Stent implantation, but not pathogen burden, is associated with plasma C-reactive protein and interleukin-6 levels after percutaneous coronary intervention in patients with stable angina pectoris

BACKGROUND

The systemic inflammatory response to percutaneous coronary intervention (PCI) is associated with recurrent cardiac events; however, the pathophysiology of this inflammatory response is not well understood. The present study was performed to investigate the role of pathogen burden of infection in determining the magnitude of C-reactive protein (CRP) and interleukin 6 (IL-6) response to PCI.

METHODS

One hundred patients with stable angina pectoris undergoing elective PCI at a single center were recruited. Antibodies against cytomegalovirus, Chlamydia pneumoniae , Epstein-Barr virus, Helicobacter pylori , and herpes simplex virus types 1 and 2 were determined before PCI. Plasma CRP and IL-6 levels were measured before and 6, 24, 48, 72 hours after PCI and data presented as area under the curve.

RESULTS

Plasma CRP and IL-6 concentrations increased significantly after PCI. Neither antibodies against single nor multiple pathogens were associated with the CRP or IL-6 response to PCI. No correlations were found between the inflammatory markers and troponin T levels after PCI. With the exception for CRP and body mass index (R = 0.20, P < .05), neither risk factors for coronary heart disease nor medication but stent implantation was associated with increased plasma CRP (76 vs 61 mg/L, P < .005) and IL-6 (74 vs 64 pg/mL, P < .005) levels after PCI.

CONCLUSION

Stent implantation, but not pathogen burden, is associated with the plasma CRP and IL-6 response to PCI.

Low back pain in Mozambican adolescents

Recent literature shows that the prevalence of low back pain (LBP) in adolescents living in Western countries approaches that of adults 18-55 years of age. Moreover, epidemiological studies have also shown that the frequency of different rheumatic disorders in developing countries is similar to that found in Western industrialized regions. The purpose of this study was to ascertain the prevalence of LBP and to explore some risk factors among adolescents living in different zones of Mozambique. A previously validated questionnaire was distributed to schoolchildren of grades 6 and 7 living in three different residential/social regions of the country. Two hundred four (204) children participated in the survey. Median age was 13 years (age range 11-16 years) and 46% were boys. Several episodes of LBP interfering with usual activities during the previous year were reported by 13.5% of the sample. Living in the wealthier urban center (as compared with the peripheral regions) and walking >30 min per day to and from school were associated with an increased risk of LBP (OR 3.1, 95% CI 0.99-9.48, and OR 4.8, 95% CI 1.61-14.28, respectively).

The effects of breath control on intra-abdominal pressure during lifting tasks

STUDY DESIGN

This was a repeated measures study examining 11 asymptomatic subjects while performing dynamic lifting using various postures, loads, and breath control methods.

OBJECTIVES

To examine the effects of breath control on magnitude and timing of intra-abdominal pressure during dynamic lifting.

SUMMARY OF BACKGROUND DATA

Intra-abdominal pressure has been shown to increase consistently during static and dynamic lifting tasks. The relationship between breath control and intra-abdominal pressure during lifting is not clear.

METHODS

Eleven healthy subjects were tested using lifting trials consisting of two levels of posture and load and four levels of breath control (natural breathing, inhalation-hold, exhalation-hold, inhalation-exhalation). Intra-abdominal pressure was measured using a microtip pressure transducer placed within the stomach through the nose. Timing of intra-abdominal pressure was determined relative to lift-off of the weights. Repeated measures analysis of variance was used to determine the effect of breath control, posture, and load on intra-abdominal pressure magnitude and timing.

RESULTS

There was a significant effect of breath control (P < 0.018) and load (P < 0.002), but not of posture (P < 0.434), on intra-abdominal pressure magnitude. The inhalation-hold form of breath control produced significantly greater peak intra-abdominal pressure than all other forms of breath control (P < 0.000 for all comparisons). No other comparisons among levels of breath were significantly different. No significant main effects of breath control were found relative to intra-abdominal pressure timing.

CONCLUSIONS

Breath control is a significant factor in the generation of intra-abdominal pressure magnitude during lifting tasks. The effects of respiration should be controlled in studies analyzing intra-abdominal pressure during lifting.

Musculoskeletal symptom survey among cement and concrete workers

Work in construction is associated with a high risk for musculoskeletal disorders and injuries. The symptom survey was conducted to determine the magnitude and musculoskeletal injury characteristics among the cement and concrete workers and identify the most problematic work-related activities and job factors that might have contributed to the occurrence of these disorders. Findings revealed that a large proportion of the laborers (77%) experienced at least one musculoskeletal disorder in the last year. Low back pain was reported as the most frequently experienced symptom (66%). 'Working while in pain' the concrete workers perceived as the major problem in the trade. Other problematic work-related activities included 'bending or twisting the back', 'work in hot, cold or wet conditions', and 'handling heavy objects'. Most of the laborers (82%) requested on-the-job safety training. Survey results combined with the outcomes of focus groups discussions and work site observations were used in the design of a training program aimed at the prevention of musculoskeletal morbidity in the trade. The program incorporated ergonomics principles, hazard recognition, safe work practices, problem solving and personal protection in the training curriculum for membership of the trade.

Work restrictions and outcome of nonspecific low back pain

STUDY DESIGN

Retrospective cohort study was conducted.

OBJECTIVE

To evaluate the association of prescribed work restrictions with work absenteeism and recurrence in cases of nonspecific low back pain.

SUMMARY OF BACKGROUND DATA

The efficacy of commonly prescribed work restrictions in limiting sickness-related absence because of back pain has not been evaluated.

METHODS

Employees who had back pain-related sickness absence were identified from medical records of a utility company. The workers were grouped into those who had received a work restriction for their back pain and those who had not. The duration of work disability was compared between the two groups. Employees who returned back to regular, full duty within 1 year of onset were followed for one additional year to determine rates of recurrence. The Cox Proportional Hazards model was used to generate hazard ratios adjusted for age, gender, and job category.

RESULTS

Restrictions were given to 43% of the workers. Sickness absence duration did not differ between those who had received restrictions and those who had not (adjusted hazard ratio, 1.12; P = 0.41). The median duration of restricted duty was 32.5 days. For 22% of the workers, restricted duty was never lifted. Recurrence appeared less likely to occur among those who had work restrictions in their initial episode. However, this difference was not statistically significant (adjusted hazard ratio, 0.77; P = 0.48).

CONCLUSIONS

No evidence of an association between a prescription of work restriction and early return to work was found. More research is needed to clarify the utility of restricted duty in promoting a positive outcome for work-related low back pain.

Arousal increases baroreflex inhibition of muscle sympathetic activity

AIM

Surprising sensory stimuli causing arousal are known to evoke short-lasting activation of human sympathetic activity in skin but not in muscle nerves. In fact, anecdotal observations suggest that muscle sympathetic activity may be inhibited. To test this hypothesis, the effects of surprising somatosensory (electrical skin pulses) or visual (flash) stimuli on multiunit muscle sympathetic activity were studied in 36 healthy subjects, aged 19-71 years.

METHODS

The stimuli were given either 200 or 400 ms after the R-wave of the electrocardiogram. Dummy stimuli, consisting of trigger pulses without sensory stimuli, served as controls.

RESULTS

On a group basis, a single sensory stimulus of either type attenuated the amplitude of one or two sympathetic bursts, while no such effects occurred after dummy stimuli. Individually, the inhibition was evoked by at least one stimulus modality or delay in 16 subjects, whereas in three subjects no significant inhibition occurred. Electrodermal signs of skin sympathetic activation were present in all subjects. Compared with one, five repeated electrical skin pulses induced only minor additional inhibition of muscle sympathetic activity, indicating marked habituation of the neural response. In nine subjects, the experiments were repeated once and in three subjects twice (with intervals of 2-3 months); in 11 of the 12 subjects, the sympathetic effects were reproducible. In the group of subjects without significant sympathetic inhibition the stimuli induced a small, transient increase of mean blood pressure, which was not present in the group with sympathetic inhibition.

CONCLUSION

The finding that different sensory stimuli induce similar effects that habituate markedly on repetition suggests that the inhibition of muscle sympathetic activity is because of arousal. The interindividual differences in sympathetic and blood pressure effects may be part of interindividual differences in behavioural responses to stress.

Measures for low back pain: a proposal for clinical use

Low back pain represents a serious public health problem. Therefore, great efforts have been made in order to improve and assess the efficacy of its treatment. Reports in international literature have presented important studies concerning instruments to assess pain and functional incapacity in patients with low back pain. This study presents a clinical protocol which was developed by a multidisciplinary team. This protocol consists of the evaluation and distribution of pain, The Spitzer Quality of Life, The Oswestry Low Back Pain Disability Questionnaire, and The Center for Epidemiological Studies Depression Scale. Instruments must be urgently developed or adapted in order to be used according to the Brazilian reality.

Predictors of compliance with short-term treatment among patients with back pain

OBJECTIVE

Great efforts have been made to find effective treatments for back pain. Nevertheless, the effectiveness of a particular treatment can depend on patient compliance. The objective of this study was to prospectively investigate whether patients' demographic factors, clinical factors, external barriers in following the treatment, and perceptions of disability, quality of life, depression, and control over health were predictive of compliance with a physical therapy program carried out with patients with low back pain.

METHODS

This was an exploratory prospective cohort study that was carried out in New York City during 1999. All study participants answered a questionnaire at the initial clinical evaluation by a physical therapist and were followed during the treatment. The study assessed compliance with the three treatment regimens that were prescribed for every patient: attending scheduled physical therapy sessions, following a program of home exercises, and watching back-education videotapes. Depending on the individual patient, the planned treatment program could last from 2 to 6 weeks. The study employed a battery of instruments to measure patient characteristics that included perceived functional limitations, perceived quality of life, depression, and their beliefs about their health. Student's t tests and chi-square tests were used to determine if non- and low-compliant patients differed significantly from high-compliant patients. Logistic regression was used to estimate adjusted odds ratios expressing the association of selected variables with compliance.

RESULTS

We found that 51% of the patients were either noncompliant or low-compliant overall with the low back pain treatment program. There were differences in compliance behavior among the three treatment regimens, with compliance being highest for watching the back-education videotapes and lowest for doing the home exercises. Poor compliance overall was positively associated with the expectation of barriers in following the proposed treatment, with comorbidity, and with longer duration of treatment in this program.

CONCLUSIONS

The findings of our study indicate that patient compliance with back pain treatment is a serious and complex problem. Nevertheless, while this study was only an exploratory one, we believe that the results of this study can be used by care providers to identify patients likely to become noncompliant and also by researchers to plan specific studies on the effectiveness of treatment programs for patients with low back pain.

Enhancing the quality of life of a client with severe developmental disabilities through the application of assistive technology. A case study

This paper describes a structural sequential process aimed to enhance the quality of life of a 29 year old man through the application of assistive technology (AT). The client had life-long severe multiple disabilities, showed increasing fragility and decreasing functional abilities that resulted, among other problems, in a problem with toileting. The process involved a thorough assessment and evaluation of the client, his physical, cognitive and perceptual skills involved in the performance of the task, requirements of the task, the technology, and the task environment. A clinical reasoning model for the provision of AT was applied during the process to identify the functional deficits of the client with respect to the problematic task. The approach enabled a multidisciplinary team of university-affiliated professionals including physical and occupational therapists, an ergonomist, a rehabilitation engineer and care providers in an institution for developmentally disabled people to determine the primary attributes of a technological intervention. The process resulted in the selection of an appropriate piece of AT followed by its modification and adaptation in order to address the specific needs of the client. The client's toilet use was improved in a manner that ultimately contributed to enhancing the quality of his life. Projections for further improvements of the quality of life of the client in this institution were also discussed.

Musculoskeletal symptom survey among mason tenders

BACKGROUND

Low back pain (LBP) constitutes a major problem in construction. The magnitude and musculoskeletal injury characteristics in certain construction trades have been studied extensively. Musculoskeletal research targeting mason tenders is limited. High physical demands of the job primarily contribute to an increased risk of LBP experienced by these laborers.

METHODS

A symptom survey was conducted to determine the magnitude and musculoskeletal injury characteristics among the mason tenders, and to identify work-related activities perceived by them as contributing to their disorders.

RESULTS

The findings revealed that 82% of the mason tenders experienced at least one musculoskeletal symptom in the last year. LBP was the most frequently reported symptom (65%). Due to LBP, 12% of the laborers missed work and 18% of them visited a physician. Bending or twisting the back, working in the same position or in pain, and heavy lifting they perceived as the most problematic work-related activities. The vast majority of the laborers requested job-safety training.

CONCLUSIONS

The mason tenders experienced high prevalence of LBP. To address the problem a model for primary prevention of LBP was developed and implemented in the trade. The model incorporated ergonomic principles, hazard recognition, and problem solving in the training curriculum for the union instructors teaching apprentices the trade-specific skills.

A 2-year prospective longitudinal study on low back pain in primary school children

There is increasing evidence that non-specific low back pain (LBP) is common among children and adolescents, but there are few longitudinal studies on this subject. This is a longitudinal prospective study aimed at finding factors associated with the prediction of low back pain in schoolchildren aged 9-12 years, which is a younger age group than has previously been studied. This study was performed on school children in the city of Antwerp, Belgium. A total of 287 children filled out a questionnaire and were examined at the beginning of the study (T1) and 2 years later (T2). The questionnaire asked about back pain, general health, health perceptions, quality of life perceptions, sports, leisure, daily life, school life (weight of satchel.) and some issues related to parents (smoking, LBP). The questionnaire reliability was tested. Logistic regression was used to analyse the data. No predictors for LBP in children could be identified. Using logistic regression techniques, we analysed the children who reported no lifetime episode of LBP at both T1 and T2, the children who did report a lifetime episode at both T1 and T2 and also those who reported a history of LBP at T2 only (New LBP). At T2 there were 51 children (17.8%) reporting suffering at least one lifetime episode of LBP who had not reported such an episode at T1. Only one parameter showed a statistical difference: New LBP was observed significantly more frequently in children who do not walk to school ( P<0.0001). An interesting point of this study is that a number of children who had reported a history of LBP at T1 did not do so at T2. It may be that LBP in children is so benign and its natural history so favourable that the memory of the episode fades away. It is extremely interesting to note that among the few significant variables, those related to general well-being and self-perception of health, are prominent. It appears, therefore, that psychological factors play a role in the experience of LBP in a similar way to what has been reported in adults. Poor self-perception of health (health belief) could be a factor behind the reporting of LBP. Some variables linked to consequences of LBP (absence from school or from gym and visit to a doctor) play a significant role in reporting LBP, which suggests that those "health care" factors may reinforce a feeling of disease severity.

Association of comorbidity and outcome in episodes of nonspecific low back pain in occupational populations

We examined the relationship between comorbidity and first return to work after episodes of work-disabling, nonspecific low back pain (NSLBP). An inception cohort of workers with new episodes of NSLBP was identified from administratively maintained occupational health records. We compared 6-month return-to-work rates between workers with one or more comorbid conditions with those without documented comorbidity. Workers with comorbidity were 1.31 times more likely to remain work disabled than those with uncomplicated NSLBP, after adjusting for age, gender, lifting demands, and company membership (adjusted hazards ratio [HR] = 1.31; 95% confidence interval [CI] 1.12 to 1.52). Concurrent injury (i.e., sprains or strains of the neck, upper extremity, and lower extremity; contusions; and lacerations) had the strongest association (adjusted HR = 1.49; 95% CI, 1.21 to 1.83), followed by musculoskeletal disorders (adjusted HR = 1.13; 95% CI, 0.77 to 1.66). Comorbidities should be routinely evaluated at first visit by occupational health professionals to better manage disability associated with LBP.

Current chemotherapy protocols for childhood acute lymphoblastic leukemia induce loss of humoral immunity to viral vaccination antigens

OBJECTIVE

To evaluate viral vaccination immunity and booster responses in children treated successfully for acute lymphoblastic leukemia by chemotherapy and to study the response to treatment of antibody-producing plasma cells that are important for persistence of humoral immunity.

METHODS

Forty-three children who were in continuous first remission for a median of 5 years (range: 2-12 years) were studied. Before the leukemia was diagnosed, all children had been immunized against measles, mumps, and rubella according to the Swedish National immunization program. We analyzed levels of serum antibodies against measles and rubella by enzyme immunoassays. Avidity tests for measles antibodies were concomitantly performed by enzyme-linked immunosorbent assay for measles virus immunoglobulin G detection. The proportion of plasma cells in bone marrow was studied by flow cytometry at different times during treatment and follow-up. Children who lacked protective levels of antibodies to vaccination antigens were reimmunized. Serum was collected 3 months after immunization to assess vaccination responses.

RESULTS

After completion of the treatment, only 26 of the 43 children (60%) were found to be immune against measles and 31 (72%) against rubella. The proportion of bone marrow plasma cells decreased during treatment but returned to normal after 6 months. Revaccination caused both primary and secondary immune responses. Six of the 14 children without immunity failed to achieve protective levels of specific antibodies against measles and 3 against rubella.

CONCLUSIONS

Our finding of loss of antibodies against measles and rubella in children treated with intensive chemotherapy suggests that reimmunization of these patients is necessary after completion of the treatment. To determine reimmunization schedules for children treated with chemotherapy, vaccination responses need to be studied further.

Glycosphingolipid antibodies in serum in patients with sciatica

STUDY DESIGN

Serum antibody titers against 10 different glycosphingolipids were investigated by enzyme-linked immunosorbent assay in three groups of patients: patients with acute sciatica (Group IA, radicular pain for 32 +/- 36 days, n = 68), a subgroup of these patients 4 years later (Group IB, n = 23), and patients undergoing lumbar discectomy because of disc herniation (Group II, n = 37).

OBJECTIVES

To investigate the immunologic response in sciatica patients by analyzing circulating autoantibodies against glycosphingolipids, molecules highly expressed in cells from the nervous system, and the possible correlation of such antibodies to clinical and imaging findings as well as to subjective symptoms.

SUMMARY OF BACKGROUND DATA

The titers of glycosphingolipid antibodies are elevated in neurologic diseases with autoimmune stimulation such as Guillain-Barré syndrome and chronic inflammatory demyelinating polyneuropathy.

METHODS

Antiglycosphingolipid antibodies were assayed by a microtiter enzyme-linked immunosorbent assay method. Antibody titers were related to a healthy population by a method that judges all positive results (positive result = patient sera/pooled blood donor serum >2, at titer 1/400) as indicating a pathologic condition.

RESULTS

Increased levels of circulating antibodies against one or more glycosphingolipids were detected in 71% of patients with acute sciatica, in 61% of sciatica patients at a 4-year follow-up visit (eight antigens analyzed) and in 54% in patients undergoing discectomy. These frequencies were somewhat higher than, and in the last group similar to, those reported for generalized nervous system disorders with autoimmune involvement. In the acute sciatica patients, positive neurologic findings were associated with increased levels of two of the examined antibodies: 3'LM1 (immunoglobulin M and/or immunoglobulin G), P = 0.023, and GD1a (immunoglobulin M), P = 0.017.

CONCLUSION

The presence of glycosphingolipid antibodies in patients with sciatica and disc herniation suggests an activation of the immune system and thus a process possibly involved in the pathophysiology of sciatica. The autoimmune response was not limited to antibodies against one specific glycosphingolipid target; rather, an overall increase in autoantibodies against nervous system-associated glycosphingolipids was observed. These results encourage further studies of the pathophysiologic and clinical relevance of autoimmune responses in patients with sciatica and disc herniation.

Self-care techniques for acute episodes of low back pain

Guidelines recommend minimal medical intervention for acute non-specific low back pain. However, patients often request strategies to reduce symptoms and recover quickly. Self-care techniques that do not contradict current evidence-based recommendations may be suggested. Self-care techniques can reduce costs and iatrogenic complications that can occur with medical treatment. They may also increase the patient's perception of control and improve long-term outcome. A shift in paradigm for the health care provider and the patient is required for self-care to be successful. These issues, as well as self-care approaches such as medication, exercises, modalities and mind-body techniques are discussed. Practice points for each approach are given.

Sleepiness and recovery in schedule change and the eighty-four hour workweek

The aims were to evaluate sleepiness and recovery during a schedule change, and during an 84-hours workweek. The control group (16 men) stayed on a six-week schedule, whereas the intervention group (12 men) transferred to a seven-week schedule. Sleepiness was estimated, using the KSS-scale, four times during the first and the third night in the fifth or sixth shift week. Recovery was assessed through four estimations on days one, three and five during the week off. Statistical testing was carried out using repeated measurement ANOVA. Sleepiness at night was affected by night (F = 4.90, p < 0.05) and hour (F = 33.64, p < 0.001) in both groups. The intervention group was sleepier during the first recovery day compared to the control group (F = 4.02, p < 0.05). Analysis of the 84-hour-week showed an effect of night (F = 8.98, p < 0.05) and hour (F = 71.60, p < 0.001) on night work, and day (F = 22.49, p < 0.01) and hour (F = 6.66, p < 0.05) on recovery. Sleepiness was more pronounced on the first recovery day (F = 23.08, p < 0.01). The seven-week schedule showed no effect that differed from that of the control group on sleepiness during the night shift. After the 84-hour workweek the workers recovered in about three days. The new schedules may affect the first recovery day negatively.

Testing apparatus and experimental procedure for position specific normalization of electromyographic measurements of distal upper extremity musculature

OBJECTIVE

An apparatus and procedure are described to determine position specific normalization coefficients for surface EMG of upper extremity musculature.

STUDY DESIGN

Thirty-nine subjects were tested three times. Repeatability of EMG measurements across test sessions was determined by computing intraclass correlation coefficients. Two-way analysis of variance was used to test upper extremity position dependent differences in EMG measurements.

BACKGROUND

EMG measurements are susceptible to error from skin movement and muscle length changes, both of which may occur when upper extremity positions vary. Normalization of the EMG signal without consideration for such positional influences may lead to erroneous conclusions regarding muscle activation during functional tasks.

METHOD

An apparatus was designed that allowed subjects to perform three repetitions of maximum elbow flexion, forearm pronation, wrist extension, and wrist flexion with the forearm in neutral and pronated positions. Surface EMG was sampled from eight muscles. Mean EMG on maximum voluntary contraction was computed, and resting EMG was subtracted to obtain EMG normalization coefficients.

RESULTS

Upper extremity position affected the EMG normalization coefficient for biceps brachii, which was lower in the pronated position, and extensor carpi radialis, which was higher in the pronated position (P<0.00625).

CONCLUSIONS

The apparatus accommodates various combined positions of the elbow, forearm and wrist. The normalization procedure is efficient for testing subjects who are being observed during functional tasks. Only two muscles were affected by upper extremity position, but group trends were not always consistent with individual behavior. This method would ensure the use of appropriate EMG normalization coefficients regardless of individual variation.

RELEVANCE

This method is effective for normalizing EMG signals using task specific upper extremity positions. It may be used to test isometric exertions of distal upper extremity musculature for clinical and research purposes.

Recovery of impaired muscle function in severe sciatica

This is a prospective cohort study of patients with acute treated severe sciatica. The objectives of the study are, firstly, to describe the recovery of muscle performance by manual and isokinetic muscle testing in patients with acute severe sciatica over 1 year, and secondly, to discuss the potential clinical relevance of the isokinetic testing of the ankle for patients with acute sciatica. In clinical daily practice, muscle performance is evaluated by means of isometric manual tests. Different authors using manual muscle tests have reported the long-term outcome of the muscle function in patients with sciatica. Overall, the results are good in terms of the recovery of muscle strength. However, it is not clear whether the isometric strength is sufficiently relevant to evaluate the more complete muscle performance of the affected muscles in patients with sciatica. This study presents data on the muscle recovery measured with manual testing and isokinetic testing of patients with severe sciatica. Consecutive patients admitted to the Cantonal Hospital for conservative management of severe acute sciatica were eligible for inclusion in the study. Patients were evaluated at admission, discharge, and follow-up at 3, 6, and 12 months. All the visits included a standardized clinical examination and the completion of questionnaires. Imaging and electromyography were conducted at the first visit. Isokinetic muscle tests at 30 degrees/s and 120 degrees/s were performed at discharge and follow-up visits. Manual and isokinetic tests were performed on foot and ankle flexor and extensor muscles. Eighty-two consecutive patients (66% men), with a mean age of 43 (+/-10.3) years, entered the study. The prevalence of major muscle weakness was low, with 7% of patients unable to perform toe walking and 11% unable to walk on the heel at visit one. Moreover, motor deficit defined as a score of 4 or less (out of 5) was found in 15% of subjects at the first evaluation. Such severe deficits were not found during the last three visits. The isokinetic tests showed a higher prevalence of muscle function impairment. At visit 5, the isokinetic test showed impaired muscle function recovery from 23% to 32%, while the manual test showed almost full recovery. The issues of agreement between manual and isokinetic muscle testing are discussed. In this selected and homogeneous cohort of patients, the prevalence of motor deficit was rather low and the outcome excellent according to the results of the manual testing. Isokinetic muscle tests showed a higher prevalence of deficit and a much slower recovery. The manual muscle test is a crude clinical test. For more indepth muscle performance evaluation, additional testing may be necessary, especially for those patients with physically demanding jobs or activities.

The test-retest reliability of a new occupational risk factor questionnaire for outcome studies of low back pain

This study reports the test-retest reliability of a 25-item occupational risk factor questionnaire that can be self-administered in clinical settings and used in outcome studies of low back pain or return to work programs. Subjects were 24 patients (workers on sick leave due to acute low back pain), 29 co-workers on active duty in the same jobs in a utility company, and 53 supervisors. Eighty-six subjects were re-tested within a mean interval of 7-10 days; one group of 20 supervisors was re-tested within 81 days. The questionnaire was self-administered during individual interviews. Reliability was estimated by the kappa statistic as the agreement on the scores within the raters in each group. The agreement ranged from 'slight' (0.15) to 'almost perfect' (0.93) when the re-test interval was less than 43 days. Patients and non-patients were consistent in their assessment of the job demands. rights reserved.

Evaluation of the Abbott AxSYM cytomegalovirus (CMV) immunoglobulin M (IgM) assay in conjunction with other CMV IgM tests and a CMV IgG avidity assay

The measurement of the avidity of cytomegalovirus (CMV) immunoglobulin G (IgG) antibodies has been shown by several investigators to be useful in identifying and excluding primary CMV infections in pregnant women. In this work, we examined the diagnostic utility of reflex testing of CMV IgM-positive specimens from pregnant women by using a CMV IgG avidity assay. The utility of this approach was directly dependent on the sensitivity of the CMV IgM assay employed during the initial screen. The higher initial reactivity rate of the AxSYM CMV IgM assay was necessary in order to detect CMV IgM in specimens containing low-avidity CMV IgG antibodies, indicative of a primary CMV infection, which other CMV IgM assays (Behring, Vidas, Captia, and Eurogenetics) fail to detect in some cases. The use of the AxSYM CMV IgM assay, followed by an avidity test, should result in more accurate diagnosis of CMV infection in pregnant women.

[Cytostatic therapy reduces the immune defense. Children treated for leukemia have impaired immunity against measles and rubella]

A study is summarized analyzing the levels of serum antibodies against vaccination antigens in 43 children treated for acute lymphoblastic leukemia. Two different therapeutical regimens were used. All children had been immunized against measles and rubella before being diagnosed with leukemia. Eight of the 24 children treated 1986-1991 lacked protective levels of antibodies against measles; four of the 24 children lacked antibodies against rubella. In the second cohort of children (n = 16) treated from 1992 and onwards, nine lacked protective levels of antibodies against measles, eight lacked antibodies against rubella.