NEWS

Passing of Joseph Keating
Chiropractic recently lost the profession’s most distinguished historian, Joseph C. Keating Jr., Ph.D., F.I.C.C.(h). He attended the State University of New York (SUNY) at Albany earning degrees in clinical psychology and clinical research methods, including his Ph.D. in 1981.

Since 1981, he had worked as a clinical researcher, faculty member, administrator and historian at several institutions, including the University of the Pacific; Palmer College of Chiropractic-West; Northwestern College of Chiropractic, where he served as director of research; Western States Chiropractic College, and Los Angeles College of Chiropractic. He had served on the editorial board of several peer-reviewed, scholarly periodicals, and had been a member of the board of directors of the National Institute of Chiropractic Research since 1988.

Dr. Keating was a former president (1994-95) of the Association for the History of Chiropractic (AHC) and served on the board of directors. Widely published, he authored in excess of 500 scholarly papers, as well as 19 books and book chapters. In late 2006, Dr. Keating moved to Kansas City, Mo., from Phoenix, Ariz. He was employed by Cleveland Chiropractic College as the Historian of the Profession, an endowed position, funded by NCMIC.

Updated guidelines for Physical Activity for Adults
More than ten years after they were first published, the American College of Sports Medicine (ACSM) and the American Heart Association (AHA) have updated their recommendations regarding physical activity for adults¹. The new guidelines, which also include modified recommendations for older adults, are intended to update and clarify the 1995 recommendations on the types and amount of exercise needed by healthy adults to improve and maintain health.

“I think if you look back during the last ten years or so, there have been some misconceptions about exercise, especially as it relates to health and the specific benefits to the heart,” Dr Jennifer Mieres, a spokesperson for the AHA. “The new guidelines give a very good definition of what constitutes physical activity, as well as the benefits that this exercise can bring about. The guidelines also give a much better roadmap in terms of fitting exercise into our daily lives.”

To promote and maintain health, the ACSM/AHA writing group recommends that “all healthy adults aged 18 to 65 years need moderate-intensity aerobic physical activity for a minimum of 30 minutes on five days each week or vigorous-intensity aerobic activity for a minimum of 20 minutes on three days each week”. Combining these exercises is also acceptable, with people allowed to meet the recommendations by walking briskly or performing an activity that noticeably accelerates the heart rate for 30 minutes twice during the week and then jogging for 20 minutes, or performing any activity that causes rapid breathing and a substantial increase in heart rate on two other days. Muscle-strengthening activities have also been included in the updated recommendations.

In addition to publishing the guidelines for adults, the ACSM/AHA also issued recommendations on the types and amounts of physical activity needed to improve and maintain health in those 65 years of age and older². The recommendations, written by lead author Dr Miriam Nelson (Tufts University, Boston, MA), for older adults are similar to the recommendations for the general public, but take into account the older adult’s aerobic fitness and promote activities that maintain or increase flexibility and improve balance.

1. Haskell WL, Lee IM, Pate RR, et al. Physical activity and public health. Updated recommendation for adults from the American College of Sports Medicine and the American Heart Association. Circulation 2007; 116; DOI: 10.1161/circulationaha.107.185649.
2. Nelson ME, Rejeski WJ, Blair SN, et al. Physical activity and public health in older adults. Circulation 2007; 116; DOI: 10.1161/circulationaha.107.185650.

Topical treatments for osteoarthritis of the knee
A systematic review was conducted to investigate the efficacy of topically applied treatments for osteoarthritis of the knee for osteoarthritis (OA). The authors purported that they are not extensively prescribed, mainly due to practitioner uncertainty about their efficacy.

Each included study had to be published in English and only involve human subjects. The search terms used were topical treatments for osteoarthritis, topical and OA, topical therapy for osteoarthritis and treatments for OA. The RCTs which met the inclusion criteria were evaluated for methodological quality, using the Jadad point-scoring system. Trials scoring three or more points were used to draw conclusions about the most efficacious topical treatments for osteoarthritis.

They concluded that there is strong evidence to suggest that topical pharmacological and non-pharmacological formulations provide relief of pain and joint stiffness, and improve levels of functional disability in patients with primary knee OA. There is some evidence that suggests the number of analgesics can be reduced when topical preparations are used for symptomatic relief for OA of the knee.

Topical treatments for osteoarthritis of the knee. Haynes S, Gemmell H. Clinical Chiropractic . Volume 10, Issue 3, Sep 2007, Pages 126-38

Migraine With Aura Increases Risk for Ischemic Stroke
New research suggests that women who have recent onset of migraine with visual aura have an almost 7-fold increased risk for ischemic stroke.

Results from the Stroke Prevention in Young Women Study found the risk for first-ever ischemic stroke was highest among women who reported new onset (within the past year) of probable migraine with visual aura (PMVA).

“Women with recent onset of probable migraine with visual symptoms (within the prior year) were almost 7 times more likely to have a stroke compared to women with no history of migraine,” principal investigator Steven Kittner, MD, MPH, Baltimore Veterans Affairs Medical Center, said in a statement.

“Eight percent of stroke cases had onset of probable migraine with visual symptoms in the prior year compared to one percent of controls,” he added.

However, Dr. Kittner pointed out that PMVA in the presence of behavioural risk factors including cigarette smoking and use of oral contraceptives (OCs) further increased the risk for stroke.

“Women who had probable migraine with visual symptoms who also smoked and used oral contraceptives had seven times the risk of stroke than women who had probable migraine with visual symptoms alone,” Dr. Kittner said in a statement.

In addition, this same group of subjects had a 10-fold increased risk for stroke compared with women with no history of migraine, who did not smoke or use OCs.

Although migraine has long been regarded as a key risk factor for ischemic stroke, the authors note that there has been little research investigating the clinical and anatomic features of this association.

For example, it is unclear whether stroke associated with a history of migraine has a specific anatomic weakness. According to investigators, a patent foramen ovale (PFO) is a risk factor for young-onset stroke and is associated with the prevalence and frequency of migraine. However, they write, there has been a lack of information about PFO in epidemiologic migraine studies.

PMVA increased stroke among women without traditional risk factors including hypertension, diabetes, and a history of myocardial infarction, a finding that, according to the authors, suggests that “PMVA may contribute to the etiology of ischemic stroke independently of atherogenic risk factors.”

In an accompanying editorial, Tobias Kurth, MD, ScD, from Brigham and Women’s Hospital in Boston, Massachusetts, says the study underscores the need to counsel young women with migraine about the substantial increased risk for stroke associated with smoking, particularly if they are also taking OCs.

Probable Migraine With Visual Aura and Risk of Ischemic Stroke. The Stroke Prevention in Young Women Study. Leah R. MacClellan, Wayne Giles, John Cole, Marcella Wozniak, Barney Stern, Braxton D. Mitchell, and Steven J. Kittner. Stroke, Published online before print, Aug 9, 2007

People in Pain: How Do They Seek Relief?
Little is known about how people with pain seek relief. To estimate the proportion of the population reporting recent pain, to identify ways people seek pain relief, and to report the perceived effectiveness of pain relief methods, the authors conducted an analysis of results from a nationwide survey of the general U.S. population. Of the 1204 respondents, 31% had experienced moderate to very severe pain within the past 2 weeks and 75% of these had sought medical attention. Only 56% of those who sought medical attention got significant pain relief. Although seeking medical attention was the primary pain relief strategy, almost all of those with pain had tried multiple alternative methods for pain control, with 92% of pain sufferers having tried 3 or more alternative strategies. People who did not seek medical attention were more likely to report pain relief from prayer and going to a chiropractor than were those who sought medical attention. Factors leading to inadequate pain relief included difficulty communicating with a health professional and lack of health insurance. People who perceive that their pain is not understood by medical providers and those without health care insurance coverage are at greater risk for poor pain control.

Shi Q, et al. The Journal of Pain. August 2007; Vol. 8, Iss. 8, pp624-36.

Associate Professor Henry Pollard!
Congratulations to Dr Henry Pollard's on his recent promotion within Macquarie University's faculty of Chiropractic to the position of Associate Professor.

Associate Professor Pollard's research activities have been independently scrutinised and placed within the top 20% of all allied health researchers (physiotherapists, osteopaths, nursing and general allied health disciplines globally. Our congratulations to Henry on behalf of all the COCA executive, staff and members.