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The Quality of Reports on Cervical Arterial Dissection Following Cervical Spinal Manipulation
The Chiro.Org Blog
SOURCE: PLoS ONE 2013 (Mar 20); 8 (3): e59170
Shari Wynd, Michael Westaway, Sunita Vohra, Greg Kawchuk
Texas Chiropractic College, Pasadena, Texas, United States of America.
Background Cervical artery dissection (CAD) and stroke are serious harms that are sometimes associated with cervical spinal manipulation therapy (cSMT). Because of the relative rarity of these adverse events, studying them prospectively is challenging. As a result, systematic review of reports describing these events offers an important opportunity to better understand the relation between adverse events and cSMT. Of note, the quality of the case report literature in this area has not yet been assessed.
Purpose 1) To systematically collect and synthesize available reports of CAD that have been associated with cSMT in the literature and
2) assess the quality of these reports.
Methods A systematic review of the literature was conducted using several databases. All clinical study designs involving CADs associated with cSMT were eligible for inclusion. Included studies were screened by two independent reviewers for the presence/absence of 11 factors considered to be important in understanding the relation between CAD and cSMT.
Results Overall, 43 articles reported 901 cases of CAD and 707 incidents of stroke reported to be associated with cSMT. The most common type of stroke reported was ischemic stroke (92%). Time-to-onset of symptoms was reported most frequently (95%). No single case included all 11 factors.
Conclusions This study has demonstrated that the literature infrequently reports useful data toward understanding the association between cSMT, CADs and stroke. Improving the quality, completeness, and consistency of reporting adverse events may improve our understanding of this important relation.
Copyright: © 2013 Wynd et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Funding: Greg Kawchuk receives salary support from the Canada Research Chairs program. Sunita Vohra receives salary support from Alberta Innovates-Health Solutions. Training support for Shari Wynd was provided by the Alberta Canadian Institutes of Health Research (CIHR) Training Program in Bone and Joint Health. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
Competing interests: The authors have declared that no competing interests exist.
From the Full-Text Article:
Introduction
In the area of harms reporting, one topic that has received significant attention is cervical spinal manipulation therapy (cSMT), an intervention most often administered by chiropractors [1, 2] to treat musculoskeletal complaints of the head and neck [3] including headaches [4]. If harms are associated with cSMT, they most commonly involve additional head and neck pain [2]. While these adverse events tend to be self-limiting [2], more serious adverse events have been reported such as neurovascular sequelae and stroke. More specifically, injuries such as cervical artery dissection (CAD), whether vertebral, internal carotid, or vertebrobasilar, have been reported to be associated with cSMT [5-7]. Although this subset of adverse events appears to occur infrequently [1, 8, 9], understanding the relation between CADs, stroke and cSMT is important given the medical [7], societal [1], economic [9], and legal [8] implications of any event leading to cerebrovascular compromise.
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  By Frank M. Painter, D.C. in Algorithm on March 26th, 2013 at 1:49 am
Algorithms for the Chiropractic Management of
Acute and Chronic Spine-Related Pain
The Chiro.Org Blog
Top Integrative Health Care 2012 (Dec 31); 3 (4)
Gregory A. Baker, DC, Ronald J. Farabaugh, DC, Thomas J. Augat, DC, MS, CCSP, FASA, Cheryl Hawk, DC, PhD, CHES
The complexity of clinical documentation and case management for health care providers has increased along with the rise of managed care. Keeping up with the policies of different insurers and third party administrators can be a daunting task. To address these issues for doctors of chiropractic (DCs) and policymakers, the Council for Chiropractic Guidelines and Practice Parameters (CCGPP) developed three consensus documents. Each of these documents was the outcome of a formal consensus process in which a multidisciplinary Delphi panel consisting of experts in chiropractic and low back pain treatment came to agreement on terminology and treatment parameters for the chiropractic management of spine-related musculoskeletal pain. [1-3]
Introduction:
The complexity of clinical documentation and case management for health care providers has increased along with the rise of managed care. Keeping up with the policies of different insurers and third party administrators can be a daunting task. To address these issues for doctors of chiropractic (DCs) and policymakers, the Council for Chiropractic Guidelines and Practice Parameters (CCGPP) developed three consensus documents. Each of these documents was the outcome of a formal consensus process in which a multidisciplinary Delphi panel consisting of experts in chiropractic and low back pain treatment came to agreement on terminology and treatment parameters for the chiropractic management of spine-related musculoskeletal pain. [1-3] Their recommendations were based on a combination of consideration of the current evidence and their clinical judgment. In addition, another consensus document related to care rendered by doctors of chiropractic for the purpose of health promotion, disease prevention, and wellness, developed through a project funded by the NCMIC Foundation, was also referenced to clarify terminology used in the algorithms. [4] (See Table 1.)
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Table 1.
Definition of terms related to acute and chronic care
The terms “supportive care” and “maintenance care,” which are frequently used within the chiropractic health care arena, are not consistent with general healthcare industry lexicon. Instead of “supportive care,” we use the more descriptive term, “ongoing/recurrent” care.
Chronic pain management can be divided into three categories:
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those who can home manage;
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those who can be managed with episodic care; and
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those who need “scheduled” ongoing care, which is a very small proportion of chronic pain sufferers. Those patients require proper documentation of responses to care and procedures, including therapeutic withdrawal response, multi-modal, multi-disciplinary consideration, patient education, etc.
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By John in Philosophy on March 22nd, 2013 at 4:39 pm
The Institute for Alternative Futures (IAF) is a leader in the creation of preferred futures. Since its founding in 1977 by Clement Bezold, Alvin Toffler and James Dator, IAF has helped organizations monitor trends, explore future possibilities and create the futures they prefer. IAF draws on a robust selection of futures methodologies, such as environmental scans, forecasts, scenarios, visioning and its own “aspirational futures” technique.
Recently the institute released Chiropractic 2025: Divergent Futures (pdf) which was made possible by funding from the NCMIC Foundation.
Therein, 4 scenarios are presented:
Scenario 1: Marginal Gains, Marginalized Field
As health care reorganizes, the historical isolation of chiropractors hinders most DCs in joining integrated care provider organizations. The majority remains in solo and small group practices and face major challenges in building or maintaining an adequate patient base. Research to develop and demonstrate evidence-informed practice grows. This gets DCs more favorable attention, yet networks often use the data to limit fees and the number of visits. Five states assign broader practice rights to DCs. Focused-scope oriented colleges join leading academic medical centers in exploring quantum biology to explain healing and subluxation. However, four chiropractic colleges close. Low starting income for chiropractors in many settings, and limited career prospects for most DCs coupled with high student debt, hamper the growth of the profession over the decade leading to 2025.
Scenario 2: Hard Times & Civil War
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Successful Management of Acute-onset Torticollis in a Giraffe
The Chiro.Org Blog
SOURCE: J Zoo Wildl Med. 2013 (Mar); 44 (1): 181-5
Liza I. Dadone, V.M.D., Kevin K. Haussler, D.V.M., D.C., Ph.D., Dipl. A.C.V.S.M.R., Greg Brown, D.V.M., Melanie Marsden, D.V.M., James Gaynor, D.V.M., Dipl. A.C.V.A., Dipl. A.A.P.M, Matthew S. Johnston, V.M.D., Dipl. A.B.V.P. (Avian), DellaGarelle, D.V.M.
Cheyenne Mountain Zoo, Colorado Springs, Colorado 80906, USA. ldadone@cmzoo.org
A 2-yr-old male reticulated giraffe (Giraffa camelopardalis reticulata) presented with severe midcervical segmental torticollis upon arrival as an incoming shipment. Despite initial medical management, the giraffe developed marked neck sensitivity, focal muscle spasms, and decreased cervical range of motion. Using operant conditioning to assist patient positioning and tolerance to cervical manipulation, a series of manually applied chiropractic treatments were applied to the affected cervical vertebrae in an effort to restore normal cervical mobility.
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By Frank M. Painter, D.C. in Announcement on March 16th, 2013 at 10:05 pm
By Frank M. Painter, D.C. in Maintenance Care on March 10th, 2013 at 2:26 pm
The Impact of Chiropractic Care On Health
Why Maintenance Care Makes Sense
The Chiro.Org Blog
A Chiro.Org Editorial
Coulter and researchers at the RAND Corporation [1] performed an analysis of an insurance database, comparing persons receiving chiropractic care with non-chiropractic patients. The study consisted of senior citizens >75 years of age.
Recipients of chiropractic care reported better overall health, spent fewer days in hospitals and nursing homes, used fewer prescription drugs, and were more active than the non-chiropractic patients.
As part of a comprehensive geriatric assessment program, the RAND Corporation studied a subpopulation of patients who were under chiropractic care compared to those who were not and found that the individuals under continuing chiropractic care were:
- Free from the use of a nursing home [95.7% vs 80.8%];
- Free from hospitalizations for the past 23 years [73.9% vs 52.4%];
- More likely to report a better health status;
- More likely to exercise vigorously;
- More likely to be mobile in the community [69.6% vs 46.8%].
Although it is impossible to clearly establish causality, it is also reasonably clear that continuing chiropractic care is among the attributes of the cohort of patients experiencing substantially fewer costly healthcare interventions.
There are many more articles like this @ our:
Maintenance Care, Wellness and Chiropractic Page
In another study, Van Breda et al [2] interviewed 200 pediatricians and 200 chiropractors, to determine what, if any, differences were to be found in the health status of their respective children, because their families were being raised with 2 very different health care models.
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The Nordic Maintenance Care Program: The Clinical Use of Identified Indications for Preventive Care
The Chiro.Org Blog
Chiropractic & Manual Therapies 2013 (Mar 6); 21: 10
Iben Axén and Lennart Bodin
Intervention & Implementation Research, Institute of Environmental Medicine, Karolinska Institutet, Nobels väg 13, Stockholm 171 77, Sweden
Background Low back pain (LBP) is a prevalent condition and has been found to be recurrent and persistent in a majority of cases. Chiropractors have a preventive strategy, maintenance care (MC), aimed towards minimizing recurrence and progression of such conditions. The indications for recommending MC have been identified in the Nordic countries from hypothetical cases. This study aims to investigate whether these indications are indeed used in the clinical encounter.
Methods Data were collected in a multi-center observational study in which patients consulted a chiropractor for their non-specific LBP. Patient baseline information was a) previous duration of the LBP, b) the presence of previous episodes of LBP and c) early improvement with treatment. The chiropractors were asked if they deemed each individual patient an MC candidate. Logistic regression analyses (uni– and multi-level) were used to investigate the association of the patient variables with the chiropractor’s decision.
Results The results showed that “previous episodes” with LBP was the strongest predictor for recommending MC, and that the presence of all predictors strengthens the frequency of this recommendation. However, there was considerable heterogeneity among the participating chiropractors concerning the recommendation of MC.
Conclusions The study largely confirms the clinical use of the previously identified indications for recommending MC for recurrent and persistent LBP. Previous episodes of LBP was the strongest indicator.
There are many similar studies in our new
Maintenance Care, Wellness and Chiropractic Page
From the Full-Text Article:
Background
In the past few decades, the prevalence of low back pain, LBP, has been found to be extremely high [1] and the resulting costs of the condition are substantial [2] . Upon further scrutiny, the condition has been found to be recurrent in most cases and persistent in some [3-5] . These facts invite preventive approaches, both from a personal and societal perspective. Secondary prevention, to minimize the recurrences or the impact of episodic LBP, and tertiary prevention, to minimize the effects of persistent LBP, seem warranted.
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Combination of Acupuncture and Spinal Manipulative Therapy: Management of a 32-year-old Patient With Chronic Tension-type Headache and Migraine
The Chiro.Org Blog
J Chiropr Med. 2012 (Sep); 11 (3): 192–201
Bahia A. Ohlsen
Chiropractic Physician, Chiropractic, Acupuncture and Yoga Center, Buffalo Grove, IL.
OBJECTIVE: The purpose of this case study is to describe the treatment using acupuncture and spinal manipulation for a patient with a chronic tension-type headache and episodic migraines.
CLINICAL FEATURES: A 32-year-old woman presented with headaches of 5 months’ duration. She had a history of episodic migraine that began in her teens and had been controlled with medication. She had stopped taking the prescription medications because of gastrointestinal symptoms. A neurologist diagnosed her with mixed headaches, some migrainous and some tension type. Her headaches were chronic, were daily, and fit the International Classification of Headache Disorders criteria of a chronic tension-type headache superimposed with migraine.
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By Frank M. Painter, D.C. in Stroke on March 6th, 2013 at 12:15 pm
ECG for Eyes Sorts Strokes from Vertigo
The Chiro.Org Blog
SOURCE: MedPage Today ~ March 05, 2013
By Crystal Phend, Senior Staff Writer, MedPage Today
Reviewed by Robert Jasmer, MD; Associate Clinical Professor of Medicine, University of California, San Francisco and Dorothy Caputo, MA, BSN, RN, Nurse Planner
A new device, described as an ECG for the eye, appears to accurately distinguish stroke from other causes of dizziness in the emergency department.
Note that the bedside device feeds webcam video from goggles mounted with an accelerometer to computer software that looks for abnormal corrective eye movements when the head turns.
A device described as an ECG for the eye accurately distinguishes stroke from other causes of dizziness in the emergency department (ED), a small proof-of-concept study showed.
When tested on 12 patients in the ED for acute vestibular symptoms, the device picked out all six vertebrobasilar strokes that were subsequently diagnosed with MRI, David Newman-Toker, MD, PhD, of the Johns Hopkins Hospital, and colleagues reported online in Stroke.
The bedside device feeds webcam video from goggles mounted with an accelerometer to computer software that looks for abnormal corrective eye movements when the head turns.
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By John in Vaccination on February 22nd, 2013 at 4:06 pm
Source Huffington Post
Flu vaccine is not as effective as public health messaging traditionally has claimed, says a new report that suggests overselling of flu shots is getting in the way of developing more effective and longer lasting vaccines.
The project that led to the report was called the CIDRAP Comprehensive Influenza Vaccine Initiative, and it involved mining more than 12,000 documents, articles and meeting transcripts as well as more than 5,700 peer-reviewed vaccine studies published from 1936 through April 2012. The full report can be found here.
In recent years studies by a variety of research groups have shown that the long-quoted claims that flu shots offered 70 to 90 per cent protection against influenza have been off the mark.
Somewhere in the order of 50 to 60 per cent, in healthy adults, is more accurate, the newer studies suggest. Efficacy rates are lower in the elderly or people in poor health. Vaccine effectiveness in those 65 and older against both influenza A and B was 27% (95% CI, -31% to 59%), and against H3N2 it was 9% (95% CI, -84% to 55%), but both numbers are statistically not significant.
The report suggests that the higher numbers came from old studies done on vaccines that were not formulated the way current shots are. It also suggests that the belief that universal vaccination for flu would be useful and desirable, rather than solid scientific evidence, was what drove decisions to recommend flu shots for all in the U.S. (The study did not look at decisions made in Canada or elsewhere.)
Even the vaccine used in the U.S. during the 2009 pandemic — where there was a perfect match between the virus in the vaccine and the strain infecting people — didn’t offer better protection. Studies cited in the report pegged the U.S. vaccine’s effectiveness at 56 per cent.
A key argument of the report is the fact that the current vaccine that offers moderate protection is actually getting in the way of developing long-lasting flu vaccines that offer more effective protection — vaccines, for example, that might require a shot every five or 10 years. Currently flu shots are reformulated every year to try to keep up with the evolution of flu viruses.
Even though a flu shot is a relatively inexpensive vaccine, manufacturers sell hundreds of millions of doses of them a year. In fact, the report notes that the global market for flu vaccine is estimated at US$2.8 billion — a decent chunk of the estimated US$20 billion annual market for all vaccines combined.
For an interesting article of influenza and the protectiveness of Vitamin D please read On the epidemiology of influenza
By John in Research on February 18th, 2013 at 9:29 pm
Source European Heart Journal
Humans evolved being exposed for about half of the day to the light of the sun. Nowadays, exposure to sunlight is actively discouraged for fear of skin cancer, and contemporary lifestyles are associated with long hours spent under artificial light indoors. Besides an increasing appreciation for the adverse effects of these life-style-related behavioural changes on our chronobiology, the balance between the beneficial and harmful effects of sunlight on human health is the subject of considerable debate, in both the scientific and popular press, and the latter is of major public health significance. While there is incontrovertible evidence that ultraviolet radiation (UVR) in the form of sunlight is a significant predisposing factor for non-melanoma and melanoma skin cancers in pale skinned people, a growing body of data suggest general health benefits brought about by sunlight.
The researchers propose that many of the beneficial effects of sunlight, particularly those related to cardiovascular health, are mediated by mechanisms that are independent of melatonin, vitamin D, and exposure to UVB alone. Specifically, they suggest that the skin is a significant store of nitric oxide (NO)-related species that can be mobilized by sunlight and delivered to the systemic circulation to exert coronary vasodilator and cardioprotective as well as antihypertensive effects. They further hypothesize that this dermal NO reservoir is a product of local production and dietary supply with nitrate-rich foods.
The full article (pdf) is available on the European Heart Journal website.
By Frank M. Painter, D.C. in Backpacks on February 13th, 2013 at 1:29 pm
Posturing for Wellness: Good Health Begins with Good Posture
The Chiro.Org Blog
SOURCE: The ACA
Doctors of chiropractic have long emphasized the importance of posture and other lifestyle factors in the body’s ability to function optimally. In a broad sense, good posture can be considered an ongoing battle against bad habits. “The body endures hundreds of insults each day,” says Scott W. Donkin, DC, DACBOH, “but we have the choice of controlling how they affect us. Once destructive habits are identified, people can change, prevent, and relieve both present and future physical problems. The quality of our later years can be enhanced and many physical problems prevented if we understand and deal early on with the underlying issues.” Dr. Donkin is the author of Sitting on the Job. [1]
Lifetime Regimen
What most people don’t know is that the following should be a lifetime regimen-for everyone-and not just when the back hurts. ACA Council on Chiropractic Orthopedics vice president Gary L. Carver, DC, DABCO, says that when they first get up in the morning, “People should use their hands and arms for support to get into a seated position. Next, they should swing their legs to the floor and stand up-using the hinge of the hips, rather than the back.”
But once the body is upright, is it up right? In other words, are the muscles, joints, and skeleton in a balanced posture? Too often, the answer is “no.” “As long as our body is performing, we take it for granted. We don’t concentrate on what we need to do to maintain good posture habits,” says Leo Bronston, DC, DABCO, DACAN, CCSP, and secretary of the ACA Council on Chiropractic Orthopedics. “Generally, we tend to hunch forward when we should be rolling our shoulders back and opening up the chest wall. That is something we need to practice-activating the proper postural muscles. We see many patients who simply don’t know how to achieve a more balanced trunk and neutral spine. Just as we learned to eat with a fork and that became automatic, we can train our muscles for good posture and balance, whether we’re standing, rising from a seated position, or getting out of bed.”
There are many more articles like this in our:
Backpacks and Children Page
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By Frank M. Painter, D.C. in Chiropractic Care on January 24th, 2013 at 8:05 pm
There Will Never Be Enough Research To Satisfy Our Critics
The Chiro.Org Blog
For some, there will never be enough research to support the use of chiropractic. These people will forever hide behind the claim that they wish to protect patients from quackish practices.
For those who may have forgotten, or for those who never knew, organized medicine spent decades and tens of millions of dollars trying to discredit and destroy chiropractic. Today, the vestiges of that same oppression is still found on fringe web sites that ignore the body of peer-reviewed research supporting chiropractic care.
The Wilk anti-trust case against the AMA and 20 other named medical groups revealed that the AMA Plan was to:
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Undermine Chiropractic schools
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Undercut insurance programs for Chiropractic patients
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Conceal evidence of the effectiveness of Chiropractic care
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Subvert government inquires into the effectiveness of Chiropractic, and
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Promote other activities that would control the monopoly that the AMA had on health care
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They even threatened their own ranks: any MD who taught in our schools, or performed research with chiropractors, or accepted a referral from, or made a referral to a chiropractor, would lose their hospital privileges, leaving them unable to treat patients.
while, all along, they knew that:
There also was some evidence before the Committee that chiropractic was effective – more effective than the medical profession in treating certain kinds of problems such as workmen’s back injuries. The Committee on Quackery was also aware that some medical physicians believed chiropractic to be effective and that chiropractors were better trained to deal with musculoskeletal problems than most medical physicians.
(Opinion pp. 7)
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Medical Students Take the Complementary, Alternative and Integrative Medicine Attitudes Questionnaire (CAIMAQ)
The Chiro.Org Blog
Medical Student Attitudes toward Complementary, Alternative and Integrative Medicine
Evidence-based Complementary and Alternative Medicine (eCAM) 2011 (Apr 14)
While the use of complementary, alternative and integrative medicine (CAIM) is substantial, it continues to exist at the periphery of allopathic medicine. Understanding the attitudes of medical students toward CAIM will be useful in understanding future integration of CAIM and allopathic medicine. This study was conducted to develop and evaluate an instrument and assess medical students’ attitudes toward CAIM. The Complementary, Alternative and Integrative Medicine Attitudes Questionnaire (CAIMAQ) was developed by a panel of experts in CAIM, allopathic medicine, medical education and survey development. A total of 1770 CAIMAQ surveys (51% of US medical schools participated) were obtained in a national sample of medical students in 2007.
Factor analysis of the CAIMAQ revealed five distinct attitudinal domains:
- desirability of CAIM therapies,
- progressive patient/physician health care roles,
- mind-body-spirit connection,
- principles of allostasis and
- a holistic understanding of disease.
The students held the most positive attitude for the “mind-body-spirit connection” and the least positive for the “desirability of CAIM therapies”. This study provided initial support for the reliability of the CAIMAQ. The survey results indicated that in general students responded more positively to the principles of CAIM than to CAIM treatment. A higher quality of CAIM-related medical education and expanded research into CAIM therapies would facilitate appropriate integration of CAIM into medical curricula. The most significant limitation of this study is a low response rate, and further work is required to assess more representative populations in order to determine whether the relationships found in this study are generalizable.
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By Frank M. Painter, D.C. in Chiropractic Care on January 19th, 2013 at 8:40 pm
The Association of Complementary and Alternative Medicine Use and Health Care Expenditures for Back and Neck Problems
The Chiro.Org Blog
Med Care. 2012 (Dec); 50 (12): 1029–1036
Brook I. Martin, PhD MPH, Mary M. Gerkovich, PhD, Richard A. Deyo, MD, MPH, Karen J. Sherman, PhD, MPH, Daniel C. Cherkin, PhD, Bonnie K. Lind, PhD, Christine M. Goertz, DC, PhD, and William E. Lafferty, MD
Department of Orthopaedics, The Geisel School of Medicine at Dartmouth & Dartmouth-Hitchcock Medical Center, Lebanon, NH 03756, USA. brook.i.martin@dartmouth.edu
BACKGROUND: Health care costs associated with use of complementary and alternative medicine (CAM) by patients with spine problems have not been studied in a national sample.
OBJECTIVES: To estimate the total and spine-specific medical expenditures among CAM and non-CAM users with spine problems.
RESEARCH DESIGN: Analysis of the 2002-2008 Medical Expenditure Panel Survey.
SUBJECTS: Adults (above 17 y) with self-reported neck and back problems who did or did not use CAM services.
MEASURES: Survey-weighted generalized linear regression and propensity matching to examine expenditure differences between CAM users and non-CAM users while controlling for patient, socioeconomic, and health characteristics.
RESULTS: A total of 12,036 respondents with spine problems were included, including 4306 (35.8%) CAM users (40.8% in weighted sample). CAM users had significantly better self-reported health, education, and comorbidity compared with non-CAM users. Adjusted annual medical costs among CAM users was $424 lower (95% confidence interval: $240, $609; P<0.001) for spine-related costs, and $796 lower (95% confidence interval: $121, $1470; P = 0.021) for total health care cost than among non-CAM users. Average expenditure for CAM users, based on propensity matching, was $526 lower for spine-specific costs (P<0.001) and $298 lower for total health costs (P = 0.403). Expenditure differences were primarily due to lower inpatient expenditures among CAM users.
CONCLUSIONS: CAM users did not add to the overall medical spending in a nationally representative sample with neck and back problems. As the causal associations remain unclear in these cross-sectional data, future research exploring these cost differences might benefit from research designs that minimize confounding.
There are many more articles like this @ our:
Cost-Effectiveness of Chiropractic Page and our
Chronic Neck Pain and Chiropractic Page
From the Dynamic Chiropractic Article:
Chiropractic Costs: A National Perspective
First national study of CAM / chiropractic expenditures for spine conditions finds neither adds to overall medical spending.
Continue reading …
By John in Nutrition on January 13th, 2013 at 1:57 pm
Source Cochrane Summaries
Antioxidant supplements for prevention of mortality in healthy participants and patients with various diseases
Bjelakovic G, Nikolova D, Gluud LL, Simonetti RG, Gluud C
Previous research on animal and physiological models suggests that antioxidant supplements have beneficial effects that may prolong life. Some observational studies also suggest that antioxidant supplements may prolong life, whereas other observational studies demonstrate neutral or harmful effects. Our Cochrane review from 2008 demonstrated that antioxidant supplements seem to increase mortality. This review is now updated.
The present systematic review included 78 randomised clinical trials. In total, 296,707 participants were randomised to antioxidant supplements (beta-carotene, vitamin A, vitamin C, vitamin E, and selenium) versus placebo or no intervention. Twenty-six trials included 215,900 healthy participants. Fifty-two trials included 80,807 participants with various diseases in a stable phase (including gastrointestinal, cardiovascular, neurological, ocular, dermatological, rheumatoid, renal, endocrinological, or unspecified diseases). A total of 21,484 of 183,749 participants (11.7%) randomised to antioxidant supplements and 11,479 of 112,958 participants (10.2%) randomised to placebo or no intervention died. The trials appeared to have enough statistical similarity that they could be combined. When all of the trials were combined, antioxidants may or may not have increased mortality depending on which statistical combination method was employed; the analysis that is typically used when similarity is present demonstrated that antioxidant use did slightly increase mortality (that is, the patients consuming the antioxidants were 1.03 times as likely to die as were the controls). When analyses were done to identify factors that were associated with this finding, the two factors identified were better methodology to prevent bias from being a factor in the trial (trials with ‘low risk of bias’) and the use of vitamin A. In fact, when the trials with low risks of bias were considered separately, the increased mortality was even more pronounced (1.04 times as likely to die as were the controls). The potential damage from vitamin A disappeared when only the low risks of bias trials were considered. The increased risk of mortality was associated with beta-carotene and possibly vitamin E and vitamin A, but was not associated with the use of vitamin C or selenium. The current evidence does not support the use of antioxidant supplements in the general population or in patients with various diseases.
Authors’ conclusions:
We found no evidence to support antioxidant supplements for primary or secondary prevention. Beta-carotene and vitamin E seem to increase mortality, and so may higher doses of vitamin A. Antioxidant supplements need to be considered as medicinal products and should undergo sufficient evaluation before marketing.
Abstract included here.
By John in General Health on January 11th, 2013 at 12:28 pm
ILInet provides an interactive activity level indicator of Flu-Like Illness for the United States.
By Frank M. Painter, D.C. in Chiropractic Care on January 8th, 2013 at 8:58 pm
Comparison of Outcomes in Neck Pain Patients With and Without Dizziness
The Chiro.Org Blog
Chiropractic & Manual Therapies 2013 (Jan 7); 21: 3
B Kim Humphreys and Cynthia Peterson
University of Zürich and Orthopaedic University Hospital Balgrist, Forchstrasse 340, 8008 Zürich, Switzerland
Background The symptom ‘dizziness’ is common in patients with chronic whiplash related disorders. However, little is known about dizziness in neck pain patients who have not suffered whiplash. Therefore, the purposes of this study are to compare baseline factors and clinical outcomes of neck pain patients with and without dizziness undergoing chiropractic treatment and to compare outcomes based on gender.
Methods This prospective cohort study compares adult neck pain patients with dizziness (n = 177) to neck pain patients without dizziness (n = 228) who presented for chiropractic treatment, (no chiropractic or manual therapy in the previous 3 months). Patients completed the numerical pain rating scale (NRS) and Bournemouth questionnaire (BQN) at baseline. At 1, 3 and 6 months after start of treatment the NRS and BQN were completed along with the Patient Global Impression of Change (PGIC) scale. Demographic information was also collected. Improvement at each follow-up data collection point was categorized using the PGIC as ‘improved’ or ‘not improved’. Differences between the two groups for NRS and BQN subscale and total scores were calculated using the unpaired Student’s t-test. Gender differences between the patients with dizziness were also calculated using the unpaired t-test.
Results Females accounted for 75% of patients with dizziness. The majority of patients with and without dizziness reported clinically relevant improvement at 1, 3 and 6 months with 80% of patients with dizziness and 78% of patients without dizziness being improved at 6 months. Patients with dizziness reported significantly higher baseline NRS and BQN scores, but at 6 months there were no significant differences between patients with and without dizziness for any of the outcome measures. Females with dizziness reported higher levels of depression compared to males at 1, 3 and 6 months (p = 0.007, 0.005, 0.022).
Conclusions Neck pain patients with dizziness reported significantly higher pain and disability scores at baseline compared to patients without dizziness. A high proportion of patients in both groups reported clinically relevant improvement on the PGIC scale. At 6 months after start of chiropractic treatment there were no differences in any outcome measures between the two groups.
There are many more articles like this @ our:
Vertigo and Chiropractic Page and our:
Whiplash and Chiropractic Page
Introduction
The complaint of neck pain is second only to low back pain in terms of common musculoskeletal problems in society today with a lifetime prevalence of 26-71% and a yearly prevalence of 30-50%. [1, 2] Most concerning is that many patients, particularly those in the working population or who have suffered whiplash trauma, will become chronic and continue to report pain and disability for greater than 6-months. [3-6] In terms of symptoms, dizziness and unsteadiness are the most frequent complaints following pain for chronic whiplash sufferers with up to 70% of patients reporting these problems. [7, 8] Apart from whiplash trauma, little is known about dizziness in the chronic neck pain population and much remains unknown about the etiology of chronic neck pain in general. [9]
Gender differences in reporting pain intensity is currently a topic of debate. Recent research suggests that females report more pain because they feel pain more intensely than males over a variety of musculoskeletal complaints. [10, 11] Furthermore, LeResche suggests that these differences may not be taken into account by health care providers, leading to less than optimal pain management for females. [12] However gender differences in neck pain patients with or without dizziness have not been described with respect to clinical outcomes over time.
Therefore, the purposes of this study on neck pain patients receiving chiropractic care are twofold:
- to compare baseline variables and the clinical outcomes of neck pain patients with and without dizziness in terms of clinically relevant ‘improvement’, pain, disability, and psychosocial variables over a 6-month period;
- to evaluate gender differences for neck pain patients with dizziness in terms of clinically relevant ‘improvement’, pain, disability, and psychosocial variables in a longitudinal study.
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By Frank M. Painter, D.C. in Chiropractic Care on January 6th, 2013 at 1:54 pm
Clinical Biomechanics: Mechanical Concepts and Terms
The Chiro.Org Blog
We would all like to thank Dr. Richard C. Schafer, DC, PhD, FICC for his lifetime commitment to the profession. In the future we will continue to add materials from RC’s copyrighted books for your use.
This is Chapter 2 from RC’s best-selling book:
“Clinical Biomechanics:
Musculoskeletal Actions and Reactions”
Second Edition ~ Wiliams & Wilkins
These materials are provided as a service to our profession. There is no charge for individuals to copy and file these materials. However, they cannot be sold or used in any group or commercial venture without written permission from ACAPress.
Chapter 2: Mechanical Concepts and Terms
All motor activities such as walking, running, jumping, squatting, pushing, pulling, lifting, and throwing are examples of dynamic musculoskeletal mechanics. To better appreciate the sometimes simple and often complex factors involved, this chapter reviews the basic concepts and terms involved in maintaining static equilibrium. Static equilibrium is the starting point for all dynamic activities.
Energy and Mass
Biomechanics is constantly concerned with a quantity of matter (whatever occupies space, a mass) to which a force has been applied. Such a mass is often the body as a whole, a part of the body such as a limb or segment, or an object such as a load to be lifted or an exercise weight. By the same token, the word “body” refers to any mass; ie, the human body, a body part, or any object.
Energy
Energy is the power to work or to act. Body energy is that force which enables it to overcome resistance to motion, to produce a physical effect, and to accomplish work. The body’s kinetic energy, the energy level of the body due to its motion, is reflected solely in its velocity, and its potential energy is reflected solely in its position. Mathematically, kinetic energy is half the mass times the square of the velocity: m/2 X V524. In a closed system where there are no external forces being applied, the law of conservation of mechanical energy states that the sum of kinetic energy and potential energy is equal to a constant for that system.
Potential energy (PE), measured in newton meters or joules, is also stored in the body as a result of tissue displacement or deformation, like a wound spring or a stretched bowstring or tendon. It is expressed mathematically in the equation PE = mass X gravitational acceleration X height of the mass relative to a chosen reference level (eg, the earth’s surface). Thus, a 100-lb upper body balanced on L5 of a 6-ft person has a potential energy of about 300 ft-lb relative the ground.
The Center of Mass
The exact center of an object’s mass is sometimes referred to as the object’s center of gravity. When an object’s mass is evenly distributed throughout, the center of mass is located at the object’s geometric center. In the human body, however, this is infrequently true, and the center of mass is located towards the heavier, often larger, aspect. When considering the body as a whole, the center of mass in the anatomic position, for instance, is constantly shifted during activity when weight is shifted from one area to another during locomotion or when weight is added to or subtracted from the body.
The term weight is not synonymous with the word mass. Body weight refers to the pull of gravity on body mass. Mass is the quotient obtained by dividing the weight of a body by the acceleration due to gravity (32 ft/sec524). Each of these terms has a different unit of measurement. Weight is measured in pounds or kilograms, while mass is measured by a body’s weight divided by the gravitational constant. The potential energy of gravity can be simply visualized as an invisible spring attached between the body’s center of mass and the center of the earth. The pull is always straight downward so that more work is required to move the body upward than horizontally (Fig. 2.1).
Newton’s Laws of Mechanics
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By Frank M. Painter, D.C. in Chiropractic Care on January 3rd, 2013 at 3:22 pm
Clinical Biomechanics: General Spinal Biomechanics
The Chiro.Org Blog
We would all like to thank Dr. Richard C. Schafer, DC, PhD, FICC for his lifetime commitment to the profession. In the future we will continue to add materials from RC’s copyrighted books for your use.
This is Chapter 6 from RC’s best-selling book:
“Clinical Biomechanics:
Musculoskeletal Actions and Reactions”
Second Edition ~ Wiliams & Wilkins
These materials are provided as a service to our profession. There is no charge for individuals to copy and file these materials. However, they cannot be sold or used in any group or commercial venture without written permission from ACAPress.
Chapter 6: General Spinal Biomechanics
This chapter discusses the vertebral column as a whole and serves as a foundation for the following three chapters that consider the regional aspects of the spine and pelvis. Emphasis here is on gross structure, function, spinal kinematics, and other general biomechanical implications.
Background
The vertebral column is a mechanical marvel in that it must afford both rigidity and flexibility.
The Spine as a Whole
The segmental design of the vetebral column allows adequate motion among the head, trunk, and pelvis; affords protection of the spinal cord; transfers weight forces and bending moments of the upper body to the pelvis; offers a shockabsorbing apparatus; and serves as a pivot for the head. Without stabilization from the spine, the head and upper limbs could not move evenly, smoothly, or support the loads imposed upon them (Fig. 6.1).
Essentially because of its various adult curvatures, the bony spine is anatomically divided into the seven cervical vertebrae, the twelve thoracic vertebrae, the five lumbar vertebrae, and the ossified five sacral and four coccygeal segments. From C1 to S1, the articulating parts of these vertebrae are the vertebral bodies, which are separated by intervertebral discs (IVD’s), and the posterior facet joints. The IVD’s tend to be static weight-bearing joints, while the facets function as dynamic sliding and gliding joints.
WEIGHT DISTRIBUTION
The flexible vertebral column is balanced upon its base, the sacrum. In the erect position, weight is transferred across the sacroiliac joints to the ilia, then to the hips, and then to the lower extremities. In the sitting position, weight is transferred from the sacroiliac joints to the ilia, and then to the ischial tuberosities.
SPINAL LENGTH
About 75% of spinal length is contributed by the vertebral bodies, while 25% of its length is composed of disc material. The contribution by the discs, however, is not spread evenly throughout the spine. About 20% of cervical and thoracic length is from disc height, while approximately 30% of lumbar length is from disc height. In all regions, the contribution by the discs diminishes with age.
Development of the Spine
In brief, development occurs in three stages: mesenchymal, chondrification, and ossification.
MESENCHYMAL AND CHONDRIFICATION ORIGINS
Just prior to the 4th week of embryonic development, a vertebral segment begins to develop as paired condensations of mesenchyme (somites) around the longitudinal notochord and dorsal neural tube. One or usually two chondrification centers appear (6 weeks) in the centrum and begin to form a cartilaginous model surrounded by anterior and posterior longitudinal ligaments which are complete by 7-8 weeks. Chondrification centers also form in the neural arches and costal processes. A thick ring of nonchrondrous cells establishes the model IVD around the longitudinal string of beaded notochordal segments (Fig. 6.2).
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By John in Health Care on December 30th, 2012 at 1:57 pm
Source NY Times
The doctor was dumbfounded: a drug that used to cost $50 was now selling for $28,000 for a 5-milliliter vial.
The physician, Dr. Ladislas Lazaro IV, remembered occasionally prescribing this anti-inflammatory, named H.P. Acthar Gel, for gout back in the early 1990s. Then the drug seemed to fade from view. Dr. Lazaro had all but forgotten about it, until a sales representative from a company called Questcor Pharmaceuticals appeared at his office and suggested that he try it for various rheumatologic conditions.
“I’ve never seen anything like this,” Dr. Lazaro, a rheumatologist in Lafayette, La., says of the price increase.
How the price of this drug rose so far, so fast is a story for these troubled times in American health care — a tale of aggressive marketing, questionable medicine and, not least, out-of-control costs. At the center of it is Questcor, which turned the once-obscure Acthar into a hugely profitable wonder drug and itself into one of Wall Street’s highest fliers.
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By John in Nutrition on December 30th, 2012 at 1:35 pm
Source Science Daily
Animals with persistently lower insulin stay trim even as they indulge themselves on a high-fat, all-you-can-eat buffet.
When we eat too much, obesity may develop as a result of chronically high insulin levels, not the other way around. That’s according to new evidence in mice reported in the December 4th Cell Metabolism, a Cell Press publication, which challenges the widespread view that rising insulin is a secondary consequence of obesity and insulin resistance.
The new study helps to solve this chicken-or-the-egg dilemma by showing that animals with persistently lower insulin stay trim even as they indulge themselves on a high-fat, all-you-can-eat buffet. The findings come as some of the first direct evidence in mammals that circulating insulin itself drives obesity, the researchers say.
The results are also consistent with clinical studies showing that long-term insulin use by people with diabetes tends to come with weight gain, says James Johnson of the University of British Columbia.
“We are very inclined to think of insulin as either good or bad, but it’s neither,” Johnson said. “This doesn’t mean anyone should stop taking insulin; there are nuances and ranges at which insulin levels are optimal.”
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Too Sweet to Be Good?
The Potential Health Hazards of Artificial Sweeteners
The Chiro.Org Blog
SOURCE: Dynamic Chiropractic
By Claudia Anrig, DC
With worldwide obesity rates doubling in the past three decades, is it any surprise that artificial sweeteners have been gaining popularity? Beginning with the creation of saccharin, “sugar substitutes” have become the supposed answer to a dieter’s prayer – and part of the daily diet of many of our children.
Let’s review the various sugar substitutes on the market today to appreciate what they are and why they may not be the best option in terms of your patients’ – and your – health.
Aspartame: NutraSweet or Equal
This sugar substitute was discovered in 1965 by accident while chemist James Schlatter was testing an anti-ulcer drug. [1] Aspartame gained FDA approval in 1981 and was approved in 1983 for use in carbonated beverages, where it is most commonly found now as the primary sweetener for most diet sodas. [2]
Aspartame accounts for over 75 percent of the adverse reactions to food additives reported to the FDA and has been linked to serious medical reactions. [3, 4] Researchers and physicians studying these reactions have concluded that the following chronic illnesses can worsen when ingesting aspartame: brain tumors, multiple sclerosis, epilepsy, chronic fatigue syndrome, Parkinson’s disease, Alzheimer’s, mental retardation, lymphoma, birth defects, fibromyalgia, and diabetes. [4]
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By John in General Health on December 23rd, 2012 at 12:39 pm
Source Health.com
Going to work when you have a chronic pain-causing condition can be difficult or even downright impossible, depending on the job. Studies have shown that people with rheumatoid arthritis are more likely to change jobs, reduce their hours, be fired, and retire early than people without the condition.
If you have chronic pain and are in the workforce, you should try to find an occupation that isn’t too physically demanding and allows you to work at your own pace.
Best: Administrative assistant
Sitting at a desk all day is not ideal for someone with painful joints. Working as an administrative assistant, however, could have its benefits. You may not have to perform a lot of repetitive movements, unless it’s typing. Also, this position probably comes with some flexibility—it’s important to be able to move around when you need to and take breaks as necessary.
A 2012 study out of the University of Georgia found that administrative assistants and office staff in general had the fewest reported injuries of the occupations studied.
Worst: Landscaping
If you have a green thumb, it’s wise to limit your talents to your own yard. Landscaping tasks like pruning that involve frequent use of hand tools can cause pain in the small joints.
Landscaping also requires a lot of bending, stooping over, and kneeling, which can cause pain in joints, particularly the knees. Finally, it also involves lifting and hauling, sometimes in wheelbarrows, which can cause back pain.
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By Frank M. Painter, D.C. in Chiropractic Care on December 19th, 2012 at 1:00 pm
Choice: It Really Does Matter!
The Chiro.Org Blog
SOURCE: Spine (Phila Pa 1976). 2012 Dec 12. [Epub ahead of print]
This review, by scientists at the Department of Orthopaedics at the Geisel School of Medicine, clearly suggests that the first doctor you choose to see will have a profound effect on whether you end up having spinal surgery.
Just look at these stats:
42.7% of workers who first saw a surgeon ended in surgery, as opposed to only
1.5% of those who (first) saw a chiropractor.
The authors conclude: “There was a very strong association between surgery and first provider seen for the injury, even after adjustment for other important variables.”
The Abstract:
Early Predictors of Lumbar Spine Surgery after Occupational Back Injury: Results from a Prospective Study of Workers in Washington State
Keeney, Benjamin J. PhD; Fulton-Kehoe, Deborah PhD, MPH; Turner, Judith A. PhD; Wickizer, Thomas M. PhD; Chan, Kwun Chuen Gary PhD; Franklin, Gary M. MD, MPH
Study Design Prospective population-based cohort study
Objective To identify early predictors of lumbar spine surgery within 3 years after occupational back injury
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