Gender Differences in the Influence of Protective Factors, Risk Factors, and Health Risk Behaviors on HIV Risk Behaviors Among Youth in South Florida

Adolescents engage in a range of risk behaviors during their transition from childhood to adulthood. Identifying and understanding interpersonal and socio-environmental factors that may influence risk-taking is imperative in order to meet the Healthy People 2020 goals of reducing the incidence of unintended pregnancies, HIV, and other sexually transmitted infections among youth. The purpose of this study was to investigate gender differences in the predictors of HIV risk behaviors among South Florida youth. More specifically, this study examined how protective factors, risk factors, and health risk behaviors, derived from a guiding framework using the Theory of Problem Behavior and Theory of Gender and Power, were associated with HIV risk behavior. A secondary analysis of 2009 Youth Risk Behavior Survey data sets from Miami-Dade, Broward, and Palm Beach school districts tested hypotheses for factors associated with HIV risk behaviors. The sample consisted of 5,869 high school students (mean age 16.1 years), with 69% identifying as Black or Hispanic. Logistic regression analyses revealed gender differences in the predictors of HIV risk behavior. An increase in the health risk behaviors was related to an increase in the odds that a student would engage in HIV risk behavior. An increase in risk factors was also found to significantly predict an increase in the odds of HIV risk behavior, but only in females. Also, the probability of participation in HIV risk behavior increased with grade level. Post-hoc analyses identified recent sexual activity (past 3 months) as the strongest predictor of condom nonuse and having four or more sexual partners for both genders. The strongest predictors of having sex under the influence of drugs/alcohol were alcohol use in both genders, marijuana use in females, and physical fighting in males. Gender differences in the predictors of unprotected sex, multiple sexual partners, and having sex under the influence were also found. Additional studies are warranted to understand the gender differences in predictors of HIV risk behavior among youth in order to better inform prevention programming and policy, as well as meet the national Healthy People 2020 goals.

Bullying Involvement and Adolescent Substance Use: A Study of Multilevel Risk and Protective Factors

Thesis (Master, Psychology) -- Queen's University, 2016-08-02 13:18:40.65

Protective and risk factors in amateur equestrians and description of injury patterns: A retrospective data analysis and a case - control survey

Background In Switzerland there are about 150,000 equestrians. Horse related injuries, including head and spinal injuries, are frequently treated at our level I trauma centre. Objectives To analyse injury patterns, protective factors, and risk factors related to horse riding, and to define groups of safer riders and those at greater risk Methods We present a retrospective and a case-control survey at conducted a tertiary trauma centre in Bern, Switzerland. Injured equestrians from July 2000 - June 2006 were retrospectively classified by injury pattern and neurological symptoms. Injured equestrians from July-December 2008 were prospectively collected using a questionnaire with 17 variables. The same questionnaire was applied in non-injured controls. Multiple logistic regression was performed, and combined risk factors were calculated using inference trees. Results Retrospective survey A total of 528 injuries occured in 365 patients. The injury pattern revealed as follows: extremities (32%: upper 17%, lower 15%), head (24%), spine (14%), thorax (9%), face (9%), pelvis (7%) and abdomen (2%). Two injuries were fatal. One case resulted in quadriplegia, one in paraplegia. Case-control survey 61 patients and 102 controls (patients: 72% female, 28% male; controls: 63% female, 37% male) were included. Falls were most frequent (65%), followed by horse kicks (19%) and horse bites (2%). Variables statistically significant for the controls were: Older age (p = 0.015), male gender (p = 0.04) and holding a diploma in horse riding (p = 0.004). Inference trees revealed typical groups less and more likely to suffer injury. Conclusions Experience with riding and having passed a diploma in horse riding seem to be protective factors. Educational levels and injury risk should be graded within an educational level-injury risk index.

Factors that affect health outcomes in adults with type 2 diabetes : a cross-sectional study

Background: Factors that individually influence blood sugar control, health-related quality of life, and diabetes self-care behaviors have been widely investigated; however, most previous diabetes studies have not tested an integrated association between a series of factors and multiple health outcomes. ---------- Objectives: The purposes of this study are to identify risk factors and protective factors and to examine the impact of risk factors and protective factors on adaptive outcomes in people with type 2 diabetes.---------- Design: A descriptive correlational design was used to examine a theoretical model of risk factors, protective factors, and adaptive outcomes.---------- Settings: This study was conducted at the endocrine outpatient departments of three hospitals in Taiwan. Participants A convenience sample of 334 adults with type 2 diabetes aged 40 and over.---------- Methods: Data were collected by a self-reported questionnaire and physiological examination. Using the structural equation modeling technique, measurement and structural regression models were tested.---------- Results: Age and life events reflected the construct of risk factors. The construct of protective factors was explained by diabetes symptoms, coping strategy, and social support. The construct of adaptive outcomes comprised HbA1c, health-related quality of life, and self-care behaviors. Protective factors had a significant direct effect on adaptive outcomes (β = 0.68, p < 0.001); however, risk factors did not predict adaptive outcomes (β = − 0.48, p = 0.118).---------- Conclusions: Identifying and managing risk factors and protective factors are an integral part of diabetes care. This theoretical model provides a better understanding of how risk factors and protective factors work together to influence multiple adaptive outcomes in people living with type 2 diabetes.

Factors influencing vulnerability and positive post-disaster response following the Mackay 2008 and Brisbane 2011 floods

This project investigated which aspects of being flooded most affected mental health outcomes. It found that stress in the aftermath of the flood, during the clean-up and rebuilding phase, including stress due to difficulties with insurance companies, was a previously overlooked risk factor, and social support and sense of belonging were the strongest protective factors. Implications for community recovery following disasters include providing effective targeting of support services throughout the lengthy rebuilding phase; the need to co-ordinate tradespeople; and training for insurance company staff aimed at minimising the incidence of insurance company staff inadvertently adding to disaster victims' stress.

Factors associated with health risk behavior among school children in urban Vietnam

Background Health risk behavior among young people is a public health problem in Vietnam. In addition, road traffic injuries are the leading cause of death for those aged 15–29 years. The consequences can be devastating for adolescents and their families, and can create a significant economic burden on society. Objective: The aim of this study was to identify protective and risk factors that may influence three health risk behaviors among school children: suicidal thinking (ST), drinking alcohol (DA), and underage motorbike driving (MD). Methods A cross-sectional survey of 972 adolescents (aged 12–15 years) was conducted in two secondary schools in Hanoi, Vietnam. The schools were purposely selected, one each from the inner city and a suburban area, from which classes (grade 6 to 8) were randomly selected. All students attending classes on survey days took part in the survey. The anonymous, self-completed questionnaire included measures of risk behavior, school connectedness, parental bonding, and other factors. Multivariable regression models were used to examine associations between the independent variables and the three health risk behaviors controlling for confounding factors. Results Young people in the inner city school reported a higher prevalence of all three risk behaviors than those in the suburban area (ST: 16.1% [95% confidence interval, or CI, 12.9–19.3] versus 4.6% [95% CI 2.7–6.5], p<0.001; DA: 20.3% [95% CI 16.8–23.8] versus 8.3% [95% CI 5.8–10.8], p<0.001, and MD: 10.1% [95% CI 7.4–12.8] versus 5.7% [95% CI 3.6–7.8], p<0.01). School connectedness and mother and father care appeared to be significant protective factors. For males, bullying in school was associated with suicidal thoughts, whereas for both males and females, school connectedness may be protective against suicidal ideation. Conclusion This study supports findings from other nations regarding suicidal thoughts and alcohol use, and appears to be one of the first to examine risk and protective factors forMD. Health promotion within schools should be introduced to improve students’ feelings of connectedness in combination with communication and education campaigns focusing on parental care and engaging teachers for the promotion of safer, supportive school environments.

Primary Fallopian tube carcinoma:occurrence, risk and prognostic factors

The aim of the study was to clarify the occurrence, and etiological and prognostic factors of primary fallopian tube carcinoma (PFTC). We studied the sociodemographic determinants of the incidence of PFTC in Finland and the role of chlamydial infections and human papillomavirus infections as risk factors for PFTC. Serum tumor markers were studied as prognostic factors for PFTC. We also evaluated selected reproductive factors (parity, sterilization and hysterectomy) as risk or protective factors of PFTC. The risks of second primary cancers after PFTC were also studied. The age-adjusted incidence of PFTC in Finland increased to 5.4 / 1,000,000 in 1993 97. The incidence rate was higher in the cities, but the relative rise was higher in rural areas. Women in the two highest social classes showed a 1.8 fold incidence compared with those in the lowest. Women in agriculture and those not working outside the home showed only half the PFTC incidence of those in higher socioeconomic occupations. Pretreatment serum concentrations of hCGβ, CA125 and TATI were evaluated as prognostic markers for PFTC. Elevated hCGβ values (above the 75th percentile, 3.5 pmol/L; OR 2.49, 95% CI 1.22 5.09), stage and histology were strong independent prognostic factors for PFTC. The effects of parity, sterilization and hysterectomy on the risk of PFTC were studied in a case control-study with 573 PFTC cases from the Finnish Cancer Registry. In multivariate analysis parity was the only significant protective factor as regards PFTC, with increasing protection associated with increasing number of deliveries. In univariate analysis sterilization gave borderline protection against PFTC and the protective effect increased with time since the operation. In multivariate analysis the protection did not reach statistical significance. Chlamydial and human papillomavirus (HPV) infections were studied in two separate seroepidemiological case-control studies with 78 PFTC patients. The incidence of women with positive HPV or chlamydial serology was the same in PFTC patients and in the control group and was not found to be a risk factor for PFTC. Finally, the possible risk of a second primary cancer after diagnosis and treatment of PFTC in a cohort of 2084 cases from 13 cancer registries followed for second primary cancers within the period 1943 2000 was studied. In PFTC patients, second primary cancers were 36% more common than expected (SIR 1.36, 95% CI 1.13 1.63). In conclusion, the incidence of PFTC has increased in Finland, especially in higher social classes and among those in certain occupations. Elevated serum hCGβ reflect a worsened prognosis. Parity is a clear protective factor, as is previous sterilization. After PFTC there is a risk of second primary cancers, especially colorectal, breast, lung and bladder cancers and non-lymphoid leukemia. The excess of colorectal and breast cancers after PFTC may indicate common effects of earlier treatments, or they could reflect common effects of lifestyle or genetic, immunological or environmental background.

Vitamin D deficiency in children with chronic illnesses: Predisposing and protecting factors

This thesis assesses clinical differences in patients with low and high vitamin D levels. The factors analyzed included the underlying disease, body size, age, ethnic background, use of vitamin D supplements and the season when the blood sample was taken. Fifty patients with the lowest and 50 patients with the highest vitamin D concentrations were selected from a cohort of 1351 chronically ill children and adolescents who had had their vitamin D status assessed at Children's Hospital. Protective factors appeared to be the usage of vitamin D supplements and young age, especially age <2 years. Predisposing factors included non-Finnish ethnic background and older age, especially age 12-18 years. High vitamin D values were more prevalent in the summer and autumn and low values in the winter and spring. Patients with non-Finnish background were overrepresented in the low value group. No differences regarding the underlying diseases could be detected. Conclusions: In the Northern latitudes UVB-radiation is insufficient for vitamin D synthesis. Vitamin D recommendations appear to be inadequate to fulfill the needs of chronically ill patients whose requirements for vitamin D are elevated compared to the general population. New guidelines for vitamin D supplementation are needed particularly for those at risk of developing vitamin D deficiency.

Victimisation of street children in Addis Ababa: factors of resilience and susceptibility

Cross-cultural variations in conceptions of childhood are discussed, particularly with regard to child abuse and child labour. Regardless of cultural background, a universal minimum standard of child rearing is required. The street child literature is reviewed, culminating in an analysis of Ethiopian street children. Theoretically this work is informed by victimology. Concepts shared by victimology and rational choice perspective are discussed, after Fattah (1993a). Victim surveys are described, highlighting their accuracy of crime estimates. Juvenile prostitution, runaways and rape are examined, particularly with regard to their relevance in Addis Ababa. Fifty five male and 135 female street children were interviewed. Interviews with boys focused on delinquency. An age-related pattern emerged, with younger boys less likely to drink, chew khat, steal or be sexually active. Interviews with street girls focused on the differences between girls living on the streets (girls of the street), girls working on the streets (girls on the street) and a sample of homebased girls. Girls of the street come to the street come to the streets for many reasons. Conflicts with a parent or guardian account for almost 50%. They are highly vulnerable to sexual assaults, particularly those 43% who have worked as prostitutes. Girls on the street experience considerably less victimisation. Urban poor girls live in socio-economic circumstances akin to girls on the street but enjoy almost universal protection from victimisation because they do not spend time on the streets. Unprotected by the stability which a family provides, girls of the street experience high victimisation levels. Such victimisation is often the result of reliance on types of work, such as prostitution, which brings the girls into contact with exploitative adults. Resistance to such victimisation is provided by a secure place to sleep, companions, and relatively safe types of work. Such protective factors are more readily available to family based children as compared to those living independently.

La investigació sobre l'èxit i el fracàs escolar des la la perspectiva dels factors de risc. Implicacions per a la recerca i la pràctica educatives

La situació problemàtica de la qual partim en aquesta tesi és la constatació de l'existència d'unes dinàmiques escolars negatives -expressades amb males notes reiterades- difícils de modificar, que determinats infants inicien i desenvolupen al llarg de la seva escolarització i que els condueix a una situació de fracàs escolar. Les males notes són el senyal que alerta pares i educadors de la presència de problemes escolars en els alumnes i constitueixen la causa explícita que motiva la cerca de solucions. Sovint es busquen solucions fora de l'escola, la qual cosa suggereix que, malgrat els esforços realitzats, l'escola i el sistema educatiu han tingut dificultats per a ajudar els infants a millorar globalment els seus resultats escolars. D'una banda, l'escola troba dificultats per a identificar el mes aviat possible quins infants seran mes susceptibles de desenvolupar unes dinàmiques escolars negatives que els puguin conduir a una situació de fracàs escolar. D'altra banda, també hi ha dificultats per trobar i aplicar estratègies preventives d'intervenció educativa a l'aula, que resultin adequades per a prevenir el desenvolupament de dinàmiques escolars negatives en alguns infants. Partint de la situació problemàtica descrita, la finalitat de la tesi es obtenir informació teòrica , empírica sobre algunes variables que puguin resultar rellevants per a articular, des de l'aula escolar, intervencions educatives destinades a prevenir el desenvolupament de les dinàmiques escolars negatives. Des de la perspectiva de la prevenció, la rellevància de les variables hauria d'establir-se en funció de la seva utilitat per a: A) Identificar des de l'aula escolar situacions de més perill -de més risc- de desenvolupar aquestes dinàmiques negatives i, consegüentment, arribar a la situació de fracàs escolar . Això implica, per tant, que les variables han de permetre la identificació abans que la situació de fracàs escolar es produeixi . B) Intervenir educativament des de l'escola; per tant, cal que siguin variables sobre les quals l'escola pugui incidir. La modificabilitat de les variables ha de permetre que es puguin emprendre accions educatives, des de la mateixa aula escolar. Variables que resultin suficientment importants de cara a disminuir el perill o evitar el desenvolupament de dinàmiques negatives. Es a dir, que la seva modificació contribueixi a evitar que els infants arribin a la situació de fracàs escolar. Per assolir aquesta finalitat es realitzen un segut de passes en funció de les quals s'ha estructurat la tesi en dues parts: Un marc teòric i un estudi de casos. EI Marc teòric té dos objectius: 1. Definir la situació problemàtica. En el capítol primer del marc teòric de la tesi, s'exposen les dimensions d'aquesta situació problemàtica. La revisió bibliogràfica entorn del tema del fracàs escolar ens ajuda a emmarcar la qüestió de les dinàmiques escolars en el fenomen complex del fracàs i l'èxit escolar, i del rendiment. Aquestes aportacions teòriques juntament amb les aportacions de la recerca educativa en relació a l'estabilitat del rendiment al llarg dels cursos són la base per a definir la situació problemàtica. 2. Delimitar, des d'un punt de vista teòric, algunes variables rellevants per a la prevenció del desenvolupament de dinàmiques escolars negatives, conduents a la situació de fracàs escolar. La primera passa per a dur a terme aquesta delimitació teòrica, que es presenta al segon capítol, ha estat revisar les aportacions de les investigacions sobre variables que incideixen en el rendiment escolar, les quals s'han analitzat en funció de la seva rellevància per a la prevenció. Aquesta revisió ha permès constatar un seguit de problemes de caire terminològic, metodològic i sobre la repercussió d'aquesta recerca en la practica educativa que afecten directament la utilitat de les aportacions d'aquestes investigacions de cara a identificar variables rellevants per a la prevenció. De l'anàlisi dels resultats d'aquestes recerques es desprèn que: a) Hi ha moltes variables associades al rendiment escolar, algunes difícilment modificables mitjançant la intervenció educativa escolar. b) EI fet que una variable estigui associada al rendiment no implica que sigui rellevant per a la prevenció c) S'obté poca informació sobre variables que contribueixin a disminuir la probabilitat de fracàs escolar. En base a aquests resultats es constata que cal buscar una perspectiva d'anàlisi de les variables mes adequades a l'enfocament preventiu, perspectiva que ha d'orientar-se a l'estudi del risc de fracàs escolar. La segona passa que es duu a terme per arribar a una delimitació teòrica de les variables rellevants es l'estudi del concepte de risc i d'altres conceptes relacionats: signe de risc, marcador de risc, factor de risc, factor protector, població en risc, infant en situació de risc, així com la revisió d'estudis i recerques que s'han plantejat en aquesta línia. Aquest treball ha permès: a) Clarificar aquests conceptes i aplicar-los en l'àmbit educatiu, en referència al problema del fracàs escolar, estructurant un marc teòric en funció del qual plantejar una anàlisi de les variables associades al rendiment escolar. b) Concretar un model per a l'anàlisi, des de l'aula escolar, de les variables que incideixen en el risc de fracàs escolar. Aquest model, que es situa en la perspectiva de l'aula escolar i que pren en consideració el paper actiu que els estudiants tenen respecte al seu aprenentatge, consta de tres components: unes variables, les seves relacions i la funció que exerceixen en relació al risc de fracàs escolar. La conclusió a la qual s'arriba es que, des d'un punt de vista teòric, una variable serà rellevant per a articular intervencions educatives preventives des de l'escola si constitueix o bé un factor de risc, o be un factor protector o compensador del risc. La delimitació empírica de variables rellevants per a la prevenció del fracàs escolar -que constitueix l'objectiu de la segona part de la tesi- es duu a terme mitjançant un estudi de casos que es deriva del plantejament teòric elaborat. L'objectiu d'aquest estudi es identificar variables que han pogut constituir factors protectors en joves que es troben en situació de risc per circumstàncies sociofamiliars. Se seleccionen tres noies i dos nois que, malgrat trobar-se en situació de risc, han assolit un cert nivell d'èxit escolar. Basant-nos en el model s'ha recollit informació sobre característiques actitudinals dels estudiants, del seu procés d'autoaprenentatge i de l'ambient d'aprenentatge. S'utilitza un disseny qualitatiu d'estudi de casos, utilitzant entrevistes amb profunditat per a recollir informació, la qual s'analitza mitjançant tècniques d'anàlisi de continguts. L'estudi de cada un dels cinc casos i la seva posterior comparació ha permès identificar algunes variables que poden haver constituït factors protectors del risc de fracàs escolar. Entre elles podem citar 1. La consciència de la pròpia situació complexa i desfavorable que han viscut o estan vivint. 2. Tenir un projecte vital a mig o llarg termini, en el qual els estudis són concebuts com a una via per assolir-lo. 3. Ser autoresponsables dels aprenentatges. 4. Haver identificat models a seguir en altres persones. Del treball realitzat tant des d'una perspectiva teòrica com empírica i les conclusions a les quals s'ha arribat se'n desprenen implicacions per a la practica educativa, per a la recerca i per a la formació professional dels educadors i educadores socials. Pel que fa a les implicacions per a la practica educativa, es proposa el model com a base per a la identificació de situacions de risc i per al disseny d'intervencions educatives amb l'objectiu de prevenir el fracàs escolar. En aquest sentit, i en funció dels resultats obtinguts a l'estudi de casos, es proposen unes línies d'intervenció preventiva en casos de risc similars als que han estat objecte d'estudi, línies que poden prendre en consideració tant els/les mestres com els educadors/es. Pel que fa a les implicacions per a la investigació educativa, es deriven quatre línies de recerca: investigació sobre factors de risc, investigació sobre factors protectors, investigació sobre el potencial preventiu d'intervencions educatives dissenyades en base a factors de risc i factors protectors, l'investigació sobre com potenciar des de diferents àmbits (escola i vida quotidiana) els fadors protectors. Quant a les implicacions per a la formació professional dels educadors/es socials, els resultats de l'estudi de casos com a possibles aspectes a treballar per part dels educadors/es impliquen un treball en el qual aquests professionals han d'haver rebut formació sobre: 1. La relació educativa com a recurs per a la intervenció educativa professional. 2. La necessitat d'un treball coordinat interdisciplinari com a estratègia de treball professional. 3. EI coneixement de programes coherents i estratègies d'intervenció sobre factors protectors. 4. L'elaboració de programes educatius, de manera que els educadors/es puguin adaptar les intervencions a les necessitats educatives dels subjectes. 5. La intervenció educativa en famílies.

Assessment of risk factors for low bone mineral density in Brazilian postmenopausal women

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Dietary factors associated with metabolic syndrome in Brazilian adults

Background: Metabolic Syndrome (MS) is defined as the association of numerous factors that increase cardiovascular risk and diet is one of the main factors related to increase the MS in the population. This study aimed to evaluate the association of diet on the presence of MS in an adult population sample.Methodology: 305 adults were clinically screened to participate in a lifestyle modification program. Anthropometric assessments included waist circumference (WC), body fat and calculated BMI (kg/m(2)) and muscle-mass index (MMI kg/m(2)). Dietary intake was estimated by 24 h dietary recall. Fasting blood was used for biochemical analysis. MS was diagnosed using NCEP-ATPIII (2001) criteria with adaptation for glucose (>= 100 mg/dL). Logistic regression (Odds ratio) was performed in order to determine the odds ratio for developing MS according to dietary intake.Results: An adequate intake of fruits, OR = 0.52 (CI:0.28-0.98), and an intake of more than 8 different items in the diet (variety), OR = 0.31 (CI: 0.12-0.79) showed to be a protective factor against a diagnosis of MS. Saturated fat intake greater than 10% of total caloric value represented a risk for MS diagnosis, OR = 2.0 (1.04-3.84).Conclusion: Regarding the dietary aspect, a risk factor for MS was higher intake of saturated fat, and protective factors were high diet variety and adequate fruit intake.

Extended Daily Dialysis in Acute Kidney Injury Patients: Metabolic and Fluid Control and Risk Factors for Death

Intermittent hemodialysis (IHD) and continuous renal replacement therapies (CRRT) are used as Acute Kidney Injury (AKI) therapy and have certain advantages and disadvantages. Extended daily dialysis (EDD) has emerged as an alternative to CRRT in the management of hemodynamically unstable AKI patients, mainly in developed countries.Objectives: We hypothesized that EDD is a safe option for AKI treatment and aimed to describe metabolic and fluid control of AKI patients undergoing EDD and identify complications and risk factors associated with death.Study Selection: This is an observational and retrospective study describing introduction of EDD at our institution. A total of 231 hemodynamically unstable AKI patients (noradrenalin dose between 0.3 and 1.0 ucg/kg/min) were assigned to 1367 EDD session. EDD consisted of 6-8 h of HD 6 days a week, with blood flow of 200 ml/min, dialysate flows of 300 ml/min.Data Synthesis: Mean age was 60.6 +/- 15.8 years, 97.4% of patients were in the intensive care unit, and sepsis was the main etiology of AKI (76.2). BUN and creatinine levels stabilized after four sessions at around 38 and 2.4 mg/dl, respectively. Fluid balance decreased progressively and stabilized around zero after five sessions. Weekly delivered Kt/V was 5.94 +/- 0.7. Hypotension and filter clotting occurred in 47.5 and 12.4% of treatment session, respectively. Regarding AKI outcome, 22.5% of patients presented renal function recovery, 5.6% of patients remained on dialysis after 30 days, and 71.9% of patients died. Age and focus abdominal sepsis were identified as risk factors for death. Urine output and negative fluid balance were identified as protective factors.Conclusions: EDD is effective for AKI patients, allowing adequate metabolic and fluid control. Age, focus abdominal sepsis, and lower urine output as well as positive fluid balance after two EDD sessions were associated significantly with death.

Study protocol: Transition from localized low back pain to chronic widespread pain in general practice: identification of risk factors, preventive factors and key elements for treatment--a cohort study

Background Chronic localized pain syndromes, especially chronic low back pain (CLBP), are common reasons for consultation in general practice. In some cases chronic localized pain syndromes can appear in combination with chronic widespread pain (CWP). Numerous studies have shown a strong association between CWP and several physical and psychological factors. These studies are population-based cross-sectional and do not allow for assessing chronology. There are very few prospective studies that explore the predictors for the onset of CWP, where the main focus is identifying risk factors for the CWP incidence. Until now there have been no studies focusing on preventive factors keeping patients from developing CWP. Our aim is to perform a cross sectional study on the epidemiology of CLBP and CWP in general practice and to look for distinctive features regarding resources like resilience, self-efficacy and coping strategies. A subsequent cohort study is designed to identify the risk and protective factors of pain generalization (development of CWP) in primary care for CLBP patients. Methods/Design Fifty-nine general practitioners recruit consecutively, during a 5 month period, all patients who are consulting their family doctor because of chronic low back pain (where the pain is lasted for 3 months). Patients are asked to fill out a questionnaire on pain anamnesis, pain-perception, co-morbidities, therapy course, medication, socio demographic data and psychosomatic symptoms. We assess resilience, coping resources, stress management and self-efficacy as potential protective factors for pain generalization. Furthermore, we raise risk factors for pain generalization like anxiety, depression, trauma and critical life events. During a twelve months follow up period a cohort of CLBP patients without CWP will be screened on a regular basis (3 monthly) for pain generalization (outcome: incident CWP). Discussion This cohort study will be the largest study which prospectively analyzes predictors for transition from CLBP to CWP in primary care setting. In contrast to the typically researched risk factors, which increase the probability of pain generalization, this study also focus intensively on protective factors, which decrease the probability of pain generalization.

Who is likely to develop persistent low back pain? A longitudinal analysis of prognostic occupational factors

OBJECTIVE: Occupational low back pain (LBP) is considered to be the most expensive form of work disability, with the socioeconomic costs of persistent LBP exceeding the costs of acute and subacute LBP by far. This makes the early identification of patients at risk of developing persistent LBP essential, especially in working populations. The aim of the study was to evaluate both risk factors (for the development of persistent LBP) and protective factors (preventing the development of persistent LBP) in the same cohort. PARTICIPANTS: An inception cohort of 315 patients with acute to subacute or with recurrent LBP was recruited from 14 health practitioners (twelve general practitioners and two physiotherapists) across New Zealand. METHODS: Patients with persistent LBP at six-month follow-up were compared to patients with non-persistent LBP looking at occupational, psychological, biomedical and demographic/lifestyle predictors at baseline using multiple logistic regression analyses. All significant variables from the different domains were combined into a one predictor model. RESULTS: A final two-predictor model with an overall predictive value of 78% included social support at work (OR 0.67; 95%CI 0.45 to 0.99) and somatization (OR 1.08; 95%CI 1.01 to 1.15). CONCLUSIONS: Social support at work should be considered as a resource preventing the development of persistent LBP whereas somatization should be considered as a risk factor for the development of persistent LBP. Further studies are needed to determine if addressing these factors in workplace interventions for patients suffering from acute, subacute or recurrent LBP prevents subsequent development of persistent LBP.