Low Back Pain: Where Exactly Is The Pain Coming From?Inspired by the opinions of Nikolai Bogduk & Charles April Often through school we are thought to render a diagnosis. We memorize the signs and symptoms and collaborate methods of treatment. This conundrum continues on and on in the academic system only to leave us just as adequate as those which have thought us. It’s easy to fall into this spiral and often at times forget to challenge yourself or the opinions of others. Let’s stop for a minute and think what do we know about back pain? The list of causes can go on and on such as a herniated disc, arthritis or even spondylolisthesis. Maybe there are other culprits such as trigger points, infections and even forms of cancer. We have now taken things and put them in a nice categorical term. Patients have something to search for when they go home on the internet and insurance companies can make their claims. However, how often do we probe deeper and forget to trace back to what caused the pain in the first place. If we don’t attempt to understand the origin of pain in the low back we will merely stay at a plateau and not progress as a profession. The key to understanding diagnosis is breaking things down to the specific structure that is causing the pain. No spectrum of symptoms lumped into a group can always answer this question. We merely need to rely on anatomy, histology, chemical processes and pain right down to the cellular level. Not easy is it..? Bogduk & April being experts in studying pain explore this idea. A list of criteria can be met in order to answer your question. 1. Could it be a source of back pain? Basically is it actually feasible that a structure can generate pain. To answer this question you have to know does it have a nociceptive nerve supply. Before the 1980’s the disc was not rendered a source of back pain. It wasn’t until studies started to show its nerve supply that the idea of discogenic pain started to evolve. Now studies are looking more thoroughly into discogenic pain (2,3,4). Anatomical studies have rendered muscles, ligaments, vertebrae, synovial joints, intervertebral disc and even fascia as structures with a nociceptive nerve supply.2. Can it be a source of back pain? Just because it’s possible for me to run a marathon doesn’t mean I will. Ok stupid analogy but although structures have the capability to produce pain doesn’t mean they will. After all there is no correlation to degenerative disc disease found on a radiograph and the amount of pain experienced by the patient. Furthermore, finding a pars defect to indicate spondylolysis doesn’t always mean it’s what causes the patients pain. Therefore the structure has to be shown to produce pain in a normal non-symptomatic person in order to fulfill this second criterion.3. Is it ever a cause of back pain? To understand this question you have to look at things in an epidemiological manner. Think of something you diagnosed a patient with that had low back pain. Now ask yourself..is it possible for an asymptomatic patient to have this problem?? Can a non symptomatic patient have degenerative disc disease or spondylolisthesis?? The answer is yes. 4. Is it ever a source of back pain? Bogduk & April discuss how pain cannot be seen, cannot be photographed and is subjective. Back pain is barley a lethal cause of death so we never really explore it at the microscopic and molecular level. Consider that we are often left with forms of imaging that look at macroscopic pathologies. Although, we see degenerative disc disease on an xray it doesn’t show things on the cellular level. It may be that we just have to take this diagnosis and look at it more microscopically to see it as a source of pain. Even if a spondylolysis is evident on radiographs we order a SPECT after to see if the pars defect is active or inactive. Their opinion is with the use of diagnostic blocking and provocation discography the essence of pain can be explored. However, this form of diagnosis is hard to come by and can be extremely painful. So although we may not have such tools in our office these forms of diagnosing are helping to set the foundation of where pain is coming from. So the next time someone comes in to you with a problem and asks you “Doctor where is the pain coming from”..go ahead try to answer them.1. Rehabilitation of the Spine: A Practitioner’s Manual 2ed. The Sources of Back Pain: Nikolai Bogduk & Charles April (Chapter). Craig Liebenson (Book). 20072. Does Diskogenic Low Back Pain and Leg Pain Exist without Nerve Root Entrapment? David L. Spencer. Approaches to Chronic Pain 1998;67-71Hurri, H., & Karppinen, J. (2004). Discogenic pain Pain, 112 (3), 225-228 DOI: 10.1016/j.pain.2004.08.016... Read more »
Slogger Charles Mudede points to a new epidemiological study on the effectiveness of carrying a gun for self defense [$-a]. Not only does packing heat fail to help in the event of an armed robbery,... individuals in possession of a gun were 4.46 (P That's right, carrying a gun increases the odds that you'll be shot by an armed assailant. It also increases the odds that you'll be shot fatally, by about 4.23 times. The authors interviewed 677 gun assault victims in Philadelphia, from between 2003 and 2006, with 648 interviews drawn from the general population in the same period as a control. (If you can't get to the paper on the journal website, Mudede links to a ScienceDaily article about the result that gives more detail.)
Here's empirical evidence that returning violence with violence (or having the ability to do so) doesn't lead to better outcomes -- unless, of course, you're of the school of thought that it's better to be shot than to lose your wallet or your pride. I doubt this will have much impact on the U.S. political conversation about guns and gun control, because as I've noted before, this is not a subject about which people think rationally. Nevertheless, it's a statistic I intend to remember for the next time I'm asked to defend the ethics of nonresistance.
Branas, C., Richmond, T., Culhane, D., Ten Have, T., & Wiebe, D. (2009). Investigating the link between gun possession and gun assault American Journal of Public Health DOI: 10.2105/AJPH.2008.143099
... Read more »
Branas, C., Richmond, T., Culhane, D., Ten Have, T., & Wiebe, D. (2009) Investigating the link between gun possession and gun assault. American Journal of Public Health. DOI: 10.2105/AJPH.2008.143099
A new study out in the Journal of Agricultural and Food Chemistry suggests a natural remedy to the negative effects of pesticides to plants. A group of plant hormones called brassinosteroids have been shown to reduce the toxicity of crops, if they’re doused with it before pesticide application.
Jing Quan Yu of Zhejiang University and his [...]
... Read more »
Xia, X., Zhang, Y., Wu, J., Wang, J., Zhou, Y., Shi, K., Yu, Y., & Yu, J. (2009) Brassinosteroids Promote Metabolism of Pesticides in Cucumber. Journal of Agricultural and Food Chemistry, 57(18), 8406-8413. DOI: 10.1021/jf901915a
As a follow-up on the AIDS vaccine post, here is an upcoming article from Science about the identification of antibodies active against the HIV virus, identified in the blood of an african donor.There is an ongoing effort to isolate antibodies that neutralize the HIV virus from people infected with the virus. One of the reoccurring issues with these neutralizing antibodies is that the ones identified so far are very specific against the strain which infected that particular individual. Antibodies in general tend to be very, very selective against a particular target, which is desirable for antibody-based medicines, since it reduces the risk for unwanted off-target activity, but not so desirable if you are trying to target something like HIV, where you are dealing with multiple, constantly evolving strains.Also, with most antibodies, once the selectivity goes down, so does the potency.Having said that, what makes this article noteworthy is the fact that now for the first time they succeeded in isolating "broad and potent neutralizing antibodies". The two antibodies identified showed potency against 127 and 119 different strains of HIV, out of a total of 162 strains they were tested against.So this looks very promising and might open the door for antibody-based treatments for people infected with HIV.To follow-up on the vaccine story, the details of the article show how difficult it is going to be to use this as the basis for an AIDS vaccine:When the team looked into what made these antibodies so potent against such a broad array of HIV strains, they found that the antibodies did not work at all when exposed to isolated proteins from the surface of the HIV virus. They only worked against a trimer that is formed by three proteins on the surface of the HIV virus. This is going to make it hard to use these findings for an AIDS vaccine, since you can't tell the human body "Go make exactly this antibody". You can only take something you want the immune system to react to, put it into a vaccine, and let the immune system come up with a way to deal with this. In this case, even if you put the 3 proteins, or pieces of the proteins, into a vaccine, there is no telling exactly against which part of the overall protein surface the immune system is going to produce antibodies against.In the article some initial work was already done to identify exactly where and how the antibodies bind to that trimer, let's hope that this can be used to synthesize a protein fragment that would trick the immune system into producing the right antibodies.And hope HIV is not going to quickly mutate its way around this, as it has done before.Ref.:Walker LM, Phogat SK, Chan-Hui PY, Wagner D, Phung P, Goss JL, Wrin T, Simek MD, Fling S, Mitcham JL, Lehrman JK, Priddy FH, Olsen OA, Frey SM, Hammond PW, Protocol G Principal Investigators, Miiro G, Serwanga J, Pozniak A, McPhee D, Manigart O, Mwananyanda L, Karita E, Inwoley A, Jaoko W, Dehovitz J, Bekker LG, Pitisuttithum P, Paris R, Allen S, Kaminsky S, Zamb T, Moyle M, Koff WC, Poignard P, & Burton DR (2009). Broad and Potent Neutralizing Antibodies from an African Donor Reveal a New HIV-1 Vaccine Target. Science (New York, N.Y.) PMID: 19729618... Read more »
Walker LM, Phogat SK, Chan-Hui PY, Wagner D, Phung P, Goss JL, Wrin T, Simek MD, Fling S, Mitcham JL.... (2009) Broad and Potent Neutralizing Antibodies from an African Donor Reveal a New HIV-1 Vaccine Target. Science (New York, N.Y.). PMID: 19729618
Children have a very important role transmitting the Influenza virus. Since they had less contact with the virus, their immune reaction is lower and less effective; therefore, during the infection they have a higher viral load. A higher viral load associated with contact with several other children from different places in the same school, playing [...]... Read more »
Cauchemez, S., Valleron, A., Boëlle, P., Flahault, A., & Ferguson, N. (2008) Estimating the impact of school closure on influenza transmission from Sentinel data. Nature, 452(7188), 750-754. DOI: 10.1038/nature06732
Although it is one of the most basic issues, Influenza virus transmission is still the target of much discussion. The role of contact contamination or through droplets and aerosols is considered a hot potato . After a certain period without many experiments, nowadays we are aware that ferrets and guinea pigs may be infected by [...]... Read more »
Moser MR, Bender TR, Margolis HS, Noble GR, Kendal AP, & Ritter DG. (1979) An outbreak of influenza aboard a commercial airliner. American journal of epidemiology, 110(1), 1-6. PMID: 463858
Klontz KC, Hynes NA, Gunn RA, Wilder MH, Harmon MW, & Kendal AP. (1989) An outbreak of influenza A/Taiwan/1/86 (H1N1) infections at a naval base and its association with airplane travel. American journal of epidemiology, 129(2), 341-8. PMID: 2912044
Our weekly compilation of science news for the week of September 27, 2009.... Read more »
Abidian, M., Ludwig, K., Marzullo, T., Martin, D., & Kipke, D. (2009) Interfacing Conducting Polymer Nanotubes with the Central Nervous System: Chronic Neural Recording using Poly(3,4-ethylenedioxythiophene) Nanotubes. Advanced Materials, 21(37), 3764-3770. DOI: 10.1002/adma.200900887
Billinger, M. (2009) Nontuberculous Mycobacteria–associated Lung Disease, United States in Hospitalized Persons, 1998–2005. Emerging Infectious Diseases. DOI: 10.3201/eid1510.090196
Bekinschtein, T., Shalom, D., Forcato, C., Herrera, M., Coleman, M., Manes, F., & Sigman, M. (2009) Classical conditioning in the vegetative and minimally conscious state. Nature Neuroscience, 12(10), 1343-1349. DOI: 10.1038/nn.2391
Those video game players with more autonomy, competence and relatedness, thus who feel free to be themselves, and usually feel capable and have closeness and intimacy with others, often play video games because they like to. Those low on these traits often become obsessive game players, they have to play a video game. Moreover the [...]
Related posts:Long Video Game Play and Time Perception, Chicken and Egg Problem It’s no secret that Dr Shock enjoys a video...Video Games Affect The Brain, Good or Bad? This is from an excellent overview about video games...Electronic Game Players No Couch Potatoes Gaming among college-aged men may provide a healthy source...
Related posts brought to you by Yet Another Related Posts Plugin.... Read more »
Przybylski, A., Weinstein, N., Ryan, R., & Rigby, C. (2009) Having to versus Wanting to Play: Background and Consequences of Harmonious versus Obsessive Engagement in Video Games. CyberPsychology , 2147483647. DOI: 10.1089/cpb.2009.0083
A NEW Slap Test-Trying to figure out the shoulder The athletes shoulder can be one of the most challenging concerns of health professionals when treating athletes. Along with the knee and back it is probably the most studied and researched topics in the sport injury world. However, each professional has a different outlook and “experts” on the topic are constantly being recycled. One injury in particular leaves many professionals constantly second guessing themselves. A SLAP lesion is a pathology which occurs in the superior aspect of the labrum and often involves a tear traveling from an anterior to posterior manner. (Hense the term SLAP lesion –superior labrum anterior to posterior). The problem with this injury is its ability to often replicate other shoulder pathologies such as shoulder impingement, bicep tendinopathies, shoulder instability and rotator cuff disease. The combination of this overlap and the delay of access to mri imaging in small towns and Canada leaves quite a dilemma. That’s why it’s important to be constantly updated on new test which are evolving in the literature. This is a review of a new test described and its validity for detecting SLAP lesions. The study involved 113 subjects all which tried conservative treatment but failed to be successful. These subjects were put through three orthopaedic tests before undergoing an arthroscopic procedure. Once the procedure confirmed or denied a suspected SLAP lesion correlations were made. Subjects were tested using the Speed’s Test, Obrien’s Test and the evaluated supine flexion resistance test (See Links)O'Brien's Test Video Speed's Test Video Supine flexion resistance test The supine flexion resistance test is performed with the patient lying in the supine position. Both of the patient’s arms are elevated above their head with the forearms resting on the table and their palms facing upward. The examiner stands on the same side as the tested shoulder. The examiner then grasps the forearm just distal to the elbow. The patient is then instructed to attempt forward flexion while the examiner applies resistance. The idea is to emulate a throwing motion. Positive – Pain deep inside the shoulder joint or along the dorsal aspect of the joint line. (See Link for video) The problem with the study was the author’s lack of correlating the test with all forms of SLAP lesions and never stated why such exclusion was done? Many statistical evaluations were performed in the study but many of non importance. Sensitivity and Specificity of the test to all groups of pathologies (all injuries found on subjects) are clinically irrelevant. This tells me the test is positive when patients are in pain but not where the pain is coming from. As you can see multiple test have multiple over lap of findings with a wide arrange of pathologies. Needless to say their rarely ever is a clear cut answer when performing testing. Subjects were found to have everything from 3 different types of SLAP lesions to AC joint arthritis.Results The presenting of the results wasn’t done very effectively by the authors. They were quick to point out the good results of their study yet completely fail to discuss some of the more important findings. Such as the specificity of the test for SLAP lesions. However the specificity for supraspinatous lesions was mentioned ....go figure? Sensitivity for isolated SLAP Lesions was 92% compared to 58% for Speeds and 75% for O’Briens This means 92% of the time if a patient has a SLAP lesion this test will pick it up. It doesn’t mean 92% of the time the test is positive it is a SLAP lesion. This is often the big problem with orthopaedic testing for the shoulder. For example the test also had high sensitivity for pathologies as a whole in the study (80%).This is why it’s important to look at the entire clinical picture with the shoulder and not just rely on one test alone. Sometimes treatment can even help figure out the diagnosis down the road.The idea Although the article lacks a good explanation of why such a test would provoke symptoms it is fairly easy to understand. The test is merely a different version of the Speed’s test. The bicep has attachments to the superior aspect of the labrum. SLAP orthopaedic test are designed to contract and tension the bicep muscle taking advantage of this bicep labrum complex. The hope is to provoke pain in which the patient is feeling due to this complex. The idea behind both the supine flexion resistance test and Speed’s is to contract the bicep tendons head and thus pull on the inflamed torn labrum. Obrien’s is usually a test used for better confirmation because it attempts to twist and torsion the head of the bicep which may continue to provoke symptoms. However my favourite test for SLAP lesions is the bicep load test number 1 and 2 (Sen 90.9%, Spec 96.9% & Sen 89.7%, Spec 96.9%). Bicep Load Test 2 Video Bicep Load Test Video Reasoning being this test actually helps rule a SLAP lesion out by attempting to lessen the patient’s symptoms. As we all know if someone is in pain most tests will be positive and thus give us insignificant clinical findings. It is much harder when given an acute injury to find test which lessen the pain then provoke it. When the bicep load tests are negative and ease symptoms it is a significant tool for ruling out a SLAP lesion. To understand this test and other articles on SLAP lesions check out the following references.1. Ebinger, N., Magosch, P., Lichtenberg, S., & Habermeyer, P. (2008). A New SLAP Test: The Supine Flexion Resistance Test Arthroscopy: The Journal of Arthroscopic & Related Surgery, 24 (5), 500-505 DOI: 10.1016/j.arthro.2007.11.0172. KIM, S., HA, K., AHN, J., KIM, S., & CHOI, H. (2001). Biceps load test II: A clinical test for SLAP lesions of the shoulder Arthroscopy: The Journal of Arthroscopic & Related Surgery, 17 (2), 160-164 DOI: 10.... Read more »
Ebinger, N., Magosch, P., Lichtenberg, S., & Habermeyer, P. (2008) A New SLAP Test: The Supine Flexion Resistance Test. Arthroscopy: The Journal of Arthroscopic , 24(5), 500-505. DOI: 10.1016/j.arthro.2007.11.017
KIM, S., HA, K., AHN, J., KIM, S., & CHOI, H. (2001) Biceps load test II: A clinical test for SLAP lesions of the shoulder. Arthroscopy: The Journal of Arthroscopic , 17(2), 160-164. DOI: 10.1053/jars.2001.20665
Shanley KJ, Green RA, & Taylor NF. (2008) An evaluation of the anatomical basis of the Biceps Load tests I and II for superior labral anterior and posterior (SLAP) lesions. Clinical anatomy (New York, N.Y.), 21(7), 647-51. PMID: 18773481
Munro W, & Healy R. (2009) The validity and accuracy of clinical tests used to detect labral pathology of the shoulder--a systematic review. Manual therapy, 14(2), 119-30. PMID: 18996735
Green RA, Taylor NF, Mirkovic M, & Perrott M. (2008) An evaluation of the anatomic basis of the O'Brien active compression test for superior labral anterior and posterior (SLAP) lesions. Journal of shoulder and elbow surgery / American Shoulder and Elbow Surgeons .. [et al.], 17(1), 165-71. PMID: 17936025
Welcome to the latest edition of Grand Rounds, the weekly compilation of the best of the medical blogosphere! I presume you would rather take a tour through the Netherlands, visiting windmills and tulips, but we will save this for another time. Right now, let’s take a trip around the library.
Because you know what William [...]... Read more »
Andreas G. Anastasiou, & Athanasios Anastasiou. (2009) The effects of current dietary trends and consumption patterns on health: evidence from the UK. Int. J. Behavioural and Healthcare Research, 1(3), 318-333. info:/
Michael E. Ash, BSc.(Hons) DO. ND. F.Dip ION has written an overview from a clinical perspective of the emerging science related to the mucosal immune system and the health of the brain in relation to affect. Published by the in house journal from Allergy Research Group it provides a strategic approach to managing individuals using a novel probiotic strategy.... Read more »
Maes M. (2008) The cytokine hypothesis of depression: inflammation, oxidative . Neuro endocrinology letters, 29(3), 287-91. PMID: 18580840
Goehler LE, Lyte M, & Gaykema RP. (2007) Infection-induced viscerosensory signals from the gut enhance anxiety: implications for psychoneuroimmunology. Brain, behavior, and immunity, 21(6), 721-6. PMID: 17428636
Benton D, Williams C, & Brown A. (2007) Impact of consuming a milk drink containing a probiotic on mood and cognition. European journal of clinical nutrition, 61(3), 355-61. PMID: 17151594
Gareau, M., Jury, J., MacQueen, G., Sherman, P., & Perdue, M. (2007) Probiotic treatment of rat pups normalises corticosterone release and ameliorates colonic dysfunction induced by maternal separation. Gut, 56(11), 1522-1528. DOI: 10.1136/gut.2006.117176
Although many people associate the Achilles tendon to an image of Brad Pitt getting an arrow through his back ankle, it is actually a fairly debilitating sports injury. There have been many attempts and different approaches to treating the Achilles. However the key to residing the pain may actually be in a treatment that provokes it. From Sweden Hakan Alfredson has done considerable research on a strict exercise regiment to help people relieve their Achilles problems. The best part about it is its non invasive, completely conservative and can be done from the comfort of your own home.Alfredson’s study found that doing “eccentric heel drops” will results in subjects with mid-portion Achilles tendinopathy returning to preinjury activity levels within 12 weeks. The success rate of these subjects was 89%.The exercise has to be done in both a knee straight position and the knee bent. The idea of these two different positions is to try and train the Gastrocnemius muscle (Knee straight) and the Soleus muscle (Knee bent). Both of these muscles join to help form the Achilles tendon. The protocol is outlined as 3 sets-15 reps, twice a day, every day for 12 weeks. This includes both the knee straight and knee bent exercises (180 reps a day). The patient has to return to the starting position by using their hands or good foot. Concentric contractions have to be completely avoided. Besides the protocol being extensive the downfall also lies in the fact these exercises have to be performed with some level of pain. If the patient is performing the exercises with no pain they have to have the exercises progressed by putting on a backpack or using weights. This increases the amount of load and force now travels through the Achilles tendon. Furthermore, Alfredson wanted to figure out why his results were not as good for those subjects with insertional Achilles problems (enthesopathy). A couple years later he performed the same protocol on those with Achilles entheopathies but changed the exercise to only bringing the foot to 90°. By this simple change the results went from 32% success rate in the past to 67%. The idea behind the change was those with enthesopathies also have retrocalcaneal bursitis accompanying the problem. By bringing the foot past 90° the calcaneous shifts backwards to impinge the bursa. Doing this repeatively did not help the problem and by simply bringing the foot to 90° you eliminate this factor. Make sure to rule out other diagnosis such as inflammatory anthropathies, posterior impingement syndrome, Haglunds disease and Sever’s disease.1.Alfredson, H., & Cook, J. (2007). A treatment algorithm for managing Achilles tendinopathy: new treatment options British Journal of Sports Medicine, 41 (4), 211-216 DOI: 10.1136/bjsm.2007.0355432.Jonsson, P., Alfredson, H., Sunding, K., Fahlstrom, M., & Cook, J. (2008). New regimen for eccentric calf-muscle training in patients with chronic insertional Achilles tendinopathy: results of a pilot study British Journal of Sports Medicine, 42 (9), 746-749 DOI: 10.1136/bjsm.2007.0395453. Pain in the Achilles Region with Hakan Aflredson and Jill Cook chapter 32 Brukner and Khan, Clinical Sports Medicine Medicine 3E, McGraw-Hill Australia 2006.... Read more »
Alfredson, H., & Cook, J. (2007) A treatment algorithm for managing Achilles tendinopathy: new treatment options. British Journal of Sports Medicine, 41(4), 211-216. DOI: 10.1136/bjsm.2007.035543
Jonsson, P., Alfredson, H., Sunding, K., Fahlstrom, M., & Cook, J. (2008) New regimen for eccentric calf-muscle training in patients with chronic insertional Achilles tendinopathy: results of a pilot study. British Journal of Sports Medicine, 42(9), 746-749. DOI: 10.1136/bjsm.2007.039545
As always the answer to this question is not simple. From recent research it’s concluded that brain training games on paper are more effective and efficient than on computer consoles (Nintendo DS, in this research). Meaning that the task completion time was shorter on paper and the error rate was lower on paper.
However the [...]
Related posts:Video Games Affect The Brain, Good or Bad? This is from an excellent overview about video games...Computer Games at Work are Good For You I’ve told you that so now and than I...Size does matter with video games and movies Recent gadgets such as the handheld portable Nintendo DS...
Related posts brought to you by Yet Another Related Posts Plugin.... Read more »
Nacke, L., Nacke, A., & Lindley, C. (2009) Brain Training for Silver Gamers: Effects of Age and Game Form on Effectiveness, Efficiency, Self-Assessment, and Gameplay Experience. CyberPsychology , 2147483647. DOI: 10.1089/cpb.2009.0013
I REFER in this case not to one of the opening chapters of the Fellowship of the Rings, but in fact to the September edition of Trends in Microbiology, in which a Dutch research team lead by Luis Lugones describe some interesting work with mushrooms.
Building upon an earlier patent by Lugones, the paper by [...]... Read more »
Berends, E., Scholtmeijer, K., Wösten, H., Bosch, D., & Lugones, L. (2009) The use of mushroom-forming fungi for the production of N-glycosylated therapeutic proteins. Trends in Microbiology, 17(10), 439-443. DOI: 10.1016/j.tim.2009.07.002
I didn’t intend to get into a theme this week, but this paper arrived in my inbox this morning, and given both the prevalence of fibromyalgia, and the often ‘fuzzy’ management that can be provided, I thought it might be worthwhile taking a look at it. The paper itself is a pre-print, but has been [...]... Read more »
Imagine you had left where you were as part of an arranged marriage. Your new life was in a very different place where the climate, the crops and even the air was different to what you had known. You could settle and try and adapt to your new life away from the family you had [...]... Read more »
Costa, M., Matheson, C., Iachetta, L., Llagostera, A., & Appenzeller, O. (2009) Ancient Leishmaniasis in a Highland Desert of Northern Chile. PLoS ONE, 4(9). DOI: 10.1371/journal.pone.0006983
From recent research it’s concluded that sending an automated short message service (SMS) message 24 hours before the appointment to patient’s cell phones reduces nonattendance rates.
Another effective strategy to reduce nonattendance rates next to phone calls or letters as appointment reminders. But these require more time and money compared to automatic sent SMS messages. [...]
Related posts:Online Real Time Cognitive Behavioral Therapy for Depression Effective Online Cognitive Behavioral Psychotherapy for Depression: Pretrial assessment screening...
Related posts brought to you by Yet Another Related Posts Plugin.... Read more »
da Costa, T., Salomão, P., Martha, A., Pisa, I., & Sigulem, D. (2009) The impact of short message service text messages sent as appointment reminders to patients’ cell phones at outpatient clinics in São Paulo, Brazil. International Journal of Medical Informatics. DOI: 10.1016/j.ijmedinf.2009.09.001
The American College of Rheumatologists developed diagnostic criteria for fibromyalgia in 1990, the culmination of many years of debate and disparagement of the existence of this pain problem. At the time, it was thought that it was a rheumatic complaint due to the presence of body pain and soft tissue tenderness, so the diagnosis and [...]... Read more »
SHIR, Y., & FITZCHARLES, M. (2009) Should Rheumatologists Retain Ownership of Fibromyalgia?. The Journal of Rheumatology, 36(4), 667-670. DOI: 10.3899/jrheum.081073
We live in an era where students, shift workers, and scientists increasingly consume drugs that modify brain activity in order to enhance cognition. Ethicists are right to fret about this as the number of addictive substances with some ill effects proliferates (DeJong et al. 2008). People will use these things regardless whether or not some [...]... Read more »
DEJONGH, R., BOLT, I., SCHERMER, M., & OLIVIER, B. (2008) Botox for the brain: enhancement of cognition, mood and pro-social behavior and blunting of unwanted memories. Neuroscience , 32(4), 760-776. DOI: 10.1016/j.neubiorev.2007.12.001
Shi J, Benowitz NL, Denaro CP, & Sheiner LB. (1993) Pharmacokinetic-pharmacodynamic modeling of caffeine: tolerance to pressor effects. Clinical pharmacology and therapeutics, 53(1), 6-14. PMID: 8422743
Light is good for your health. Most notably, there are significant health benefits from vitamin D, which is produced in our bodies by the absorption into the skin of ultraviolet (UV) radiation. There are also dietary sources of vitamin D, but one of the best and most enjoyable involves simply sitting back and soaking up the sun's rays.
Moan, J., Lagunova, Z., Cicarma, E., Aksnes, L., Dahlback, A., Grant, W., & Porojnicu, A. (2009). Sunbeds as Vitamin D Sources Photochemistry and Photobiology DOI: 10.1111/j.1751-1097.2009.00607.x
Image by robigouk. (Creative Commons Attribution).
read more... Read more »
Do you write about peer-reviewed research in your blog? Use ResearchBlogging.org to make it easy for your readers — and others from around the world — to find your serious posts about academic research.
If you don't have a blog, you can still use our site to learn about fascinating developments in cutting-edge research from around the world.
Research Blogging is powered by SMG Technology.
To learn more, visit seedmediagroup.com.