Watch Their Backs

Children account for over 10,000 backpack-related visits annually to emergency departments or physicians. Backpacks cause acute injuries, such as bruises and sprains, and chronic problems, such as persistent low back pain. The daily stress of carrying a backpack on one shoulder may also alter a child's posture and gait. Despite all these potential problems, many parents aren't addressing the issue of backpack safety.

Researchers in a recent study gathered data on parental knowledge of their child's backpack weight by evaluating nearly 200 students, grades K-5, from three Texas schools. Only children with backpacks weighing at least 10% of their body weight were assessed.

Average pack weight was approximately 11 lbs., which represented about 15% of student body weight. Researchers found that fully one-third of students reported their parents had never once checked their backpack contents, and less than 5% of parents had ever actually weighed their child's backpack. In this report in the Archives of Disease and Childhood, the backpacks of students whose parents never checked the packs weighed significantly more than packs of students whose parents kept an eye on pack weight and contents.

As a parent, you are possibly the best source for backpack safety promotion for your child, and can do so simply by inspecting the backpack weight and contents. Physicians and parents should also ensure that student backpacks are the right size; carry no unnecessary or additional items; are worn on both shoulders; and weigh less than 10-15% of the student's body weight.

Reference: Forjuoh SN, Little D, et al. Parental knowledge of school backpack weight and contents. Archives of Disease and Childhood 2003:88, pp. 18-19.

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Don't Get Weighed Down

More than 60% of Americans are now overweight or obese, with more women than men falling into this category. Being overweight increases a person's chances of developing numerous chronic conditions, including high blood pressure; heart disease; diabetes; stroke; and breast or colon cancer. Exercise and proper diet can both successfully help you combat weight gain.

A study in the Journal of the American Medical Association focused on only one of these weapons against weight gain: exercise. For a one-year period, 173 overweight or obese women, ages 50 to 75, completed either an exercise or a stretching program. Exercisers completed moderate-intensity exercises, like walking or stationary biking, for an average of three hours per week, while women in the other group stretched once per week but didn't add exercise to their program.

Women who exercised lost several pounds over the year, while women who stretched actually gained weight. Although weight loss in exercisers was modest, fat loss was significant: Those who worked out at least three hours and 15 minutes each week cut their abdominal body fat by 7% and their total body fat by 4.2%, while the stretching-only women saw no significant changes in body fat. Predictably, the more exercise a woman completed, the more weight and body fat she lost.

Don't get weighed down by what your scale says. Even if exercising only helps you shed a few pounds, it is probably vastly improving your health while creating a leaner, fitter you. On top of looking better, working out will improve your cardiorespiratory fitness levels, which can reduce your risk for cardiovascular disease. Also, incorporating a healthy diet into your exercise program will yield much greater weight and fat reductions.

Reference: Irwin ML, Yasui Y, et al. Effect of exercise on total and intra-abdominal body fat in postmenopausal women: A randomized controlled trial. Journal of the American Medical Association 2003:289(3), pp. 323-330.

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Gradual Change

If you've taken a geology course, you know that changes to the earth, such as the formation of mountains, take a very long time. Likewise, our bodies, while not as slow, sometimes take a considerable amount of time to regenerate certain tissues. Glucosamine, a dietary supplement, may help relieve arthritis symptoms and regenerate cartilage; this supplement appears to do its work gradually, however.

Knee osteoarthritis, caused by joint degeneration or "wear and tear" of cartilage, occurs primarily in people who have suffered severe cartilage injury; obesity and aging also add to degeneration. In this study, 50 volunteers with regular knee pain (most likely from cartilage damage or osteoarthritis) were divided into two groups to take either 2,000 milligrams per day of glucosamine or a daily placebo. Over 12 weeks, four clinical testing sessions recorded changes in knee pain and function.

On self-report evaluations over the 12-week period, 88% of those taking glucosamine reported some degree of pain improvement in their knees, compared to only 17% of those taking a placebo. Both groups had improved scores over time, indicating that even the placebo pills had some positive effect, yet quality of life scores were also significantly higher for the glucosamine group than those taking a placebo.

Glucosamine was slow-acting, though. At the dosage of glucosamine taken in this study, most improvements did not appear until after eight weeks of supplementation. The message here is to be patient if you're trying out glucosamine - it might not work at first, but eventually may come around. The authors of this study in the British Journal of Sports Medicine note that this may be the first study to evaluate the effects of glucosamine vs. placebo beyond eight weeks, so over time, supplementation may prove even more effective.

Reference: Braham R, Dawson B, Goodman C. The effect of glucosamine supplementation on people experiencing regular knee pain. British Journal of Sports Medicine 2003:37, pp. 45-49.

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A Bad Gut Feeling

Painkillers are popular. Nearly $2 billion are spent annually in the U.S. on prescription NSAIDs (nonsteroidal anti-inflammatory drugs), not to mention nonprescription drugs in this class (which include aspirin and ibuprofen). These drugs, widely used for arthritis, take their toll: Every year, approximately 100,000 Americans are hospitalized and 16,500 die from NSAID-associated stomach-ulcer complications.

To reduce ulcer complications, specialized NSAIDs (called "COX-2-selective NSAIDs") such as Vioxx and Celebrex - which reportedly cause minimal stomach damage - are being prescribed for arthritis patients. To compare these "safer" treatments to other NSAIDs for arthritis, roughly 300 patients with arthritis and a predisposition to ulcer bleeding were divided to receive either regular NSAIDs or the special NSAIDs daily.

After six months, the probability of recurrent ulcer bleeding was nearly the same in both groups: about 6% in the regular-NSAID group and 5% in the special-NSAID group. Renal failure, hypertension and fluid build-up in the legs were observed in nearly the same number of patients in both groups, although the newer drugs appeared to offer some advantage.

The authors of this study in The New England Journal of Medicine note that patients receiving the new drugs showed an incidence of ulcer complications that continued to rise beyond the six-month study period. Arthritis patients at a high risk for recurrent ulcers don't appear to have a much safer treatment option in newer painkillers. Perhaps a holistic, drug-free approach to arthritis would be better. Talk to your chiropractor for more information.

Reference: Chan FKL, Hung LCT, et al. Celecoxib versus diclofenac and omeprazole in reducing the risk of recurrent ulcer bleeding in patients with arthritis. The New England Journal of Medicine 2002:347(26), pp. 2104-2110.

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Take a Crack at Chiropractic

The spine and adjacent tissues are pivotal in nearly all major bodily movements. So when back or neck pain strike the one-third of adults who suffer from one or both condition(s) every year, the impact can be enormous. In fact, back pain is the second most common reason people visit physicians in the U.S., with neck pain close behind.

Because of the blossoming use of complementary and alternative therapies, a study appearing recently in the journal Spine assessed the prevalence of use of different forms of therapy for back and neck pain. The national telephone survey of over 2,000 randomly selected Americans asked a series of questions on whether or not each respondent suffered from any forms of back or neck pain the previous year, and if so, what type of treatment he or she sought.

Chiropractic was the most-used complementary therapy in this study, with 20% of back or neck pain sufferers seeking chiropractic care; Overall, complementary medicine was used far more than conventional medicine (54% vs. 37%, respectively). Perhaps more importantly, chiropractic was considered more helpful than conventional medicine. Over 60% of sufferers considered chiropractic "very helpful" for treating back and neck pain, compared to 27% for conventional providers.

The authors of this study estimate that 628 million visits were made to complementary therapy providers in 1997, a number that increases every year, and that a third of these visits were specifically for back or neck pain. A multitude of studies have shown that chiropractic and other so-called alternative therapies, such as massage, are highly effective for musculoskeletal pain. Isn't it time you gave them a try?

Reference: Wolsko PM, Eisenberg DM, et al. Patterns and perceptions of care for treatment of back and neck pain: Results of a national survey. Spine 2003:28(3), pp. 292-298.

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To Eat or Not to Eat?

Mercury is a dangerous heavy metal that can damage the brain and kidneys if ingested. Women who are or may become pregnant are especially encouraged to avoid eating foods that may contain mercury, namely larger fishes. Recent evidence in The New England Journal of Medicine suggests that people in general should avoid some fishes high in mercury, because they may also increase the risk for cardiovascular disease, thus eliminating the protective effects of the omega-3 fatty acids found in fish.

A study conducted in eight European nations and Israel was designed to find out how mercury levels in the body affect risk for cardiovascular disease and to see if high mercury levels can eliminate the heart-protective effect of eating fish. Researchers measured toenail mercury levels in approximately 700 men who had suffered a heart attack, and another 700 who had not. They also measured levels of the healthy omega-3 acid DHA, provided by fish and fish oil, in these men.

Mercury levels in men who had suffered heart attacks were 15% higher than in men who had not; the odds for a heart attack were twice as high in men with the highest mercury levels as in men with the lowest levels. Conversely, higher DHA levels were linked to a reduced risk for a heart attack, as previous studies have shown.

So, the question regarding fish consumption is, to eat or not to eat? If you are eating fishes high in mercury, you are probably negating the positive effects that could otherwise be obtained from them. Fish to be avoided, in order of higher to lower mercury levels, include tilefish, swordfish, mackerel and shark. Most smaller fishes and shellfish have low mercury concentrations, and are safe to eat.

Reference: Guallar E, Sanz-Gallardo MI, et al. Mercury, fish oils, and the risk of myocardial infarction. The New England Journal of Medicine 2002:347(22), pp. 1747-1754.

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On the Lookout for Strokes

The primary reason most stroke victims receive inadequate immediate treatment is the inability of the sufferer or bystanders to recognize the symptoms of a stroke in progress. Public knowledge of stroke warning signs has traditionally been poor, with only about half of all people able to name even one stroke warning sign correctly. How many can you name?

A study in the Journal of the American Medical Association assessed public knowledge of stroke warning signs and preventable risk factors in 2000, and compared it with figures compiled from the same area around Cincinnati, Ohio, recorded five years earlier. Nearly 2,200 individuals completed the survey.

The good news first: The number of people who could correctly name at least one stroke warning sign increased significantly between 1995 and 2000, from 57% to 70%. About the same percentage correctly identified one or more risk factors in both surveys, although there was a slight increase (68% to 72%) over five years.

Now the bad news: 30% of people still can't identify even one stroke warning sign. Also, individuals with the highest risk of stroke (those over age 75, blacks and men) appear to be the least likely to know the warning signs or risk factors for one. After reading this, you'll have no excuse: Other risk factors that increase your chances for a stroke include high blood pressure; smoking; diabetes; heart disease; and heavy alcohol consumption. Also, below is a list of warning signs that, if occurring suddenly, may indicate a stroke in progress:

• numbness or weakness in the arms, legs or face, especially on one side of the body;
• confusion or trouble speaking;
• difficulty seeing;
• problems with walking or balance due to dizziness or sudden loss of coordination; or
• severe headache.

Reference: Schneider AT, Pancioli AM, et al. Trends in community knowledge of the warning signs and risk factors for stroke. Journal of the American Medical Association 2003:289(3), pp. 343-346.

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Stressed to Death?

Stressed out at work? Many of us are, but did you know that besides raw nerves, stress can lead to cardiovascular disease? A recent study in the British Medical Journal highlighted the importance of being relaxed at, and satisfied with, your work environment.

To determine the possible link between work stress and risk of death from cardiovascular disease, approximately 800 employees at factories in Finland were evaluated for job strains, salaries and job demands in 1973, and followed for the next 25 years to record deaths from cardiovascular disease. Participants' jobs ranged from heavy foundry work and precision engineering positions to clerical and administrative jobs.

Employees with high job strain, based on responses to a questionnaire designed to evaluate job pressures, were more than twice as likely to die from cardiovascular disease as those with low job strain. Also, employees who felt they had a lower salary or fewer career opportunities relative to the amount of effort they put into their work were approximately 2.5 times more likely to die from cardiovascular disease. Those with high job strain had significantly increased blood cholesterol levels as well.

Cardiovascular disease is the number-one cause of death today. This study shows that having a low-stress job is one way to help prevent it. In addition to promoting your cardiovascular health through not smoking; drinking alcohol only in moderation; eating a low-fat diet; and exercising, tackling other major sources of stress in your life may also need to be addressed. Talk to your doctor of chiropractic about various forms of stress reduction.

Reference: Kivimäki M, Leino-Arjas P, et al. Work stress and risk of cardiovascular mortality: Prospective cohort study of industrial employees. British Medical Journal 2002:325, pp. 857-861.

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