A "Bone" of Contention

"Bone-setting" is a type of traditional manipulative therapy utilized by folk healers in Finland. This form of therapy is considered the basis for the development of modern chiropractic and osteopathy. Researchers recently sought to find out if this predecessor to chiropractic is as valid as modern manipulative therapy.

In this study, published in the Journal of Manipulative and Physiological Therapeutics, over 100 patients who had suffered back pain for at least seven weeks were divided into three groups, based on the treatment they received: bone-setting (by four traditional healers), physiotherapy, or light exercise. Up to 10 treatment sessions were allowed over a six-week period. Disability scores were calculated at the end of the treatment and three, six, and 12 months later.

The bone-setting group showed the highest improvement in disability scores (each time scores were taken); an analysis of the additional therapies showed a smaller subgroup experienced an even more enhanced effect from bone-setting. The physiotherapy patients showed a decrease in health-center visits for their back pain, however, unlike the other two groups.

Bone-setting may be more effective than light exercise or physiotherapy for back pain. The simple fact that this form of therapy has survived so long suggests that it offers valuable health benefits, which will come as no surprise to chiropractors and their patients. Your doctor of chiropractic can tell you more about the history of chiropractic, or you can read about it here.

Reference: Hemmilä HM, Keinänen-Kiukaanniemi SM, Levoska S, et al. Long-term effectiveness of bone-setting, light exercise therapy, and physiotherapy for prolonged back pain: A randomized controlled trial. Journal of Manipulative and Physiological Therapeutics 2002:25(2), pp. 99-104.

Unhappy about Antidepressants

Prescriptions for antidepressant medications tripled in the U.S. between 1988 and 1998. Antidepressants are used to treat a wide range of disorders in adults - and children, despite few studies that support their safe and effective use in younger individuals.

To determine trends in antidepressant use in children and adolescents from 1988-1994, the authors of this study in the journal Pediatrics reviewed the records of over 800,000 youths in three health organizations: a group health maintenance organization (HMO) in the northwestern U.S.; Midwestern Medicaid (MWM); and Mid-Atlantic Medicaid (MAM). In the 2- to 19-year-old children, antidepressant use was defined as a prescription claim for the drugs during the previous year.

Information gathered from all three organizations showed an increase in antidepressant treatment. Over the seven-year period, the HMO, MWM, and MAM saw increases in pediatric antidepressant prescriptions of 3.6 times, 2.9 times, and 4.6 times, respectively. Over half of the antidepressant prescriptions in this period were prescribed for attention-deficit/hyperactivity disorder (ADHD). Use of antidepressants was highest in boys in the 10- to 14-year-old range and girls in the 15- to 19-year-old range.

Avoid any medication that hasn't been clearly proven to be safe and effective, and always talk to your doctor about the benefits and risks before filling a prescription.

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Reference: Zito JM, Safer DJ, dosReis S, et al. Rising prevalence of antidepressants among US youths. Pediatrics 2002:109(5), pp. 721-727.

Let's Get Physical!

You probably already know that an above-average fitness level can help prevent cardiovascular disease and heart attacks. This health measure is valuable to patients and doctors because it is a noninvasive, inexpensive, and accurate method. But how accurately does exercise capacity predict risk of death, compared to other health measures?

The authors of a recent study in The New England Journal of Medicine examined data on more than 6,000 men who had completed treadmill tests and were followed for an average of six years. The men were divided into two groups: those with normal exercise-test results and no cardiovascular disease, and those with abnormal test results and/or a history of cardiovascular disease. Exercise capacity was estimated based on the grade and speed settings of the treadmill.

Peak exercise capacity was the best predictor of death in both healthy individuals and those with cardiovascular disease. In other words, men who were able to work out longer and harder were the most likely to live longer. Those with cardiovascular disease were older and used more medications.

Exercise capacity may be a better predictor of risk of death in men than other established factors associated with cardiovascular disease, including smoking, hypertension, diabetes, and other exercise variables. Do not underestimate the value of regular exercise: It is clearly one of the best methods of promoting longevity and warding off disease.

Reference: Myers J, Prakash M, Froelicher V, et al. Exercise capacity and mortality among men referred for exercise testing. The New England Journal of Medicine 2002:346(11), pp. 793-801.

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Is It Safe to Work During Pregnancy?

Women are increasingly working outside of the home while they're pregnant. After all, there is no such thing as a "free lunch." But while the effects of work on both the mother and the unborn child are unclear, maternal work in the third trimester of pregnancy has been suggested to raise the risks for preterm delivery, low birth weight, and "pre-eclampsia" - a potentially fatal condition involving increased blood pressure and abnormal swelling.

To determine if working during pregnancy affects blood pressure and pre-eclampsia risk, the authors of a recent study in the Journal of Epidemiology and Community Health evaluated nearly 1,000 expectant mothers in Dublin, Ireland. The women were divided into three groups based on work status: currently working; not working; or normally working, but not currently employed. Blood pressure was measured between the 18th and 24th weeks of pregnancy.

Women currently working were almost five times more likely to develop pre-eclampsia than nonworking women. Working women also had higher average daytime blood pressures than nonworking women. Women who had worked, but were not currently working, were still approximately three times more likely to suffer from pre-eclampsia than nonworkers, although their blood pressures were similar to those of the nonworkers.

If you are currently pregnant or plan to be in the future, talk to your doctor about ways to avoid pre-eclampsia and other conditions that can strike during pregnancy. If you must work while pregnant, try to avoid stressful situations, long hours, and added responsibilities.

Reference: Higgins JR, Walshe JJ, Conroy RM, et al. The relation between maternal work, ambulatory blood pressure, and pregnancy hypertension. Journal of Epidemiology and Community Health 2002:56, pp. 389-393.

For more studies on keeping healthy while pregnant, click here.

Half of Computer Users May Develop Pain

The U.S. Census Bureau reports that in 1997, 92 million American adults used a computer, almost 40% of all households had a computer, and half of employed adults worked on a computer on the job. Dozens of studies have evaluated musculoskeletal symptoms and disorders of the hands and arms in computer users, yet the long-term effects of numerous hours at the keyboard remain uncertain.

To determine the incidence of conditions developing from workplace computer use, over 600 recently hired employees who used computers at least 15 hours per week were asked to complete diaries on the hours they worked, hours they spent on the computer, and presence of symptoms in their necks, shoulders, hands, and arms for up to three years. Researchers sought those with symptoms requiring medication or scoring high on a pain scale; the results of their study were published recently in the American Journal of Industrial Medicine.

Over 50% of the workers suffered from musculoskeletal symptoms in their first year at the new job. Almost one-third suffered a new onset of neck or shoulder symptoms, and a quarter of the individuals suffered new onset of symptoms in the arms or hands. Carpal tunnel syndrome, one of the best-known conditions related to long-term keyboard use, was surprisingly one of the least likely disorders seen in this study - only 1% of the workers developed it. Women and those over age 30 were most likely to exhibit symptoms from computer use.

If you spend many hours in front of a computer, either at work or at home, be sure to use the proper form and follow basic guidelines to avoid injury: Maintain an upright posture; keep your keyboard even with or slightly below elbow level; be sure your mouse and other devices are within easy reach; and be sure to get up and walk around regularly to stretch and get the blood flowing to your extremities.

Reference: Gerr F, Marcus M, Ensor C, et al. A prospective study of computer users: I. Study design and incidence of musculoskeletal symptoms and disorders. American Journal of Industrial Medicine 2002:41(4), pp. 221-235.

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Avoid the IRS!

Nobody is suggesting you shouldn't pay your taxes. The IRS discussed here is "insulin resistance syndrome" - a condition that increases a person's odds for heart disease and possibly diabetes and some forms of cancer. IRS occurs when the body demonstrates a reduced ability to control the processing of blood sugar. It can be caused by a combination of factors, including obesity, smoking, excessive levels of the hormone insulin, and a diet low in dairy foods.

In this study of cardiovascular disease risk factors in four U.S. cities, published in the Journal of the American Medical Association, researchers analyzed four-week diet questionnaires from over 3,000 individuals. Researchers focused on the amount of dairy products people ate, such as milk and sour cream.

In overweight individuals, the risk for developing IRS was almost 75% less in those with the highest dairy consumption (over 35 times per week) compared to the lowest (less than 10 times per week). Each additional occasion of dairy consumption per day was linked to a 21% decrease in risk for insulin resistance. Also, the odds for IRS were 4-5 times higher in overweight individuals than healthy subjects. In individuals with healthy weight levels, dairy consumption did not significantly affect insulin resistance.

The high levels of calcium, potassium, and magnesium found in dairy products may be responsible for their potential to reduce risks for type-2 diabetes and heart disease. When selecting dairy foods, seek out those with reduced fat content, and remember that one of the keys to good nutrition is incorporating a wide variety of foods in your diet, so don't each too much of any type of food.

Reference: Pereira MA, Jacobs DR, Van Horn L, et al. Dairy consumption, obesity, and the insulin resistance syndrome in young adults: The CARDIA study. Journal of the American Medical Association 2002:287(16), pp. 2081-2089.

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Athletics Don't Affect Girls' Growth

Many parents and coaches are concerned that intense physical training in young female athletes may slow maturity and impede growth. After all, you may notice that gymnasts, who undergo rigorous strengthening exercises, tend to be much smaller than their peers. This review in the British Journal of Sports Medicine focused on the limited information available on a possible link between reduced growth/maturity and intense athletic participation in girls.

Growth specifically relates to increased body size; maturation relates to physically attaining adulthood. Both may occur at different rates between individuals, but while end growth varies greatly in the population, essentially everyone will attain biological maturity. While hormonal and genetic factors largely affect these processes, environmental variables like sports may also play a role.

After reviewing the related literature, the authors determined that training does not impact growth or maturity. Rather, they suggest, "It is more likely that young athletes select themselves, or are selected by coaches and sport systems, into their specific sports." Most gymnasts and ballet dancers, for example, are selected because they mature late; in these sports, smaller size can be beneficial. Small hands and feet, a low center of gravity, and short, compact limbs help gymnasts compete better. In contrast, basketball players and swimmers may be selected for their sports because they are generally larger than their peers.

Until more long-term research has been established on this subject, the available information is insufficient to blame intense training for reduced stature in female athletes. In addition, there are a multitude of advantages to getting your daughter involved with sports, such as increased self-esteem, cardiovascular fitness, weight maintenance, and participation in a safe hobby - reducing exposure to illegal drugs and other unsafe activities.

Reference: Baxter-Jones ADG, Maffulli N. Intensive training in elite young female athletes. British Journal of Sports Medicine 2002:36, pp. 13-15.

To learn more about pediatric health, click here.

Folding under Pressure

Many people (and their kids) flock to the free blood-pressure measuring machines in their local supermarkets or discount stores. These devices are widely available to the general population, and may help enhance people's involvement with their own healthcare. But just how accurate are they?

A recent study in the Canadian Medical Association Journal compared the validity of three blood-pressure recording devices: a standard automated device that has circulated publicly since 1990, a similar but clinically validated device, and a sphygmomanometer (the hand-held device that doctors use to measure your blood pressure) operated by a qualified researcher. The effectiveness of each method was determined in approximately 100 adults, based on Association for the Advancement of Medical Instrumentation (AAMI) standards.

Neither of the automated devices met the AAMI accuracy requirements for systolic blood pressure. Also, neither machine was as accurate in a community setting as in a laboratory. Based on their findings, the authors of the study concluded that reliance on these devices could result in "an inaccurate or missed diagnosis of hypertension."

There are no published minimum standards for blood-pressure measuring devices created for use in the community. Don't rely on grocery-store devices to determine your true blood pressure. Have a qualified physician accurately take your blood pressure on a regular basis using a sphygmomano... well, you know - the one they wrap around your arm and pump by hand.

Reference: Lewis JE, Boyle E, Magharious L, et al. Evaluation of a community-based automated blood pressure measuring device. Canadian Medical Association Journal 2002:166(9), pp. 1145-1148.

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