Circadian variation in onset of acute ischemic stroke.

A circadian pattern for the onset of myocardial and cerebral infarction has been identified. To evaluate this phenomenon further, we analyzed prospectively collected data from 151 patients with acute ischemic stroke. The number of strokes per 6-hour period were the following: midnight to 6 AM, 20 (13%); 6 AM to noon, 86 (57%); noon to 6 PM, 21 (14%); and 6 PM to midnight, 24 (16%). This pattern was not affected by previous use of aspirin. The most frequent time of onset was 6 AM to noon for all subgroups of ischemic stroke: small artery, 71%; cardioembolic, 62%; large artery atherothrombotic, 57%; large artery atheroembolic, 46%; and "other" or unknown cause, 40%. We also investigated the time between awakening and stroke onset in 145 patients and found that 24% of ischemic strokes occurred within the first hour after awakening. Our data demonstrate that an early morning peak exists for all subtypes of stroke. Our data also suggest that the most critical period is the first hour after awakening.

Sleep patterns in rural elders: demographic, health, and psychobehavioral correlates.

Altered sleep patterns, including changes in bedtime, sleep latency, total sleep time, and arising time, have been reported to occur with increasing age. We examine self-reported sleep patterns in a geographically-defined population (n = 3097) of persons aged 65 years and older. Sleep patterns were characterized according to demographic variables, clinical conditions, and physical, psychological, and social functioning. Sleep latency and total hours of sleep increased with age, and older respondents went to bed earlier. The percentage of respondents who reported feeling rested in the morning decreased with age. Women went to bed later, had longer sleep latency, and fewer hours of sleep than men, and were less likely to report feeling rested than men. Sleep patterns were also related to educational attainment, self-perceived health status, physical functional status, psychotropic drug use, alcohol use, depressive symptoms, life satisfaction, and social and recreational activity level. This population study suggests that sleep problems among the elderly are sometimes associated with treatable health conditions and modifiable behavioral and environmental characteristics.

Carpal tunnel syndrome: conservative and nonconservative treatment. A chiropractic physician's perspective.

OBJECTIVE: To discuss the treatment of carpal tunnel syndrome (CTS) including indications for referral to medical evaluation and/or comanagement. DATA SOURCE: More than 200 articles published in the health care literature from 1963 to 1997 and indexed on Medline concerning conservative and surgical intervention for CTS. Indexing terms used were "Carpal Tunnel," combined with keywords "Conservative" and "Surgery." STUDY SELECTION: Reports involving either conservative or non-conservative treatment for CTS or original descriptive reports of surgical techniques of carpal tunnel release. DATA EXTRACTION: Indications and contraindications for each conservative and surgical option. Concise and general descriptions of manual, medical and surgical interventions in current use, including summaries of the benefits and risks of each treatment. DATA SYNTHESIS: The review is presented as a discussion of diagnostic technique and conservative and surgical treatments for CTS currently used in North America. CONCLUSIONS: Recommendations are that CTS, accompanied by demyelination but without axonal degeneration, can be treated initially with conservative medical or manual procedures.

Comparative efficacy of conservative medical and chiropractic treatments for carpal tunnel syndrome: a randomized clinical trail.

OBJECTIVE: To compare the efficacy of conservative medical care with chiropractic care in the treatment of carpal tunnel syndrome. DESIGN: Two-group, randomized, single-blind trial with 9 wk of treatment and a 1-month follow-up interview. SETTING: Wolfe-Harris Center for Clinical Studies at Northwestern College of Chiropractic in Bloomington, Minnesota. PATIENTS: Ninety-one of 96 eligible subjects who reported symptoms that were confirmed by clinical exam and nerve conduction studies. INTERVENTIONS: Interventions included ibuprofen (800 mg 3 times a day for 1 wk, 800 mg twice a day for 1 wk and 800 mg as needed to a maximum daily dose of 2400 mg for 7 wk) and nocturnal wrist supports for medical treatment. Chiropractic treatment included manipulation of the soft tissues and bony joints of the upper extremities and spine (three treatments/week for 2 wk, two treatments/week for 3 wk and one treatment/week for 4 wk), ultrasound over the carpal tunnel and nocturnal wrist supports. MAIN OUTCOME MEASURES: Outcome measures were pre- and postassessments of self-reported physical and mental distress, nerve conduction studies and vibrometry. RESULTS: There was significant improvement in perceived comfort and function, nerve conduction and finger sensation overall, but no significant differences between groups in the efficacy of either treatment. CONCLUSIONS: Carpal tunnel syndrome associated with median nerve demyelination but not axonal degeneration may be treated with commonly used components of conservative medical or chiropractic care.