Self-Management of Chronic Pain: Interventions, Strategies, Barriers, and Facilitators

Background & Purpose: Chronic pain is a prevalent chronic condition for which the best management options rarely provide complete relief. Individuals with chronic pain with neuropathic characteristics (NC) report more severe pain and experience less relief from interventions. Little is known about current self-management practices. The purpose of this dissertation was to inform self-management of chronic pain with and without NC at the individual, health system, and policy levels using the Innovative Care for Chronic Conditions Framework. Methods: The study included a systematic search and review and cross-sectional survey. The review evaluated the evidence for chronic pain self-management interventions and explored the role of health care providers in supporting self-management. The survey was mailed to 8,000 randomly selected Canadians in November 2011, and non-respondents were followed-up in May 2012. Screening questions were included for both chronic pain and NC. The questionnaire captured pain descriptions, self-management strategies, and self-management barriers, and facilitators. Results: Findings of the review suggested that self-management interventions are effective in improving pain and health outcomes. Health care professionals provided self-management advice and referred individuals to self-management interventions. The questionnaire was completed by 1,520 Canadians. Those with chronic pain (n=710) identified primary care physicians as the most helpful pain management professional. Overall, use of non-pharmaceutical medical self-management strategies was low. While use positive emotional self-management strategies was high, individuals with NC were more likely to use negative emotional self-management strategies compared to those without NC. Multiple self-management barriers and facilitators were identified, however those with NC were more likely than those without NC to experience low self-efficacy, depression and severe pain which may impair the ability to self-management. Conclusions: Health care professionals have the opportunity to improve chronic pain outcomes by providing self-management advice, referring to self-management interventions, and addressing self-management barriers and facilitators. Individuals with NC may require additional health services to address their greater self-management challenges, and further research is needed to identify non-pharmaceutical interventions effective in relieving chronic pain with NC. Public policy is needed to facilitate health systems in providing long-term self-management support for individuals with chronic pain.

The “re-socialization” of Gypsy women in the literacy courses aimed to the recipients of the Social Integration Revenue Policy of the Region of Madrid

This article studies the gender values that are promoted both in the literacy courses for gypsy women beneficiaries of the Social Integration Revenue Policy of the Region of Madrid and in the events that are organized for this group by public institutions and NGOs. The process of “socialization” that occurs in the educative groups for Gypsy women is focused on constructing an image of what it is to be a “Gypsy modern woman”. Through multiple mechanisms and discursive techniques a specific conception of gender equality is transmitted in these educative spaces. In addition to this, Gypsy women are continually urged to assume certain values and social practices (of gender identity, of "citizenship", of parenting, etc..), while an archetype of "Gypsy Woman" which condenses powerful stereotypes and prejudices about the "Gypsy culture" and the gender relations characteristics of this group is constructed.

Pension structural reforms, re-reforms and their effects on social welfare: The case of Chile

This article fi rst summarizes the structural reforms of pensions (total or partial privatization) in Latin America and Central and Eastern Europe, identifying their advantages and disadvantages, and does the same with the international process of re-reforms of pensions with a greater role of the state. Second, chooses Chile as a case study, as a world pioneer in both types of reforms; describes their characteristics and effects on social welfare of the structural reform of 1981 and the re-reform of 2008. Such effects are evaluated based on ten basic principles of social security from the International Labour Offi ce (ILO): 1) social dialogue to approve the reforms, 2) universal coverage of the population, 3) equal treatment of insured persons, 4) social solidarity, 5) gender equity, 6) suffi ciency of benefi ts, 7) effi ciency and reasonable administrative cost, 8) social participation in the management of the system, 9) role of the state and supervision, and 10) fi nancial sustainability. Third, it summarizes the advantages and disadvantages-challenges of the re-reform and informs on the current debate for further reforms.

Self-cooling of a micro-mirror by radiation pressure

Cooling of mechanical resonators is currently a popular topic in many fields of physics including ultra-high precision measurements, detection of gravitational waves and the study of the transition between classical and quantum behaviour of a mechanical system. Here we report the observation of self-cooling of a micromirror by radiation pressure inside a high-finesse optical cavity. In essence, changes in intensity in a detuned cavity, as caused by the thermal vibration of the mirror, provide the mechanism for entropy flow from the mirror's oscillatory motion to the low-entropy cavity field. The crucial coupling between radiation and mechanical motion was made possible by producing free-standing micromirrors of low mass (m approximately 400 ng), high reflectance (more than 99.6%) and high mechanical quality (Q approximately 10,000). We observe cooling of the mechanical oscillator by a factor of more than 30; that is, from room temperature to below 10 K. In addition to purely photothermal effects we identify radiation pressure as a relevant mechanism responsible for the cooling. In contrast with earlier experiments, our technique does not need any active feedback. We expect that improvements of our method will permit cooling ratios beyond 1,000 and will thus possibly enable cooling all the way down to the quantum mechanical ground state of the micromirror.

Social identification and prevalence of PTSD in Northern Ireland

Background Understanding of the psychological impact of politically motivated violence is poor. Aims To examine the prevalence of post-traumatic symptoms subsequentto the ‘troubles’ in Northern Ireland. Method A telephone survey of 3000 adults, representative of the population in Northern Ireland and the border counties of the Irish Republic, examined exposure to political violence, post-traumatic stress disorder (PTSD) and national identity. Results Ten per cent of respondents had symptoms suggestive of clinical PTSD. These people were most likely to come from low-income groups, rate national identity as relatively unimportant and have higher overall experience of the ‘troubles’than other respondents. Conclusions Direct experience of violence and poverty increase the risk of PTSD, whereas strong national identification appears to reduce this risk.

Notes on the History of Social Work: An Examination of the Transition from Philanthropy to Professional Social Work in Ireland

The objective of the article is to examine the way in which social work in Ireland evolved from practices of philanthropy in the late 19th century to a distinct professional strategy in the present. Results: The results of archival research show that philanthropy in Ireland was provided almost exclusively by religious organizations and was constructed within a discourse of sectarianism and rivalry between the two main denominations, Catholic and Protestant, up to the 1960s. It is only in the past 30 years that social work has become firmly established as a secular strategy. Conclusions: It is concluded that although social work is now clearly distinct from voluntary and religious-based social work practices, some of its present principles and practices remain continuous with its historical antecedents.

Self-perception of dentofacial attractiveness among patients requiring orthognathic surgery

Objective: To test the hypothesis that the self-perception of dental and facial attractiveness among patients requiring orthognathic surgery is no different from that of control patients.

Materials and Methods: Happiness with dental and facial appearance was assessed using questionnaires completed by 162 patients who required orthognathic treatment and 157 control subjects. Visual analog scale, binary, and open response data were collected. Analysis was carried out using a general linear model, logistic regression, and chi-square tests.

Results: Orthognathic patients were less happy with their dental appearance than were controls. Class II patients and women had lower happiness scores for their dental appearance. Among orthognathic patients, the "shape" and "prominence" of their teeth were the most frequent causes of concern. Older subjects, women, and orthognathic patients were less happy with their facial appearance. Class III orthognathic patients, older subjects, and women were more likely to have looked at their own face in profile. A greater proportion of Class II subjects than Class III subjects wished to change their appearance.

Conclusions: The hypothesis is rejected. The findings indicate that women and patients requiring orthognathic surgery had lower levels of happiness with their dentofacial appearance. Although Class II patients exhibited the lowest levels of happiness with their dental appearance, there was some evidence that concerns and awareness about their facial profile were more pronounced among the Class III patients.