March 18, 2003 Research Update

James Bogash, D.C. Mesa, AZ
info@lifecarechiropractic.com
www.lifecarechiropractic.com

Breastfeeding & Risk of Hospitalization for Respiratory Disease in Infancy

Okay...how much more money do we want to spend on determining that breast milk is superior to formula? Pick a benefit, pick a long term benefit and breastfeeding is superior. Breastfeeding and the Risk of Hospitalization for Respiratory Disease in Infancy: A Meta-analysis

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Development in pain and neurologic complaints after whiplash

I realize that this article is a little off the usual topic, but I am a DC after all. Basically, there has been many attempts to minimize the injuries sustained during a whiplash. Well, any physician that treats these types of injuries knows that they are real and patients do experience both short term and long term effects. 74% of whiplash patients had pain 1 year later. Personally, I think that number reflects poor care following the accident.... Neurology -- Abstracts: Kasch et al. 60 (5): 743

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L monocytogenes infection as complication of TNF alpha blockade

I know that, to many patients with autoimmune conditions like Crohns and RA, these drugs can work miracles. However, many (if not most) of the patients on these drugs have never been given a strong trial of lifestyle changes (lowering of insulin levels, obesity reduction, increased intakes of fish oils and fruits and veggies) to affect their diseases. The newest type of drug to manage these conditions are TNF alpha blockers. However, TNF alpha is an essential aspect of the immune system and is needed to fight off infections and cancer. I know that, as these drugs are on the market longer and longer, we will begin to see some of the truly damaging effects of TNF alpha lowering. Article Abstract

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Homocysteine and Risk for Congestive Heart Failure

Well, while mainstream medicine is deciding whether homocysteine is really a risk factor and if it is, whether it is cost effective to test, patients are dropping left and right from heart disease due in part to elevated homocysteine. Do yourself a favor--insist on having your homocysteine and hsCRP levels check to more fully assess your cardiovascular risk next time you're getting blood drawn. If your doctor refuses, change doctors--this one hasn't cracked a medical journal in years. JAMA -- Abstracts: Vasan et al. 289 (10): 1251

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A Primer on Early Childhood Obesity and Parental Influence

This one always gets me. Overweight children and overweight dogs are 100% the fault of the parent. Well...maybe 96%. Parents need to educate themselves on the difference between high quality foods and junk. Poor nutritional foods are pervasive and the marketing is effective at getting parents to think the food is healthy. Sunny Delight with real fruit juice (10% with the rest as sugar), Ovaltine with all 2 essential nutrients (and the rest is non-essential chemicals and sugar). Pediatric Nursing Journal - Current Content

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Reflux esophagitis in coeliac disease: beneficial effect of a gluten free diet

No need to make lifestyle changes like avoiding wheat--just take acid suppressive therapy. After all, acid is not important for digestion of proteins, activation of multiple digestive enzymes, activation of multiple anti-cancer compounds in foods, absorption of nutrients like B12, iron and certain types of calcium and sterilization of bacteria--so what's the big idea of shutting it down? On a more common sense note, a trial of a wheat free diet is a very good idea for any patients with reflux. Many of these patients also respond well to addtion of stomach acid, contrary to popular (but wrong...) belief. Gut -- Abstracts: Cuomo et al. 52 (4): 514

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Cardiac Benefits of Fish Consumption May Depend on the Type of Fish Meal Consumed

Wow!! Here's another incredible research finding. Fish 3x or more per week lowered risk 49% of total IHD death and 58% lower risk of arrhythmic IHD . Fried and breaded fish sandwiches, on the other hand, seemed to increase risk slightly. My gosh...who agrees to pay for these studies!!?? Circulation -- Abstracts: Mozaffarian et al. 107 (10): 1372

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Effects of Estrogen plus Progestin on Health-Related Quality of Life

Sorry to be in the negative mode, but the subject of HRT is becoming so dead in the water that it is laughable. The drug companies are so desperately scrambling for a use for this multi billion dollar industry and keep striking out left and right. He we see no impact on sleep disturbance, physical functioning, and bodily pain. So..no benefits, but it does increase risk of gallstones, breast cancer, endometrial cancer and heart disease. Why the hell is this product still on the market? If this was a natural product it would've been yanked off the shelves faster than tryptophan in the eighties!! NEJM -- Effects of Estrogen plus Progestin on Health-Related Quality of Life

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Epidural Analgesia and Severe Perineal Laceration

While I'm never going to have a baby, I strongly question the rampant use of epidurals for pregnancy. They are accepted as safe with no effects on the baby and yet the evidence speaks otherwise. Ever heard those war stories of perineal damage leading to severe pain, painful intercourse and incontinence?

J Am Board Fam Pract 16(1):1-6, 2003 This study assessed whether epidural analgesia was an independent risk factor for severe perineal laceration. Methods: A retrospective cohort study analyzed 2,759 patients at St. Francis Regional Medical Center who had vertex, spontaneous or induced, singleton, live, vaginal deliveries of neonates of at least 36 weeks' gestation. Patients with diabetes or severe cardiac disease were excluded. Outcomes measured were third- or fourth-degree perineal lacerations. Results: Overall rate of severe perineal laceration was 6.38% (n = 176). Epidural analgesia was given to 634 (22.98%) women. Among women who had epidural analgesia, 10.25% (65 of 634) had severe perineal lacerations compared with 5.22% (111 of 2,125) of the women who did not have epidural analgesia. After controlling for major variables in a logistic regression analysis, epidural analgesia remained a significant predictor of severe perineal injury (odds ratio [OR] = 1.528, 95% confidence interval [CI] = 1.092-2.137). When instrument use was included in the model, epidural analgesia was no longer a statistically significant, independent predictor of severe perineal injury. (OR = 1.287, 95% CI = 0.907-1.826). Instrument use was found to be a strong predictor of severe laceration (OR = 3.245, 95% CI = 2.162-4.869). A logistic regression model examining predictors of instrument use found that epidural analgesia does significantly predict instrument use (OR = 3.01, 95% CI = 2.225-4.075). Conclusion: Epidural analgesia is associated with an increase in severe perineal trauma as a result of an associated threefold increased risk of instrument use. Instrument use in vaginal delivery more than triples the risk of severe perineal laceration.

Effect of Epidural Anesthesia on Breast-Feeding of Healthy Newborns

Their articles...not mine!!

J Am Board Fam Pract 16(1):7-13, 2003 Background: Epidural anesthesia is commonly administered to laboring women. Some studies have suggested that epidural anesthesia might inhibit breast-feeding. This study explores the association between labor epidural anesthesia and early breast-feeding success. Methods: Standardized records of mother-baby dyads representing 115 consecutive healthy, full-term, breast-feeding newborns delivered vaginally of mothers receiving epidural anesthesia were analyzed and compared with 116 newborns not exposed to maternal epidural anesthesia. Primary outcome was two successful breast-feeding encounters by 24 hours of age, as defined by a LATCH breast-feeding assessment score of 7 or more of 10 and a latch score of 2/2. Means were compared with the Kruskal-Wallis test. Categorical data were compared using the Mantel-Haenszel chi-square test. Stratified analysis of potentially confounding variables was performed using Mantel-Haenszel weighted odd ratios (OR) and chi-square for evaluation of interaction. Results: Both epidural and nonepidural anesthesia groups were similar except maternal nulliparity was more common in the epidural anesthesia group. Two successful breast-feedings within 24 hours of age were achieved by 69.6% of mother-baby units that had had epidural anesthesia compared with 81.0% of mother-baby units that had not (odds ratio [OR] 0.53, P = .04). These relations remained after stratification (weighted odds ratios in parenthesis) based on maternal age (0.52), parity (0.58), narcotics use in labor (0.49), and first breast-feeding within 1 hour (0.49). Babies of mothers who had had epidural anesthesia were significantly more likely to receive a bottle supplement while hospitalized (OR 2.63; P < .001) despite mothers exposed to epidural anesthesia showing a trend toward being more likely to attempt breast-feeding in the 1 hour (OR 1.66; P = .06). Mothers who had epidural anesthesia and who did not breast-feed within 1 hour were at high risk for having their babies receive bottle supplementation (OR 6.27). Conclusions: Labor epidural anesthesia had a negative impact on breast-feeding in the first 24 hours of life even though it did not inhibit the percentage of breast-feeding attempts in the first hour. Further studies are needed to elucidate the exact nature of this association.