A UK population-based case–control study of Hodgkin's disease (HD) in young adults (16–24 years) included 118 cases and 237 controls matched on year of birth, gender and county of residence. The majority (103) of the cases were classified by Epstein–Barr virus (EBV) status (EBV present in Reed–Stenberg cells), with 19 being EBV-positive. Analyses using conditional logistic regression are presented of subject reports of prior infectious disease (infectious mononucleosis (IM), chicken pox, measles, mumps, pertussis and rubella). In these analyses HD cases are compared with matched controls, EBV-positive cases and EBV-negative cases are compared separately with their controls and formal tests of differences of association by EBV status are applied. A prior history of IM was positively associated with HD (odds ratio (OR) = 2.43, 95% confidence interval (CI) = 1.10–5.33) and with EBV-positive HD (OR = 9.16, 95% CI = 1.07–78.31) and the difference between EBV-positive and EBV-negative HD was statistically significant (P = 0.013). The remaining infectious illnesses (combined) were negatively associated with HD, EBV-positive HD and EBV-negative HD (in the total series, for ≥2 episodes compared with ≤1, OR = 0.45, 95% CI = 0.25–0.83). These results support previous evidence that early exposure to infection protects against HD and that IM increases subsequent risk; the comparisons of EBV-positive and EBV-negative HD are new and generate hypotheses for further study. © 2000 Cancer ResearchCampaign

The results of this trial suggest that CMT in conjunction with SMC offers a significant advantage for decreasing pain and improving physical functioning when compared with only standard care, for men and women between 18 and 35 years of age with acute LBP.

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Infectious mononucleosis (IM) is an established risk factor for Hodgkin's disease (HD). A substantial minority (33%) of cases of HD have Epstein-Barr virus (EBV) DNA within the malignant cells (are EBV ؉veAbundant epidemiologic evidence supports the hypothesis that Hodgkin's disease (HD) aetiology differs for cases diagnosed in the young adult peak and diagnosed in older people (aged Ն 50). 1 Under the late host-response model, 2 HD in the young adult peak arises as a sequel to relatively late first infection with a common infectious agent-a similar pattern to that seen for infectious mononucleosis (IM) in relation to the Epstein-Barr virus (EBV). Large cohort studies 3,4 have demonstrated that HD risk is increased around 3-fold in the followup of subjects with IM compared to the general population. This could indicate that EBV is causally implicated in HD or, alternatively, that IM is a marker of a type of lifestyle that predisposes to late first exposure to many infectious agents. A direct link seemed probable when EBV viral DNA was identified within the HD tumour cells. 5,6 It is now established that EBV is associated with a substantial minority (referred to here as EBV ϩve ) of cases of HD, and IARC has recently classified EBV as a probable human carcinogen in relation to HD. 7 Subsequent research has indicated the complexity of the association between EBV and HD. For example, the proportion of cases that are EBV ϩve is markedly lower in the young adult peak (16 -34 years) than for HD in children or older people. 8 Because the late host-response model applies to the young adult peak, this suggests that EBV is not the elusive agent involved in that model, if indeed there is just 1 agent.One key question is whether IM is associated specifically with EBV ϩve HD or, alternatively, associated as strongly with the cases that lack EBV (the EBV -ve cases) that constitute the majority of cases in the young adult peak. Very few studies have looked at epidemiologic risk factors for HD with cases classified as EBV ϩve or EBV -ve . Only 2 studies have collected personal data to address this question: a US case-series that compared EBV ϩve and EBV -ve HD and included cases aged 16 -55 years at diagnosis, 9 and a UK case-control study 10,11 that was restricted to subjects aged 16 -24 years and analysed as both a case-series and case-control study. These 2 studies generated results that are potentially inconsistent, and suggest different answers to the key question. Sleckman et al. 9 found no evidence that a history of IM conveyed specific risk for EBV ϩve compared to EBV -ve HD. In contrast, Alexander et al. 10,11 reported evidence that increased risk after IM was specific to EBV ϩve HD, although there was also a small excess risk of EBV -ve HD after IM. These 2 results are consistent only if the age at diagnosis of HD becomes critical to the association of IM with subsequent HD.The study of Alexander and colleagues also found that family history of IM was a significant risk factor for EBV ϩve HD in the age range 16 -24 ye...

BackgroundMore than 100 years after its inception the chiropractic profession has failed to define itself in a way that is understandable, credible and scientifically coherent. This failure has prevented the profession from establishing its cultural authority over any specific domain of health care.ObjectiveTo present a model for the chiropractic profession to establish cultural authority and increase market share of the public seeking chiropractic care.DiscussionThe continued failure by the chiropractic profession to remedy this state of affairs will pose a distinct threat to the future viability of the profession. Three specific characteristics of the profession are identified as impediments to the creation of a credible definition of chiropractic: Departures from accepted standards of professional ethics; reliance upon obsolete principles of chiropractic philosophy; and the promotion of chiropractors as primary care providers. A chiropractic professional identity should be based on spinal care as the defining clinical purpose of chiropractic, chiropractic as an integrated part of the healthcare mainstream, the rigorous implementation of accepted standards of professional ethics, chiropractors as portal-of-entry providers, the acceptance and promotion of evidence-based health care, and a conservative clinical approach.ConclusionThis paper presents the spine care model as a means of developing chiropractic cultural authority and relevancy. The model is based on principles that would help integrate chiropractic care into the mainstream delivery system while still retaining self-identity for the profession.

Abstract-Chiropractic services have been delivered on station at select Veterans Health Administration (VHA) medical facilities since late 2004. No published data describing the characteristics of VHA chiropractic physicians (chiropractors) and chiropractic clinics exist at a national level. This study was designed to examine elements of the structures of chiropractic services in VHA settings. Web-based survey methods were used to question all chiropractors in VHA facilities (N = 36). Data were obtained from 33 providers, yielding a 91.6% response rate. Most respondents were full-time VHA employees, while others were part-time employees or contractors. Differences were found in prior training, integrated practice, and academic or research experience. Of the respondents, 88% ranked low back pain as the most common patient complaint seen in practice and 79% ranked cervical pain the second most common complaint. Of the new patient consultations, 67.6% originated from primary care, 9.4% from pain management, and 6.2% from physiatry. Most respondents were similar in their reported use of diagnostic and therapeutic procedures, but their reported rates of participation in various facility activities were different. Further work is needed for researchers and policy makers to more fully understand the integration and delivery of chiropractic services in VHA settings.

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BackgroundEvidence-based clinical practice (EBCP) is a practice model gaining prominence within healthcare, including the chiropractic profession. The status of EBCP has been evaluated in a variety of healthcare disciplines, but little is known regarding the attitudes doctors of chiropractic (DCs) hold toward this model of healthcare. This project examines the attitudes toward EBCP within a specialty discipline of DCs.MethodsWe identified a survey questionnaire previously used to evaluate EBCP among non-chiropractic complementary and alternative practitioners. We adapted this questionnaire for use among DCs and pretested it in 5 chiropractic college faculty. The final version was administered to DCs with diplomate-level training in orthopedics. The survey was emailed to 299 potential participants; descriptive results were calculated.Results144 surveys were returned, resulting in a 48% response rate. The majority of respondents perceived EBCP as an important aspect of chiropractic practice. Respondents also believed themselves to have an above average skill level in EBCP, reported that training originated from their diplomate education, and based the majority of their practice on clinical research.ConclusionDoctors of chiropractic with an orthopedic diplomate appear to have favorable attitudes toward EBCP. Further study will help understand EBCP perceptions among general field DCs. A logical next step includes validation of this questionnaire.