Evaluation of a randomized preventive behavioural medicine work site intervention for public health workers at risk for developing chronic pain.

Because of the substantial increase of sick listing, reports of work disabilities and early retirement due to the musculoskeletal chronic pain, prevention studies at the work site are greatly needed. The purpose of the present study was to investigate the effects of a cognitive behavioural work site intervention on a group of public health workers judged to be at risk for developing chronic pain. Following baseline measurements, a group of 29 practical nurses with daily pain symptoms working at services for the elderly were randomized into two conditions: an active treatment based on cognitive behaviour therapy and a passive treatment based on traditional symptom alleviation. The two treatment conditions, provided by a registered nurse and a physical therapist, took place 30 min a week each once a week, on an individual basis for 4 weeks at the work site during work time. Results at 4 and 8 weeks and at 6, 12 and 24 month follow-ups showed improvements for those individuals receiving the active treatment with regard to the reduction of use of pain-killers, perception of one's self as being sick and the fear-avoidance response to work-related activities. A preliminary conclusion was that this short-term work site programme for the prevention of chronic pain for individuals at risk may be a promising development in the treatment of pain.

Oral terbinafine in toenail dermatophytosis. A double-blind, placebo-controlled multicenter study with 12 months' follow-up.

The treatment of onychomycosis has previously often been protracted and unsuccessful. Terbinafine has been shown to be effective in short-term regimens. In this double-blind, placebo-controlled study, 148 patients with toenail dermatophytosis were randomized to treatment with either 250 mg terbinafine daily or placebo for 3 months. An additional treatment was given for 3 months to patients whose infection had not responded. The patients were followed clinically and mycologically through 12 months. After 3 months 82% of the terbinafine-treated group, versus 5% of the placebo group, showed significant improvement, i.e. negative culture and growth of unaffected nail more than 2 mm (p = < 0.0001). After 12 months clinical and mycological cure was seen in 40% of the patients treated with terbinafine for 3 or 6 months, while 67-81% were clinically cured, but with positive microscopy. Side-effects occurred in 13.5% of the terbinafine group, versus 5.4% of the placebo group, and were mild. 250 mg terbinafine daily for 3 months was significantly more effective than placebo. The efficacy did not appear to improve with additional treatment for 3 months.

Patch test study with calcipotriol ointment in different patient groups, including psoriatic patients with and without adverse dermatitis.

One hundred and sixty-eight individuals (psoriatic patients treated with calcipotriol with dermatitis due to calcipotriol, psoriatic patients treated with calcipotriol with no dermatitis, psoriatic patients never treated with calcipotriol, patients with eczema and healthy volunteers) were patch-tested (Finn chambers, back, 48 h) with dilutions of calcipotriol ointment (50, 10, 2, 0.4 micrograms/g) and an ointment vehicle. Test evaluation was based on clinical scoring and various non-invasive measuring methods. Doubtful (?+) and weak (1+) reactions were common, irrespective of patient group and history. Moderate (2+) reactions were uncommon and with no increased frequency among psoriatic patients with adverse dermatitis during calcipotriol treatment. The blood flow of test sites measured by laser Doppler flowmetry was, however, increased in psoriatics, who developed dermatitis during calcipotriol treatment as an isolated finding. Furthermore a 1-week repeated open application test (ROAT) was performed on all subjects. None of the persons having a strong reaction in the patch test showed any dermatitis in the ROAT test, indicating that they were not sensitized. Calcipotriol was found to be a mild irritant of the non-corrosive type, i.e. with no influence on the skin barrier. Reactions were dominated by redness (increased laser Doppler flow and chroma a*) and only oedema formation in advanced reactions. The calcipotriol dose-irritation curve was found to be scattered. Calcipotriol induced no increase of transepidermal water loss (TEWL) versus the ointment vehicle, but the ointment vehicle itself increased TEWL. The special ointment vehicle needed for calcipotriol for stability reasons may itself be irritant and cause some impairment of the skin water barrier, with increase in TEWL values. Future patch test studies for calcipotriol allergy should not be done with this vehicle. The non-irritant threshold concentration of calcipotriol in an appropriate test vehicle is still unknown.

Milking machine function and analysis.

Milking system evaluation is facilitated by use of a pulsator recorder, airflow meter, and a vacuum stability gauge. The most important points of a milking system are vacuum, inflations, and pulsation. An evaluation sheet for milking systems as proposed by the National Mastitis Council is presented. Paramount to evaluation of any milking system is that the parameters must relate to milking performance or teat and udder health.

The impact of dietary sodium, potassium and calcium on blood pressure.

A blood pressure survey was conducted in 3,886 male Taiwanese workers of a single Fukien ethnic group. Their mean age was 34 years. Hypertension defined as a systolic blood pressure of greater than or equal to 140 and/or diastolic blood pressure of greater than or equal to 90 mmHg was present in 370 subjects (9.5%). The high ethnic homogeneity in the study population allowed for an examination on the relationship between diet and blood pressure. A case control study was conducted in 161 subjects with elevated blood pressure and 154 subjects with normal blood pressure, randomly selected in each group, to assess the effects of dietary sodium, potassium and calcium on blood pressure. A 24-hour dietary recall was collected independently by a nutritionist. Using regression analysis, a significant (p less than 0.01) positive association of sodium intake and blood pressure was noted independent of age, body mass index and alcohol intake. The risk of elevated blood pressure was 2.5 times greater in men with a daily sodium intake of greater than 15g compared with those whose daily sodium intake was less than 15g. A negative association of calcium and potassium with blood pressure was noted in a group who ingested potassium greater than 2g and calcium greater than 0.5g daily. However, a statistical significance was achieved for calcium (p less than 0.01) but not for potassium (p = 0.15). These results indicate that dietary sodium and calcium are related to blood pressure and hypertension status within a unique and culturally homogeneous male group of Fukien ethnicity.

Treatment of hyperhidrosis manuum by tap water iontophoresis.

In a randomised, double-blind, controlled clinical trial of the effect of treatment with tap water iontophoresis, 11 patients with palmar hyperhidrosis were treated actively on one hand and with placebo on the other. The patients' sweat production was 100% higher (median) than measured in control subjects of the same age and sex. Prior to iontophoresis, the patient's sweat production was the same on both hands but after treatment it was reduced significantly on the treated hand (p less than 0.01) compared with the sweat production prior to treatment as well as with that of the untreated side. An 81% reduction (median) in sweating was found in 6 patients receiving maintenance treatment every second week.

Axillary hyperhidrosis. Local treatment with aluminium-chloride hexahydrate 25% in absolute ethanol with and without supplementary treatment with triethanolamine.

In a randomized, double-blind, half-sided experiment, 30 volunteers were treated in both armpits with aluminium chloride hexahydrate 25% in ethanol. In order to neutralize pH and thus reduce the skin irritation, post-treatment was performed in one armpit with triethanolamine 50% in ethanol. The sweat production was measured after physical labour by means of a combined colorimetric/gravimetric method. The combined treatment with aluminium chloride hexahydrate and triethanolamine was found to be statistically significantly (p less than 0.01) less irritating to the skin, but also statistically significantly (p less than 0.01) less effective than treatment with aluminium chloride hexahydrate alone. However, the reduction in the effect of the treatment was not of a sufficient extent as to be noticed by the volunteers themselves.

Serum IgE antibodies to the scabies mite.

Porcine scabies mites, Sarcoptes scabiei var. suis are more readily available in sufficient quantities than are human scabies mites. Circulating IgE antibodies specific to porcine scabies mites were found in 6 (30%) of 20 scabies patients with an RAST score of at least 2. Seven patients had elevated serum total IgE levels. Correlation between the RAST values, the duration of pruritus, and the IgE levels was not found. The results do not prove the existence of antibodies specific to porcine scabies mites but strongly support this assumption.