Is acupuncture effective in the treatment of fibromyalgia?

BACKGROUND: We conducted this study to assess the effectiveness of acupuncture in the treatment of fibromyalgia syndrome (FMS), report any adverse effects, and generate hypotheses for future investigation. METHODS: We searched MEDLINE, EMBASE, Manual Therapy Information System, the Cochrane registry, the University of Maryland Complementary and Alternative Medicine in Pain, the Centralized Information Service for Complementary Medicine, and the National Institutes of Health Office of Alternative Medicine databases for the key words "acupuncture" and "fibromyalgia." Conference abstracts, citation lists, and letters supplemented the search. We selected all randomized or quasi-randomized controlled trials, or cohort studies of patients with FMS who were treated with acupuncture. Methodologic quality, sample characteristics, type of acupuncture treatment, and outcomes were extracted. Statistical pooling was not performed because of the differences in control groups. RESULTS: Seven studies (3 randomized controlled trials and 4 cohort studies) were included; only one was of high methodologic quality. The high-quality study suggests that real acupuncture is more effective than sham acupuncture for relieving pain, increasing pain thresholds, improving global ratings, and reducing morning stiffness of FMS, but the duration of benefit following the acupuncture treatment series is not known. Some patients report no benefit, and a few report an exacerbation of FMS-related pain. Lower-quality studies were consistent with these findings. Booster doses of acupuncture to maintain benefit once regular treatments have stopped have been described anecdotally but not investigated in controlled trials. CONCLUSIONS: The limited amount of high-quality evidence suggests that real acupuncture is more effective than sham acupuncture for improving symptoms of patients with FMS. However, because this conclusion is based on a single high-quality study, further high-quality randomized trials are needed to provide more robust data on effectiveness.     

Does the type of treatment supporter influence tuberculosis treatment outcomes in Zimbabwe?

Zimbabwe National Tuberculosis Guidelines advise that direct observation of anti-tuberculosis treatment (DOT) can be provided by a family member/relative as a last resort. In 2011, in Nkayi District, of 763 registered tuberculosis (TB) patients, 59 (8%) received health facility-based DOT, 392 (51%) received DOT from a trained community worker and 306 (40%) from a family member/relative. There were no differences in TB treatment outcomes between the three DOT groups, apart from a higher frequency rate of ‘no reported outcomes’ for those receiving family-based DOT. Family members should be trained to use a suitable DOT support package.     

Is the therapeutic alliance overvalued in the treatment of eating disorders?

In this article, we make the case for a systematic program of research into the causal relationship between the therapeutic alliance and outcomes of psychological treatments for the eating disorders. To make that case, we need to begin by considering the validity of existing assumptions about that alliance‐outcome relationship. We will then suggest what research is needed to allow clinicians to structure their work to best effect (e.g., should therapists focus on establishing a strong alliance even if it means not applying more therapy‐specific techniques, or should they stress the application of those techniques even when the working alliance might seem likely to be weakened as a result). Although the authors have a background in cognitive‐behavioral therapy (CBT), our aim is to suggest a research base that applies to a variety of psychotherapies, allowing for common or different conclusions about the alliance‐outcome relationship, depending on what the proposed research indicates. © 2013 Wiley Periodicals, Inc. (Int J Eat Disord 2013; 46:779–782)     

Effect of the Novel Polysaccharide PolyGlycopleX? on Short-Chain Fatty Acid Production in a Computer-Controlled in Vitro Model of the Human Large Intestine

Many of the health benefits associated with dietary fiber are attributed to their fermentation by microbiota and production of short chain fatty acids (SCFA). The aim of this study was to investigate the fermentability of the functional fiber PolyGlyopleX^® (PGX^®) in vitro. A validated dynamic, computer-controlled in vitro system simulating the conditions in the proximal large intestine (TIM-2) was used. Sodium hydroxide (NaOH) consumption in the system was used as an indicator of fermentability and SCFA and branched chain fatty acids (BCFA) production was determined. NaOH consumption was significantly higher for Fructooligosaccharide (FOS) than PGX, which was higher than cellulose (p = 0.002). At 32, 48 and 72 h, acetate and butyrate production were higher for FOS and PGX versus cellulose. Propionate production was higher for PGX than cellulose at 32, 48, 56 and 72 h and higher than FOS at 72 h (p = 0.014). Total BCFA production was lower for FOS compared to cellulose, whereas production with PGX was lower than for cellulose at 72 h. In conclusion, PGX is fermented by the colonic microbiota which appeared to adapt to the substrate over time. The greater propionate production for PGX may explain part of the cholesterol-lowering properties of PGX seen in rodents and humans.     

Does working in the agricultural sector affect the selection of a family planning method?

Seasonal farmworkers are one of the groups that should be examined in terms of family planning method because low socio-economic levels, limited accommodation, and living conditions in agricultural areas can restrict workers' access to information and health services. The study was carried out to determine the effect of working environment in agriculture on female seasonal workers' choice of family planning method. This cross-sectional study was performed on 300 women. It was found that the working and living conditions in the agricultural sector forced women to change their family planning method.     

Public skepticism in Canadian healthcare: the real cause of inertia in the system?

Although Canada has not examined issue related to public trust in as much depth as the United States, we can assume that despite improvements in life expectancy, quality of life and infant mortality rates during the past 30 years, Canadians perceive their healthcare to have deteriorated over the last two decades. Should we worry about this phenomenon, and can anything be done about it?     

Cyanamide or disulfiram in the treatment of adolescent alcohol misusers?

The Randomised Controlled Trial by Niederhofer et al.(2003)describing the successful use of cyanamide in a group of alcohol-misusingadolescents, is further and convincing evidence of the effectivenessof deterrent or antagonist medication in the management of sometypes of substance     

Effect of moderate maternal malnutrition on the levels of alkaline ribonuclease activity in the human placenta†

Ribonuclease (RNAse) activity was measured in placentas from a sample of 49 urban Guatemalan women from low (30) and high (19) socioeconomic status (SES). Low SES women had a larger proportion (40%) of high levels of RNAse (> 60,000 units/g) than women from the high SES group (5 %). A trend to inverse association (p = 0.06) was also observed between amount of supplemented food energy during pregnancy and RNAse activity in rural populations covered by two food supplementation programs (protein energy and energy). Two indicators of maternal nutrition, third trimester weight and height, also showed inverse associations with placental RNAse activity. It is inferred from these results that improved maternal nutrition decreases placental RNAse activity. Moreover, high levels of placental RNAse activity were associated, up to 36 months of age, with higher proportions of: physical growth retardation in weight, height and head circumference; below‐average psychological test performance; and infant deaths. These results deserve consideration from both the physiological and public health points of view.     

The Effect of the Interaction between Obesity and Drinking ?on Hyperuricemia in Japanese Male Office Workers

Background

Obesity and drinking are acknowledged risk factors for hyperuricemia. However, the effect of the interaction between obesity and drinking on hyperuricemia is not well understood.

Methods

The cases comprised 3028 male office workers with hyperuricemia (serum uric acid level ≥7.0 mg/dL); the controls were 5348 men with a serum uric acid level less than 6.0 mg/dL. Logistic regression analysis was used to assess risk factors for hyperuricemia and the interaction between obesity and drinking in hyperuricemia. Participants were divided into 2 groups according to their BMI: individuals with a BMI of 25 or higher were classified as obese and those with a BMI less than 25 were classified as non-obese. In addition, participants were divided into 5 groups based upon their ethanol consumption. The 2 variables were then combined to create 10 groups.

Results

With non-obese non-drinkers as the reference category, the odds ratio for hyperuricemia was 1.80 for non-obese drinkers of less than 25 mL/day of ethanol, 2.15 for non-obese drinkers of 25–49 mL/day, 2.60 for non-obese drinkers of 50–74 mL/day, 2.56 for non-obese drinkers of 75+ mL/day, 4.40 for obese non-drinkers, 5.74 for obese drinkers of less than 25 mL/day, 6.57 for obese drinkers of 25–49 mL/day, 5.55 for obese drinkers of 50–74 mL/day, and 7.77 for obese drinkers of 75+ mL/day. The interaction between obesity and drinking in hyperuricemia was statistically significant.

Conclusion

Our results suggest that although combining the effects of obesity and drinking did not result in a multiplicative increase in the risk for hyperuricemia, the combined risk was greater than the sum of the effects of obesity and drinking.Key words: drinking, epidemiology, hyperuricemia, interaction, obesity     

The impact of second-line agents on patients’ health-related quality of life in the treatment for non-small cell lung cancer: a systematic review

Purpose

In advanced non-small cell lung cancer (NSCLC), progressive disease burdens patients considerably. Second-line (2L) chemotherapy improves survival marginally but humanistic outcomes (i.e., quality of life, QOL) are underreported. The impact of 2L therapy remains an important consideration for patients and caregivers, and there have been QOL reviews for 1L, but not 2L, therapies. This review assessed QOL outcomes of approved, guideline-supported 2L chemotherapy with docetaxel, erlotinib, gefitinib, and pemetrexed in advanced NSCLC.

Methods

Clinical trial reports of approved, guideline-supported 2L or maintenance therapy for NSCLC published from 2000 to 2010 were identified from PubMed/Medline and clinical meetings. Outcomes were stratified by overall QOL impact, domain/symptom-specific effects, effect over time, and subgroup effects.

Results

Of 145 studies identified, 24 full-text articles were retained. Studies with docetaxel versus best supportive care (n = 1) and active comparators (n = 4) reported non-significant overall QOL improvements, as did studies of gefitinib versus placebo and active comparator (n = 7). Overall QOL improvements were seen for gefitinib versus docetaxel (n = 2) and gefitinib in a single-arm study (n = 1). At the symptom level, studies of docetaxel (n = 4/7), gefitinib (n = 7/9), and pemetrexed (n = 1) reported non-significant results. Subgroup analyses indicated improved QOL outcomes for gefitinib-treated responders versus non-responders, worse QOL for gefitinib-treated smokers versus placebo, worse QOL for gefitinib-treated Asian patients versus placebo, and longer time to symptom deterioration in erlotinib versus placebo-treated elderly patients.

Conclusions

Significant improvements in overall QOL with 2L chemotherapy for advanced NSCLC were infrequent. Single-arm studies and those with less toxic regimens more commonly provided statistically significant improvements in QOL outcomes. Methodological heterogeneity impedes cross-study QOL comparisons.     

Is the urban excess in lung cancer in Scotland explained by patterns of smoking?

Numerous studies have shown that lung cancer rates are higher in urban than rural areas, controlling for differences in age and sex profiles. One explanation is that smoking rates are higher in urban areas, although it is not clear whether the variations in smoking behaviour fully account for the observed urban/rural gradient in lung cancer incidence. Indeed, some studies have demonstrated an excess of cases in urban areas, even controlling for smoking behaviour. However, previous studies have been hampered by the lack of small-area smoking estimates which are required if urban/rural variations are to be examined reliably. This paper considers whether there is an urban excess in lung cancer incidence in Scotland, a country with particularly high rates of the disease, for the period 1988-1991. First, we examine whether an urban excess exists in Scotland using Poisson probabilities and a cluster detection technique. Second, regression analysis was then used to test whether any urban excess in lung cancer incidence remained once smoking behaviour was controlled for, using smoking estimates calculated for small areas throughout Scotland. The results demonstrate that the rates of lung cancer were higher in urban areas and that all the significant clusters of cases of lung cancer were located in the large urban centres of Scotland. Smoking behaviour did account for much of this urban excess in lung cancer, although it did not explain the entire effect. These results suggest that there are urban effects that influence the incidence of lung cancer that are not explained entirely by smoking behaviour. Possible explanations include the variations in exposure to air pollution, occupational differences and the legacy of selective migration between urban and rural areas.