Coping Style and Depressive Symptomatology during Pregnancy in a Private Setting Sample

Aim: to evaluate the association of antenatal depressive symptomatology (AD) with life events and coping styles, the hypothesis was that certain coping strategies are associated to depressive symptomatology. Methods: we performed a cross sectional study of 312 women attending a private clinic in the city of Osasco, Sao Paulo from 27/05/1998 to 13/05/2002. The following instruments were used: Beck Depression Inventory (BDI), Holmes and Rahe Schedule of Recent Events (SSRS), Folkman and Lazarus Ways of Coping Questionnaire and questionnaire with social-demographic and obstetric data. Inclusion criteria: women with 110 past history of depression, psychiatric treatment, alcohol or drug abuse and no clinical-obstetrical complications. Odds ratios and 95% CI were used to examine the association between AD (according to BDI) and exposures variables. Hypothesis testing was done with chi(2) tests and a p value < .05. Results: AD occurred in 21.1% of pregnant women. By the univariate analyses, education, number of pregnancies, previous abortion, husband income, situation of marriage and score of SSRS were associated with AD. All coping styles were associated with AD, except seeking support and positive reappraisal. By the multivariate analyses, four coping styles were kept in the final model: confront (p = .039), accepting responsibility (p < .001), escape-avoidance (p = .002), problem-solving (p = .005). Conclusions: AD was highly prevalent and was associated with maladaptive coping styles.

Actualización, consolidación, migración y contingencia de un entorno hardware y software para la gestión de bases de datos

[ES]El objetivo de este Trabajo es el de actualizar un entorno de gestión de bases de datos existente a la versión 11.2 del software de bases de datos Oracle y a una plataforma hardware de última generación. Se migran con tiempo de parada cero varias bases de datos dispersas en distintos servidores a un entorno consolidado de dos nodos dispuestos en alta disponibilidad tipo "activo-activo" mediante Oracle RAC y respaldado por un entorno de contingencia totalmente independiente y sincronizado en tiempo real mediante Oracle GoldenGate. Se realiza un estudio del entorno actual y, realizando una estimación de crecimiento, se propone una configuración de hardware y software mínima para implementar con garantías de éxito los requerimientos del entorno de gestión de bases de datos a corto y medio plazo. Una vez adquirido el hardware, se lleva a cabo la instalación, actualización y configuración del Sistema Operativo y el acceso redundado de los servidores a la cabina de almacenamiento. Posteriormente se instala el software de clúster de Oracle, el software de la base de datos y se crea una instancia que albergará los esquemas requeridos de las bases de datos a consolidar. Seguidamente se migran los esquemas al entorno consolidado y se establece la replicación de éstos en tiempo real con la máquina de contingencia usando en ambos casos Oracle GoldenGate. Finalmente se crea y prueba un esquema de copias de seguridad que incluye copias lógicas y físicas de la propia base de datos y de archivos de configuración del clúster a partir de los cuales será posible restaurar el entorno completamente.

Beiträge zur Steuerung und Analyse von technischen Bearbeitungssystemen mit Methoden der nichtlinearen Zeitreihenanalyse

Die Nichtlineare Zeitreihenanalyse konnte in den letzten Jahren im Rahmen von Laborexperimenten ihre prinzipelle Brauchbarkeit beweisen. Allerdings handelte es sich in der Regel um ausgewählte oder speziell konstruierte nichtlineare Systeme. Sieht man einmal von der Überwachung von Prozessen und Produkten ab, so sind Anwendungen auf konkrete, vorgegebene dynamische Probleme im industriellen Bereich kaum bekannt geworden. Ziel dieser Arbeit war es, an Hand von zwei Problemen aus der technischen Praxis zu untersuchen, ob die Anwendung des kanonischen Schemas der Nichtlinearen Zeitreihenanalyse auch dort zu brauchbaren Resultaten führt oder ob Modifikationen (Vereinfachungen oder Erweiterungen) notwendig werden. Am Beispiel der Herstellung von optischen Oberflächen durch Hochpräzisionsdrehbearbeitung konnte gezeigt werden, daß eine aktive Störungskompensation in Echtzeit mit einem speziell entwickelten nichtlinearen Vorhersagealgorithmus möglich ist. Standardverfahren der Nichtlinearen Zeitreihenanalyse beschreiten hier den allgemeinen, aber sehr aufwendigen Weg über eine möglichst vollständige Phasenraumrekonstruktion. Das neue Verfahren verzichtet auf viele der kanonischen Zwischenschritte. Dies führt zu einererheblichen Rechenzeitersparnis und zusätzlich zu einer wesentlich höheren Stabilität gegenüber additivem Meßrauschen. Mit den berechneten Vorhersagen der unerwünschten Maschinenschwingungen wurde eine Störungskompensation realisiert, die die Oberflächengüte des bearbeiteten Werkstücks um 20-30% verbesserte. Das zweite Beispiel betrifft die Klassifikation von Körperschallsignalen, die zur Überwachung von Zerspansprozessen gemessen werden. Diese Signale zeigen, wie auch viele andere Prozesse im Bereich der Produktion, ein hochgradig nichtstationäres Verhalten. Hier versagen die Standardverfahren der Nichtlinearen Datenanalyse, die FT- bzw. AAFT-Surrogate benutzen. Daher wurde eine neue Klasse von Surrogatdaten zum Testen der Nullhypothese nichtstationärer linearer stochastischer Prozesse entwickelt, die in der Lage ist, zwischen deterministischen nichtlinear chaotischen und stochastischen linearen nichtstationären Zeitreihen mit change points zu unterscheiden. Damit konnte gezeigt werden, daß die untersuchten Köperschallsignale sich statistisch signifikant einer nichtstationären stochastischen Folge von einfachen linearen Prozessen zuordnen lassen und eine Interpretation als nichtlineare chaotische Zeitreihe nicht erforderlich ist.

Frame-driven Extraction of Linked Data and Ontologies from Text

Ontology design and population -core aspects of semantic technologies- re- cently have become fields of great interest due to the increasing need of domain-specific knowledge bases that can boost the use of Semantic Web. For building such knowledge resources, the state of the art tools for ontology design require a lot of human work. Producing meaningful schemas and populating them with domain-specific data is in fact a very difficult and time-consuming task. Even more if the task consists in modelling knowledge at a web scale. The primary aim of this work is to investigate a novel and flexible method- ology for automatically learning ontology from textual data, lightening the human workload required for conceptualizing domain-specific knowledge and populating an extracted schema with real data, speeding up the whole ontology production process. Here computational linguistics plays a fundamental role, from automati- cally identifying facts from natural language and extracting frame of relations among recognized entities, to producing linked data with which extending existing knowledge bases or creating new ones. In the state of the art, automatic ontology learning systems are mainly based on plain-pipelined linguistics classifiers performing tasks such as Named Entity recognition, Entity resolution, Taxonomy and Relation extraction [11]. These approaches present some weaknesses, specially in capturing struc- tures through which the meaning of complex concepts is expressed [24]. Humans, in fact, tend to organize knowledge in well-defined patterns, which include participant entities and meaningful relations linking entities with each other. In literature, these structures have been called Semantic Frames by Fill- 6 Introduction more [20], or more recently as Knowledge Patterns [23]. Some NLP studies has recently shown the possibility of performing more accurate deep parsing with the ability of logically understanding the structure of discourse [7]. In this work, some of these technologies have been investigated and em- ployed to produce accurate ontology schemas. The long-term goal is to collect large amounts of semantically structured information from the web of crowds, through an automated process, in order to identify and investigate the cognitive patterns used by human to organize their knowledge.

108 Sn studied with intermediate-energy Coulomb excitation

In dieser Arbeit wurde der instabile, Neutronenarme Kern 108Sn mit Hilfe der Coulomb-Anregung bei intermediaeren Energien in inverser Kinematik studiert. Diese Methode wurde bisher zur Untersuchung der ersten angeregten 2+ Zustaende und deren E2 Zerfallsraten in Kernen mit Kernladungszahl Z< 30 angewendet. 108Sn ist somit der Kern mit der groeßten Kernladungszahl, bei dem diese Studien bisher stattfanden. Das Ziel dieses Experiments war die Messung der unbekannten reduzierten Uebergangswahrscheinlichkeit B(E2,0+ -> 2+). Der B(E2)-Wert von 0.230(57) e2b2 wurde relativ zu dem bekannten Wert des Isotops 112Sn bestimmt. Das Experiment wurde an der GSI Darmstadt mit Hilfe des RISING Detektors und des Fragmentseperators (FRS) durchgefuehrt. Sekundaere Strahlen (108Sn, 112Sn) mit einer Energie von ca. 150 MeV pro Nukleon wurden auf ein 386 mg/cm2 dickes 197Au Target geschossen. Die Projektilfragmente wurden mit Hilfe des Fragmentseparators selektiert und identifiziert. Zur Selektion des Reaktionskanals und zur Bestimmung des Winkels der gestreuten Fragmente wurde das Teilchenteleskop CATE, das sich hinter dem Target befand, verwendet. Gammastrahlung, die in Koinzidenz mit den Projektilrestkernen emittiert wurde, wurde in den Germanium-Cluster Detektoren des RISING Detektors nachgewiesen. Der gemessene B(E2,0+ -> 2+)-Wert von 108Sn ist in Uebereinstimmung mit neueren Schalenmodellrechnungen, die auf realistischen effektiven Wechselwirkungen basieren und im Rahmen eines verallgemeinerten Seniorit¨ats-Schemas erklaert werden.

Lexis paidike. L'infanzia in Origene

La tesi considera la trattazione del tema dell’infanzia nell’opera di Origene di Alessandria attraverso l’analisi dei testi trasmessi nell’originale greco e delle traduzioni latine di Rufino e Gerolamo. Il motivo dell’infanzia è considerato nei suoi molteplici significati, a più livelli: esegetico, antropologico, filosofico, teologico. La ricerca non si limita dunque ad un’analisi di taglio storico, ma ambisce a definire la concezione e la considerazione della prima età dal punto di vista di Origene e nel contesto più ampio della letteratura coeva. Attraverso una lettura estensiva del corpus dell’Alessandrino sono stati isolati tutti i passi che si riferiscono all’infanzia a livello letterale e metaforico. Ne emerge una trattazione complessa del tema: il bambino è per Origene, in linea con le contemporanee dottrine filosofiche, un essere eminentemente irrazionale. Il pieno sviluppo della facoltà razionale si colloca al termine di questa prima fase dell’esistenza. L’irrazionalità infantile previene nei più piccoli l’insorgere delle passioni. A questa dottrina, di matrice stoica, si ricollegano alcuni sviluppi di grande rilievo: la non-imputabilità dei minori ed il legame tra razionalità e responsabilità individuale; la riflessione sulla sofferenza dei bambini e la ricerca di una sua causa, che non intacchi il principio della giustizia divina; l’ipotesi della preesistenza delle anime. Sul piano teologico la ricerca si focalizza sulle nozioni di paternità e filiazione e sul tema, centrale nell’orizzonte origeniano, della pedagogia. Origene concepisce la pedagogia umana, sul modello di quella divina, come una rete dinamica di relazioni che ricalca i rapporti parentali. A fianco di questi ambiti d’interesse principali l’analisi considera aspetti ulteriori: risalto è concesso, in particolare, all’elemento biografico ed all’aspetto linguistico e letterario della prosa origeniana, quest'ultimo spesso trascurato dalla critica. Lo studio mostra inoltre la vitalità di alcuni modelli esegetici origeniani nella tradizione successiva.

Semantic Publishing: issues, solutions and new trends in scholarly publishing within the Semantic Web era

This work is concerned with the increasing relationships between two distinct multidisciplinary research fields, Semantic Web technologies and scholarly publishing, that in this context converge into one precise research topic: Semantic Publishing. In the spirit of the original aim of Semantic Publishing, i.e. the improvement of scientific communication by means of semantic technologies, this thesis proposes theories, formalisms and applications for opening up semantic publishing to an effective interaction between scholarly documents (e.g., journal articles) and their related semantic and formal descriptions. In fact, the main aim of this work is to increase the users' comprehension of documents and to allow document enrichment, discovery and linkage to document-related resources and contexts, such as other articles and raw scientific data. In order to achieve these goals, this thesis investigates and proposes solutions for three of the main issues that semantic publishing promises to address, namely: the need of tools for linking document text to a formal representation of its meaning, the lack of complete metadata schemas for describing documents according to the publishing vocabulary, and absence of effective user interfaces for easily acting on semantic publishing models and theories.

A new double laser pulse pumping scheme for transient collisionally excited plasma soft X-ray lasers

Within this thesis a new double laser pulse pumping scheme for plasma-based, transient collisionally excited soft x-ray lasers (SXRL) was developed, characterized and utilized for applications. SXRL operations from ~50 up to ~200 electron volt were demonstrated applying this concept. As a central technical tool, a special Mach-Zehnder interferometer in the chirped pulse amplification (CPA) laser front-end was developed for the generation of fully controllable double-pulses to optimally pump SXRLs.rnThis Mach-Zehnder device is fully controllable and enables the creation of two CPA pulses of different pulse duration and variable energy balance with an adjustable time delay. Besides the SXRL pumping, the double-pulse configuration was applied to determine the B-integral in the CPA laser system by amplifying short pulse replica in the system, followed by an analysis in the time domain. The measurement of B-integral values in the 0.1 to 1.5 radian range, only limited by the reachable laser parameters, proved to be a promising tool to characterize nonlinear effects in the CPA laser systems.rnContributing to the issue of SXRL pumping, the double-pulse was configured to optimally produce the gain medium of the SXRL amplification. The focusing geometry of the two collinear pulses under the same grazing incidence angle on the target, significantly improved the generation of the active plasma medium. On one hand the effect was induced by the intrinsically guaranteed exact overlap of the two pulses on the target, and on the other hand by the grazing incidence pre-pulse plasma generation, which allows for a SXRL operation at higher electron densities, enabling higher gain in longer wavelength SXRLs and higher efficiency at shorter wavelength SXRLs. The observation of gain enhancement was confirmed by plasma hydrodynamic simulations.rnThe first introduction of double short-pulse single-beam grazing incidence pumping for SXRL pumping below 20 nanometer at the laser facility PHELIX in Darmstadt (Germany), resulted in a reliable operation of a nickel-like palladium SXRL at 14.7 nanometer with a pump energy threshold strongly reduced to less than 500 millijoule. With the adaptation of the concept, namely double-pulse single-beam grazing incidence pumping (DGRIP) and the transfer of this technology to the laser facility LASERIX in Palaiseau (France), improved efficiency and stability of table-top high-repetition soft x-ray lasers in the wavelength region below 20 nanometer was demonstrated. With a total pump laser energy below 1 joule the target, 2 mircojoule of nickel-like molybdenum soft x-ray laser emission at 18.9 nanometer was obtained at 10 hertz repetition rate, proving the attractiveness for high average power operation. An easy and rapid alignment procedure fulfilled the requirements for a sophisticated installation, and the highly stable output satisfied the need for a reliable strong SXRL source. The qualities of the DGRIP scheme were confirmed in an irradiation operation on user samples with over 50.000 shots corresponding to a deposited energy of ~ 50 millijoule.rnThe generation of double-pulses with high energies up to ~120 joule enabled the transfer to shorter wavelength SXRL operation at the laser facility PHELIX. The application of DGRIP proved to be a simple and efficient method for the generation of soft x-ray lasers below 10 nanometer. Nickel-like samarium soft x-ray lasing at 7.3 nanometer was achieved at a low total pump energy threshold of 36 joule, which confirmed the suitability of the applied pumping scheme. A reliable and stable SXRL operation was demonstrated, due to the single-beam pumping geometry despite the large optical apertures. The soft x-ray lasing of nickel-like samarium was an important milestone for the feasibility of applying the pumping scheme also for higher pumping pulse energies, which are necessary to obtain soft x-ray laser wavelengths in the water window. The reduction of the total pump energy below 40 joule for 7.3 nanometer short wavelength lasing now fulfilled the requirement for the installation at the high-repetition rate operation laser facility LASERIX.rn

Synthese und Testung von COX-1-, COX-2- und 5-LOX-Inhibitoren zur topischen Anwendung

Das Ziel der Dissertation war die Synthese und pharmakologische Charakterisierung von COX-1-, COX-2- und 5-LOX-Inhibitoren, die zur Behandlung entzündlicher Dermatosen für die topische Anwendung geeignet sein sollten. Hierfür wurden zwei Strukturklassen - die sogenannten Imidazothiazole und die Chalcone-Derivate - entworfen und synthetisiert sowie in verschiedenen in vitro-Testsystemen auf ihre pharmakologische Wirksamkeit untersucht. rnDie Leitsubstanz der ersten Strukturklasse wurde in Anlehnung an die Struktur von Licofelon entworfen. Licofelon ist ein dualer COX/LOX-Inhibitor, der für die Indikation Osteoarthritis eingesetzt werden soll. Durch den Austausch einzelner Substituenten an den Phenylringen wurde die Leitstruktur schrittweise verändert, um die Wirksamkeit zu optimieren. Die Substituentenvariation erfolgte anhand des sogenannten Topliss-Schemas. Bei der zweiten Substanzklasse wurde durch Kombination zweier antiinflammatorisch wirksamer Molekülgruppen - mit dem Ziel eines synergistischen Effekts - eine Grundstruktur entwickelt, die zur Optimierung der Wirksamkeit derivatisiert wurde. Als Komponenten dienten 4,5-Bis(4-methoxyphenyl)-1H-imidazol-2-thiol (Z11) und ein Chalcon. Z11 ist sowohl in der Literatur als auch in vorangegangen Arbeiten des Arbeitskreises als dualer COX/LOX-Inhibitor beschrieben. Chalcone besitzen eine 1,3-Diphenylpropenon-Partialstruktur und können über einen der beiden Phenylringe mit Z11 verknüpft werden. In der Literatur wurde vielfach über die vielfältigen pharmakologischen Eigenschaften der Chalcone berichtet; im Rahmen dieser Arbeit stand deren antiinflammatorische Eigenschaft im Vordergrund. rnZur Beurteilung der Effektivität und Toxizität der Substanzen wurden diese anschließend pharmakologisch charakterisiert werden. Hierfür standen verschiedene in vitro-Testsysteme zur Verfügung, die Aufschluss über die COX-1-, COX-2- und 5-LOX-Inhibition der synthetisierten Substanzen gaben. Des Weiteren wurden die Substanzen auf eine mögliche inhibitorische Aktivität gegenüber TNF- untersucht. Da die Entwicklung der Testverbindungen mit dem Ziel der topischen Anwendung erfolgte, wurde eine log P-Wert-Bestimmung durchgeführt, um eine Aussage über die Lipophilie der Verbindungen treffen zu können.rn

Inserimento eterofamigliare supportato di adulti sofferenti di disturbi psichici: Valutazione degli esiti

L’Inserimento Eterofamigliare Supportato di Adulti (IESA) sofferenti di disturbi psichici consiste nell’accogliere persone in cura presso i servizi psichiatrici territoriali, nel proprio domicilio, integrandole nelle proprie relazioni famigliari. Obiettivo è migliorare la qualità di vita dell’utente e favorirne l’integrazione nella comunità. Obiettivo. Valutare gli esiti dello IESA, con un disegno di ricerca longitudinale, considerando: psicopatologia, benessere psicologico, funzionamento sociale e familiare. Metodologia. 40 soggetti: 20 pazienti e 20 ospitanti. La valutazione clinica è stata effettuata all’inizio della convivenza e al follow-up di 1, 3, 6 e 12 mesi. Strumenti utilizzati: BPRS, VGF, PWB, SQ, FAD. Analisi statistica: Modello Lineare Generale (GLM) con l’Analisi della Varianza per prove ripetute e calcolo dell’effect-size. Risultati. 15 pazienti maschi e 5 femmine, 17 italiani. 11 soddisfano i criteri diagnostici (DSM-IV-TR) per schizofrenia e disturbi psicotici, 5 per i disturbi dell’umore e 4 per i disturbi di personalità. Dopo l’inserimento 3 sono stati i ricoveri e 4 le visite psichiatriche urgenti. 8 pazienti modificano/diminuiscono la terapia e 3 la sospendono. Aumenta il benessere psicologico (PWB); diminuiscono i sintomi psicopatologici (BPRS ed SQ) e migliora il funzionamento globale (VFG). Il gruppo dei famigliari composto da 11 uomini e 9 donne, 19 di nazionalità italiana; con età media di 55 anni. 8 sono coniugati, 6 celibi/nubili, 4 divorziati e 2 vedovi. 9 hanno figli, 11 lavorano e 8 sono pensionati. Nei famigliari aumenta il benessere psicologico (PWB), migliora il funzionamento famigliare (FAD) e la valutazione del funzionamento globale (VGF) rimane costante nel tempo. Discussioni e conclusioni. Il progetto IESA sembra migliorare la psicopatologia, con una diminuzione dei comportamenti maladattativi e un aumento delle capacità relazionali dell’ospite favorendone l’integrazione. Inoltre, lo IESA sembra diminuire i costi della cronicità psichiatrica: diminuzione degli accessi al Pronto Soccorso, delle visite psichiatriche urgenti e delle giornate di ricovero.

The phenomenological experiences of Autobiographical Memory: A cross-sectional and a longitudinal study

Phenomenology is a critical component of autobiographical memory retrieval. Some memories are vivid and rich in sensory details whereas others are faded; some memories are experienced as emotionally intense whereas others are not. Sutin and Robins (2007) identified 10 dimensions in which a memory may vary—i.e., Vividness, Coherence, Accessibility, Sensory Details, Emotional Intensity, Visual Perspective, Time Perspective, Sharing, Distancing, and Valence—and developed a comprehensive psychometrically sound measure of memory phenomenology, the Memory Experiences Questionnaire (MEQ). Phenomenology has been linked to underlining stable dispositions—i.e. personality, as well as to a variety of positive/negative psychological outcomes—well-being and life satisfaction, depression and anxiety, among others. Using the MEQ, a cross-sectional and a longitudinal study were conducted on a large sample of American and Italian adults. In both studies, participants retrieved two ‘key’ personal memories, a Turning Point and a Childhood Memory, and rated the affect and phenomenology of each memory. Participants also completed self-reported measures of personality (i.e. Neuroticism and Conscientiousness), and measures of depression, well-being and life satisfaction. The present research showed that phenomenological ratings tend (a) to cross-sectionally increase across adulthood (Study 1), and (b) to be moderately stable over time, regardless the contents of the memories (Study 2). Interrelations among memory phenomenology, personality and psychological outcome variables were also examined (Study 1 and Study 2). In particular, autobiographical memory phenomenology was proposed as a dynamic expression of personality functioning that partially explains adaptive/maladaptive psychological outcomes. In fact, the findings partially supported the hypothesized mediating effect of phenomenology on the personality association with psychological outcomes. Implications of the findings are discussed proposing future lines of research. In particular, the need for more longitudinal studies is highlighted, along with the combined application of both self-report questionnaires and narrative measures.

Structural patterns for document engineering: from an empirical bottom-up analysis to an ontological theory

This thesis aims at investigating a new approach to document analysis based on the idea of structural patterns in XML vocabularies. My work is founded on the belief that authors do naturally converge to a reasonable use of markup languages and that extreme, yet valid instances are rare and limited. Actual documents, therefore, may be used to derive classes of elements (patterns) persisting across documents and distilling the conceptualization of the documents and their components, and may give ground for automatic tools and services that rely on no background information (such as schemas) at all. The central part of my work consists in introducing from the ground up a formal theory of eight structural patterns (with three sub-patterns) that are able to express the logical organization of any XML document, and verifying their identifiability in a number of different vocabularies. This model is characterized by and validated against three main dimensions: terseness (i.e. the ability to represent the structure of a document with a small number of objects and composition rules), coverage (i.e. the ability to capture any possible situation in any document) and expressiveness (i.e. the ability to make explicit the semantics of structures, relations and dependencies). An algorithm for the automatic recognition of structural patterns is then presented, together with an evaluation of the results of a test performed on a set of more than 1100 documents from eight very different vocabularies. This language-independent analysis confirms the ability of patterns to capture and summarize the guidelines used by the authors in their everyday practice. Finally, I present some systems that work directly on the pattern-based representation of documents. The ability of these tools to cover very different situations and contexts confirms the effectiveness of the model.

[Chronic right-sided pain-associated nondermatomal somatosensory deficit following an accident]

We present the case of a 48-year old man who, eight years after an industrial accident, presents with chronic right-sided nondermatomal pain and hypaesthesia to heat and touch. During symmetric peripheral touch functional magnetic resonance imaging revealed hypometabolism in the left thalamus, somatosensory cortex, and anterior cingulate cortex. Pain-associated nondermatomal somatosensory deficits (NDSDs) localizing to one side of the body are a frequent clinical entity, which are often triggered by an accident. The tendency of NDSDs to extend to adjunct ipsilateral body parts and to become chronic points to maladaptive adjustment of pain-processing areas in the central nervous system. Psychological stress prior to or around the triggering event seems an important risk factor for NDSDs.

Predicting the transition from acute to persistent low back pain

BACKGROUND: Most people experience low back pain (LBP) at least once in their lifetime. Only a minority of them go on to develop persistent LBP. However, the socioeconomic costs of persistent LBP significantly exceed the costs of the initial acute LBP episode. AIMS: To identify factors that influence the progression of acute LBP to the persistent state at an early stage. METHODS: Prospective inception cohort study of patients attending a health practitioner for their first episode of acute LBP or recurrent LBP after a pain free period of at least 6 months. Patients were assessed at baseline addressing occupational and psychological factors as well as pain, disability, quality of life and physical activity and followed up at 3, 6, 12 weeks and 6 months. Variables were combined to the three indices 'working condition', 'depression and maladaptive cognitions' and 'pain and quality of life'. RESULTS: The index 'depression and maladaptive cognitions' was found to be a significant baseline predictor for persistent LBP up to 6 months (OR 5.1; 95% CI: 1.04-25.1). Overall predictive accuracy of the model was 81%. CONCLUSIONS: In this study of patients with acute LBP in a primary care setting psychological factors at baseline correlated with a progression to persistent LBP up to 6 months. The benefit of including factors such as 'depression and maladaptive cognition' in screening tools is that these factors can be addressed in primary and secondary prevention.

Predicting the transition from acute to persistent low back pain

BACKGROUND: Most people experience low back pain (LBP) at least once in their lifetime. Only a minority of them go on to develop persistent LBP. However, the socioeconomic costs of persistent LBP significantly exceed the costs of the initial acute LBP episode. AIMS: To identify factors that influence the progression of acute LBP to the persistent state at an early stage. METHODS: Prospective inception cohort study of patients attending a health practitioner for their first episode of acute LBP or recurrent LBP after a pain free period of at least 6 months. Patients were assessed at baseline addressing occupational and psychological factors as well as pain, disability, quality of life and physical activity and followed up at 3, 6, 12 weeks and 6 months. Variables were combined to the three indices 'working condition', 'depression and maladaptive cognitions' and 'pain and quality of life'. RESULTS: The index 'depression and maladaptive cognitions' was found to be a significant baseline predictor for persistent LBP up to 6 months (OR 5.1; 95% CI: 1.04-25.1). Overall predictive accuracy of the model was 81%. CONCLUSIONS: In this study of patients with acute LBP in a primary care setting psychological factors at baseline correlated with a progression to persistent LBP up to 6 months. The benefit of including factors such as 'depression and maladaptive cognition' in screening tools is that these factors can be addressed in primary and secondary prevention.