February 24, 2004 [Volume 5, Issue 5]

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In this issue of To Your Health:

• Do You Know the Risk Factors for Back Pain?
• Want to Save a Life? Exercise Some Restraint
• Coronary Heart Disease in Women: Know the Risks
• The Perils of Prescription Medication

While the old saying goes that the only two sure things in life are death and taxes, back pain isn't far behind. The National Institutes of Health estimates that between 60 percent and 85 percent of all American adults experience back pain at some point in life, and that between 20 percent and 30 percent of the adult population suffers from back pain at any given time. Unfortunately, it can be quite difficult to predict who will suffer back pain, when it will occur, and what factors are likely to cause the problem.

A recent study examined the records of more than 11,000 Canadian adults who reported no back problems in 1994-1995. At a follow-up interview two years later, the participants were asked whether they had been diagnosed by a health professional with any back problems.

Based on the follow-up interviews, women were slightly more likely (9 percent) than men (8.1 percent) to have suffered back pain in the past two years. In men, the significant factors leading to back pain were age (particularly between ages 45 and 64), height, activity patterns (especially heavy work), a lack of gardening or yard work, and chronic stress. Women who suffered back pain were more likely to be restricted to performing certain activities; have been diagnosed with arthritis or rheumatism; suffer from personal stress; and have a history of psychological trauma that occurred as a child or teenager.

If you fall into one of the risk categories mentioned above, now may be a particularly good time to schedule an appointment with a doctor of chiropractic. Your chiropractor can talk to you about ways to treat and prevent back pain, and provide suggestions that will keep you healthy, active and pain-free. To learn more about back pain, visit www.chiroweb.com/find/tellmeabout/backpain.html.

Reference: Kopec JA, Sayre EC, Esdaile JM. Predictors of back pain in a general population cohort. Spine 2003:29(1), pp. 70-78.

Although many automobile accidents are unavoidable, most of them are survivable, provided a person has taken the necessary precaution of "buckling up" first - wearing a seat belt or strapping your child into a car seat. In rare instances, however, a person wearing the proper restraints can be injured or even killed when an unrestrained passenger in the same car careens forward, backward or sideways into the restrained person during a crash.

A study in the Journal of the American Medical Association examined the effect an unrestrained person can have on the outcome of an otherwise "routine" automobile accident. In the study, researchers analyzed data on all car crashes on public roads in the U.S. between 1988 and 2000 that resulted in the death of at least one person, within 30 days of the accident. A variety of configurations were used in the analysis, including the number of occupants in the car, the sex and location of each occupant, seat position, whether an occupant was restrained, and whether the car was hit from the front, rear, or side.

Occupants who were restrained in the front seat of a car were 20 percent more likely to die with an unrestrained passenger behind them, compared to a restrained passenger. Similarly, a restrained passenger in the rear of the car was 22 percent more likely to be killed with an unrestrained occupant in front of them versus a restrained occupant. Similar results were seen in side-impact and angle crashes.

If the information above sounds confusing, the message isn't: If you want to increase your odds of surviving an automobile accident, make sure you - and everyone else who drives with you - use a seat belt, child-safety seat or other restraining device. It really could be a matter of life and death.

To learn more about general health and wellness, visit www.chiroweb.com/find/.

Reference: Cummings P, Rivara FP. Car occupant death according to the restraint use of other occupants. A matched cohort study. Journal of the American Medical Association, Jan. 21, 2004;291(3), pp. 343-349.

Traditionally, coronary heart disease (CHD) has been considered a disease that primarily affects men. Statistics indicate, however, that approximately 250,000 women die from CHD, and a 2002 study found that 28 percent of all women above age 50 die from coronary heart disease, making it the leading cause of death for women in that age group.

As with men, the reasons women develop CHD vary, but the most likely risk factors include hypertension, smoking, obesity and lack of exercise. A recent study in the Journal of the American Medical Women's Association examined these factors, and provided the following suggestions for lowering the risk of CHD:

• Maintain healthy blood pressure. Studies have found that women with high blood pressure have a 3- to 4-fold increased risk of CHD, but that even minor reductions in diastolic blood pressure can have a significant lower the risk of CHD. Among the best ways to reduce hypertension are lifestyle changes, such as increasing physical activity, reducing weight, and decreasing alcohol and salt intake.
  
  
• Quit smoking. To help female smokers fight their addiction to cigarettes, the researchers recommended using nicotine replacement products, and adding agents such as buproprion to reduce cravings. They also stressed the role of the health practitioner in providing counsel and support.
  
  
• Avoid excess weight gain/obesity. While there is no direct evidence that losing weight alone reduces the risk of CHD, weight loss does decrease blood pressure and may improve blood cholesterol levels, both of which are important factors for heart disease. As with smoking, the researchers noted that health care providers can affect their patients by providing information on diet and nutrition and encouraging them to adopt healthy eating habits.
  
  
• Exercise consistently. Dozens of studies have shown that a lack of exercise can increase the risk of a cardiovascular event, while regular exercise strengthens the heart and increases blood flow. Health care providers should encourage regular exercise as one of the best ways to lower the risk of CHD.

While coronary heart disease is prevalent in the elderly female population, it's not inevitable. By living a healthy lifestyle, exercising regularly, eating a nutritious, well-balanced diet and avoiding (or stopping) smoking, women can significantly lower their risk of CHD.

Your doctor of chiropractic can create a lifestyle plan that incorporates elements of the above factors, and will help reduce your chances of suffering a cardiovascular event. For additional information concerning women's health issues, go to www.chiroweb.com/find/tellmeabout/women.html.

Reference: Hong S, Friedman J, Alt S. Modifiable risk factors for the primary prevention of heart disease in women. Journal of the American Medical Women's Association 2003;58(4), pp. 278-284.

Each year, elderly people in the U.S. make almost 17 million outpatient visits, either to their doctor's office or to a local hospital. Many of these visits occur so that patients can either fill an existing prescription, or get a new prescription for medication. Unfortunately, elderly patients sometimes receive drugs included in the Beers Criteria. Also known as the "always avoid" list, the Beers Criteria contains approximately three dozen medications that can cause adverse side-effects when given to older people, ranging from memory problems to dizziness, falls and high blood pressure.

To see how often elderly people receive inappropriate medications, the author of this study reviewed more than 8,100 outpatient visits made by senior citizens to doctors' offices and hospitals between 1995 and 2000. The analysis showed that in 7.8 percent of the visits - nearly one in 12 - an elderly patient received one or more drugs from the "always avoid" list. Elderly women over age 65 were twice as likely to get an inappropriate prescription than elderly men, and the risk of getting an unsafe medication was higher for patients who took several medications compared to those who took fewer medications.

Receiving the wrong medication can have serious - even fatal - consequences. If you (or a family member) is above the age of 65 and on prescription medication, here are a few recommendations:

• Ask the doctor if he or she is aware of the Beers Criteria.
  
  
• Bring a list of drugs you (or your family member) is taking to each doctor.
  
  
• Before starting a new medication, talk to the doctor about possible side-effects.
  
  
• Also, before starting a new medication, ask about taking tests on memory, mood and balance, so that any changes can be monitored.

To learn more about senior health, visit www.chiroweb.com/find/archives/senior/

Reference: Rauch Golding M. Inappropriate medication prescribing for elderly ambulatory care patients. Archives of Internal Medicine, Feb. 9, 2004;164(3), pp. 305-312.

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