Asymptomatic COVID-19 with ambiguous test results. / Asymptomatisk covid-19 med usikre testresultater.

BACKGROUND: Testing for SARS-CoV-2 using polymerase chain reaction (PCR) and SARS-CoV-2 antibody tests is a significant part of the effort to combat the COVID-19 pandemic. Mass testing of healthy individuals raises several issues, however, and the results can be challenging to interpret. CASE PRESENTATION: A healthy 19-year-old man entered the military after two weeks of quarantine. The recruit had no respiratory symptoms or fever before, during or after his enrolment, and no history of SARS-CoV-2 exposure. At enrolment, he had a positive rapid test and a venous blood sample showed antibodies against SARS-CoV-2. PCR tests of specimens obtained from the upper respiratory tract were negative at enrolment and at week three, but were positive at week six. INTERPRETATION: The overall assessment of all the tests indicates a probable asymptomatic infection. This case report illustrates the challenge of interpreting screening results in asymptomatic individuals.

Correction to: Complementary and alternative medicine for treatment of atopic eczema in children under 14 years old: a systematic review and meta-analysis of randomized controlled trials.

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Placebo by proxy expectations toward acupuncture change over time: a survey comparing parental expectations to acupuncture pre- and postoperatively.

BACKGROUND: Patients entering a treatment have expectancy to outcome based on their previous experience, the information received, and the credibility of the treatment. Once the treatment has started, patients may detect and interpret contextual cues and somatic state. Influenced and conditioned by positive or negative interpretations, their reappraisal may improve or worsen the treatment outcome. The aims were to investigate whether parental pre-treatment expectancies towards acupuncture differ compared to post-treatment expectancies, and assess predictors for possible change of parental expectancy. Further, we wanted to explore whether the change correlates with the treatment outcome, i.e. postoperative vomiting in children. METHODS: Two hundred and eighty-two parents completed per- and 24 h postoperatively a survey on their expectancy to acupuncture treatment for alleviation of postoperative vomiting in children. The survey was embedded in a randomised controlled trial. RESULTS: Parental expectancy to acupuncture treatment changed over time. The changes were predicted by several variables such as children's gender, parents' age and education, previous experiences, and assignment to treatment group. The strongest predictor was parental anxiety to their child undergoing surgery. Further, the change of parental expectancy was correlated with postoperative vomiting. CONCLUSIONS: Anxious parents are prone to change their expectancy in a positive direction during the treatment period, which in turn may improve treatment outcome. Acupuncture therapists in clinical practice should pay a special attention to the potential that lies here, and acknowledge parental anxiety as a possible facilitator, and not a barrier, to elicit placebo by proxy effects. Further research to expand the findings of the present study into other treatments is in order. Future research should also provide more knowledge about how parental expectancy changes over time, and how different factors predict and produce change of parental expectancy. TRIAL REGISTRATION: ClinicalTrials.gov NCT01729052 . Registered November 20, 2012.

Prevalence and reasons for intentional use of complementary and alternative medicine as an adjunct to future visits to a medical doctor for chronic disease.

BACKGROUND: Intentional use of complementary and alternative medicine (CAM) has previously only been researched in small, possibly biased, samples. There seems to be a lack of scientific information regarding healthy individual's attitudes and presumed use of CAM. The aim of this study is to describe prevalence and characteristics of participants who intend to see a CAM provider compared to participants who intend to see a medical doctor (MD) only when suffering from a chronic, non- life-threatening disease and in the need of treatment. Further to describe differences between the groups regarding expected reasons for CAM use and expected skills of CAM providers. METHOD: The survey was conducted in January 2016 as part of the "TNS Gallup Health policy Barometer". In total, 1728 individuals aged 16-92 years participated in the study, constituting an overall response rate of 47%. The survey included questions regarding opinions and attitudes towards health, health services and health politics in Norway. RESULTS: The majority of the participants (90.2%) would see a MD only if they were suffering from a chronic, non- life-threatening disease and were in the need of treatment. Men over the age of 60 with a university education tended to see a MD only. Only 9.8% of all respondents would in addition visit a CAM provider. Being an intentional user of a MD + CAM provider was associated with being a woman under the age of 60. The respondents believed that CAM providers have professional competence based on formal training in CAM. They also believed that individuals seeing a CAM provider have poor health and are driven by the hope of being cured. Further, that they have heard that others have good experience with such treatment. CONCLUSION: Intentional use of CAM is associated with positive attitudes, trustworthiness, and presumed positive experiences in the CAM-patient-setting. Intentional CAM users also have the impression that CAM providers have professional competence based on formal training in alternative therapies.

Complementary and alternative medicine for treatment of atopic eczema in children under 14 years old: a systematic review and meta-analysis of randomized controlled trials.

BACKGROUND: Due to limitations of conventional medicine for atopic eczema (AE), complementary and alternative medicine (CAM) is widely used as an alternative, maintaining, or simultaneous treatment for AE. We aimed to evaluate the beneficial and harmful effects of CAM for children with AE under 14 years old. METHODS: We searched for randomized trials on CAM in 12 Chinese and English databases from their inception to May 2018. We included children (< 14 years) diagnosed with AE, who received CAM therapy alone or combined with conventional medicine. We extracted data, and used the Cochrane "Risk of bias" tool to assess methodological quality. Effect was presented as relative risk (RR) or mean difference (MD) with 95% confidence interval (CI) using RevMan 5.3. RESULTS: Twenty-four randomized controlled trials involving 2233 children with AE were included. Methodological quality was of unclear or high risk of bias in general. The trials tested 5 different types of CAM therapies, including probiotics, diet, biofilm, borage oil, and swimming. Compared to placebo, probiotics showed improved effect for the SCORAD index (MD 9.01, 95% CI 7.12-10.90; n = 5). For symptoms and signs such as itching, skin lesions, CAM combined with usual care was more effective for symptom relief ≥95% (RR 1.47, 95% CI 1.30-1.68; n = 8), and for ≥50% symptoms improvement (RR 1.34, 1.25-1.45; n = 9) compared to usual care. There was no statistic significant difference between CAM and usual care on ≥95% improvement or ≥ 50% improvement of symptoms. However, swimming, diet and biofilm showed improvement of clinical symptoms compared with usual care. At follow-up of 8 weeks to 3 years, CAM alone or combined with usual care showed lower relapse rate (RR 0.38, 0.28-0.51, n = 2; RR 0.31, 0.24-0.40, n = 7; respectively) compared to usual care. Twelve out of 24 trials reported no occurrence of severe adverse events. CONCLUSIONS: Low evidence demonstrates that some CAM modalities may improve symptoms of childhood AE and reduce relapse rate. Safety remains unclear due to insufficient reporting. Further well-designed randomized trials are needed to confirm the potential beneficial effect and to establish safety use.

Frostbite in the Norwegian Armed Forces. / Frostskader i Forsvaret.

BAKGRUNN: Det finnes lite forskning på forekomst av frostskader, både sivilt og militært. Prognosen og tidsforløpet ved slike skader har ikke tidligere vært undersøkt i større kohorter. MATERIALE OG METODE: Deltagerne var personer registrert i Forsvarets helseregister med kulde- og frostskade i tidsrommet 1.1.2010-31.12.2014. Data om diagnostikk, forløp og behandling ble innhentet fra i alt 460 personer ved hjelp av et spørreskjema. Svarprosenten på undersøkelsen var 66. RESULTATER: 397 av 460 personer (86,3 %) som var registrert med frostskade i Forsvarets helseregister bekreftet at de hadde hatt en kulde- og frostskade. 123 av 397 personene som svarte (30,1 %) anga at de hadde hatt blemmer, noe som gir mistanke om at de hadde pådratt seg annengrads frostskade. 225 av 397 (56,7 %) anga at de hadde hatt frostskade, men ikke blemmer. De aller fleste fikk frostskaden under feltøvelse/vinterøvelse (81,1 %), og ⅔ av de som pådro seg skader var vernepliktige. Langt de fleste hadde skader på fingre/hender eller tær/føtter (96,0 %). To av tre (69,8 %) hadde fortsatt plager fra sin frostskade mer enn to år etter skadetidspunktet. FORTOLKNING: Mange i militæret pådrar seg frostskader under tjenestegjøring. En femdel anga kroniske helseplager som påvirker arbeidsevnen. Kunnskap om forekomsten av frostskader hos militært mannskap er viktig for Forsvarets videre skadeforebyggende arbeid.

Alternative treatment and grey areas. / Alternativ behandling og gråsoner.

Links are made in the media these days between alternative treatment and various health-related activities such as shamanism, aesthetic medicine and health blogging, which have widely differing responsibilities, duties and rights. What does the term alternative treatment mean?

Acupuncture and related techniques in ambulatory anesthesia.

PURPOSE OF REVIEW: Along with a growing awareness of quality in healthcare, has come a focus on postanesthetic morbidities, which still remain challenging in our daily practice of anesthesia. Acupuncture and related techniques (acustimulation) are often suggested to be adequate treatments with low cost and minimal adverse effects. This review focuses on the current evidence and applicability of these techniques for use in ambulatory anesthesia. RECENT FINDINGS: Trials exploring the effects of acustimulation may produce ambiguous results and sometimes be difficult to evaluate. Controversies still remain as to the clinical relevance. Recent trials suggest that acustimulation may prevent postoperative pain, nausea and vomiting. There are also promising results for the use of the techniques in reducing preoperative anxiety, postoperative shivering and emergence delirium. SUMMARY: Pharmacological drug treatment may be only partially effective and produce an adverse event. Research suggests that acustimulation may alleviate postoperative morbidities, although the body of evidence of the effect is equivocal. The treatments are easy to perform, and adverse events and costs are minimal. It may be profitable to implement this beneficial treatment to asmbulatory patients.

Freezing cold injuries among soldiers in the Norwegian Armed Forces - A cross sectional study.

INTRODUCTION: Freezing cold injuries (FCI) are a common risk in extreme cold weather warfare operations. The Norwegian Armed Forces (NAF) have the expertise and capabilities in education and training for warfighting capabilities in the Arctic. Nevertheless, a substantial number of Norwegian soldiers sustain freezing cold injuries annually. The aim of this study was to describe the FCI in the NAF, the associated risk factors and clinical associations. METHODOLOGY: The subjects for the study were soldiers registered with FCI in the Norwegian Armed Forces Health Registry (NAFHR) between January 1st 2004-July1st 2021. The soldiers answered a questionnaire regarding background, activities at the time of injury, description of the FCI, risk factors, medical treatment and any sequelae from their FCI. RESULTS: FCI in the NAF were most frequently reported among young conscripts (mean20.5 years). Hands and feet are most often injured (90.9%). Only a minority (10.4%) received medical treatment. The majority (72.2%) report sequelae. Extreme weather conditions was the most important risk factor (62.5%). CONCLUSIONS: Most soldiers had the knowledge to avoid FCI, but they were injured anyway. It is concerning that only one in 10 injured soldiers received medical treatment after diagnosed with FCI, increasing the risk of FCI sequelae.

Human performance and medical treatment during cold weather operations - synthesis of a symposium.

In October 2022, the Human Factors and Medicine (HFM) panel of the NATO Science and Technology Organization convened a review of progress in military biomedical research for cold weather operations. This paper represents a summary of the research presentations and future directions. The importance of realistic training was an overarching theme. Many reported studies took advantage of cold weather training exercises to monitor soldiers' health and performance; these are valuable data, using winter exercises as a platform to gain further knowledge regarding human performance in the cold and represent an excellent extension of controlled laboratory studies. Topics also included prevention of Cold Weather Injuries (CWI); effects of cold weather stressors on cognitive function; field treatment of freezing cold injuries (FCI); and new consideration to injury and trauma care in the cold. Future work programmes re-emphasise development of cold weather training and establishment of consensus diagnostic criteria and treatments for FCI and non-FCI. CWI prevention should take advantage of biomathematical models that predict risk of CWI and provide guidance regarding optimal clothing and equipment and move from group averages to personalised predictions. The publication of selected presentations from the symposium in this special issue increases attention to military cold weather research.

Botulinum Toxin A in the treatment of frostbite sequelae - results from a blinded, early-phase, comparative trial.

INTRODUCTION: Freezing Cold Injuries (FCI) have been associated with long-term sequelae including vasospasm. The aims of the pilot study are to explore the research methodology and investigate the tolerability and safety of treatment with Botulinum Toxin-A (BTX-A) in FCI Sequelae. METHODOLOGY: This pilot study tests the logistics, the treatment setting and the follow-up procedure in an early-phase, double-blinded, randomized, controlled trial study-design. The variables in the study were subjective symptoms, peripheral micro-vascularization/rewarming, somatosensory responsiveness, and generic measure of health status. RESULTS: No major challenges or difficulties were noticed according to the protocol or the study methodology. The monitoring of tolerability and safety of treatment with BTX-A did not reveal any major unwanted and/or adverse reactions among the patients in the pilot study and no challenges occurred during data collection of endpoints. The study revealed an inaccuracy of the 2nd degree FCI diagnosis and uncover a need for relevant and sufficient clinical information for FCI classification. CONCLUSIONS: This pilot study showed the study methodology with minor adjustments is feasible in a future full-scale clinical trial. The recruitment process needs to be more refined to ensure that the eligible study participants are a homogenous group of FCI patients.

The classification of freezing cold injuries - a NATO research task group position paper.

INTRODUCTION: Freezing cold injuries (FCI) are a common risk in extreme cold weather operations. Although the risks have long been recognised, injury occurrences tend to be sparse and geographically distributed, with relatively few cases to study in a systematic way. The first challenge to improve FCI medical management is to develop a common nomenclature for FCI classification. This is critical for the development of meaningful epidemiological reports on the magnitude and severity of FCI, for the standardisation of patient inclusion criteria for treatment studies, and for the development of clinical diagnosis and treatment algorithms. METHODOLOGY: A scoping review of the literature using PubMed and cross-checked with Google Scholar, using search terms related to freezing cold injury and frostbite, highlighted a paucity of published clinical papers and little agreement on classification schemes. RESULTS: A total of 74 papers were identified, and 28 were included in the review. Published reports and studies can be generally grouped into four different classification schemes that are based on (1) injury morphology; (2) signs and symptoms; (3) pathophysiology; and (4) clinical outcome. The nomenclature in the different classification systems is not coherent and the discrete classification limits are not evidence based. CONCLUSIONS: All the classification systems are necessary and relevant to FCI medical management for sustainment of soldier health and performance in cold weather operations and winter warfare. Future FCI reports should clearly characterise the nature of the FCI into existing classification schemes for surveillance (morphology, symptoms, and appearance), identifying risk-factors, clinical guidelines, and agreed inclusion/exclusion criteria for a future treatment trial.

Publication status and reporting quality of case reports on acupuncture-related adverse events: A systematic reviews of case studies.

Introduction: Case reports on acupuncture-related adverse events (AEs) have been consistently published in the literature. This review aims to assess the current publication status of case reports on acupuncture-related AEs and evaluate their reporting quality in order to identify areas for improvement. Methods: This study is a systematic review (SR) of case reports. Studies describing cases for acupuncture-related AEs between 2010 and 2023 (until July) were searched in PubMed, Embase, and local databases (China and Korea), as well as by hand-searching references included in published relevant SRs. A bibliometric analysis was conducted to examine the publication trends of the included literature. The appropriateness of the acupuncture described in the cases, the causality assessment between AEs and acupuncture treatment, and the presence of necessary items from the CAse REport guidelines (CARE) checklist were narratively analyzed. Results: A total of 169 case reports were included in this review. Over the past decade, an average of 12 case reports on acupuncture-related AEs were published annually. However, only 38.2% of the articles provided sufficient information to determine the appropriateness of the acupuncture treatment used in the reported cases, and considerable numbers of the included case reports did not suggest enough information for the assessment of a causal relationship. The majority of cases did not report the timeline (n = 164), patient perspectives (n = 157), and informed consent (n = 121) items from the CARE checklist. Discussion: Acupuncture-related AEs persist in being frequently reported in the literature. Nonetheless, the information concerning acupuncture and causality assessment within these publications is still found to be insufficient. The development of reporting guidelines for future case reports on acupuncture-related AEs is anticipated to promote an academic environment conducive to more comprehensive reporting.

Reflexology for acute rhinosinusitis - Results from a blinded, early-phase comparative trial.

BACKGROUND: Reflexology is commonly used as an adjunct to conventional treatment by patients with respiratory tract infections. The effect of reflexology needs to be tested in a full-scale randomized controlled study. Small early-phase trials can give an indication on whether full-size clinical trials are warranted. The objective of this study is to determine whether the study design is feasible in a full-scale study of reflexology as an add-on to usual care compared to usual care alone in acute rhinosinusitis, and further if there is a statistical indication of an effect of reflexology warranting a full-scale study. METHODS: 20 patients with symptoms compatible with acute rhinosinusitis, and an illness duration of 28 days or less were randomized to additional reflexology treatment along with usual medical care, or usual care alone. The patients scored how much each of 16 sinus-related symptoms bothered them in the past few days on a six-point scale (zero = no problem to five = severe problem). To determine if there is a statistical indication of an effect of reflexology warranting a full-scale study, the separation test was used. RESULTS: The methodology was considered feasible and could therefore be applied in a full-scale study of reflexology for acute rhinosinusitis. The mean reduction in symptom score from baseline to day two was 0.95 in the reflexology group and 0.78 in the control group. From baseline to day ten the mean reduction in symptom score was 2.12 in the reflexology group and 1.63 in the control group. A statistical indication of effect in a full-scale study in favor of reflexology was found from baseline to day ten but not from baseline to day two. CONCLUSIONS: The research methodology in this study could be used in a full-scale study of reflexology in acute sinusitis. The results from the separation test indicates an effect warranting a full-scale study of reflexology regarding effects in acute sinusitis ten days after treatment.

Introduction: Training is more important than technology (for performance in the cold).

After more than 50 years of studying soldiers in the cold, we are well past the phase of defining the unique problems; the research requirements are known but the solutions have been slow in coming. This requires iterative testing of proposed lab-based solutions with soldiers in the real environment. Representing a renewed effort to produce and implement solutions to human biomedical challenges in Arctic operations, this journal supplement highlights presentations from a three-day NATO Human Factors and Medicine panel-sponsored symposium in Washington DC in October 2022. While technology can certainly aid soldiers in extreme environments, it is ultimately training that is the most important factor for ensuring optimal performance and survival. By investing in the development of specialized Arctic forces training and implementing new solutions to protect their health and performance, we can ensure success in the coldest and harshest of environments.

Abstracts from The Cold Weather Operations Conference 2021.

A common effort for both military and civil healthcare is to achieve knowledge-based health care in cold weather injuries and fatal accidents in harsh arctic environment. The Cold Weather Operations Conference in November 2021, having more than 300 participants from 20 countries, was addressing the prevention and treatment of injuries and trauma care in cold weather conditions and the challenges for military prehospital casualty care. The intention of the programme was to stimulate further research and systematic knowledge-based clinical work. The abstracts from the conference present cold weather research and clinical experience relevant for readers of the International Journal of Circumpolar Health.