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Chronic low back pain (CLBP) remains a leading cause of disability worldwide and imposes a substantial personal and socioeconomic burden. Despite exercise being the first-line recommended intervention in clinical guidelines, its efficacy on pain relief remains modest and the hypoalgesia induced by exercise seems to be limited in individuals with musculoskeletal pain. Previous transcranial direct current stimulation (tDCS) studies have mainly targeted the motor cortex, yielding heterogeneous results, underscoring the need to evaluate alternative brain areas. Recently, tDCS studies targeting the dorsolateral prefrontal cortex (DLPFC) may enhance endogenous pain modulation and thereby potentiate the response to exercise. This study aims to compare the effects of adjunctive anodal DLPFC tDCS combined with a standardised exercise programme versus sham tDCS combined with the same exercise programme on pain and function in adults with CLBP.
This is a single-centre, triple-blinded, parallel-group randomised controlled trial. 48 participants with CLBP will be randomly assigned to receive either anodal tDCS over the left PFC combined with exercises, or sham tDCS combined with the same exercise programme, over nine sessions during a 3-week period. The primary outcome is the change in the multidimensional impact of CLBP, assessed using the Core Outcome Measures Index, from baseline to postintervention (week 4). Secondary outcomes include pain intensity, disability, psychological factors (fear-avoidance beliefs, catastrophising, anxiety, depression), measured at baseline, postintervention and at 12- and 24-week follow-up. Functional brain connectivity via electroencephalography and neuromuscular function of the erector spinae (flexion–relaxation phenomenon) will be measured at baseline and postintervention.
This study was approved by the Commission Cantonale d’Ethique de la Recherche sur l’être humain (CCER) in December 2022 (reference number: 2022-D0077). Written informed consent will be obtained from all participants. The results will be disseminated through peer-reviewed publications and presentations at national and international conferences.
El presente estudio fundamenta la construcción de un modelo de cuidado holístico e intercultural de las mujeres indígenas del Pueblo de los Pasto en el ciclo del embarazo, parto y puerperio; consta de cuatro elementos claves, la relación-tensión entre el conocimiento en salud y saber indígena, los actores que diversifican las formas de cuidado institucional y cultural, los escenarios de cuidado más allá de las instituciones de salud con implicación del saber étnico, la reivindicación de las percepciones, vivencias y experiencias de las mujeres y de las parteras reclamando un cuidado integral bajo la sinergia entre el saber científico y el étnico. La fundamentación fue resultado de un proceso hermenéutico en cuádruple vía- encuentro con ideas fuerza resultado de la revisión bibliográfica, priorización de marcos normativos exigentes de una atención humanizada y diferencial, el diálogo con mujeres gestantes y el reconocimiento invaluable de las parteras del pueblo de los Pastos. En ese sentido, la investigación se guio por el análisis e interpretación en doble vía, primero, interpretación bibliográfica de textos científicos, académicos y marcos normativos afines al estudio, y segundo, relatos y argumentos culturales obtenidos a través de entrevista, grupos focales y diálogos de saberes con mujeres y parteras.
by Mario Alejandro Mercado Mendoza, Armando Sánchez Vargas, Pierre Mokondoko
Landslides threaten sustainable development through economic and human losses. This study integrates machine learning methods to construct susceptibility maps, including topographic-hydrological indicators, to improve the inclusion of earthflow landslides. Furthermore, we aim to find relationships between landslide susceptibility and social lag using Copula models and SHAP values. Results reveal differentiated dependence across different partitions. Specifically, we found regime-specific co-occurrences of high social lag and high landslide susceptibility areas in steep, deprived areas, contrasting resilient affluent zones. Educational deprivation emerges as the top vulnerability factor, followed by healthcare access, overcrowding, and housing deficits. Highlighting spatial inequities, the analysis advocates targeted interventions blending slope stabilization and social policies.
FreshRSS 