STUDY:

JOURNAL: American Journal of Psychiatry 03

AUTHORS:

ABSTRACT: The branched-chain amino acids, leucine, isoleucine and valine, help to control tardive dyskinesia among patients taking antipsychotic drugs. Tardive dyskinesia is a disorder that occurs frequently among long-term antipsychotic drug users, characterized by twitching and other involuntary movements.

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COMMENTARY: Sixity-eight men with tardive dyskinesia randomly received low-dose, medium-dose or high-dose branched chain amino acids or a placebo three times daily for three weeks. The amino acid formula consisted of valine, isoleucine and leucine in a ratio of 3:3:4.

Tardive dyskinesia movements were videotaped for analysis. At the study's conclusion, the men who received the high dose exhibited a highly significant decrease in their symptoms compared to the placebo group, with diminishment of symptoms occurring as soon as one week following treatment.

Some other differences were seen between the groups before and after the trial, including changes in blood glucose or medication levels. Mild gastrointestinal symptoms were the only side effects noted.



While blood levels of the branched-chain amino acids were measured after three weeks, an increase in their levels was observed in the groups receiving them. The aromatic amino acids phenylalanine, tyrosine and tryptophan simultaneously declined in these groups and correlated with the decrease in tardive dyskinesia movements, leading the researchers to suggest reduced synthesis of monoamine neurotransmitters (dopamine, noradrenaline, and serotonin) from aromatic amino acid precursors as a possible mechanism of action for isoleucine, leucine and valine against tardive dyskinesia symptomps in this study.

STUDY:

JOURNAL: American Urological Association

AUTHORS:

ABSTRACT: Prostate cancer patients who consumed the soy isoflavone genistein for six months experienced a drop in prostate specific antigen (PSA) levels of up to 61 percent. Prostate specific antigen is a marker for prostate tumors, and levels in prostate cancer patients are monitored to evaluate disease progression.

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COMMENTARY: The study involved 62 men with prostate cancer who received 5 grams of genistein concentrated polysaccharide daily for six months. Forty-six of the subjects had undergone treatment for the disease, which involved radiation, androgen deprivation therapy or surgery, and the remainder were on watchful waiting.

Watchful waiting is often advised for prostate cancer patients who are asymptomatic with small, contained tumors.

The majority of participants on watchful waiting experienced a decline in PSA levels while all but one of the men who had been treated saw a rise in PSA.

The results of the study, which found a 38 percent increase in PSA among the watchful waiting group compared to a 98 percent increase in the treated group, indicate that genistein may help prevent prostate cancer progression in men who have not elected to undergo treatment. The authors conclude, "Patients on watchful waiting may do better due to grade of disease or distribution and concentration of genistein within the prostate.

STUDY:

JOURNAL: Journal of Pharmacology and Experimental Therapeutics

AUTHORS: Dr Hsu

ABSTRACT: Researchers from the Medical College of Georgia have discovered yet another health benefit for green tea: the ability to heal wounds and skin diseases. The research team, led by cell biologist Dr Stephen Hsu, studied the effect of epigallocatechin-3-gallate (EGCG), the most abundant polyphenol found in green tea, on growing and aging human epidermal skin cells. Previous research had found that the compound induced apoptosis (programmed cell death) in tumor cells.

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COMMENTARY: In the current study, the researchers found that EGCG accelerated cell differentiation in the growing cells and renewed DNA synthesis in the aged cells. Dr Hsu commented, "Cells that migrate toward the surface of the skin normally live about 28 days, and by day 20, they basically sit on the upper layer of the skin getting ready to die. But EGCG reactivates them. I was so surprised. When exposed to EGCG, the old cells found in the upper layers of the epidermis appear to start dividing again. They make DNA and produce more energy. They are reactivated. There are lots of unknowns-this is the first step into the door-but if we can energize dying skin cells, we can probably improve the skin condition.”

Dr Hsu believes the finding is promising for conditions such as apthous ulcers, wrinkles, rosacea, psoriasis and wounds, and may also be of value for diabetics, who experience delayed healing. He explained, "If skin cells surrounding wounds or infections don't heal in time, fibroblasts in the connective tissue may rush in to fill the void and cause scar tissue formation. If we can spur the skin cells to differentiate and proliferate, we can potentially accelerate the wound-healing process and prevent scarring."

STUDY:

JOURNAL: International journal of oncology.; 2003 Nov;23(5) p22637

AUTHORS: Lloyd FP J; Slivova V; Valachovicova T; Sliva D;

ABSTRACT: Cell adhesion, proteolytic degradation and cell migration are interrelated

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processes responsible for the invasion and metastasis of cancer.

COMMENTARY: One of the crucial molecules involved in cancer metastasis is urokinase-type

plasminogen activator (uPA). An elevated concentration of uPA is a strong

indicator of poor prognosis. In addition to the proteolytic activity of

uPA, which degrades the extracellular matrix, uPA also binds to its receptor

(uPAR) and controls cell adhesion and migration through the reorganization

of actin cytoskeleton.

We have recently demonstrated that constitutively active nuclear factor-kappa B (NF-kappa is responsible for the increased secretion of uPA and that inhibition of NF-kappaB suppresses secretion of uPA and cell migration of highly invasive cancer cells.

Aspirin and other nonsteroidal anti-inflammatory drugs have been recently shown to have a chemopreventive effect in colon and pancreatic cancers. Here we show that aspirin inhibits NF-kappaB, resulting in the suppression of uPA secretion from the highly invasive human prostate cancer cells PC-3. Furthermore, aspirin inhibited migration of PC-3 cells, suggesting an effect on the uPA-uPAR signaling complex.

Finally, aspirin suppressed adhesion of PC-3 cells to fibronectin (FN), which binds to an alpha3beta1 integrin receptor, and to vitronectin (VN), which binds to alphavbeta3 integrin receptor.

Altogether, our data suggests that aspirin inhibits the formation of uPA-uPAR-FN-alpha3beta1 and uPA-uPAR-VN-alphavbeta3 complexes, resulting in the suppression of cell adhesion and cell motility of the highly invasive prostate cancer cells PC-3. These results indicate that aspirin may contribute directly to reducing invasion and metastasis of prostate cancers by inhibiting cell migration and invasion.

STUDY: Not Good

JOURNAL: The Lancet

AUTHORS:

ABSTRACT: Scientists have found evidence that the human form of mad cow disease can spread through blood transfusions.

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COMMENTARY: The findings were made in response to the British Government's announcement last year that doctors might have found the world's first case of variant Creutzfeldt-Jakob disease (vCJD) caused by transfusion.

The Government said an unidentified patient had died after receiving blood from someone who was later diagnosed with vCJD. Doctors were unsure whether the illness had been caused by the transfusion or the eating of infected beef.



Two studies published yesterday in The Lancet medical journal showed infection through transfusion was possible.

Professor Robert Will, the author of one of the studies, said: "Our findings raise the possibility that this infection was trans-fusion-transmitted."

Variant CJD is the human equivalent of Bovine Spongiform Encephalopathy (BSE) or mad cow disease, an incurable, degenerative brain disorder linked to eating meat infected with BSE.

The illnesses are caused when normal brain proteins, called prions, transform themselves into infectious agents.

STUDY: Study finds lower risk of Alzheimer’s and dementia

JOURNAL: Neurology

AUTHORS: Dr. Thomas Truelsen

ABSTRACT: A new study adds to a growing body of evidence suggesting that wine contains healthful compounds.

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COMMENTARY: People who drink wine seem to have a lower risk of developing Alzheimer’s disease and other forms of dementia.

Regular beer drinkers actually had a higher risk of developing dementia, the researchers reported in a study that adds to a growing body of evidence suggesting that wine contains healthful compounds.

The results, published in the the journal Neurology, showed people who drank up to 21 glasses of wine a week had a measurably lower risk of dementia.

Monthly and weekly intake of wine is associated with a lower risk of dementia. People who had just a glass of wine a day had a lower risk of dementia than people who drank no wine at all.

While men tended to drink more than women, there were no differences in the health consequences of drinking between men and women.

These results don’t mean that people should start drinking wine or drink more wine than they usually do but the idea that the colored compounds in wine should have people looking for red fruits and veggies.

STUDY:

JOURNAL: Gut 2004;53:246-250.

AUTHORS: Dr. Tim Card

ABSTRACT: Antibiotic use is associated with the subsequent development of Crohn's disease.

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COMMENTARY: Genetic factors are recognized as playing a role in Crohn's disease, but other elements must be involved to account for the rise in incidence over the last century.

Since intestinal flora is associated with Crohn's disease, Dr. Card's group surmised that antibiotics, by interfering with normal colonization, may be one of the missing components in disease etiology. They therefore analyzed data from the General Practice Research Database, where antibiotic use had been prospectively recorded.

They identified 587 patients with Crohn's disease for whom data had been recorded for at least 5 years prior to diagnosis, with whom the authors matched 1460 control subjects by age and gender.

Antibiotics were prescribed at least once 2 to 5 years before the index date for 71% of cases and 58% of controls (p < 0.001). In multivariate analysis excluding subjects with symptoms suggestive of Crohn's disease and those prescribed a gastrointestinal drug 2 to 5 years before the index date, the odds ratio was 1.53. This, according to Dr. Card's team, "is evidence against the association being a result of reverse causation.

The authors estimate that the population attributable fraction was 17% for antibiotics, versus 10% for smoking, another recognized risk factor for Crohn's disease.

STUDY: Dietary intake of folate and risk of stroke in US men and women.

JOURNAL: Stroke 2002;33:1183–9.

AUTHORS: Bazzano LA, He J, Ogden LG, et al

ABSTRACT: The evidence supporting the many health benefits of folic acid has been enhanced with the recent publication of a study in the journal Stroke. The study found that people with a dietary intake of at least 300 mcg per day of folic acid reduced their risk of stroke and heart disease by 20% and 13%, respectively, compared with those who consumed less than 136 mcg of folic acid per day.

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COMMENTARY: After years of research confirming that pregnant women taking folic acid are less likely to have children with neural tube defects, this study is one of the first to demonstrate that dietary intake of folic acid not only reduces heart disease risk, but also prevents stroke. Stroke and heart disease are two of the top three causes of death in the United States.

The new study followed the eating habits of 9,764 men and women between the ages 25 and 74 who showed no signs of heart disease at the beginning of the study. Other trials suggest that 400 mcg per day of folic acid may prevent heart disease by lowering homocysteine levels in the blood. Homocysteine has been shown to be a significant risk factor for heart disease; the risk of having a heart attack goes up as homocysteine levels rise.

The protective effects against heart disease and stroke reinforce the benefits of supplementing with folic acid, which healthcare professionals have long known.

Good sources of folic acid include dark, green leafy vegetables such as kale, Swiss chard and mustard greens, oranges, Brewer’s yeast, soybeans, beets, asparagus, and red meat. Dietary intake can be augmented with folic acid supplements.



1. Bazzano LA, He J, Ogden LG, et al. Dietary intake of folate and risk of stroke in US men and women. Stroke 2002;33:1183–9.

2. Rydlewicz A, Simpson JA, Taylor RJ, et al. The effect of folic acid supplementation on plasma homocysteine in an elderly population. Q J Med 2002;95:27–35.

3. Tice JA, Ross E, Coxson PG, et al. Cost-effectiveness of vitamin therapy to lower plasma homocysteine levels for the prevention of coronary heart disease. JAMA 2001;286:936–43.

4. Quinlivan EP, McPartlin J, McNulty H, et al. Importance of both folic acid and vitamin B12 in reduction of risk of vascular disease. Lancet 2002;359:227–8.

5. Werler MM, Shapiro S, Mitchell AA. Periconceptional folic acid exposure and risk of occurrent neural tube defects. JAMA 1993;269:1257–61.

6. Berry RJ, Li Z, Erickson JD et al. Preventing neural tube defects with folic acid in China. N Engl J Med 1999;341:1485–90.

7. Reynolds EH. Effects of folic acid on the mental state and fit frequency of drug treated epileptic patients. Lancet 1967;1:1086–8.

8. Seligmann H, Potasman I, Weller B, et al. Phenytoin-folic acid interaction: a lesson to be learned. Clin Neuropharmacol 1999;22:268–72.

STUDY: Physical activity is associated with a lower risk of prevalent and incident depression

JOURNAL: Am J Epidemiol 2002;156:328-334.

AUTHORS: Dr. William J. Strawbridge

ABSTRACT: Physical activity is associated with a lower risk of prevalent and incident depression among older adults.according to a report in the American Journal of Epidemiology.

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COMMENTARY: Dr. William J. Strawbridge, of the Public Health Institute, Berkeley, California, and colleagues studied 1947 subjects from the Alameda County Study who were between 50 and 94 years of age at baseline and were followed for 5 years.

The investigators examined the effects of physical activity (measured on an 8-point scale) on depression, with and without excluding disabled patients.

Every 1-point increase in physical activity protected against both prevalent depression (adjusted odds ratio [OR] = 0.90) and incident depression (adjusted OR = 0.83) over 5 years after adjusting for age, sex, ethnicity, financial strain, chronic conditions, disability, body mass index, alcohol consumption, smoking, and social relations. The incidence results were not attenuated by exclusion of disabled patients (adjusted OR = 0.79), the researchers found.

Regular physical activity, such as walking, exercising, swimming, or playing active sports for older adults will reduce the risk of subsequent depression. This benefit is similar for those with and without physical disabilities.

The most common form of physical activity for members of the Alameda County Study is taking long walks, which shows that physical activity does not have to involve elaborate equipment.

The investigators note that it is plausible that persons with high levels of physical activity are also more likely to engage in other beneficial health behaviors such as not smoking, avoiding obesity, and not drinking to excess.

Keep in mind that a little exercise goes a long way.

Get out there and do something.

STUDY: Initial findings in people support calorie effect seen in lab animals.

JOURNAL: Science

AUTHORS: George S. Roth

ABSTRACT: For the first time, researchers have found evidence suggesting people may live longer by eating fewer calories each day, a dietary restriction that already has shown in experiments to extend the lives of laboratory animals by up to 40 percent.

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COMMENTARY: Even if the evidence proves to be correct, it’s unknown how much extra time people might live.

Laboratory studies for decades have shown that reducing the calories fed to lab mice and rats enabled the animals to live much longer.

Now, George S. Roth and his colleagues at the National Institute on Aging say they have preliminary evidence that biological changes that help create superaged rodents may also work in humans.

The biological markers — lower temperature, lower insulin levels and a steady level of a steroid hormone called DHEAS — all occur in restricted-diet rodents that live about 40 percent longer than fellow rodents on a normal diet.The same biological markers have now been found in men who are living longest in a continuing study in Baltimore on aging.

Men whose biomarkers were similar to those of the calorie-restricted, long-lived rodents were dying at a much slower rate than were men with other biomarker measurements.

STUDY:

JOURNAL: Lancet. 2004;363:411-412, 417-421, 422-428

AUTHORS: Robert G. Will

ABSTRACT: — Blood transfusion may be a mode of transmitting variant Creutzfeldt-Jakob disease (vCJD).

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COMMENTARY: On Dec. 17, 2003, the U.K. announced the death from vCJD of an individual who had previously received a red cell transfusion from a donor who subsequently developed vCJD. Symptoms of vCJD developed in the recipient 6.5 years after the transfusion, and in the donor 3.5 years after the transfusion.

Using the national blood-donor database and the U.K. CJD register, a team from the National CJD Surveillance Unit of Western General Hospital in Edinburgh, U.K., identified 48 individuals, including the subject of the case report, who received a blood component from 15 donors who later developed vCJD.

"Our findings raise the possibility that this infection was transfusion transmitted," senior author Robert G. Will says in a news release. "Infection in the recipient could have been due to past dietary exposure to the BSE [bovine spongiform encephalopathy] agent.

The clinical presentation and preliminary examination of neuropathology of this patient were typical of vCJD. Although magnetic resonance imaging did not show the classical pulvinar sign seen in most cases of vCJD, fluid attenuated inversion recovery sequences with the highest sensitivity were not obtained.

The red blood cells transfused in this patient were not leucodepleted, but the authors note that the efficiency of leucodepletion in reducing infectivity is uncertain.

The surviving recipients of blood transfusions from donors who later developed vCJD are being informed of their possible increased risk of developing vCJD and warned not to donate organs or blood.

"To date, no case of vCJD has been identified with a history of exposure to fractionated blood products," the authors write. "The most direct action to reduce risk is a careful case-by-case evaluation of the need for blood transfusion."

The National Blood Service supported this study.

In an animal study in the same issue of The Lancet, Corinne Lasmézas and colleagues, from the French Atomic Energy Commission, compared the degree of tissue infectivity among macaques with oral or intravenous exposure to tissue containing the BSE agent.

Using the misfolded prion protein as a marker, they found that the degree of organ infectivity was similar regardless of the route of entry, and that tonsil tissue was the most strongly infected. In addition to expected concentrations of prion protein in the brain and spinal cord, it was also present in the autonomic nervous system, in peripheral nerves, and in Peyer's patches in the gut, suggesting possible risk of transmission from endoscopic procedures.

"In view of the high efficiency of transmission of the BSE agent to primates by the intravenous route, the latter should be regarded as a likely route of contamination for vCJD patients with a medical history involving a transfusion during the period at risk," the authors write.

"To avoid further contamination to human beings from peripheral tissues, the same precautionary measures taken for primary vCJD cases should apply to possible transfusion cases of the disease."

STUDY:

JOURNAL: Am J Clin Nutr. 2004;79:261-267

AUTHORS: Jose M. Saavedra

ABSTRACT: Probiotic-supplemented infant formula is well tolerated and safe, according to the results of a randomized, double-blind, placebo-controlled trial published in the February issue of the American Journal of Clinical Nutrition.

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Furthermore, treated infants had a lower rate of colic and use of antibiotics.

COMMENTARY: "Nonpathogenic live bacteria are consumed as food by many children, particularly in the form of yogurt," write Jose M. Saavedra, from the Johns Hopkins University School of Medicine in Baltimore, Maryland, and colleagues.

"The tolerance and safety of long-term consumption of specific types and strains of probiotic bacteria are not well documented.... Adequate documentation of safety with prolonged use in infants is mandatory if recommendations for use are to be made in this population."

In this prospective study, 118 healthy infants aged three to 24 months were randomized to receive one of three standard milk-based formulas: formula containing 1 x 107 colony-forming units (CFU)/g each of Bifidobacterium lactis and Streptococcus thermophilus, formula containing 1 x 106 CFU/g each of B. lactis and S. thermophilus, or unsupplemented formula.

At enrollment, mean age was 7.0 ± 2.9 months; the groups were similar in age, sex, and duration of formula consumption (mean, 210 ± 127 days). Compared with the unsupplemented formula, the supplemented formulas were well accepted and were associated with a lower frequency of reported colic or irritability (P < .001) and of antibiotic use (P < .001).

Growth, utilization of healthcare services, daycare absenteeism, and other health variables were similar between groups.

"To our knowledge, this is the first careful documentation of intake of live bacteria over any extended period of time in any population. The intakes studied can be used as a benchmark for well-tolerated, safe intake of these bacterial agents," the authors write.

"Long-term consumption of formulas supplemented with B. lactis and S. thermophilus was well tolerated and safe and resulted in adequate growth, reduced reporting of colic or irritability, and a lower frequency of antibiotic use."

Nestlé USA supported this study and provided formulas.

STUDY:

JOURNAL: Diabetes Care. 2004;27:436-440

AUTHORS: Dr. Ludvik

ABSTRACT: Caiapo has beneficial effects on the plasma glucose and cholesterol levels of patients with type 2 diabetes, according to the results of a randomized, double-blind, placebo-controlled trial.

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COMMENTARY: Caiapo is a nutraceutical made from the extract of a variety of white sweet potato (Ipomoea batatas) that has been eaten raw in Japan for treatment of anemia, hypertension, and diabetes.

Bernhard Ludvik, MD, and colleagues from the University of Vienna in Austria selected 61 clinically stable type 2 diabetic patients. Subjects discontinued antidiabetic medication and followed a weight-maintaining diet (28-32 kcal/kg of body weight) consisting of 55% carbohydrates, 30% fat, and 15% proteins.

Patients were allowed to continue drinking alcohol and smoking cigarettes, although in limited amounts. Investigators advised subjects to maintain usual physical activity at a constant level throughout the study period.

The researchers divided patients into two groups: group 1 (n = 30) consumed Caiapo 4 g/day, and group 2 (n = 31) consumed placebo. Patients took Caiapo or placebo orally once daily, in the morning before breakfast. Data from both groups showed no differences at baseline except for glucose levels measured two hours after dinner.

The investigators administered a 75 g oral glucose tolerance test (OGTT) at baseline and after one, two, and three months. Fasting and two-hour glucose levels were measured from venous samples by the glucose oxidase method. Patients measured their blood glucose levels at home using a blood glucose test system three times per week: Monday before breakfast, Wednesday two hours after beginning lunch, and Friday two hours after beginning dinner. The investigators also measured HbA1c, cholesterol, and triglyceride levels.

After months 2 and 3, HbA1c levels significantly decreased in the Caiapo group (from 7.21% ± 0.15% at baseline to 6.94% ± 0.14% at two months and 6.68% ± 0.14% at three months; P < .05) compared with no change in the placebo group (P = .08 after two months and P = .23 after three months). At months 2 and 3, HbA1c values in the Caiapo group were lower than those in the placebo group (P < .0001).

Fasting blood glucose levels decreased in the Caiapo group (143.7 ± 1.9 mg/dL vs. 128.5 ± 1.7 mg/dL; P < .001) and did not change in the placebo group (144.3 ± 1.9 mg/dL vs. 138.2 ± 2.1 mg/dL; P = .052). The investigators observed a decrease in body weight in both the placebo group (P = .0027) and in the Caiapo group (P < .0001).



Body weight was linked to improvement in glucose control in the Caiapo group (r = 0.618; P < .0002). Two-hour glucose levels decreased significantly in the Caiapo group (193.3 ± 10.4 mg/dL vs. 162.8 ± 8.2 mg/dL) compared with the placebo group (191.7 ± 9.2 mg/dL vs. 181.0 ± 7.1 mg/dL; P < .001).



The investigators also found significantly lower levels of mean cholesterol in the Caiapo group at the end of treatment (214.6 ± 11.2 mg/dL) than in the placebo group (248.7 ± 11.2 mg/dL; P < .05). They did not observe significant changes in triglyceride levels or blood pressure. Caiapo was well tolerated without significant adverse effects.

"This study confirms the beneficial effects of Caiapo on fasting and postprandial plasma glucose levels, as well as on cholesterol, in patients with type 2 diabetes," they write. "For the first time, we demonstrated the long-term efficacy of Caiapo on glucose control by the observed reduction of HbA1c."

STUDY:

JOURNAL: BMJ. 2004;328:19-21

AUTHORS: Per Hall

ABSTRACT: Infants exposed to doses of ionizing radiation equivalent to a computed tomography (CT) scan have lower cognitive abilities as adults.

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COMMENTARY: "Ionising radiation may impair the developing human brain and adversely affect cognitive processes," write Per Hall, from Karolinska Institute in Stockholm, Sweden, and colleagues. "CT scanning, which delivers high doses of ionising radiation, is increasingly being used in young children after minor head trauma."

The study cohort consisted of 3,094 men who had received radiation therapy during the period from 1930 to 1959, before they were 18 months of age. At age 18 or 19 years, psychological testing revealed a negative dose-response relationship for three cognitive tests for learning ability and logical reasoning, but not for spatial recognition.

The proportion of boys who attended high school decreased with increasing doses of ionizing radiation to both frontal and posterior brain regions, from 32% for no radiation exposure to 17% for exposure greater than 250 mGy. With frontal radiation, the multivariate odds ratio for high school attendance was 0.47 (95% confidence interval [CI], 0.26 - 0.85; P = .0003 for trend), and with posterior radiation it was 0.59 (95% CI, 0.23 - 1.47; P = .0005).

"Irradiation of the brain with dose levels overlapping those imparted by CT can, in at least some instances, adversely affect intellectual development when the infant brain is exposed to ionising radiation at doses equivalent to CT scans of the skull," the authors write. "The risk and benefits of CT scans in minor head trauma need re-evaluating."

The European Commission supported this study, and the authors report no conflicts of interest.

STUDY:

JOURNAL: BMJ. 2003;326:911-914

AUTHORS: Ingeborg Korthals-de Bos

ABSTRACT: Manual therapy is more effective than traditional physiotherapy or general medical care for the treatment of neck pain.

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COMMENTARY: "Our findings showed manual therapy to be more cost effective than physiotherapy and continued care provided by a general practitioner in the treatment of nonspecific neck pain," write Ingeborg Korthals-de Bos, from VU University Medical Centre in Amsterdam, the Netherlands, and colleagues.

A total of 183 patients with neck pain for at least two weeks were recruited by 42 general practitioners in the Netherlands. Age range was 18 to 70 years. Of the 183 subjects, 60 were randomized to manual therapy consisting of spinal mobilization, 59 to physiotherapy consisting mainly of exercise, and 64 to standard care from a general practitioner, including counseling, education, and medications. "Spinal mobilization was defined as low velocity passive movements within or at the limit of joint range of motion. Spinal manipulation (low amplitude, high velocity techniques) was not provided," according to the authors.

After 26 weeks, patients in the manual therapy group recovered more quickly than did patients in the other two groups. By 52 weeks, there were no significant differences between groups. The total average costs of manual therapy were $402, about one third of the costs in the other two groups (P < .01).

"Manual therapy had significantly lower costs and slightly better effects in treating neck pain at 52 weeks compared with physiotherapy and general practitioner care," the authors write. "The clinical outcome measures showed that manual therapy resulted in faster recovery."

STUDY:

JOURNAL: Br J Obstet Gynaecol 2002;109:1121-1125.

AUTHORS: Dr. Choy

ABSTRACT: High blood levels of mercury that might be caused by eating a lot of seafood are linked to infertility in men and women.

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COMMENTARY: Dr. Christine Choy and others at the Chinese University of Hong Kong compared mercury levels in 157 infertile couples and 26 fertile couples. They found that 35% of the men and 23% of the women in the infertile group had abnormally high blood mercury concentrations, compared to 15% of men and 3.8% of women in the fertile group.

Among men, mean blood mercury levels were 44.2 mmol/L in those with abnormal semen compared with 31.2 mmol/L in the control group. Among women, levels were 37.0 mmol/L in those with unexplained infertility versus 17.5 mmol/L in the controls.

The researchers also recorded the levels of seafood consumed by the couples and found that patients who reported eating more seafood tended to have higher blood mercury levels.

Contamination of the marine waters around Hong Kong with heavy metals is common, they note. "Seafood contaminated with mercury is a possible source of excessive mercury exposure in our infertile population," Dr. Choy and colleagues write.

"The positive correlation between quantity of seafood consumption and blood mercury concentrations suggests that higher seafood consumption may contribute to higher blood mercury concentrations."

In men, mercury might disrupt sperm membrane permeability, mitochondrial function or microtubule-generated motion, the researchers note. How the metal might affect female fertility is less clear, although it could induce some cytotoxic or genotoxic damage in the ovaries, they suggest.

Dr. Choy said cutting back on seafood could be a way of avoiding high blood mercury levels. "However, this should be balanced against the beneficial effects of other components of fish, such as those of 3-omega fatty acids and selenium," she added.

STUDY: Preventing falls among older people is crucial

JOURNAL: British Medical Journal 2002;325:128-131

AUTHORS: Dr. Lesley Day

ABSTRACT: Healthy elderly people living on their own who exercised in a group weekly and on their own twice a week were less likely to fall, according to the results of an Australian study.

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COMMENTARY: Preventing falls among older people is crucial for their health and ability to live independently, because falls often result in debilitating injuries such as hip fractures.

Dr. Lesley Day of Monash University in Victoria and colleagues randomly assigned 1,090 people aged 70 to 84 to an exercise program, home hazard management, vision improvement, or combinations of these interventions. The exercise component included a 1-hour weekly exercise class supplemented by daily home exercises. About one third of the exercises were designed to improve balance; flexibility and leg strength were also addressed.

At the end of 15 weeks, study participants who exercised showed improvements in thigh muscle strength, stability and balance. At the end of 18 months, the increase in muscle strength had disappeared, but improvements in balance remained.

Patients who exercised were 18% less likely to fall during the course of the study. While home hazard reduction or vision improvement alone did not prevent falls, study participants who completed all three interventions showed the most dramatic reduction in falls. Those who exercised and completed the home hazard and vision improvements were 33% less likely to fall during the study.

The investigators conclude that improved balance was behind the fall reduction among exercisers.

Compliance with home exercise was relatively poor, with participants working out an average of only twice weekly. This is the lowest intensity group-based exercise program shown to be effective in reducing falls among community-dwelling older people.

The Australian team estimated that 14 clients would need to receive the exercise intervention to prevent one fall annually. Only half that number would need to participate if all three components were included in the intervention.

Participation in an exercise intervention is appropriate for senior citizens living on their own, who are of relatively good health, and who have their family doctor's approval. She added that community agencies and local government organizations can deliver such interventions effectively.