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In a randomized clinical trial to assess the effectiveness of different strategies for treating low-back pain in a managed-care setting, 681 adult patients presenting with low-back pain were randomized to four treatment groups: medical care with and without physical therapy; and chiropractic care with and without physical modalities. Follow-up information was obtained by questionnaires at two and six weeks, six, 12 and 18 months and by a telephone interview at four weeks. One outcome measurement at each follow-up is the patient's self-report on the perception of low-back pain improvement from the previous survey, recorded as 'A lot better,' 'A little better,' 'About the same' and 'Worse.' Since the patient's perception of improvement may be influenced by past experience, the outcome is analysed using a transition (first-order Markov) model. Although one could collapse categories to the point that logistic regression analysis with repeated measurements could be used, here we allow for multiple categories by relating transition probabilities to covariates and previous outcomes through a polytomous logistic regression model with Markov structure. This approach allows us to assess not only the effects of treatment assignment and baseline characteristics but also the effects of past outcomes in analysing longitudinal categorical data.

Purpose: The objective of the study was to compare chiropractic management and medical management of low back pain of musculoskeletal etiology in a multispecialty group practice., Study Design: The design was a retrospective cohort study in which the subcohorts were defined by source of low back pain care and identified before follow-up was complete. Data collection occurred at the end of the third month following their initial visits. One hundred and three chiropractic patients and 187 medical patients aged 16 or greater who had not been treated within the preceding month of their initial visit participated., Main Findings: A greater proportion of chiropractic than medical patients perceived their treatment to be successful (RR = 1.91, 95% CI = 1.29, 2.82), had 0 days with low back pain during the week preceding the evaluation (RR = 1.60, 95% CI = 1.00, 2.59), and had no functional impairment due to low back pain after 3 months following their initial visit according to the Roland-Morris Disability Questionnaire (RR = 1.42, 95% CI = 0.81, 2.50). General health status was similar for both chiropractic and medical patients., Conclusions: Chiropractic care was at least as effective as medical care in reducing low back pain and functional disability due to low back pain. Chiropractic patients were more likely to perceive their treatment to be successful in reducing low back pain compared to medical patients.

Between July and November 1982, 14 cases of the hemolytic-uremic syndrome occurred in the Sacramento, California, metropolitan area; 9 of the 14 patients lived within a 7.5-mile radius in northeast Sacramento, 10 were female, 12 were white non-Hispanic and 13 were children with a mean age of 3.6 years. Of the 14 patients, 13 were admitted to hospital; 7 required peritoneal dialysis. The 14th child, a 3-month-old white female infant, was found dead in her crib and had renal histopathologic findings consistent with the hemolytic-uremic syndrome. Of the 13 nonfatal cases, 12 patients had diarrhea before being admitted to hospital. A case-control study involving 11 cases and 22 controls did not show any significant differences in exposure to a variety of possible risk factors including restaurants, specific foods and water supply. Stool specimens were negative for enteric bacterial pathogens by culture and for viruses by tissue culture assay, suckling mouse inoculation and immune electron microscopy; no serologic evidence was found for infection due to enteroviruses, respiratory viruses or arenaviruses. Two of four children tested, however, showed serologic evidence of infection by Vero-cytotoxin-producing Escherichia coli. These 14 cases represent one of the largest reported outbreaks of the hemolytic-uremic syndrome in the United States.