Abstract Background The prevalence of back pain and neck/shoulder pain among nurses is high. This study reports a detailed description of health related characteristics of experienced nurses with and without severe back pain or severe neck/shoulder pain in Sweden. Methods Cross-sectional data was collected in a national investigation of nursing graduates from 26 Swedish universities to identify three groups of nurses 11–15 years after graduation: nurses with severe back pain (n = 212), nurses with severe neck/shoulder pain (n = 277), and nurses with no or little such pain (n = 1525). Severe pain was defined as much discomfort from pain the preceding four weeks. Descriptive statistics were used to summarise general health and pain characteristics, use of health resources and impact of pain on work. Results Nurses with severe back or neck/shoulder pain described worse general state of health and lifestyle, such as personal or mental health problems, fatigue, dizziness and pain in other body regions, less physical activity and lower sleep quality, than those with no or little pain. They used more health resources as over-the-counter and prescription painkillers and care seeking for physical ailments. The course of the severe pain was often persistent, and those nurses commonly reduced their working hours, changed work tasks, and had days off work. Conclusions This study describes variations of nurses’ health related characteristics by pain levels. Experienced nurses with severe back or neck/shoulder pain describe worse states of general health and lifestyle, and more use of health resources than experienced nurses with no or little such pain. The course of the severe pain is often persistent and affects work capacity. Clinical trial number Not applicable.

Neck and back pain are common musculoskeletal conditions in university students and associated with unhealthy lifestyle behaviors such as physical inactivity, unhealthy dietary habits, smoking and risky alcohol use. Cohort studies have investigated the effect of a healthy lifestyle including several lifestyle behaviors on the risk and prognosis for neck and back pain. Studies of an association between an unhealthy lifestyle and musculoskeletal conditions in university students are lacking. This study aimed to assess the association between an unhealthy lifestyle and incident activity-limiting neck/back problems (ALNBP) in university students. Participants enrolled in the Sustainable UNiversity Life (SUN) study who did not report baseline ALNBP in the past three months were included (n = 3492). The baseline web-survey assessed unhealthy lifestyle behaviors (physical inactivity, high sitting time, meal skipping and risky use of alcohol, tobacco, and illicit drugs) with valid instruments and single-item questions. Participants with ≥ 3 unhealthy lifestyle behaviors were categorized as exposed to an unhealthy lifestyle. Responses to web-based follow-up surveys every third month until first reporting ALNBP or to the end of the one-year follow-up were used. The outcome ALNBP was defined as reporting limitations in daily activities due to a neck, low back and/or midback problem the past three months, assessed with a modified version of the Nordic Musculoskeletal Questionnaire. Crude and adjusted Cox regression models were built to assess the association between an unhealthy lifestyle and incident ALNBP, reported as a hazard rate ratio (HRR) with a 95

PURPOSE:To determine the gender-specific impact of recent exposure to different forms of sexual harassment and sexual violence (SHV) on depression and anxiety symptoms three, six, and nine months later. METHODS:We recruited 2229 women and 1274 men studying at Swedish universities and followed them with web-surveys every three months over one year. We estimated mean differences (MDs) of depression and anxiety symptoms between exposed and unexposed at each follow-up, adjusting for prior SHV, prior depression and anxiety symptoms and potential confounders. RESULTS:For women, sexual harassment (wide subjective definition) was associated with higher symptom levels of depression (MD 1.0 [95% CI: 0.3; 1.7]) and anxiety (MD 0.8 [95% CI: 0.3; 1.4]) three months later. Unwanted sexual attention was associated with higher symptom levels of anxiety three (MD 0.5 [95% CI: 0.1; 0.8]) and six months later (MD 0.4 [95% CI: 0.0; 0.7]). Exposure to sex against ones will was associated with higher depression symptoms three (MD 1.7 [95% CI: 0.1;3.4]), and six months later (MD 3.1 [95% CI: 1.0; 5.2]). Trends indicated that associations with subsequent mental health differed between forms of SHV among women, and that most associations were more pronounced in temporal proximity to the exposures. For men, we refrain from interpreting the results since they showed high variability and were not robust to sensitivity analyses using multiple imputation to account for missing outcome data. CONCLUSIONS:Among women, several forms of SHV were associated with higher subsequent depression and anxiety symptoms.

Aims: Back pain and neck/shoulder pain are common among nurses. The aim of this study was to investigate the association between nurses' exposure to a demanding psychosocial work environment during the first three years after graduation and the occurrence of severe back pain and neck/shoulder pain in the longer term, 11-15 years later. Methods: The Longitudinal Analysis of Nursing Education (LANE) study (nursing graduates from 26 Swedish universities in the years 2002, 2004 and 2006) was used to create two risk cohorts of nurses not reporting severe back pain (n=1764) or neck/shoulder pain (n=1707). Nurses exposed to a demanding psychosocial work environment for one, two or three of the first three years in their career were compared to nurses not having a demanding psychosocial work environment for any of these three years regarding the incidence of severe back pain or neck/shoulder pain at follow-up, 11-15 years later. Relative risks (RR) with 95% confidence intervals (CI) were calculated using binomial regression. Results: The RR (95% CI) of having severe back pain for nurses who had a demanding psychosocial work environment for one of the three years was 1.36 (0.82-2.28) and 2.08 (1.21-3.57) for two of the three years and 2.82 (1.43-5.55) for all three years. Corresponding RRs (95% CIs) for severe neck/shoulder pain were 1.35 (0.87-2.10), 1.49 (0.88-2.51) and 1.41 (0.62-3.20), respectively. Conclusions: Nurses who were repeatedly exposed to a demanding psychosocial work environment early in their career reported severe back pain to a higher extent in the longer term.

BackgroundHealth care professions face increasing pressure to integrate research evidence into practice to improve patient outcomes. For many professions, the uptake of evidence-based practice (EBP) remains poorly understood, including for osteopaths in Canada. The primary aim of this study was to determine the perceptions, training, self perceived skills, use, barriers, and facilitators of EBP amongst Canadian osteopaths.MethodsCanadian Osteopaths were invited to participate in an online survey using the Evidence-Based Practice Attitude and Utilisation Survey.ResultsFour hundred and eight osteopaths’ (response rate 13.4%) provided informed consent of which three hundred and forty answered all questions. The majority of respondents had a favourable perception and believed EBP was important (70.8%). Most respondents (>65%) rated their skills in performing EBP at a medium-high level. EBP use was infrequent among respondents. Barriers to the utilisation of EBP were lack of clinical evidence, time, and relevance to osteopathic practice. Facilitators of EBP use included having greater access to research articles and tools, and further information regarding critical analysis of research. Although searching and consulting research information was rarely performed by respondents, they were perceived as the most important aspect of clinical decision making along with clinical practice guidelines, personal and patient preferences.ConclusionCanadian osteopathic manual practitioners were largely supportive of EBP but there was limited commitment to its integration within clinical practice. Improving knowledge and skills of EBP, addressing the barriers of EBP uptake, and integrating EBP into educational programs may improve the uptake of EBP within osteopathic practice.

Objectives The purpose of this study was to identify, critically assess, and summarize evidence of the effectiveness of primary care treatments for adults with non-specific chronic low back pain (NSCLBP). Methods We conducted an umbrella review of systematic reviews focusing on primary care treatments for NSCLBP. We searched the PubMed and Cochrane library databases for systematic reviews of randomized controlled trials (RCTs) evaluating primary care treatments for adults with NSCLBP published between January 2007 and March 2021. Two reviewers independently assessed the quality of these systematic reviews using the AMSTAR checklist. We selected systematic reviews with a low or moderate risk of bias and graded the evidence based on Grading of GRADE criteria. Results Among the initial 66 systematic reviews meeting our inclusion criteria, 19 systematic reviews with low or moderate bias risk were selected for analysis. These reviews included a total of 365 studies involving 62 832 participants. The evidence suggested moderate to high support for the effectiveness of certain primary care treatments in improving pain and function in NSCLBP patients. These treatments included NSAIDs and opioids compared to placebos, spinal manipulation versus exercise/physical therapy, and MBR versus exercise/education/advice/no treatment. Conclusions Recommendations for specific primary care treatments for NSCLBP in adults remain inconclusive. Further high-quality systematic reviews and RCTs are needed to better understand the effectiveness of these treatments. Future RCTs should prioritize the assessment of NSAIDs, opioids, spinal manipulation, and MBR, as they appear promising for improving NSCLBP outcomes in certain comparisons.

Background Evidence-based practice (EBP) is essential in improving the quality of healthcare and of importance for all health care personnel. No study in Norway has investigated attitudes, skills and use related to EBP among chiropractors. The aim of this study was to describe Norwegian chiropractors’ attitudes, skills, and use of EBP, as well as the barriers and facilitators to their use of EBP. Methods A national cross-sectional survey, the online version of the Evidence Based practice Attitudes & Utilisation SurvEy (EBASE), was sent by email to 770 Norwegian practicing chiropractors, all members of the Norwegian Chiropractic Association. Three EBASE sub-scores were generated (Attitudes, Skills and Use), and the demographic characteristics of the sample were reported. Linear regression analyses were conducted to examine the association between responses of the three sub-scores and demographic characteristics. Information on main barriers and facilitators of EBP was collected and described. Results A total of 312 (41%) chiropractors responded to the survey, and 95% agreed that EBP is necessary for chiropractic practice. While overall use of EBP activities was low participants were interested in learning and improving their skills to incorporate EBP into practice. Chiropractors’ attitudes, skills, and use of EBP were positively associated with being female and having spent more than one hour per week on research, but negatively associated with having practiced more than 10 years. Main barriers of EBP were lack of skills to critically evaluate, interpret, and apply research findings to practice. Main facilitators of EBP included access to the internet and free online databases in the workplace. Conclusion Although chiropractors in Norway reported positive attitudes and moderate skills in EBP, their use of EBP activities was limited. The main barriers and facilitators to EBP were primarily related to perceived skills deficits, whilst enablers of EBP were mostly related to infrastructure requirements.

Evidence-based practice (EBP) is fundamental to the delivery of high-quality, safe and effective health care. Naprapaths, manual therapy providers that specialize in the treatment of musculoskeletal pain and dysfunction, became a Swedish licensed health profession in 1994. This study investigated the attitudes, skills and implementation of EBP among licensed naprapaths in Sweden. Licensed naprapaths (n = 950) of Svenska Naprapatförbundet (the Swedish Naprapathy Association) were invited by email to take part in this cross-sectional anonymous online study using the Evidence-Based Practice Attitude and Utilisation Survey in February 2019. Fourteen percent (137/950) of invited naprapaths completed the survey. There was an approximately equal gender divide among responders; most were in the mid-career age range, practiced in city areas, and had a university or college certificate/diploma as their highest qualification. The majority of naprapaths agreed or strongly agreed that EBP was necessary in the practice of naprapathy, assisted them in making care decisions, and improved the quality of patient care. Naprapaths’ self-reported skills in EBP were mostly in the moderate to moderate-high range. The majority of participating naprapaths reported infrequent implementation of EBP. Perceived minor or moderate barriers to EBP uptake included a lack of colleague support for EBP and a lack of relevant resources. Access to the internet and free online databases were reported as very useful enablers to improving EBP uptake. The licensed naprapaths participating in this survey reported positive attitudes toward EBP, moderate levels of EBP skills, and infrequent implementation of EBP.

Previous research shows that sleep quality may interact with some other predictors of depression, such that poor sleep could strengthen the association between these factors and depression. We aimed to determine the presence of statistical interactions between sleep quality and loneliness, risky alcohol use, perfectionistic concerns and/or physical inactivity in relation to depressive symptoms. Further, we aimed to describe the functional form of the statistical interactions and associations. We used a cross-sectional design and included 4262 Swedish university students. All measures were self-reported, sleep quality was measured with the Pittsburgh Sleep Quality Index, and depressive symptoms with the short-form Depression, Anxiety and Stress Scale. Regression models of increasing complexity (linear and non-linear, with and without interactions) were compared to determine the presence of associations and statistical interactions, and to explore the best functional form for these associations and interactions. Out-of-sample R2 from repeated cross-validation was used to select the final models. We found that sleep quality was associated with depressive symptoms in all final models. Sleep quality showed a linear interaction with perfectionistic concerns in relation to depressive symptoms, such that perfectionistic concerns were more strongly associated with depressive symptoms when sleep quality was poor. Loneliness, risky alcohol use and physical inactivity were non-linearly associated with depressive symptoms but did not interact with sleep quality. We concluded that out of the four examined variables, only perfectionistic concerns interacted with sleep quality in relation to depressive symptoms. This interaction was weak and explained little of the overall variance in depressive symptoms.

Importance Procrastination is prevalent among university students and is hypothesized to lead to adverse health outcomes. Previous cross-sectional research suggests that procrastination is associated with mental and physical health outcomes, but longitudinal evidence is currently scarce. Objective To evaluate the association between procrastination and subsequent health outcomes among university students in Sweden. Design, Setting, and Participants This cohort study was based on the Sustainable University Life study, conducted between August 19, 2019, and December 15, 2021, in which university students recruited from 8 universities in the greater Stockholm area and Örebro were followed up at 5 time points over 1 year. The present study used data on 3525 students from 3 time points to assess whether procrastination was associated with worse health outcomes 9 months later. Exposure Self-reported procrastination, measured using 5 items from the Swedish version of the Pure Procrastination Scale rated on a Likert scale from 1 (“very rarely or does not represent me”) to 5 (“very often or always represents me”) and summed to give a total procrastination score ranging from 5 to 25. Main Outcomes and Measures Sixteen self-reported health outcomes were assessed at the 9-month follow-up. These included mental health problems (symptoms of depression, anxiety, and stress), disabling pain (neck and/or upper back, lower back, upper extremities, and lower extremities), unhealthy lifestyle behaviors (poor sleep quality, physical inactivity, tobacco use, cannabis use, alcohol use, and breakfast skipping), psychosocial health factors (loneliness and economic difficulties), and general health. Results The study included 3525 participants (2229 women [63%]; mean [SD] age, 24.8 [6.2] years), with a follow-up rate of 73% (n = 2587) 9 months later. The mean (SD) procrastination score at baseline was 12.9 (5.4). An increase of 1 SD in procrastination was associated with higher mean symptom levels of depression (β, 0.13; 95% CI, 0.09-0.17), anxiety (β, 0.08; 95% CI, 0.04-0.12), and stress (β, 0.11; 95% CI, 0.08-0.15), and having disabling pain in the upper extremities (risk ratio [RR], 1.27; 95% CI, 1.14-1.42), poor sleep quality (RR, 1.09, 95% CI, 1.05-1.14), physical inactivity (RR, 1.07; 95% CI, 1.04-1.11), loneliness (RR, 1.07; 95% CI, 1.02-1.12), and economic difficulties (RR, 1.15, 95% CI, 1.02-1.30) at the 9-month follow-up, after controlling for a large set of potential confounders. Conclusions and Relevance This cohort study of Swedish university students suggests that procrastination is associated with subsequent mental health problems, disabling pain, unhealthy lifestyle behaviors, and worse psychosocial health factors. Considering that procrastination is prevalent among university students, these findings may be of importance to enhance the understanding of students’ health.

INTRODUCTION:Mental health problems and musculoskeletal pain are common health problems among young adults including students. Little is known about the aetiology and prognosis of these problems in university students. We aim to determine the role of personal, sociodemographic, academic and environmental factors for risk and prognosis of symptoms of depression, anxiety and stress as well as musculoskeletal pain in university students. The constructs that will be studied are based on the biopsychosocial model and psychopathology associated with disabling pain. This model acknowledges illness to consist of interrelated mechanisms categorised into biological, psychological, environmental and social cues.METHODS AND ANALYSIS:This cohort study aims to recruit around 5000 Swedish full-time students. Data will be collected using five online surveys during one academic year. A subgroup (n=1851) of the cohort, recruited before the COVID-19 pandemic, receive weekly text messages with three short questions assessing mood, worry and pain, sent through the web-based platform SMS-track . Statistical analyses will include Kaplan-Meier estimates, Cox regression analyses, multinomial logistic regression analyses and generalised estimating equations. We will assess effect measure modification when relevant and conduct sensitivity analyses to assess the impact of lost to follow-up.PROTOCOL AMENDMENTS:Due to opportunity and timing of the study, with relevance to the outbreak of the COVID-19 pandemic, this study further aims to address mental health problems, musculoskeletal pain and lifestyle in university students before and during the pandemic.ETHICS AND DISSEMINATION:The Sustainable UNiversity Life study was approved by the Swedish ethics authority (2019-03276; 2020-01449). Results will be disseminated through peer-reviewed research papers, reports, research conferences, student theses and stakeholder communications.TRIAL REGISTRATION NUMBER:NCT04465435.

ObjectiveTo examine the use and out-of-pocket expenses resulting from consultations, products and practices across conventional, self-care, and complementary medicine (CM) treatments for osteoarthritis (OA) among Australian women.Design, setting and participantsA cross-sectional survey of 800 women from the 45 and Up Study who had reported a clinical diagnosis of OA.Outcome measuresWomen’s use of conventional, CM and self-prescribed treatments for OA and the associated out-of-pocket cost.ResultsCompleted questionnaires were returned by 403 women (50.4%). Their average time since the first diagnosis of OA was 15.4 years, and self-rated severity of OA was 5.1 (out of 10) over the past 12 months. During the previous year, 67.0% of the women consulted a doctor, 39.2% consulted an allied health practitioner and 34.7% consulted a CM practitioner for their OA. Some women (19%) consulted with practitioner(s) from all three practitioner groups, 27% consulted with practitioner(s) from two of the three practitioner groups, while 6% consulted with a CM practitioner only. Women with a greater time since diagnosis had more consultations, as did women who rated their OA as more severe. Women’s average combined out-of-pocket expenditure for OA-related healthcare consultations, prescription medications, products, and practices was $673 per annum. Extrapolated to all Australian women with OA, aged 50 years and over, the total out-of-pocket expenditure for this condition is estimated to be $873 million per annum.ConclusionsAustralian women with OA use a range of conventional and CM consultations, self-care, products and practices to manage their condition, incurring significant out-of-pocket expenses. Given the high individual and societal burden of OA, there is a need for further research into the concurrent use of different healthcare resources with a view to providing safe, cost-effective management of OA across the healthcare system and the wider community.

Abstract Background Changes in Swedish university students’ lifestyle behaviors during the COVID-19 pandemic are unknown. This study aimed to assess physical activity, sitting time, meal frequency and risk substance use (alcohol, tobacco, and illicit use of drugs) in Swedish university students before and during the first six months of the COVID-19 pandemic, for all and stratified by age and sex. Methods Data were obtained from the Sustainable University Life cohort study in which web-based surveys were sent to university students repeatedly for one year. Baseline assessment (before the pandemic) was between August 2019-March 2020, follow-up 1 (FU1) between March-June 2020, and follow-up 2 (FU2) between June–September 2020. Participants reported weekly minutes of physical activity, daily sitting hours, meal frequency by weekly intake of different meals, and motivation for eating irregularly, if so. Also, harmful use of alcohol, tobacco and illicit drugs was assessed. Population means and differences with 95% confidence intervals (95% CI) in lifestyle behaviors between time points were calculated with Generalized Estimating Equations. Results 1877 students (73% women, mean age 26.5 years) answered the baseline survey. Weekly exercise decreased by -5.7 min (95% CI: -10.0, -1.5) and -7.7 min (95% CI: -12.6, -2.8) between baseline and FU1 and FU2, respectively. Weekly daily activities increased by 5.6 min (95% CI: 0.3, 11.7) and 14.2 min (95% CI: 7.9, 20.5) between baseline and FU1 and FU2. Daily sitting time decreased by -1.4 h (95% CI: -1.7, -1.2) between baseline and FU2. Breakfast intake increased by 0.2 days per week (95% CI: 0.1, 0.3) between baseline and FU2. Lunch intake decreased by -0.2 days per week (95% CI: -0.2, -0.1) between baseline and FU1 and by -0.2 days per week (95% CI: -0.3, -0.0) between baseline and FU2. Dinner intake decreased by -0.1 days per week (95% CI: -0.2, -0.0) between baseline and both FU1 and FU2. Only minor differences in risk substance use were observed. Similar changes were observed in analyses stratified by age and sex. Conclusions Lifestyle behaviors in Swedish university students slightly improved during the first six months of the COVID-19 pandemic compared to before. Trial registration ClinicalTrials.gov, NCT04465435 . 10/07/2020.

Mental health problems among university students have been reported to be significantly increasing and suggested to be associated with college drop-out. Body dissatisfaction and compulsive exercise are both constructs relevant for mental health problems in general and eating disorders in particular. This study examined associations between body dissatisfaction, compulsive exercise and self-reported symptoms of depression among Swedish university students. Participants (n = 4262) are students in an ongoing cohort study, and data from the baseline assessment were used. Four linear regression models were built to explore the associations between body dissatisfaction, compulsive weight control exercise and depressive symptoms. Our findings showed that females reported higher levels of body dissatisfaction than males. Body dissatisfaction and compulsive exercise were associated with self-reported symptoms of depression in this non-clinical population. Results showed that compulsive exercise was negatively associated with reported symptoms of depression, while body dissatisfaction was positively associated with symptoms of depression. In line with previous research, there was a gender difference in body dissatisfaction where females displayed higher levels of dissatisfaction than males.  Body dissatisfaction was  positively associated with reported symptoms of depression, suggesting support of previous research indicating body dissatisfaction to increase mental health problems. Compulsive exercise was negatively associated with symptoms of depression suggesting a behavior negatively reinforced, supporting both constructs to be of interest for reported symptoms of depression in a non-clinical population of Swedish university students. III, cohort study. http://clinicaltrials.gov/ID : NCT04465435.

Abstract Background Musculoskeletal pain is among the most common reasons for seeking care, specialist competence for its treatment in primary care limited and waiting lists for orthopaedics often amongst the longest. Many referrals to orthopaedics do not concern disorders that benefit from surgery. Manual therapy is effective, yet not integrated in national health care systems, and there is a lack of research on other than neck and low back pain, and a lack of long-term follow-ups. The present study evaluates the long-term effects of a manual therapy (naprapathy) for common orthopaedic disorders. Methods An 8-year follow-up (96 months) of a pragmatic randomized controlled trial of naprapathy (experimental group) versus standard orthopaedic care (control group) for non-surgical patients of working age with the most common musculoskeletal disorders on the waiting lists (n = 78). Bodily pain, physical function (SF36), Quality of life (QoL; SF6D), and data on health care utilization were collected. The treatments lasted from January 2007 to November 2007. Results N = 75 participants in the original study sample completed the 8-year follow-up. The differences in bodily pain (21.7 (95% CI: 9.1–34.3)), physical function (17.6 (6.7–28.4)), and QoLs (0.823 (95% CI: 0.785–0.862) compared with 0.713 (95% CI: 0.668–0.758)) were statistically significantly in favor of the experimental group (p-values < 0.01). After sensitivity analysis the experimental group had altogether 260 health care visits compared with 1161 in the control group. Conclusions Naprapathy is a continuously effective treatment. Together with earlier research our study suggests that specialized manual therapy should be considered when triaging patients with common non-surgical musculoskeletal disorders in national health care systems. Trial registration: Not applicable, as per information given by ClinicalTrials.gov.

Aims: The COVID-19 pandemic has had a profound effect on societies and citizens worldwide, raising concerns about potential mental health impacts. We aimed to describe trajectories of depression, anxiety and stress symptoms during the COVID-19 outbreak compared to before the outbreak, and to determine if trajectories were modified by pre-pandemic loneliness, poor sleep quality and mental health problems. Methods: We conducted a cohort study with 1836 Swedish university students entering the study before 13 March 2020, the onset of the pandemic, with follow-ups within three (FU1) and six months (FU2) of the outbreak. Generalized Estimating Equations were used to estimate mean differences in symptom levels over time-periods, and to estimate potential effect modifications. Results: We found small differences in mean levels of the depression, anxiety and stress scale (DASS-21) over time. Compared to before the pandemic, depression increased by 0.25 points of 21 (95% CI: 0.04 to 0.45) at FU1 and decreased by 0.75/21 (95% CI:−0.97 to −0.53) at FU2. Anxiety decreased from baseline to FU1 by 0.09/21 (95% CI: −0.24 to 0.07) and by 0.77/21 (95% CI: −0.93 to −0.61) to FU2. Stress decreased from baseline to FU1 by 0.30/21 (95% CI: −0.52 to −0.09) and by 1.32/21 (95% CI: −1.55 to −1.09) to FU2. Students with pre-pandemic loneliness, poor sleep quality or pre-pandemic mental health problems did not have worse trajectories of mean mental health symptoms. Conclusions: Symptom levels were relatively stable during the first three months of the pandemic, while there was a slight decrease during the summer months, probably due to seasonality effects.

Background In the USA, colorectal cancer is among the top diagnosed cancers. The current study specifically targets the US adult population that have a history of colorectal cancer. Methods We used the 2017 National Health Interview Survey (NHIS) to investigate the prevalence and predictors of colorectal cancer survivors using complementary medicine in the past 12 months in a representative sample of the US population ( N = 26,742). We descriptively analyzed the 12-month prevalence of any complementary medicine use separately for individuals with a prior diagnosis of colorectal cancer and those without. Using chi-squared tests and backward stepwise multiple logistic regression analyses, we identified predictors of complementary medicine use in the past 12 months. Results A weighted total of 1,501,481 US adults (0.6%) had a history of colorectal cancer. More individuals without (weighted n = 76,550,503; 31.2%) than those with a history of colorectal cancer (weighted n = 410,086; 27.3%) had used complementary medicine. The most commonly used complementary medicine among colorectal cancer patients was mind-body medicine, followed by chiropractic. A higher prevalence of complementary medicine use was associated with being female, higher educated and/or living in the US Midwest or South. Conclusions In this study, over one fourth of the US colorectal cancer survivors had used complementary medicine. Mind-body medicine was found to be the most commonly used. With evidence supporting the effectiveness and safety of mind-body medicine use among colorectal cancer patients, promoting the use of evidence-based mind-body medicine for colorectal cancer management could be considered.

Background: Evidence-based practice (EBP) is integral to the provision of ethical, safe and high-quality health care. While osteopathy is an established and registered health profession in many countries, it is a developing, unregistered health profession in Sweden. This study explored the perceptions, skills, use, barriers and enablers of EBP among Swedish osteopaths. Methods: Osteopath members of the Swedish Osteopathic Association were invited by email to participate in an anonymous online survey - a Swedish-translated and pilot-tested version of the Evidence-Based Practice Attitude and Utilisation Survey. Data collection was conducted between January and March 2019. Results: Thirty-one per cent (78/249) of invited osteopaths responded to the survey. Respondents were largely supportive of EBP and most agreed or strongly agreed that EBP assisted clinical decision-making (84.7%), improved quality of patient care (83.3%), and was necessary in the practice of osteopathy (80.8%). Respondents typically reported moderate to moderate-high levels of EBP skills, whereas their level of engagement in EBP activities was variable and infrequent. The main reported barrier for EBP uptake was lack of clinical evidence in osteopathy. Workplace access to the internet and free online databases, and the ability to download full-text journal articles, were considered very useful enablers of EBP. Conclusions: The responding Swedish osteopaths appeared largely supportive of EBP, reported moderate to moderate-high levels of EBP skills but participated infrequently in EBP activities. Studies of interventions aimed at enhancing the skills and clinical use of EBP in osteopathy are warranted.

Background. The COVID-19 pandemic has had a profound effect on societies, economies, and daily life of citizens worldwide. This has raised important concerns about the mental health of different populations. We aimed to determine if symptom levels of depression, anxiety, and stress were different during the COVID-19 outbreak compared to before, with the Depression, Anxiety and Stress Scale as main outcome. We also aimed to determine whether pre-pandemic loneliness, poor sleep quality and mental health problems were associated with worse trajectories of mental health. Methods. We conducted a cohort study with 1658 Swedish university students answering questionnaires before the pandemic and a 81 % response-rate to follow-ups during the pandemic. Generalized Estimating Equations were used to estimate mean levels of symptoms before and during the pandemic, and to estimate effect modification by levels of loneliness, sleep quality and pre-existing mental health problems. Results . We found small differences in symptoms. Mean depression increased by 0.23/21 (95% CI:0.03 to 0.43), mean anxiety decreased by -0.06/21 (95% CI: -0.21 to 0.09) and mean stress decreased by - 0.34/21 (95% CI: -0.56 to -0.12). Loneliness, poor sleep quality and pre-existing mental health problems minimally influenced trajectories. Conclusions. Contrary to widely held concerns, we found minimal changes in mental health among Swedish university students during the first months of the COVID-19 pandemic.

Background. Gynecological cancer is a major health burden globally. In the US, it is common for cancer patients to utilize different types of complementary medicine. This study aims to investigate the prevalence of mind-body medicine use among US women diagnosed with gynecological cancer. Methods. We used data from the 2017 National Health Interview Survey (NHIS) to investigate prevalence and predictors of mind-body medicine utilization in the past 12 months among gynecological cancer patients in a representative sample of the US population (N = 26,742). We descriptively analyzed the 12-month prevalence of any mind-body medicine use, separately for women with a prior diagnosis of gynecological cancer and those without. Using and b multiple logistic regression analyses, we identified predictors of mind-body medicine use. Results. A weighted total of 2,526,369 women (2.0%) reported having received a diagnosis of gynecological cancer. More women diagnosed with gynecological cancer (weighted n = 964,098; 38.2%) than those not diagnosed with gynecological cancer (weighted mean = 36,102,852; 28.8%) had used mind-body medicine in the past 12 months. A higher prevalence of mind-body medicine use was associated with being non-Hispanic White, living in Western US and having received higher education. Spiritual meditation was found to be the most frequently used mind-body medicine modality, followed by yoga and progressive relaxation. Conclusions. While mind-body medicine is popular among US gynecological cancer patients, clinical evidence supporting the effectiveness of different mind-body medicine modalities is yet to be established. Randomized controlled trials should be conducted to evaluate the effectiveness of popular modalities like spiritual meditation or yoga to inform clinical decision and patient choice. (C) 2020 Elsevier Inc. All rights reserved.