SAFETY CLIMATE AMONG CONTRACTORS’ ORGANIZATIONS

Introduction: Emergency departments as one of the most important wards of hospitals, provide the emergency therapeutic care to decrease the mortality and disability rates among patients. The management and evaluation of emergency activities are possible through timely, accurate, and complete registration of information, based on standard rules. Thus, the aim of this research was detecting the observance rate of documentation standards in the emergency department of Al-Zahra Hospital, Isfahan, to find patients’ files documentation failures and eliminate them. Methods: I This was a cross sectional study performed in the emergency department of Al-Zahra Hospital, Isfahan, 2009. For data gathering, a checklist included 23 questions in two parts was used. The first and second parts had 9 and 14 questions to detect observance rate of patients’ characteristics documentation and nurse reports documentation, respectively. Based on Likert scale, the answer of each option includes blank (score 1), illegible (score 2), incomplete (score 3), and complete (score 4). Therefore, the minimum and maximum reachable scores were determined 9-36 in the documentation of patients’ characteristics and 14-56 in the nurse reports. Data was analyzed using SPSS 8 and Chi-squared test and Fisher’s exact test were applied to compare qualitative data. Student’s t-test was used to compare quantitative information, too. P<0.05 was considered as significant. Results: 300 documents were studied in this research. The average of reached score in the quality assessment of patients record completion was 24.66±17 (15-34), (the maximum reachable score was 36). The total score of emergency patients records was 61.8±4.8 (45-74) from total of 92 reachable scores. The average of total reached score for nurse reports was 37.2±3.7 (28-46), (with the maximum reachable score of 56). No significant difference was seen in the accuracy of patients’ documentation according to referring shift (p=0.37) and being close or not (p=0.61). Conclusion: Based on findings of the present study, status and quality of observance in registration standards of files did not have desirable level. So that most of failures in recording of patients’ characteristics were related to registrations on the file and other indexes; the comments’ signs with date and time documentation and also finishing the comments by the physician were seen, too. Most of documentation failures in nurse reports were related to not finishing the end of report with a straight line, lack of explanation about the cause, status, and type of refer, and not enough statements regarding the patient’s general condition.

Scoring language learners’ writing exams is a difficult task for graders since many task-relevant or irrelevant variables such as the user-friendliness of the rubric, difficulty of the task, students’ handwriting or grader characteristics (being too lenient or harsh) are involved in the process. To be able to gain valid and reliable scores, studying the variables that affect scoring procedures and seeking ways to control and minimize them are crucial concerns for institutions in order to assure their learners that their assigned scores are genuine and given in the least subjective way that could be possible. That is why analysing grader attitudes while scoring and identifying the stringent and lenient graders in the rater-pool is important not only to be able to set the best matches of graders where multiple scorings or cross-marking sessions are applied but for making those raters be aware of their scoring habits. In this exploratory study, 6 writing graders who had more than 10-year-expertise in grading writing voluntarily scored 20 student essays including two separate tasks. MFRM (Many Faceted Rasch Measurement) was used to explore graders’ marking behaviours and discover how those behaviours affect test scores of language learners. Finally, results of the study showed that graders, while they all used the same rubric and had enough expertise in grading, have significant score differences and a significant level of stringency in scoring essays. Article visualizations:

본 연구의 목적은 임신 여성을 대상으로 산전우울의 발생 정도와 이와 관련된 영향요인을 파악하기 위함이다. D광역시 소재 종합병원 및 산부인과 병원 외래를 방문하거나 원내 특강을 받는 160명의 임부를 연구대상으로 하였으며, 우울을 측정하기 위한 도구로 한국형 EPDS(Edinburgh Postnatal Depression Scale)를 사용하였다. 자료분석은 서술적 통계, t-test, ANOVA, Pearson's correlation coefficients와 stepwise multiple regression을 사용하였다. 연구결과, 임신 여성의 우울점수는 평균 $7.80{\pm}4.86$ 점(0-30점)이었으며, 대상자의 56.3%가 정상(0-8점), 23.1%가 경계선(9-12점), 20.6%는 심각한 수준(13점 이상)인 것으로 나타났다. 임신 여성의 산전우울 영향요인으로는 주관적 건강상태, 임부스트레스, 자아존중감 순이었으며, 이 변수들은 산전우울을 36.7% 설명하는 것으로 나타났다. 따라서 산전우울을 예방하기 위해 이러한 변수들이 충분히 고려되어야 할 것으로 생각된다. 【The purpose of this study was to identify the rate and influencing factors on antepartum depression in pregnant women. A self-administered questionnaire-based study was performed in 160 pregnant women who visited outpatient clinics or attended special lectures of the general hospital in D metropolitan city. All participants were interviewed using the Korean version of Edinburgh Postnatal Depression Scale(EPDS). The data were analyzed using descriptive statistics, t-test, ANOVA, Pearson's correlation coefficients, and stepwise multiple regression. On the results, the mean score of antepartum depression was $7.80{\pm}4.86$ scores(0-30 scores). The percentage of all participants for EPDS scale were 56.3% with normal level, 20.6% with a boundary line and 23.1% with serious level. Influencing factors on antepartum depression were accounted for 36.7% of the total variance which consisted of perceived health status, pregnancy stress and self esteem. The results indicate that these variables should be considered in preventing depression of pregnant women.】

Background: Functional dyspepsia (FD) is defined as the presence of dyspeptic symptoms in the absence of an organic cause that readily explains them. Life stressors, individuals’ perceptions, their coping responses, and social supports are linked and can affect the well-being of individuals. The aim of the current study was to assess the relationship between FD and life stressors, coping strategies, and social support. Methods: In a cross-sectional study conducted in Isfahan Province, Iran, in 2013, the employees of Isfahan University of Medical Sciences, Isfahan, were evaluated. Symptoms of FD were measured using the modified ROME III questionnaire. The Stressful Life Event (SLE) Questionnaire, modified COPE scale, and Multidimensional Scale of Perceived Social Support (MSPSS) were used for assessing life stressors, coping strategies, and social support. Logistic regression analysis was applied to assess the crude and adjusted effects of each variable on FD. Results: About 55.8% of participants were women and 79.3% were married. In total, 723 (15.2%) participants had FD, 457 (63.2%) of whom were women. The mean scores of perceived intensity and frequencies of all life stressors were significantly higher in patients with FD (P < 0.05). In addition, the mean score of social support in patients with FD was significantly lower (P < 0.05). Logistic regression analyses demonstrated that the frequency of stressors and perceived intensity of stressors were significantly associated with FD (OR = 1.08 and 1.025, respectively). Moreover, the acceptance coping strategy had a significant relationship with FD (OR = 0.85, 95% CI, 0.75-0.95). Among the socio-demographic factors, sex (OR = 1.65, 95% CI, 1.3-2.1) and education (OR = 0.6, 95% CI, 0.5-0.8) demonstrated significant relationships with FD. Conclusions: FD was more common in those individuals who had a higher rate of stressors and lower social support.

Background: The cardiovascular derangements of severe sepsis in human include arteriolar, venular dilation, capillary leak, and immunomodulatory response. Intravascular volume replacement during resuscitation most frequently converts the circulation to a high-out put hypotensive state. We hypothesized that patients with severe sepsis had any predicting factors to survive than those who do not. Design and Method: Randomized Clinical Trials were conducted of 110 patients suffered from severe sepsis in ICU/HCU. Admission APACHE II, SOFA scores, IFN- , IL-12, TNF- Ai , and fluid balance were computed from the extracted data. Patients allowed to severe sepsis treatment according with the International Consensus Committee. Summary estimates using both the Mantel-Haenszel test and precision based approaches were computed for statistical analysis. Result: Of 110 patients ranged in age from 46 to 71 years with a mean (± SE) age of 63.45 ± 3.97 years. The mean admission APACHE II score was 25.96 ± 3.65; and the day 1 SOFA score was 9.57 ± 1.24. Twenty one patients did not survive, Non-survival had higher mean APACHE II than survivals (29.85 vs 20.46), respectively (p 500 mL on > of the first 3 days of treatment survived (RR 5.0; 95% CI : 2.3 to 10.7, p < 0.0001). Conclusion : These results suggest that at least 1 day of negative fluid balance (<-500mL), IFN- , IL-12, and TNF- Ai may be a good independent predictors of survival in patients with severe sepsis. These findings suggest the hypothesis that four independent predictors of severe sepsis portend a good prognosis for a larger prospective study (Sains Medika, 4(1):13-22).

Introduction: Heart failure is a highly complex clinical syndrome in aspects related to pathophysiology and therapy. The implementation of telecare by nurses is a strategy of great importance for the elderly with heart failure; therefore, it provides better adherence to treatment, improved self-care and a better quality of life. Objective: Analyze the effectiveness of telecare performed by nurses in self-care and in the quality of life of elderly with heart failure.Method: A quasi-experimental study, non-randomized selection, applied to the elderly with HF, sample consisted of 35 participants. The project was approved under No. 01380518.2.0000.5243 and No. 01380518.2.3001.5259 after submission to the Ethics and Research Committees of the Fluminense Federal University and a university hospital in the city of Rio de Janeiro.The study was developed through face-to-face nursing consultation and telecare; this in turn was applied on a weekly interval in the first month and a biweekly interval in the second month. In order to achieve the proposed outcomes, two nurses collected the data through the nursing consultation instrument, a flowchart instrument to evaluate the outcome. functional classification (NYHA), self-care assessment tool (EHFScBS), Minnesota quality-of-life tool and telecare tool. Data were evaluated using SPSS version 24.0 statistical software. It was performed through mean, median, frequency, paired t test, Pearson correlation and Spearman test. Results: The group consisted of 35 elderly with HF who remained in the study until the end. The sample was characterized by elderly (NYHA I, II and III) and with LVEF 50%, most of them with LVEF <50%. The study showed a difference between the mean self-care scores (p-value = 0.000; 95% CI 2.926 - 6.045) and Minnesota (p-value = 0.000; 95% CI 6.688 - 14.455), before and after the interventions, with The median final score of both scales is lower than the average of the initial score, indicating an improvement of the scores. It also demonstrated a positive and moderate linear correlation (r = 0.34; p-value = 0.046) between self-care scores and quality of life after interventions. Conclusion: The telecare showed positive effects on self-care and quality of life scores, due to the comparison between the mean self-care scores and quality of life, showing an improvement after the intervention. In addition, there is a positive and moderate linear correlation between self-care scores and quality of life after interventions

The study aimed to calculate hierarchy score on concept map (CM) by applying questions as instructional technique in presenting theoretical background to class and discussion about the issue of project based learning. The subjects were 35 high school students. Research is a classroom action research with research procedure includes: planning for preparing RPP and its completeness, execution on action activity, observation to calculate hierarchy CM score and reflection for next action. Triangulation validation tests include: verification of conformity of CM hierarchy scores and documentation by expert hierarchy of CM and interviews to represent mastery of concept classification. Reduction to select data completeness, data presentation and conclusion based on complete hierarchy data. Data analysis with qualitative descriptive. The results showed hierarchy scores based on expert hierarchy of CM on prasiklus scored below 25.71% on average of total students, while cycle I and cycle II fell to 11.43% and 0%. Above average hierarchy score on prasiklus was obtained at 11.43%, while cycle I went down to 0% and cycle II was obtained 48.57% improvement, thus question as instructional technique in presenting theoretical background to class and discussion about the issue project based learning increasing the hierarchy CM scores both individual and classical

Background: Currently used pediatric Echocardiographic Z scores are mostly founded on western data and have restricted applicability for newborns in developing nations. Since biological parameters may vary in different populations the data from those studies cannot be applied to the Indian neonates directly. Aims &amp; Objectives: This study was directed to obtain echocardiographic data of various routinely measured cardiovascular structures using 2D and M mode echocardiography in Indian newborns up to 24 hours after birth and to derive Z-Score graphs for those parameters. Materials and Methods: This was a prospective observational study of a cohort of normal newborns conducted at a tertiary care hospital in western India. Neonates with congenital heart disease on screening echo were excluded and 100 normal neonates were included in the study with the intention of obtaining echocardiographic data of various routinely assessed cardiac parameters and to obtain a Z - score graph for each parameter. Echocardiographic evaluation was done utilizing a GE vivid S6 system. For the assessment of the relationship of an individual parameter with respect to BSA, regression equation was applied. Results: 22 parameters were assessed and using polynomial regression model relation to Body surface area was assessed and Z score charts were derived. Conclusion: Majority of the Z score values and reference ranges in our study were lower compared to the western standards thus it emphasizes the need for such a Z score in a developing country and hence these Z score values obtained from our study could be useful as compared to western charts for use in developing countries for planning the appropriate cardiac intervention and surgery in the neonatal population. However, large-scale studies with heterogenicity of age groups will be needed before they can become clinically applicable in the general population.

Successful ageing theories suggest the potential for wellbeing to improve with age. Indeed, rates of depression have been shown to be lower amongst elderly residing in the community compared to younger adults. Unfortunately, the same cannot be said for elderly living in Residential Aged Care facilities (RACFs). Prevalence data indicates rates of depression between 16-50% in Australian RACFs. Moreover, rates of subthreshold depressive symptoms have been reported to be between 10-70%. Of concern, this pervasive and debilitating mental illness has been shown to not only diminish individuals’ quality of life, but also increase their risk of mortality. Although the high level of comorbidity between dementia and depression goes some way towards explaining the increased prevalence of depression in this cohort, research has shown that rates of depression amongst cognitively-intact elderly residing in RACFs are also substantially higher than community-based elderly. A range of biopsychosocial factors have been suggested to account for the increased prevalence of depression in this population; however, the real challenge is to determine how RACFs can create the conditions to reduce mental illness and maximise wellbeing. To date, the focus has been on managing medical illness in the elderly, with early theories of successful ageing emphasising physical illness as the key factor in depleting elderly sense of wellbeing. More recently, psychosocial factors such as self-efficacy, personal mastery and social engagement have been shown to be central to maintaining a sense of wellbeing and reducing the risk of mental illness, particularly depression. Music Therapy and Animal-Assisted Activities are two psychosocial treatments increasing in popularity in many RACFs in Australia. These interventions are typically implemented as aspects of a suite of diversional therapies offered to enrich the residential care environment. Proponents suggest that the interventions not only reduce depression and promote general mental health and wellbeing, but also reduce anxious/agitated behaviours and maintain physical and cognitive abilities. To date, although some favourable findings have been reported for both interventions, research has generally lacked methodological rigour. Moreover, little is known about the effectiveness of the interventions in cognitively-intact elderly samples. The high prevalence of depression in RACFs, and the well-established negative association between depression and wellbeing, makes it ideally suited as a target for intervention amongst this population. To this end, the aim of this thesis was to first characterise the clinical presentation of subthreshold and clinical depression in cognitively-intact elderly using a range of self-report and objective indices; and second, to explore the effectiveness of Music Therapy and Animal-Assisted Activities to reduce depressive symptoms. Participants were recruited from 15 RACFs in Melbourne, Victoria, Australia. Using a Randomised Controlled Trial (RCT) design, each facility was randomly allocated an intervention: Treatment as Usual, Animal-Assisted Activities or Music Therapy. Participants in facilities allocated to an intervention participated in twice-weekly, hour long group therapeutic interventions for four weeks, facilitated by registered therapists’ in the respective interventions. The total sample comprised 96 (84 years ± 6.91 years) cognitively-intact elderly (SMMSE = 26.6 ± 2.62) with varying levels of depression as assessed by GDS-15 scores (score range = 0-13) and clinical interview. Following screening, pre- and post-intervention data for affective (GDS-15, BHS, HADS), quality of life (AQoL) and cognitive functioning (neuropsychological and electrophysiological measures) was collected. Significant differences in the clinical presentation of depression between non-depressed, subthreshold and clinically depressed elderly were observed. Trends consistently revealed higher levels of impairment across affective, quality of life and neuropsychological indices amongst participants in the subthreshold group relative to those with no depressive symptomatology. Participants with clinical depression were shown to have significantly poorer perceptions of quality of life and affective and cognitive functioning relative to participants with no depression and subthreshold depression. Neither of the psychosocial interventions significantly improved affective outcomes relative to Treatment as Usual; however, trends suggested improvements in executive functioning for both Music Therapy and Animal-Assisted Activities relative to Treatment As Usual amongst clinically depressed participants. The findings have implications for the diagnosis and management of depression in Residential Aged Care settings.

Simulation from a categorical or diagnostic perspective, has turned into a more dimensional point of view, so it is possible to establish different “levels” of simulation. In order to analyse, from a psychometric perspective, the possible prediction of simulated behaviour based on common measures of general psychopathology, the objective of the current study was to analyse possible predictors of the Structured Symptomatic Simulation Inventory (SIMS) scores considering as dependent variables the total SIMS score, the SIMS subscales scores, and the cut-off points usually suggested to discriminate between “no suspected simulation”/“suspected simulation”, which usually are 14 and 16. In terms of possible predictors, a set of variables were established: a) categorical (sex, type of treatment - psychopharmacological, psychotherapeutic, combined-, type of work activity, being self- employed or not, presence-absence of a history of psychopathology (both familial and personal), presence or not of associated physical pathology, diagnosis -according to ICDJONNPR. 10- and the final proposal -return to work, sick leave extended, proposal of permanent work incapacity-); and b) continuous (perceived stress -general and current), self-esteem, results of a screening questionnaire for personality disorders and scores on a symptoms questionnaire. In addition, a descriptive study of all variables was carried out and possible differences of genre were analysed.

Objective To explore the quality of life and mental health status of adolescents in Zhengzhou, and to compare with HongKong and Taiwan. Methods A total of 6 401 students from 12 primary and secondary schools in Zhengzhou City. A total of 3 642 students from HongKong and 1 547 students from Taiwan were selected by cluster sampling. And Padiatric Quality of Life Inventory Version 4.0, Self-Esteem Scale, General Self-efficacy Scale, Depression Anxiety Stress Scale and self-made general situation questionnaire were used to conduct questionnaire survey. Results The total score of quality of life and the scores of each dimension in Zhengzhou were significantly higher than those in HongKong, while self-esteem and anxiety were lower than those of Taiwan adolescents ( P<0.05). In addition to self-esteem, anxiety and stress, the scores of quality of life and mental health of adolescents of different grades and genders in Zhengzhou were statistically different ( t = 13.53, 20.71, 10.92, 20.26, 14.68, −16.03, 21.26; 6.16, 3.81, −2.22, −0.33, 8.76, 4.16, 2.71, P<0.01). The quality of life of adolescents in HongKong and Taiwan in different grades and genders were basically the same as those in Zhengzhou, and the differences of depression and stress scores in grades were the same as those in Zhengzhou. Conclusion The overall quality of life and mental health of adolescents in Zhengzhou is better than that in Hong Kong and Taiwan. It is necessary to explore the relationship between the quality of life and mental health of adolescents in order to improve their quality of life. 【摘要】 目的 探讨郑州市青少年的生存质量和心理健康现状并与中国香港、台湾地区进行比较,为今后相应教育方案 的制定提供依据。 方法 分层整群抽取郑州市 12 所中小学四至九年级 6 401 名学生,分别整群抽取香港和台湾地区四至 九年级 3 642 和 1 547 名学生,使用儿童生活质量普适性核心量表、自尊量表、一般自我效能感量表、抑郁-焦虑-压力量表 中文精简版及自制一般情况调査表进行问卷调査。 结果 郑州、香港和台湾三地区青少年在生存质量总分及各维度、自 尊、自我效能、焦虑、抑郁、压力得分差异均有统计学意义 ( F 值分别为 398.17, 257.90, 193.53, 321.34, 258.89, 191.30, 171.28, 51.13, 119.00, 67.40, P 值均<0.05)。郑州市青少年生存质量总分及各维度得分髙于香港地区,而自尊和焦虑得 分低于台湾青少年 ( P 值均<0.05)。除自尊、焦虑和压力方面,不同年级和性别郑州市青少年的生理功能、情感功能、社会 功能、学校功能、自我效能、抑郁及生活质量总分差异均有统计学意义 ( t 值分别为 13.53, 20.71, 10.92, 20.26, 14.68, −16.03, 21.26; 6.16, 3.81, −2.22, −0.33, 8.76, 4.16, 2.71, P 值<0.01)。港台地区青少年生存质量在不同年级和性别上表 现出的特征与郑州市青少年基本一致,抑郁、压力得分在年级变化上的差异与郑州市青少年相同。 结论 郑州市青少年生 存质量和心理健康整体良好,且优于港台地区。需探讨青少年生存质量和心理健康状况之间的关系,以期提髙青少年的生 存质量水平。

Introduction: Patients with chronic respiratory diseases are suffering from dyspnea and decreased daily activity, which affects quality of life and psychological status. One of the objectives of pulmonary rehabilitation programs is to improve their psychological status. Aim: to evaluate the benefits of pulmonary rehabilitation (PR) on level of anxiety and depression among patients included in a pulmonary rehabilitation program. Method: A prospective study on COPD (Chronic obstructive lung disease) patients participating in a 7 weeks outpatient rehabilitation program that includes: generally physical training, chest physiotherapy, psychological counselling (one session / week). The following parameters were evaluated before and after RR: dyspnea (BORG scale), quality of life (St. George's Respiratory Questionnaire: SGRQ), psychological status (Hospital Anxiety and Depression Scale). Results: 47 COPD patients, mean age 61.83±12.3 years, 37 males. Before the rehabilitation, we found in 38/47 patients anxiety and depression (HADS score>8 points), of which 35 had moderate and severe scores. After the RR program: mean dyspnoea score decreased from 2.6 to 1.8 points (BORG scale, p = 0.000, test Wilcoxon), improved quality of life (SGRQ score decreased from 52.3 to 47.1 points, p = 0.000, t student). Mean HADS value significantly decreased from 14.4 to 12.3 points, p=0.000, t student). The benefits on psychological status were higher in the age group > 65 years, severe functional COPD stages, women. Conclusions: Our pulmonary rehabilitation program had statistically significant positive effects on dyspnea, quality of life and anxiety and depression in COPD patients. Psychological counselling added to muscular training increase the success rate of rehabilitation and the adherence to the program.

To compare the effectiveness of ibuprofen phonophoresis (PH) with conventional ultrasound (US) therapy in knee osteoarthritis. Sixty patients with a mean age of 59.8 +/- 9.0 years were randomly assigned to PH or US groups. Continuous ultrasonic waves of 1 MHz frequency and 1 watt/cm2 power were applied for 5 minutes to the target knee joint. Acoustic gel without any active pharmacological agent was applied in the US group, whereas cream containing 5% ibuprofen was applied in the PH group for a total treatment period of 10 sessions. The Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scores, pain on passive and active motion, 20 metres walking time, knee range of motion (ROM), and global assessments of disease activity and treatment efficacy by the investigator and by the patients were evaluated before and after therapy. Primary outcome measure of the study was 30% improvement in total WOMAC scores at the end of the study with respective scores at baseline. At the end of two weeks, 30% improvement in total WOMAC score was observed in 12 (40%) and 14 (46.6%) of patients in the PH and US groups respectively, indicating no significant difference in improvement rates. Pain scores, knee ROM degrees, 20 metres walking time measurements and all global assessment scores also improved significantly in both groups, yet these variables showed no significant differences between the two groups. When treatment efficacy was assessed as satisfaction rates, investigator satisfaction rates were 96.7% and 90%, while patient satisfaction rates were 93.3% and 83.3% in the PH and US groups respectively, suggesting similar satisfaction rates for both treatment methods. Both therapeutic modalities were found to be effective and generally well tolerated after 10 therapy sessions. Ibuprofen PH was not superior to conventional ultrasound in patients with knee osteoarthritis.

Endogenous cannabinoids activate cannabinoid receptors in the brain and elicit mood-altering effects. Parallel effects (eg, anxiolysis, analgesia, sedation) may be elicited by osteopathic manipulative treatment (OMT), and previous research has shown that the endorphin system is not responsible for OMT's mood-altering effects. The authors investigate whether OMT generated cannabimimetic effects for 31 healthy subjects in a dual-blind, randomized controlled trial that measured changes in subjects' scores on the 67-item Drug Reaction Scale (DRS). Chemical ionization gas chromatography and mass spectrometry were also used to determine changes in serum levels of anandamide (AEA), 2-arachidonoylglycerol (2-AG), and oleylethanolamide (OEA). In subjects receiving OMT, posttreatment DRS scores increased significantly for the cannabimimetic descriptors good, high, hungry, light-headed, and stoned, with significant score decreases for the descriptors inhibited, sober, and uncomfortable. Mean posttreatment AEA levels (8.01 pmol/mL) increased 168% over pretreatment levels (2.99 pmol/mL), mean OEA levels decreased 27%, and no changes occurred in 2-AG levels in the group receiving OMT. Subjects in the sham manipulative treatment group recorded mixed DRS responses, with both increases and decreases in scores for cannabimimetic and noncannabimimetic descriptors and no changes in sera levels. When changes in serum AEA were correlated with changes in subjects' DRS scores, increased AEA correlated best with an increase for the descriptors cold and rational, and decreased sensations for the descriptors bad, paranoid, and warm. The authors propose that healing modalities popularly associated with changes in the endorphin system, such as OMT, may actually be mediated by the endocannabinoid system.

Objective: To assess the clinical effects of treating elderly degenerative lumbar spondylolisthesis suffering from lumbocrural pain by lumbar paravertebral injection of oxygen-ozone combined with lumbar functional exercise. Methods: A prospective, randomized, controlled clinical trial was carried on 77 elderly patients suffering from lumbocrural pain caused by degenerative lumbar spondylolisthesis during Mar 2010 to May 2011. All patients were divided with the random number table method into three groups, lumbar paravertebral injection of oxygen-ozone combined with lumbar functional exercise group (ozone-grp), lumbar paravertebral injection of 0.5% lidocaine combined with lumbar functional exercise group(local-blok-grp) and single lumbar functional exercise group (control-grp). All groups performed lumbar functional exercise of rolling and rotating maneuvers with hip and knee flexion. The local-blok-grp also received lumbarparavertebral injection of 0.5% lidocaine at the same period for 4 to 6 times (once a week). The ozone-grp received lumbar paravertebral injection of 0.5% lidocaine and oxygen-ozone at the same period for 4 to 6 times (once a week). The improvement of clinical symptoms were assessed with VAS for waist pain, the lower limb pain VAS and the lumbar JOA score. Results: A total of 68 patients completed the full 1-year follow up. The VAS for ozone-grp were significantly lower than that for control-grp and local-blok-grp at 1 week and 1 month after treatment (P ＜ 0.05). There was no significant difference in VAS scores at 1 week and 1 month between local-blok-grp and control-grp (P ＞ 0.05). The VAS scores for ozone-grp were significantly lower than for control-grp and local-blok-grp at 1 year after treatment (P ＜ 0.05). For the three groups, the intragroup comparisons of VAS scores at 1 year after treatment and before showed statistically significant differences (P ＜ 0.05). According to the results of lumbar JOA scores after the treatment, the total effective rate for ozone-grp were higher than for control-grp and local-blok-grp(P ＜ 0.05). The average duration of painkiller medicine use for ozone-grp was 5.23±1.78 days, significantly shorter than those for controlgrp (13.68±5.18 days) and local-blok-grp (18.76±7.57 days (P ＜ 0.05). Conclusion: The therapy of lumbar paravertebral injection of oxygen-ozone combined with functional exercise for elderly degenerative lumbar spondylolisthesis is safe, effective, and worthy of clinical promotion.