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Lighten the Load: Backpack Strategies for Parents From the American Chiropractic Association

ARLINGTON, Va. -- As students savor the last precious days of summer vacation, parents are out making the final run for school supplies. So, parents, take note -- when back to school shopping this year there is one essential item that requires very special attention: your child's backpack. Backpack weight is becoming an increasing problem, and studies show that heavy backpacks can lead to both back pain and poor posture, noted the American Chiropractic Association (ACA). In fact, in 2001 backpacks were the cause of 7,000 emergency room visits and countless complaints of muscle spasms, neck and shoulder pain. "In my own practice, I have noticed a marked increase in the number of young children who are complaining about back, neck and shoulder pain," said Dr. Scott Bautch, a chiropractor from Wausau, Wis., and noted ergonomics expert. "The first question I ask these patients is, 'Do you carry a backpack to school?' Almost always, the answer is 'yes.'" This painful trend among youngsters isn't surprising when you consider the disproportionate amounts of weight they carry in their backpacks -- often slung over just one shoulder. According to Dr. Bautch, "Many of these kids are carrying a quarter of their body weight over their shoulders for a large portion of the day. That's equivalent to a 180-pound man carrying around a 45- pound load." Thankfully, backpacks have undergone a radical evolution in recent years and now many are designed to be ergonomic while remaining fashionable. Not to mention, the backpack of today has adapted to keep up with our changing lives. Children not only pack heavy schoolbooks, band instruments and running shoes into their backpacks, many of them also tuck away popular electronics -- such as laptops, cellular phones, MP3 players, CD players and personal digital assistants (PDA) -- into specially designed compartments inside their backpacks. Bulging backpacks offer a significant risk to children, but parents can help limit the strain on young necks, backs and shoulders. The ACA offers the following tips to help prevent the pain caused by backpack misuse. --- Make sure your child's backpack weighs no more than 10 percent of his or her body weight. A heavier backpack will cause your child to stoop forward in an attempt to support the additional weight. --- The backpack should never hang more than 4 inches below the waistline. A backpack that hangs too low increases the weight on the shoulders, causing your child to lean forward when walking. --- A backpack with individualized compartments helps position the contents most effectively. Make sure that pointy or bulky objects are packed away from the area that will rest on your child's back, and try to place the heaviest items closet to the body. --- Bigger is not necessarily better. The more room there is in a backpack, the more your child will carry and the heavier the backpack will be. --- Urge your child to wear both shoulder straps. Lugging the backpack around by one strap can cause a disproportionate shift of weight to one side, leading to neck and muscle spasms, as well as low-back pain. --- Wide, padded straps are very important. Non-padded straps are uncomfortable, and can dig into your child's shoulders. --- The shoulder straps should be adjustable so the backpack can be fitted to your child's body. Straps that are too loose can cause the backpack to dangle uncomfortably and cause spinal misalignment and pain. --- If the backpack is still too heavy, talk to your child's teacher. Ask if your child could leave the heaviest books at school, and bring home only lighter handout materials or workbooks. Ask the teacher for a set oftext books to keep at home. Chiropractic has been practiced in the United States for more than 100 years, and each year, millions of Americans trust their health to one of the nation's 60,000 doctors of chiropractic. To read research studies about the effectiveness of chiropractic care, visit ACA's website at:

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Survey: Chronic Back Pain Sufferers Prefer Drug Free Pain Management

ARLINGTON, Va. -- More than 80 percent of chronic back pain sufferers surveyed would prefer to avoid the use of medication to treat their ailments, yet ironically, a majority are taking either narcotics, muscle relaxants or over-the-counter medications to deal with their pain, according to a study conducted for the American Chiropractic Association (ACA) by a national market research firm. In addition, more than 64 percent of survey respondents reported that they would consider seeking the professional health care services of a doctor of chiropractic (DC), health care providers who offer a drugless approach to pain relief. The omnibus survey, conducted in the spring of 2004 for ACA by I/H/R Research Group, a full service market research firm that includes experienced health care managers, interviewed 800 adults nationwide. The survey was conducted to gain insight into the treatment methods used by those with chronic back pain and to better understand the amount of relief experienced from various treatment options. Survey results did indicate that while millions of Americans trust their health care to one of the nation's 60,000 doctors of chiropractic, only 13.8 percent of respondents were currently seeking health care from a DC. However, when survey participants were asked if they felt their pain was under control as a result of their current treatment, 30 percent indicated their pain was not, and an additional 39.3 percent said their pain was only moderately under control. Furthermore, more than 27 percent of respondents reported that they were taking a form of analgesic or narcotic for their chronic back pain; 25 percent indicated they relied on over-the-counter medications; and 19.6 percent used muscle relaxants. "The survey results reiterate that chiropractic care offers the treatment options desired by patients -- compassionate health care that works safely without drugs or surgery," said American Chiropractic Association (ACA) President Donald J. Krippendorf, DC. "However, the information provided also shows that more needs to be done to educate patients, physicians and the health community about the benefits of chiropractic care and its ability to manage pain effectively." Other survey highlights include: * 18 percent of all chronic back pain was reported as the result of an accident or injury * Almost 40 percent reported their pain as very severe or severe at the time of the survey * 71 percent of respondents said they had suffered from chronic back pain for five or more years Eighty percent of Americans suffer from back pain at some point in their lives, and back pain is the second most common reason for visits to the doctor's office, outnumbered only by upper-respiratory infections. "Given the physical and mental demands of the fast-paced, active lifestyles that many Americans lead, it is essential that we keep ourselves in good physical condition without overusing medications that can negatively affect our health. Some medications can induce drowsiness and impair judgment," Dr. Krippendorf said. "You can achieve an improved level of medication-free wellness with the help of your doctor of chiropractic." Recent evidence supporting the efficacy of chiropractic care comes from a study published in the July 15, 2003, edition of the journal Spine, which found that manual manipulation -- the primary form of treatment performed by doctors of chiropractic -- provides better relief of chronic spinal pain than does acupuncture or even a variety of medications. Additional research The ACA offers the following tips for choosing a doctor of chiropractic. * Be sure the chiropractor has attended an accredited chiropractic college. A list can be found on ACA's Web site: * Be sure the chiropractor is licensed to practice in your state. After graduating from an accredited chiropractic college, chiropractors must pass rigorous state and national board exams before they can practice. * The chiropractor should be willing to answer your questions and should talk freely with you about your concerns and your course of treatment. * Talk to your friends, family and co-workers. The best referrals often come from satisfied patients.

Vitamin E may help upper respiratory track infection

ABSTRACT Vitamin E and Respiratory Tract Infections in Elderly Nursing Home Residents A Randomized Controlled Trial Simin Nikbin Meydani, DVM; Lynette S. Leka, BS; Basil C. Fine, MD; Gerard E. Dallal, PhD; Gerald T. Keusch, MD; Maria Fiatarone Singh, MD; Davidson H. Hamer, MD Context -- Respiratory tract infections are prevalent in elderly individuals, resulting in increased morbidity, mortality, and use of health care services. Vitamin E supplementation has been shown to improve immune response in elderly persons. However, the clinical importance of these findings has not been determined. Objective -- To determine the effect of 1 year of vitamin E supplementation on respiratory tract infections in elderly nursing home residents. Design, Setting, and Participants -- A randomized, double-blind, placebo-controlled trial was conducted from April 1998 to August 2001 at 33 long-term care facilities in the Boston, Mass, area. A total of 617 persons aged at least 65 years and who met the study's eligibility criteria were enrolled; 451 (73%) completed the study. Intervention -- Vitamin E (200 IU) or placebo capsule administered daily; all participants received a capsule containing half the recommended daily allowance of essential vitamins and minerals. Main Outcome Measures -- Incidence of respiratory tract infections, number of persons and number of days with respiratory tract infections (upper and lower), and number of new antibiotic prescriptions for respiratory tract infections among all participants randomized and those who completed the study. Results -- Vitamin E had no significant effect on incidence or number of days with infection for all, upper, or lower respiratory tract infections. However, fewer participants receiving vitamin E acquired 1 or more respiratory tract infections (60% vs 68%; risk ratio [RR], 0.88; 95% confidence interval [CI], 0.76-1.00; P = .048 for all participants; and 65% vs 74%; RR, 0.88; 95% CI, 0.75-0.99; P = .04 for completing participants), or upper respiratory tract infections (44% vs 52%; RR, 0.84; 95% CI, 0.69-1.00; P = .05 for all participants; and 50% vs 62%; RR, 0.81; 95% CI, 0.66-0.96; P = .01 for completing participants). When common colds were analyzed in a post hoc subgroup analysis, the vitamin E group had a lower incidence of common cold (0.67 vs 0.81 per person-year; RR, 0.83; 95% CI, 0.68-1.01; P = .06 for all participants; and 0.66 vs 0.83 per person-year; RR, 0.80; 95% CI, 0.64-0.98; P = .04 for completing participants) and fewer participants in the vitamin E group acquired 1 or more colds (40% vs 48%; RR, 0.83; 95% CI, 0.67-1.00; P = .05 for all participants; and 46% vs 57%; RR, 0.80; 95% CI, 0.64-0.96; P = .02 for completing participants). Vitamin E had no significant effect on antibiotic use. Conclusions -- Supplementation with 200 IU per day of vitamin E did not have a statistically significant effect on lower respiratory tract infections in elderly nursing home residents. However, we observed a protective effect of vitamin E supplementation on upper respiratory tract infections, particularly the common cold, that merits further investigation. JAMA. 2004;292:828-836. Read the full text at:

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In-Hospital Deaths from Medical Errors at 195,000 per Year, HealthGrades' Study Finds

Little Progress Seen Since 1999 IOM Report on Medical Errors Lakewood, CO – An average of 195,000 people in the U.S. died due to potentially preventable, in-hospital medical errors in each of the years 2000, 2001 and 2002, according to a new study of 37 million patient records that was released today by HealthGrades, the healthcare quality company. The HealthGrades Patient Safety in American Hospitals study is the first to look at the mortality and economic impact of medical errors and injuries that occurred during Medicare hospital admissions nationwide from 2000 to 2002. The HealthGrades study applied the mortality and economic impact models developed by Dr. Chunliu Zhan and Dr. Marlene R. Miller in a research study published in the Journal of the American Medical Association (JAMA) in October of 2003. The Zhan and Miller study supported the Institute of Medicine’s (IOM) 1999 report conclusion, which found that medical errors caused up to 98,000 deaths annually and should be considered a national epidemic. The HealthGrades study finds nearly double the number of deaths from medical errors found by the 1999 IOM report “To Err is Human,” with an associated cost of more than $6 billion per year. Whereas the IOM study extrapolated national findings based on data from three states, and the Zhan and Miller study looked at 7.5 million patient records from 28 states over one year, HealthGrades looked at three years of Medicare data in all 50 states and D.C. This Medicare population represented approximately 45 percent of all hospital admissions (excluding obstetric patients) in the U.S. from 2000 to 2002. “The HealthGrades study shows that the IOM report may have underestimated the number of deaths due to medical errors, and, moreover, that there is little evidence that patient safety has improved in the last five years,” said Dr. Samantha Collier, HealthGrades’ vice president of medical affairs. “The equivalent of 390 jumbo jets full of people are dying each year due to likely preventable, in-hospital medical errors, making this one of the leading killers in the U.S.” HealthGrades examined 16 of the 20 patient-safety indicators defined by the Agency for Healthcare Research and Quality (AHRQ) – from bedsores to post-operative sepsis – omitting four obstetrics-related incidents not represented in the Medicare data used in the study. Of these sixteen, the mortality associated with two, failure to rescue and death in low risk hospital admissions, accounted for the majority of deaths that were associated with these patient safety incidents. These two categories of patients were not evaluated in the IOM or JAMA analyses, accounting for the variation in the number of annual deaths attributable to medical errors. However, the magnitude of the problem is evident in all three studies. “If we could focus our efforts on just four key areas – failure to rescue, bed sores, postoperative sepsis, and postoperative pulmonary embolism – and reduce these incidents by just 20 percent, we could save 39,000 people from dying every year,” said Dr. Collier. The HealthGrades study was released in conjunction with the company’s first annual Distinguished Hospital Award for Patient SafetyTM, which honors hospitals with the best records of patient safety. Eighty-eight hospitals in 23 states were given the award for having the nation’s lowest patient-safety incidence rates. A list of winners can be found at Study Highlights

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Dietary niacin may protect against Alzheimer’s disease

ABSTRACT Dietary niacin and the risk of incident Alzheimer’s disease and of cognitive decline M C Morris, D A Evans, J L Bienias, P A Scherr, C C Tangney, L E Hebert, D A Bennett, R S Wilson and N Aggarwal Background: Dementia can be caused by severe niacin insufficiency, but it is unknown whether variation in intake of niacin in the usual diet is linked to neurodegenerative decline. We examined whether dietary intake of niacin was associated with incident Alzheimer’s disease (AD) and cognitive decline in a large, prospective study. Methods: This study was conducted in 1993–2002 in a geographically defined Chicago community of 6158 residents aged 65 years and older. Nutrient intake was determined by food frequency questionnaire. Four cognitive tests were administered to all study participants at 3 year intervals in a 6 year follow up. A total of 3718 participants had dietary data and at least two cognitive assessments for analyses of cognitive change over a median 5.5 years. Clinical evaluations were performed on a stratified random sample of 815 participants initially unaffected by AD, and 131 participants were diagnosed with 4 year incident AD by standardised criteria. Results: Energy adjusted niacin intake had a protective effect on development of AD and cognitive decline. In a logistic regression model, relative risks (95% confidence intervals) for incident AD from lowest to highest quintiles of total niacin intake were: 1.0 (referent) 0.3 (0.1 to 0.6), 0.3 (0.1 to 0.7), 0.6 (0.3 to 1.3), and 0.3 (0.1 to 0.7) adjusted for age, sex, race, education, and ApoE e4 status. Niacin intake from foods was also inversely associated with AD (p for linear trend = 0.002 in the adjusted model). In an adjusted random effects model, higher food intake of niacin was associated with a slower annual rate of cognitive decline, by 0.019 standardised units (SU) per natural log increase in intake (mg) (p = 0.05). Stronger associations were observed in analyses that excluded participants with a history of cardiovascular disease (ß = 0.028 SU/year; p = 0.008), those with low baseline cognitive scores (ß = 0.023 SU/year; p = 0.02), or those with fewer than 12 years’ education (ß = 0.035 SU/year; p = 0.002) Conclusion: Dietary niacin may protect against AD and age related cognitive decline. SOURCE: Morris, M.C. Journal of Neurology, Neurosurgery, and Psychiatry, August 2004; vol 75: pp 1093-1099.


For a child’s cough, sugar water no better then cough syrup

ABSTRACT Effect of Dextromethorphan, Diphenhydramine, and Placebo on Nocturnal Cough and Sleep Quality for Coughing Children and Their Parents Objectives. To determine whether the commonly used over-the-counter medications dextromethorphan and diphenhydramine are superior to placebo for the treatment of nocturnal cough and sleep difficulty associated with upper respiratory infections and to determine whether parents have improved sleep quality when their children receive the medications when compared with placebo. Methods. Parents of 100 children with upper respiratory infections were questioned to assess the frequency, severity, and bothersome nature of the nocturnal cough. Their answers were recorded on 2 consecutive days, initially on the day of presentation, when no medication had been given the previous evening, and then again on the subsequent day, when either medication or placebo was given before bedtime. Sleep quality for both the child and the parent were also assessed for both nights. Results. For the entire cohort, all outcomes were significantly improved on the second night of the study when either medication or placebo was given. However, neither diphenhydramine nor dextromethorphan produced a superior benefit when compared with placebo for any of the outcomes studied. Insomnia was reported more frequently in those who were given dextromethorphan, and drowsiness was reported more commonly in those who were given diphenhydramine. Conclusions. Diphenhydramine and dextromethorphan are not superior to placebo in providing nocturnal symptom relief for children with cough and sleep difficulty as a result of an upper respiratory infection. Furthermore, the medications given to children do not result in improved quality of sleep for their parents when compared with placebo. Each clinician should consider these findings, the potential for adverse effects, and the individual and cumulative costs of the drugs before recommending them to families. Ian M. Paul, MD, MSc, Katharine E. Yoder, Kathryn R. Crowell, MD, Michele L. Shaffer, PhD, Heidi S. McMillan, MD, Lisa C. Carlson, MD, Deborah A. Dilworth, RN and Cheston M. Berlin, Jr., MD Pediatrics 2004; 114: e85-e90.


New Facts About Alternative Health Use In US Revealed In CDC Study

Centers for Disease Control and Prevention (CDC) released study on the use of complementary and alternative medicine (CAM) in U.S. The study involved more then 31,000 U.S. adults and appears to be one of the most comprehensive to date. To view the study click on the link below:

The Natural Treatment of Hypertension

ABSTRACT The goal of this review is to evaluate the efficacy of commonly available dietary supplements in the treatment of hypertension, using the average blood pressure reduction achieved with the implementation of lifestyle modifications as a standard. For this reason, the authors focus on the antihypertensive potential of these agents rather than pharmacology, pharmacokinetics, adverse effects, or supplement ñ drug interactions. For the purpose of this review, dietary supplements are defined as exhibiting some evidence of benefit if a systolic blood pressure reduction of 9.0 mm Hg or greater and/or a diastolic blood pressure reduction of 5.0 mm Hg or greater has been observed in previously published, peer-reviewed trials. These defining limits are based on the average blood pressure reduction associated with the implementation of certain lifestyle modifications. Agents with some evidence of benefit include coenzyme Q10, fish oil, garlic, vitamin C, and L-arginine. J Clin Hypertens (2004) 6;5:242-248

Vitamin C and the risk of developing inflammatory polyarthritis: prospective nested case-control study

ABSTRACT Objective: To investigate whether, there is an association between consumption of fruit and vegetables and dietary antioxidants and the risk of developing inflammatory polyarthritis (IP). Methods: In a prospective, population based, nested case-control study of residents of Norfolk, UK, men and women aged 45–74 years were recruited, between 1993 and 1997 through general practice age-sex registers to the Norfolk arm of the European Prospective Investigation of Cancer (EPIC-Norfolk). Dietary intake was assessed at baseline using 7 day diet diaries. Seventy three participants who went on to develop IP between 1993 and 2001 and were registered by the Norfolk Arthritis Register (NOAR) were identified. Incident cases of IP, assessed by general practitioners, fulfilled the criteria of two or more swollen joints, persisting for a minimum of 4 weeks. Each case of IP was matched for age and sex with two controls free of IP. Results: Lower intakes of fruit and vegetables, and vitamin C were associated with an increased risk of developing IP. Those in the lowest category of vitamin C intake, compared with the highest, increased their risk of developing IP more than threefold, adjusted odds ratio (OR) with 95% confidence intervals (CI) 3.3 (95% CI 1.4 to 7.9). Weak inverse associations between vitamin E and ß-carotene intake and IP risk were found. Conclusion: Patients with IP (cases) consumed less fruit and vitamin C than matched controls, which appeared to increase their risk of developing IP. The mechanism for this effect is uncertain. Thus similar studies are necessary to confirm these results. Annals of the Rheumatic Diseases 2004;63:843-847


FDA Gives Dynatronics Go-Ahead to Market New Laser Probe

SALT LAKE CITY, - Dynatronics Corporation today announced the U.S. Food and Drug Administration has given marketing clearance for the company's new Solaris D890 low-power laser probe. The laser treats muscle and joint pain, including the pain and stiffness associated with arthritis. The Solaris D890 is the second probe designed for use as an accessory to the company's popular new Solaris Series products. The probe is expected to be ready for shipment within 30 to 60 days. "We are thrilled with the FDA's decision to allow us to begin marketing this laser probe," stated Kelvyn H. Cullimore Jr., president of Dynatronics. "Our first attempt to obtain approval for a laser probe was over 20 years ago. That makes this clearance even more satisfying." According to Larry K. Beardall, Dynatronics' executive vice president of marketing and sales, "The new D890 probe will expand the foundation of success our Solaris product line has already achieved. With two decades of clinical research behind them, lasers have been of keen interest to the medical community and have found many applications in medical settings. Hundreds of people around the country have already benefited from light therapy. The results have been remarkable." More information regarding this technology is available at:


Quantitative Assessment of Mechanical Laxity in the Functionally Unstable Ankle

Abstract: Purpose: Delineating between functional and mechanical instability in those with chronic ankle dysfunction is a challenging task. Current methods of assessing ankle ligamentous laxity are subjective in nature and limit our ability to identify the site and extent of instability; therefore, a need exists for objective laxity measurements. The purpose of this study was to determine whether subjects with self-reported, functional ankle instability (FAI) demonstrated increased mechanical laxity when tested with instrumented arthrometry and stress radiography. Methods: Both ankles were tested in 51 subjects with self-reported unilateral FAI. An instrumented ankle arthrometer measured ankle-subtalar joint motion for total anteroposterior (AP) displacement (mm) during loading at 125 N and total inversion-eversion (I-E) rotation (degrees of ROM) during loading at 4 N[middle dot]m. The Telos GA-II/E device provided either anterior or lateral stress (15 kp) while fluoroscopic radiographs were recorded for anterior displacement (mm) and talar tilt (degrees). Results: The arthrometry measurements of anterior and total AP displacement and the radiographic measurements of anterior displacement were greater (P < 0.05) in the FAI ankles when compared with the uninjured ankles. There were no differences in total I-E rotation, inversion rotation, or talar tilt between ankles when analyzed with either measurement technique. Conclusion: The ability to objectively measure mechanical instability in the functionally unstable ankle is important to understanding the nature and cause of the instability. Ankle arthrometry and stress radiographic measurements are objective assessment tools for mechanical laxity. Despite finding greater laxity in the functionally unstable ankle, the clinical significance of the observed displacement remains unanswered. Further research is needed to determine the amount of laxity that constitutes mechanical instability and how this relates to FAI. Medicine & Science in Sports & Exercise. 36(5):760-766, May 2004. © 2004 American College of Sports Medicine


Detection of Airborne Rhinovirus and Its Relation to Outdoor Air Supply in Office Environments

ABSTRACT Rhinoviruses are major causes of morbidity in patients with respiratory diseases; however, their modes of transmission are controversial. We investigated detection of airborne rhinovirus in office environments by polymerase chain reaction technology and related detection to outdoor air supply rates. We sampled air from 9 A.M. to 5 P.M. each workday, with each sample run for 1 work week. We directly extracted RNA from the filters for nested reverse transcriptase–polymerase chain reaction analysis of rhinovirus. Nasal lavage samples from building occupants with upper respiratory infections were also collected. Indoor carbon dioxide (CO2) concentrations were recorded every 10 minutes as a surrogate for outdoor air supply. To increase the range of CO2 concentrations, we adjusted the outdoor air supply rates every 3 months. Generalized additive models demonstrated an association between the probability of detecting airborne rhinovirus and a weekly average CO2 concentration greater than approximately 100 ppm, after controlling for covariates. In addition, one rhinovirus from a nasal lavage contained an identical nucleic acid sequence similar to that in the building air collected during the same week. These results suggest that occupants in buildings with low outdoor air supply may have an increased risk of exposure to infectious droplet nuclei emanating from a fellow building occupant.


New Government Survey Reflects Widespread Use of Complementary and Alternative Therapies

According to a new nationwide government survey, [1] 36 percent of U.S. adults aged 18 years and over use some form of complementary and alternative medicine (CAM). CAM is defined as a group of diverse medical and health care systems, practices, and products that are not presently considered to be part of conventional medicine. When prayer specifically for health reasons is included in the definition of CAM, the number of U.S. adults using some form of CAM in the past year rises to 62 percent. "These new findings confirm the extent to which Americans have turned to CAM approaches with the hope that they would help treat and prevent disease and enhance quality of life," said Stephen E. Straus, M.D., Director, National Center for Complementary and Alternative Medicine (NCCAM). "The data not only assists us in understanding who is using CAM, what is being used, and why, but also in studying relationships between CAM use and other health characteristics, such chronic health conditions, insurance coverage, and health behaviors." The survey, administered to over 31,000 representative U.S. adults, was conducted as part of the Centers for Disease Control and Prevention's (CDC) 2002 National Health Interview Survey (NHIS). Developed by NCCAM and the CDC's National Center for Health Statistics (NCHS), the survey included questions on 27 types of CAM therapies commonly used in the United States. These included 10 types of provider-based therapies, such as acupuncture and chiropractic, and 17 other therapies that do not require a provider, such as natural products (herbs or botanical products), special diets, and megavitamin therapy. Although there have been many surveys of CAM use to date, the various surveys included fewer choices of CAM therapies. In addition, they often surveyed smaller population samples primarily relying on telephone or mail surveys versus in-person interviews used for this survey. Thus, the results from the CAM portion of the NHIS provide the most comprehensive and reliable data to date describing CAM use by the U.S. adult population. Overall, the survey revealed that CAM use was greater among a variety of population groups, including women; people with higher education; those who had been hospitalized within the past year; and former smokers, compared to current smokers or those who had never smoked. In addition, this was the first survey to yield substantial information on CAM use by minorities. For example, it found that African American adults were more likely than white or Asian adults to use CAM when megavitamin therapy and prayer were included in the definition of CAM. "We're continuously expanding the health information we collect in this country, including information on the actions people take in dealing with their own health situations," said NCHS Director Edward J. Sondik, Ph.D. "Over the years we've concentrated on traditional medical treatment, but this new collection of CAM data taps into another dimension entirely. What we see is that a sizable percentage of the public puts their personal health into their own hands." CAM approaches were most often used to treat back pain or problems, colds, neck pain or problems, joint pain or stiffness, and anxiety or depression. However, only about 12 percent of adults sought care from a licensed CAM practitioner, suggesting that most people who use CAM do so without consulting a practitioner. According to the survey, the 10 most commonly used CAM therapies and the approximate percent of U.S. adults using each therapy were: • Prayer for own health, 43 percent • Prayer by others for the respondent's health, 24 percent • Natural products (such as herbs, other botanicals, and enzymes), 19 percent • Deep breathing exercises, 12 percent • Participation in prayer group for own health, 10 percent • Meditation, 8 percent • Chiropractic care, 8 percent • Yoga, 5 percent • Massage, 5 percent • Diet-based therapies (such as Atkins, Pritikin, Ornish, and Zone diets), 4 percent. In addition to gathering data on the use of CAM practices, the survey also sought information about why people use CAM. Key findings indicate that: • 55 percent of adults said they were most likely to use CAM because they believed that it would help them when combined with conventional medical treatments; • 50 percent thought CAM would be interesting to try; • 26 percent used CAM because a conventional medical professional suggested they try it; and • 13 percent used CAM because they felt that conventional medicine was too expensive. Interestingly, the survey also found that about 28 percent of adults used CAM because they believed conventional medical treatments would not help them with their health problem; this is in contrast to previous findings that CAM users are not, in general, dissatisfied with conventional medicine. The results of the survey reveal new patterns of CAM use among various population groups and provide a rich source of data for future research. Furthermore, the survey results provide a baseline for future surveys, as it establishes a consistent definition of CAM that can be used to track trends and prevalence of CAM use. [1] Barnes P, Powell-Griner E, McFann K, Nahin R. CDC Advance Data Report #343. Complementary and Alternative Medicine Use Among Adults: United States, 2002. May 27, 2004.


An Approach to Identifying Osteopenic Women at Increased Short-term Risk of Fracture

ABSTRACT Background - Identification and management of women to reduce fractures is often limited to T scores less than –2.5, although many fractures occur with higher T scores. We developed a classification algorithm that identifies women with osteopenia (T scores of –2.5 to –1.0) who are at increased risk of fracture within 12 months of peripheral bone density testing. Methods - A total of 57 421 postmenopausal white women with baseline peripheral T scores of –2.5 to –1.0 and 1-year information on new fractures were included. Thirty-two risk factors for fracture were entered into a classification and regression tree analysis to build an algorithm that best predicted future fracture events. Results - A total of 1130 women had new fractures in 1 year. Previous fracture, T score at a peripheral site of –1.8 or less, self-rated poor health status, and poor mobility were identified as the most important determinants of short-term fracture. Fifty-five percent of the women were identified as being at increased fracture risk. Women with previous fracture, regardless of T score, had a risk of 4.1%, followed by 2.2% in women with T scores of –1.8 or less or with poor health status, and 1.9% for women with poor mobility. The algorithm correctly classified 74% of the women who experienced a fracture. Conclusions - This classification tool accurately identified postmenopausal women with peripheral T scores of –2.5 to –1.0 who are at increased risk of fracture within 12 months. It can be used in clinical practice to guide assessment and treatment decisions.

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Associations of Mortality With Ocular Disorders and an Intervention of High-Dose Antioxidants and Zinc in the Age-Related Eye Disease Study

ABSTRACT Objective - To assess the association of ocular disorders and high doses of antioxidants or zinc with mortality in the Age-Related Eye Disease Study (AREDS). Methods - Baseline fundus and lens photographs were used to grade the macular and lens status of AREDS participants. Participants were randomly assigned to receive oral supplements of high-dose antioxidants, zinc, antioxidants plus zinc, or placebo. Risk of all-cause and cause-specific mortality was assessed using adjusted Cox proportional hazards models. Results - During median follow-up of 6.5 years, 534 (11%) of 4753 AREDS participants died. In fully adjusted models, participants with advanced age-related macular degeneration (AMD) compared with participants with few, if any, drusen had increased mortality (relative risk [RR], 1.41; 95% confidence interval [CI], 1.08-1.86). Advanced AMD was associated with cardiovascular deaths. Compared with participants having good acuity in both eyes, those with visual acuity worse than 20/40 in 1 eye had increased mortality (RR, 1.36; 95% CI, 1.12-1.65). Nuclear opacity (RR, 1.40; 95% CI, 1.12-1.75) and cataract surgery (RR, 1.55; 95% CI, 1.18-2.05) were associated with increased all-cause mortality and with cancer deaths. Participants randomly assigned to receive zinc had lower mortality than those not taking zinc (RR, 0.73; 95% CI, 0.61-0.89). Conclusions - The decreased survival of AREDS participants with AMD and cataract suggests that these conditions may reflect systemic rather than only local processes. The improved survival in individuals randomly assigned to receive zinc requires further study. Arch Ophthalmol. 2004;122:716-726. To view the full article click on the link below:


Doctors of Chiropractic Offer Mothers Day Advice for Active Moms

ARLINGTON, Va., The American Chiropractic Association (ACA) has Mothers Day advice for active moms who want more time to bond with their babies: take your child along with you when you take a walk or a hike -- but be careful that you do it properly. With new products unheard of a generation ago -- like baby carriers and slings -- even the tiniest among us are able to enjoy the great outdoors. But while these items can make life easier and more enjoyable for both parent and child, they can be the cause of pain and injury if not used properly. As many mothers know, backpack-style or front-side baby carriers can be effective tools for toting your little one. However, Dr. Scott Bautch of ACA's Occupational Health Council cautions that there are risks involved with the popular backpack-style carrier. "Because the cervical spine of a child less than a year old is not fully developed, it's important at that age that the head does not bob around. The backpack-type carrier is not ideal because the parent cannot watch to make sure the child's head is stable. So a front-side carrier is better for a very young child." Dr. Bautch also urges you to consider the following: * A backpack-style or front-side carrier decreases a parent's stability when walking or hiking. It is critical that a parent gets into shape before attempting to use one of these products. * Since these carriers will change the feel of walking or hiking, they should not be used by beginning hikers. * If using a backpack-style or front-side baby carrier, make sure to select one with wide straps for your shoulders and waist. This will help distribute the carrier's weight evenly. The shoulder straps should fit comfortably over the center of your collarbone. * Once you place the child in the carrier, check to make sure there is no bunching of material against the child's body, particularly on the back, buttocks and spine. Isolated, uneven pressure like this can produce pain. The "baby sling" is becoming more and more popular thanks to its versatility of positions and comfort. But if you wish to use a baby sling, keep in mind that it is intended only for very young infants, and be sure to follow these tips: * A baby can become very hot inside the sling, so be mindful of the temperature around you. Also, make certain the baby's breathing is clear and unobstructed by the sling's material. * Never run or jog while carrying a baby in any backpack-style carrier, front-side carrier or baby sling. A baby's body is not adjusted to the cyclic pattern that is a part of running and jogging. This motion can do damage to the baby's neck, spine and/or brain. Finally, don't forget about your own health and comfort. When lifting a child, bend from the waist, but begin in a 3-point squat and implement a two-stage lift that consists of a) pulling the child up to your chest and then b) lifting straight up with your leg muscles. Chiropractic Care Can Help If you or your child experiences any pain or discomfort resulting from these or other outdoor activities, call your doctor of chiropractic. Doctors of chiropractic are licensed and trained to diagnose and treat patients of all ages, and can provide health tips for you and your children that will make enjoying outdoor activities safer and more enjoyable.

Simple and Efficient Recognition of Migraine With 3-Question Headache Screen

ABSTRACT Objective. To correlate the results of a new 3-question headache screen to 3 established methods of diagnosing migraine: the International Headache Society diagnostic criteria, physician's clinical impression, and presence of recurring disabling headaches. Background. A simple tool to recognize patients who experience migraine may facilitate diagnosis of this debilitating and frequently undiagnosed condition. Methods. Primary care physicians and neurologists in the United States enrolled 3014 adults with a diagnosis of migraine based on one of the following: International Headache Society criteria, an investigator's clinical impression, or presence of recurring disabling headaches. Each patient completed a 3-question headache screen: (1) Do you have recurrent headaches that interfere with work, family, or social functions? (2) Do your headaches last at least 4 hours? (3) Have you had new or different headaches in the past 6 months? A diagnosis of migraine was suggested by a yes answer to questions 1 and 2 and a no answer to question 3. Results. The 3-question headache screen identified migraine in 77% of the study population; including 78% of the patients enrolled based on International Headache Society criteria, 74% based on clinical impression, and 68% because of recurring disabling headaches. Conclusions. Positive 3-question headache screen results agreed well with migraine diagnoses based on International Headache Society criteria, clinical impressions, and presence of recurring disabling headaches. These findings support use of the 3-question headache screen to recognize migraine.

FCER Responds to Newsweek's

April 29, 2004 Editorial Department Newsweek Magazine P.O. Box 2120 Radio City Station New York, New York 10101 To the Editor: For such a widespread condition that costs the U.S. $100B annually, I was deeply disappointed by a glaring misrepresentation which appeared in your April 26 issue on "The Great Back Pain Debate." That distortion had to do with the suggestion that "there's not a lot of data on how effective it is in the long term" when it comes to the chiropractic care of back pain patients. As the Director of Research of the largest and oldest foundation which has contributed substantially to the evidence which supports the effectiveness of spinal manipulation for back pain patients, I take strong exception to Dan Cherkin's statement. In truth, a summary of no less than 73 clinical trials involving spinal manipulation recently published in the Annals of Internal Medicine attests to the effectiveness of this treatment in managing back pain with none of the trials having produced negative results. Furthermore, official guidelines from the governments of at least 8 countries in North America, western Europe and Australia propose that spinal manipulation is one of the two most-documented and effective management strategies for back pain [the other being the use of analgesics and nonsteroidal anti-inflammatory agents]. With this type of documented effectiveness, fewest side effects, and avoidance of expensive alternatives when possible, the treatments which chiropractors apply demand far more thoughtful review in a healthcare environment that is increasingly dependent upon the documentation of rigorous scientific evidence, regrettably overlooked in your article. [Signed] ANTHONY ROSNER, PH.D., LL.D [HON.] BROOKLINE, MASSACHUSETTS Foundation for Chiropractic Education and Research 1330 Beacon Street, Suite 315 Brookline, MA 02446-3202 UNITED STATES 617-734-3397 617-734-0989 FAX [email protected] Newsweek's editorial policy limits letters to the editor to one paragraph.


Effect of Vitamin D on Falls (A Meta-analysis)

Taking vitamin D supplements by older people can cut falls by over 20%, according to new research. A meta-analysis published in the Journal of the American Medical Association looked at data from ten randomised controlled trials. Abstract Context - Falls among elderly individuals occur frequently, increase with age, and lead to substantial morbidity and mortality. The role of vitamin D in preventing falls among elderly people has not been well established. Objective To assess the effectiveness of vitamin D in preventing an older person from falling. Data Sources - MEDLINE and the Cochrane Controlled Trials Register from January 1960 to February 2004, EMBASE from January 1991 to February 2004, clinical experts, bibliographies, and abstracts. Search terms included trial terms: randomized-controlled trial or controlled-clinical trial or random-allocation or double-blind method, or single-blind method or uncontrolled-trials with vitamin D terms: cholecalciferol or hydroxycholecalciferols or calcifediol or dihydroxycholecalciferols or calcitriol or vitamin D/aa[analogs & derivates] or ergocalciferol or vitamin D/bl[blood]; and with accidental falls or falls, and humans. Study Selection - We included only double-blind randomized, controlled trials (RCTs) of vitamin D in elderly populations (mean age, 60 years) that examined falls resulting from low trauma for which the method of fall ascertainment and definition of falls were defined explicitly. Studies including patients in unstable health states were excluded. Five of 38 identified studies were included in the primary analysis and 5 other studies were included in a sensitivity analysis. Data Extraction - Independent extraction by 3 authors using predefined data fields including study quality indicators. Data Synthesis - Based on 5 RCTs involving 1237 participants, vitamin D reduced the corrected odds ratio (OR) of falling by 22% (corrected OR, 0.78; 95% confidence interval [CI], 0.64-0.92) compared with patients receiving calcium or placebo. From the pooled risk difference, the number needed to treat (NNT) was 15 (95% CI, 8-53), or equivalently 15 patients would need to be treated with vitamin D to prevent 1 person from falling. The inclusion of 5 additional studies, involving 10 001 participants, in a sensitivity analysis resulted in a smaller but still significant effect size (corrected RR, 0.87; 95% CI, 0.80-0.96). Subgroup analyses suggested that the effect size was independent of calcium supplementation, type of vitamin D, duration of therapy, and sex, but reduced sample sizes made the results statistically nonsignificant for calcium supplementation, cholecalciferol, and among men. Conclusions - Vitamin D supplementation appears to reduce the risk of falls among ambulatory or institutionalized older individuals with stable health by more than 20%. Further studies examining the effect of alternative types of vitamin D and their doses, the role of calcium supplementation, and effects in men should be considered. Additional information on Vitamin D • Food sources of Vitamin D Fortified foods are the major dietary sources of vitamin D (4). Prior to the fortification of milk products in the 1930s, rickets (a bone disease seen in children) was a major public health problem in the United States. Milk in the United States is fortified with 10 micrograms (400 IU) of vitamin D per quart, and rickets is now uncommon in the US (7). One cup of vitamin D fortified milk supplies about one-fourth of the estimated daily need for this vitamin for adults. Although milk is fortified with vitamin D, dairy products made from milk such as cheese, yogurt, and ice cream are generally not fortified with vitamin D. Only a few foods naturally contain significant amounts of vitamin D, including fatty fish and fish oils (4). The table of selected food sources of vitamin D suggests dietary sources of vitamin D. • Exposure to sunlight Exposure to sunlight is an important source of vitamin D. Ultraviolet (UV) rays from sunlight trigger vitamin D synthesis in the skin (7, 8). Season, latitude, time of day, cloud cover, smog, and sunscreens affect UV ray exposure (8). For example, in Boston the average amount of sunlight is insufficient to produce significant vitamin D synthesis in the skin from November through February. Sunscreens with a sun protection factor of 8 or greater will block UV rays that produce vitamin D, but it is still important to routinely use sunscreen whenever sun exposure is longer than 10 to 15 minutes. It is especially important for individuals with limited sun exposure to include good sources of vitamin D in their diet.


Treating Back Pain

NEW YORK -- Back-pain sufferers in America cost this country more than $100 billion annually in medical bills, disability and lost productivity at work. And 80 percent of Americans will battle back pain at some point in their lives, making it the number two reason for doctor visits, after coughs and other respiratory infections, Newsweek reports in the current issue. To relieve the pain, Americans wanted a quick fix and thus, between 1996 and 2001, there was a 77 percent increase in spinal-fusion surgery, the most costly (about $34,000 a pop) and invasive form of therapy. But, as General Editor Claudia Kalb reports in the April 26 cover story, "Treating Back Pain," (on newsstands Monday, April 19), many of these procedures simply don't work and doctors are now looking for simpler, more effective ways to treat one of the most vexing problems in medicine. "We've come to the point where we have to think out of the box," says Harvard researcher Dr. David Eisenberg, who is studying nonsurgical alternatives like massage and acupuncture. "The time is now." Kalb examines the controversy around spinal fusion and alternatives to treating pain. Chiropractic treatment, the most popular nonsurgical back therapy, is booming, with 60,000 chiropractors practicing today, a 50 percent increase since 1990. While experts generally agree that the treatment, which involves spinal manipulation and stretching, is safe for the lower back, there's not a lot of data on how effective it is in the long term. Dr. Dan Cherkin, of the Center for Health Studies in Seattle, is now conducting the first large trial of the practice. Massage has seen an increasing number of addicted patients, too, and research shows it does help knead out persistent pain; one study even found that patients took fewer medications during treatment, Kalb reports. Acupuncture is also popular, though there's a dearth of evidence about its effectiveness. But even conventional doctors say if it makes you feel better, go for it. Dr. Jeffrey Ngeow, an anethesiologist by training, pushes the tiny needles into patients at New York's Integrative Care Center. He says acupuncture, which seems to stimulate the release of feel-good endorphins, won't provide instant relief, but it will have a cumulative effect. And then there's back pain's relationship to stress. Dr. John Sarno, of NYU Medical Center's Rusk Institute of Rehabilitation Medicine, believes that almost all back pain is rooted in bottled-up emotions. He says patients need to recognize the connection between mind and body before they'll feel better. In addition, there is currently an NIH-funded pilot program at Harvard where a diverse group of 25 specialists -- surgeons as well as complementary medicine experts -- are educating one another on how they diagnose and treat back pain. The goal: to see if there is a more efficient, multidisciplinary way to attack the problem -- and to make it cost-effective, too. Please click on the link below for more information on this story: