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Vitamin D and Calcium: A Systematic Review of Health Outcomes (Update)

September 18, 2014 Comments off

Vitamin D and Calcium: A Systematic Review of Health Outcomes (Update)
Source: Agency for Healthcare Research and Quality

In 2009, the Tufts Evidence-based Practice Center (EPC) conducted a systematic review of the scientific literature on vitamin D and calcium intakes as related to status indicators and health outcomes. The purpose of this report was to guide the nutrition recommendations of the Institute of Medicine (IOM) Dietary Reference Intakes (DRIs).

In September 2007, the IOM held a conference to examine the lessons learned from developing DRIs, and future challenges and best practices for developing DRIs. The conference concluded that systematic reviews would enhance the transparency and rigor of DRI committee deliberations. With this framework in mind, the Agency for Healthcare Research and Quality (AHRQ) EPC program invited the Tufts EPC to perform the systematic review of vitamin D and calcium.

In May and September 2007, two conferences were held on the effect of vitamin D on health. Subsequently, a working group of scientists from the United States and Canadian Governments convened to determine whether enough new research had been published since the 1997 vitamin D DRI to justify an update. Upon reviewing the conference proceedings and results from a recent systematic review, the group concluded that sufficient new data beyond bone health had been published. Areas of possible relevance included new data on bone health for several of the life stage groups, reports on potential adverse effects, dose-response relations between intakes and circulating 25-hydroxyvitamin D (25(OH)D) concentrations and between 25(OH)D concentrations, and several health outcomes. Throughout the remainder of this summary and in the report, new text is presented in boldface type.

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Cigna: 20 Years of Disability Claims Data Reveal Emerging Workforce Productivity Challenges

June 23, 2014 Comments off

Cigna: 20 Years of Disability Claims Data Reveal Emerging Workforce Productivity Challenges
Source: Cigna

An analysis of 20 years of Cigna’s short-term disability claims shows that absence related to obesity, treatment for skin cancer and herniated disc surgery increased significantly from 1993 to 2012, while a reduction in absences related to depression coupled with an increase in prescribed anti-depressants may signal a hidden problem. These and other health trends identified by the analysis are important for employers to understand when structuring an integrated wellness and absence management program to improve workforce productivity.

Five-Week Outcomes From a Dosing Trial of Therapeutic Massage for Chronic Neck Pain

June 20, 2014 Comments off

Five-Week Outcomes From a Dosing Trial of Therapeutic Massage for Chronic Neck Pain
Source: Annals of Family Medicine

PURPOSE
This trial was designed to evaluate the optimal dose of massage for individuals with chronic neck pain.

METHODS
We recruited 228 individuals with chronic nonspecific neck pain from an integrated health care system and the general population, and randomized them to 5 groups receiving various doses of massage (a 4-week course consisting of 30-minute visits 2 or 3 times weekly or 60-minute visits 1, 2, or 3 times weekly) or to a single control group (a 4-week period on a wait list). We assessed neck-related dysfunction with the Neck Disability Index (range, 0–50 points) and pain intensity with a numerical rating scale (range, 0–10 points) at baseline and 5 weeks. We used log-linear regression to assess the likelihood of clinically meaningful improvement in neck-related dysfunction (≥5 points on Neck Disability Index) or pain intensity (≥30% improvement) by treatment group.

RESULTS
After adjustment for baseline age, outcome measures, and imbalanced covariates, 30-minute treatments were not significantly better than the wait list control condition in terms of achieving a clinically meaningful improvement in neck dysfunction or pain, regardless of the frequency of treatments. In contrast, 60-minute treatments 2 and 3 times weekly significantly increased the likelihood of such improvement compared with the control condition in terms of both neck dysfunction (relative risk = 3.41 and 4.98, P = .04 and .005, respectively) and pain intensity (relative risk = 2.30 and 2.73; P = .007 and .001, respectively).

CONCLUSIONS
After 4 weeks of treatment, we found multiple 60-minute massages per week more effective than fewer or shorter sessions for individuals with chronic neck pain. Clinicians recommending massage and researchers studying this therapy should ensure that patients receive a likely effective dose of treatment.

Helmet therapy in infants with positional skull deformation: randomised controlled trial

May 2, 2014 Comments off

Helmet therapy in infants with positional skull deformation: randomised controlled trial
Source: British Medical Journal

Objective
To determine the effectiveness of helmet therapy for positional skull deformation compared with the natural course of the condition in infants aged 5-6 months.

Design
Pragmatic, single blinded, randomised controlled trial (HEADS, HElmet therapy Assessment in Deformed Skulls) nested in a prospective cohort study.

Setting
29 paediatric physiotherapy practices; helmet therapy was administered at four specialised centres.

Participants
84 infants aged 5 to 6 months with moderate to severe skull deformation, who were born after 36 weeks of gestation and had no muscular torticollis, craniosynostosis, or dysmorphic features. Participants were randomly assigned to helmet therapy (n=42) or to natural course of the condition (n=42) according to a randomisation plan with blocks of eight.

Interventions
Six months of helmet therapy compared with the natural course of skull deformation. In both trial arms parents were asked to avoid any (additional) treatment for the skull deformation.

Main outcome measures
The primary outcome was change in skull shape from baseline to 24 months of age assessed using plagiocephalometry (anthropometric measurement instrument). Change scores for plagiocephaly (oblique diameter difference index) and brachycephaly (cranioproportional index) were each included in an analysis of covariance, using baseline values as the covariate. Secondary outcomes were ear deviation, facial asymmetry, occipital lift, and motor development in the infant, quality of life (infant and parent measures), and parental satisfaction and anxiety. Baseline measurements were performed in infants aged between 5 and 6 months, with follow-up measurements at 8, 12, and 24 months. Primary outcome assessment at 24 months was blinded.

Results
The change score for both plagiocephaly and brachycephaly was equal between the helmet therapy and natural course groups, with a mean difference of −0.2 (95% confidence interval −1.6 to 1.2, P=0.80) and 0.2 (−1.7 to 2.2, P=0.81), respectively. Full recovery was achieved in 10 of 39 (26%) participants in the helmet therapy group and 9 of 40 (23%) participants in the natural course group (odds ratio 1.2, 95% confidence interval 0.4 to 3.3, P=0.74). All parents reported one or more side effects.

Conclusions
Based on the equal effectiveness of helmet therapy and skull deformation following its natural course, high prevalence of side effects, and high costs associated with helmet therapy, we discourage the use of a helmet as a standard treatment for healthy infants with moderate to severe skull deformation.

NCCAM Clinical Digest: Chronic Low-Back Pain and Complementary Health Approaches

April 4, 2014 Comments off

NCCAM Clinical Digest: Chronic Low-Back Pain and Complementary Health Approaches
Source: National Center for Complementary and Alternative Medicine

This issue of the digest summarizes current scientific evidence about spinal manipulation, acupuncture, massage, and yoga, the complementary approaches most often used by people for chronic low back pain.

The relation between total joint arthroplasty and risk for serious cardiovascular events in patients with moderate-severe osteoarthritis: propensity score matched landmark analysis

November 15, 2013 Comments off

The relation between total joint arthroplasty and risk for serious cardiovascular events in patients with moderate-severe osteoarthritis: propensity score matched landmark analysis
Source: British Medical Journal

Objective
To examine whether total joint arthroplasty of the hip and knee reduces the risk for serious cardiovascular events in patients with moderate-severe osteoarthritis.

Design
Propensity score matched landmark analysis.

Setting
Ontario, Canada.

Participants
2200 adults with hip or knee osteoarthritis aged 55 or more at recruitment (1996-98) and followed prospectively until death or 2011.

Main outcome measure
Rates of serious cardiovascular events for those who received a primary total joint arthroplasty compared with those did not within an exposure period of three years after baseline assessment.

Results
The propensity score matched cohort consisted of 153 matched pairs of participants with moderate-severe arthritis. Over a median follow-up period of seven years after the landmark date (start of the study), matched participants who underwent a total joint arthroplasty during the exposure period were significantly less likely than those who did not to experience a cardiovascular event (hazards ratio 0.56, 95% confidence interval 0.43 to 0.74, P<0.001). Within seven years of the exposure period the absolute risk reduction was 12.4% (95% confidence interval 1.7% to 23.1%) and number needed to treat was 8 (95% confidence interval 4 to 57 patients).

Conclusions
Using a propensity matched landmark analysis in a population cohort with advanced hip or knee osteoarthritis, this study found a cardioprotective benefit of primary elective total joint arthroplasty.

Total Body Bone Area, Bone Mineral Content, and Bone Mineral Density for Individuals Aged 8 Years and Over: United States, 1999–2006

August 20, 2013 Comments off

Total Body Bone Area, Bone Mineral Content, and Bone Mineral Density for Individuals Aged 8 Years and Over: United States, 1999–2006 (PDF)
Source: National Center for Health Statistics

Objectives
This report presents bone measurement data from total body dual energy x-ray absorptiometry scans for 28,454 persons aged 8 years and over who participated in the 1999–2006 National Health and Nutrition Examination Survey. The sample consisted of 22,667 respondents with valid data, and 5,787 with missing data that were successfully multiply imputed (i.e., not highly variable). Bone area, bone mineral content, and bone mineral density (BMD) are presented for the total body, the total body minus the head (e.g., subtotal), and 10 subregions of the body.

Methods
Means, standard deviations, and selected percentiles were calculated for the total body, total body minus head (subtotal), and 10 body subregions by sex, race and ethnicity, and age. Smoothed mean total body BMD was plotted by age, sex, and race and ethnicity. Multiple regression was used to evaluate differences in mean total body BMD by age, sex, and race and ethnicity

Results
After adjusting for race and ethnicity, total body BMD among those under age 20 was significantly higher in respondents aged 12–19 than in those aged 8–11 in both sexes.Among adults of both sexes, total body BMD in persons aged 20–49 was significantly higher than in those aged 50–79, and significantly lower in persons aged 80 and over than in those aged 50–79, after adjusting for race and ethnicity.After adjusting for age, total body BMD was significantly higher in non-Hispanic black persons than in non-Hispanic white persons, regardless of age or sex. However, the pattern differed by age when Mexican-American persons were compared with non-Hispanic white persons:Age-adjusted total body BMD was significantly lower among MexicanAmerican males aged 8–19, was similar in Mexican-American females aged 8–19, and was significantly lower in MexicanAmerican men and women aged 20 and over.

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