This study explores associations between language ability and hand preference in children with Down syndrome. Compared to typically developing children of the same age, children with Down syndrome showed weaker hand preference, were less consistent in the hand they used and also less willing to reach to extreme positions in contralateral space. Within the group of children with Down syndrome, those who showed a stronger or more consistent hand preference had better language and memory skills. This association could not be explained by differences in non-verbal cognitive ability or hearing loss. These findings are discussed within the theory of neurolinguistic development proposed by Locke [Locke (1997). Brain & Language, 58, 265-326].

Dev Psychobiol. 2008 Apr;50(3) Groen MA, Yasin I, Laws G, Barry JG, Bishop DV. University of Hamburg, Biological Psychology and Neuropsychology, Von-Melle-Park 11, 20146 Hamburg, Germany. margriet.groen@uni-hamburg.de

ABSTRACT: BACKGROUND: Chiropractic treatment for low back pain (LBP) can often be divided into two phases: Initial treatment of the problem to attempt to remove pain and bring it back into its pre-clinical or maximum improvement status, and "maintenance care", during which it is attempted to maintain this status. Although the use of chiropractic maintenance care has been described and discussed in the literature, there is no information as to its precise indications. The objective of this study is to investigate if there is agreement among Swedish chiropractors on the overall patient management for various types of LBP-scenarios, with a special emphasis on maintenance care. METHOD: The design was a mailed questionnaire survey. Members of the Swedish Chiropractors' Association, who were participants in previous practice-based research, were sent a closed-end questionnaire consisting of nine case scenarios and six clinical management alternatives and the possibility to create one's own alternative, resulting in a "nine-by-seven" table. The research team defined its own pre hoc choice of "clinically logical" answers based on the team's clinical experience. The frequency of findings was compared to the suggestions of the research team. RESULTS: Replies were received from 59 (60%) of the 99 persons who were invited to take part in the study. A pattern of self-reported clinical management strategies emerged, largely corresponding to the "clinically logical" answers suggested by the research team. In general, patients of concern would be referred out for a second opinion, cases with early recovery and without a history of previous low back pain would be quickly closed, and cases with quick recovery and a history of recurring events would be considered for maintenance care. However, also other management patterns were noted, in particular in the direction of maintenance care. CONCLUSION: To a reasonable extent, Swedish chiropractors participating in this survey appear to agree on the clinical management for different cases of LBP.

Axén I, Rosenbaum A, Eklund A, Halasz L, Jørgensen K, Lövgren PW, Lange F, Leboeuf-Yde C. Private practice and the Karolinska Institute, Stockholm, Sweden. iben.axen@ki.se. Chiropr Osteopat. 2008 Jun 18;16:6.

PURPOSE OF REVIEW: The aim is to summarize recent evidence from the National Institute for Health and Clinical Excellence clinical guidelines and high-quality systematic reviews for the use of cognitive behavioural therapy to treat children and adolescents with mental health problems. RECENT FINDINGS: Data from meta-analyses of randomized controlled trials suggest that the best evidence for the potential of cognitive behavioural therapy is in the treatment of children and adolescents with generalized anxiety disorder, depression, obsessive compulsive disorder and posttraumatic stress disorder. More limited evidence suggests that attention deficit hyperactivity disorder and behavioural problems may also respond to cognitive behavioural therapy. We found no or insufficient evidence to determine whether cognitive behavioural therapy is useful for the treatment of antisocial behaviour, psychotic and related disorders, eating disorders, substance misuse and self-harm behaviour. SUMMARY: Clinical guidelines and recent systematic reviews establish that cognitive behavioural therapy has a potentially important role in improving the mental health of children and adolescents.

Curr Opin Psychiatry. 2008 Jul;21(4) Muñoz-Solomando A, Kendall T, Whittington CJ. Child and Family Centre Tonteg, Wales, UK.

This controlled and patient blinded study tested the effect of hypnosis on persistent idiopathic orofacial pain (PIOP) in terms of clinical and psychosocial findings. Forty-one PIOP were randomized to active hypnotic intervention or simple relaxation as control for five individual 1-h sessions. Primary outcome was average pain intensity scored three times daily in a pain diary using visual analogue scale (VAS). Secondary outcome measures were pain quality assessed by McGill pain questionnaire (MPQ), psychological symptoms assessed by symptom check list (SCL), quality of life assessed by SF36, sleep quality, and consumption of analgesic. Data were compared between groups before and after treatment using ANOVA models and paired t-tests. The change in VAS pain scores from baseline to the last treatment (t4) was (33.1+/-7.4%) in the hypnosis group and (3.2+/-5.4%) in the control group (P<0.03). In the hypnosis group, highly hypnotic susceptible patients had greater decreases in VAS pain scores (55.0+/-12.3%) when compared to less susceptible patients (17.9+/-6.7%) (P<0.02). After the last treatment there were also statistically significant differences between groups in perceived pain area (MPQ) and the use of weak analgesics (P<0.03). There were no statistically significant changes in SCL or SF36 scores from baseline to t4. In conclusion, hypnosis seems to offer clinically relevant pain relief in PIOP, particularly in highly susceptible patients. However, stress coping skills and unresolved psychological problems need to be included in a comprehensive management plan in order also to address psychological symptoms and quality of life.

Abrahamsen R, Baad-Hansen L, Svensson P. Department of Clinical Oral Physiology, School of Dentistry, University of Aarhus, Vennelyst Boulevard 9, DK-8000 Aarhus, Denmark. rabrahamsen@odont.au.dk Pain. 2008 May;136(1-2):44-52.

OBJECTIVE: To determine the efficacy of an Internet-based Arthritis Self-Management Program (ASMP) as a resource for arthritis patients unable or unwilling to attend small-group ASMPs, which have proven effective in changing health-related behaviors and improving health status measures. METHODS: Randomized intervention participants were compared with usual care controls at 6 months and 1 year using repeated-measures analyses of variance. Patients with rheumatoid arthritis, osteoarthritis, or fibromyalgia and Internet and e-mail access (n = 855) were randomized to an intervention (n = 433) or usual care control (n = 422) group. Measures included 6 health status variables (pain, fatigue, activity limitation, health distress, disability, and self-reported global health), 4 health behaviors (aerobic exercise, stretching and strengthening exercise, practice of stress management, and communication with physicians), 5 utilization variables (physician visits, emergency room visits, chiropractic visits, physical therapist visits, and nights in hospital), and self-efficacy. RESULTS: At 1 year, the intervention group significantly improved in 4 of 6 health status measures and self-efficacy. No significant differences in health behaviors or health care utilization were found. CONCLUSION: The Internet-based ASMP proved effective in improving health status measures at 1 year and is a viable alternative to the small-group ASMP.

Lorig KR, Ritter PL, Laurent DD, Plant K. Stanford University School of Medicine, Stanford, California, USA. Arthritis Rheum. 2008 Jul 15;59(7):1009-17.

Mark Phoenix formally trained in hypnotherapy in 1996 under the renowned hypnotherapist Neil French. He has worked at Manchester University and has a Diploma in Hypnotherapy and Psychotherapy and was elected to be a Member of the International Association of Hypno-Analysts, European's largest professional association of Analytical Hypnotherapists and recently elected to be placed on the Register of Advanced Hypnotherapists, one of only four registered in Spain. Mark has written many articles both in the UK and here in Spain, and has appeared on local television.

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The nocebo effect consists in delivering verbal suggestions of negative outcomes so that the subject expects clinical worsening. Here we show that nocebo suggestions, in which expectation of pain increase is induced, are capable of producing both hyperalgesic and allodynic responses. By extending previous findings on the placebo effect, we investigated the role of learning in the nocebo effect by means of a conditioning procedure. To do this, verbal suggestions of pain increase were given to healthy volunteers before administration of either tactile or low-intensity painful electrical stimuli. This nocebo procedure was also carried out after a pre-conditioning session in which two different conditioned visual stimuli were associated to either pain or no-pain. Pain perception was assessed by means of a Numerical Rating Scale raging from 0=tactile to 10=maximum imaginable pain. We found that verbal suggestions alone, without prior conditioning, turned tactile stimuli into pain as well as low-intensity painful stimuli into high-intensity pain. A conditioning procedure produced similar effects, without significant differences. Therefore, in contrast to placebo analgesia, whereby a conditioning procedure elicits larger effects compared to verbal suggestions alone, learning seems to be less important in nocebo hyperalgesia. Overall, these findings indicate that, by defining hyperalgesia as an increase in pain sensitivity and allodynia as the perception of pain in response to innocuous stimulation, nocebos can indeed produce both hyperalgesic and allodynic effects. These results also suggest that learning is not important in nocebo hyperalgesia compared to placebo analgesia.

Colloca L, Sigaudo M, Benedetti F. Department of Neuroscience, University of Turin Medical School, and National Institute of Neuroscience, Corso Raffaello 30, 10125 Turin, Italy. luana.colloca@unito.it Pain. 2008 May;136(1-2):211-8.

CONTEXT: Spinal cord injury often results in chronic pain syndromes that conventional pain management is unable to resolve. Healing Touch (HT) is a biofield therapy that involves using the hands to promote healing and mediate the perception of pain by affecting the energy field of the person. The practice of HT is based on the premise that the energy field has the ability to provide valuable information about the person's physical, emotional, mental, and spiritual condition and can influence the dense matter of physical form. OBJECTIVE: This secondary analysis using case study reviews describes two different experiences of receiving a HT session for management of chronic neuropathic pain and its sequelae, utilizing energy field data and reports of participants and their HT practitioners. DESIGN: Qualitative case study approach was used. SETTING: Data were obtained from 42 HT sessions that took place within the homes of seven veterans with spinal cord injury. METHOD: Two cases involving the most common patterns of response were selected from seven cases to represent the participants' and practitioners' experiences. A descriptive qualitative approach informed the results. RESULTS: The findings indicate that a variety of experiences can exist in individuals with chronic pain due to spinal cord injury; experiences will also vary with their healing touch practitioners. There are commonalities in the perception of the practitioners in the damage to the energy field and energy centers, with individualized and consistent resolution of the field over time.

Wardell DW, Rintala D, Tan G. The University of Texas Houston, Health Science Center, School of Nursing, Houston, TX, USA. diane.wardell@uth.tmc.edu Explore (NY). 2008 May-Jun;4(3):187-95.

Ann Berger, MSN, MD, is one of the foremost specialists in pain management in the nation. A medical oncologist specializing in pain treatment, she has written and edited numerous books on pain and palliative care for patients and health-care providers. Dr. Berger is also senior editor of the most widely used textbook on palliative care, Principles and Practice of Palliative Care and Supportive Oncology. She currently resides in Darnestown, Maryland.

Content on integrative healthcare and complementary and alternative medicine is being taught in hundreds of educational programs across the country. Nursing, medical, osteopathic, chiropractic, acupuncture, naturopathic, and other programs are finding creative and innovative ways to include these approaches in new models of education and practice. This column spotlights such innovations in integrative healthcare and CAM education and presents readers with specific educational interventions they can adapt into new or ongoing educational efforts at their institution or programs. We invite readers to submit brief descriptions of efforts in their institutions that reflect the creativity, diversity, and interdisciplinary nature of the field. Please submit to Dr Sierpina at vssierpi@utmb.edu or Dr Kreitzer at kreit003@umn.edu. Submissions should be no more than 500 to 1500 words. Please include any Web site or other resource that is relevant, as well as contact information.

Kreitzer MJ, Sierpina V, Maiers M, Delagran L, Baldwin L, Evans R, Chase M. Explore (NY). 2008 Jul-Aug;4(4):278-81.

The professional support increased chances of success for smoking cessation and is an important goal in health politics. A short advice by pharmacists can make a significant contribution to this. This article describes tobacco dependence and the "stages of change-model". Afterwards we explain possible therapies: besides cognitive-behavioral intervention, different forms of medical treatment, e.g. nicotin replacement therapy, bupropion and varenicline, are discussed.

Bölcskei PL, Walden K. Institut für Raucherberatung und Tabakentwöhnung Bayern, München. info@irt-rauchfreiwerden.de Med Monatsschr Pharm. 2008 May;31(5):173-8.

This study explored the psychometric properties and utility of the exposure hierarchy as a measure of treatment outcome for social anxiety disorder (SAD). An exposure hierarchy was created for each of 103 individuals with a diagnosis of SAD who completed a course of cognitive behavioral group therapy. Exposure hierarchy ratings were collected on a weekly basis, and a series of self-report measures were collected before and after treatment. Results indicated that the exposure hierarchy demonstrated high test-retest reliability, as well as significant convergent validity, as participants' exposure hierarchy ratings correlated positively with scores on conceptually related measures. Hierarchy ratings were significantly associated with changes in SAD symptoms over time. However, exposure hierarchy ratings were correlated to general measures of psychopathology, suggesting limited discriminant validity. The study highlights the clinical and scientific utility of the exposure hierarchy.

Behav Modif. 2008 Jul;32(4): Katerelos M, Hawley LL, Antony MM, McCabe RE. Anxiety Treatment and Research Centre, St. Joseph's Healthcare, Canada.

BACKGROUND: The literature supporting the use of music therapy in palliative care is growing. However, the number of quantitative research studies investigating the use of music therapy in palliative care, and specifically anxiety, is limited. OBJECTIVE: The aim of this research project was to examine the effectiveness of a single music therapy session in reducing anxiety for terminally ill patients. DESIGN: A randomized-controlled design was implemented and the following hypotheses tested. There will be a significant difference between the experimental and control groups on anxiety levels as demonstrated by the anxiety measurement of the Edmonton Symptom Assessment System (ESAS), and heart rate. The experimental group received a single music therapy intervention and the control group received a volunteer visit. SETTING/SUBJECTS: Twenty-five participants with end-stage terminal disease receiving inpatient hospice services were recruited. RESULTS: The first hypothesis was supported. Results demonstrated a significant reduction in anxiety for the experimental group on the anxiety measurement of the ESAS (p = 0.005). A post hoc analysis found significant reductions in other measurements on the ESAS in the experimental group, specifically pain (p = 0.019), tiredness (p = 0.024) and drowsiness (p = 0.018). The second hypothesis was not supported. CONCLUSIONS: The study supports the use of music therapy to manage anxiety in terminally ill patients. Further studies are required to examine the effect of music therapy over a longer time period, as well as addressing other symptom issues.

J Palliat Med. 2008 May;11(4) Horne-Thompson A, Grocke D. Calvary Health Care Bethlehem, Melbourne, Victoria, Australia. thompson_anne@optusnet.com.au

PURPOSE: Biofeedback is known to effect symptomatic and objective cure in children with dysfunctional voiding. While some authors advocate animation assisted biofeedback to achieve success, we previously demonstrated similar success without animation. We recently used animated biofeedback aimed at simplifying muscle isolation and encouraging patient interest. We compared the efficacy of biofeedback with and without animation in treating dysfunctional voiding, and its concomitant urinary symptoms. MATERIALS AND METHODS: We compared our experience with the last 60 cases of biofeedback using electromyography tracing alone (nonanimated) with our first 60 cases using the Urostym Pediflow program (animated). All 120 girls presented with urinary complaints and exhibited dysfunctional voiding on electromyography uroflow. Post-void residual measurements were made by ultrasound. We compared the 2 groups with respect to time to resolution of symptoms and dysfunctional voiding, and improvement in post-void residual volume after treatment. RESULTS: The nonanimated and animated groups were comprised of girls of similar ages (7.3 years vs 6.9 years). There was no significant difference between the 2 groups regarding symptom relief at a mean of 5.4 months after therapy, including daytime incontinence, nocturnal enuresis, urgency, frequency and hoarding. Three patients in each group experienced urinary tract infection following treatment, compared to 42 and 41 before treatment in the nonanimated and animated groups, respectively. Dysfunctional voiding resolved in 95% of patients in both groups. Post-void residual reduction was similar, namely from 35% to 9% of pre-void volume in the nonanimated group, and from 28% to 8% in the animated group. Children in the animated biofeedback group achieved success in significantly fewer sessions (3.6) than those undergoing nonanimated biofeedback (7.6, t test p <0.05). CONCLUSIONS: Despite our proved experience with nonanimated biofeedback systems and our inexperience with an animated system, animated biofeedback systems yielded similar results in a significantly shorter time. Animated and nonanimated biofeedback is efficacious in the treatment of dysfunctional voiding and its symptoms.

J Urol. 2008 Jul;180(1) Kaye JD, Palmer LS. Division of Pediatric Urology, Schneider Children's Hospital of North Shore-Long Island Jewish Health System, Long Island, New York, USA.

Neurostimulation to restore cognitive and physical functions is an innovative and promising technique for treating patients with severe brain injury that has resulted in a minimally conscious state (MCS). The technique may involve electrical stimulation of the central thalamus, which has extensive projections to the cerebral cortex. Yet it is unclear whether an improvement in neurological functions would result in a net benefit for these patients. Quality-of-life measurements would be necessary to determine whether any benefit of neurostimulation outweighed any harm in their response to different degrees of cognitive and physical disability. These measures could also indicate whether the technique could be ethically justified and whether surrogates could give proxy consent to its use on brain-injured patients.

Bioethics. 2008 Jul;22(6) Glannon W. University of Calgary - Philosophy, Social Sciences, 1226 2500 University Dr., NW Calgary Alberta T2N 1N4, Canada. wglannon@ucalgary.ca

Historically, herbs and spices have enjoyed a rich tradition of use for their flavor enhancement characteristics and for their medicinal properties. The rising prevalence of chronic diseases worldwide and the corresponding rise in health care costs is propelling interest among researchers and the public for multiple health benefits related to these food items, including a reduction in cancer risk and modification of tumor behavior. A growing body of epidemiological and preclinical evidence points to culinary herbs and spices as minor dietary constituents with multiple anticancer characteristics. This review focuses on the antimicrobial, antioxidant, and antitumorigenic properties of herbs and spices; their ability to influence carcinogen bioactivation; and likely anticancer contributions. While culinary herbs and spices present intriguing possibilities for health promotion, more complete information is needed about the actual exposures to dietary components that are needed to bring about a response and the molecular target(s) for specific herbs and spices. Only after this information is obtained will it be possible to define appropriate intervention strategies to achieve maximum benefits from herbs and spices without eliciting ill consequences.

J Nutr Biochem. 2008 Jun;19(6) Kaefer CM, Milner JA. Nutritional Science Research Group, National Cancer Institute, Rockville, MD 20892, USA.

Anita Johnston, PhD is the author of Eating in the Light of the Moon: How Women Can Transform Their Relationships with Food through Myth, Metaphor, and Storytelling which has been published in five languages. She is the Director of the Anorexia & Bulimia Center of Hawaii which she co-founded in 1982, is the Clinical Director and the Founder of the 'Ai Pono Intensive Out-Patient Eating Disorder Programs in Honolulu, and Clinical Consultant to Focus Center for Eating Disorders in Chattanooga, Tennessee. Dr. Johnston has a private practice specializing in women's issues and is a recognized international workshop presenter, lecturing widely to professional organizations, universities, medical institutions, and the community at large.

For more information, visit: www.DrAnitaJohnston.com.

Pain is a complex phenomenon, influenced by many individual and external factors, and may be experienced differently with age. The detrimental health and social effects of chronic pain are well known. Age-related disorders, such as dementia, may interfere with the communication of pain. Health care provider bias and cultural expectations also may be barriers to the recognition and management of pain in the elderly. A multidisciplinary and multimodal approach in older adults is essential to effective assessment and management. Behavioral approaches to pain should be considered and incorporated into treatment where appropriate.

Norelli LJ, Harju SK. Department of Psychiatry, Albany Medical College, 43 New Scotland Avenue, Albany, NY 12208, USA. norelll@mail.amc.edu Clin Geriatr Med. 2008 May;24(2):335-44, vii.

The purpose of this study was to test the predictions of an integrated cognitive and behavioral model of agoraphobic avoidance in patients with chronic panic disorder and agoraphobia during the process of observed therapeutic change. Treatment was residential with the majority (n=165, 88%) receiving cognitive therapy, while the remaining 23 (12%) received guided mastery therapy. The results of latent variable path modeling of the changes occurring over the course of this treatment suggested that the anxiety elicited by bodily sensations influenced catastrophic beliefs, which, in turn, increased avoidance. Avoidance increased the anxiety elicited by bodily sensations.

J Behav Ther Exp Psychiatry. 2008 Sep;39(3) Hoffart A, Sexton H, Hedley LM, Martinsen EW. Research Institute, Modum Bad, N-3370 Vikersund, Norway.

Irritable bowel syndrome (IBS) is one of the most common conditions seen in primary care settings. Despite this, there is no consensus as to the pathogenesis of this disorder or a consistently effective therapeutic regimen for many patients. This has encouraged the use of various alternative therapies from behavioral or complementary medicine. This review will address the evidence for alternative therapies, including the following: cognitive behavior therapy, hypnosis, elimination diets based on food antibody testing, nutrition supplements (such as fiber, probiotics, and prebiotics), and, finally, peppermint, l-glutamine, zinc, and cromolyn sodium. The review also explores the evidence for and the therapeutic ramifications of the hypothesis that increased intestinal permeability underlies the symptoms of IBS in many patients, and how a therapeutic plan that addresses nutrition, elimination diets, and nutrition supplements may be useful in restoring the integrity of the gut immune barrier.

Wald A, Rakel D. Section of GI and Hepatology, University of Wisconsin School of Medicine and Public Health, Madison, WI 53792, USA. axw@medicine.wisc.edu Nutr Clin Pract. 2008 Jun-Jul;23(3):284-92.

OBJECTIVE: Outcome assessment normally used in research can support the therapeutic process by tracking patient symptoms and function and offering a common language to clinicians and researchers. This study's objectives were to (1) identify patient-based outcomes assessments used in published chiropractic studies, (2) describe a framework for identifying appropriate sets of measures, and (3) address the challenges associated with these measures relevant to chiropractic. METHODS: This literature review identified and evaluated the most commonly used to outcome measures in chiropractic research. Instruments were evaluated in terms of feasibility, practicality, economy, reliability, validity, and responsiveness to clinical change. A search of PubMed and Index to Chiropractic Literature (from inception to June 2006) was performed. RESULTS: A total of 1166 citations were identified. Of these, 629 were selected as relevant. The most common patient-based outcomes assessments instruments identified were the Oswestry Pain/Disability Index, Visual Analog Scale, and Short Form 36. CONCLUSIONS: The integration of outcome measures is consistent with current national initiatives to enhance health care quality through performance measurement and can also be used to further the field of chiropractic health care research. Outcome measures are both a research tool and a means by which providers can consistently measure health care quality. Based upon this review, there is a wide range of outcome measures available for use in chiropractic care. Those most commonly cited in the literature are the numeric rating scale, Visual Analog Scale, Oswestry Pain/Disability Index, Roland-Morris Low Back Pain and Disability Questionnaire, and Short Form 36.

Khorsan R, Coulter ID, Hawk C, Choate CG. Integrative Medicine and Military Medical Research, Samueli Institute, Corona del Mar, CA 92625, USA. rkhorsan@siib.org J Manipulative Physiol Ther. 2008 Jun;31(5):355-75.

Robert Kelly has studied hypnotherapy for about seventeen years. For the last fifteen years he has been in full time practice.

Robert has studied and/or trained with most of the recognized experts in the fields of: hypnotherapy, psychotherapy, counseling, clinical supervision, forensic hypnosis, sexual abuse/sexual offending and many more. He is the Administrative Secretary of The IAPH, and Director of Training/Continuing Professional Development as well as being director of his own training organization, and a published author. Robert is the senior lecturer in the IAPH, and is recognised by many as the most significant figure in the field of Analytical Hypnotherapy, and smoking cessation. In his own clinical practice, Robert has helped over 10,000 clients - including stopping over 6000 smokers. He still treats 30+ clients every week.

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Although massage administered between workouts has been suggested to improve recovery and subsequent performance, its application between bouts of repetitive supramaximal anaerobic efforts within a given workout has received little attention. The purpose of the study compared different forms of very short rest periods administered between resistance exercise sets of individual workouts on subsequent performance. With a within-subjects design methodology, subjects (n = 30) performed three workouts that were identical in terms of the exercises (45 degrees leg press, prone leg curl, seated shoulder press, standing barbell curl), number of sets, and the resistance employed. For each workout, subjects received one of the following treatments between sets: 1 minute of rest as they stood upright, 30 seconds of rest as they stood upright, or 30 seconds of concurrent massage and body part elevation (MBPE), which entailed petrassage of the exercised limbs in a raised and supported position in an attempt to abate fatigue and enhance recovery from the previous set. Subjects were instructed to perform as many repetitions as possible for each set. For each exercise, two dependent variables were calculated: a total work/elapsed time ratio and the cumulative number of repetitions performed. For each exercise, one-way repeated-measures analysis of variance and Tukey's post hoc test revealed the following total work/elapsed time results: 1 minute rest <30 seconds' rest, 30 seconds' MBPE. For each exercise, cumulative repetition results were as follows: 1 minute rest >30 seconds' rest, 30 seconds' MBPE. Results imply that rest period duration exerts more influence on resistance exercise performance than MBPE. Those who seek improved resistance exercise performance should pay particular attention to rest period durations.

Caruso JF, Coday MA. Exercise Science Program, University of Tulsa, Tulsa, Oklahoma, USA. john-caruso@utulsa.edu J Strength Cond Res. 2008 Mar;22(2):575-82.

PURPOSE: To determine how hypnosis and empathic attention during percutaneous tumor treatments affect pain, anxiety, drug use, and adverse events. MATERIALS AND METHODS: For their tumor embolization or radiofrequency ablation, 201 patients were randomized to receive standard care, empathic attention with defined behaviors displayed by an additional provider, or self-hypnotic relaxation including the defined empathic attention behaviors. All had local anesthesia and access to intravenous medication. Main outcome measures were pain and anxiety assessed every 15 minutes by patient self-report, medication use (with 50 mug fentanyl or 1 mg midazolam counted as one unit), and adverse events, defined as occurrences requiring extra medical attention, including systolic blood pressure fluctuations (> or =50 mm Hg change to >180 mm Hg or <105 mm Hg), vasovagal episodes, cardiac events, and respiratory impairment. RESULTS: Patients treated with hypnosis experienced significantly less pain and anxiety than those in the standard care and empathy groups at several time intervals and received significantly fewer median drug units (mean, 2.0; interquartile range [IQR], 1-4) than patients in the standard (mean, 3.0; IQR, 1.5-5.0; P = .0147) and empathy groups (mean, 3.50; IQR, 2.0-5.9; P = .0026). Thirty-one of 65 patients (48%) in the empathy group had adverse events, which was significantly more than in the hypnosis group (eight of 66; 12%; P = .0001) and standard care group (18 of 70; 26%; P = .0118). CONCLUSIONS: Procedural hypnosis including empathic attention reduces pain, anxiety, and medication use. Conversely, empathic approaches without hypnosis that provide an external focus of attention and do not enhance patients' self-coping can result in more adverse events. These findings should have major implications in the education of procedural personnel.

Lang EV, Berbaum KS, Pauker SG, Faintuch S, Salazar GM, Lutgendorf S, Laser E, Logan H, Spiegel D. Department of Radiology, Beth Israel Deaconess Medical Center/Harvard Medical School, Boston, Massachusetts 02215, USA. elang@bidmc.harvard.edu J Vasc Interv Radiol. 2008 Jun;19(6):897-905.

BACKGROUND: Questions about the risks and regulatory requirements of naturopathy and western herbal medicine (WHM) in Australia prompted research by the Department of Human Services Victoria. This article offers findings from a survey of education providers, which was one of several studies carried out for the report. (The full report can be found at http://www.health.vic.gov.au/pracreg/naturopathy.htm.) METHOD: Questionnaires were sent to 43 Australian providers of naturopathy and WHM education. RESULTS: Unsustainable variation was found in award types, contact hours, clinical education, length of courses, and course content. CONCLUSIONS: Naturopaths and WHM practitioners are primary contact health professionals but educational standards vary widely, with some practitioners not likely to be adequately prepared. The degree of risk in their practice, and the need for better integration of complementary care with mainstream healthcare, require education at least to the level of a bachelor degree. Courses should be subject to independent external accreditation. However, attempts to determine appropriate minimum educational standards are unlikely to succeed without the support of a regulatory system that can mandate those minimum requirements.

McCabe P. School of Public Health, La Trobe University, Bundoora 3086, Victoria, Australia. Complement Ther Clin Pract. 2008 Aug;14(3):168-75.

OBJECTIVES: To compare outcomes in perception of pain and disability for a group of patients suffering with chronic low-back pain (CLBP) when managed in a hospital by either a regional pain clinic or a chiropractor. DESIGN: The study was a pragmatic, randomized, controlled trial. SETTING: The trial was performed at a National Health Service (NHS) hospital outpatient clinic (pain clinic) in the United Kingdom. SUBJECTS AND INTERVENTIONS: Patients with CLBP (i.e., symptom duration of >12 weeks) referred to a regional pain clinic (outpatient hospital clinic) were assessed and randomized to either chiropractic or pain-clinic management for a period of 8 weeks. The study was pragmatic, allowing for normal treatment protocols to be used. Treatment was administered in an NHS hospital setting. OUTCOME MEASURES: The Roland-Morris Disability Questionnaire (RMDQ) and Numerical Rating Scale were used to assess changes in perceived disability and pain. Mean values at weeks 0, 2, 4, 6, and 8 were calculated. The mean differences between week 0 and week 8 were compared across the two treatment groups using Student's t-tests. Ninety-five percent (95%) confidence intervals (CIs) for the differences between groups were calculated. RESULTS: Randomization placed 12 patients in the pain clinic and 18 in the chiropractic group, of which 11 and 16, respectively, completed the trial. At 8 weeks, the mean improvement in RMDQ was 5.5 points greater for the chiropractic group (decrease in disability by 5.9) than for the pain-clinic group (0.36) (95% CI 2.0 points to 9.0 points; p = 0.004). Reduction in mean pain intensity at week 8 was 1.8 points greater for the chiropractic group than for the pain-clinic group (p = 0.023). Conclusions: This study suggests that chiropractic management administered in an NHS setting may be effective for reducing levels of disability and perceived pain during the period of treatment for a subpopulation of patients with CLBP.

J Altern Complement Med. 2008 Jun;14(5) Wilkey A, Gregory M, Byfield D, McCarthy PW. Private Practice, Oldham, United Kingdom.

This study examined how rumors originating in 3- to 6-year-olds' causal inferences can affect their own and their peers' memories for a personally experienced event. This was accomplished by exposing some members of classrooms to contextual clues that were designed to induce inferences about the causes of two unresolved components of the event. After a 1-week delay, a substantial number of children who were exposed to the clues misremembered their inferences as actual experiences. Causal inferential memory errors were most pronounced among 5- and 6-year-olds. Also, many of the children whose classmates were exposed to the clues mistakenly incorporated their classmates' causal inferences into their own accounts, with 3- and 4-year-olds being most likely to make this error.

Principe GF, Guiliano S, Root C. Department of Psychology, Ursinus College, Collegeville, PA 19426, USA. gprincipe@ursinus.edu J Exp Child Psychol. 2008 Feb;99(2):135-55.

Iodine deficiency is generally recognized as the most commonly preventable cause of mental retardation and the most common cause of endocrinopathy (goiter and primary hypothyroidism). Iodine deficiency becomes particularly critical in pregnancy due to the consequences for neurological damage during fetal development as well as during lactation. The safety of therapeutic doses of iodine above the established safe upper limit of 1 mg is evident in the lack of toxicity in the Japanese population that consumes 25 times the median intake of iodine consumption in the United States. Japan's population suffers no demonstrable increased incidence of autoimmune thyroiditis or hypothyroidism. Studies using 3.0- to 6.0-mg doses to effectively treat fibrocystic breast disease may reveal an important role for iodine in maintaining normal breast tissue architecture and function. Iodine may also have important antioxidant functions in breast tissue and other tissues that concentrate iodine via the sodium iodide symporter.

Patrick L. Bastyr University graduate 1984; private practice, Durango, CO, specializing in environmental medicine and chronic hepatitis C; faculty, Postgraduate Certification Course in Environmental Medicine, Southwest College of Naturopathic Medicine; contributing editor, Alternative Medicine Review; physician-member of the Hepatitis C Ambassadors Team. Correspondence address: 117 CR 250 Suite A, Durango, CO 81301. Email: lpatrick@frontier.net. Altern Med Rev. 2008 Jun;13(2):116-127.

A 67-year-old woman with proven diagnosis of giant cell arteritis (GCA) and polymyalgia rheumatica (PMR) was admitted to stationary treatment twice to receive a complex therapy with methods of natural medicine comprising fasting as its main treatment element. Both times, a discrepancy between the course of markers of the acute phase on the one hand, and subjective as well as objective clinical outcome on the other hand could be observed.This may point to special conditions of this chronic inflammatory disease as compared to e.g.rheumatoid arthritis, but also to specific problems in assessing possible effects of the treatments chosen, particularly fasting therapy, as compared to effects of conventional therapies.

lement Med (2006). 2007 Aug;14(4):235-9. Epub 2007 Jul 20. Stange R, Pflugbeil C. Abteilung für Naturheilkunde, Immanuel-Krankenhaus Berlin-Wannsee, Königstrasse 63, 14109 Berlin-Wannsee, Germany. r.stange@immanuel.de

OBJECTIVE: Half of the adults in the United States use complementary and alternative medicine with mind-body therapy being the most commonly used form. Neurology patients often turn to their physicians for insight into the effectiveness of the therapies and resources to integrate them into their care. The objective of this article is to give a clinical overview of mind-body interventions and their applications in neurology. METHODS: Medline and PsychInfo were searched on mind-body therapies and neurologic disease search terms for clinical trials and reviews and published evidence was graded. RESULTS: Meditation, relaxation, and breathing techniques, yoga, tai chi, and qigong, hypnosis, and biofeedback are described. Mind-body therapy application to general pain, back and neck pain, carpal tunnel syndrome, headaches, fibromyalgia, multiple sclerosis, epilepsy, muscular dysfunction, stroke, aging, Parkinson disease, stroke, and attention deficit-hyperactivity disorder are reviewed. CONCLUSIONS: There are several conditions where the evidence for mind-body therapies is quite strong such as migraine headache. Mind-body therapies for other neurology applications have limited evidence due mostly to small clinical trials and inadequate control groups.

Wahbeh H, Elsas SM, Oken BS. Department of Neurology, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Mail Code CR120, Portland, OR 97239, USA. Neurology. 2008 Jun 10;70(24):2321-8.

Non-specific low back pain (NSLBP) is commonly conceptualised and managed as being inflammatory and/or mechanical in nature. This study was designed to identify common symptoms or signs that may allow discrimination between inflammatory low back pain (ILBP) and mechanical low back pain (MLBP). Experienced health professionals from five professions were surveyed using a questionnaire listing 27 signs/symptoms. Of 129 surveyed, 105 responded (81%). Morning pain on waking demonstrated high levels of agreement as an indicator of ILBP. Pain when lifting demonstrated high levels of agreement as an indicator of MLBP. Constant pain, pain that wakes, and stiffness after resting were generally considered as moderate indicators of ILBP, while intermittent pain during the day, pain that develops later in the day, pain on standing for a while, with lifting, bending forward a little, on trunk flexion or extension, doing a sit up, when driving long distances, getting out of a chair, and pain on repetitive bending, running, coughing or sneezing were all generally considered as moderate indicators of MLBP. This study identified two groups of factors that were generally considered as indicators of ILBP or MLBP. However, none of these factors were thought to strongly discriminate between ILBP and MLBP.

Man Ther. 2008 Jun 12. Walker BF, Williamson OD. School of Chiropractic and Sports Science, Faculty of Health Sciences, Murdoch University, 6150 Murdoch, Western Australia, Australia.

OBJECTIVE: To test whether healing treatments by biofield practitioners can protect normal human brain cells against cell death induced by oxidative stress. DESIGN: Cultured human brain cells were exposed to increasing concentrations of hydrogen peroxide and cell death was quantified by computerized time-lapse microscopy. Biofield treatments were delivered to cells from a short distance in 24 independent experiments. Six highly experienced biofield practitioners each participated, all with exceptional reputations within their respective communities (4 independent experiments each). An equal number of control experiments involving no healing intervention were conducted to provide a measure of intrinsic variability of the experimental system. Experiments were conducted with blinding applied to each of the scientists and randomized sample assignment. INTERVENTION: Healing treatments were delivered to cells from a short distance by a single practitioner, before and after exposure to hydrogen peroxide, for a total of 30 minutes. OUTCOME MEASURE: Cell death was quantified over a 4-hour period following experimental treatments. RESULTS: We found no significant difference in cell death rates between treatment and control groups.

Mager J, Moore D, Bendl D, Wong B, Rachlin K, Yount G. California Pacific Medical Center Research Institute, San Francisco, CA, USA. Explore (NY). 2007 Jul-Aug;3(4):386-90.

OBJECTIVE: To test whether healing treatments by biofield practitioners can protect normal human brain cells against cell death induced by oxidative stress. DESIGN: Cultured human brain cells were exposed to increasing concentrations of hydrogen peroxide and cell death was quantified by computerized time-lapse microscopy. Biofield treatments were delivered to cells from a short distance in 24 independent experiments. Six highly experienced biofield practitioners each participated, all with exceptional reputations within their respective communities (4 independent experiments each). An equal number of control experiments involving no healing intervention were conducted to provide a measure of intrinsic variability of the experimental system. Experiments were conducted with blinding applied to each of the scientists and randomized sample assignment. INTERVENTION: Healing treatments were delivered to cells from a short distance by a single practitioner, before and after exposure to hydrogen peroxide, for a total of 30 minutes. OUTCOME MEASURE: Cell death was quantified over a 4-hour period following experimental treatments. RESULTS: We found no significant difference in cell death rates between treatment and control groups.

Mager J, Moore D, Bendl D, Wong B, Rachlin K, Yount G. California Pacific Medical Center Research Institute, San Francisco, CA, USA. Explore (NY). 2007 Jul-Aug;3(4):386-90.

Tim Law specializes in 'Pure' Hypno-analysis (analytical therapy), Cognitive Behavioural Therapy especially for OCD and male sexual problems and Clinical Hypnotherapy. Tim is also particularly successful with older children and young adults. Tim's earlier career in business has lead to him to develop highly successful training courses for corporate clients, including Hypnosis for Sales Success, Hypnosis for Management and many personal development programs.

For more information visit: www.TheHypnoClinic.co.uk

A Book Review by Tim Brunson DCH

While many teachers and therapists have explored the realm of past lives, rarely have I found anyone in the clinical community who has endeavored to discuss the impact of the period between death and reincarnation. This is just what you will find in Dr. Georgina Cannon's book Discovering the Interlife: Your Journey Between Lifetimes, Your Life Between Lives. Whether you refer to that in between period as purgatory, bardo or use her term "Interlife", she feels that regression back to the "in between period" could give you lessons that may lead to personal awakening and transformation.

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Reiki touch therapy is a complementary biofield energy therapy that involves the use of hands to help strengthen the body's ability to heal. There is growing interest among nurses to use Reiki in patient care and as a self-care treatment, however, with little supportive empirical research and evidence to substantiate these practices. The purpose of this integrative review is to begin the systematic process of evaluating the findings of published Reiki research. Selected investigations using Reiki for effects on stress, relaxation, depression, pain, and wound healing management, among others is reviewed and summarized. A summary of Reiki studies table illustrates the study descriptions and Reiki treatment protocols specified in the investigations. Synthesis of findings for clinical practice and implications for future research are explored.

Vitale A. Villanova University, 800 Lancaster Avenue, Villanova, PA 19085, USA. annern2@gmail.com Holist Nurs Pract. 2007 Jul-Aug;21(4):167-79; quiz 180-1.

INTRODUCTION: Herbal products have gained increasing popularity in the last decade, and are now used by approximately 20% of the population. Herbal products are complex mixtures of organic chemicals that may come from any raw or processed part of a plant, including leaves, stems, flowers, roots, and seeds. Under the current law, herbs are defined as dietary supplements, and manufacturers can therefore produce, sell, and market herbs without first demonstrating safety and efficacy, as is required for pharmaceutical drugs. Although herbs are often perceived as "natural" and therefore safe, many different side effects have been reported owing to active ingredients, contaminants, or interactions with drugs. RESULTS: Unfortunately, there is limited scientific evidence to establish the safety and efficacy of most herbal products. Of the top 10 herbs, 5 (ginkgo, garlic, St. John's wort, soy, and kava) have scientific evidence suggesting efficacy, but concerns over safety and a consideration of other medical therapies may temper the decision to use these products. CONCLUSIONS: Herbal products are not likely to become an important alternative to standard medical therapies unless there are changes to the regulation, standardization, and funding for research of these products.

J Gen Intern Med. 2008 Jun;23(6) Bent S. Osher Center for Integrative Medicine, University of California, San Francisco, CA, USA. Stephen.Bent@ucsf.edu

This randomized pilot study investigated the effects of meditation with yoga (and psychoeducation) versus group therapy with hypnosis (and psychoeducation) versus psychoeducation alone on diagnostic status and symptom levels among 46 individuals with long-term depressive disorders. Results indicate that significantly more meditation group participants experienced a remission than did controls at 9-month follow-up. Eight hypnosis group participants also experienced a remission, but the difference from controls was not statistically significant. Three control participants, but no meditation or hypnosis participants, developed a new depressive episode during the study, though this difference did not reach statistical significance in any case. Although all groups reported some reduction in symptom levels, they did not differ significantly in that outcome. Overall, these results suggest that these two interventions show promise for treating low- to moderate-level depression. Copyright 2008 Wiley Periodicals, Inc.

Butler LD, Waelde LC, Hastings TA, Chen XH, Symons B, Marshall J, Kaufman A, Nagy TF, Blasey CM, Seibert EO, Spiegel D. Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA 94305-571, USA. butler@stanford.edu J Clin Psychol. 2008 Jul;64(7):806-20.

BACKGROUND: Therapeutic touch (TT), a complementary therapy, has been shown to decrease stress, anxiety, and pain in adults and children, as well as improve mobility in patients with arthritis and fibromyalgia. However, less has been reported about the effectiveness of this therapy with infants, particularly preterm infants. OBJECTIVES: The aims of this research study were to explore the nature of the use of TT with preterm infants and describe a TT treatment process for this vulnerable population. DESIGN: Narrative inquiry and qualitative descriptive methods were used to discover knowledge about how TT is used with preterm infants. DATA COLLECTION: Telephone/in-person interviews and written narratives provided the data describing nurses' use of TT with preterm infants. PARTICIPANTS: The participants were registered nurses who practiced TT with preterm infants for varying years of experience. RESULTS: The participants described the responses of infants, 25 to 37 weeks postgestational age, whom they treated with TT. The infants' responses to TT included reduced heart and respiratory rates, enhanced ability to rest, improved coordination in sucking, swallowing, and breathing, and a greater ability to engage with the environment. The practitioners described the phases and elements of TT for preterm infants, which revealed unique patterns, for example, the treatment phase included the elements of smoothing and containing. CONCLUSION: The description that emerged from the practitioners' narratives of the TT treatment process for preterm infants provides preliminary data for the systematic use and evaluation of TT as an adjunct to facilitating preterm infants' physiological, behavioral, energy field development, and well-being.

Hanley MA. School of Nursing, Texas Tech University Health Sciences Center, Lubbock, TX. Explore (NY). 2008 Jul-Aug;4(4):249-58.

OBJECTIVE: Outcome assessment normally used in research can support the therapeutic process by tracking patient symptoms and function and offering a common language to clinicians and researchers. This study's objectives were to (1) identify patient-based outcomes assessments used in published chiropractic studies, (2) describe a framework for identifying appropriate sets of measures, and (3) address the challenges associated with these measures relevant to chiropractic. METHODS: This literature review identified and evaluated the most commonly used to outcome measures in chiropractic research. Instruments were evaluated in terms of feasibility, practicality, economy, reliability, validity, and responsiveness to clinical change. A search of PubMed and Index to Chiropractic Literature (from inception to June 2006) was performed. RESULTS: A total of 1166 citations were identified. Of these, 629 were selected as relevant. The most common patient-based outcomes assessments instruments identified were the Oswestry Pain/Disability Index, Visual Analog Scale, and Short Form 36. CONCLUSIONS: The integration of outcome measures is consistent with current national initiatives to enhance health care quality through performance measurement and can also be used to further the field of chiropractic health care research. Outcome measures are both a research tool and a means by which providers can consistently measure health care quality. Based upon this review, there is a wide range of outcome measures available for use in chiropractic care. Those most commonly cited in the literature are the numeric rating scale, Visual Analog Scale, Oswestry Pain/Disability Index, Roland-Morris Low Back Pain and Disability Questionnaire, and Short Form 36.

J Manipulative Physiol Ther. 2008 Jun;31(5) Khorsan R, Coulter ID, Hawk C, Choate CG. Integrative Medicine and Military Medical Research, Samueli Institute, Corona del Mar, CA 92625, USA. rkhorsan@siib.org