Strain-counterstrain to treat restrictions of the mobility of the cervical spine in patients with neck pain: a sham-controlled randomized trial.

OBJECTIVE: Strain-counterstrain is an osteopathic technique which is widely used for treating mobility restrictions in the neck. We aimed to investigate whether a single strain-counterstrain intervention is more effective than a sham intervention in improving restricted cervical range of motion in patients with neck pain. METHODS: 61 adult patients with neck pain and restricted cervical mobility were randomly allocated to receive either a single strain-counterstrain intervention or a sham treatment. After outcome measurement all patients received full individualized osteopathic treatment. Mobility of the cervical spine was measured by a blinded observer using the Cervical Range of Motion (CROM) tool. In addition, patients rated pain intensity and assessed the treatment effect. The main outcome measure was the sum of changes in mobility restriction (in %) after treatment compared to normal mobility. RESULTS: All patients completed the study. Mobility restriction decreased by 2.0% (SD 6.9%) in the group receiving strain-counterstrain treatment and 0.6% (SD 5.7%) in the group receiving sham treatment (mean difference 1.5%, 95% confidence interval -1.7 to 4.8%; p=0.35). There were no significant differences between groups for secondary outcomes. After receiving the full osteopathic treatment the group initially receiving strain-counterstrain improved by another 4.2% (7.0%; p=0.003) and the group initially receiving sham by another 5.6% (SD 6.8%; p<0.001). CONCLUSIONS: Strain-counterstrain as a single intervention did not have immediate effects on mobility and pain over a sham treatment. Future studies should probably focus on the investigation of full osteopathic treatment.

Patient participation in medical and social decisions in Alzheimer's disease.

OBJECTIVES: To analyze the preferences of people with amnestic mild cognitive impairment (aMCI) and mild dementia in Alzheimer's disease (AD) regarding different aspects of healthcare-related decisions, to correlate these findings with different measures of decision-making capacity, and to explore the views of relatives and referring physicians. DESIGN: Cross-sectional survey. SETTING: University-based memory clinic in Munich, Germany. PARTICIPANTS: One hundred people with aMCI or mild AD, their relatives (N = 99), and their referring physicians (N = 93). MEASUREMENTS: Participation preferences and decisional capacity and assessment of these measures according to relatives and physicians. RESULTS: Patients had a preference for participation in healthcare-related decisions, especially in social ones. Overall, individuals wanted their relatives to play a secondary role in decision-making. Relatives and referring physicians performed poorly in predicting the individuals' participation preferences, and relatives wanted to attribute less decision-making power to patients than the patients did themselves. Patients refrained from participation if they had lower Mini-Mental State Examination scores or were unsure about their decisional capacity. There were deficits in decision-making capacity, which mostly related to understanding of the information presented. There was only weak correlation between the different measures (patient's, relative's, and physician's estimate, MacArthur Competence Assessment Tool for Treatment) of the patients' decisional capacity. CONCLUSION: The combination of marked participation preferences and impairments in the decisional capacity of individuals with aMCI and early AD constitute an ethical and practical challenge. A thorough implementation of structured probes of the patients' decisional capacity combined with interventions that aid patients in their decision-making capability might help to overcome some of these challenges.

[Oversized patient arms: a problem with blood pressure measurements]. / Patientenarm in Ubergrösse: Ein Problemfall bei der Blutdruckmessung.

The increase in the worldwide prevalence of obesity systematically leads to a higher number of individuals who may be wrongly diagnosed as hypertensive because their arms are too large for standard blood pressure cuffs, which are ordinarily appropriate in patients with normal sized arms. The aim was to gain real data of upper arm and wrist circumferences in 327 elected subjects with larger arms (upper arm circumference >32.5 cm) from two Bavarian general practices. We found that 93.9% of all patients had an upper arm circumference of a maximum of 41.0 cm and a wrist circumference of at most 20.5 cm. These data were then compared with the approved size ranges of six wrist blood pressure measurement devices, one special three-in-one cuff for different sizes and the two large adult cuffs recommended by the German Hypertension Society. Availability of one large cuff and one wrist blood measurement device (either used at the upper arm or at the wrist depending on patient dimensions) seems to be sufficient. This should allow for true blood pressure readings to be obtained in at least 96% of all patients with arms of more than normal circumference.

DNA adduct formation by the environmental contaminant 3-nitrobenzanthrone after intratracheal instillation in rats.

3-Nitrobenzanthrone (3-NBA) is an environmental pollutant and suspected human carcinogen found in emissions from diesel and gasoline engines and on the surface of ambient air particulate matter; human exposure to 3-NBA is likely to occur primarily via the respiratory tract. In our study female Sprague Dawley rats were treated by intratracheal instillation with a single dose of 0.2 or 2 mg/kg body weight of 3-NBA. Using the butanol enrichment version of the (32)P-postlabeling method, DNA adduct formation by 3-NBA 48 hr after intratracheal administration in different organs (lung, pancreas, kidney, urinary bladder, heart, small intestine and liver) and in blood was investigated. The same adduct pattern consisting of up to 5 DNA adduct spots was detected by thin layer chromatography in all tissues and blood and at both doses. Highest total adduct levels were found in lung and pancreas (350 +/- 139 and 620 +/- 370 adducts per 10(8) nucleotides for the high dose and 39 +/- 18 and 55 +/- 34 adducts per 10(8) nucleotides for the low dose, respectively) followed by kidney, urinary bladder, heart, small intestine and liver. Adduct levels were dose-dependent in all organs (approximately 10-fold difference between doses). It was demonstrated by high performance liquid chromatography (HPLC) that all 5 3-NBA-derived DNA adducts formed in rats after intratracheal instillation are identical to those formed by other routes of application and are, as previously shown, formed from reductive metabolites bound to purine bases. Although total adduct levels in the blood were much lower (41 +/- 27 and 9.5 +/- 1.9 adducts per 10(8) nucleotides for the high and low dose, respectively) than those found in the lung, they were related to dose and to the levels found in lung. These results show that uptake of 3-NBA by the lung induces high levels of specific DNA adducts in several organs of the rat and an identical adduct pattern in DNA from blood. Therefore, 3-NBA-DNA adducts present in the blood are useful biomarkers for exposure to 3-NBA and may help to assess the effective biological dose in humans exposed to it.