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Back braces may not be best remedy for scoliosis

1 in 1,000 teens has curved spine
By BLYTHE BERNHARD
St. Louis Post-Dispatch
Updated: 11/22/2009 01:37:12 AM PST

Scoliosis screenings in middle schools find thousands of teenagers with curved spines each year.

But treatment for scoliosis hasn't changed in five decades — if the spine is curved to a certain degree, the teenager gets a back brace. Research, however, has not conclusively proved the benefits of the braces.

Some young people who don't wear a brace never have problems and their curves never worsen. Others wear the braces for years and still end up needing back surgery.

A long-term study at Washington University and more than 20 other research centers hopes to figure out why.

"If we can say that bracing doesn't change (the progression of a spinal curve), then it's a treatment regimen that we shouldn't offer," said Dr. Matthew Dobbs, a pediatric orthopedic surgeon and lead investigator at Washington University. "Why do school screenings? Why identify a child with a small curve and put them through years of bracing if it's not going to alter natural curve?"

Half of the participants in the study will receive back braces to wear at least 18 hours a day, and the other half won't wear braces. Both groups will receive regular X-rays to check their spinal curves.

Braces aren't thought to correct the curves but to prevent progression.

"But again we have no data to support that, despite all of us doing this for years and years and years," Dobbs said. "We don't know what the best treatment is; we don't know who's going to progress."

Curves that progress to 50 degrees — about 10percent of cases — are generally thought to require spinal fusion surgery.

Dobbs predicts the research will show that certain patients benefit from bracing and others don't, depending on the type of spinal curve.

Adolescent idiopathic scoliosis occurs in about one in 1,000 teenagers, and is 10 times more common in girls. It can cause back pain, and in severe cases can affect heart and lung function.

The cause is unknown, although Dobbs and other researchers are studying the disorder's genetic factors.

Most states conduct scoliosis screenings by checking students' backs, typically in sixth and eighth grades.

Smaller spinal curves are typically monitored by a doctor, but patients whose curves reach between 20 and 40 degrees are usually recommended for back braces.

If it's found that fewer teens need braces, the research could save money on treatments plus spare some teenagers the psychological stress of wearing a brace. That's why patients in the study are also monitored psychologically to see how they're handling the brace.

"If we see a child in the study who dips on their mood and mental health during the study, we need to figure out what's going on," Dobbs said.

Kelli Sargent of Belleview, Mo., has worn a brace for 20 hours every day since January, after doctors measured a 27-degree curve in her spine.

The seventh-grader hasn't let scoliosis keep her from activities including volleyball and basketball, which she plays without the brace.

But starting middle school this fall was sometimes tough when new kids asked her about the brace.

But "if you just act like it's no big deal," then other kids will too, she said.

Kelli does have a difficult time picking up books from the bottom of her locker and tying her shoes, because the brace can dig into her upper thighs when she bends. And now she has to buy jeans and tops a little bit bigger to fit over the brace.

Otherwise, she's gotten used to it and even nicknamed the brace "Shelly" since it feels like she's wearing a shell.

Study raises concerns about outdoor second-hand smoke

Indoor smoking bans have forced smokers at bars and restaurants onto outdoor patios, but a new University of Georgia study in collaboration with the Centers for Disease Control and Prevention suggests that these outdoor smoking areas might be creating a new health hazard.

The study, thought to be the first to assess levels of a nicotine byproduct known as cotinine in nonsmokers exposed to second-hand smoke outdoors, found levels up to 162 percent greater than in the control group. The results appear in the November issue of the Journal of Occupational and Environmental Hygiene.

"Indoor smoking bans have helped to create more of these outdoor environments where people are exposed to secondhand smoke," said study co-author Luke Naeher, associate professor in the UGA College of Public Health. "We know from our previous study that there are measurable airborne levels of secondhand smoke in these environments, and we know from this study that we can measure internal exposure.

"Secondhand smoke contains several known carcinogens and the current thinking is that there is no safe level of exposure," he added. "So the levels that we are seeing are a potential public health issue."

Athens-Clarke County, Ga., enacted an indoor smoking ban in 2005, providing Naeher and his colleagues and ideal environment for their study. The team recruited 20 non-smoking adults and placed them in one of three environments: outside bars, outside restaurants and, for the control group, outside the UGA main library. Immediately before and after the six-hour study period, the volunteers gave a saliva sample that was tested for levels of cotinine, a byproduct of nicotine and a commonly used marker of tobacco exposure.

The team found an average increase in cotinine of 162 percent for the volunteers stationed at outdoor seating and standing areas at bars, a 102 percent increase for those outside of restaurants and a 16 percent increase for the control group near the library.

Naeher acknowledges that an exposure of six-hours is greater than what an average patron would experience but said that employees can be exposed for even longer periods.

"Anyone who works in that environment -- waitresses, waiters or bouncers -- may be there for up to six hours or longer," Naeher said. "Across the country, a large number of people are occupationally exposed to second-hand smoke in this way."

Studies that measured health outcomes following indoor smoking bans have credited the bans with lowering rates of heart attacks and respiratory illness, but Naeher said that the health impacts of outdoor second-hand smoke are still unknown.

In Naeher's study, cotinine levels in the volunteers at the bar setting saw their levels increase from an average pre-exposure level of 0.069 ng/ml (nanograms per milliliter) to an average post-exposure level of 0.182 ng/ml. The maximum value observed, however, was 0.959 ng/ml. To put that number into context, a widely cited study has determined that an average cotinine level of 0.4 ng/ml increases lung cancer deaths by 1 for every 1,000 people and increases heart disease deaths by 1 for every 100 people.

Still, the researchers caution that it's too early to draw policy conclusions from their findings. Cotinine is a marker of exposure to tobacco, Naeher said, but is not a carcinogen. The team is currently planning a study that would measure levels of a molecule known as NNAL, which is a marker of tobacco exposure and a known carcinogen, in people exposed to second-hand smoke outdoors.

"Our study suggests that there is reason to be concerned about second-hand smoke levels outdoors," said study co-author Gideon St. Helen, who is pursuing his Ph.D. through the university's Interdisciplinary Toxicology Program, "and our findings are an incentive for us to do further studies to see what the effects of those levels are."

Dark Chocolate: The New Antianxiety Drug?

The team of researchers was led by Sunil Kochhar, PhD, who heads the BioAnalytical Science Department at the Nestlé Research Center in Switzerland. He and his colleagues designed the study to see whether eating dark chocolate every day for two weeks could affect the way the body metabolizes stress hormones.

They recruited 30 healthy young people—11 men and 19 women. They tested their anxiety levels and determined that 13 of them tested as “high anxiety” and 17 tested as “low anxiety” on standardized anxiety tests. They gave the volunteers 40 grams of dark chocolate (about an ounce and a half), containing 74% cocoa, every day for two weeks and tested their blood and urine at the beginning and end of the trial.

In the high anxiety group, eating chocolate reduced levels of their stress hormones, and the changes were “biologically significant,” Dr. Kochhar tells me. What’s more, people felt less anxious after munching on chocolate. The findings did not apply to the low anxiety group. “We observed improvement in the anxiety states of subjects immediately after their consumption of chocolate,” he says.
Though the product used in the study, Nestlé Noir Intense, is not available in the United States, Dr. Kochhar tells me that any dark chocolate with a cocoa content of more than 60% is likely to have the same benefits. We know from other chocolate studies that the darker the chocolate (the higher its cocoa content), the more health benefits it offers.

Though the participants consumed about 220 extra calories a day, they didn’t experience measurable changes in blood-sugar levels. But if you’re thinking about regularly eating this much dark chocolate, better trim 220 calories elsewhere, or you could find yourself 23 pounds heavier a year from now.

New antioxidant compounds have been identified in foods such as olive oil, honey and nuts

Scientists at the University of Granada have identified and characterized for the first time different antioxidant compounds from foods such as olive oil, honey, walnuts and a medicinal herb called Teucrium polium. They have used two new techniques, capillary electrophoresis and high resolution liquid chromatography, that have enabled them to identify and quantify a great part of the phenolic compounds contained in these foods.

Functional foods such as olive oil, honey, walnuts and a medicinal herb called Teucrium polium are able to provide different health benefits, so their study and characterization is of great interest. Among the compounds that give such functional characteristics to these foods are phenolic compounds that have generated great interest due to their antioxidant capacity, which endows them with a chemopreventive effect in humans and causes them to have a great influence on the stability of oxidation present in food. Therefore, according to UGR researchers, the "identification and quantification [of these compounds] is a good means for the characterization of foods that contain them."

This work has been performed by Ana María Gómez Caravaca, and directed by Professors Alberto Fernández Gutiérrez and Antonio Segura Carretero, from the Department of Analytical Chemistry at the UGR.

Scientists stress that phenolic compounds have a high antioxidant power and also influence the organoleptic properties of food. Therefore, studies such as the one carried out at the UGR are of great interest because they can determine the amount of these compounds present in foods, and also what compounds are included in every matrix, being able to even determine which one presents a higher activity and its concrete action.

Phenolic Fraction

This research has shown the potential of these techniques for the separation, identification and quantification of the phenolic fraction of vegetable matrices, using appropriate methodologies for this purpose and in the case of olive oil, studying certain technical parameters that affect the phenolic profile.

Information obtained by scientists from the UGR is useful because these compounds have many beneficial health properties. It is widely reported that they have a high antioxidant activity and are able to positively influence the organism by preventing the onset of certain diseases (diabetes, obesity, cardiovascular diseases, cancer, arterial hypertension, etc.).

The laboratory analyses were performed using the separation techniques of capillary electrophoresis and HPLC coupled to different types of detectors (UV-Vis, MS, NMR). Capillary electrophoresis connected to mass spectrometry proved to be innovative, as it had never before been used for the analysis of the phenolic fraction of honey and walnut. Moreover, these methods allowed identification of some phenolic compounds in these foods for the first time - a point of great interest for its possible antioxidant activity in the phenolic fraction.

Alcohol 'protects men's hearts'

Drinking alcohol every day cuts the risk of heart disease in men by more than a third, a major study suggests.

The Spanish research involving more than 15,500 men and 26,000 women found large quantities of alcohol could be even more beneficial for men.

Female drinkers did not benefit to the same extent, the study in Heart found.

Experts are critical, warning heavy drinking can increase the risk of other diseases, with alcohol responsible for 1.8 million deaths globally per year.

The study was conducted in Spain, a country with relatively high rates of alcohol consumption and low rates of coronary heart disease.

The research involved men and women aged between 29 and 69, who were asked to document their lifetime drinking habits and followed for 10 years.

Crucially the research team claim to have eliminated the "sick abstainers" risk by differentiating between those who had never drunk and those whom ill-health had forced to quit. This has been used in the past to explain fewer heart-related deaths among drinkers on the basis that those who are unhealthy to start with are less likely to drink.

Good cholesterol

The researchers, led by the Basque Public Health Department, placed the participants into six categories - from never having drunk to drinking more than 90g of alcohol each day. This would be the equivalent of consuming about eight bottles of wine a week, or 28 pints of lager.

For those drinking little - less than a shot of vodka a day for instance - the risk was reduced by 35%. And for those who drank anything from three shots to more than 11 shots each day, the risk worked out an average of 50% less.

The same benefits were not seen in women, who suffer fewer heart problems than men to start with. Researchers speculated this difference could be down to the fact that women process alcohol differently, and that female hormones protect against the disease in younger age groups.

The type of alcohol drunk did not seem to make a difference, but protection was greater for those drinking moderate to high amounts of varied drinks.

The exact mechanisms are as yet unclear, but it is known that alcohol helps to raise high-density lipoproteins, sometimes known as good cholesterol, which helps stop so-called bad cholesterol from building up in the arteries.

'Binge-drinking'

UK experts said the findings should be treated with caution because they do not take into account ill-health from a range of other diseases caused by excess drinking.

"Whilst moderate alcohol intake can lower the risk of having a heart attack, coronary heart disease is just one type of heart disease. Cardiomyopathy, a disease of the heart muscle, is associated with high alcohol intake and can lead to a poor quality of life and premature death," said the British Heart Foundation's senior cardiac nurse, Cathy Ross.

"The heart is just one of many organs in the body. While alcohol could offer limited protection to one organ, abuse of it can damage the heart and other organs such as the liver, pancreas and brain."

The Stroke Association meanwhile noted that overall, evidence indicated that people who regularly consumed a large amount of alcohol had a three-fold increased risk of stroke.

"Six units within six hours is considered 'binge-drinking' and anyone indulging in regular 'binge-drinking' increases their risk of stroke greatly," said research officer Joanne Murphy.

Public health specialists warned no-one should be encouraged to drink more as a result of this study.

"The relationship between alcohol and heart disease remains controversial," said Professor Martin McKee of the London School of Hygiene and Tropical Medicine.

"While there is good evidence that moderate consumption is protective in people who are at substantial risk of heart disease - which excludes most people under the age of 40 - we also know that most people underestimate how much they drink. This paper adds to the existing literature but should not be considered as definitive. "

In the UK, the recommendation is no more than two to three units of alcohol a day for women - the equivalent of one standard glass of wine - and three to four units for men.

The British Liver Trust said: "There have been several studies suggesting that small amounts of alcohol can reduce the risk of coronary heart disease in men over the age of 40.

"But these are often misinterpreted by people looking for a health reason to consume alcohol.

"If you want to look after your health, stay within the limits of no more than 3-4 units a day for men or 2-3 for women and aim to give yourself at least two days off alcohol a week."

Professor Alan Maryon-Davis, president of the UK Faculty of Public Health, agreed that the message from this study was not clear: "At the end of the day, you're juggling different risks and benefits, maybe helping your heart or maybe damaging your brain and liver.

"The simple message is moderation.

"Stick to the guidelines, and you won't go far wrong."

Strength training can help people with lung disease

NEW YORK (Reuters Health) - People with chronic lung disease like emphysema or bronchitis can strengthen their arms and legs with resistance training, and this strength may help them perform everyday tasks more easily, a new review of 18 studies confirms.

Rehabilitation programs are intended to help people with chronic obstructive pulmonary disease (COPD), who often experience loss of muscle strength and fatigue, learn to exercise safely, Dr. Simone D. O'Shea of Charles Sturt University in Albury, New South Wales, Australia and her colleagues note in their report in the medical journal Chest.

There has been a growing emphasis in such programs on progressive resistance training, in which a person moves increasingly heavy weights to improve their strength, the researchers add. They undertook a review of the literature on resistance training for COPD patients to update current understanding of the benefits and risks.

Small but significant increases in strength of arm and leg muscles were seen after short-term progressive resistance training, O'Shea and her colleagues report, but the two trials evaluating whether patients added muscle mass and reduced their body fat were inconclusive.

Five of the studies included in their analysis looked at cycling endurance. When compared to no exercise at all, cycling offered some endurance benefit, but aerobic training was more beneficial, and it wasn't clear whether combining the two types of exercise offered additional benefit.

The four trials that looked at measures of daily function showed benefits for stair climbing and the speed at which a person was able to rise from a chair, and these benefits were greater than those seen with aerobic training. But the design of these trials meant they could have overestimated the benefits of exercise, O'Shea and her colleagues say.

Often, the researchers note, COPD patients don't have access to weight machines, so it's important to determine if home exercises with resistance bands, free weights, and other simple equipment could be helpful.

"Long-term strategies for maintaining health in COPD patients are essential; therefore, an examination of longer-term outcomes, suitable maintenance dose exercise prescriptions, and long-term adherence is warranted," they conclude.