By J. Pranck. California National University for Advanced Studies.

The programme did not make it clear that Vincent Marks was an active member of HealthWatch order differin 15 gr amex, or that he has spent most of his professional life persuading people that sugar does you no harm — even in megadoses purchase differin 15gr with amex. This programme cheap differin 15 gr overnight delivery, like many others, failed to interview a doctor who works with vitamins and food supplements. They subscribe to the view that vitamins are good for you and therefore things which are good for 28 you cannot do you any harm. Some of the hocus pocus treatments are so bizarre as to be unbelievable, and I 30 believe some of them may be harmful. Well, there we have the considered scientific view, people being tested for non-existent allergies, paying for evening primrose oil or pumpkin seeds, where will it all end? Nurse Jessie Thompson felt stressed, so she bought some herbal relaxation pills from a health food shop. She took 30 pills — and suffered jaundice, kidney failure and such serious liver damage she spent 10 weeks in hospital. Professor Bender has worked, throughout his life, for the processed food manufacturers. He was head of research at Farley Infant Foods, head of research at Bovril, and has received 33 research funding from Cadbury Schweppes, Heinz and Kelloggs. The mind boggles, and just think, if they found these things in health food shops, what would they find in any of the major food retailers? Perhaps the most amazing thing about articles of this kind is that it makes one realise that the Medicines Act should cover the licensing of journalists, some of whom can of course seriously damage your health. Chapter Thirty Two Wellcome, Part Four : Colonising the Voluntary Sector Illness, a central concept of medicine, is not a matter of objective scientific fact. If illness is a judgement, the practice of medicine can be understood in terms ofpower. After a drug has been granted a licence, there is still competitive pressure from other manufacturers. The large sums invested in the research and development of most drugs mean that the product has to run the full course of its licence without competition in order to ensure maximum profits. The later years of the licence are the most important because it is only then, when research and development costs have been cleared, that the product begins to make a profit. Firstly, few illnesses are community-specific and rarely do people with specific illnesses form cohesive communities unless compelled by social pressure. Would doctors be able to persuade these patients to trust to the apparent benefits of orthodox medicine as quietly as cancer patients had succumbed? Rare contemporary examples of community-based illness, such as the site-specific aluminium pollution at Camelford, gave Wellcome a glimpse of how volatile and politically conscious a community assaulted by illness could become. The marketing of a new pharmaceutical by specialised advertising and public relations companies begins long before it is granted a licence. A subsidiary of Collier and Waring, Colloquium, was employed to organise meetings, conferences and symposia. Kingsway had organised many campaigns for the processed food and chemical companies. When Kingsway became Kingsway Rowland and was then taken into Rowland International, Crouch continued to be a consultant, until he moved on to the Westminster Communications Company. See Chapter Twenty Three The wider shores of public relations work are rarely revealed,!! Each drug produced by Wellcome has a marketing team which works with advertising agencies and public relations companies organising the sales campaign. In fact, Wellcome would have really liked to deal directly with the patient population and completely cut out possibly critical, medical professionals. Experience in America had shown that, there were doctors within the gay community who had worked with alternative therapies for years. It needed maximum propaganda to counter accusations of profiteering which would inevitably be levelled at Wellcome. It takes up to twelve years to develop, test and then gain a licence for a new drug. Such a treatment programme might emerge quickly from any number of doctors working in the field of alternative medicine. Obviously, in its own publications, Wellcome would make little reference to adverse side effects or toxicity. Possible licensing approval for a competitor company is again something which does not happen overnight. Wellcome was confident of controlling the apex of the system, with highly placed individuals, agreements with the DoH and influence inside the Committee on the Safety of Medicines. At the early stages of the journey to a licence, any competitor drug would have to go through trials. After 1988 and the beginning of the Anglo-French Concorde Trials, the majority of cohort subjects came under the control of Wellcome. Official figures were the principal guide to this projection, and these were in the main collated by official sources, then re-presented in the press or via a populist interpretation through spokespersons for the voluntary agencies. With many new drugs, the drug company has first to persuade the general practitioner of the efficacy of the treatments. This is done by using marketing techniques which range from persuasive arguments to persuasive golfing holidays in the Caribbean. To captivate and colonise the patients, and their organisations, Wellcome used sophisticated marketing arguments and a seemingly endless stream of financial donations. So covert and well organised was this infiltration and usurpation that large numbers of workers in the sector were completely oblivious of the fact that they were doing the bidding of Wellcome. To some extent, the relationship was also based upon the creation of financial insecurity.

Royal College of General Practitioners discount 15 gr differin mastercard, Nicholas A buy cheap differin 15 gr on line, DeBias D cheap differin 15gr on line, Ehrenfeuchter W et al 1987 A London somatic component to myocardial infarction. Journal of the American Osteopathic Association 87(2):123–133 Rocobado M 1985 Arthrokinematics of the temporomandibular joint. Journal Harper & Row, New York of the National Chiropractic Association 27(11):21 Rosenthal E 1987 Alexander technique and how it Norris C 1995 Spinal stabilisation. Physiotherapy 81(3):127–138 2:53–57 Chapter 6 • Assessment/Palpation Section: Skills 195 Rosero H, Greene C, DeBias D 1987 Correlation of Uber-Zak L, Venkateshme Y 2002 Neurologic palpatory observations with anatomic locus of acute complications of sit-ups associated with the valsalva myocardial infarction. Therapy 79(6):591–599 Eastland Press, Seattle Selye H 1976 Stress in health and disease. McGraw-Hill, New of 5th Interdisciplinary World Congress on Low Back York and Pelvic Pain, Melbourne, Australia, p 56–79 Shipley D 2000a Manipulation therapy for the van Wingerden J-P 1997 The role of the hamstrings in naturopathic physician, 2nd edn. Churchill Shipley D 2000b Manipulation therapy for the Livingstone, New York naturopathic physician, 2nd edn. Health For All Publishing, London Simons D 1993a Myofascial pain and dysfunction review. Journal of Musculoskeletal Pain 1(2):131 Vleeming A, Mooney A, Dorman T et al 1989 Load application to the sacrotuberous ligament: influences on Simons D 1993b Referred phenomena of myofascial sacroiliac joint mechanics. In: Vecchiet L, Albe-Fessard D, Lindbolm 4:204–209 U (eds) New trends in referred pain and hyperalgesia. Elsevier, Amsterdam Vleeming A, Mooney V, Dorman T, Snijders C, Stoeckart R (eds) 1997 Movement, stability and low Simons D 1996 Clinical and etiological update of back pain. Journal of Musculoskeletal Pain 4:93–121 Wall P, Melzack R 1989 Textbook of pain, 2nd edn. Churchill Livingstone, London Simons D, Mense S 1997 Understanding and measurement of muscle tone as related to clinical Ward R (ed) 1997 Foundations of osteopathic medicine. Pain 75(1):1–17 Williams & Wilkins, Baltimore Simons D, Travell J, Simons L 1999 Myofascial pain Weiss J 2001 Pelvic floor myofascial trigger points: and dysfunction: the trigger point manual, vol. In: Chaitow L (ed) Positional release Staubesand J, Li Y 1997 Begriff und Substrat der techniques, 2nd edn. Churchill Livingstone, Edinburgh, Faziensklerose bei chronisch-ven’ser Insuffizienz. Stanley fibromyalgia and myofascial pain syndromes: a Thornes, Cheltenham preliminary study of tender points and trigger points in persons with fibromyalgia, myofascial pain Swerdlow B, Dieter N 1992 Evaluation of syndrome and no disease. Pain 48:205–213 19(6):944–951 Travell J, Simons D 1983a Myofascial pain and Yahia L, Pigeon P, DesRosiers E 1993 Viscoelastic dysfunction: the trigger point manual, vol. Williams & Wilkins, Baltimore Biomedical Engineering 15:425–429 Travell J, Simons D 1983b Myofascial pain and Zink G, Lawson W 1979 An osteopathic structural dysfunction: the trigger point manual, vol 1: the upper examination and functional interpretation of the soma. Alexander technique) 256 Clinical prediction 206 Prolotherapy 257 Centralization/peripheralization categorization 206 [Manual] pump techniques – lymphatics, liver or Using directional preference in rehabilitation 207 spleen 261 Biopsychosocial factors: a broader classification Rehabilitation methods 262 approach 207 Shiatsu, acupressure, etc. Examples of such ‘spe- physical medicine approaches employed in naturo- cific’ indicators are to be found later in this chapter pathic medicine. These modalities are commonly used where methods of categorization of low back pain to address local dysfunction, or they may be utilized (used as an example) are discussed. Evidence shows Constitutional approaches that manipulation of the ‘exercise sensitive’ class of In Chapter 8 various distinctively naturopathic, con- back pain would offer little benefit and, likewise, spe- stitutional (whole-body) means of evaluating and cific exercises are unlikely to help ‘manipulation sen- treating general health, as well as locally dysfunc- sitive’ back problems (Flynn et al 2002). Of course tional conditions, are described and explored in the there are also back problems that are unlikely to context of the use of neuromuscular technique, or of respond to either manipulation or exercise, and some a general mobilization approach known as general that may respond to both. Individual modalities may be Efficacy and safety interchangeable In numerous instances, many of the modalities dis- In this chapter evidence of efficacy of individual cussed and outlined in this chapter may be seen to be methods, techniques and modalities will be graded in virtually interchangeable. For example, where an area a spectrum ranging from ‘very good’ (systematic of soft tissue dysfunction is characterized by excessive review evidence) to ‘poor’ (rumor, tradition). That tone and shortness in muscle, the choice between said, it is worth reminding ourselves that lack of proof employing muscle energy technique methods or of efficacy does not represent proof of a lack of efficacy. Instead, it approaches the discussion by out- of compression and distraction (lengthening) features lining the methods, their suggested physiological that are common to many other techniques (proprio- effects, and how these methods are best applied in the ceptive neuromuscular facilitation, muscle energy, context of musculoskeletal distress in particular, and etc. The relative advantages of incorporating different Chapter 7 • Modalities, Methods and Techniques 199 features in various clinical settings are explained the usefulness of massage, but questions spinal wherever evidence exists for such discussion. Spinal manipulation applicable technique, method, approach or modality generated no advantage over general practitioner care, that will always be helpful in restoring pain-free func- analgesics, physical therapy, exercise or back school. Unpicking this quoted statement brings sharply into An individualized approach is demanded, since two focus the danger of relying on such evidence. These would benefit from quite different thera- of causes, ranging from biomechanical to peutic and rehabilitation strategies – one possibly pathological, psychological and functional requiring deactivation of myofascial trigger points features, possibly involving intervertebral followed by postural re-education, the other calling disc problems, facet joint dysfunction, for joint mobilization achieved by high velocity thrust hypermobility, muscular and/or ligamentous methodology, supported by appropriate soft tissue imbalances, sacroiliac restrictions, trigger normalization possibly involving stretching and/or points and disturbed emotion/somatization core stability training. These variables make use of the word ‘massage’ manipulative attention, at precisely the same potentially uninformative, since that word covers spinal region. Both balancing, muscle energy and strain/ approaches produced good to excellent results; counterstrain techniques (Yates et al 2002). As however, since the reader is left with the will become clearer to those unfamiliar with mystery as to what ‘gold standard physical these methods (see the descriptions later in this therapy’ is, and just how breathing chapter), there can hardly be more diverse rehabilitation is achieved, the chances of methods for modifying tissue status, or reproducing the results remains questionable. However, individual, appears to offer clear benefit in a range of it is a criticism of reviewers who attempt to back and other problems. In these, the It is also important that we regularly refer to the elements of treatment used to help the patient underlying principles – as outlined in Chapter 1 – that are not tested – only the intervention of the inform clinical decision-making in naturopathic medi- discipline. This allows a greater opportunity cine in general and naturopathic physical medicine in for a non-linear dynamic interplay between particular. Chapter 7 • Modalities, Methods and Techniques 201 Tension Compression Rotation Bending Shearing Figure 7.

N) were signifcantly studies have examined the effects of repetitive magnetic stimula- lower generic differin 15 gr on-line, and trabecular separation(Tb cheap differin 15 gr with amex. Conclusion: The results demonstrated that electroa- frequency (10 Hz buy differin 15 gr, 1 Tesla) groups (n=4 dishes/group) and were cupuncture can inhibit subchondral bone loss and protected articu- stimulated for 3 days. However, whether electroacupuncture Akt and Erk was investigated by Western blotting analysis 3 days protect against articular cartilage erosion by inhibiting subchondral after repetitive magnetic stimulation. Re- 138 sults: There were differences in cell proliferation based on stimulus frequency. These fndings represent a promising op- loss, especially on the weight bearing bone. In mature bone, dis- portunity to gain insight into how different frequenciesof repetitive use osteoporosis is manifested by increased bone resorption and magnetic stimulation may mediate cell proliferation. Exercise will increase the thickness of cortical more than trabecular bone but electrostimulation inhibited the loss of trabecular more than 137 cortical bone. Li3 biphasic, asymmetrical square wave, frequency 2 Hz, pulse width 1The First Affliated Hospital of University of South China, Depart- 250 μs, duty cycle 5:10s. Two sets of 3 hours period daily with 2-h ment of Rehabilitation-, Hengyang, China, 2Hunan Polytechnic of rest in between, 3×/week for 4 weeks), but the left legs were not Environment and Biology, Department of Rehabilitation, Heng- stimulated. After yang, China, 3The First Affliated Hospital of University of South 4 weeks, all samples were sacrifced and taken the tibial bone, de- China, Department of Rehabilitation, Hengyang, China calcifed, microtomized and prepared with Hematoxycillin Eosin staining. Trabecular, cortical dan periosteum thickness were meas- Introduction/Background: To investigate effects of electroacupunc- ured with micrometer and compared. Our results showed that 1 respiration, especially deep inspiration, changes the morphology of Dulap 1 the pharynx and larynx. During deep inspiration, larger pharyngeal Southwestern University, College of Rehabilitative Sciences, Cebu volume and area was observed with no change in length, suggested City, Philippines that the larger volume was produced by increasing cross-sectional Introduction/Background: Spasticity management has evolved in area. Further study is necessary to determine the mechanism for many years from the use of pharmacologic agents to application of these changes in anatomical confguration. This study determined the effect of Baclofen and elec- trical simulation on patients with spasticity. Material and Meth- 141 ods: Included in this quasi-experimental study were 21 patients with upper motor neuron lesion who manifested spasticity. Saitoh1 groups were treated for 10 sessions and the spasticity of the sub- 1Fujita Health University- School of Medicine, Department of Re- jects were measured using the Tardieu scale before and after 10 habilitation Medicine, Toyoake, Japan, 2Fujita Health University treatment sessions. Paired t-test was used to determine whether Hospital, Department of Rehabilitation, Toyoake, Japan, 3Fujita there is a signifcant change in the mean spasticity score before Health University, Faculty of Rehabilitation, Toyoake, Japan and after treatment in each group, and independent t-test was used to determine the signifcant difference in the mean score between Introduction/Background: Various bolus have been used for pa- groups, all at p<0. However, physiological effects of viscosity in the Tardieu mean score before and after treatment in group 3 and volume have been rarely investigated in detail. Material and Methods: Conclusion: The combination of electrical stimulation and oral Thirteen healthy adults (average age; 28. Participants swallowed saliva, 3 ml thin liquid, 3ml nectar thick liquid, and 20 ml thin liquid, and 20 ml nectar 140 thick liquid. Two trials were performed for each bolus and the task order was randomly assigned. They had signifcantly longer duration compared to saliva (428±90 ms), 3 ml thin liquid (519±83 ms), or 3 ml nectar thick Y. Palmer3 pharyngeal pressure of 20 ml thin liquid was signifcantly larger 1Fujita Health Univesity, Faculty of Rehabilitation, Toyoake, Ja- than that of 20 ml thin liquid (p<0. Maximum velopharyngeal pan, 2Fujita Health Univesity, Department of Rehabilitation Medi- pressure of 3 ml thin liquid was signifcantly larger than that of 3 cine I, Toyoake, Japan, 3Johns Hopkins Univerisity, Department of ml thin liquid (p<0. The purpose of this study was to examine the effects of respiratory phase on the shape and size of pharynx and larynx. For patients after radiotherapy of nasopharyngeal measurement to fnd unmet needs in post stroke patient. Without the proper nutritional support, even the best rehabilitation regimen may not yield targeted results. Lin1 In this study, we analyzed the current situation of tube feeding and 1Changhua Christian Hospital, Physical Medicine & Rehabilita- dysphagia therapy in our rehabilitation ward. Material and Meth- tion, Changhua, Taiwan ods: Patients admitted into our rehabilitation ward from Jan 2012 to Dec 2014 (three years) were screened. However, its design was based on Delphi rehabilitation ward during the three year period. The patients were requested to answer the questionnaire and to viding the nutritional needs of patients with post-stroke dysphagia. Hundred Supervision, Kita-ku- Tokyo, Japan and thirty nine subjects participated to the inter-rater reliability as- sessment; thirty were enrolled in the intra-rater reliability assess- Introduction/Background: There are few well-established statistical ment. Two observers measured the spinal sagittal curves of each methods to assess the validities of content (Selected items of measure- participant with the surface goniometer IncliMed®. Hundred and ment) and of construct (Meaning of measurement) in psychometric thirty nine subjects were measured by the two raters within a tem- measures such questionnaire. There has been only choice to depend poral range of 10 minutes, in the same setting. Thirty returned at a upon the opinion of experts with long experience or upon the com- mean distance of 28 days for the intra-rater data collection. We present a new method ment limit and coeffcient of repeatability were calculated according to confrm the items structure in questionnaire, which is refected in to the linear regression analysis, and the Bland and Altman method content and construct validities, using statistical calculation in place applied to obtain the average of the differences and the standard er- of expert’s knowledge. Results: The inter-observer vari- for psychometric assessment usually deal with categorical data as ability for IncliMed® measurements was ±11° both for the kyphosis form of a contingency table. Conclu- with graphical model could provide domain structures to describe the sion: The IncliMed® method represents a reliable, non-invasive and degree of association among items. The proposed method is intended user-friendly tool for the clinical measurement and monitoring of to estimate the probability distribution on the basis of the comparison the spinal sagittal curves in children and adolescents.

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