[Acupuncture in stroke]. / Akupunktur ved hjerneslag.

In 1995 we reported that acupuncture treatment of stroke patients in the subacute stage resulted in added therapeutic benefit. The purpose of the present study was to determine, one year after discharge from the rehabilitation centre, whether the treatment continued to have effect. Initially, 45 stroke patients were included in the study; median 40 days post stroke. The patients were randomized into two groups; one acupuncture group and one control group, taking into considering the patients' sex and the actual site of the lesion. All subjects received an individually adapted, multidisciplinary rehabilitation programme. The acupuncture group received additional treatment with classical acupuncture for six weeks. The patients were thereafter given individual treatment at the rehabilitation centre and then under the primary health care service. 41 of the patients were available for further study one year after treatment ended; 21 patients from the acupuncture group and 20 from the control group. The results show that there was a significantly greater improvement in the acupuncture group than in the control group, both during the six-week treatment period, and even more so during the following year. These assessments were based on the Motor Assessment Scale, the Sunnaas Index of Daily Living (ADL), the Nottingham Health Profile and the patients' social circumstances.

A one year follow-up study on the effects of acupuncture in the treatment of stroke patients in the subacute stage: a randomized, controlled study.

OBJECTIVE: We recently reported that acupuncture treatment of stroke patients in the subacute stage gave additive therapeutic benefit. The purpose of the present study was to determine, approximately one year after discharge from the rehabilitation hospital, whether the group differences still remained. DESIGN: The patients were randomized into two groups: one acupuncture group and one control group, considering gender and side of hemispheral localization of lesion. With regard to the main parameters the groups were comparable at baseline. SETTING: Initially, 45 stroke patients admitted to Sunnaas Rehabilitation Hospital were included in the study: median 40 days post stroke. SUBJECTS: Forty-one of the patients were available one year after the treatment period: 21 patients in the acupuncture group and 20 controls. INTERVENTION: All subjects received an individually adapted, multidisciplinary rehabilitation programme. The acupuncture group received additional treatment with classical acupuncture for 30 min three to four times weekly for six weeks. MAIN OUTCOME MEASURES: The patients were evaluated at inclusion, after six weeks and approximately 12 months after discharge from the rehabilitation hospital. The Motor Assessment Scale (MAS) for stroke patients, Sunnaas Index of Activity of Daily Living (ADL) and Nottingham Health Profile (NHP) were used. In addition, the social situations of the patients were recorded at one year follow-up. RESULTS: The results show that the acupuncture group improved significantly more than the controls, both during the treatment period of six weeks, and even more during the following year, both according to MAS, ADL, NHP and the social situation. CONCLUSION: Although the mechanism of the effects is debatable, there seems to be a positive long-term effect of acupuncture given in the subacute stage post stroke.

[Norwegian physicians and alternative medicine. Knowledge, attitudes and experiences]. / Norske leger og alternativ medisin. Kunnskaper, holdninger og erfaringer.

1272 members of the Norwegian Medical Association took part in a survey on knowledge about, attitudes towards and experience of acupuncture, reflexology, healing, homoeopathy and herbalism. The response rate was 91%. Knowledge about these five complementary methods of treatment was poor, particularly in regard to reflexology, healing and herbalism. Four out of five physicians, on the other hand, felt that they needed such knowledge to put them in a position to inform their patients. Furthermore, the physicians' attitudes were also fairly negative, except towards acupuncture. Only 4-11% regarded homoeopathy, reflexology or healing as valuable supplements to scientific medicine. 9% of the physicians had undergone acupuncture, and 4% practised this method. 65% referred their patients to acupuncture. Experience of the other four methods was less common. Poor knowledge and limited experience put Norwegian physicians in a weak position in the debate about complementary methods of treatment.

[Research in alternative medicine. What is documented, and what is documentation?]. / Forskning i alternativ medisin. Hva er dokumentert, og hva er dokumentasjon?

A study of the literature describing research on alternative medicine showed that, in general, the research was of poor quality. Any clinical effect of kinesiology had not been documented. Only few studies on reflexology had been controlled. Several controlled studies on healing showed significant effect, mainly in patients with psychosomatic disorders, or when the patient had great faith in the healer. Acupuncture seems to be effective against nausea, in patients with chronic pain and in patients who have had stroke. The data do not support the claim that acupuncture is effective for asthma or addiction. In the case of homeopathy the evidence from clinical trials is positive but not sufficient to draw a definite conclusion, for example, is it better than placebo? The majority of studies seems to disregard the principle of homeopathy, i.e. that the treatment should be individualised. Even if the documented effect of alternative medicine is not convincing, the effect is favourable empirically and may in itself be sufficient to give practitioners of alternative medicine an authorization. The term "alternative medicine" should be replaced by "complementary medicine".

Side-effects of chiropractic spinal manipulation: types frequency, discomfort and course.

OBJECTIVE: To make a preliminary appraisal of the types of unpleasant reactions reported by patients after spinal manipulation and to estimate their frequency. STUDY DESIGN: Standardized interview data collected in a longitudinal survey. METHOD: Ten chiropractors collected data on all unpleasant reactions that were reported after a maximum of six visits by ten consecutive patients per chiropractor, with the use of a questionnaire that contained mainly closed-ended questions. RESULTS: Following 368 treatments in 95 patients, some type of side-effect was reported after 1/3 of treatments. Local or radiating symptoms were most commonly reported (23%). No alarming events were reported. Ninety percent of all reactions were graded by the patients as moderate or slight. They commenced on the day of therapy in 87% of cases, and had disappeared within 24 hours in 83%. CONCLUSION: Results from this preliminary study indicate that reactions to spinal manipulation may be relatively common but benign in nature and of short duration. No estimate could be made of rare or serious side-effects.

[Changing market for Oslo physicians. Justification for and consequences of changes in agreements]. / Legemarkedet i Oslo i forandring. Begrunnelser for og konsekvenser av endringer i avtaleforhold.

During the 1970s the number of salaried general practitioners in Oslo rose to approximately half of all general practitioners in the city. However, during the last ten years, increasing differences in wages between general practitioners on salary and fee-for-service general practitioners has led to difficulties in recruiting doctors to salaried positions. As a result many doctors have negotiated new contracts with the sub-municipalities of Oslo, a typical arrangement being a combination of fee-for-service payment for work with patients and a fixed salary for one or two days per week for work in nursing homes and mother-and-child clinics. General practitioners in four sub-municipalities of Oslo reported better opportunities for recruiting staff, greater autonomy and higher income as the main driving forces behind the changes. The increase in income has indeed been formidable, approximately NOK 100,000-200,000 per year, depending on the specific contract. The number of consultations has increased substantially in centres where general practitioners have switched to fee-for-service payment and waiting lists have been eliminated, partly as a consequence of higher turnover of consultations, and partly because of fewer vacant posts. The economic consequences to the municipalities are more uncertain, and the experiences of auxilliary staff in regard to the charges that have occurred are mixed.

[Acupuncture therapy in stroke during the subacute phase. A randomized controlled trial]. / Akupunkturbehandling ved hjerneslag i subakutt fase. En randomisert kontrollert studie.

The aim of this study was to investigate whether acupuncture treatment, if given to stroke patients in subacute phase in addition to rehabilitation would influence motor function, activity of daily living (ADL) and quality of life. After obtaining informed consent, 45 patients (median age 57 years) were randomised into a control group (n = 21) and an acupuncture group (n = 24). Median time from onset of stroke to inclusion in the study was 40 days. The inclusion criterion was hemiparesis following a first-ever stroke. When included and six weeks later all patients were evaluated by three measurement systems: the Motor Assessment Scale for stroke patients, Sunnaas Index of ADL and Nottingham Health Profile. All patients underwent individually adapted rehabilitation therapy. The patients in the treatment group were given classical acupuncture three to four times a week for six weeks, each session lasting 20-30 minutes. Both groups improved significantly in motor function and ADL. However, improvement was significantly greater among the acupuncture group than among the controls. Only the acupuncture group rated a significantly improved quality of life. Our results indicate that acupuncture gives an additive therapeutic benefit when given to stroke patients during their rehabilitation programme in the subacute phase.

Effect of homoeopathy on pain and other events after acute trauma: placebo controlled trial with bilateral oral surgery.

OBJECTIVE: To examine whether homoeopathy has any effect on pain and other inflammatory events after surgery. DESIGN: Randomised double blind, placebo controlled crossover trial with "identical" oral surgical procedures performed on two separate occasions in 24 patients. INTERVENTIONS: Treatment started 3 hours after surgery with either homoeopathy or placebo. MAIN OUTCOME MEASURES: Postoperative pain and preference for postoperative course assessed by patients on visual analogue scales. Measurements of postoperative swelling and reduction in ability to open mouth. Assessment of bleeding after surgery. RESULTS: Pain after surgery was essentially the same whether treated with homoeopathy or placebo. Postoperative swelling was not significantly affected by homoeopathy, but treatment tended to give less reduction in ability to open mouth. No noticeable difference was seen in postoperative bleeding, side effects, or complaints. Thirteen of the 24 patients preferred the postoperative course with placebo. CONCLUSIONS: No positive evidence was found for efficacy of homoeopathic treatment on pain and other inflammatory events after an acute soft tissue and bone injury inflicted by a surgical intervention. Differences in the order of 30% to 40% would have been needed to show significant effects.

Vegetarian diet for patients with rheumatoid arthritis--status: two years after introduction of the diet.

We have previously reported that a significant improvement can be obtained in rheumatoid arthritis patients by fasting followed by an individually adjusted vegetarian diet for one year. The patients who changed their diet could be divided into diet responders and diet nonresponders. After the clinical trial the patients were free to change diet or medication and after approximately one year they were asked to attend a new clinical examination. We compared the change from baseline (i.e. at the time of study entry) to the time of the follow-up examination for diet responders, diet nonresponders and controls who ate an omnivorous diet. The following variables favoured diet responders: pain score, duration of morning stiffness, Stanford Health Assessment Questionnaire index, number of tender joints, Ritchie's articular index, number of swollen joints, ESR and platelet count [corrected]. The difference between the three groups were significant for all the clinical variables, except for grip strength. There was no significant difference between the groups with regard to laboratory or anthropometric variables. At the time of the follow-up examination all diet responders but only half of the diet nonresponders still followed a diet. Our findings indicate that a group of patients with rheumatoid arthritis benefit from dietary manipulations and that the improvement can be sustained through a two-year period.

[Effect of Arnica D 30 during hard physical exertion. A double-blind randomized trial during the Oslo Marathon 1990]. / Effekt av Arnica D 30 ved hard fysisk anstrengelse. En dobbeltblind randomisert undersøkelse under Oslo Maraton 1990.

The effect of Arnica Montana on stiffness, restitution time and cell damage during hard physical exercise was evaluated in a randomized double blind trial during the Oslo Marathon. 36 participants were randomized: one group received Arnica 10(-30) five pills twice daily for five days, starting the day before the event. The other group received placebo pills. Blood tests were carried out before and immediately after finish, and after 48 and 72 hours. Stiffness was evaluated on a visual analogue scale after finish and on the next three days. There was no difference between the groups as regards ALAT, ASAT, GT, LD, creatinine, haptoglobin or magnesium. CK increased in both groups, but to a higher level in the placebo group. The difference was greatest on the second day (p = 0.07). A feeling of stiffness was more pronounced in the placebo group on all four occasions (p = 0.06 and 0.07 on day 2 and 3). There was no indication that Arnica reduced the time of restitution.

Continuity of care: influence of general practitioners' knowledge about their patients on use of resources in consultations.

OBJECTIVE: To examine the relation between general practitioners' knowledge about their patients and the use of resources in consultations. DESIGN: A cross sectional evaluation of consultations. SETTING AND SUBJECTS: A representative sample of 133 Norwegian general practitioners were each asked to record 30 consecutive consultations. 131 did so, and of 3990 possible registrations, 3918 (98%) were evaluated. MAIN OUTCOME MEASURES: The influence, as assessed by the doctor, of accumulated knowledge on the use of laboratory tests, expectant management, prescriptions, sickness certification, referrals, and time spent in the consultation. RESULTS: Accumulated knowledge was a substantial factor in saving time, especially in consultations with children, the elderly, patients with psychosocial problems, and those with chronic diseases. It also influenced the overall use of laboratory tests, expectant management, sickness certification, and referrals, and to a lesser degree the use of medication. CONCLUSION: The findings imply strong but complex associations between accumulated knowledge and the use of resources in the consultation.

Controlled trial of fasting and one-year vegetarian diet in rheumatoid arthritis.

Fasting is an effective treatment for rheumatoid arthritis, but most patients relapse on reintroduction of food. The effect of fasting followed by one year of a vegetarian diet was assessed in a randomised, single-blind controlled trial. 27 patients were allocated to a four-week stay at a health farm. After an initial 7-10 day subtotal fast, they were put on an individually adjusted gluten-free vegan diet for 3.5 months. The food was then gradually changed to a lactovegetarian diet for the remainder of the study. A control group of 26 patients stayed for four weeks at a convalescent home, but ate an ordinary diet throughout the whole study period. After four weeks at the health farm the diet group showed a significant improvement in number of tender joints, Ritchie's articular index, number of swollen joints, pain score, duration of morning stiffness, grip strength, erythrocyte sedimentation rate, C-reactive protein, white blood cell count, and a health assessment questionnaire score. In the control group, only pain score improved score. In the control group, only pain score improved significantly. The benefits in the diet group were still present after one year, and evaluation of the whole course showed significant advantages for the diet group in all measured indices. This dietary regimen seems to be a useful supplement to conventional medical treatment of rheumatoid arthritis.

[Nausea in cancer patients. An analysis of its frequency and an evaluation of the treatment of nausea]. / Kvalme hos kreftpasienter. En analyse av forekomst og vurdering av kvalmebehandlingen.

Frequency of nausea was investigated during the last six months of life of 342 patients who died from cancer in 1987. 44% received antiemetic treatment, but only 2% obtained complete relief. There was a close connection between opiate treatment, cytostatic treatment and nausea. The highest frequency of nausea was found among patients with gastrointestinal and ovarian cancer, whilst the lowest frequency was found in the prostate cancer group. We discuss antiemetic treatments in this connection.

[Pain treatment of patients with cancer]. / Smertebehandling av kreftpasienter.

In Vestfold, with a population of 192,200, all patients who died from cancer in 1987 were followed retrospectively through their last six months. 61% (n = 342) had cancer-related pain and received analgesic treatment. In 9% pain remained a problem. In the same group, 74% suffered from other symptoms, such as nausea, dyspnoea, anxiety and depression. These symptoms were reduced efficiently in only 58%. Nausea was the main problem. We found a significant connection between nausea, chemotherapy and opiate treatment. Anxiety and depression were recognised in about 20% of the patients, and were seldom adequately relieved. In order to provide optimal quality of life, more attention should be drawn not only to pain but also to the other symptoms.

Clinical examination of medical students in general practice.

As a trial a group of medical students underwent an oral examination in general practice. The results from the trial period are discussed, and the conclusion is that oral examination in a general practice setting is feasible and valid, but also time-consuming. It is suitable for testing the students' skills in communication and problem-solving, but also allows the testing of attitudes and knowledge.

[Oral contraceptives and prodromal symptoms in fatal pulmonary embolism in young women]. / P-piller og prodromalsymptomer ved fatal lungeemboli hos unge kvinner.

PIP: 8 fatal cases of thromboembolism complications among young users of contraceptive pills have been reported in Norway during the period 1978-1984. 5 of these died of lung embolisms. The average age was 24 years (18-33). 4 of the 5 experienced symptoms which can have been precursors of lung emboli: increasing pains low in the chest and dyspnea, especially upon exertion. It is important that pill users be informed adequately about symptoms of thromboembolism reactions and that such complications be suspected in all pill users who complain of these symptoms.^ieng