Exercise 'can prevent a cold', a study shows

People who exercise regularly are less likely to get a cold, researchers say.


A study of 1,000 people found that staying active nearly halved the odds of catching cold viruses and, failing that, made the infection less severe.

Experts told the British Journal of Sports Medicine that this could be because exercise helps bolster the immune system to fight off bugs.

But you may not have to actually do much exercise - those who merely think they are fit enjoy the same lower risk.

Adults can expect to suffer two to five colds per year. This latest research suggests there are lifestyle choices you can make to improve your odds of either avoiding them, or suffering too badly from them.

For their study, US researchers asked the healthy volunteers to keep a record of any coughs and sniffles they experienced over a three-month period during the autumn and winter.

The volunteers were also asked to say how frequently in any given week they would do exercise lasting at least 20 minutes and intensive enough to break a sweat.

How should value be defined in spine surgery?

Introduction
In a health care economy with limited resources, providers and consumers of health care services need to be accountable for the end result and the cost of care. The value proposition in health care is an analysis of the benefits of care relative to the direct cost and risk of providing the care. Measurement of benefits and costs is challenging, and a consensus on the measures that encompass the relevant components of the value equation has not been reached. Traditional outcome measures in orthopedics including survival, radiographic outcomes, and disease-specific outcome tools do not adequately reflect the patient’s health care experience, or the impact of an intervention on health-related quality of life. Similarly, measuring cost of care is complex, and may encompass both direct costs of treatment and alternative treatments, and indirect costs including time from work or family role, loss of productivity, and cost of caretakers.

The value equation may vary depending on the perspective of the stakeholder in the health care economy. Hospitals and facilities providing care may measure outcome and costs by factors that affect their short-term, single admission interaction, including length of stay, implant utilization, and complications. Third-party payors may focus on a timeframe that is longer that a single admission, and may include factors in the value equation such as readmission within 90 days, or cost of outpatient care. Hospital- and payor-based quality measures may be misinterpreted as measures of outcome or value. Length of stay, surgical times, compliance with antibiotic or thromboembolic prophylaxis, and perioperative complications are process measures that may be useful to compare hospital and provider performance when appropriately matched and stratified. However, they are not useful in measuring a patient’s health care experience, or the impact of an intervention on long-term health-related quality of life. In fact, a focus on quality and process measures alone may be misleading in the pursuit of value in health care, and may provide incentive for counterproductive care strategies that serve the measurement system rather than the patient.

The health care provider and the patient measure outcome by the impact of an orthopedic intervention on health-related quality of life (HRQoL). The timeframe for the patient and provider is a lifetime, rather than a single admission. As Porter and Teisberg wrote in 2006, the right goal for health care delivery is superior patient value, which is measured at the level of specific medical conditions. Measurement of outcomes of care needs to reflect the patient’s long-term health care experience, and the impact of one intervention compared with alternatives on the patients self-assessment of HRQoL.

Study: Growing Rods for Childhood Scoliosis Treatment Likely to Cause Autofusion

While the use of growing rods has produced efficacy in the control of deformity within the growing spine, the surgery also has high rates of unintended autofusion, which can lead to a difficult and moderate correction, according to an article published in Spine.

Researchers conducted a retrospective review of the medical records and radiographs of young patients who received treatment for scoliosis using growing rods. The researchers collected data on complications, pre- and postoperative Cobb angles, total spine length, correction since initiation of treatment, total number of surgeries and the number of patients found to have autofusion at the time of device removal.

The rate of autofusion in the patients treated with growing rods was 89 percent. The average percent of the Cobb angle was 44 percent, and an average of seven osteotomies per patient were required at the time of definitive fusion due to autofusion.

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Get pillow smart

Thursday, 25 l 03 l 2010 ; Source: Mind Your Body, The StraitsTimes
By Stacey Chia

Investing in the right one can mean the difference between a good night’s sleep and waking up with neck ache. STACEY CHIA reports

Like most people, you probably spend about a third of your time in bed, so investing in the right pillow can be an asset to your health.

The right pillow can help you acquire better sleep and at the same time lower your risk of neck pain and headaches, said Dr Charles Siow, a consultant neurologist and pain specialist at Siow Neurology Headache and Pain Centre.

These aches and pains usually result from a lack of head and neck support from your pillow.

Dr Kenny Pang, the director of Pacific Sleep Centre, explained that the human neck curves slightly forward to take the weight of the head when upright and it is important that this curve is maintained while at rest.

Pillows help ensure that your head is kept in a neutral alignment.

This means that your head should not lean too far forward or backwards.

When buying a pillow, it is important to take into account your sleeping position, said Ms Karen Koh, a senior principal physiotherapist at the Singapore General Hospital (SGH).If you tend to sleep on your back, your pillow should be kept low so that your head and neck is fairly aligned with your body.

If you sleep on your side, you will need a higher pillow. Ms Koh said a higher pillow would be more suitable in maintaining the alignment as it fills the space between your head and the mattress.

Dr Kevin Lau, a chiropractor at Orchard Clinic, advised against sleeping on your stomach as it causes a strain on your back by exaggerating the arch at the base of your spine.

If you are particular about the type of pillow stuffing, Dr Lau recommends buying a memory foam pillow.

Such a pillow is said to reduce pressure points by moulding and adjusting itself as you move throughout the night, thus ensuring that your neck is always supported.

It is, however, not a necessity, he said.

Dr Lim Li Ning, the medical director of the Sleep Neurology and Sleep Centre agreed, adding that there is no good scientific evidence to support the use of one type of pillow over another.

“Most people can sleep on any type of pillow depending on their preference and no special stuffing is needed,” said Dr Lim.

Dr Lau said that pillows to avoid are those stuffed with feathers as they tend to lose firmness over time and become too flat to provide sufficient support.

Dr Pang said: “A large part of what makes a good pillow is personal preference. If the pillow feels comfortable, it is likely to help one become relaxed and thus get a good night’s sleep.”

When is a Placebo Not Really a Placebo? Maybe More Often Than You Think

By Katherine Hobson

When you read in a study that a drug performed better or worse than a placebo, you probably don’t give much thought to whether the ingredients of the placebo had anything to do with the results.

Beatrice Golomb, an associate professor of medicine at the University of California, San Diego, School of Medicine, was researching cholesterol when she came across some older drug studies that actually said what was in the dummy pills — corn oil and olive oil, which of course we know now may have their own cholesterol-fighting properties. Study researchers noticed that the mortality rate in the control group was unexpectedly low, and that the drug being studied showed no improvement over the placebo, but they didn’t connect the dots and hypothesize that the placebo might actually have been helping.

“We hear the word ‘placebo’ and think ‘inert,’” even though there no known substances that are completely physiologically inert, Golomb tells the Health Blog. Even “filler” ingredients that pass through the body without being absorbed can have effects, say, by also preventing other things from being absorbed, she says.

Substances in placebos can also bias findings in favor of the drug being studied, she says, pointing to a study of a drug aimed at helping cancer patients keep weight on. The placebo included lactose, and cancer patients are prone to lactose intolerance, leading to increased GI symptoms in the control group. That may have made the drug look better than it was, she says.

There are no regulations on what goes into placebos, and very few studies actually report the composition of dummy pills or capsules: just 8.2% of the two years’ worth of studies published in four major medical journals that Golomb and colleagues combed through. The results of their research appear in Annals of Internal Medicine. For all placebos, including injections and other treatments, the disclosure rate was 26.7%.

“There’s a lot of attention paid to making them look and taste similar, but there’s very little attention paid to the actual ingredients,” she says. The placebo and nocebo effects (the latter is when a study subject reports ill effects from a supposedly inert dummy pill) get chalked up to patient suggestibility rather than possible physiological effects, she says.

Given that there’s no perfectly inert placebo, Golomb and her co-authors suggest that disclosure is key and call for major journals to lead the way by instituting a reporting requirement. “We can just accept that among the range of things that are never perfect in a clinical trial, placebos are seldom perfect,” she says.

Clarification: Golomb is an associate professor of medicine in the division of general internal medicine at UCSD School of Medicine. A previous version of this post referred imprecisely to her title.

Study: Vitamin B12 may help ward off Alzheimer's

People who consume lots of foods rich in vitamin B12 -- such as fish and fortified cereals -- may be at lower risk of developing Alzheimer's disease than people who take in less of the vitamin, a small study conducted in Finland suggests.

In the study, which was published in Neurology, researchers in Scandinavia analyzed blood samples from 271 individuals ages 65 to 79 who showed no evidence of dementia. The researchers tested for levels of a blood marker of vitamin B12 and for levels of homocysteine, an amino acid that has been linked to an increased risk of Alzheimer's disease (as well as heart disease and stroke).

B vitamins, including B12 and folate, have been shown to help lower homocysteine levels, so high levels of the amino acid suggest low levels of B12.

Over the next seven years, 17 study participants were diagnosed with Alzheimer's disease. The people with the highest levels of homocysteine at the beginning of the study had the greatest risk of developing the disease. In contrast, each unit increase in the marker of vitamin B12 (known as holotranscobalamin) reduced the risk of developing Alzheimer's by 2 percent.

The relationship between vitamin B12 and Alzheimer's risk is "complex," says Dr. Sudha Seshadri, M.D., an associate professor of neurology at the Boston University School of Medicine and the author of an editorial accompanying the study. But, she adds, "B12 levels, particularly holotranscobalamin levels, likely play a contributory role."

The links among Alzheimer's risk, homocysteine, and B12 were more pronounced in older individuals, the study found.

Blood levels of folate, which the researchers also measured, were not related to homocysteine levels or Alzheimer's risk in this study. Folic acid -- a synthetic version of folate found in many supplements and multivitamins -- has been shown to lower homocysteine in previous studies, but its effect on disease risk is disputed.

A National Institutes of Health panel recently concluded that there are no foods or vitamins that definitively prevent the development of Alzheimer's disease, and experts say this study is consistent with the panel's recommendations. "A healthy diet likely remains important," Seshadri says. "The role of supplementation remains unclear."

Maria Carillo, Ph.D., the senior director of medical and scientific relations at the Alzheimer's Association, a nonprofit research and advocacy group, urges caution in interpreting the new findings, especially given that so few study participants developed the disease.

"We do know that vitamin B12 is a huge contributor to lowering homocysteine levels," she says. "Lowering these in general is important for cardiovascular health, and this study strengthens our knowledge about its role in risk for Alzheimer's disease."

Dr. Sam Gandy, M.D., the associate director of the Alzheimer's Disease Research Center at the Mount Sinai School of Medicine, in New York City, says that it may make sense for people to get blood tests to measure their levels of B12 and folate
However, he says, the study findings may not necessarily translate to people outside Scandinavia. And he worries that the results may spur doctors to recommend B12 injections to their patients -- a preventive treatment that he says is unfounded and already overused.

It's still unclear whether increasing your intake of vitamin B12 will help protect you from Alzheimer's, Gandy says. "Good nutrition should minimize the risk of Alzheimer's disease, but we can't say that any specific food has been proven to reduce this risk."

3 Lifestyle Choices Lower Breast Cancer Risk

Women who make healthy lifestyle choices lower their risk of developing invasive breast cancer, regardless of whether they have a family history of the disease, according to a new study.

"We have more awareness of our familial risks, and we may be led to believe there's nothing we can do — that it's fate," said study researcher Dr. Robert Gramling, a professor at the University of Rochester in New York. But his study showed "whether or not you have a family history of the disease, engaging in healthy behaviors is beneficial."

Women with a family history of breast cancer had a higher risk than those without, he said, but both groups lowered their risk by a similar proportion by maintaining a healthy lifestyle.

Specifically, the researchers found women who had a family history of breast cancer lowered their risk by about one-fourth by getting regular exercise, limiting their alcohol intake and maintaining a healthy body weight.

Similarly, women without a family history of the disease who followed a healthy lifestyle lowered their risk by about the same amount, Gramling said.

The researchers based their analysis on data from 85,644 postmenopausal women who participated in the Women's Health Initiative, a long-term study launched in 1991 and conducted by the National Institutes of Health. They considered a woman to have a family history of breast cancer if her mother or sister developed the disease after age 45.

Gramling was surprised, he said, that the findings in the two groups were nearly the same.

"It would have been expected that women without a family history of the disease would have lowered their risk," with a healthy lifestyle, he said. That women with a family history of breast cancer lowered their risk by a nearly-identical amount was more unexpected, he said.

In his medical practice, Gramling told MyHealthNewsDaily, he's encountered women who seem to have come to believe there's nothing they can do to lower their risk, but these results show otherwise.

The researchers defined regular exercise as 20 minutes of moderate or vigorous activity at least five times a week, moderate drinking as fewer than seven drinks per week and a healthy body weight as having a body mass index or BMI (a measure of a person's weight in proportion to her height) between 18.5 and 24.9.

The researchers chose to include exercise, BMI and alcohol intake in their definition of a healthy lifestyle, Gramling said, as opposed to other factors such as eating lots of fruits and vegetables, because these criteria have shown the strongest evidence, based on previous studies, of having an impact on one's breast cancer risk.

"Many of us have some family history of a scary disease," Gramling said, "this shouldn't be a barrier to making healthy choices."

The analysis excluded women who had previously had breast cancer, as well as those with a mother or sister who had developed early-onset breast cancer (before age 45), because it was more likely such women have genetic factors that may put them at an even higher risk.

Vitamin D Deficiency Puts Inflammatory Bowel Disease Patients at Greater Risk of Osteoporosis, Study Finds

ScienceDaily (Oct. 18, 2010) — Vitamin D deficiency puts patients with Inflammatory Bowel Disease (IBD) at greater risk of osteoporosis, osteopenia and an overall higher rate of abnormal bone density, according to the results of a new study unveiled at the American College of Gastroenterology's (ACG) 75th Annual Scientific meeting in San Antonio, Texas.

The study, "Vitamin D Deficiency and Abnormal DEXA Scans in Inflammatory Bowel Disease Patients," found that of the 161 IBD patients in the cohort, reduction in bone density with a diagnosis of osteoporosis or osteopenia was found in 22 percent of these patients, 50 percent of whom were under age 50.

IBD is a fairly common condition affecting more than one million people in the United States. The number of IBD patients is split equally between those with Crohn's disease and those with ulcerative colitis. Children and adults with IBD between the ages of 10 and 70 participated in the prospective study between 2008 and 2010. Vitamin D deficiency was defined as Vitamin D 25‐hydroxy levels less than 30ng/mL. DEXA scan results were considered abnormal if osteopenia and osteoporosis were found.

"IBD patients with an abnormal bone density exam had a significantly higher rate of Vitamin D deficiency than those who had normal DEXA scans," said Dr. Bincy P. Abraham, Assistant Professor of Medicine, Baylor College of Medicine and Director, Baylor Clinic Inflammatory Bowel Disease Program.

Dr. Abraham, who presented the findings, said that previous research has suggested a high prevalence of osteoporosis and overall abnormal bone density in IBD patients that is likely caused by corticosteroid use and excess of inflammatory cytokines, as well as from calcium and Vitamin D malabsorption.

"We aimed to determine the association between Vitamin D deficiency and abnormal bone density in IBD patients," said Dr. Abraham.

According the study, Crohn's disease patients with Vitamin D deficiency were four times more likely to have a higher rate of abnormal bone density exams compared to patients with ulcerative colitis.

"This finding is not surprising since Crohn's disease usually affects the small intestine, which is the part of the gut that absorbs the most nutrients," said Dr. Abraham. "The widespread malabsorption in Crohn's disease does not occur in ulcerative colitis, which involves only the colon."

However, both Crohn's disease and ulcerative colitis patients diagnosed with osteoporosis had a significantly higher rate of Vitamin D deficiency irrespective of prednisone intake, according to the study.

"Abnormal bone density was relatively high among our IBD patients with Vitamin D deficiency irrespective to age, gender or corticosteroid use that would place them at a significantly higher risk of having an abnormal DEXA result," said Dr. Abraham. "It remains important for those caring for IBD patients to evaluate for Vitamin D nutritional deficiency and for its potential consequence of osteopenia or osteoporosis."

Study makes the case for vegetable juice

A study published in Nutrition Journal has suggested that promotion of vegetable juice could be an effective way of increasing vegetable intake among healthy adults.

A diet rich in vegetables has been associated with lower risk of various health disorders including heart disease and yet the authors of the paper said vegetable consumption in the US has fallen over the past decade.

Working from the nutritional science lab at the University of California, Davis, the scientists therefore sought to determine whether drinking vegetable juice is a practical way of closing the gap between dietary recommendations and vegetable intake. The second research aim was to see how vegetable juice affected cardiovascular health.

To fulfill these objectives, a randomised, controlled study was constructed with 90 volunteers who received 0, 8 or 16 fluid ounces of vegetable juice daily for 12 weeks and were asked to follow the Dietary Approaches to Stop Hypertension (DASH) diet.

Daily vegetable servings with and without the vegetable juice were measured along with heart health parameters including blood pressure

Study results

Without the addition of the juice, the results showed that consumption of vegetable juice was below both dietary guidelines and DASH diet recommendations. This was in spite of the education that the participants received about the DASH diet.

Compared to public health recommendations of 4 servings per day, average vegetable intake for all groups, without counting vegetable juice, was 2.6 servings per day after 6 weeks and 2.3 servings per day after 12 weeks.

But once the vegetable juice was counted, the participants were able to reach the daily recommendations.

The authors concluded from these results that vegetable intake, even in an educated, healthy population, remains lower than recommendations and that adding vegetable juice daily was “an effective and acceptable way for healthy adults to close the dietary vegetable gap.”

Heart health impact

Regarding the secondary aim of the study, the authors said that generally parameters associated with heart health did not change over time. However, participants who were pre-hypertensive at the start of the study showed a significant decrease in blood pressure during the intervention period.

The authors called for more research to be done to explore the health impact of drinking vegetable juice among other at risk subgroups.

Funding for the study was provided by the Campbell Soup Company, which makes V8 vegetable juice, and the UC Davis Center for Health and Nutrition Research.

Source: Nutrition Journal
The use of a commercial vegetable juice as a practical means to increase vegetable intake: a randomized controlled trial
Authors: Sonia F Shenoy, Alexandra G Kazaks, Roberta R Holt, Hsin Ju Chen1, Barbara L Winters, Chor San Khoo, Walker SC Poston, C Keith Haddock, Rebecca S Reeves, John P Foreyt, M Eric Gershwin and Carl L Keen