Introducing a new method to record injuries during military training: a prospective study among 296 young Norwegian conscripts.

INTRODUCTION: Most epidemiological studies in the field of military medicine have been based on data from medical records and registries. The aims of this study were to test a self-reporting injury surveillance system commonly used in sports medicine in a military setting, and to describe the injury pattern among Norwegian army conscripts during a period of military training. METHOD: A total of 296 conscripts in His Majesty the King's Guard were asked to report all injuries each week for 12 weeks, using a modification of the Oslo Sports Trauma Research Center Questionnaire on Health Problems (OSTRC-H2). We recorded all injuries irrespective of their need for medical attention or consequences for military participation. In addition, we retrieved data on injuries recorded by military physicians in the medical record from the Norwegian Armed Forces Health Register. RESULTS: The mean weekly response rate was 74%. A total of 357 injuries were recorded, of which 82% were only captured through the OSTRC-H2 and 3% only in the medical records. The average weekly prevalence of injury was 28% (95% CI: 25% to 31%), and 10% (95% CI: 8% to 12%) experienced injuries with a substantial negative impact on training and performance. The greatest injury burden was caused by lower limb injuries, with knee and foot injuries as the predominant injury locations. CONCLUSION: The OSTRC-H2 is suitable for use in a military setting and records substantially more injuries than the standard medical record. The prevalence of injuries among conscripts is high and comparable with many elite sports.

Recruitment and inclusion procedures as "pain killers" in clinical trials?

BACKGROUND: Recruitment and inclusion procedures in clinical trials are time critical. This holds particularly true for studies investigating patients with fluctuating symptom patterns, like those with chronic neck pain. In a feasibility study on neck pain, we found a clinically relevant decrease in pain ratings within the recruitment period. This paper analyses the phenomenon and gives recommendations for recruitment procedures in clinical trials on pain. METHODS: Changes in pain intensity scores of 44 chronic neck pain patients (6 males and 36 females; mean age: 45.3±13.2 years) between the first telephone contact and baseline assessment were analyzed. Inclusion criterion was a mean pain intensity of ≥40 on a 0-100 numerical rating scale during the last three months. Statistical analyses were performed using ANOVA and parametric/non-parametric correlation coefficients. RESULTS: Average pain intensity score decreased significantly from 60.3±13.3 at telephone interview to 38.1±21.7 at baseline assessment. This represents a relative change of 36.8%. A weak but significant negative correlation was found between number of days between assessments and pain rating differences. There was a positive correlation between change of pain intensity and the pain level at the first contact, indicating that the decreased pain ratings over time were also dependent on the initial pain rating. CONCLUSIONS: The clinically significant changes in pain intensity were weakly related to waiting time and moderately dependent on initial pain intensity, suggesting regression to the mean. The natural course of the disease and the Hawthorne effect are also discussed as contributing factors.

Attitudes to the contribution of placebo in acupuncture--a survey.

Interest in placebo is increasing, and recent research suggests that the therapeutic consequence of placebo is generated through mental processes in which attitudes are important. The aim of this study is therefore to explore attitudes and beliefs concerning placebo effect in acupuncture therapy, among doctors, patients and acupuncturists. From February 1994 until June 1995, four anonymous questionnaires were distributed among 1135 randomly selected doctors, 294 medical students, 432 acupuncturists and a random sample of 653 in the general population in Norway. Fifty-seven percent indicated the treatment effect seen in acupuncture as mainly a genuine acupuncture effect, 30% indicated that half of the effect in acupuncture comes from placebo, while 13% indicated that the treatment effect in acupuncture is mainly based on placebo. Doctors and students express a more skeptical view than the others, and having tried acupuncture for one's own disease is significantly associated with a less skeptical view within all study groups. Attitudes to the use of acupuncture for cancer patients are associated with attitudes to placebo for doctors and medical students, but not for the general population or acupuncturists.

[Acupressure against morning sickness]. / Akupressur mot svangerskapskvalme.

BACKGROUND: Although stimulation of certain acupressure points for long has been claimed to alleviate nausea, previous research has left contradictory results. The aim of our study was to find out if acupressure can alleviate nausea and vomiting in early pregnancy. MATERIAL AND METHODS: 97 women with mean gestational length between 8 and 12 weeks were randomized to use either active acupressure or placebo acupressure bands. Symptoms were recorded before they entered the study, during the use of the wristbands, and after the end of the study, according to the intensity, duration and nature of complaints. RESULTS: 71% of the women in the intervention group reported both less intensive morning sickness and shorter duration of symptoms. The same tendency was seen in the placebo group, with 59% reporting less intensity and 63% shorter duration of symptoms, However, significance levels of 5% were reached regarding duration of symptoms, which was reduced by 2.74 hours in the intervention group compared to 0.85 hours in the placebo group (p = 0.0018). INTERPRETATION: Acupressure wristband might be an alternative for morning sickness in early pregnancy, especially before pharmaceutical treatment is considered.

The epidemiology of injuries in Svalbard compared with Harstad.

STUDY OBJECTIVE: To survey all injuries treated in Longyearbyen hospital, Svalbard and to describe the injury epidemiology for Svalbard (residents and visitors), comparing it with Harstad. SETTING: The Norwegian arctic archipelago, Svalbard and the mainland city Harstad during three years from 8 March 1997. PARTICIPANTS: The person years of the study were 4211 for Svalbard residents and 69,014 for Harstad. MEASUREMENTS AND MAIN RESULTS: The variables followed the Nordic system. Of 630 recorded injuries, 107 were snowmobile related. Crude injury rates (per 1000 person years) [corrected] for Svalbard residents were for men 100.9 and for women 76.3. Corresponding rates were not significantly higher for men in Harstad (115.4, p = 0.19) and for women (80.1, p = 0.56). Home injuries were more prevalent in Harstad (30.5%) compared to Svalbard residents (13.1%, p < 0.001) and visitors (8.9%, p < 0.001). Work and leisure related injuries were more prevalent for Svalbard visitors (38.8% and 48.7%) and residents (27.2% and 41.9%) compared to Harstad (13.2% and 34.8%) (both p < 0.001). 43.5% of Svalbard visitors sustained work related injuries at sea. These injuries had higher AIS (abbreviated injury scale) mean score (1.83) than visitors' work injuries occurring on land (1.41) (p < 0.05) and residents' work injuries (1.29) (p < 0.001). Harstad had lowest AIS score for work related injuries (1.24). The violence rate (per 1000 person years) was 0.9 for Svalbard residents, less than a third of the Harstad rate (p < 0.02). There was one Svalbard resident fatality (drowning).

Acupressure treatment of morning sickness in pregnancy. A randomised, double-blind, placebo-controlled study.

OBJECTIVE: To find out whether acupressure wristband can alleviate nausea and vomiting in early pregnancy. DESIGN: Double-blind, placebo-controlled study. SUBJECTS: 97 women with mean gestational length completed 8-12 weeks. MAIN OUTCOME MEASURES: Symptoms were recorded according to intensity, duration and nature of complaints. RESULTS: 71% of women in the intervention group reported both less intensive morning sickness and reduced duration of symptoms. The same tendency was seen in the placebo group, with 59% reporting less intensity and 63% shorter duration of symptoms. However, a significance level of 5% was reached only in the case of duration of symptoms, which was reduced by 2.74 hours in the intervention group compared to 0.85 hours in the placebo group (p = 0.018). CONCLUSIONS: Acupressure wristband might be an alternative therapy for morning sickness in early pregnancy, especially before pharmaceutical treatment is considered.

A survey of acupuncture patients: results from a questionnaire among a random sample in the general population in Norway.

The objective of this study is to survey attitudes to, and use of acupuncture in the general Norwegian population. An anonymous questionnaire was dispatched to a random sample of 1100 in the general population, and 653 responded (60.7%). Nineteen per cent of the general population, most often suffering from musculo-skeletal pain, had tried acupuncture treatment. Lack of effect of conventional medicine was most often given as the reason to try acupuncture. Acupuncture patients had tried other kinds of alternative medicine twice as often as others, most often homeopathy (P<0.01). Acupuncture patients visit their GP more often (P<0.01), and are more concerned about own health (P<0.01) than patients who have not tried acupuncture. Sixty-six per cent say they benefited from acupuncture, and 7% report that the acupuncture treatment had adverse effects. Fifty-six per cent of those with experience of acupuncture felt that doctors should recommend acupuncture for migraine patients, and 34% of those never having tried acupuncture agreed (P<0.01). Both patients who had tried acupuncture and those who had not, felt that the doctor should not interfere in the cancer patient's wish to try acupuncture.

Doctors' attitudes to acupuncture--a Norwegian study.

1466 Norwegian working doctors under 71 y of age were surveyed in February 1994 on their attitudes to acupuncture and experience as acupuncture patients. 1135 doctors responded (response rate: 77%). More than 8% had undergone acupuncture treatment and 38% of these reported benefit from the treatment. Over 53% would realistically consider acupuncture if they got problems or diseases where acupuncture treatment could be an alternative. More than 38% recommend acupuncture treatment to their migraine patients. More than four out of five doctors would not try to interfere with a patient's wish to try acupuncture treatment for cancer. 81% said that acupuncture is, or should be integrated in the national health care system. More general practitioners held this view than other doctors (p < 0.001). Positive attitudes were strongest among doctors who either had already undergone acupuncture treatment or intended to do so. If this development continues, acupuncture could be an integrated part of the national Norwegian health care system in the near future.

[Attitudes of Norwegian physicians to homeopathy. A questionnaire among 2 019 physicians on their cooperation with homeopathy specialists]. / Norske legers holdninger til homøopati. En spørreundersøkelse blant 2019 leger om samarbeid med homøopater.

This study presents Norwegian doctors' attitudes concerning co-operation with homeopaths, their advice to patients who want to try homeopathic treatment and for which diseases, if any, they might be positive to homeopathic treatment. The Norwegian Medical Association made a randomised, stratified sample consisting of 2,019 Norwegian doctors below the age of 71. The study was made questionnaire-based and a total of 1,434 doctors (71%) replied. 7% of the doctors have or wish to have patient-associated collaboration with homeopaths. 32% would give positive advice to patients who expressed a desire to try homeopathic treatment, while 50%, owing to insufficient knowledge, would not give advice. Doctors educated abroad are more positive to homeopathic treatment than doctors educated in Norway are. 50% of Norwegian doctors tend to be positive to homeopathic treatment for one or more specific conditions. Anxiety, migraine and hayfever are the conditions most often mentioned. Male senior doctors are the least positive to homeopathic treatment for all of the listed conditions. Patients who would like to try homeopathic treatment after consultation with a doctor should consult a female general practitioner who has studied abroad.

Adverse effects of acupuncture: a study of the literature for the years 1981-1994.

This study presents the adverse effects of acupuncture as recorded in the Medline database for the years 1981-1994. A total of 125 papers were localized by the keywords acupuncture adverse effects. Articles without case reports were excluded, and 78 reports forms the basis for the present paper. A total of 193 patients were reported with adverse effects of acupuncture in 14 years. Pneumothorax is the most common mechanical organ injury, while hepatitis dominates among infections. Acupuncture treatment is claimed to be responsible in the death of three patients. One patient died from bilateral pneumothorax, another got endocarditis, and died of complications. The third patient died of severe asthma while under acupuncture treatment. Most adverse effects of acupuncture seem to rely on insufficient basic medical knowledge, low hygienic standard, and inadequate acupuncture education. The study confirms the adverse effects of acupuncture under certain circumstances. Serious adverse effects, however, are few, and acupuncture can generally be considered as a safe treatment.

[Complications of acupuncture therapy. A study of the literature from 1981-92]. / Komplikasjoner ved akupunkturbehandling. Litteraturstudie for årene 1981-92.

This study presents the adverse affects of acupuncture as recorded in the Medline database for the years 1981-92. Pneumothorax is the most common mechanical organ injury caused, while hepatitis dominates the infections. Neither pneumothorax nor hepatitis is reported from any Nordic country. Most of the adverse effects of acupuncture seem to be associated with insufficient basic medical knowledge, a low standard of hygiene and inadequate education in acupuncture. The study confirms adverse effects of acupuncture in certain circumstances. Serious adverse effects are few, and acupuncture can be considered as a fairly harmless form of treatment.

[Attitudes to acupuncture--a questionnaire study among medical students in Tromsø]. / Holdninger til akupunktur--en spørreundersøkelse blant medisinstudentene i Tromsø.

In February 1992, 80% of the medical students at Tromsø University filled in a questionnaire concerning attitudes to acupuncture. 63% of the students would recommend acupuncture when the diagnosis was migraine, while 14% of the students would support a patient who tried acupuncture as cancer therapy. 86% of the students thought that placebo could account for 25-50% of the effect of acupuncture. Most of the students wanted more scientific documentation, although 75% said that acupuncture already was, or at least should be, part of the ordinary health care system. The main result of this study was a generally positive attitude towards acupuncture. The students want to learn the method, and they will recommend acupuncture for their future patients.