Acupuncture in the treatment of rheumatoid arthritis: a double-blind controlled pilot study

<p>Abstract</p> <p>Background</p> <p>In planning a randomized controlled trial of acupuncture, we conducted a pilot study using validated outcome measures to assess the feasibility of the protocol, and to obtain preliminary data on efficacy and tolerability of 3 different forms of acupuncture treatment as an adjunct for the treatment of chronic pain in patients with Rheumatoid arthritis (RA).</p> <p>Methods</p> <p>The study employs a randomized, prospective, double-blind, placebo-controlled trial to evaluate the effect of electroacupuncture (EA), traditional Chinese acupuncture (TCA) and sham acupuncture (Sham) in patients with RA. All patients received 20 sessions over a period of 10 weeks. Six acupuncture points were chosen. Primary outcome is the changes in the pain score. Secondary outcomes included the changes in the ACR core disease measures, DAS 28 score and the number of patients who achieved ACR 20 at week 10.</p> <p>Results</p> <p>From 80 eligible patients, 36 patients with mean age of 58 ± 10 years and disease duration of 9.3 ± 6.4 years were recruited. Twelve patients were randomized to each group. Twelve, 10 and 7 patients from the EA, TCA and Sham group respectively completed the study at 20 weeks (p < 0.03); all except one of the premature dropouts were due to lack of efficacy. At week 10, the pain score remained unchanged in all 3 groups. The number of tender joints was significantly reduced for the EA and TCA groups. Physician's global score was significantly reduced for the EA group and patient's global score was significantly reduced for the TCA group. All the outcomes except patient's global score remained unchanged in the Sham group.</p> <p>Conclusion</p> <p>This pilot study has allowed a number of recommendations to be made to facilitate the design of a large-scale trial, which in turn will help to clarify the existing evidence base on acupuncture for RA.</p> <p>Trial registration</p> <p>ClinicalTrials.gov NCT00404443</p

Variáveis climáticas, condições de vida e saúde da população: a leptospirose no município do Rio de Janeiro de 1996 a 2009 Climate variables, living conditions and the health of the population: leptospirosis in the city of Rio de Janeiro from 1996 to 2009

Os eventos climáticos extremos têm fortes repercussões na saúde das pessoas, especialmente quando produz doenças ou mesmo quando provoca vítimas por acidentes. A população do Rio de Janeiro é vulnerável diante das variabilidades climáticas, principalmente pelo seu aspecto socioeconômico, pois o município tem topografia e clima que favorecem esta vulnerabilidade. Este artigo discute a evolução da leptospirose no Município do Rio de Janeiro, pelas trinta e duas Regiões administrativas, no período de 1996 a 2009, testando a hipótese de que as variações climáticas acarretam um aumento no número de casos da doença.Os dados meteorológicos utilizados foram fornecidos pelo Instituto Nacional de Meteorologia e pela Empresa Brasileira de Infra-Estrutura Aero-Portuária Os dados referentes à morbimortalidade da leptospirose foram coletados da Secretaria Municipal de Saúde e Defesa Civil/RJ. Neste trabalho, concluiu-se que há correlação entre a incidência da leptospirose e a pluviometria. No entanto, ao final, é enfatizado que a oscilação do número de casos não é determinada apenas pelo índice pluviométrico, outros fatores influenciam nessa dinâmica, tais como: saneamento, assim como fatores ambientais e sociais.<br>Extreme climate events have major repercussions on the health of the population, especially when they cause disease or even result in victims due to accidents. The population of Rio de Janeiro is vulnerable to climate variations, mainly due to the socio-economic factors, as the city has a topography and climate that enhance this vulnerability. This article discusses the evolution of leptospirosis in the thirty-two administrative regions of the city of Rio de Janeiro from 1996 through 2009, testing the hypothesis that climate variations lead to an increase in the number of cases of the disease. The meteorological data examined were provided by the National Meteorology Institute and the Brazilian Airport Infrastructure Company. Data on the morbidity and mortality of leptospirosis was collected from Rio de Janeiro's Municipal Health and Civil Defense Department. In this work, it was concluded that there is a direct correlation between the incidence of leptospirosis and rainfall. However, in the final analysis, it must be emphasized that the oscillation of the number of cases is not only determined by rainfall, since other factors influence this dynamic, such as sanitation, in addition to environmental and social factors