Linkages between health systems and communities for chronic care: a scoping review protocol.

INTRODUCTION: Linkages between health systems and communities may leverage community assets to address unmet needs and provide services for improved continuity and coordination of care. However, there are limited examples of specific strategies for such linkages for chronic disease management. Guided by a local need from stakeholders, this scoping review aims to clarify and map methods and strategies for linkages between communities and health systems across chronic diseases, to inform future implementation efforts. METHODS AND ANALYSIS: The scoping review will be conducted following Arksey and O'Malley's methodological framework and latest Joanna Briggs Institute (JBI) guidelines, with continuous stakeholder engagement throughout. A structured literature search of records from January 2001 to April 2022 will be completed in MEDLINE/PubMed, CINAHL, EMBASE, PsycINFO, in addition to grey literature. Two reviewers will independently complete study selection following inclusion criteria reflecting population (chronic disease), concept (integrated care) and context (health systems and communities) and will chart the data. Data will be analysed using descriptive qualitative and quantitative methods, to map and operationalise the linkages between health systems and communities. ETHICS AND DISSEMINATION: The scoping review does not require ethics approval as it will examine and collect data from publicly available materials, and all stakeholder engagement will follow guidelines for patient and public involvement. Findings will be reported through a summarising list of considerations for different linkage strategies between health systems and community resources and implications for future research, practice and policy will be discussed and presented. The results will also be used to inform an integrated knowledge translation project to implement community-health system linkages to support chronic pain management. REGISTRATION NUMBER: 10.17605/OSF.IO/UTSN9.

Sex differences in the contributions of spinal atypical PKCs and downstream targets to the maintenance of nociceptive sensitization.

BACKGROUND: Chronic pain has been shown to depend on nociceptive sensitization in the spinal cord, and while multiple mechanisms involved in the initiation of plastic changes have been established, the molecular targets which maintain spinal nociceptive sensitization are still largely unknown. Building upon the established neurobiology underlying the maintenance of long-term potentiation in the hippocampus, this present study investigated the contributions of spinal atypical protein kinase C (PKC) isoforms PKCι/λ and PKMζ and their downstream targets (p62/GluA1 and NSF/GluA2 interactions, respectively) to the maintenance of spinal nociceptive sensitization in male and female rats. RESULTS: Pharmacological inhibition of atypical PKCs by ZIP reversed established allodynia produced by repeated intramuscular acidic saline injections in male animals only, replicating previously demonstrated sex differences. Inhibition of both PKCι/λ and downstream substrates p62/GluA1 resulted in male-specific reversals of intramuscular acidic saline-induced allodynia, while female animals continued to display allodynia. Inhibition of NSF/GluA2, the downstream target to PKMζ, reversed allodynia induced by intramuscular acidic saline in both sexes. Neither PKCι/λ, p62/GluA1 or NSF/GluA2 inhibition had any effect on formalin response for either sex. CONCLUSION: This study provides novel behavioural evidence for the male-specific role of PKCι/λ and downstream target p62/GluA1, highlighting the potential influence of ongoing afferent input. The sexually divergent pathways underlying persistent pain are shown here to converge at the interaction between NSF and the GluA2 subunit of the AMPA receptor. Although this interaction is thought to be downstream of PKMζ in males, these findings and previous work suggest that females may rely on a factor independent of atypical PKCs for the maintenance of spinal nociceptive sensitization.

Reliability of Head, Neck, and Trunk Anthropometric Measurements Used for Predicting Segment Tissue Masses in Living Humans.

Soft and rigid tissue mass prediction equations have been previously developed and validated for the segments of the upper and lower extremities in living humans using simple anthropometric measurements. The reliability of these measurements has been found to be good to excellent for all measurement types (segment lengths, circumferences, breadths, skinfolds). However, the reliability of the measurements needed to develop corresponding equations for the head, neck, and trunk has yet to be determined. The purpose of this study was to quantify the inter- and intrameasurer reliability of 34 surface anthropometric measurements of the head, neck, and trunk segments. Measurements (11 lengths, 7 circumferences, 11 breadths, 5 skinfolds) were taken twice separately on 50 healthy, university-age individuals using standard anthropometric tools. The mean inter- and intrameasurer measurement differences were fairly small overall, with 64.7% and 67.6% of the relative differences less than 5%, respectively. All measurements, except for the right lateral trunk, had intraclass correlation coefficients (ICCs) greater than 0.75, and coefficients of variation (CVs) less than 10%, indicating good reliability overall. These results are consistent with previous work for the extremities and provide support for the use of the defined surface measurements for future tissue mass prediction equation development.

Head, Neck, Trunk, and Pelvis Tissue Mass Predictions for Young Adults Using Anthropometric Measures and Dual-Energy X-Ray Absorptiometry.

Accurate prediction of wobbling mass (WM), fat mass (FM), lean mass (LM), and bone mineral content (BMC) of living people using regression equations developed from anthropometric measures (lengths, circumferences, breadths, skinfolds) has previously been reported, but only for the extremities. Multiple linear stepwise regression was used to generate comparable equations for the head, neck, trunk, and pelvis of young adults (38 males, 38 females). Equations were validated using actual tissue masses from an independent sample of 13 males and 13 females by manually segmenting full-body dual-energy x-ray absorptiometry scans. Prediction equations exhibited adjusted R2 values ranging from .249 to .940, with more explained variance for LM and WM than BMC and FM, especially for the head and neck. Mean relative errors between predicted and actual tissue masses ranged from -11.07% (trunk FM) to 7.61% (neck FM). Actual and predicted tissue masses from all equations were significantly correlated (R2 = .329 to .937), except head BMC (R2 = .046). These results show promise for obtaining in-vivo head, neck, trunk, and pelvis tissue mass estimates in young adults. Further research is needed to improve head and neck FM and BMC predictions and develop tissue mass prediction equations for older populations.