03.28.12

Women Drivers at Greater Risk in Car Crashes

Posted in Motor Vehicle Accidents at 4:57 AM by Dr. Greathouse

By Maggy Patrick

Oct 20, 2011 4:09pm

Women Drivers at Greater Risk in Car Crashes, Says Study

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gty woman driving car jt 111020 main Women Drivers at Greater Risk in Car Crashes, Says Study

A new report by the American Journal of Public Health finds that female drivers are at a greater risk of injury or death when involved in car crashes, because seatbelts and other lifesaving devices installed in cars are not designed for their bodies.

The report said that on average, women are shorter, lighter, tend to sit in different positions and drive newer passenger cars when compared with men. Because of these factors, the odds of a woman sustaining an injury while wearing a seatbelt were 47 percent higher than for  men wearing seatbelts.

One reason safety systems are designed more for the male population is that men  are three times more likely to be involved in a car crash that leads to serious or fatal injuries. In recent years, however, there has been an increase in female drivers getting into these types of accidents.

Although Clarence Ditlow of the Center for Auto Safety says that the study had the right concept,  it doesn’t apply to today’s vehicles. The researchers focused on crashes (and cars) between 1998 and 2008. All of the cars used in the study were an average of six years old.

“The average life of a car is around 12 years,” said Ditlow. “The study would have a lot more value if it were limited to 2000 and later model year vehicles to make sure all vehicles had female friendly airbags,” he said. Since new 2012 models are coming out now, some of the cars used in the study are almost 20 years old.

“There wasn’t even a dynamic side impact test standard in effect in 1992,” said Ditlow.

Ditlow also said that while the study did highlight the disparity between the risks for male and female drivers, that’s something  the government and industry have been working on over the past three decades.

The authors of the study said in a statement that “female motor vehicle drivers today may not be as safe as their male counterparts; therefore, the relative higher vulnerability of female drivers … when exposed to moderate and serious crashes must be taken into account.”

03.19.12

Soda Heart & Disease

Posted in Nutrition, Wellness at 4:52 PM by Dr. Greathouse

A Soda a Day Raises CHD Risk by 20%

Lisa Nainggolan

March 12, 2012 (Boston, Massachusetts) — Sugary drinks are associated with an increased risk of coronary heart disease (CHD) as well as some adverse changes in lipids, inflammatory factors, and leptin, according to a new analysis of men participating in the Health Professionals Follow-up Study, reported by Dr Lawrence de Koning (Children’s Hospital Boston, MA) and colleagues online March 12, 2012 in Circulation [1].

“Even a moderate amount of sugary beverage consumption — we are talking about one can of soda every day — is associated with a significant 20% increased risk of heart disease even after adjusting for a wide range of cardiovascular risk factors,” senior author Dr Frank B Hu (Harvard School of Public Health, Boston, MA) told heartwire . “The increased risk is quite substantial, and I think has important public-health implications given the widespread consumption of soda, not only in the US but also increasing very rapidly in developing countries.”

The increased risk is quite substantial, and I think has important public-health implications given the widespread consumption of soda.

The researchers did not find an increased risk of CHD with artificially sweetened beverages in this analysis, however. “Diet soda has been shown to be associated with weight gain and metabolic diseases in previous studies, even though this hasn’t been substantiated in our study,” says Hu. “The problem with diet soda is its high-intensity sweet taste, which may condition people’s taste. It’s still an open question whether diet soda is an optimal alternative to regular soda; we need more data on this. ”

Hu says water is the best thing to drink, or coffee or tea. Fruit juice is “not a very good alternative, because of the high amount of sugar,” he adds, although if diluted with water, “it’s much better than a can of soda,” he notes.

And Hu says although the current results apply only to men, prior data from his group in women in the Nurses’ Health Study [from 2009] were comparable, “which really boosts the credibility of the findings.”

Inflammation could be a pathway for impact of soda upon CHD risk

Hu and colleagues explain that while much research has shown a link between the consumption of sugar-sweetened beverages and type 2 diabetes, few studies have looked at the association of these drinks with CHD.

Hence, they analyzed the associations of cumulatively averaged sugar-sweetened (eg, sodas) and artificially sweetened (eg, diet sodas) beverage intake with incident fatal and nonfatal CHD (MI) in 42 883 men in the Health Professionals Follow-up study. Beginning in 1986 and every two years until December 2008, participants answered questionnaires about diet and other health habits. A blood sample was provided midway through the study.

There were 3683 CHD cases over 22 years of follow-up. Those in the top quartile of sugar-sweetened-beverage intake had a 20% higher relative risk of CHD than those in the bottom quartile (RR 1.20; p for trend < 0.001) after adjustment for age, smoking, physical activity, alcohol, multivitamins, family history, diet quality, energy intake, body-mass index, preenrollment weight change, and dieting.

Adjustment for self-reported high cholesterol, high triglycerides, high blood pressure, and diagnosed type 2 diabetes only slightly attenuated these associations, which suggests that drinking soda “may impact on CHD risk above and beyond traditional risk factors,” say the researchers.

Consumption of artificially sweetened drinks was not significantly associated with CHD (multivariate RR 1.02; p for trend=0.28).

Intake of sugar-sweetened drinks, but not artificially sweetened ones, was also significantly associated with increased triglycerides and several circulating inflammatory factors — including C-reactive protein, interleukin 6 (IL-6), and tumor-necrosis-factor receptor 1 (TNFr1) — as well as decreased HDL cholesterol, lipoprotein (a) (Lp[a]), and leptin (p < 0.02).

“Inflammation is a key factor in the pathogenesis of cardiovascular disease and cardiometabolic disease and could represent an additional pathway by which sugar-sweetened beverages influence risk,” say Hu et al.

Cutting consumption of soda is one of easiest behaviors to change

Hu says that one of the major constituents of soda, high-fructose corn syrup, is subsidized in the US, making such drinks “ridiculously cheap” and helping explain why consumption is so high, particularly in lower socioeconomic groups.

Doctors should be advising people with heart disease or at risk to cut back on sugary beverages; it’s almost a no-brainer.

“Doctors should set an example for their patients first,” he stresses. “Then, for people who already have heart disease or who are at high risk, physicians should be advising them to cut back on sugary beverages; it’s almost a no-brainer, like recommending that they stop smoking and do more exercise. The consumption of sugary beverages is a relatively easy behavior to change.”

And although this particular study included mostly white subjects and there are few data on the risk of cardiovascular disease associated with the consumption of soda in people of other ethnicities, there are data on its effect on type 2 diabetes in these groups, he says.

“It has been shown for minority groups — such as African Americans and Asians — that they are more susceptible to the detrimental effects” of sugary drinks on diabetes incidence, he notes.

The authors report no conflicts of interest.

References

  1. de Koning L, Malik VS, Kellogg MD et al. Sweetened beverage consumption, incident coronary heart disease and biomarkers of risk in men. Circulation 2012; DOI: 10.1161/CIRCULATIONAHA.111.067017. Available at: http://circ.ahajournals.org.

Knee Replacement Data Scarce for Long-Term Safety, Effectiveness

Posted in Extremities at 1:40 PM by Dr. Greathouse

From Medscape Medical News

Not my area of expertise to be sure, but, I see my share of knee problems. Not to mention I have knee problems too. I know of patients I treat that still have knee pain after total knee replacement. I know that low back surgery outcomes are poor, but they continue and cost has continued to rise, but back pain prevails. At any rate, more food for thought and more reason perhaps, to exhaust conservative care before the big move to surgery. If you really need it, thank goodness it’s available! Be kind to your spine (and knees)!

Knee Replacement Data Scarce for Long-Term Safety, Effectiveness

March 5, 2012 — Knee replacement surgery is a success story of modern medicine, yet not enough is known about patient outcomes or the effectiveness of various implants, and consensus is lacking about the precise indications for the procedure, according to a study published online March 6 in the Lancet.

The authors, based in the United Kingdom, Sweden, and Australia, write that surgeons need improved decision-making as more and more possible candidates for new knees fall are younger than 55 years — a group that has a higher rate of revision or follow-up surgery. On another problematic note, some patients undergo the operation despite having good functional ability and only mild pain beforehand.

The article, based on a literature review going back to 1970, is the second in less than a week raising doubts about the evidence on orthopaedic joint implant safety and effectiveness. On February 28, the British Medical Journal published an article charging that hundreds of thousands of patients with metal-on-metal hip replacements were kept in the dark about possible exposure to toxic substances.

Andrew Carr, FRCS FmedSci, lead author of the Lancet article, and coauthors write that the number of total knee replacements (TKRs) in the United States increased from 31.2 per 100,000 person-years in the period from 1971 to 1976 to 220.9 per 100,000 person-years in 2008, for a total that year of more than 650,000 procedures. The authors predict that the demand for knee replacement will continue to grow in developed countries, in light of aging populations and rising obesity rates, which both portend higher rates of osteoarthritis, the main clinical indication for the operation.

Although more and more people are getting new hardware for their knees, fuzzy thinking prevails as to who really needs it.

“No clear consensus exists within the surgical community about exact indications, particularly severity of preoperative symptoms, obesity, and age,” Dr. Carr and coauthors write. They point to a task force organized by the Osteoarthritis Research Society International and a rheumatology organization that found that “pain, function, and radiographic severity are not associated with a surgeon’s recommendation for knee replacement.

03.15.12

Medicare Says ‘No’ to TENS for Low Back Pain

Posted in Pain Management at 6:28 PM by Dr. Greathouse

Medicare is set to withdraw most coverage of transcutaneous electrical nerve stimulation (TENS) for chronic low back pain, the Centers for Medicare and Medicaid Services indicated Tuesday.

Reimbursements for this indication would be available only when patients are participating in a randomized, controlled trial of the technology’s clinical effectiveness, according to a proposeddecision memo from CMS.

Currently, Medicare pays for FDA-approved TENS equipment and supplies when prescribed by a physician for chronic intractable pain, and reimburses physicians and physical therapists for evaluating patients’ suitability for the treatment, which is typically used at home.

CMS decided on its own to review its coverage of TENS for chronic low back pain in the wake of a 2010 report by an American Academy of Neurology panel that found the treatment was not effective.

The panel had conducted a systematic review of published studies of TENS. “The review concluded that there was conflicting evidence for the use of TENS in the treatment of chronic low back pain and that TENS should be deemed ineffective for this purpose,” the CMS memo said.

CMS also cited a series of other reviews that failed to find clear support for the technology’s efficacy. On the other hand, some individual studies had shown that it can reduce pain and improve patients’ physical function.

The memo also noted that the National Institute of Neurological Disorders and Stroke has listed TENS as a “possible treatment option” for lower back pain that has not responded to conventional therapies.

But in the absence of consistent evidence of TENS’s efficacy in this indication, CMS plans to withhold coverage except in the context of randomized trials.

Patients in such trials must have been suffering for low back pain for at least three months, with the pain not resulting from conditions such as inflammatory autoimmune disease or metastatic spinal tumors. The trials must also directly address TENS’s clinical efficacy and be designed and powered to yield clear-cut answers. Listing on the Clinicaltrials.gov website is mandatory.

CMS emphasized that Medicare will continue to reimburse for TENS when prescribed for chronic, treatment-refractory pain indications other than low back pain, such as for patients with chronic or severe post-operative pain.

CMS is accepting public comments on the proposed decision through April 12, after which it will issue a final determination.

By John Gever, Senior Editor, MedPage Today

Published: March 14, 2012