HANDEDNESS INFLUENCES SHOULDER ROM

When assessing shoulder range of motion (ROM), it’s important to take into consideration if the patient is right-handed or left-handed, according to a new report in the Journal of Manipulative and Physiological Therapeutics.

Investigators measured shoulder ROM in 50 right-handed female college students who were not athletes and not practicing repetitive activities involving the upper limbs.

Findings showed that “There is statistically significance difference between the 2 sides when the rotational range of motion is compared; the dominant shoulder presented increased external rotation … and decreased internal rotation … compared to the opposite shoulder.

JMPT - February 2009;23:149-53.

WEATHER, BUT NOT POLLUTION, PREDICT HEADACHE

A new study shows that higher temperatures and lower barometric air pressure may lead to a higher, short-term risk of headaches, but air pollution may not have a significant effect on headache. The research is published in today’s issue of Neurology.

For the study, researchers looked at 7,054 people who were diagnosed with headache in a Boston emergency department over seven years. Scientists then compared temperature levels, barometric pressure, humidity and other air pollutant or weather factors during one to three days leading up to the hospital visit.

The study found that higher temperatures increased the risk of headache. The risk went up by 7.5 percent for every five degree Celsius increase in temperature. Lower barometric air pressure within the two or three days leading up to a person’s hospital visit also increased the risk of non-migraine headaches. Air pollution levels had no affect on the risk of headache in the study.

“Air temperature and pressure have been widely cited as a possible trigger for headaches, particularly migraines, but the potential connection hasn’t been well-documented,” says study author Kenneth Mukamal, MD.

“There is growing interest in exploring whether there is any link between air pollution and headaches. While our study did not find an association, other studies have shown that air pollution has possible links to other health problems like heart disease and stroke,” adds Dr. Mukamal.

Neurology March 2009;72:922-927.

www.neurology.org

STRESS AND WOUND HEALING

Stress is a factor in the healing of wounds, according to findings presented last week at the American Psychosomatic Society’s 67^th annual meeting at the Chicago.

“We believe what may improve healing in one tissue type may possibly worsen healing in a different type of tissue,” notes study author Christopher Engeland.

In the new study, 65 UIC dental students received a small circular wound and a small longitudinal wound on the hard palate of the mouth at two different times: during the high-stress week of examinations, and during their relatively relaxed summer vacation.

The researchers found that wound closure was delayed during high stress. The stress of examinations was associated with a state of “hyper-inflammation” in healthy tissue and higher inflammatory responses in wounded tissue, comments Engeland.

Previous studies showed that stress is associated with reduced inflammation in skin wounds, an effect that appears to be reversed in the mucosal tissue of the palate. The paradox suggests that attempts to improve healing by altering inflammation should be made in a tissue-specific manner, Engeland suggests.

American Psychosomatic Society - March 8, 2009.

www.psychosomatic.org

February 26, 2009

ADJUSTMENTS HAVE IMMEDIATE EFFECT ON NECK PAIN

A new study adds additional evidence that chiropractic adjustments have an immediate positive effect on mechanical neck pain.

The investigation included 37 women with mechanical neck pain. “Participants were randomly assigned into 1 of 2 groups as follows: an experimental group that received a spinal manipulation of the atlanto-occipital joint and a control group that received a manual contact placebo intervention. Outcomes collected were assessed pretreatment and 5 minutes posttreatment by an assessor blinded to the treatment allocation and included active mouth opening and pressure pain thresholds (PPTs) over both sides of the sphenoid bone.”

Findings showed significant improvement among the women who received chiropractic adjustments, compared with the control group for both active mouth opening and PPTs.

JMPT – February 2009;32:101-6.

RESEARCH DOES NOT SUPPORT INSURANCE LIMITING CHIROPRACTIC CARE TO 6 TO 12 VISITS

The authors of a new study explain that “many US insurance companies, managed care organizations, chiropractic researchers, and chiropractic academics claim that, if low back pain resolves with Spinal Manipulative Therapy (SMT), it does so in 6 to 12 visits.”

However, does the research support this claim? To investigate, researchers pooled data on 65 randomized control trials (RCTs)

Findings reveal that “data from RCTs did not support claims of restricting Chiropractic care to 6-12 visits for low back pain. In fact, assuming a constant linear dosage response curve, in studies with chiropractors as the treating doctors it was estimated that 28 visits were needed to document, resolve, and stabilize this condition.”

JVRS – February 14, 2009:1-16.

www.jvsr.com

CLBP AFFECTS SPEECH PRODUCTION

A new study finds that chronic low-back pain (CLBP) may affect speech production.

The investigators explain that “chronic back pain and its sequelae can influence cognitive, affective, and neuromuscular functioning. Speech production — a complex sensorimotor activity — integrates shared cognitive, neuromuscular, and musculoskeletal resources, and therefore could be altered by chronic pain.”

According to the study, “50 participants, fully or partially disabled by chronic back pain, completed standardized protocols related to pain, depression, disability, medications, as well as [speech alternating motion rates (speech AMRs)].”

“Higher levels of back pain were significantly associated with slower speech AMRs. Stepwise multiple regression assessed the unique and cumulative effects of specific variables such as degree of back pain, depression, level of disability, and medication use on speech motor performance. Speech motor slowness was uniquely related to back pain and the use of nonprescription pain medications, but not to level of depression or disability.”

“Chronic back pain independently influences speech motor rates,” conclude the study’s authors.

Pain Medicine – January 2009;10:164-71.

www.painmed.org

MENTAL FATIGUE INFLUENCES EXERCISE PERFORMANCE

Mental fatigue may negatively influence exercise performance, according to a report in the Journal of Applied Physiology.

As part of the study 16 participants rode a stationary bicycle to exhaustion under two conditions: once when they were mentally fatigued and once when they were mentally rested. The mental fatigue sessions began with a challenging 90-minute mental task that required close attention, memory, quick reaction and an ability to inhibit a response. The trials took place in the laboratory on different days. The participants got the same amount of sleep, drank the same amount and had the same meal before each of the sessions.

Throughout both exercise sessions, the researchers tracked a variety of physiological measures, such as oxygen consumption, heart rate, cardiac output, blood pressure, ventilation, and blood lactate levels.

Results revealed that the volunteers stopped exercising an average of 15% earlier when they were mentally fatigued. However, the study also found that mental fatigue did not cause the heart or muscles to perform any differently. So the difference in performance was due to “perceived effort.”

Journal of Applied Physiology – March 2009;106:857-64.

jap.physiology.org

DRINKING TEA PREVENTS STROKE

Drinking at least three cups of green or black tea a day can significantly reduce the risk of stroke, according to a UCLA review of nine studies.

“By drinking three cups of tea a day, the risk of a stroke was reduced by 21%. It didn’t matter if it was green or black tea,” explains lead study author Lenore Arab, PhD.

And extrapolating from the data, the effect appears to be linear, Dr. Arab adds. For instance, if one drinks three cups a day, the risk falls by 21 percent; follow that with another three cups and the risk drops another 21 percent.

This effect was found in tea made from the plant Camellia sinensis, not from herbal teas.

Stroke – February 19, 2009;Epub.

stroke.ahajournals.org

February 11, 2009

STUDY TO INVESTIGATE NET FOR ADHD

A new scientific clinical trial is investigating the effectiveness of Neuro Emotional Technique (NET) for Attention Deficit Hyperactivity Disorder (ADHD).

The placebo controlled, double blind randomized clinical trial includes children ages 5 to 10 years with medically diagnosed ADHD. Participants were divided into two groups.

According to the study authors, “the control group continued on their existing medical regimen and the intervention and placebo groups had the addition of the NET and sham NET protocols added to their regimen respectively. These two groups attended a clinical facility twice a week for the first month and then once a month for six months. The Conners’ Rating Scales (CRS) were used at the start of the study to establish baseline data and then in one month and in seven months time, at the conclusion of the study. The primary outcome measures chosen were the Conners’ ADHD Index and Conners’ Global Index. The secondary outcome measures chosen were the DSM-IV: Inattentive, the DSM-IV:Hyperactive-Impulsive, and the DSM-IV:Total subscales from the Conners’ Rating Scales, monitoring changes in inattention, hyperactivity and impulsivity.”

The study’s authors predict that “the present study should provide information as to whether the addition of NET to an existing medical regimen can improve outcomes for children with ADHD.”

Trials – January 27, 2009;10:6.

www.trialsjournal.com

EXERCISE BETTER THAN WALKING FOR LBP

An exercise program is better than walking for nonspecific, recurrent low back pain (LBP), say researchers.

As part of the experiment, 71 patients “with recurrent nonspecific LBP seeking care at an outpatient physiotherapy clinic were randomized into 2 treatment groups; graded exercise intervention or daily walks. The primary outcome was perceived disability and pain at 12-month follow-up. Secondary outcomes included physical health, fear-avoidance, and self-efficacy beliefs.”

“At 12 months, between-group comparison showed a reduction in perceived disability in favor of the exercise group, whereas such an effect for pain emerged only immediately postintervention. Ratings of physical health and self-efficacy beliefs also improved in the exercise group over the long term, though no changes were observed for fear-avoidance beliefs.”

The study’s authors concluded that “a graded exercise intervention, emphasizing stabilizing exercises, for patients with recurrent LBP still at work seems more effective in improving disability and health parameters than daily walks do. However, no such positive results emerged for improvement regarding pain over a longer term, or for fear-avoidance beliefs.”

Spine – February 1, 2009;34:221-28.

www.mayoclinicproceedings.com

ARTIFICIAL NIGHTTIME LIGHT LINKED WITH PROSTATE CANCER

Countries in which nighttime artificial lighting is used more intensively tend to have a higher risk of prostate cancer in men, concludes a new study.

Data was collected from a database of the International Agency for Research on Cancer, on the incidence of prostate cancer in 164 countries. Data on the levels of lighting at night were gathered from satellite images.

According to the researchers, there are a number of theories that could explain the increased incidence of prostate cancer due to exposure to lighting at night, such as suppression of melatonin production, suppression of the immune system, and an effect on the body’s biological clock because of confusion between night and day. Whatever the cause, there is a definite link between the two. “This does not mean that we have to go back to the Middle Ages and turn the lights out on the country. What it means is that this link should be taken into account in planning the country's energy policies,” the researchers pointed out.

Chronobiology International – February 2009;Epub.

www.informaworld.com

TEEN TV EXPOSURE TIED WITH DEPRESSION

Exposure to more television and other electronic media during the teenage years appears to be associated with developing depression symptoms in young adulthood, especially among men, according to a report in the February issue of Archives of General Psychiatry.

Dr. Brian A. Primack and colleagues determine exposure to electronic media among 4,142 adolescents who were not depressed at the beginning of the study in 1995.

Seven years later (at an average age of 21.8), participants were screened again. In total, 7.4% had developed symptoms consistent with depression. “In the fully adjusted models, participants had significantly greater odds of developing depression by follow-up for each hour of daily television viewed,” the authors write. “In addition, those reporting higher total media exposure had significantly greater odds of developing depression for each additional hour of daily use.” Given the same amount of media exposure, young women were less likely to develop symptoms of depression than young men.

Archives of General Psychiatry – February 2009;66:181-88.

archpsyc.ama-assn.org

ER IN YOUNGER MEN DOUBLES RISK OF HEART DISEASE

Men who experience erectile dysfunction between the ages of 40 and 49 are twice as likely to develop heart disease as men without dysfunction, say scientists who followed 1,402 men for 10 years.

Researchers also found that men with erectile dysfunction have an 80 percent higher risk of heart disease.

Mayo Clinic Proceedings – February 2009.

January 28, 2009

RESEARCH ON LUMBAR MUSCLE SPINDLES CONDUCTED AT PALMER

Cutting-edge research, which was conducted by researchers at Palmer College of Chiropractic in Davenport, IA, is slated for publication in an upcoming issue of the Journal of Neurophysiology.

“Muscle spindles contribute to sensorimotor control by supplying feedback regarding muscle length and consequently information about joint position. While substantial study has been devoted to determining the position sensitivity of spindles in limb muscles there appears to be no data on their sensitivity in the low back,” explain the study’s authors.

“We determined the relationship between lumbar paraspinal muscle spindle discharge and paraspinal muscle lengthening estimated from controlled cranialward movement of the L6 vertebra in anesthetized cats.”

The investigators found “apparently high” muscle spindle position sensitivity in the lumbar spine.

Journal of Neurophysiology – January 21, 2009;Epub.

http://jn.physiology.org/

STUDY LOOKS AT EFFECT OF TRAUMA ON CERVICAL DICS

An analysis in the journal Spine sheds new light on how trauma impacts the cervical spine.

As part of the experiment, “the anterior portion of intervertebral discs and endplates of 30 patients with traumatic injuries to the cervical spine were studied histologically … and ultrastructurally.” Similar studies were conducted on porcine cervical spine specimens.

Results revealed that “electron and light microscopy showed up to 75% of human disc cells die within the first 24 hours of trauma, mainly by necrosis … . This study reports on 2 morphologies, chondroptosis and balloon cells, previously not described in the disc. Chondroptosis had been significantly higher and ballooned cells were exclusively seen in discs from fractures with compression, where apoptosis was also most common. Porcine samples revealed comparable rates of apoptosis and chondroptosis as fractures with less compression. Glycogen was commonly found in disc cells after trauma.”

The investigators conclude: “Traumatic injuries of the human cervical spine lead to rapid changes in disc cell morphology and cell death, particularly via necrosis. The type of fracture and load seems to influence cell death.”

Spine – January 15, 200934:131-40

SPONDYLOLYSIS AND SPONDYLOLISTHESIS: ASSOCIATED WITH LBP?

As part of the study, researchers looked at lumbar CT images of 180 individuals, between the ages of 40 and 80 years. The study participants also completed questionnaires to determine if they had suffered back pain in the past 12 months.

“No significant association was identified between spondylolysis, isthmic spondylolisthesis, or degenerative spondylolisthesis, and the occurrence of LBP,” found the study.

Interestingly, the study’s authors also note that “based on CT imaging of an unselected community-based population, the prevalence of lumbar spondylolysis is 11.5%, nearly twice the prevalence of previous plain radiograph-based studies.”

Spine – January 15, 200934:199-205.

FIT KIDS DO BETTER IN SCHOOL

A new investigation finds that physically fit kids scored better in school than their less fit peers.

Researchers examined the relationship between physical fitness and academic achievement in a racially and economically diverse urban public school district of children enrolled in grades 4–8 during the 2004–2005 academic year.

Results of their study show that there is a significant relationship between students’ academic achievement and physical fitness. The odds of passing both standardized math and English tests increased as the number of fitness tests passed increased, even when controlling for gender, race/ethnicity, and socio-economic status.

“For families and schools, these results suggest investments of time and resources in physical activity and fitness training may not detract from academic achievement in core subjects, and, may even be beneficial,” the authors conclude.

Journal of School Health – January 2009;79:30-37.

www3.interscience.wiley.com/journal/117974040/home

GOOD NEWS ABOUT LIFE EXPECTANCY AND AIR QUALITY

A new study by researchers at Brigham Young University and Harvard School of Public Health shows that average life expectancy in 51 US cities increased nearly three years over recent decades, and approximately five months of that increase came thanks to cleaner air.

“Such a significant increase in life expectancy attributable to reducing air pollution is remarkable,” comments lead author C. Arden Pope III. “We find that we’re getting a substantial return on our investments in improving our air quality. Not only are we getting cleaner air that improves our environment, but it is improving our public health.”

The research matched two sets of data from 51 cities across the nation: changes in air pollution between about 1980 and about 2000; and residents’ life expectancies during those years. The scientists applied advanced statistical models to account for other factors that could affect average life spans, such as changes in population, income, education, migration, demographics and cigarette smoking.

In cities that had previously been the most polluted and cleaned up the most, the cleaner air added approximately 10 months to the average resident’s life. On average, Americans were living 2.72 years longer at the end of the two-decade study period; up to five months, or 15%, of that increase came because of reduced air pollution. Other studies show that these gains are likely coming from reductions in the cardiovascular and cardiopulmonary disease that typically accompany air pollution.

NEJM – January 22, 2009;360:376-86.

www.nejm.org

January 16, 2009

CASE STUDY SHOWS CHIROPRACTIC BENEFITS PATIENT WITH FAILED BACK SURGERY

A new case study “demonstrates improved function and quality of life in a failed back surgery case.”

According to the report, “the patient was a 58 year old male who entered the clinic with a primary complaint of low back pain and left lateral leg pain. He suffered an acute injury to the low back upon performing job duties and elected to have surgery on the lumbar spine. Afterwards, the condition has worsened.”

Results revealed that “the patient was adjusted using specific osseous motion palpation/Gonstead manual adjustments. Improvements were noted in several areas. VAS improved from 2 to 8, although the Borg pain scale remained relatively constant. SF-36 testing showed a decrease in Physical PCS in the initial stages of treatment and a rise in the latter stages and there was an increase in the Mental MCS. Posture showed significant improvement as did ROM for lumbar flexion in the initial phases of care.”

JVSR – January 10, 2009;1-5.

www.jvsr.org

STUDY LOOKS AT CHIROPRACTIC CARE FOR FIBROMYALGIA

“Fibromyalgia syndrome (FMS) is one of the most commonly diagnosed nonarticular soft tissue conditions in all fields of musculoskeletal medicine, including chiropractic,” explain the authors of a comprehensive literature review “for the most commonly used treatment procedures in chiropractic for FMS.”

The review, which included 38 studies, found “resulted in the following recommendations regarding nonpharmaceutical treatments of FMS. Strong evidence supports aerobic exercise and cognitive behavioral therapy. Moderate evidence supports massage, muscle strength training, acupuncture, and spa therapy (balneotherapy). Limited evidence supports spinal manipulation, movement/body awareness, vitamins, herbs, and dietary modification.”

The study concludes that “several nonpharmacologic treatments and manual-type therapies have acceptable evidentiary support in the treatment of FMS.”

JMPT – January 2009;32:25-40.

www.americangeriatrics.org

MOST SENIORS IN CHRONIC PAIN

Slightly over half of people aged 70 and older suffer from some type of chronic pain, and women and the obese are particularly vulnerable, according to a new investigation by Dr. Richard B. Lipton and colleagues from the Albert Einstein College of Medicine in the Bronx, New York.

Dr. Lipton and his team looked at 840 men and women ages 70 and older living in the Bronx.

Overall, 52% had some type of chronic pain, including 40% of men and 59% of women. People with chronic pain were at double the risk of having symptoms of depression or anxiety compared to those who were pain-free. Chronic pain was twice as common among obese people as normal-weight individuals, and four times more common among the severely obese.

Even after the researchers accounted for depression, anxiety, high blood pressure, and diabetes, as well as age, gender and education, the relationship between obesity and chronic pain remained strong.

JAJS – January 2009;57:115-19.

CONFIDENCE AND MOTIVATION MOST IMPORTANT FACTORS DETERMINING EXERCISE

The main factors influencing the amount of physical exercise people carry out are their self-perceived ability and the extent of their desire to exercise. A study of 5167 Canadians, reported in the journal BMC Public Health, has shown that psychological concerns are the most important barriers to an active lifestyle.

Sai Yi Pan, from the Public Health Agency of Canada, led a team of researchers who carried out a study that examined data from a nationwide series of telephone interviews. She explains that the findings “highlight the need for health promotion programs to enhance people’s confidence and motivation, as well as providing education on the health benefits of physical activity.”

The strong effects of self-efficacy and intention on physical activity suggest that interventions designed to increase exercise should target these factors. The authors conclude that “future research is needed to identify how those influences can be optimally incorporated into interventions that will increase people's belief in their ability and motivation/intention to be physically active.’

PEER COUNSELING PREVENTS PND IN HIGH RISK MOMS

Over the past decade a growing number of women have been diagnosed with postnatal depression (PND) and prescribed antidepressant medication. This medication not only may produce hazardous side effects for the mother, but it may also affect breast milk.

Now, a new study in the British Medical Journal reveals a surprisingly effective drug-free alternative. Specifically, a heart-to-heart chat with a peer cuts the risk of PND in high risk women by 50%.

Dr. Cindy-Lee Dennis and colleagues screened more than 21,000 women from seven health regions in Ontario. Of this group, 701 high risk mothers were recruited and randomized to receive standard postnatal care or standard care and the support of a peer volunteer (who had experienced postnatal depression themselves).

Mothers who received peer support had half the risk of developing postnatal depression at 12 weeks after birth than those in the control group. Mothers were receptive to receiving telephone-based peer support and more than 80% said they were satisfied with their experience and would recommend this support to a friend.

In an accompanying editorial, Dr. Dennis says “Women and family members need to be educated about postnatal depression so they can recognize the symptoms. Treatment needs to be convenient and accessible to new mothers.”

BMJ – January 16, 2009;338:a3064.

January 7, 2009

STUDY LOOKS AT CHIROPRACTIC FOR KNEE PAIN

Chiropractic care significantly reduce knee pain, according to a new report, which followed 43 people with chronic, non-progressive history of osteoarthritic knee pain, aged between 47 and 70 years.

The randomized, controlled trial separated the participants into two groups. “The intervention consisted of the Macquarie Injury Management Group Knee Protocol whilst the control involved a non-forceful manual contact to the knee followed by interferential therapy set at zero. Participants received three treatments per week for two consecutive weeks with a follow up immediately after the final treatment.”

Results revealed that “prior to the intervention, there was no significant differences in age or present knee pain intensity. Following treatment, the intervention group reported a significant decrease in the present pain severity (mean 1.9) when compared to the control group (mean 3.1). Response to treatment questions indicated that compared to the control group, the intervention group felt the intervention had helped them (intervention mean 7.0; control mean 3.4), felt it decreased their knee symptoms such as crepitus (intervention mean 6.0; control mean 3.4) and improved their knee mobility (intervention mean 6.4; control mean 3.4) and their ability to perform general activities (intervention mean 6.5; control mean 3.8). Importantly the MIMG Knee Protocol intervention group reported no adverse reactions during treatment.”

JCCA – December 2008;52:229-42.

www.jcca-online.org

CHIROPRACTIC FOR GERD

A case study in the Journal of the Canadian Chiropractic Association suggests that chiropractic care may alleviate gastroesophageal reflux disease.

According to the article, “the mother of a 3-month old girl presented her daughter for chiropractic care with a medical diagnosis of gastroesophageal reflux disease. Her complaints included frequently interrupted sleep, excessive intestinal gas, frequent vomiting, excessive crying, difficulty breastfeeding, plagiocephaly and torticollis. Previous medical care consisted of Prilosec prescription medication.”

“Notable improvement in the patient's symptoms was observed within four visits and total resolution of symptoms within three months of care. This case study suggests that patients with complaints associated with both musculoskeletal and non-musculoskeletal origin may benefit from chiropractic care.”

JCCA – December 2008;52:248-55.

www.jcca-online.org

DANGERS OF FOSOMAX GREATER THAN DRUG COMPANIES CLAIM

A new study is among the first to acknowledge that even short-term use of common oral osteoporosis drugs may leave the jaw vulnerable to devastating necrosis.

Fosomax is the most widely prescribed oral bisphosphonate, ranking as the 21^st most prescribed drug on the market since 2006.

After controlling for referral bias, nine of 208 healthy University Of Southern California School of Dentistry patients who take or have taken Fosamax for any length of time were diagnosed with osteonecrosis of the jaw (ONJ). The study’s results are in contrast to drug makers’ prior assertions that bisphosphonate-related ONJ risk is only noticeable with intravenous use of the drugs, not oral usage, explains study author Parish Sedghizadeh.

“We’ve been told that the risk with oral bisphosphonates is negligible, but four percent is not negligible,” he said.

“Here at the School of Dentistry we’re getting two or three new patients a week that have bisphosphonate-related ONJ,” he said, “and I know we’re not the only ones seeing it.”

Journal of the American Dental Association – January 2009;140:61-6.

jada.ada.org

PROCESSED FOODS UP RISK OF LUNG CANCER

New research demonstrates that a diet high in inorganic phosphates, which are found in a variety of processed foods including meats, cheeses, beverages, and bakery products, might speed growth of lung cancer tumors and may even contribute to the development of those tumors in individuals predisposed to the disease.

“Our study indicates that increased intake of inorganic phosphates strongly stimulates lung cancer development in mice, and suggests that dietary regulation of inorganic phosphates may be critical for lung cancer treatment as well as prevention,” notes study author Myung-Haing Cho, DVM., PhD.

“Lung cancer is a disease of uncontrolled cell proliferation in lung tissue, and disruption of signaling pathways in those tissues can confer a normal cell with malignant properties,” Dr. Cho adds. “Deregulation of only a small set of pathways can confer a normal cell with malignant properties, and these pathways are regulated in response to nutrient availability and, consequently, cell proliferation and growth.”

“Phosphate is an essential nutrient to living organisms, and can activate some signals,” he added. “This study demonstrates that high intake of inorganic phosphates may strongly stimulate lung cancer development by altering those (signaling) pathways.”

AJRCC – January 1, 2009;179:59-68.

ajrccm.atsjournals.org

MISSED SLEEP TIED WITH CORONARY DISEASE

Getting enough sleep seems to decrease the risk of coronary artery calcification, an early step down the path to cardiovascular disease, a research team based at the University of Chicago Medical Center reports.

About 12% of those in the study (495 healthy volunteers in their 40s) first developed coronary artery calcification over five years of follow-up. Calcified arteries, however, were found in 27% of those who slept less than five hours a night. That dropped to 11% for those who slept five to seven hours and fell to six percent for those who slept more than seven hours a night.

The benefits of sleep appeared to be greater for women. They did not vary according to race.

The benefit of one hour of additional sleep was comparable to the gains from lowering systolic blood pressure by 17 mm Hg.

“The consistency and the magnitude of the difference came as a surprise,” comments study director Diane Lauderdale, PhD. “It’s also something of a mystery. We can only speculate about why those with shorter average sleep duration were more likely to develop calcification of the coronary arteries.”

JAMA – December 24/31, 2008;300:2859-66.

www.jama.com

December 12, 2008

MIGRAINE MEDICATIONS WORSEN CONDITION

A recent investigation found that the use of medications commonly prescribed to relieve episodic migraine (EM) significantly boost the risk of developing transformed migraine (TM), a form of migraine characterized by 15 or more days of headache per month.

In the study, 8,219 people with episodic migraine were followed for one year; 2.5% developed TM over the course of the year. The use of commonly prescribed medications, particularly narcotics (such as acetaminophen with codeine or Percocet), or barbiturates (such as Fiorinal, Fioricet and Esgic) were associated with a dose-dependent increased risk of new onset of TM.

Principal investigator and senior author of the study, Richard Lipton, MD notes that “this confirms the longstanding feeling among many doctors that certain medications used to treat migraine may increase the frequency of headaches if overused. These findings have important public health implications.”

Headache – December 10, 2008;Epub.

www.headachejournal.org

ARE ADVERSE EVENTS FROM CERVICAL ADJUSTMENTS RELATED TO OUTCOME?

Researchers in the Netherlands have determined that mild adverse events from cervical spine adjustments, such as stiffness or soreness, are not associated with a worse outcome after 3 months.

“This was a prospective, multicenter, observational cohort study conducted in the private clinics of chiropractors throughout The Netherlands,” write the study’s authors. “All new, consecutive patients, between 18 and 65 years of age with neck pain of any duration, who had not undergone chiropractic or manual therapy in the prior 3 months, were eligible for recruitment. Self-reported questionnaires were administered at the first 3 visits and at 3 months.”

The analysis concluded that “self-reported benign adverse events after chiropractic care for neck pain are associated with worse short-term outcomes. Intense adverse events are associated with more neck disability and clinically relevant differences at the short-term only. However, there is no association between adverse events and worse outcomes at 3 months.”

Spine – December 1, 2008;33:E950-6.

SOCIAL NETWORKS MAJOR INFLUENCE ON HAPPINESS

New research from James Fowler of UC San Diego and Nicholas Christakis of Harvard Medical School shows that happiness spreads far and wide through a social network —traveling not just the well-known path from one person to another but even to people up to three degrees removed.

“One of the key determinants of human happiness is the happiness of others,” said Christakis. “An innovative feature of our work was exploring the idea that emotions are a collective phenomenon and not just an individual one.”

Christakis and Fowler used data from the Framingham Heart Study to recreate a social network of 4,739 people whose happiness was measured from 1983 to 2003.

The research shows that happiness loves company. Happy people tend to cluster together, and, on the surface, people with more social contacts seem generally happier. Fowler and Christakis observe, however, that what matters there is not just the total number of connections but the number of happy ones.

On average, every happy friend increases your own chance of being happy by 9 percent. Each unhappy friend decreases it by 7 percent. Happiness, the researchers found, spreads in a social network up to three degrees of separation: You are 15% more likely to be happy if directly connected to a happy person; 10% if it’s the friend of a friend who is happy; and 6% if it’s the friend of a friend of a friend. Unhappiness also spreads, but not nearly as much.

“The effects we observe may not seem like much at first,” comments Fowler, “but consider that $5,000 extra dollars, in 1984, was associated with just a 2% increase in happiness and you see that the power of other people is incredible. Someone you don’t know and have never met — the friend of a friend of a friend — can have a greater influence than hundreds of bills in your pocket.”

BMJ – December 4, 2008;Epub.

SUGARY BEVERAGE CONSUMPTION ON THE RISE

Over the past two decades, the number of adults consuming sugar-sweetened beverages such as soft drinks, fruit drinks and punches has increased dramatically, according to a study led by researchers at the Johns Hopkins Bloomberg School of Public Health.

“More adults are drinking sugar-sweetened beverages and, among those drinkers, consumption has increased,” said Sara N. Bleich, PhD, lead author of the study. “From 1988 to 2004, the percentage of sugar-sweetened beverage drinkers increased five percent. Per capita consumption of energy from sugar-sweetened beverages increased 46 kilocalories (kcal) per day, and daily sugar-sweetened beverage consumption among drinkers increased 6 ounces per day.”

Sugar-sweetened beverage consumption was highest among young adults (231-289 kcal/day), who consumed roughly 20% of their sugar-sweetened beverage calories at work, and lowest among the elderly (68-83 kcal/day). Among race/ethnicity groups, the percentage of sugar-sweetened beverage drinkers and per capita consumption of sugar-sweetened beverages was highest among blacks followed by Mexican Americans. Overweight/obese adults who were trying to lose weight were less likely to drink sugar-sweetened beverages compared to those who were not, but they still consumed a considerable amount from 1999 to 2004 (278 kcal/day).

“Although this analysis does not attempt to estimate the effect of sugar-sweetened beverage intake on obesity incidence, a number of studies have linked sugar-sweetened beverage consumption to obesity and type 2 diabetes,” said coauthor Youfa Wang, MD, PhD. “Based on these nationally representative surveys, our study found higher sugar-sweetened beverage consumption also happened to be among populations at greater risk for obesity. There are few signs of improvement over the past decade and the situation seems to become worse among young adults aged 20 to 44.”

AJCN – January 2009;Epub.

www.ajcn.org

AEROBIC EXERCISE BETTER AT SUPPRESSING HUNGER

A vigorous 60-minute workout on a treadmill affects the release of two key appetite hormones, ghrelin and peptide YY, while 90 minutes of weight lifting affects the level of only ghrelin, according to a new study. Ghrelin is the only hormone known to stimulate appetite. Peptide YY suppresses appetite. Consequently, the research shows that aerobic exercise is superior at suppressing appetite than non-aerobic exercise.

In this experiment, 11 male university students did three eight-hour sessions. During one session they ran for 60 minutes on a treadmill, and then rested for seven hours. During another session they did 90 minutes of weight lifting, and then rested for six hours and 30 minutes. During another session, the participants did not exercise at all.

During each of the sessions, the participants filled out surveys in which they rated how hungry they felt at various points. They also received two meals during each session. The researchers measured ghrelin and peptide YY levels at multiple points along the way.

They found that the treadmill (aerobic) session caused ghrelin levels to drop and peptide YY levels to increase, indicating the hormones were suppressing appetite. However, a weight-lifting (non-aerobic) session produced a mixed result. Ghrelin levels dropped, indicating appetite suppression, but peptide YY levels did not change significantly.

Based on the hunger ratings the participants filled out, both aerobic and resistance exercise suppressed hunger, but aerobic exercise produced a greater suppression of hunger. The changes the researchers observed were short term for both types of exercise, lasting about two hours, including the time spent exercising.

American Journal of Physiology-Regulatory, Integrative and Comparative Physiology – November 2008;Epub.

ajpcon.physiology.org

December 3, 2008

CERVICAL ADJUSTMENT BENEFITS TENNIS ELBOW

A single cervical spinal adjustment can produce a significant reduction in pain associated with lateral epicondylitis (LE), according to a new report.

As part of the experiment, 5 women and 5 men with tennis elbow attended two experimental sessions on two separate days at least 48 hours apart. At each session, participants received either a cervical spine adjustment or a manual contact intervention.

Pressure pain threshold (PPTs), hot pain thresholds (HPTs) and cold pain thresholds (CPTs) “over the lateral epicondyle of both elbows was assessed preintervention and 5 minutes postintervention by an examiner blinded to the treatment allocation of the patients.”

The investigators also measured pain-free grip strength (PFG) on the affected arm and maximum grip force on the unaffected side.

Findings showed that “the application of a manipulation at the cervical spine produced an immediate bilateral increase in PPT in patients with LE. No significant changes for HPT and CPT were found. Finally, cervical manipulation increased PFG on the affected side, but not the maximum grip force on the unaffected arm.”

JMPT – November 2008;31:678-81.

REVIEW STUDY LOOKS AT CHIROPRACTIC FOR LBP

A large review study confirms that chiropractic adjustments are highly effective at eliminating low-back pain.

The analysis pooled data on a total of 887 source documents. Specifically, these included 12 research guideline reports, 64 randomized control trials, 13 systematic reviews/meta-analyses and 11 cohort studies.

Results revealed that “as much or more evidence exists for the use of spinal manipulation to reduce symptoms and improve function in patients with chronic LBP as for use in acute and subacute LBP. Use of exercise in conjunction with manipulation is likely to speed and improve outcomes as well as minimize episodic recurrence. There was less evidence for the use of manipulation for patients with LBP and radiating leg pain, sciatica, or radiculopathy.”

JMPT – November 2008;31:659-74.

DRUG APPROVAL TOO QUICK, STUDY SAYS

With new drugs being reviewed by regulatory agencies and then released onto the market faster than ever before, patients’ safety is being compromised, warns a study published on-line today in the British Medical Journal.

In the analysis, Dr David Kao reviews trends in drug approval times in the United States, and suggests how drug marketing techniques could be used to improve the way new drugs are monitored.

Previous research has shown that drugs approved in the US during the two months before the mandated deadline were more likely to be withdrawn for safety reasons or to carry a warning.

Today’s marketing techniques are so sophisticated, says Dr. Kao, that once a drug has been approved the products can be released on websites within 90 minutes. He cites the example of Merck’s new treatment Sitagliptin for hyperglycaemia. Within 14 days of approval 188 million patients, or 73% of the insured US population, had been targeted by the marketing campaign.

Dr. Kao also points out that agencies often collect fees from drug companies so that they can hire staff to review the drugs more quickly. The European Agency for the Evaluation of Medicinal Products receives 75% of its funding in this way, 43% of the US Food and Drug Administration (FDA) budget is similarly derived, and the UK’s Medicines and Healthcare Products Regulatory Agency is completely funded by drug companies.

BMJ – December 2, 2008;337:a2591.