Preying on the Elderly

More than 90% of people over age 65 may use at least one medication each week, and up to 40% may use five or more drugs per week. With so many seniors taking medications (or combinations of multiple medications), errors in prescription or administration are inevitable. Although the majority of these medication errors do not cause injury, extensive drug use by the elderly generates a significant number of deadly reactions or side-effects.

Based on data gathered over a one-year period from almost 30,000 Medicare patients ages 65 or older, potential adverse drug events (ADEs) were compiled from multiple sources: health-care provider reports; hospital discharge summaries; emergency department notes; administrative incident reports; etc. Adverse reactions occurring in the hospital setting were not evaluated in this study from the Journal of the American Medical Association.

The overall rate of adverse drug events was approximately 50 cases per 1,000 patients over one year; over a fourth of the ADEs were considered preventable. More than one-third of the reactions were deemed fatal, serious or life-threatening (an even higher percentage of these most-dangerous events - 42% - were preventable). Errors most often occurred in the prescribing or monitoring stages. Cardiovascular medications and antibiotics were not only the most-prescribed medication classes, but also the most likely to be linked to an ADE.

If these findings are generalized to all Medicare patients, nearly 2 million ADEs - a half-million of which are preventable and 180,000 of which are fatal or life-threatening - may be suffered annually in the U.S. Complicated medication regimens can confuse seniors and the family members who assist them. Also, rushed appointments with busy doctors can lead to mistakes in prescription and communication. Be absolutely certain that each and every medication you take is considered safe, especially when combined with other prescriptions. Taking the fewest drugs possible is the best way to avoid an accidental reaction.

Reference: Gurwitz JH, Field TS, et al. Incidence and preventability of adverse drug events among older persons in the ambulatory setting. Journal of the American Medical Association 2003:289(9), pp. 1107-1116.

For more senior health information click here.

Prone to Problems

Reports of sudden infant death syndrome (SIDS) in the U.S. have declined dramatically since measures in the 1994 National Institute of Child and Health and Human Development-sponsored "Back to Sleep" campaign convinced most parents to place their babies on their backs for sleeping. Persistent concerns of possible dangers (e.g., choking on vomit) have prevented some parents from adopting recommendations to place their infant on its back for sleeping, however; one in 10 infants is still placed on its stomach, or in a prone position, to sleep. Are these fears realistic, or merely myths?

Information on almost 4,000 infants that always were placed in the same position for sleep (back, front or side) was analyzed in this study from the Archives of Pediatrics and Adolescent Medicine. At one, three and six months of age, researchers asked the mother about the presence of symptoms like coughing, fever, trouble breathing or sleeping, and vomiting.

Infants placed to sleep on their backs were not at an increased risk for health problems. In fact, they were less likely to have fevers, stuffy noses or ear infections than infants placed to sleep on their stomachs or sides, and reportedly slept better. No back-sleepers were noted to choke on their vomit. Also, no symptoms were significantly more common in infants sleeping on their backs or sides than in infants sleeping prone.

Not only does placing your baby to sleep on his or her back reduce the chances for SIDS, it also appears to reduce the risk for other health problems found in infants. Research is more reliable than hearsay advice; be sure to always place your baby on his or her back at naptime.

Reference: Hunt CE, Lesko SM, et al. Infant sleep position and associated health outcomes. Archives of Pediatrics and Adolescent Medicine 2003:157(5), pp. 469-474.

For more information on children's health click here.

Unbalanced Reporting

Patients often name the media, along with doctors and pharmacists, as a primary source of information about new prescription medications. One of the primary goals of news media is to protect the public good by providing fair, balanced and accurate information. Minimally, news reports on new drugs should list both the harms and benefits, along with their role in treating a condition.

In Canada, where more money is collectively spent on prescription drugs than doctor visits, a study in the Canadian Medical Association Journal evaluated newspaper articles in 2000 reporting on new drug benefits and risks, and other aspects related to fair and balanced reporting. Researchers looked at news coverage of five prescription drugs launched between 1996 and 2001 that were prominently named in the media (Lipitor, Celebrex, Tamiflu, Aricept and Evista). Articles that named at least one benefit or harm for any of these medications in any of Canada's 24 largest daily newspapers were considered.

Almost 200 newspaper articles reported at least one benefit or harm of one of these five drugs in 2000. Every article mentioned a minimum of one benefit, but over two-thirds did not mention any possible side-effects or risks from taking these drugs. In fact, drug benefits were five times more likely to be mentioned in articles than harmful side-effects. And merely 4% of the articles mentioned contraindications to drugs, or significant reasons not to take them - information needed before safely deciding to take a medication.

This study highlights the concern that media reports on new drugs may be incomplete and present an unbalanced view of medications, making people decide they need a particular drug for their condition based on minimal information. Although this study was conducted in Canada, for comparison, a similar study conducted in the U.S. showed that over half of media reports mentioning drug benefits listed no potential harmful side-effects.

Don't formulate opinions about the value of a new medication based on the media - only your physician is qualified to determine which prescription drugs are safe and effective. Your chiropractor is also an important source of information, particularly when it comes to proposing nonpharmaceutical options for dealing with your condition.

Reference: Cassels A, Hughes MA, et al. Drugs in the news: An analysis of Canadian newspaper coverage of new prescription drugs. Canadian Medical Association Journal 2003:168(9), pp. 1133-1137.

To read about the many risks associated with prescription and over-the-counter drugs click here

More Good News for Wine Drinkers

If you consume alcohol on a regular basis, here is some information you'll want to know. Past research has shown a link between alcohol intake and colorectal cancer. According to a recent study in the journal Gut, however, that risk diminishes when the alcohol consumed is wine, as opposed to beer and other spirits.

Researchers in Denmark conducted a study of approximately 30,000 men and women between the ages of 23 and 95 over a period of nearly 15 years. The amount and types of alcohol consumed were determined at the beginning of the study period, and cases of colon and rectal cancer recorded in the Danish Cancer Registry were used to determine possible relationships to drinking alcohol.

Those who consumed over 14 drinks per week in the form of beer and spirits only were over three times more likely to develop rectal cancer than nondrinkers. On the other hand, people who drank the same amount of alcohol, but reporting one-third of their drinks to be wine, were less than twice as likely to develop this form of cancer. The researchers also found that people who drank excessively (more than 41 alcoholic beverages per week) had twice the risk of developing rectal cancer than nondrinkers, regardless of the type of alcohol drank.

This study offers two important points to alcohol drinkers: First, drinking any alcohol appears to increase a person's risk for rectal cancer. The more you drink, the higher your risk for cancer. Second, if you do drink, you may want to consider sticking to wine. The powerful antioxidants in wine appear to blunt some of the harmful effects of alcohol.

Reference: Pedersen A, Johansen C, Grønbaek M. Relations between amount and type of alcohol and colon and rectal cancer in a Danish population based cohort study. Gut 2003:52(6), pp. 861-867.

For more information on nutrition click here.

Take the Stress Out of Repetitive Stress Injuries

Repetitive strain injuries (RSIs) are among the most common work-related illnesses in the U.S., affecting hundreds of thousands of people each year. Frequently associated with computer use, RSIs can cause pain and discomfort in the neck, back, arms and hands. They are also quite expensive: The Department of Labor estimates that carpal tunnel syndrome and other repetitive-strain disorders cost more than $20 billion a year in time lost from work and worker's compensation.

A series of experiments published in a recent issue of Applied Psychophysiology and Biofeedback show how working on a computer can alter a person's posture breathing patterns, and how proper training can reduce the incidence of RSI in the workplace. In the first study, 18 computer users were hooked up to a monitoring system that measured their muscle tension and breathing rate while working at a PC. The monitoring session found that when users became more immersed in their work, they tended to elevate the shoulders and breathe faster. Muscle tension in all of the muscle groups increased, especially the muscles in the upper back opposite the hand that used a computer mouse. In addition, users often continued working without taking breaks, which would have relieved some of the tension and reduced the risk of developing a repetitive strain injury.

In a separate experiment, the researchers trained a group of computer users in muscle relaxation and breathing techniques, then compared them with a group of workers who did not receive training. After three training sessions, the computer users reported significantly decreased symptoms of repetitive strain compared to the untrained workers. Trained users relaxed their necks and shoulders more often, breathed from the diaphragm rather than the chest, and took more frequent breaks.

If you use a computer, there are several steps you can take to reduce, or even eliminate, the risk of repetitive strain injury. Take regular breaks and stretches. Organize your office equipment so it is ergonomically correct. And of course, talk to your doctor about specific exercises and other habits you can adopt to keep RSIs out of your workspace.

Reference: Peper E, Wilson V, Gibney K. The integration of electromyography (SEMG) at the workstation: assessment, treatment and prevention of repetitive strain injury (RSI). Applied Psychophysiology and Biofeedback June 2003.

Repetitive stress injuries are one of many injuries affecting the musculoskeletal system.

To learn more about musculoskeletal health, click here.

Oh, My Aching Backpack!

We're all familiar with the term "growing pains," right? Health care providers use this term to describe the aches and pains children experience in their joints and limbs as a result of rapid growth. Previous research has shown that up to 50 percent of all 15- and 16-year olds experience some sort of back pain, but can all of this be due to the growth process? A new study attributes the incidence of adolescent back pain not to growing pains, but something entirely different: backpacks.

In this study, 1,126 children between the ages of 12 and 18 were asked about their health, activities and backpack use. A child was classified as suffering from back pain if he or she met one or more of the following criteria in the preceding month: neck or back pain that interfered with school or leisure-time activities; pain in the back or neck with a severity rating of 2 or more (on a scale of 0 to 10); a visit to a physician or therapist for neck or back pain; or being exempted from physical education or sports because of neck or back pain.

Based on the above criteria, 74.4 percent of the children surveyed were classified as having back pain. Among the key points:

Adolescents with back pain displayed "significantly poorer" general health scores; performed fewer physical activities; and had more general bodily pain.

Significant relationships drawn between the incidence of lower back pain and both the weight of the backpack and the amount of time the backpack was used. Some backpacks were inordinately heavy; 18.9 percent of the students carried backpacks that, when full weight more than 20 percent of the student's body weight.

Females were more than twice as likely to experience back pain compared to males.

Additionally, girls who carried a purse along with their backpack had significantly more back pain than girls who did not.

As the results of this study show, backpacks appear to be a leading contributor to back pain in adolescents. If you have a young child, check his or her backpack to ensure that it isn't too heavy. You may also want to consider buying your child a wheeled backpack, which can take a tremendous amount of stress off his or her back. And of course, regular visits to your local chiropractor can do a world of good, too!

Reference: Sheir-Neiss G, Kruse R, Rahman T, et al. The association of backpack use and back pain in adolescents. Spine, May 1, 2003: Volume 28, Number 9, pp.922-930.

For more information on back pain (and ways to avoid it!), click here.

Obesity May Contribute to Cervical Cancer

Obesity has been linked to a multitude of health problems, from increased blood pressure and heart disease to sleep apnea, breathing problems and gallstones. In women, excessive fat has been shown to increase levels of estrogen, which can lead to the development of endometrial cancer, a condition that affects the lining of the uterus.

Height and weight can also contribute to endometrial cancer, and they are risk factors for cervical cancer, whereas the role obesity plays in cervical cancer remains uncertain. To test whether obesity may lead to an increased risk of developing cervical cancer, investigators evaluated at a variety of potential risk factors in 560 women: 124 diagnosed with adenocarcinoma (a type of cervical cancer linked specifically to high estrogen levels); 139 with squamous-cell cervical cancer; and 307 women who did not have cancer. Among their findings:

Women who were heavier, had a high body mass index (BMI) or had fat that was concentrated in the midsection were far more likely to have adenocarcinoma.

Women with a BMI greater than 30 (considered clinically obese) and "apple-shaped" women (those with high waist-to-hip ratios) were both twice as likely to develop adenocarcinoma.

Women with high BMIs had more advanced stages of adenocarcinoma when they were diagnosed with cancer, even if they received regular Pap smears.

Although larger studies are needed, these results support the theory that obesity, like height and weight, may lead to the onset of some types of cervical cancer. Women who are obese should speak with their physician about ways to lose weight and the benefits of a healthy, low-fat diet, and receive more frequent Pap smears to detect the early signs of adenocarcinoma.

Reference: Lacey JV, Swanson CA, Briton LA, et al. Obesity as a potential risk factor for adenocarcinomas and squamous cell carcinomas of the uterine cervix. Cancer Aug. 15, 2003: Volume 98, Number 4, pp.814-821.

To learn more about women's health issues, click here.

Something Fishy About Protecting the Heart

For years, scientists have examined the link between fatty fish and reduced risk of death from heart attack. Most research has pointed to the high levels of fatty acids in certain fish as one of the secrets to maintaining a healthy heart, but no one has been able to figure out exactly how these acids work.

New research from France has shed more light on the relationship between fatty fish and heart health. In this study published in Circulation (a journal of the American Heart Association), researchers tracked 9,700 men ages of 50- 59 who had no signs of heart disease, for two years. Among the factors the researchers documented were heart rate; blood pressure; cholesterol levels; and diet - including how often the men ate fish. A subgroup of 407 men also underwent a series of tests to determine levels of fatty acids in their blood.

Men who ate fish more than twice a week had an average heartbeat of 65.5 beats per minute, compared to 67.5 beats per minute for men who ate fish less than once a week. While it may not seem like a big difference, consider that in the course of a year, based on the above figures, the heart of a person who regularly ate fish would beat 1,051,200 times less than the heart of person who didn't eat fish regularly.

Eating fish had other benefits as well. Regular fish-eaters had higher levels of fatty acids in the blood, which help protect the heart. They also had lower triglyceride levels and lower blood pressure, and their HDL, or "good," cholesterol levels were higher than men who ate less fish.

If fish isn't already a regular part of your diet, now may be a good time to start including it. Fatty fish, such as salmon, mackerel and herring, contain high levels of omega-3 fatty acids, so they may offer the best protection against heart problems. Your doctor of chiropractic can help you draw up a diet that includes more servings of fish, and can discuss other ways of keeping your heart beating strong year after year.

Reference: Dallongeville J, Yarnell J, Ducimetiere P, et al. Fish consumption is associated with lower heart rates. Circulation Aug. 19, 2003; Volume108, pp.820-825.

For more information on the benefits of nutrition, click here.