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Background In chronic conditions, such as back pain, the use of interventions that address physical, social and psychological aspects within a biopsychosocial framework are encouraged, however, applying this holistic multimodal approach in physical therapy practice (i.e., chiropractic and physiotherapy) is challenging. To explore the problem of delivering a biopsychosocially informed package of care in physical therapy practice a recent randomised control trial (RCT) called ‘Mind Your Back’ was conducted to evaluate the effectiveness of a combined physical and internet-delivered psychological intervention (psychologically informed physical treatments) compared to standard treatment for improving disability and self-efficacy in people with chronic LBP. The results of the trial indicated no difference between the two intervention groups. Although high-quality RCTs are considered gold standard for effectiveness of interventions, qualitative research methods embedded within a process evaluation framework are also used to reveal other issues and important information that help to explain clinical trial results, and to further the field of digital health interventions research. Therefore, within a process evaluation framework, the aim is to explore participants experiences of the interventions received throughout the Mind Your Back trial which led to a null result. Methods In-line with recommendations for a process evaluation this study used in-depth interviews and qualitative thematic analysis with participants of both arms of the trial 5–6 months after study completion. Semi-structured telephone interviews were conducted with twenty-five participants to explore their experiences of taking part in the Mind Your Back trial. Interviews were conducted in November 2017, transcribed verbatim and data analysed thematically. Results Two main themes were identified: (1) Personalised support and therapeutic alliance are important, and (2) MoodGYM lacked relevant, personalised and tailored support. Conclusion It is important to deliver tailored digital health supports that is personalised and fosters a therapeutic alliance.

Background Statistical analysis plans describe the processes of data handling and analysis in clinical trials; by doing so they increase the transparency of the analysis and reporting of studies. This paper reports the planned statistical analysis plan for the Whiplash ImPaCT study. For individuals with whiplash injury, Whiplash ImPaCT aims to assess the effectiveness of a guidelines-based clinical pathway of care compared with usual care. Methods We report the planned procedures, methods, and reporting for the primary and secondary analyses of the Whiplash ImPaCT study. The primary outcomes are Global Recovery and Neck Disability Index at 3 months post-randomisation. Outcomes will be analysed according to the intention to treat principle using linear mixed models. A cost-utility analysis will be conducted to compute the incremental cost-effectiveness of the intervention to usual care. We describe data handling, our analytical approach, assumptions about missing data, and our planned methods of reporting. Discussion This paper will provide a detailed description of the planned analyses for the Whiplash ImPaCT trial.

Purpose This paper aims to provide a snapshot of workers’ experience while working from home (WFH) during the Australian lockdown in the middle of the Covid-19 pandemic. It focuses on lessons to inform organizations, employees and the design of the workspaces post-2020, human, organizational and environmental considerations may affect satisfaction, productivity and health. Design/methodology/approach Two separate surveys were designed for this study to target Australian organizations and knowledge workers. Participants included 28 organizations and 301 employees, and descriptive and correlational analyses were conducted. Findings Organizations stated productivity losses, maintaining culture and workplace health and safety concerns with WFH setup while employees were more concerned about their social interactions, internet connectivity and increased workload. Employees also found the social aspects of WFH challenging and disclosed that face-to-face interactions with their colleagues was the most important reason they wanted to return to the office. High level of trust and value was reported amongst the organizations and workers. Originality/value In the scarcity of academic literature around negative and positives of the WFH experiment during the COVID-19 pandemic, the main sources of information have been industry-focused reports. This study aims to contribute to this knowledge gap by identifying positives and negative aspects of WFH during the first wave of lockdowns in Australia in 2020 from the organization and workers’ perspective, including human, organizational and environmental considerations.

To explore health professionals' acceptance of the guidelines for acute whiplash associated disorders (WAD), and to identify barriers and facilitators to adherence.Qualitative descriptive study involving focus group discussions among health professionals who treat people with WAD in primary and secondary care settings in New South Wales and Queensland, Australia. Twenty-eight health professionals (physiotherapists = 19; chiropractors = 6; osteopaths = 3) participated in six semi-structured focus group discussions that were held in independent offices in Sydney and Brisbane, Australia between September and December 2015. Discussions were audio recorded and verbatim, de-identified transcripts produced. Thematic analysis was conducted using an inductive approach to identify commonly held beliefs.Acceptance of guideline recommendations appeared to be influenced by factors related to the guideline itself, practitioner and practice characteristics, and patient-related factors. Specifically, acceptance was hindered by conflicting belief systems, ambiguity in guideline recommendations, and patient characteristics and expectations.Practitioners demonstrated a positive attitude towards the use of the guidelines in general; however, in some cases, acceptance of key recommendations appeared selective. Future guideline revision and implementation might focus on explaining the underlying principles of the guidelines, providing more detailed recommendations, and involving strategies that challenge inconsistent beliefs and promote informed decision-making. IMPLICATIONS FOR REHABILITATIONSelective acceptance of guideline recommendations in favour of those not requiring practice change may present a challenge for the implementation of evidence-based practice in the management of whiplash.Participants demonstrated variable, sometimes polar attitudes to guideline key messages and recommendations.Guideline developers need to focus more strongly on changing practitioner beliefs and attitudes, as well as better explaining the underlying principles of the guidelines, and providing more detailed recommendations.

Nurses play an important role in educating patients on breast cancer and have a positive influence in encouraging women to participate in breast screening. This current study aimed to use a train-the-trainer model to improve the level of knowledge of nurses on breast cancer and screening in Ras Al Khaimah, United Arab Emirates. The study also focused on the nurses’ ability to train other nurses in assisting women to engage in breast screening. This interventional study used a mixed-method design. Seventeen female nurses (aged 28–60 years) were recruited from public and private health centers and participated in a breast cancer train-the-trainer workshop. They completed a survey before and after the workshop. The surveys included a series of open and closed questions to assess their knowledge of breast cancer symptoms, risk factors, diagnosis, and patient communication. The study found that nurse participants had good baseline knowledge of breast cancer topics, including breast self-examinations, clinical breast examinations, and mammography. Responses were deemed accurate if they answered open-ended questions without incorrect information and correct options were selected in the quantitative sections. However, training improved the detail and accuracy of the participant responses. Training also improved the confidence of nurse participants to teach other women and nurses how to perform breast self-examinations and provide breast cancer information. There were significant increases in nurse participants’ knowledge of risk factors (p

Purpose From poor indoor environmental quality conditions to musculoskeletal discomfort, the interior design of workspaces has the potential to negatively affect human health. One of the key responses from industry has been the rise of health-related guidelines, certification and rating tools. Despite the rapid adoption of such tools by the Australian high-end corporate real estate, there is a scarcity of empirical evidence arising from such premises. This study aims to compare results from certified premises against other open-plan offices to understand differences arising from occupants’ satisfaction, perceived productivity and health. Design/methodology/approach A total of 1,121 post-occupancy evaluation (POE) surveys conducted in 9 offices were analyzed. All these premises hold a certification from the Green Building Council of Australia and two achieved a WELL rating. The analysis is performed in three parts: comparing WELL-certified (2 cases) and non-WELL certified (7 cases) offices along with comparison with a benchmark of 9,794 POE surveys from the BOSSA database, comparing activity-based working (ABW) (5 cases) and traditional (4 cases) offices along with comparison with BOSSA database and qualitative study of the similar design features in all 9 offices accompanied with an in-depth analysis of the health-related issues that might have occurred because of poor ergonomic design. For the first two parts, several t-tests are performed. Findings Highest scores for overall satisfaction, workability, perceived productivity and health were reported on WELL-rated premises. Offices incorporating active design principles outperformed others on workability, satisfaction with work area, collaboration, unwanted interruptions, perceived productivity and health. ABW environments outperformed the traditional offices on spatial comfort, thermal comfort, noise and privacy, personal control, comfort of furnishing, adjustability of the work area and space to collaborate. People using sit–stand workstations reported spending significantly less time seated and female workers were more prone to reporting pain over the past 12 months. The best-performing offices implemented active and biophilic design, prioritized overall ergonomics and different spaces designed to support a variety of work-related activities. Originality/value This research conducts a comparison between certified premises against other offices in terms of occupants’ satisfaction, perceived productivity and health. A qualitative analysis is also conducted to investigate personal and physical environmental aspects. The way of working (ABW or traditional), implementation of active design features, self-reported musculoskeletal discomfort and physical activity were also investigated. The study has taken a holistic approach to investigate many health-related physical, environmental and emotional aspects in certified workspaces.

The aim of this systematic review was to summarise the effects of ergonomics interventions on work-related upper limb musculoskeletal pain and dysfunction, and on productivity in sonographers, surgeons and dentists. A total of 31 studies were included. All studies reported effects on upper limb pain. Nine studies reported effects on dysfunction and only two studies reported effects on productivity. Moderately strong evidence in reducing upper limb pain was found for instigation of microbreaks into long duration surgical procedures, and the use of wider, lighter handles in dental instruments. Moderate evidence was also found for use of prismatic glasses and favourable positioning in reducing upper limb pain. Weak, inconsistent or no evidence was found for all other ergonomics interventions in reducing upper limb pain and dysfunction and increasing productivity. The lack of high quality research, particularly in sonographers and in the outcome of productivity, should be addressed. Practitioner summary: This systematic review investigates the effectiveness of ergonomics interventions on upper limb pain, dysfunction and productivity in sonographers, dentists and surgeons. Instigation of microbreaks during long duration procedures and the use of wider, lighter instrument handles were most effective in reducing upper limb work-related pain. Abbreviations: ANOVA: analysis of variance; CLS: conventional laparoscopic surgery; DMAIC: define, measure, analyze, improve and control; GRADE: grading of recommendations, assessment, development and evaluations; HD: high definition; PRISMA: preferred reporting items for systematic reviews and meta-analyses; PROSPERO: The International Prospective Register of Systematic Reviews; RCT: randomised control trial; SILS: single incision laparoscopic surgery; VITOM: video telescopic operative microscope; WNSWLHD: Western New South Wales Local Health District; WMSD: work related musculoskeletal disorder.

Purpose. This study investigated the effect of different sit–stand workstations on lumbar spine kinematics, lumbar muscle activity and musculoskeletal pain. Methods. Thirty-two office workers were ...

Currently, the available studies on the prediction of building energy performance and real occupancy data are typically characterized by aggregated and averaged occupancy patterns or large thermal zones of reference. Despite the increasing diffusion of smart energy management systems and the growing availability of longitudinal data regarding occupancy, these two domains rarely inform each other. This research aims at understanding the potential of employing real-time occupancy data to identify better cooling strategies for activity-based-working (ABW)-supportive offices and reduce the overall energy consumption. It presents a case study comparing the energy performance of the office when different resolutions of occupancy and thermal zoning are applied, ranging from the standard energy certification approach to real-time occupancy patterns. For the first time, one year of real-time occupancy data at the desk resolution, captured through computer logs and Bluetooth devices, is used to investigate this issue. Results show that the actual cooling demand is 9% lower than predicted, unveiling the energy-saving potential to be achieved from HVAC systems for non-assigned seating environments. This research demonstrates that harnessing real-time occupancy data for demand-supply cooling management at a fine-grid resolution is an efficient strategy to reduce cooling consumption and increase workers’ comfort. It also emphasizes the need for more data and monitoring campaigns for the definition of more accurate and robust energy management strategies.

ObjectivesTo establish normative reference values for work ability in healthy Australian adults using the Work Ability Score and investigate the association of physical performance factors.MethodsThe Work Ability Score was collected from 720 participants aged 18–101 years from the 1000 Norms Project. Physical performance was evaluated by assessing isometric strength of 13 muscle groups; flexibility of six joints; and 11 functional measures categorised as gross motor, fine motor and balance tasks. Correlations and multiple regression analyses were performed to identify physical performance factors independently associated with work ability.ResultsAge-stratified reference values were generated for work ability. Work ability increased during young adulthood (18–44 years) and declined from middle adulthood (45–64 years) into older adulthood (≥65 years), with no sex differences. Greater gross motor function and balance correlated with work ability (r=−0.498 to −0.285; p2=0.333, pConclusionsReference data can be used to identify individuals with low work ability. This study has identified physical factors associated with work ability that can potentially be targeted to maintain longevity in work. Physical tests such as the timed up and down stairs test may assist in the development of objective job-specific screening tools to assess work ability, supplementing subjective evaluation.

Highlights • Total physical activity is inversely associated with chronic back conditions. • At least 300 min/week of moderate intensity or 30 min/week of vigorous intensity activities are associated with a low odds of having chronic back conditions. • Medium domestic activity, football/rugby, or running/jogging are inversely associated with chronic back conditions. • High-level manual domestic activity is associated with a higher odds of having chronic back conditions. • High-level sport/exercise is associated with a low odds of having chronic back conditions, and low-level sport/exercise is associated with high odds of having chronic back conditions., Background Little is known about the association between different types of physical activity (PA) and chronic back conditions (CBCs) at the population level. We investigated the association between levels of total and type-specific PA participation and CBCs. Methods The sample comprised 60,134 adults aged ≥16 years who participated in the Health Survey for England and Scottish Health Survey from 1994 to 2008. Multiple logistic regression models, adjusted for potential confounders, were used to examine the association between total and type-specific PA volume (walking, domestic activity, sport/exercise, cycling, football/rugby, running/jogging, manual work, and housework) and the prevalence of CBCs. Results We found an inverse association between total PA volume and prevalence of CBCs. Compared with inactive participants, the fully adjusted odds ratio (OR) for very active participants (≥15 metabolic equivalent h/week) was 0.77 (95% confidence interval (CI): 0.69–0.85). Participants reporting ≥300 min/week of moderate-intensity activity and ≥75 min/week of vigorous-intensity activity had 24% (95%CI: 6%–39%) and 21% (95%CI: 11%–30%) lower odds of CBCs, respectively. Higher odds of CBCs were observed for participation in high-level manual domestic activity (OR = 1.22; 95%CI: 1.00–1.48). Sport/exercise was associated with CBCs in a less consistent manner (e.g., OR = 1.18 (95%CI: 1.06–1.32) for low levels and OR = 0.82 (95%CI: 0.72–0.93) for high levels of sport/exercise). Conclusion PA volume is inversely associated with the prevalence of CBCs.

Objectives To investigate the effectiveness of incidental (non-structured) physical activity interventions for the management of people with low back pain (LBP). Design Systematic review and meta-analyses of randomised controlled trials. Setting Eligible published trials from the earliest date available to November 2017. Participants People with non-specific LBP aged 18 years or over. Outcome measures Pain, disability and physical activity-related outcomes. Results Three trials were included (including a total of 422 participants). The quality of trials, assessed by PEDro scale, was high (7 out of 10). For pain, the pooled results did not show any significant effects between the incidental physical activity intervention and other interventions at any time point. For disability, incidental physical activity was not statistically more effective than other interventions at short-term; however, the pooled results favoured incidental physical activity at intermediate-term (weighted mean difference (WMD) = -6.05, 95%CI: -10.39 to −1.71) and long-term (WMD = −6.40 95%CI: -11.68 to −1.12) follow-ups among participants with chronic LBP. The overall quality of evidence was rated “moderate-quality” based on the GRADE system. Conclusions The incidental physical activity intervention provided improvement in disability in intermediate- and long-term for people with chronic LBP, although this improvement was small and may not be clinically significant.

Purpose In the rise of offices designed to support activity-based working (ABW), parts of industry have fully transitioned to open-plan environments and then later to unassigned seating, whereas other parts, such as tertiary education, are still in the process of moving away from individual offices. There are a few relevant studies to understand how occupants from industry sectors with different levels of adoption of ABW perceived environments designed to support this way of working. This paper aims to contribute to the knowledge gap by providing insight into workers’ satisfaction and dissatisfaction from open-plan offices designed to support ABW along with the key predictors of perceived productivity. Design/methodology/approach A data set of 2,090 post-occupancy evaluation surveys conducted in five sectors – tertiary education, finance, construction, property/asset management and design/engineering – was analyzed. ANOVA and confirmatory factor analysis (CFA) were conducted for the survey questionnaires. First, ANOVA tests were conducted for the whole sample with perceived productivity as the dependent variable. A seven-point Likert scale with five theoretical factors was generated with all survey questionnaires. CFA was performed to show the factor loadings. In addition, regression analyses were carried out for each of factor item taken as the independent variable, where perceived productivity was the dependent variable. Key sources of satisfaction and dissatisfaction per sector were analyzed and differences between occupants reporting a negative or positive impact on their productivity were also investigated. Finally, open-ended comments were analyzed to show the key sources of dissatisfaction based on open-ended comments. Findings Workers from construction were the most satisfied, followed by finance and tertiary education. Occupants from all industry sectors consistently rated their workspaces highly on biophilic and interior design. Distraction and privacy received the lowest scores from all sectors. Open-ended comments showed mismatches between spatial and behavioral dimensions of ABW both for satisfaction and perceived productivity. Interior design was the strongest predictor for perceived productivity for all sectors. Findings dispel the notion that ABW implementation may not be suitable for certain industries, as long as the three key pillars of ABW are fully implemented, including design, behavior and technology. Originality/value This paper provides insight into workers’ satisfaction and dissatisfaction from open-plan offices designed to support ABW in different industry sectors along with the key predictors of perceived productivity.

One of the potential positive aspects of spaces designed to support Activity-Based Working (ABW) concept is to allow people to choose to work from zones that suit their Indoor Environmental Quality (IEQ) preferences. The vast majority of studies reporting findings relevant to IEQ performance of ABW spaces rely on spot measurements and/or subjective surveys and as such it is difficult to map longitudinal actual utilisation patterns and IEQ performance. This study contributes to this topic by analyzing a longitudinal dataset of space utilisation of an ABW over a twelve-month period. Analysis aims to identify overlaps between space utilisation patterns and expected IEQ performance in order to understand which types of zones occupants seem to prefer to work from. Occupants’ demographics (age and gender) were also analyzed with respect to the use of space. Further, specific physical markers were investigated, namely proximity to window, air-conditioning outlets, and high-low noise locations. The impact of physical markers on workplace choice was classified and predicted during a day using a decision-tree diagram developed on the basis of the CHAID algorithm. Overall, workers tended to choose to work within the inner zones (after 11 a.m.) during winter. Findings show that female workers moved away from air-conditioning outlets. Additionally, female workers worked from workstations situated in high and medium noise zones. Results illustrated the potential to use utilisation datasets to understand how workers move away or towards zones in response to expected IEQ performance - thermal comfort (cold/warm), acoustics (noisy/quiet), and access to the outdoor environment/view (window) proximity.

Objectives This systematic review and meta-analysis examined relationships between low back pain (LBP)–related disability and pain beliefs, including pain catastrophizing, pain-related fear, self-efficacy, and back pain beliefs, in non–English-speaking populations. Additionally, the effects of selected cultural factors (i.e., language/geographic area) on the strength of relationships were examined. Study design Systematic review and meta-analysis. Methods Nine databases were searched. Studies included observational or randomized control clinical trials. Eligible studies had to report estimates of the association between pain beliefs and disability. Pooled estimates of correlation coefficients were obtained through random-effects meta-analysis methods. Results Fifty-nine studies, (n = 15,383) were included. Moderate correlations were identified between disability and pain self-efficacy (chronic LBP r = −0.51, P ≤ 0.001), between disability and pain catastrophizing (acute LBP r = 0.47, P ≤ 0.001; chronic LBP r = 0.44, P ≤ 0.001), and also between disability and pain-related fear (chronic LBP r = 0.41, P ≤ 0.001). Otherwise, weak correlations were identified between disability and most pain beliefs (range r = −0.23 to 0.35, P ≤ 0.001). Pooled correlation coefficients between disability and all pain beliefs (except the Fear Avoidance Belief Questionnaire–Work subscale) represent medium effects and suggest that lower disability was associated with greater pain self-efficacy, less pain-related fear, less catastrophic thinking, and less negative back pain beliefs about the nature and cause of back pain. Results were consistent across most language groups and geographic regions; few studies reported ethnicity or religion. Discussion LBP-related disability was associated with pain-related beliefs, with consistency demonstrated for each pain belief construct across divergent non–English-speaking populations. Further research examining cultural factors, such as ethnicity or religion, and with a more diverse population is warranted.

Introduction Sonographers in the Western New South Wales Local Health District (WNSWLHD) reported a musculoskeletal pain prevalence rate of 95%. Participatory ergonomics, where workers are consulted about improving work conditions, was utilised to identify work-related musculoskeletal disorder (WMSD) risks and potential solutions. The aim of this study was to compare the prevalence of WMSD in a cohort of sonographers before and after implementation of ergonomic changes that were driven by recommendations from a participatory ergonomics approach. Methods This observational mixed methods study analysed the impact of participatory ergonomic-driven interventions on changes on musculoskeletal pain in a cohort of sonographers employed within the WNSWLHD. A retrospective analysis of 10 sonographer WMSD pain surveys over five sites was completed, along with semi-structured interviews regarding which interventions were perceived as useful, which interventions were not implemented and any barriers to implementation. Results Installation of patient monitors, use of ergonomic scanning techniques and job rotation were perceived as responsible for decreased musculoskeletal pain. Taking lunch breaks and microbreaks, use of antifatigue mats and having two sonographers perform mobile exams were not fully implemented. No interventions were perceived as responsible for increased pain. Conclusion This small study provides preliminary evidence that a participatory ergonomics approach facilitated identification of occupation and site-specific risks for WMSD in the WNSWLHD, allowing implementation of ergonomic changes to be tailored to the workplace, resulting in a safer work environment for sonographers.

Background Although chronic low back pain (LBP) is a leading cause of disability and accounts for large costs, none of the available conventional treatments are clearly more favourable in treating people at increased risk of chronicity. Objectives To examine the feasibility and initial efficacy of a wearables-based walking intervention in addition to usual physiotherapy care in people with LBP at risk of chronicity. Methods Twenty-six adult participants, diagnosed with non-specific LBP with medium or high risk of chronicity, were recruited from physiotherapy private practices. Participants were randomized into usual physiotherapy care (control, n = 14) and usual physiotherapy care plus a wearables-based walking intervention (experimental, n = 12). The intervention duration was 8 weeks. Feasibility outcomes included recruitment rate, adherence to the intervention, dropout rate, and serious adverse events reporting rate. Other outcomes included disability and pain (primary); and physical activity level, daily walking steps, depression, pain catastrophizing and fear of movement (secondary). The outcomes were assessed at baseline, post-intervention and 26 weeks post-randomization follow-up. Results Adherence of experimental participants with the prescribed walking program was moderate. Four participants dropped out during the intervention, and no serious adverse events were reported. Participants in the experimental group showed significant improvement in pain at 26 weeks (β = -0.38; 95% confidence interval (CI) -0.66, -0.10; P = .013), compared with the control group. No between-group differences were found for disability at any time point and pain immediately post-intervention. Experimental participants demonstrated post-intervention improvement in light-intensity (β = 156.71; 95% CI 86.79, 226.64; P < .001), moderate-intensity physical activity (β = 0.46; 95% CI 0.12, 0.80; P = .012), and daily walking steps (β = 7099.13; 95% CI 4522.93, 9675.32; P < .001). Experimental participants demonstrated post-intervention increase in pain catastrophizing (β = 0.52, 95% CI 0.18, 0.86; P = .006). No between-group differences were found for pain catastrophizing at 26 weeks and other secondary outcomes. Conclusion Usual physiotherapy care plus a wearables-based walking intervention program was safe and moderately feasible, and provided significant reduction in pain at 26 weeks as well as increasing the total volume of light- and moderate-intensity physical activity, and daily walking steps immediately post-intervention.

In the United Arab Emirates (UAE), women&rsquo, s participation in breast cancer screening is low, and women are commonly diagnosed in advanced stages. This study investigated women&rsquo, s attitudes towards breast cancer screening, their use of health services in the UAE emirate of Ras Al Khaimah, and their preferred medium for breast cancer information. In this qualitative study, six focus groups were conducted with Emirati (n = 28) and non-Emirati (n = 26) women as Ras Al Khaimah is a highly multi-cultural region. Women were separated into different age groups (25&ndash, 34, 30&ndash, 44, 44+) so as to obtain perspectives of young (n = 16), middle (n = 19), and older women (n = 19). The focus group transcripts were analysed using thematic analysis. Women recognised that any breast change should be checked by a doctor, and that women with symptoms or those at higher risk may need to have breast screening earlier than the recommended starting age. However, participants wanted more information from doctors or other health personnel. Women had observed breast cancer information and campaigns advertisements in multiple media but recommended greater use of social media and WhatsApp to disseminate information. Overall, women had positive attitudes towards breast cancer screening but wanted more breast cancer awareness campaigns year-round and better access to screening.

The study explored the role of healthcare organisations in Ras Al Khaimah, United Arab Emirates, in improving women’s breast cancer awareness and screening participation in a multi-cultural society. In-depth interviews were conducted with eight representatives from five healthcare organisations involved in breast cancer campaigns in RAK including hospitals, clinics, and universities. The interviews were analysed using thematic analysis. The organisations’ campaigns focused on breast cancer awareness, providing free doctor consultations or clinical breast examinations, and where possible, offering free or subsidised screening or health checks. Breast campaigns and free screening were often limited to October, breast cancer awareness month, but breast screening clinics held more frequent awareness campaigns year-round to focus on increasing screening participation. Collaboration between institutions helped strengthen campaigns along with multiple advertising mediums to reach more women. The representatives believed that campaigns have resulted in greater breast cancer awareness and proactive attitudes among women. There were a variety of strategies used in breast cancer campaigns in RAK, and the involvement of nurses and collaboration between organisations can help strengthen breast cancer campaigns.

BackgroundPredicting ongoing disability for chronic non-specific low back pain (LBP) is important to avoid prolonged disability.ObjectiveDetermine predictors of disability at 6 month follow-up in patients with LBP at medium risk of ongoing disability.MethodsBaseline data was collected from 108 patients with medium-risk chronic non-specific LBP (mean age 50.4 years, SD 13.6) from six private chiropractic and physiotherapy clinics in Australia who took part in a randomised control trial. All patients received a pragmatic course of multimodal physical treatments [e.g., manual therapy (spinal manipulation or mobilization and/or soft tissue massage)] combined with advice, education and exercise. Baseline prognostic variables included sociodemographic, physical and psychological characteristics. Primary outcome was disability (Roland Morris Disability) at 6 month follow-up. Multivariable linear regression analysis was conducted.ResultsVariables remaining in the final multivariable model: lower work ability (β = − 1.05, 95% CI − 1.40 to − 0.70; p 2 = 0.31). Those with a lower work ability (scale 1 to 10) and who had seen a medical specialist for their back pain were more likely to report greater LBP-related disability at 6 months.ConclusionPatients with chronic LBP presenting to primary care with lower work ability and recent consultation with a medical specialist for LBP are more likely to have a worse prognosis; these are indicators to clinicians that standard conservative care may not adequately manage the patients’ needs.

Objectives. To examine the interrater and intrarater reliability and construct validity of the Pain Behaviour Scale during standard physical performance tests in people with chronic low back pain and to confirm the test-retest reliability of the physical performance tests in this population. The Pain Behaviour Scale (PaBS) is an observational scale that was recently designed to uniquely measure both the presence and severity of observed pain behaviours. Methods. Twenty-two participants with chronic low back pain were observed during performance of five physical performance tests by two raters. Pain behaviours were assessed using the Pain Behaviour Scale. The Visual Analogue Scale and Modified Oswestry Disability Index were used to measure pain and disability, respectively. Descriptive statistics were used to report demographic features of participants. Reliability was analyzed using ICCs. Rater agreement was analyzed using the weighted Cohen’s kappa. Correlations between PaBS, self-reported measures, and physical performance tests were calculated using Pearson’s product-moment correlations. Results. The PaBS demonstrated excellent interrater (ICC2,1 = 1.0, 95% CI: 0.9 to 1.0) and intrarater (ICC3,1 = 0.9, 95% CI: 0.8 to 1.0) reliability. Component physical performance tests (i.e., time and distance) demonstrated good test-retest (0.6–1.0) reliability. Perfect agreement in the reporting of pain behaviours was found (95–100%). Correlations between pain behaviour severity and pain intensity (r = 0.6) and disability (r = 0.6) were moderate. Moderate correlations were found between pain behaviours and physical performance tests in sit to stand (r = 0.5), trunk flexion (r = 0.4), timed up and go (r = 0.4), and 50-foot walk (r = 0.4). Conclusion. The Pain Behaviour Scale is a valid and reliable tool for measuring the presence and severity of pain behaviour, and the physical performance tests are reliable tests.

An amendment to this paper has been published and can be accessed via a link at the top of the paper.

Objective: To examine the effects of different sit-stand protocols on work-time sitting and physical activity (PA) of office workers. Methods: Participants (n = 26, 77% women, mean age 42) were randomly allocated to usual sitting (control) or one of three sit-stand protocols (intervention) facilitated by height-adjustable workstations for a 4-week period between June and August 2015. Sitting, standing, and stepping time were assessed by inclinometry (activPAL); leisure-time physical activity (LTPA) by self-report. One-way analysis of covariance (ANCOVA) and post-hoc (Bonferroni) tests explored between-group differences. Results: Compared with baseline, intervention groups reduced work sitting time by 113 minutes/8-hour workday (95% confidence interval [CI] [-147,-79]) and increased work standing time by 96 minutes/8-hour workday (95% CI [67,125]) without significantly impacting LTPA/sleep time. Conclusions: Sit-stand protocols facilitated by height-adjustable workstations appear to reduce office workers' sitting time without significant adverse effects on LTPA.

The aim of this study was to explore personal and workplace environmental factors as predictors of reduced worker productivity among older workers with chronic knee pain.A questionnaire-based survey was conducted among 129 older workers who had participated in a randomized clinical trial evaluating dietary supplements. Multivariable analyses were used to explore predictors of reduced work productivity among older workers with chronic knee pain.The likelihood of presenteeism was higher in those reporting knee pain (≥3/10) or problems with other joints, and lower in those reporting job insecurity. The likelihood of work transitions was higher in people reporting knee pain (≥3/10), a high comorbidity score or low coworker support, and lower in those having an occupation involving sitting more than 30% of the day.Allowing access to sitting and promoting positive affiliations between coworkers are likely to provide an enabling workplace environment for older workers with chronic knee pain.

This study aimed to understand the coping strategies used by men with Adult Onset Epileptic Seizures (AOES) following elective neurosurgery, and in particular, how those adaptive skills relate to their subjective wellbeing (SWB). Open-ended qualitative interviews were conducted with five men with a history of neurosurgery for AOES (aged 34–59). The interview data was thematically analysed utilising interpretive phenomenological analysis. The findings indicated that the men experienced significant role marginalisation by family and co-workers, and also poor communication provided by health care professionals. They reported a higher sense of SWB with the use of ego-buffering strategies, such as positive reframing, threat minimisation, emotional self-acceptance and engaging in wish-fulfilling fantasies. Self-blame led to lower SWB. Findings imply that agentic behaviour is important to successful living with AOES following neurosurgery.

Background Low back pain (LBP) is prevalent, costly and disabling. A biopsychosocial treatment approach involving physical and cognitive behavioural therapy (CBT) is recommended for those with chronic LBP. It is not known if online psychological coaching tools might have a role in the secondary prevention of LBP related disability. To assess the effectiveness of an internet-delivered psychological program (MoodGYM) in addition to standard physical treatment in patients with chronic non-specific LBP at medium risk of ongoing disability. Methods A multisite randomized controlled trial was conducted with 108 participants (aged mean 50.4 ± 13.6 years) with chronic LBP attending one of six private physiotherapy or chiropractic clinics. Disability (Roland Morris Disability Questionnaire) and self-efficacy (Patient Self-Efficacy Questionnaire), were assessed at baseline, post-treatment (8-weeks) with follow-up at six- and twelve-months. Participants were randomized into either the intervention group, MoodGYM plus physical treatments, or the control group which received physical treatments alone. Results No statistically significant between group differences were observed for either disability at post-treatment (Effect size (standardised mean difference) 95% CI) RMD − 0.06 (− 0.45,0.31), 6-months RMD 0.01 (− 0.38,0.39) and 12-months − 0.20 (− 0.62,0.17) or self-efficacy at post-treatment PSEQ 0.06 (− 0.31,0.45), 6-months 0.02 (− 0.36,0.41) and 12-months 0.21 (− 0.16,0.63). Conclusion There was no additional benefit of an internet-delivered CBT program (MoodGYM) to physical treatments in those with chronic non-specific LBP at medium risk of ongoing disability measured at post-treatment, or at 6 and 12 months. Trial registration This trial was prospectively registered with Australian New Zealand Clinical Trials Registry Number (ACTRN) 12615000269538.

Breast cancer is the most common form of cancer among women worldwide. Early detection is central to improving disease outcomes. Three main screening methods - mammography, breast self-examination (BSE), and clinical breast examination (CBE) - have been developed and tested in Western nations. There is ongoing debate regarding the efficacy of BSE and CBE in terms of mortality reduction, and a number of international organizations no longer recommend them as screening methods. In technically less developed countries, however, where women are usually diagnosed with breast cancer at advanced stages and younger ages, the benefits of BSE and CBE might outweigh the harm and facilitate early detection of breast cancer. This paper reviews the history of BSE and CBE and discusses their value as early detection methods. It can contribute to informed decision-making by health policy-makers and clinicians who are involved in breast cancer screening in the developing world to improve women's well-being.

Active travel can support the achievement of recommended levels of physical activity. Monitoring travel behavior of university students and staff provides a useful insight into patterns of regional travel and population level changes in physical activity. This study sought to evaluate current travel and physical activity behaviors in a university population and to determine whether these changed over time. An online survey of travel behavior and physical activity was conducted at the University of Sydney, Australia. The survey was actively promoted for three weeks prior to the release of the survey among staff and students, which asked about travel behavior on a specific day in September 2017. The survey questions were the same as those used in a similar online survey conducted across the University in 2012. In total, 4359 People completed the survey, representing 10.8% of staff and 4.1% of students. Approximately two thirds of survey respondents were students, in both the 2012 and 2017 surveys. Compared with 2012, there was an increase in active travel to the University in 2017 from increased walking and train travel. Compared to 2012, in 2017 there was an increase in average minutes walked by about nine minutes, and less time spent sitting. Trip lengths increased, with 68% of trips taking longer than 30 min in 2017. The amount of time spent in low&ndash, moderate levels physical activity increased between 2012 and 2017, potentially related to active travel behavior. Citywide changes towards a system-wide transport fare structure was the biggest change in the transport environment between the two surveys and may have contributed to increased train travel.

ObjectiveTo identify the prevalence of pain in people with chronic ankle instability (CAI) and how pain is related to the impairments of CAI.Data SourcesWe searched the databases of AMED, CINAHL, EMBASE, MEDLINE, PubMed, Scopus, SPORTDiscus, and Web of Science from inception to March 2017.Study SelectionEligible studies were peer-reviewed research in which investigators reported the presence of ankle pain or assessed the effects of pain on impairments in participants with CAI. Age and language were not restricted. Studies that included only surgical interventions were excluded.Data ExtractionStudies identified by the search strategy were screened according to the eligibility criteria, and 2 independent reviewers extracted the data. Outcome measurements were (1) pain ratings using measures such as a visual analog scale and (2) other residual impairments, such as feelings of weakness, giving way, or deficits in functional performance.Data SynthesisOf the 5907 records identified through the database search, 14 studies were included in this review. All authors assessed ankle pain by self-report questionnaires or physical examination, or both. Pain was self-reported by 23% to 79% of participants and present on physical examination in 25% to 75% of participants, depending on the test applied. Among these studies, the highest reported pain level was 4.9 on the 11-point visual analog scale. Studies were heterogeneous for pain measures, participant groups, interventions, and follow-up periods. The relationship between pain and the structural and functional impairments associated with CAI was not investigated in the included studies.ConclusionsPain was present in a large proportion of people who had CAI, but pain levels were low. Information about the effects of pain was not reported, so researchers should examine the association between pain and function, balance, or other activities in people with CAI.

© 2018, © 2018 Informa UK Limited, trading as Taylor & Francis Group. Activity-based working (ABW) provides office workers with a variety of indoor workspaces purposively designed to accommodate different tasks. Despite an increased use of ABW, studies focusing on its impact and the resultant office design are yet to follow suit. This paper addresses this knowledge gap by providing empirical evidence from studies conducted before and after relocation from contemporary open-plan offices to ABW spaces. Results from post-occupancy evaluation (POE) surveys (n = 896 responses), spot measurements of indoor environmental quality (IEQ) and step-count monitoring (one case study; n = 20 participants) before and after relocation are reported. A total of 10 workspaces participated (six combi and four ABW) in this study. Design features were documented and analyzed. While there were limited differences in the measured IEQ conditions between office layouts investigated here, ABW workspaces yielded significantly higher satisfaction results on key IEQ dimensions, perceived productivity and health. Office layout was also found as a significant (or nearly significant) predictor of occupants’ lightly active and sedentary time but did not affect occupants’ daily step counts and distance they travelled. These results highlight the significance and impact of office layout and human-centred approach to design on occupants’ satisfaction, perceived productivity and incidental physical activity opportunities.

BACKGROUND CONTEXT Chronic low back pain (CLBP) is a major health problem. Identifying prognostic factors is essential for identifying people at risk of developing CLBP-related disability. PURPOSE To examine associations between CLBP-related disability at 12-month follow-up and individual, psychosocial and physical factors at baseline, as well as treatment-related factors between baseline and 12-month follow-up among a Saudi population. Additionally, associations between pain intensity and general perceived efficacy (GPE) at 12 months were examined with the aforementioned factors. DESIGN A prospective cohort study. PARTICIPANTS One hundred Saudi participants over 18 years with a history of LBP greater than 3 months' duration. MAIN OUTCOME MEASUREMENTS The primary outcome variable was CLBP-related disability measured by the Arabic Oswestry disability index. Secondary outcome measures were pain intensity over the prior week measured by the VAS and the participant's global perceptions of recovery (general perceived efficacy [GPE]) at 12 months. METHODS At baseline (n=115), participants completed questionnaires covering demographics, disability, pain intensity, back beliefs, fear avoidance, psychological distress, and physical activity. They performed standardized physical performance tests, including assessment of pain behaviors using a pain behavior scale. After 12 months, participants (n=100) completed questionnaires on disability, pain intensity, GPE and provided treatment-related information during the previous year. Predictors of disability, pain, and GPE were explored using univariate and multivariate regression analyses. RESULTS The prognostic model for moderate-severe CLBP-related disability at 12 months explained 53.0% of the variance. Higher pain intensity, higher fear-avoidance work, and older age predicted higher disability. Having no additional somatic symptoms predicted lower disability. Pain intensity at 12-month follow-up was explained by higher disability at baseline, while not being in paid employment appeared protective (25.7% of variance explained). As univariate associations were weak between predictor variables and GPE, multivariate analysis was not conducted. CONCLUSION The study results supported the multifactorial nature of CLBP and reported an important prognostic model in the Saudi population.

STUDY DESIGN A cross-sectional study. OBJECTIVE The aim of this study was to describe multi-dimensional profiles for people with chronic low back pain (CLBP) and to examine the associations between CLBP-related disability and individual, psychosocial and physical factors in a Saudi population. SUMMARY OF BACKGROUND DATA CLBP-related disability is a multidimensional phenomenon. There is growing interest in exploring factors associated with CLBP-related disability in Saudi Arabia but research is limited in comparison to other countries. METHODS Participants completed questionnaires covering demographics, pain intensity, back beliefs, fear avoidance, psychological distress, and physical activity. Oswestry Disability Index (ODI) was used to measure disability. Participants also performed a standardized sequence of physical performance tests and a Pain Behavior Scale was used to evaluate pain behaviors during performance of these tests. The relationships between disability and all variables were explored using univariate and multivariate regression analyses. RESULTS One hundred and fifteen participants were included, 63% of whom were female. Participants demonstrated moderate disability (mean [SD]: 26.6 [13.5]). The mean (SD) back beliefs score was 28.6 (7.3). Mean depression, anxiety, and stress (DASS 21) scores indicated mild distress; however, 26% to 39% scored in the moderate to severe range for at least one subscale. In univariate analyses, pain intensity and fear avoidance beliefs (physical activity and work) were moderately associated with disability (r = 0.56, 0.49, 0.52, respectively, P

Objectives To provide reference data for the Cumberland Ankle Instability Tool (CAIT) and to investigate the prevalence and correlates of perceived ankle instability in a large healthy population. Design Cross-sectional observational study. Setting University laboratory. Participants Self-reported healthy individuals (N=900; age range, 8–101y, stratified by age and sex) from the 1000 Norms Project. Interventions Not applicable. Main Outcome Measures Participants completed the CAIT (age range, 18–101y) or CAIT-Youth (age range, 8–17y). Sociodemographic factors, anthropometric measures, hypermobility, foot alignment, toes strength, lower limb alignment, and ankle strength and range of motion were analyzed. Results Of the 900 individuals aged 8 to 101 years, 203 (23%) had bilateral and 73 (8%) had unilateral perceived ankle instability. The odds of bilateral ankle instability were 2.6 (95% confidence interval [CI], 1.7–3.8; P P =.001) for each year of increasing age, increased by 3% (95% CI, 0%–6%; P =.041) for each degree of ankle dorsiflexion tightness, and increased by 4% (95% CI, 2%–6%, P Conclusions Perceived ankle instability was common, with almost a quarter of the sample reporting bilateral instability. Female sex, younger age, increased abdominal adiposity, and decreased ankle dorsiflexion range of motion were independently associated with perceived ankle instability.

STUDY DESIGN Translation, cross-cultural adaptation, and psychometric testing. OBJECTIVE To translate the Back Beliefs Questionnaire (BBQ) into Arabic and investigate its psychometric properties in an Arabic-speaking sample of individuals with low back pain (LBP). SUMMARY OF BACKGROUND DATA Back pain beliefs are associated with pain chronicity and disability in people with LBP. The BBQ is a recognized and frequently used tool for measuring these beliefs. To date the BBQ has not been translated into Arabic. METHODS The English version of the BBQ was translated and culturally adapted into Arabic (BBQ-Ar) according to published guidelines. The BBQ-Ar was then tested in a sample of 115 Arabic-speaking individuals with LBP. Reliability was evaluated through internal consistency (Cronbach α) and test-retest reliability (intraclass correlation coefficient), the latter in a subgroup of 25. Construct validity was assessed using exploratory factor analysis and by examining the correlation between the BBQ-Ar, the Oswestry Disability Index and a Numerical Pain Rating Scale. RESULTS Internal consistency of the BBQ-Ar was good (Cronbach α = 0.77). Test-retest reliability was good (intraclass correlation coefficient [2,1] = 0.88). Exploratory factor analysis revealed a three-factor structure, explaining 46% of total variance, with the first factor alone explaining 24%. Eight of the nine scoring items were loaded on the first factor thus forming a unidimensional scale. A significant negative correlation was found between Oswestry Disability Index and BBQ-Ar scores (r = -0.307; P

Purpose Laboratory-based cardiopulmonary exercise testing from which to prescribe cycle training intensity in pulmonary rehabilitation for people with chronic obstructive pulmonary disease (COPD) is not readily available in clinical practice. Alternative methods of prescribing cycle exercise intensity, such as patient symptoms of dyspnea or rating of perceived exertion (RPE), have been used, but it is unknown whether cycle intensity based on such symptoms elicits an exercise intensity appropriate for achieving physiological training responses. The aim of the study was to determine the exercise intensity elicited when continuous cycle exercise was prescribed at symptoms of moderate dyspnea or RPE in people with COPD. Methods Participants with diagnosed COPD performed lung function tests and an incremental cycle test to peak work capacity. On a subsequent day, participants performed 10 minutes of cycle exercise based on moderate symptoms (CycleSYMP) of either dyspnea or RPE, depending on which symptom limited the incremental cycle test. Oxygen uptake ((Equation is included in full-text article.)O2) was measured during all exercise using a portable metabolic system (Cosmed K4b). Results Thirty participants, mean age of 70 ± 9 years and FEV1 60 ± 12% predicted, completed the study. The mean intensity achieved during CycleSYMP was 78 ± 12%(Equation is included in full-text article.)O2peak and 71 ± 18 % (Equation is included in full-text article.)O2Reserve. Steady-state (Equation is included in full-text article.)O2 was achieved by the sixth minute of CycleSYMP. Conclusions Using symptoms of moderate dyspnea or RPE as a method of prescribing cycle exercise elicited a high training intensity at which steady-state was achieved in people with mild to moderate COPD.

Objective: Prospectively investigating whether different approaches of physical work demands are associated with need for recovery (NFR), employment status, retirement intentions, and ability to prolong working life among older employees from the industry and health care sector.Methods: A subsample from the Maastricht Cohort Study was studied (n = 1126). Poisson, Cox, and logistic regression analyses were performed to investigate outcomes.Results: Perceiving physical work demands as strenuous was associated with higher NFR. Continuous physical strain was associated with being out of employment 4 years later. Employees with the highest amount of physical work demands perceived they were less able to prolong working life, although no significant associations between physical work demands and retirement intentions were found.Conclusions: Overall, physical work demands were associated with adverse outcomes, with divergent insights for the different approaches of physical work demands.

Background Clinical decision-making regarding diagnosis and management largely depends on comparison with healthy or ‘normal' values. Physiotherapists and researchers therefore need access to robust patient-centred outcome measures and appropriate reference values. However there is a lack of high-quality reference data for many clinical measures. The aim of the 1000 Norms Project is to generate a freely accessible database of musculoskeletal and neurological reference values representative of the healthy population across the lifespan. Methods/design In 2012 the 1000 Norms Project Consortium defined the concept of ‘normal', established a sampling strategy and selected measures based on clinical significance, psychometric properties and the need for reference data. Musculoskeletal and neurological items tapping the constructs of dexterity, balance, ambulation, joint range of motion, strength and power, endurance and motor planning will be collected in this cross-sectional study. Standardised questionnaires will evaluate quality of life, physical activity, and musculoskeletal health. Saliva DNA will be analysed for the ACTN3 genotype (‘gene for speed'). A volunteer cohort of 1000 participants aged 3 to 100 years will be recruited according to a set of self-reported health criteria. Descriptive statistics will be generated, creating tables of mean values and standard deviations stratified for age and gender. Quantile regression equations will be used to generate age charts and age-specific centile values. Discussion This project will be a powerful resource to assist physiotherapists and clinicians across all areas of healthcare to diagnose pathology, track disease progression and evaluate treatment response. This reference dataset will also contribute to the development of robust patient-centred clinical trial outcome measures.

Australian government and organizational age-management policies continue to target employment participation among older workers in light of an aging population. Typically, efforts to reduce early retirement among older workers have focused on well-established factors, including the promotion of worker health, reducing injury, supporting caregivers, reducing age discrimination and enhancing skill development. This research extends on the former approach by examining established factors along with important emerging factors, namely work-life conflict, work centrality and person-job fit. Additionally, the research analyses the effects of gender and financial pressure on older workers’ employment participation and preferences. Logistic regression analysis of cross-sectional survey data involving 1,504 Australians aged 45–65, revealed that two established factors, physical health and caregiving, and all three emerging factors were associated with employment participation and preferences to be employed. However, important variations on the basis of gender and financial pressure were also identified. Caregiving was more strongly associated with the preference to remain employed for men (OR = 0.2.54, p < 0.01) than women (OR = 1.03, ns) and person-job fit was more strongly associated with the preference to remain employed for women (OR = 1.64, p < 0.001) than men (OR = 0.91, ns). Work-life conflict was more strongly associated with the preference to leave employment for those reporting limited financial pressure (OR = 0.60, p < 0.001) compared to those in poorer financial circumstances (OR = 0.87, ns). These findings suggest that organizational age management policies should focus on both established and emerging factors, particularly the provision of flexible working conditions and improving the psychosocial work environment. However, such efforts should carefully consider the different needs of men and women, and those under varying levels of financial stress. With respect to government policy to promote employment participation, the findings support a stronger focus on improving physical and psychosocial work conditions rather than increasing the pension eligibility age. This may require further collaboration between government and employers.

Background: People with chronic knee pain may opt to continue to work without seeking specific ergonomic adaptations or disclose the existence or severity of their pain to work colleagues or supervisors due to the pressures of maintaining employment. To gain a deep personal perspective on how people with chronic knee pain cope while working [7, 8, 17, 18], qualitative research methods are a useful way of in encouraging meaningful discussion amongst workers with chronic knee pain of potential work-related strategies to minimize their work-related disability. Objective: To conduct an in-depth exploration of the impact of chronic knee pain on the working life of selected individuals. The specific aim was to identify barriers and enablers for promoting sustainable work within the work environment following the methodological principles from grounded theory. Method: Eleven workers with chronic knee pain participated in one of three focus groups (age range 51–77 years). All focus group sessions were audiotaped and transcribed verbatim. Two researchers independently identified themes around the common challenges for continuing employment among older people with chronic knee pain. Results: The main themes expressed in these focus groups were: 1) the effect of knee pain on work productivity, 2) strategies to improve work productivity, and 3) future suggestions about sustainable work for older people with chronic knee pain. New insights gained from the focus groups included the extent of physical limitations due to chronic knee pain, lack of ergonomic policies within the workplace, types of work transitions utilized to accommodate knee pain, complexity of disclosure, social support at work, and the unpredictability of future arthritis progression. Conclusion: This research suggests that in providing the appropriate work environment to enable individuals with knee pain to continue to be productive members of society, workplace strategies are needed to minimize the stigma and encourage communication about chronic knee pain, as well investment in appropriate ergonomic support equipment.

Purpose Improved mammographic sensitivity is associated with reduced mammographic density. This study aims to: provide a preliminary report on mammographic density among women in Riyadh; identify risk factors associated with mammographic density; and consider the potential implications for screening practices. Methods Based on a cross-sectional design, we examined a total of 792 women using an area-based mammographic density method (LIBRA). Spearman's correlation, Mann-Whitney U, Kruskal–Wallis and binary logistic regression were used for analyses. Results The study population had a mean age of 49.6 years and a high proportion of participants were overweight or obese (90%). A large number of women had low mammographic density, with a mean dense breast area of 19.1 cm2 and percent density of 10.3 cm2. Slightly more than half of the variations in the dense breast area and percent density models were explained by BMI. In the adjusted analyses, BMI, menopausal status, age at menarche and number of children remained statistically significant predictors. Conclusion Given the high proportion of women with low mammographic density, our findings suggest that women living in Riyadh may not require additional imaging strategies beyond mammography to detect breast cancers. The high proportion of obese women reported here and across Saudi Arabia suggests that mammographic density is less likely to have an adverse impact on mammographic sensitivity. Thus and to improve clinical outcomes among Saudi women, annual mammography and commencing screening at a younger age are suggested. Additional studies are required to shed further light on our findings.

Background Whiplash is a health and economic burden worldwide. Contributing to this burden is poor guideline adherence and variable management by health care professionals (HCPs). Web-based tools that facilitate clinical pathways of care are an innovative solution to improve management. Objective The study aimed to develop, implement, and evaluate a Web-based tool to support whiplash management following a robust process. Methods This study followed the first 3 processes of a research translation framework (idea generation, feasibility, and efficacy) to inform the development, implementation, and evaluation of a website that supports HCPs in whiplash management. Development followed the idea generation and feasibility processes to inform the content, design, features, and functionality of the website. This involved stakeholder (eg, industry partners, website developers, and HCPs) consultations through face-to-face meetings, surveys, and focus group discussions. Implementation followed the feasibility process to determine the practicality of the website for clinical use and the most effective strategy to promote wider uptake. Implementation strategies included classroom education, educational meetings, educational outreach, reminders, and direct phone contact. The analysis of website use and practicality of implementation involved collection of website metrics. Evaluation followed the feasibility and efficacy processes to investigate the acceptability and extent to which the website assisted HCPs in gaining knowledge about whiplash management. Surveys were conducted among student, primary, and specialist HCPs to explore ease of access, use, and satisfaction with the website, as well as self-rated improvements in knowledge of risk assessment, management, and communication between HCPs. Website logs of specialist management decisions (eg, shared care, specialist care, and referred care) were also obtained to determine actual practice. Results The development process delivered an interactive, user-friendly, and acceptable website, My Whiplash Navigator, tailored to the needs of HCPs. A total of 260 registrations were recorded from June 2016 to March 2018, including 175 student, 65 primary, and 20 specialist HCPs. The most effective implementation strategies were classroom education for students (81% uptake, 175/215) and educational meetings for primary HCPs (43% uptake, 47/110). Popular pages visited included advice and exercises and risk assessment. Most HCPs agreed that their knowledge about risk management (79/97, 81%) and exercises (85/97, 88%) improved. The specialists’ most common management decision was shared care, an improvement from a previous cohort. Areas to improve were navigation and access to outcome measures. Conclusions A robust process resulted in an innovative, interactive, user-friendly, and acceptable website, the My Whiplash Navigator. Implementation with HCPs was best achieved through classroom education and educational meetings. Evaluation of the website showed improved knowledge and practice to be more consistent with a risk-based clinical care pathway for whiplash. The positive results provide sufficient evidence to scale implementation nationally and involve other target markets such as people with whiplash, insurers, and insurance regulators.