NEWS
It is with great sadness that we heard about passing of Dr Alf Nachemson, founder of the Back Review Group and Co-ordinating Editor from 1994 to 2002. He became interested in evidence-based medicine when he heard about Sir Iain Chalmers, whose work with the Pregnancy and Childbirth Cochrane Group helped save the lives of thousands of babies. Dr Nachemson visited the U.K Cochrane Centre to meet with Sir Chalmers and shortly after founded the Cochrane Back Group. Dr Nachemson was involved in basic and clinical research on spinal disorders for more than 50 years, conceiving his first experiment (on intradiscal pressure) while still a medical student in the 1950s. During his illustrious career, he published more than 400 papers and supervised more than 80 PhD theses in orthopaedics. Dr Nachemson was well known and admired internationally. In recognition of his work, he received prestigious awards from more than 20 orthopaedic societies over his career. The Alf Nachemson Lectureship was established by the Institute for Work & Health in 2002 to honour Dr. Nachemson’s significant contribution to research evidence in clinical decision-making. We fondly remember his honest and engaging presentations at the Melbourne COCA conference “The Back Pain Challenge”, 1997.

Heightened Height Loss Increases Mortality in Men
Excess shrinking as men age accelerates the risk of an earlier death, investigators have found. A longitudinal study showed that men who lose three centimetres or more of height (about 1.18 inches) as they age are at an increased risk of death, compared to men who lose less than a centimetre, according to S. Goya Wannamethee, Ph.D., of the Royal Free and University College Medical School. The excess mortality was largely attributable to cardiovascular and respiratory conditions and other causes, but not to cancer, Dr. Wannamethee and colleagues reported in the Dec. 11 issue of Archives of Internal Medicine.

The study involved 7,735 men ages 40 to 59 years, who were selected from one general practice in each of 24 British communities from 1978 to 1980. The study found that, compared with men who lost less than one centimetre in height (about 0.39 inches), those who lost three centimetres or more had a 64% increase in all-cause mortality risk. Adjustment for other factors, including established cardiovascular risk factors, lung function, pre-existing cardiovascular disease, albumin concentration, self-reported poor or fair health, and weight loss had only a modest impact on mortality risk, the researchers found.

The study wasn’t able to pin down exactly why the height loss is associated with an increased risk of death, Dr. Wannamethee and colleagues said, although osteoporosis increases the risk of death and may play a role. It’s possible the some underlying mechanism is responsible both for height loss and for other health consequences that combine to give rise to the increased risk of death, the researchers said.

Moderate Drinking Lowers Death Risk
Moderate drinking has a protective effect on all-cause mortality, not only coronary heart disease, according to investigators here. In a meta-analysis of 34 prospective studies, a few drinks a day — one to two for women and two to four for men — led to lengthier lives, found Augusto Di Castelnuovo, Sc.D., of the Catholic University here, and colleagues.

“Our data show that consumption of little amounts of alcohol leads to a reduction of mortality up to 18%,” Dr. Di Castelnuovo said. But, he cautioned, “after a certain number of glasses things radically change” and the risk of death rises again. The finding was based on an analysis of studies involving 1,015,835 persons and 94,533 deaths, Dr. Di Castelnuovo reported in the Dec. 11 issue of the Archives of Internal Medicine. Previous studies have shown an inverse relationship between moderate alcohol consumption and coronary heart disease, Dr. Di Castelnuovo and colleagues said, but this is the first to show a similar effect for all-cause mortality.

The researchers defined a drink as 10 grams of ethanol and found that women benefited when they had a daily intake of between 10 and 25 grams, while men had a benefit from about 20 grams to 42 grams. The researcher noted that confounding factors could still have played a role in the finding — especially the suggestion that people who drink moderately are more concerned about their health in the first place and might be, for example, more physically active. But Dr. Di Castelnuovo said the researchers adjusted their results for a range of possible outside factors and “our data suggest that, even considering all main confounding factors (such as dietary habits, physical activity, or the health of people studied), a moderate consumption of alcoholic beverages keeps on showing a real positive effect.”

First WA Graduates to Join the Profession
The chiropractic profession in Western Australia will undergo a transformation this year with the first ever group of local graduates registering at Murdoch University. Fifty-six School of Chiropractic students will celebrate the end of a rigorous five-year course with a formal registration at Murdoch University’s state-of-the-art, on-campus clinic.

Head of School Brian Nook said the students have spent the final year of their studies practicing their chiropractic skills in the new clinic which is open to the public. “Most of the students have already gained employment either locally or nationally and at this ceremony they will be fully recognised as registered chiropractors in WA,” Associate Professor Nook said. COCA extends their congratulations (to the staff as well!) and best wishes for the future.

Benefit of Opioids for Chronic Back Pain Unclear, and Addiction Risk High
NEW YORK (Reuters Health) Jan 15- Findings from a systematic review of published research suggest that opioids often provide no advantage over non-opioids for relieving chronic back pain, but carry a high risk of addiction. Dr. David A. Fiellin, from Yale University in New Haven, Connecticut, and colleagues conducted a search of MEDLINE (1966 to 2005) and other databases to identify studies that looked at the use of opioids for back pain. Data from 38 studies were included in the analysis.

Opioid prescribing rates for back pain varied widely between studies, ranging from 3% to 66%, the investigators report in the Annals of Internal Medicine for January 16. A meta-analysis of data from four studies revealed no significant pain-relieving advantage for opioids over either placebo or nonopioid controls. Similarly, an analysis of data from five studies comparing the relative efficacy of different opioids showed only a nonsignificant drop in pain from baseline. The percentage of subjects with a substance use disorder at some point in their lives ranged from 36% to 56%. Up to 43% of subjects had a current substance use disorder. Between 5% and 24% of subjects showed “aberrant medication-taking behaviours,” the investigators note.

Student Backpacks Carrying a Risky Load
(VillageVoice.Com.Au; Posted 15 January, 2007) The humble school bag is a risky weight on students’ shoulders, says Leichhardt chiropractor Anthony Vitiello, who is turning to technology to prevent back problems in children and adolescents.

Mr Vitiello, who is undertaking his PhD on how backpack design affects back muscles, said an unsuitable backpack can carry a checklist of problems. Primary school children risk stunted long bone growth, while their high-school siblings regularly report lower back pain and neck pain. There is also potential for problems of the heart, lungs, posture and nervous structures from repeatedly carrying heavy loads, Mr Vitiello said.

Chiropractic research suggests that people shouldn’t carry more than 10 per cent of their body weight in a bag. But during Mr Vitiello’s PhD study on high school students he found that not only were their backpack loads too heavy, most of the items they were carrying were those required by schools which taught up to eight subjects every day. He believes the heavy textbooks being lugged around by senior high school students in particular should be replaced with multimedia CDs and DVDs. “We can drop bag loads by 95 per cent overnight,” Mr Vitiello said.

Sydney Secondary College’s Balmain campus principal Mr Lee Wright, whose students only have four periods per day, said that while many textbooks already came with CDs, money was an obstacle to getting rid of hardback texts altogether.

Mr Vitiello said that using the right bag is the best protection against back problems currently available. A good backpack will have a well-padded and supportive hip belt, wide shoulder straps and will curve to the wearer’s spine to redistribute weight from the shoulders, he said. Convincing image-conscious students to wear bags with a thick strap belt attached to their hips was ‘a problem’, but he hoped young people would come around to the idea for the sake of their health. Health professionals also found it hard speaking to schools about reducing students’ bag loads when studies have only been able to show weight as being a risk factor in back pain, rather than a direct cause of it, Mr Vitiello said.