 1.4 to 2.5) for back pain and 1.5 (95% CI, 1.2 to 1.9) for leg pain. The superiority of HF10 therapy over traditional SCS for leg and back pain was sustained through 12 months (P < 0.001). HF10 therapy subjects did not experience paresthesias. CONCLUSION: HF10 therapy promises to substantially impact the management of back and leg pain with broad applicability to patients, physicians, and payers.

Health literacy and obesity among native Hawaiian and Pacific Islanders in the United States.

OBJECTIVES: Our purpose was to describe relationships between demographic characteristics, body mass index (BMI), and health literacy among Native Hawaiians and other Pacific Islanders (NHPIs). DESIGN AND SAMPLE: In this cross-sectional survey, we interviewed 364 NHPI adults. MEASURES: We used Newest Vital Sign (NVS), a health literacy tool; measured heights and weights; and demographic questions. RESULTS: According to participants' NVS scores, 45.3% had at least a possibility of low health literacy. Lower NVS scores were associated with increased BMI (r = -0.12, p = .027) and increased age (r = -0.26, p < .001). Higher NVS scores were associated with higher incomes (r = 0.21, p = .001) and higher education (r = 0.27, p < .001). Women scored significantly better than men (t = -2.0, p = .05). Participants' NVS scores in Hawaii versus Utah were not significantly different (t = .26, p = .80). CONCLUSIONS: Pathways to health literacy are complex; however, age, income, education, and BMI explained a modest 19.95% of the combined variance in NVS scores. Public health nurses working to improve health literacy could include review of critical information on nutrition facts labels, frequently used calculations, and application of this information when making food choices.

The relationship between select demographic characteristics and body mass index among Native Hawaiian and other Pacific Islander caregiving adults.

PURPOSE: Native Hawaiian and other Pacific Islanders (NHOPIs) have the highest prevalence of overweight and obesity in the world. We identified the proportion of our NHOPI sample in each body mass index (BMI) category and explored relationships between BMI and demographic characteristics. DESIGN/METHOD: Our descriptive correlational study included 364 NHOPI caregiver adults in Utah (n = 155) and Hawaii (n = 209). We gathered demographic information with a questionnaire. Height and weight were measured for BMI calculations. RESULTS: According to the Centers for Disease Control and Prevention's BMI categories, 84.3% of our sample was overweight or obese. Participants in Utah had significantly higher BMIs than participants in Hawaii. Educational attainment was inversely related with BMI; however, age, gender, and income were not significantly related with BMI. DISCUSSION: NHOPIs on the U.S. mainland may be at greater risk for obesity than those in Hawaii; food price differences between locations may help explain this. NHOPIs in early adulthood had high BMIs; overtime this situation could worsen without intervention. IMPLICATIONS FOR PRACTICE: NHOPIs with low education levels or in areas of low food prices are at increased risk for obesity. Future research should focus on culturally sensitive interventions to reduce NHOPI obesity and associated risks.

Eating competence of college students in an introductory nutrition course.

OBJECTIVE: Describe eating competence, a positive and flexible way of conceptualizing eating attitudes and behaviors, in students enrolled in an introductory nutrition course. METHODS: Online completion of the Satter Eating Competence Inventory (ecSI) and self-assessment of eating disorder status by 557 students (343 ages 18-20 years and 180 ages 21-26 years; 377 females) at the beginning of 1 semester. Analysis of variance and post hoc Tukey adjusted tests were used. RESULTS: The mean ecSI score was 30.7 ± 0.29; 47.4% were classified as eating competent, or ecSI ≥ 32. Mean ecSI was higher for males than females (29.4 ± 0.95 vs 27.4 ± 0.77; P < .001). Mean ecSI was higher for students who never had an eating disorder, compared with those reporting current (32.0 ± 0.43 vs 22.9 ± 1.91; P < .001) or past (28.8 ± 0.93; P < .01) eating disorders. CONCLUSIONS AND IMPLICATIONS: Students had limited eating competence, but a majority of males were eating competent. Students who had never had an eating disorder had higher eating competence than students with current or past disorders. Examining nutrition courses as currently taught may reveal ways courses could contribute to eating competence.

Novel spinal cord stimulation parameters in patients with predominant back pain.

OBJECTIVES: To examine the feasibility of novel high-frequency spinal cord stimulation therapy in a cohort of patients with chronic predominant back pain during a four day, percutaneous trial. DESIGN: Prospective, multicenter open label pilot trial. SETTING AND PATIENTS: Twenty-four patients with back pain greater than leg pain who were candidates for spinal cord stimulation were trialed at five U.S. centers. INTERVENTIONS: Patients completed a percutaneous trial with a commercially available spinal cord stimulator. The implanted leads were then connected to the novel external stimulation device and patients were trialed for an additional four days. OUTCOME MEASURES: Pain intensity ratings, subjective descriptions, and patients' preference. RESULTS: There was significant improvement from baseline in overall pain scores (8.68 to 2.03, [p < 0.001]) and back pain scores (8.12 to 1.88, [p < 0.001]) with the investigational stimulation. The investigational stimulation was preferred to the commercially available systems in 21 of 24 patients (88%). CONCLUSIONS: Patients with predominant back pain reported a substantial reduction in overall pain and back pain when trialed with high-frequency spinal cord stimulation therapy.

A randomized, placebo-controlled study to assess the efficacy of lateral branch neurotomy for chronic sacroiliac joint pain.

OBJECTIVE: The objective of this study was to compare the efficacy of lateral branch neurotomy using cooled radiofrequency to a sham intervention for sacroiliac joint pain. DESIGN: Fifty-one subjects were randomized on a 2:1 basis to lateral branch neurotomy and sham groups, respectively. Follow-ups were conducted at 1, 3, 6, and 9 months. Subjects and coordinators were blinded to randomization until 3 months. Sham subjects were allowed to crossover to lateral branch neurotomy after 3 months. SUBJECTS: Subjects 18-88 years of age had chronic (>6 months) axial back pain and positive response to dual lateral branch blocks. INTERVENTIONS: Lateral branch neurotomy involved the use of cooled radiofrequency electrodes to ablate the S1-S3 lateral branches and the L5 dorsal ramus. The sham procedure was identical to the active treatment, except that radiofrequency energy was not delivered. OUTCOME MEASURES: The principal outcome measures were pain (numerical rating scale, SF-36BP), physical function (SF-36PF), disability (Oswestry disability index), quality of life (assessment of quality of life), and treatment success. RESULTS: Statistically significant changes in pain, physical function, disability, and quality of life were found at 3-month follow-up, with all changes favoring the lateral branch neurotomy group. At 3-month follow-up, 47% of treated patients and 12% of sham subjects achieved treatment success. At 6 and 9 months, respectively, 38% and 59% of treated subjects achieved treatment success. CONCLUSIONS: The treatment group showed significant improvements in pain, disability, physical function, and quality of life as compared with the sham group. The duration and magnitude of relief was consistent with previous studies, with current results showing benefits extending beyond 9 months.

A double-blind, randomized, prospective study of epidural steroid injection vs. the mild® procedure in patients with symptomatic lumbar spinal stenosis.

BACKGROUND: Epidural steroid injections (ESIs) are commonly used to treat low back pain, including symptomatic lumbar spinal stenosis (LSS). Reports on LSS treatment with ESIs have not differentiated between neurogenic claudication, which is believed to result from nerve root compression, and lumbar radicular pain, thought to be caused by inflammation. While there is overlap between these groups, the clinical relevance of ESI treatment cannot be generalized between these 2 distinct diseases with completely different pathophysiological causes. METHODS: This was a double-blind, randomized, prospective study of ESI vs. the mild procedure in patients with symptomatic LSS, conducted at a single pain management center. Patient reported outcome measures included Visual Analog Scale, Oswestry Disability Index, and Zurich Claudication Questionnaire (ZCQ) patient satisfaction. RESULTS: Thirty-eight patients were randomized into 2 treatment groups, 21 in mild and 17 in ESI. At 6- and 12-week follow-up, patients treated with mild reported significantly greater pain decrease over time (P < 0.0001), and significantly greater functional mobility improvement over time (P < 0.0018) than ESI patients. At week 6, mild ZCQ patient satisfaction score of 2.2 indicated a higher level of satisfaction than for ESI with a score of 2.8. In addition, 12-week ZCQ satisfaction score was 1.8, demonstrating sustained near-term satisfaction in the mild group. No major mild or ESI device or procedure-related complications were reported. CONCLUSIONS: This study demonstrated that in LSS patients suffering with neurogenic claudication, mild provides statistically significantly better pain reduction and improved functional mobility vs. treatment with ESI.

Qualitative description of college students' dinner groups.

OBJECTIVE: To discover how college students conduct dinner groups and perceptions of the benefits and difficulties of participation. DESIGN: Qualitative study conducted with 7 focus groups. SETTING AND PARTICIPANTS: A university campus, with 36 students participating in dinner groups, defined as a group of 3 people or more cooking for one another (or together) and eating together at least 4 times a week. MAIN OUTCOME MEASURE: Dinner groups. ANALYSIS: The focus group recordings were transcribed, coded, and reconciled. NUDIST NVivo software (version 8, QSR International, Victoria, Australia, 2008) assisted in coding data to identify themes and subthemes. RESULTS: Dinner groups were composed of roommates or students living nearby. They rotated who made each dinner. Benefits identified included social interaction, increasing confidence in cooking, saving money and time, and eating more varied and healthful foods. Difficulties, which were uncommon, included increased time spent on days the student cooked and stresses related to cooking on a schedule. Students found that the benefits far outweighed the difficulties and universally wanted to continue in a dinner group. CONCLUSIONS AND IMPLICATIONS: College students enjoyed dinner groups, and promoting them may be an option for improving college students' eating habits. Nearly all students believed that they ate better in a dinner group, but research is needed to assess actual intake.

Functional outcomes in patients with chronic nonmalignant pain on long-term opioid therapy.

OBJECTIVES: Although long-term opioid therapy for chronic nonmalignant pain (CNMP) is widely accepted, it is controversial as to whether long-term benefits outweigh detrimental side effects. This study examines the effect of long-term opioid therapy on quality of life in terms of both physical and mental health in patients with CNMP. METHODS: We retrospectively studied a cohort of patients with CNMP. With informed consent, data were collected prior to and at 6-36 months after the institution of opioid therapy in 67 patients with CNMP. The Short Form 36 (SF-36) health survey was used to compare self-reported measures of health-related quality of life in nine subscales. Visual analog scale (VAS) for pain intensity scores, disability status, and ability to return to work were also assessed. The pre- and post-therapy parameters were compared. RESULTS: The average scores of self-reported quality of life improved significantly in eight out of the nine parameters in the SF-36 after at least 6 months of opioid therapy. The increase in reported scores was statistically significant for physical functioning, physical role, bodily pain, general health, validity, social functioning, emotional role, and mental health. No significant changes were observed in reported health transition, VAS pain scores, disability status, or return to work. CONCLUSIONS: We conclude that judicious use of opioid therapy may lead to improvement in perceived quality of life and certain aspects of functional capacity and daily activities in a highly selected group of patients with CNMP who have not responded to other therapeutic modalities for over 6 months.

Heritage retention and bean intake correlates to dietary fiber intakes in Hispanic mothers--Qué Sabrosa Vida.

OBJECTIVE: To determine the correlation between fruit/vegetable and bean stage of change and heritage retention with fiber intake in Hispanic mothers. DESIGN: Cross-sectional study design used baseline survey data from the Qué Sabrosa Vida nutrition intervention developed by the University of Texas School of Public Health, Human Nutrition Center (Houston, TX). Participants were recruited and data gathered from telephone surveys using random digit dial methodology ensuring proportional representation of demographic subgroups. SUBJECTS: Hispanic mothers (N=293) responded to the baseline survey in El Paso, TX. ANALYSES: Using SPSS version 11.0 (SPSS Inc, Chicago, IL), descriptive statistics, chi2 , correlations, and analyses of variance were used to determine the relationship of variables to fiber intake. Potential confounding variables included were grain stage of change, age, education level, and marital status. RESULTS: Mean fiber intake for mothers was 21.9 g/day and mean age was 35.8 years. Chi2 of fruit/vegetable stage was P =.784. Chi 2 of bean stage, heritage retention score, age, and education to fiber intake were significant, P =.008, P =.004, P =.005, and P =.001, respectively. Bean stage, heritage retention score, age, and education level were significantly correlated. One-way analysis of variance of bean stage, heritage retention score, age, and education level by fiber intake were significant, P =.006, P =.001, P =.004, and P =.002, respectively. CONCLUSIONS: Older Hispanic mothers in the action/maintenance bean stage with strong heritage retention score had greater fiber intakes than younger mothers in pre-action bean stage with weak heritage retention score. As education level increased fiber intake decreased. Encouragement of bean consumption and heritage retention may increase fiber intake in this Hispanic mother population.

College students can benefit by participating in a prepaid meal plan.

We compared Food Guide Pyramid (FGP) intake of college students according to their participation in a campus prepaid meal plan and their sex. Subjects were 503 single undergraduates (73 males, 430 females) who completed a 3-day dietary analysis assignment for an introductory nutrition course. Average intake for virtually all students fell short of FGP recommendations. We examined the difference between students' mean intake of foods from each FGP group and the recommended intakes. When compared with other student categories and food groups, male meal plan participants' vegetable and meat intakes were closer to recommended intakes, and meal plan participants' and females' fruit intakes were closer to recommended intakes. However, nonparticipants were closer than participants to recommended grain intakes. Participation in the prepaid campus meal plan appears to offer modest nutritional benefits to students through increased servings of foods from fruit, vegetable, and meat groups.

The relationship between reading beauty and fashion magazines and the use of pathogenic dieting methods among adolescent females.

This study examined the relationship between reading women's beauty and fashion magazines and the use of pathogenic dieting methods (laxatives, appetite suppressants/diet pills, skipping two meals a day, intentional vomiting, and restricting calories to 1,200 or less each day) among 502 high school females. Weak to moderate positive associations were found between reading frequency and each of these unhealthful practices except the use of laxatives. When controlling for anxiety about weight and frequency of regular exercise, however, the original bivariate relations between reading frequency and skipping two meals a day, and reading and intentional vomiting, disappeared. Replication and weak specification effects were found when examining the relationships between reading and taking appetite suppressant/weight control pills, and reading and restricting calories, under the control conditions. These findings suggest that two of the most common adolescent dieting methods--restricting calories and taking diet pills--appear to be influenced by the reading of women's beauty and fashion magazines.