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On The Other Hand Podcast episode: Dr. David Seaman on Chronic Inflammation and Nutrition

April 30, 2011 By Brett Kinsler

PodcatIs inflammation a good thing or a bad thing? Sometimes, the fact that the body gets inflamed is beneficial – swelling caused by acute inflammation following an injury can help promote healing and fight local infection. It’s an appropriate immune response. But another kind of inflammation, a chronic sort, can occur throughout the body, and over long periods of time may actually increase the risk of heart disease, stroke, diabetes and cancer. Chronic inflammation is kind of a glitch in the system — a feedback loop gone awry. How do you test for the presence of this chronic inflammation and, if it is present, what should we do about it? Dr. Brett Kinsler presents a new podcast episode of On The Other Hand, in which we hear from Dr. David Seaman, chiropractor, professor at National University of Health Sciences in St Petersburg Fl. and the producer of the website Deflame.com. He’s an expert in the connection between nutrition and chronic inflammation.

Podcast can be found on iTunes or at OnTheOtherHand.KinslerPress.com

Filed Under: chiropractic

New Quick-and-Easy Autism Screening for One-Year-Olds

April 29, 2011 By autism

A new quick-and-easy screening questionnaire may allow pediatricians to identify one-year-olds at risk of developing autism and related disorders.  According to the Wall Street Journal:

...UC-San Diego researchers found pediatricians were able to use a five-minute questionnaire to successfully identify potential problems in communication and language skills during a 12-month-old's wellness checkup. Questions included whether parents could tell if their infant was happy or upset, or responsive to certain cues.

Of the nearly 10,500 infants screened, 184 scored lower than expected and were referred for further evaluation and tracked for up to three years. Ultimately, 32 of them were diagnosed with an autism-spectrum disorder, while an additional 101 were determined to have a language or developmental delay or a related condition.

Several of the children who were diagnosed with an autism spectrum disorder quickly lost that diagnosis as they gained new skills.

The CSBS DP IT checklist (Communication and Symbolic Behavior Scales Developmental Profile Infant-Toddler) is described as "an easy-to-use, norm-referenced screening and evaluation tool that helps determine the communicative competence (use of eye gaze, gestures, sounds, words, understanding, and play) of children with a functional communication age between 6 months and 24 months (chronological age from about 6 months to 6 years)." To measure such concerns, the test asks questions about topics including

  • Emotion and Eye Gaze
  • Communication
  • Gestures
  • Sounds
  • Words
  • Understanding
  • Object Use

If you're curious the test, you can actually access it online, along with an accompanying infant/toddler checklist, form for taking a behavioral sample, and caregiver questionnaire.   The Brookes Publishing website, where the test is housed, states that the test should be administered by a qualified speech language pathologist and notes that children who are delayed ONLY in their use of speech are likely to simply catch up with their peers while children with the social and behavioral delays described on the test are likely to wind up with a more signficant diagnosis.

What if your child tests positive for being at risk of autism?  Some researchers interviewed in today's news raise concerns that treatments tested only in older children might not be effective for one years olds.  But most of the treatments recommended for young children with early signs of autism are developmental, and involve age-appropriate play and interactivity.

If you have concerns about your child, you should, of course, contact your pediatrician and set up a screening and evaluation.  But early intervention has been shown to be an important tool for improving autism outcomes, and you may not want to sit on your hands.  While you wait, you might want to pick up a copy of Stanley Greenspan's book, Engaging Autism.  It's a book that provides parents with instructions for implementing a form of play therapy called Floortime.  While Floortime may not be a panacea for autism, it is a well-regarded, parent friendly, low-tech, low cost way to get started helping your child...  with no risk should your child prove to have no significant issues at all!

More About Early Signs and Diagnosis of Autism

New Quick-and-Easy Autism Screening for One-Year-Olds originally appeared on About.com Autism on Friday, April 29th, 2011 at 08:05:47.

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Who’s Asleep Over at MedScape?

April 27, 2011 By Frank M.

In general, I find the reporting at MedScape to be top notch, but I have significant problems with their 4-20-11 essay titled: “The Potential Complications of Chiropractic Therapy”.

Answer this question:

If I sneeze, and there is a car accident across the street,
have we discovered the *cause* of car accidents?

The scientific method would propose that we sneeze a hundred times, and count the car accidents.

That’s how you begin to determine if there is an actual relationship between one event (like drinking milk) and it’s potential consequences (like developing cancer).

The Bone and Joint Decade Task Force was appointed by the World Health Organization (WHO) to look at the causes of, and treatments for neck pain, and after years of review, they published their results in the prestigious Spine Journal. One of the most relevant articles (to this conversation) was titled:

“Risk of Vertebrobasilar Stroke and Chiropractic Care: Results of a Population-based Case-control and Case-crossover Study”
Spine 2008 (Feb 15); 33 (4 Suppl): S176–183

CONCLUSION: VBA stroke is a very rare event in the population. The increased risks of VBA stroke associated with chiropractic and PCP visits is likely due to patients with headache and neck pain from VBA dissection seeking care before their stroke. We found no evidence of excess risk of VBA stroke associated chiropractic care compared to primary care.

There was an association between chiropractic services and subsequent vertebrobasilar artery stroke in persons under 45 years of age, but a similar association was also observed among patients receiving general practitioner services. This is likely explained by patients with vertebrobasilar artery dissection-related neck pain or headache seeking care before having their stroke.

This Blog (and our website in general) has published regularly on this topic:

WARNING: Conducting an Orchestra Can Cause Vertebral Artery Dissection and Stroke
http://www.chiro.org/wordpress/?p=5005

If Not Chiropractic Care, Then What’s Your Alternative?
http://www.chiro.org/wordpress/?p=3671

Do You Still Beat Your Wife?
http://www.chiro.org/wordpress/?p=3658

Chiropractic and Stroke Incidence
http://www.chiro.org/wordpress/?p=1769

Respected Researcher Validates Chiropractic Standard of Care and Safety
http://www.chiro.org/wordpress/?p=1721

We also have access to an interview with the author himself:

Podcast Interview with J. David Cassidy: No Increased Risk of Stroke With Chiropractic
http://www.chiro.org/wordpress/?p=4963

This interview, with author, researcher and epidemiologist J David Cassidy, DC, DrMedSc, PhD, should quell the fears of even the most vehement critics who would normally carry on on by mis-quoting, ignoring, or twisting the existing scientific literature to suit their pre-conceived notions and biases.

The Stroke and Chiropractic Page has been online since early 1996, compiling the literature which documents how chiropractic care has been mis-labeled as the “proximal event” in reported cases of vertebral artery injury.

Most telling is Terrett’s seminal work Misuse of the Literature by Medical Authors in Discussing Spinal Manipulative Therapy Injury, which clearly demonstrates that many of the reported injuries ascribed to chiropractic actually occurred following care provided by MDs, PTs and even hair-dressers, even though the authors of those works knew the truth. Where I come from, that’s called bald-faced lying, not *misuse*.

The unadorned FACT is that there is ZERO scientific evidence that a chiropractic adjustment has EVER *caused* a stroke. None.

I hope the Editors at MedScape will publish a retraction and apology, while explaining how and why they missed mentioning the results published by the Spinal Task Force.

Filed Under: chiropractic, News

Are You an Autism Mom? Submit a Guest Blog for Mother’s Day!

April 26, 2011 By autism

As Autism Awareness Month draws to a close, my thoughts are fast turning to NEXT month - and Mother's Day.

This year, I'm inviting autism moms to submit a guest blog to be published on this site during the month of May.  Here are the details:

  • Autism moms (or the people who love them) are invited to submit a guest blog of up to 1,000 words.  These should be personal reflections on motherhood and autism rather than essays on the state of the autism community, public policy, etc.
  • Photos and short author bios are welcome but optional.  Be sure you have the rights to any images and can provide a credit and caption.
  • If you are already a blogger, please send me an original piece that is NOT presently on your blog, along with a link to your blog so I can include it in the post.
  • I'm hoping to include moms of all sorts - that is, international moms; moms of very young children and moms of adults; moms who are themselves autistic and moms who never heard of autism until their child was born; moms of children with Asperger syndrome and moms of children with severe autism... moms who are hopeful and moms who are discouraged, moms who write for a living and moms who are just now starting to put their experiences in writing.
  • While I am open to all kinds of moms, I will not be publishing blogs that are thinly veiled (or unveiled) ads or promotions for a particular therapy, therapist, product, political belief, etc.

Please shoot me an email at autism.guide@about.com with any questions or to let me know you plan to submit a blog.  I'm asking that blogs be submitted between now and May 8, 2011 (Mother's Day).

PLEASE PASS THIS POST ALONG!

Are You an Autism Mom? Submit a Guest Blog for Mother's Day! originally appeared on About.com Autism on Tuesday, April 26th, 2011 at 10:24:01.

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Exam Study Tips for Students With ADHD

April 25, 2011 By add

If you have ADHD you probably spend more time and effort studying for exams than a student without ADHD. Finding the best way to study, understand and absorb information is an individualized process, but here are some general tips that may help.

Exam Study Tips

Photo © Microsoft

Exam Study Tips for Students With ADHD originally appeared on About.com ADD / ADHD on Monday, April 25th, 2011 at 18:12:06.

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Play With Your Autistic Child: More Easily Said Than Done

April 25, 2011 By autism

If there's one issue that's shared by all young children with autism, it's difficulty with ordinary play skills.  Little ones with autism may line up or stack toys, play by themselves and resist interaction with their peers, or simply spin, rock or otherwise spend time in their own world.  It's this self-absorption that makes it so hard for autistic children to learn from imitation, socialize with other children, or connect with the adults in their lives.

In theory, parents can play a key role in actually teaching their autistic children to play.  But while "playing with your child" sounds like a no-brainer, it can be very, very challenging for the parent of an autistic child.

What's so tough about playing with an autistic child?

  • It's not always easy to even capture the attention of an autistic child, or to hold their attention for more than a minute or so
  • Once engaged, a child with autism will often prefer to do the same things over and over again, and it can be hard to break the pattern
  • Children with autism will rarely bring their own ideas or energy to interactive play, so all the ideas and energy must come from the parent.  This can be exhausting and frustrating.
  • The usual tools we use to engage children - asking questions, offering suggestions, starting an intriguing activity - may go right past the child with autism.

But all of these issues are nothing compared with parents' very real sense of hurt and sadness when their own child ignores them in favor of an internal world or object.  Yes, most parents can get past a feeling of rejection to experiment with new ways of engaging and connecting.  But when we reach out to our child and he ignores us; when we hug our child and she pulls away; when we engage our child and he appears oblivious - it's extraordinarily difficult to find the emotional energy to keep trying.

Another major hurdle is the sad reality that an awful lot of parents have forgotten how to just play.  Sure, they can play board games or sports - but the idea of  pretending to be someone or something they're not is no longer appealing.  Most parents can just arrange play dates and stand back while their children practice symbolic interactions, build relationships, experience and manage emotions.  But parents with autistic kids don't have that luxury.

There are developmental therapies geared specifically to providing parents with the tools to play with their autistic children - and those therapies are not only tools for play, but also tools for communicative and cognitive growth.  Floortime and RDI are both good directions for parents to turn.  But even with support and information about "how to play with your autistic child," most parents feel a bit overwhelmed by the challenge.

How do you play with your young child with autism?  Have you found tools or tricks to keep yourself up and energized, and to keep the creative juices flowing?

Developmental Therapies for Autism Spectrum Disorders

Developmental therapies for Autism Spectrum Disorders work on autism's "core deficits" including problems with social and communication skills. They are tailored to the individual child, and are very often administered by parents. Floortime, RDI and Son-Rise are the top developmental therapies for autism. Learn more about developmental therapy and the different approaches. Are these techniques for you?

What Is Floortime?

Floortime, a form of therapeutic play, is the central feature of the DIR (Developmental, Individual-Difference, Relationship-Based)therapeutic approach developed by Stanley Greenspan and Serena Weider. Read Dr. Greenspan's answer to the question "what makes floortime play different from ordinary play?"


Getting Started with Floortime

Floortime, a form of therapeutic play, is not only an important developmental treatment -- it's also a great way for parents to bond with their autistic children.


Relationship Development Intervention (RDI): A Treatment for Autism

Relationship Development Intervention (RDI)is a relatively new approach to autism treatment. Developed by Dr. Steven Gutstein, its claim is that it addresses "core deficits" to vastly improve social/communication skills and flexible thinking.



Play With Your Autistic Child: More Easily Said Than Done originally appeared on About.com Autism on Monday, April 25th, 2011 at 08:42:19.

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The Evidence-based Rap, orWhat’s Wrong With My Pain Meds?

April 23, 2011 By Frank M.

Editorial Commentary:

Based on: “A systematic review on the effectiveness of pharmacological interventions for chronic non-specific low-back pain ”
Eur Spine J. 2011 (Jan); 20 (1): 40–50 ~ FULL TEXT

OK, maybe this isn’t a genuine Rap, and I’m not rhyming-Simon, but somebody needs to bust-a-cap on the pain-med industry, because they hold themselves to a much lower standard than they expect my profession to maintain.

Fortunately (and, to the rescue) comes this study from the Dutch Institute for Health Care Improvement. They actually busted the cap, by deciding to explore “the effectiveness of pharmacological interventions [i.e., non-steroid anti-inflammatory drugs (NSAIDs), muscle relaxants, antidepressants, and opioids] for non-specific chronic low-back pain (LBP)”.

I say Bravo, because these drugs are medicine’s sole conservative approach for managing LBP. This Blog has previously published numerous (and recent) studies suggesting that chiropractic management for low back pain is orders of magnitude more effective for pain relief, and is also significantly more cost-effective than standard medical management. [1-8]

Now this study comes along challenging the benefits and effectiveness of medicine’s reliance on drug treatments for pain management. The Iatrogenic Injury Page [9] clearly documents the dangers associated with these drugs (primarily death). This current study reviewed 17 randomized controlled trials for pain treatments: NSAIDs (n = 4), antidepressants (n = 5), and opioids (n = 8). No studies were found for muscle relaxants.

They concluded that NSAIDs and opioids “seem to lead to a somewhat higher relief in pain on the short term, as compared to placebo” (aka no treatment at all!), “in patients with non-specific chronic low back pain and that both types of medication show more adverse effects than placebo”. (What an elegant understatement that is!)

Review of the Iatrogenic Injury Page reveals that thousand die ever year from the use of NSAIDs for simple pain relief, and overdose deaths from prescribed opiates has doubled in the last 2 decades. [10] And yet we don’t see the headlines screaming about how this medicine is killing patients by the tens of thousands. Who is asleep at the wheel?
When will the madness stop???

The current healthcare debate has brought up basic questions about how medicine should work. On one hand we have the medical establishment with its enormous cadre of M.D.s, medical schools, big pharma, and incredibly expensive hospital care. On the other we have the semi-condoned field of alternative medicine that attracts millions of patients a year and embraces literally thousands of treatment modalities not taught in medical school.

One side, mainstream medicine, promotes the notion that it alone should be considered “real” medicine, but more and more this claim is being exposed as an officially sanctioned myth. When scientific minds turn to tackling the complex business of healing the sick, they simultaneously warn us that it’s dangerous and foolish to look at integrative medicine, complementary and alternative medicine, or God forbid, indigenous medicine for answers. Because these other modalities are enormously popular, mainstream medicine has made a few grudging concessions to the placebo effect, natural herbal remedies, and acupuncture over the years. But M.D.s are still taught that other approaches are risky and inferior to their own training; they insist, year after year, that all we need are science-based procedures and the huge spectrum of drugs upon which modern medicine depends. [11] And now, even that claim is eroding.

REFERENCES:

1. New LBP Study Reveals Chiropractic Is Superior to PT and MD Care
Chiro.Org Blog ~ 3-17-2011

2. Chiropractic Cost-Effectiveness
Chiro.Org Blog ~ 3-16-2011

3. Chiropractic Goes To The Hospital
Chiro.Org Blog ~ 3-06-2011

4. Chiropractic Treatment of Workers’ Compensation Claimants in the State of Texas
Chiro.Org Blog ~ 2-24-2011

5. New Study Confirms That Maintenance Care Delivers!
Chiro.Org Blog ~ 1-26-2011

6. Primary Care MDs Decline Training In Pain Management
Chiro.Org Blog ~ 1-20-2011

7. The Cost-Effectiveness of Chiropractic Page

8. Patient Satisfaction With Chiropractic Page

9. The Iatrogenic Injury Page

10. Painkiller Deaths Double in Ontario
Chiro.Org Blog ~ 12-08-2009

11. The Mythology Of Evidence-Based Medicine
Chiro.Org Blog ~ 2-25-2011

Filed Under: chiropractic, Research

Happy Easter from Chiro.Org!

April 22, 2011 By Frank M.

Filed Under: chiropractic

The New York Times Comments on Andrew Wakefield

April 21, 2011 By autism

I've already received the same link twice today - a link to an article in the New York Times entitled The Crash and Burn of an Autism Guru.  It's a piece about Andrew Wakefield, whose 1998 study linking measles vaccine and autism was retracted from the Lancet, and whose medical license was revoked in the UK.  Some believe that Wakefield is a charlatan.  Some believe he's a martyr.  This piece explains both perspectives.  Perhaps as importantly, it has brought  Wakefield into focus for the wider world that, until recently, had never heard of the man, his theories, or his life story.

Who is Wakefield?

J.B. Handley, founded of Generation Rescue, is quoted as saying, "To our community, Andrew Wakefield is Nelson Mandela and Jesus Christ rolled up into one.  He's a symbol of how all of us feel."

Brian Deer, a reporter writing for the British Medical Journal, "... compares him to the kind of religious leader who is a true believer but relies on the occasional use of smoke and mirrors to goose the faith of his followers. "He believed it was true," Deer says of Wakefield's theory of M.M.R., but he was also willing to stretch the truth to get more financing for more research. Deer theorizes that Wakefield's maneuverings were all rationalized by his conviction that he was right: "He would prove it next time."

There's no doubt that the autism community has strong feelings for and against Wakefield.  If Handley's description of Wakefield as "Jesus Christ" represents one point of view, it's probably fair to say that there are those who view him precisely the opposite light - as a sort of anti-Christ.

Do you have an opinion regarding Andrew Wakefield?  Share it here!

Note: the link above allows readers to write an opinion piece which will become a permanent part of the About.com site, but it is not intended to host a back-and-forth debate.  If you are interested in discussing this issue at length, I invite you to use the Forum!


The New York Times Comments on Andrew Wakefield originally appeared on About.com Autism on Thursday, April 21st, 2011 at 16:07:39.

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Half of All Children with Autism Wander or Bolt

April 21, 2011 By autism

A new survey from the Kennedy Krieger Interactive Autism Network finds that "approximately half of parents of children with autism report that their child elopes, with the behavior peaking at age four. Among these families, nearly 50% say that their child went missing long enough to cause significant concern about safety."  While the specific reasons for this are not known, parents responding to the survey with their own interpretations as follows:

o Enjoys exploring (54%)
o Heads for a favorite place (36%)
o Escapes demands/anxieties (33%)
o Pursues special topic (31%)
o Escapes sensory discomfort (27%)

As many as 40% of respondents say they are concerned that their child with autism will wander out of the house at night, and 62% say they stay away from public activities for fear that their child with autism will wander or bolt.

Our experience may be similar to that of other families: our son, Tom, was a "bolter" during his preschool and kindergarten years.  He would, often without warning, run out of a classroom or wander away from a group on the playground.  Sometimes we could see that his interest was piqued; at other times he would head for a favorite shop or item - or run away when told "no."   Today, while he doesn't actually bolt, he does respond to stressful situations by talking about his desire to get away.  His ability to communicate his feelings verbally, however, seems to have lessened his need to actually leave the scene - and his maturing understanding of the wider world means that he does understand the potential dangerous or frightening consequences of his actions.

Children with autism, of course, are often limited in their ability to express their thoughts and feelings verbally.  Even high functioning children with autism, at the age of 3, 4 or 5, may not have the emotional and cognitive maturity to stop, think, and use their words.  In addition, they may be unusually naive about the dangers of the wide world.  When anxiety or sensory issues strike, and emotions run high, bolting may seem like the only viable option.  There are increasingly frequent media stories of children with autism who wander.  In some cases these children return or are returned safely, but several recent stories have told of children who have drowned in pools or been injured as a result of an "elopement" episode.

In many cases, too, the incidence of wandering doesn't end when a child becomes a teen or an adult.  This reality can be very frightening, both for caregivers and for the individual on the autism spectrum when he or she is lost or frightened.  All too often, too, an adult with autism who is lost and frightened can wind up in trouble with the law - or in physical danger.

Not long ago, I wrote a blog about a potential new medical code for autistic elopers.  While some favor the idea, others are concerned that such a code could result in more restraint and seclusion for children with autism.  Another concern is that once such a code is in place, caregivers might cease to search for the causes of bolting or wandering, assuming that it's "just part of autism."

Have you experience wandering or bolting?  What are your thoughts on the subject?

More on Wandering and Autism

Half of All Children with Autism Wander or Bolt originally appeared on About.com Autism on Thursday, April 21st, 2011 at 11:19:55.

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Landmark Legislation Passes In The Texas Senate

April 20, 2011 By Frank M.

SOURCE: Texas Journal of Chiropractic

The Texas Chiropractic Association reports that on Thursday, April 14, 2011, the Texas Senate passed Senate Bill 1001. Says the Texas Chiropractic Association:

“This landmark legislation is significant for two reasons: It allows chiropractors to form professional associations with medical doctors, and it ensures that chiropractors will be treated fairly by insurance companies that decide to cover services that can legally be provided by chiropractors and other types of practitioners. …We have been trying to pass this type of legislation for more than 20 years.”

The Senate Journal reflects that “Senator Carona offered the following amendment to the bill”: These amendments include:

“A COLLABORATION BETWEEN PHYSICIANS AND CHIROPRACTORS. a person licensed under Subtitle B, Title 3, and a person licensed under Chapter 201 are authorized to: (1) collaborate with each other in providing services to a client ….”

Title 3 is the Health Professions portion of the Occupations Code.
Subtitle B relates to Physicians.
Chapter 201 of Subtitle C relates to Chiropractors.

“ASSOCIATIONS. (a) a person licensed under Subtitle B, Title 3, and a person licensed under Chapter 201 of this code may form a partnership, professional association, or professional limited liability company according to the requirements of this section and any other applicable law.

(b) When persons licensed under Chapter 201 of this code form a professional entity with persons licensed under Subtitle B, Title 3 of this code, as provided by this section, the authority of each practitioner is limited by that practitioner’s scope of practice, and a practitioner may not exercise control over another practitioner’s clinical authority granted by the other practitioner’s license, either through agreements, bylaws, directives, financial incentives, or other arrangements that would assert control over treatment decisions made by the practitioner.

(c) The state agencies exercising regulatory control over professions to which this section applies continue to exercise regulatory authority over their respective licenses.

(d) A person licensed under Subtitle B, Title 3 of this code, who forms a professional entity under this section shall report the formation of the entity and any material change in agreements, bylaws, directives, financial incentives, or other arrangements related to the operation of the entity to the Texas Medical Board no later than the 30th day after the entity is formed or the material change is made.”

“If physical modalities and procedures are covered services under a health benefit plan and within the scope of the license of a chiropractor and one or more other type of practitioner, a health benefit issuer may not: (1) deny payment or reimbursement for physical modalities and procedures provided by a chiropractor if: (A) the chiropractor provides the modalities and procedures in strict compliance with laws and rules relating to a chiropractor’s license; and (B) the health benefit plan issuer allows payment or reimbursement for the same physical modalities and procedures performed by another type of practitioner; (2) make payment or reimbursement for particular covered physical modalities and procedures within the scope of a chiropractor’s practice contingent on treatment or examination by a practitioner that is not a chiropractor; or (3) establish other limitations on the provision of covered physical modalities and procedures that would prohibit a covered person from seeking the covered physical modalities and procedures from a chiropractor to the same extent that the covered person may obtain covered physical modalities and procedures from another type of practitioner.”

The amendment was adopted, the Senate Journal reports, with “all members … deemed to have voted ‘Yea’” with the exception of one absent-excused Senator. The bill passed to the third reading by a vote of 30 yeas and 0 nays. On final reading the bill passed the Senate 30 to 0 with one senator excused-absent.

The TCA reports that “Dallas state Sen. John Carona deserves our thanks and praise for successfully guiding SB 1001 through the Senate. … SB 1001 now goes to the Texas House, where it must also be approved.”

Review the text of the final Senate Bill 1001

The House is noted as having received the bill from the Senate on April 15, 2011.

Filed Under: chiropractic, News

Danish vaccine scientist indicted in US

April 20, 2011 By John

Autism researcher accused of embezzling $1 million
Source Copenhagen Post

American prosecutors are seeking to extradite a Danish scientist who a federal grand jury in Atlanta has charged with 13 counts of wire fraud and nine counts of money laundering. They allege that Poul Thorsen, 49, stole over $1 million from autism research funding between February 2004 and June 2008, and used the proceeds to buy a home in Atlanta, two cars and a Harley Davidson.

Thorsen helped two Danish government agencies obtain research grants, which amounted to $11 million between 2000 and 2009, whilst he was working as a visiting scientist at the Atlanta-based Centers for Disease Control and Prevention (CDC) in the 1990s. He returned to Denmark as the ‘principal investigator’ for the programme, which studied the relationship between autism and exposure to vaccines, allegedly putting him in charge of the administration of the funding.


It is alleged that over the four-year period he submitted over a dozen false invoices from the CDC for research expenses to Aarhus University, where he held a faculty position, instructing them to transfer the funds to a CDC account, which was in fact his personal account.

“Grant money for disease research is a precious commodity,” noted Sally Quillian Yates, from the US Attorney’s office for the Northern District of Georgia, in a news release. “When grant funds are stolen, we lose not only the money, but also the opportunity to better understand and cure debilitating diseases.”

It was while Thorsen was working in the 1990s at the CDC division of Birth Defects and Developmental Disabilities that the CDC started soliciting grant applications for research into the relationships between autism and exposure to vaccines, cerebral palsy and infection during pregnancy, and childhood development and fetal alcohol exposure. Thorsen saw an opportunity to promote his homeland and played a central role in winning the grant.

Thorsen’s research on autism is widely known in academic circles, where he was until this week a highly respected figure. A paper of his on the subject, which is known as ‘The Danish Study’, is quoted extensively to refute the autism vaccine connection.

Each count of wire fraud carries a maximum of 20 years in prison and each count of money laundering a maximum of 10 years in prison, with a fine of up to $250,000 for each count. The federal government will also seeks forfeiture of all property derived from the alleged offenses.
Filed Under: chiropractic, Research

Advising on Prevention in Chiropractic: A Look at Public Health Promotion

April 19, 2011 By Frank M.

Advising on Prevention in Chiropractic:
A Look at Public Health Promotion and Health Behavior Theory Used in Clinical Education Settings

SOURCE: Topics in Integrative Health Care 2011: 2 (1)

There are more articles like this at the:
Health Promotion & Wellness Page

Harrison Ndetan, M.Sc., MPH, DrPH, Michael Ramcharan, DC, Marion Willard Evans, Jr., DC, PhD, MCHES, CWP

The Abstract:

Chiropractic care is among the more commonly used Complementary and Alternative Medical (CAM) therapies. Spinal co-morbidities include many of the most common causes of premature death and disability. Health promotion and disease prevention have been used in the profession and taught in educational settings but not yet fully embraced in usual practice. This manuscript reviews areas in which health promotion has been emphasized in chiropractic education along with instances in which health behavior theories (HBTs) have been applied. Chiropractic clinical and educational programs should consider application of HBTs to move clinicians and interns forward regarding better advising roles with patients related to prevention and health promotion.

Introduction

The actual causes of death in the United States include many chronic diseases that are attributable to modifiable behavioral risk factors such as tobacco use, physical inactivity or sedentary lifestyle, alcohol consumption, poor nutrition or eating habits. [1] An increased emphasis on prevention, health promotion (HP), and education has been recommended for decades but has failed to reduce many of the threats related to premature morbidity and mortality. [2,3] Complementary and alternative medicine (CAM) use has also increased; in many cases aimed at chronic disease management. [4-7]

Chiropractic care is one of the most frequently used professional CAM health care systems in the U.S. [4,5,7] Musculoskeletal conditions such as low back and neck pain, which are among the most common reasons patients visit medical physicians in the U.S., [8] are also among the conditions most frequently treated with chiropractic care. [7-9] The relative efficacy and cost effectiveness of chiropractic and medical care have emerged as important issues in the broader debate on evidence-based healthcare. [10,11]

Chiropractors and health promotion

Chiropractic principles claim to emphasize wellness, prevention and, to a certain degree, health promotion. In addition, chiropractors report providing a substantial portion of prevention and wellness-based care in the U.S. [12-14] Several studies have investigated whether doctors of chiropractic (DCs) perform HP and most report some health educational activities in practice. [14,15] However, the question as to whether chiropractic care influences modifiable risk behavior is largely unanswered, especially from the perspective of the patients.

The Job Analysis of Chiropractic, 2005 reported that the percentage of patients receiving some HP advice ranged from 40% receiving advice on disease prevention to 65% on general physical fitness and exercise. [13] Interestingly, a study by Jamison in Australia gives some indication as to the type of health information DCs are most comfortable providing from a self-reported, self-efficacy perspective. [16] It should be noted that self-efficacy is simply the feeling one can replicate the behavior desired such as advising adequately in this case. Her study suggests that DCs are very comfortable with giving advice on exercise, for instance, but much less comfortable with advice on other “wellness” topics. While 91% said they felt comfortable giving advice on exercise, only 13% felt comfortable giving advice on alcohol use and only 12% regarding substance abuse.

Recent analyses of the National Health Interview Survey indicated that respondents who reported seeing a DC and not a medical physician (MD) in a period of 12 months were more likely to report “heavy drinking” compared to those seeing only an MD [17] and very few stated that they had been advised by their doctors on diet change and weight loss even when they were overweight or obese. However, when advised by either a MD or DC, a majority reported an attempt at compliance. [18] Previous investigation indicates that U.S. medical and chiropractic curricula are deficient in training their students on advising roles in HP, especially smoking cessation. [19-22] HP and health education have been emphasized for years in the field of chiropractic, [15,22-28] but studies do not indicate a wide adoption of HP activities in the profession. [17,18,29-31] However, topics covered recently do include areas such as fall prevention, [32,33] balance, [34-38] domestic violence prevention [39,40] and screening for adverse drug events. [41]

The need for health promotion practice in chiropractic care

The American Chiropractic Association and the Association of Chiropractic Colleges have position statements that encourage HP and preventive efforts related to wellness. [42,43] This is important, since so many acute neck and back pain patients consult DCs and because a minority of medical patients report having been counseled on health-related behavioral change. [44,45] Further, patients who develop chronic spine problems tend to have a higher prevalence of co-morbid health conditions than the general public in aggregate. [46-48] In addition to those indications that spinal patients may need more emphasis on general preventive care, numerous agencies, researchers, and accrediting bodies have called for more prevention and HP education emphasis within the practice of health care delivery. [13,19, 46-48] Limiting morbidity and disability from back conditions is also a focus area under Healthy People guidelines. [3]

According to the Council on Chiropractic Education (CCE):

“Health promotion includes general strategies to enhance quality of life, prevent disease, trauma and illness including ergonomics, psychosocial supports, exercise, diet and nutrition including lifestyle counseling and health screening…” [49]

In January 2006, this new CCE standard for the delivery of HP and wellness went into effect at America’s chiropractic colleges. This included demonstration of the ability to determine how lifestyle, behavior, and other factors affect the wellness of the patient and the demonstration of skills, knowledge, and ability to communicate needs regarding required changes in lifestyle that will be conducive toward better health. [49]

The aim of this report was to review the literature for papers that stressed the use of health promotion, with or without health behavior theories (HBT), and to assess the literature on advising prevention in the chiropractic clinical educational setting. In addition, this report emphasizes the various HBTs and outlines how they may assist in promoting better advising behaviors among clinicians and interns in the clinical education setting.

Methods

The authors searched the literature using PubMed, Google Scholar, ChiroAccess, as well as their personal literature files and reference tracking. Search terms included “chiropractic and health promotion” and “chiropractic and prevention.” The authors restricted the review to papers that included an emphasis on health promotion in the clinical education setting or that used HBT to frame an intervention or educational program.

Results

Only a few studies could be identified within the chiropractic literature documenting HBT-based interventions to improve the practitioner’s behavior towards health promotion. However, additional papers emphasized the need to apply HBT in practice ranging from patient communications [50-52] to promoting health advocacy [53] through use of Ecological Theory (ET), [54] which posits multi-factorial cause for most health problems including social and environmental constructs.

Notable non-theory publications

In 2003 Hawk and colleagues [28] pre and post-tested students’ familiarity with and intention to use key HP concepts, resources, and practice techniques following an educational intervention. The goal of their study was to implement and evaluate a model course on “wellness concepts” for chiropractic students that emphasized national goals and evidence-based practices for HP and prevention. The study was conducted at a chiropractic college and employed teaching methods that included traditional lecture discussions and experiential activities, centered on the Healthy People 2010 objectives. The investigators noted significant increases in students’ self-reported familiarity on key HP concepts. Although slight increases in intent were noted during the education process, statistically significant differences were rare from pre to post intervention evaluations because a majority of the students had predetermined they would use HP at baseline. This study did not attempt to evaluate the actual practice of HP by the students. The authors suggested that didactic methods of teaching HP be integrated into the clinical education, as well as an emphasis on practical application of HP in chiropractic clinical practice.

Hawk and Evans assessed 9 teaching clinics on smoking cessation advising and intake paperwork related to assessment of patient smoking status. [55] Although they assessed for provider cues to take action, they did not mention HBT. Gordon and colleagues proposed a pilot program to focus chiropractors on advising on tobacco cessation. [56] They mention barriers to this process as well as readiness to quit smoking as constructs, but do not specifically cite or mention HBTs.

Killinger proposed HP for older Americans engaged in chiropractic care [57] and although no HBTs were mentioned, she suggested the need for enabling and reinforcing factors as well as the need for the doctor to “cue” patients to take action; both of which are integral parts of HBTs. Globe and colleagues performed two chart reviews to assess the effect of a model program in public health on advising rates. [30-31] Although they did not report measurable differences, and did not mention specific HBTs, they do mention the need to frame messages toward the positive when recommending behavior changes.

Ndetan and colleagues performed random chart reviews at two teaching clinics after the CCE standard went into effect and found some HP activities but noted a fragmented system of recording them and serious gaps in delivery of HP delivery, often indicating patients at risk receiving no HP advice at all on a given visit. [58]

Terre and colleagues authored a selective review of the empirical literature on family violence. [39] This paper discussed integrating the screening and detection of family violence with chiropractic training. The authors held that there is a clear need to translate the didactics of family violence into the clinical setting but made no attempt to design any interventions in this regard. Mertz and a team of investigators assessed various scoliosis screening programs for their use of planning theories or change theories but found none that relied on either of those. [59] Borody and Till reported on a new course on HP modeled after an online course on public health at the Canadian Memorial Chiropractic College. [60] The investigators surveyed students’ perceptions and motivation to study and apply course content in clinical settings before and after the implementation of the new online model course. Their report indicated significant improvements in perceived relevance of HP to chiropractic practice and motivation to learn the material as a foundation for clinical practice. In the short term, the students embraced changes made to the content and delivery of the course based on the online course model, but no mention of HBT is noted.

In 2008 Rose and Ayad published a study on the factors associated with changes in knowledge and attitude toward public health concepts among chiropractic college students enrolled in a community health class. [61] Although this was not an interventional study targeting the HP behavior of chiropractic students, it assessed factors associated with an intervention that was already in place. The intervention was a second-year chiropractic college course in community health. The authors noted that the course had a positive impact on students’ knowledge of and attitudes towards HP and public health concepts, while also eliminating the eminent disparities in these views across gender, race, age, political inclinations and religious beliefs that existed at baseline (before the course was given). However, the investigators noted a certain degree of stigmatization regarding immunization and recommended that additional educational strategies were needed to ensure changes in future practice behavior, particularly in the area of opposing necessary, routine vaccinations. In 2009 Johnson and Green described how DCs could view public health, wellness and prevention within the context of practice by applying best-practices in the clinical setting. [62]

Theory-driven chiropractic interventions

The literature related to the application of health behavior theories in improving the chiropractors’ or chiropractic interns’ behavior regarding HP practice is sparse. Table 1 lists papers or interventions that have utilized specific HBTs. Evans and colleagues published two papers in 2005 and 2006 [63-64] that reported on a theory-based intervention to increase intern and staff advising on smoking cessation at one teaching clinic. In their study, they used methods driven by evidence-based health behavior theories in planning an education campaign (intervention) aimed at improving the behavior of chiropractic interns towards advising their patients on smoking cessation. The overall goal of the study was to move interns from possible lack of awareness related to the need to advise patients, to awareness, agreement with the need to advise, and adopting this as practice, then adhering to smoking cessation counseling as a new behavior. The study was based on Pathman-PRECEDE theoretical framework [65] which, in turn, was constructed after the Green and Krueter’s PRECEDE-PROCEED model. [66] The model was applied in an educational campaign, with focus on identifying the predisposing, reinforcing, and enabling, factors for the new advising behaviors. In this study, Evans and colleagues identified factors that would aid the facilitation and focused on moving interns toward adoption within the PRECEDE-PROCEED model, which was also centered on winning the support of key college stakeholders such as the college president, the clinic chief-of-staff, and the director of research. Their interventions led to the change of vision of the college to include a wellness orientation and the college later became a smoke-free campus.

Table 1.  HBT Utilized in Chiropractic Education or Research

Author(s)

Aim of Intervention

Theory or Constructs Cited

Outcome
Evans 50 Increase awareness of HBTs with DCs

Message-framing, TTM

N/A
Evans 51 Increase awareness of HBTs with DCs

HBM, TTM, SLT, ET

N/A
Evans 52 Increase awareness of HBTs with DCs

TTM, Cues to action

N/A
Mertz, Thompson, Green, Wyatt,
Akagi 59 		Assess scoliosis interventions for presence of planning or HBTs

PRECEDE-PROCEED, HBM

No use of HBT noted in review

Hawk, Baird 19 Pilot project on tobacco advising with DC as audience

Advised doctor cue to action(HBM, SLT)

Advising and doctor cue to action feasible
Hawk, Evans 22 Assess intake paperwork, patient population for advice given on tobacco cessation, information given in 9 teaching clinics

Assessed doctor cue to action (HBM, SLT)

Fragmented system of record keeping, low level of advising, information
Evans, Hawk, Strasser 62 Education campaign to increase advising and information given to patients on smoking cessation

HBM, SLT, ET

Increased advising rates, increased among of information from pre/post
Evans, Hawk,
Boyd 63 		Education campaign to increase advising and information given to patients on smoking cessation

As above (Describes intervention in more detail)

As above
Evans, Breshears 68 Assessed barriers, knowledge,  attitudes toward hand hygiene and table surface sanitizing in teaching clinics 

HBM, SLT, ET

N/A
Shearere, Bhandari 40 Cross-sectional survey on intimate partner violence

Assessed attitudes, knowledge, beliefs

N/A
Evans, Williams, Perko 53 Increase awareness of advocacy role of DCs

ET

N/A
Evans, Ndetan, Williams 70 Cross-sectional survey of future intentions of interns on use of HP in practice

TRA

High level of behavioral intent to use HP in practice
Evans, Ramcharan, Ndetan, et al. 72 Education campaign to increase hand hygiene and table surface sanitizing in 2 teaching clinics

HBM, SLT, ET

Increased observed and reported hand /surface hygiene
Gordon, Istvan, Haas 56 Pilot study to increase advising on tobacco by DCs

Doctor cue to action, readiness to change assessed

Patients reported some compliance in pilot
Ndetan, Evans, Lo et al. 58 Assessed two teaching clinics for advising on HP by retrospective file review

Assessed intern or staff doctors cues to action

Low levels of cues to action
Leach and Yates 74 To have DCs encourage better diet and soccer participation by area youths

SLT

Pilot project-could be effective, nutrition knowledge increased

This study applied two health behavior theories within the PRECEDE-PROCEED planning model, and constructs of Bandura’s Social Learning Theory were applied in addressing the self-efficacy of the interns. [67] The theory’s construct of “cue to action” was also emphasized regarding the interns’ ability as health care providers to get their patient to quit smoking as was vicarious learning from staff clinicians who were to model the advisory role behavior.

The second theoretical model they considered as essential to their smoking cessation educational campaign project was the Trans-Theoretical Model (TTM), developed by Prochaska and DiClemente. [68] This model makes reference to 5 stages of susceptibility to health behavior change (stages of change): the pre-contemplation (no idea or intention of changing a behavior); contemplation (actively considering making a change in behavior, perhaps thinking about where to begin); preparation (taking steps to prepare for change); action (taken some action such as date setting, discussing intentions with others, etc); and maintenance (maintaining a new behavior for at least 6 months). The study employed materials and delivery methods developed according to constructs of these health behavior principles. Materials were of two broad classes: instructional materials for interns including an hour Power Point lecture given by the principal investigator; 3″ X 5″ card guiding interns through engagement of patients using the Surgeon General’s 5-A’s; a chart stamp for clinic supervising doctors to track smoking cessation advising done by interns and; informational materials for their patients (campaign buttons for the intern’s clinic jacket, posters placed in each treatment of report room of the outpatient clinic from the CDC, brochure rack at the clinic check-out desk to provide quick and easy access to brochures for patients and resource directory of cessation programs available in the Dallas/Ft. Worth Metroplex). Key to the campaign were the Surgeon General’s 5-A’s which instructed the interns to “ask” all patients about smoking status; “advise” all patients to quit smoking; “assess their willingness to make a quit attempt”; “assist” in any patient cessation effort; and “arrange for follow-up” and set a date to check on the patient. This campaign was a one month campaign and pre-post campaign evaluation of interns advising role on smoking cessation increased by 25% as noted in the literature.

Evans and Breshears [69] tested interns’ attitudes toward hand hygiene and table sanitizing using the Health Belief Model (HBM) [70] to identify barriers to this practice and looked at peer attitudes and knowledge based on ET. [54] Evans, Ndetan and Williams assessed intentions of chiropractic interns regarding use of HP in practice. [71] They applied the Theory of Reasoned Action (TRA) [72] assessing the intentions on use of HP in practice and identify attitudes, beliefs, and other influencing factors of graduating interns along with their feelings about how wellness and HP education was being delivered in a chiropractic college. Constructs of the TRA served to frame 20 survey questions that helped determine what factors in the educational experience of the students might influence use of HP in their future practice. TRA explores health behaviors in relation to intentions, beliefs, and attitudes. It suggests that an essential determinant of behavior is an individual’s behavioral intention. The theory proposes that behavioral action is determined by intentions with an individual’s intention to perform a behavior determined by attitude towards the behavior and normative beliefs.

Evans and a team of researchers at two college campuses pre- and post-tested an education campaign aimed at increasing compliance on hand hygiene and treatment table surface sanitizing utilizing components of the HBM, ET and SLT. [73] This campaign increased both observed and self-reported compliance levels.

A project by Leach and Yates aimed at clinical education could be applied in the education of DCs or in the field. [74] This program applied SLT to develop a model of better nutrition advice and encouragement of physical activity through soccer for combating obesity and overweight in youths. They applied the specific constructs of observational learning, behavioral capability and enhancement of self-efficacy from SLT.

Discussion

The role of theory in planning health interventions

Effective HP and public health intervention programs can have dramatic effects not only on people but on the entire health care system, especially in this era of persistent health care crises (increased mortality/morbidity and burgeoning cost). This can assist patients in maintaining and improving health, reducing disease risks, and managing chronic illnesses which in turn can help reduce health care cost. Such programs have the potential to impact well-being and self-sufficiency at different levels: individuals, families, organizations, and/or communities. [75] Many existing programs target the patient population directly but studies that focus on changing the behavior of health care providers appear to be less common. Yet, these are equally important especially since HP has not been fully embraced by US health care delivery system. It is important to note that not all health programs and initiatives achieve the desired outcomes. A clear understanding of targeted health behaviors and the environmental context in which they occur is crucial. Interventions (planning, implementation, and monitoring) that are theory-driven are likely to be more successful compared to those developed without considerations of a theoretical perspective. [75]

Using theory as a foundation for program planning and development is consistent with the current emphasis on using evidence-based interventions in public health, behavioral medicine, and preventive medicine. Theory presents a systematic way of understanding events or situations and can be applied to a broad variety of situations. Health behavior and health promotion theories (conceptual or theoretical frameworks) draw upon various disciplines, such as psychology, sociology, anthropology, consumer behavior, and marketing. [75] This diversity in perspectives gives planners the tools for moving beyond intuition to design and evaluate health behavior/interventions based on understanding of behavior and help them identify the most suitable target audiences, methods for fostering change, and outcomes for evaluation. Theory can also help to explain the dynamics of health behaviors, including processes for changing them, and the influences of the many forces that affect health behaviors, including social and physical environments. Apart from explaining “why,” “what,” and “how” health problems should be addressed, health theories also help identify which indicators should be monitored and measured during program evaluation.

The success and effectiveness of many interventions depend on using theories and strategies that are appropriate to a situation. Because there is a plethora of health explanatory and change theories, deciding how well a theory or model “fits” a particular situation/issue is usually challenging and requires care and deliberation. In addition to working knowledge of specific theories, familiarity with how they have been applied in the past may also be insightful. Investigators or practitioners who use theory develop a nuanced understanding of realistic program outcomes that drives the planning process.

Extent of application of health behavior theory in changing/assessing HP behavior of future chiropractors

Problems, behaviors, populations, cultures, and contexts of public health practice are broad and varied. As such, no single theory dominates health education and promotion. In the education campaign to improve the cigarette cessation advising role (behavior) of chiropractic interns, Evans and colleagues [63,64] used the PRECEDE-PROCEED model. [66] PRECEDE-PROCEED is not a model aimed at changing individual behavior but rather a planning model that allows health educators and others design effective communications or health promotion efforts in a community. The design by Evans and colleagues is an eloquent testimony of putting theory and practice together by applying both planning and HBTs. The PRECEDE-PROCEED planning model offers a framework for identifying intervention strategies to address factors that are linked to a specific outcome of interest such as a major health risk in a community. It helps develop an intervention program step by step, integrating perhaps multiple theories to explain and address a health problem. Typical steps would include epidemiological, behavioral, educational, environmental, organizational, administrative and policy diagnoses or assessments. A central feature of a comprehensive planning model such as this is resource acquisition and identification of problem-specific scenarios. This was a big part of the design by Evans et al, as the investigators identified that institutional policies, including stakeholders (college president, research director and clinic chief-o-staff) as well as sources of funding were major challenges and marshaled initial efforts in overcoming these perceived barriers. They combined two behavior change theories for greater impact and use them as bases for evaluation.

Bandura’s Social Learning Theory [67] was used to develop a set of assumptions that centered on self-efficacy of the interns as well as the premise of cue-to-action. They went on to test and adjust these while adding more assumptions through the application of the TTM. To a larger extent this was a well designed theory-driven intervention and the result did not only elicit positive behavior changes among the interns but also enacted a policy (a smoke free campus). Although the theory was not mentioned by name, they certainly applied some aspects of the HBM [70] (which also contained the constructs of self-efficacy and the cue-to-action in addition to some constructs on perceived threat and benefits) to their intervention. The overall goal of that project was to move interns from possible lack of awareness to awareness and agreement that they should be advising patients, adopting this as practice, and adhering to smoking cessation counseling as a new behavior. Although TTM which they applied would offer explanations for stages of change it does not guarantee linear changes along a continuum. TTM acknowledges people may experience recidivism. A possible alternative model to this that offers theoretical bases to directly explore and evaluate the stages of change addressed in the study goal is the Stages of the Precaution Adoption Process Model. [76] This model specifies seven distinct stages in the journey from lack of awareness (a focus of the intervention) to adoption and/or maintenance of a behavior.

Another avenue to explore that has been considered to have significant impact in changing behavior is motivational interviewing (MI). [77] This method attempts to get the patient to contemplate the reasoning behind a needed behavior change and to move them toward self-motivated action through guided, empathetic dialogue.

In the theory-driven evaluation of behavioral intention the TRA was reasonably applied as an explanatory theory. It offered explanations on how behavioral intention determines a behavior and how attitudes towards a behavior, subjective norms, and perceived behavioral control influence behavioral intentions. While this model validly explains how the causal web of beliefs, attitudes, and intentions drive behavior there is still a missing piece in the pie: how the presence or lack of enabling, predisposing or reinforcing factors that may make it easier or more difficult to perform the behavior affects perceived behavioral control which can drive behavioral intentions. This missing piece could be addressed by a potential extension of this model to including the Theory of Planned Behavior, [78] especially as it assumes that factors such as culture and social environment influence certain behaviors (an assumption that is implicit in this study). A planning model such as PRECEDE-PROCEED would also aid in filling in those gaps as well.

Non-medical providers and other CAM providers interact with patients on a more frequent basis than physicians and may be more likely to advise positive behavior changes. [79] This aspect of patient care should not be underestimated when helping patients move toward reductions in risky health behaviors.

Conclusion

Included in the health care responsibilities of primary contact practitioners is the requirement that they serve as a relevant information source for their patients when it comes to reducing health risks. Chiropractors may effectively achieve disease intervention and prevention by participating in the health education of their patients. Clinicians should teach and model this educating and advising role. In line with chiropractic philosophy, their perspective should be holistic. In order to minimize intrusion upon the practice of their clinical expertise, health education tools are recommended for use by these practitioners with an HP conscience. Chiropractic has traditionally regarded itself a wellness profession. As prevention and a wellness model of care can be postulated to predict the future growth of this profession, the development of a wellness ethos acceptable within conventional health care is desirable. Thus, there is urgent need to prepare future DCs (current interns) for the role of advising prevention. Emphasis should be placed on providing interns with HP techniques, skills, self-efficacy, and motivation in an effort to prepare them for the challenge of interfacing with an increasingly evidence-based health care system.

Chiropractic researchers or program planners may derive benefits from the application of health behavior theories in designing interventions targeting healthy behavior. In applying theories or adopting models that have been successful in other settings the concept of targeting a population based on shared characteristics or risks and tailoring change messages for improved health outcomes should be seriously considered.

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Filed Under: chiropractic

Dr. Robert Naseef on Autism and Dads

April 19, 2011 By autism

Dr. Robert Naseef has practiced for over 20 years as a psychologist. He is a graduate of Temple University. He specializes in families of children with disabilities and has published several articles on the subject, including the book Special Children, Challenged Parents: The Struggles and Rewards of Raising a Child with a Disability.  He co-edited Voices from the Spectrum (2006) with Dr. Ariel.  Dr. Naseef presents locally and nationally on issues related to family life with special needs and has a special interest in the psychology of men.  Dr. Naseef has contributed a number of articles to this site; scroll down to find links!

"I am just so angry."  With his voice shaking, he said what other men in the circle were thinking and feeling.  "When I get home and approach my son, he pushes me away.  I can't stand it anymore.  He just wants his mother, and he pushes me away from her too.  The other day I told my wife I am ready to sign my parental rights away."

Alex loves his son, but it's the autism this man hates and the way it makes connecting seem impossible.  The occasion for this fathers (and male therapists) group meeting on April 15 was the opening of the Autism Resource Center by the Ontario Arc in Canandaigua, New York where I was their guest speaker.

Everywhere I have traveled this year speaking to groups of parents about taking care of everyone's needs, fathers have turned out in significant numbers.  They come to listen and talk about what they can do.

Once the anger was outed, the whole group of men seemed to open up.  Inside the shell of anger, the men found fear, sadness, guilt, and sometimes shame for how they had been acting.  Their honesty with each other opened the door to possibilities for connecting with their children--and their wives whose feelings are quite similar.  The man who started the discussion didn't come to disown his son-- he came to find out what he could do.

Another man talked about how getting on the floor with his son and just tickling opened the door to the possibilities of playing together.  Others shared what they could do with their children and how to follow their child's lead, and those still at a loss got ideas and inspiration.  They planned to meet again.

After my presentation the next day, Jen approached me to say that her husband, Alex, came home determined to find ways of connecting with their son.  Maybe now she could get some breaks. She was so grateful there was now a fathers' group planning to meet again in their town.

Of course, these parents will wake up the next day and their children will still have autism.  Their feelings will come and go.  But perhaps the best medicine is learning how to connect one on one and having some fun.  This is a route that can sustain a family through the inevitable ups and downs and uncertain future that autism brings.

More Insights from Dr. Robert Naseef

In the Forum: Talk About Life as an Autism Dad

Dr. Robert Naseef on Autism and Dads originally appeared on About.com Autism on Tuesday, April 19th, 2011 at 15:53:38.

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Predictors For Success Of Spinal Manipulation For Neck Pain

April 19, 2011 By Frank M.

SOURCE: J Manipulative Physiol Ther. 2011 (Mar); 34 (3): 144–152

This newly published JMPT study attempted to identify those prognostic clinical factors that may potentially identify, a priori, patients with mechanical neck pain who are likely to experience a rapid and successful response to spinal manipulation of the cervical and thoracic spine.

Data from 81 subjects were included in the analysis, of which 50 had experienced a successful outcome (61.7%). Five variables were found to be associated with a positive response:

  • Initial pain intensity greater than 4.5 points

  • Cervical extension less than 46°

  • Hypomobility at T1 vertebra

  • A negative upper limb tension test [1]

  • Female sex

Interestingly, if 4 of 5 variables were present in a particular individual, the likelihood of success increased from the average success rate of 61.7% to a whopping 75.4%.

Although there are several limitations within this study, including the limited group size, and the lack of a comparative control group, this study is a sound first step towards developing a clinical prediction formula associated with a rapid and positive response to care.

Guidelines, and the more recent evidence-based care pathways were originally conceived as a method to inform clinicians and improve patient outcomes. There is no question that the excessive cost of American medical care needs to be reined in. There is also no question that third party payers in managed care have been ruthless in establishing rules and procedures based on financial targets, rather than reasonable patient care. Money that should be going to patient care is going to their bloated administration and the managed care owners. Crucial differences in the quality and success of care are being ignored.

In the field of spinal manipulation for example, there are fundamentally different levels of education and skill for different health professions utilizing spinal adjusting. This is apparent from trials such as:

Meade et al., where chiropractors received significantly superior results for back pain patients than did physical therapists, and

Carey et al., where medical doctors, given postgraduate training in spinal manipulation, proved unable to assess and treat back pain patients successfully.

Our website has published extensively about the vast gap between medical and chiropractic skill sets. That is especially evident in the management of low back pain.

You may also want to review our original Practice Guidelines Page and the newer, evidence-based “Best Practice” Initiative Page, because they reflect the evolution in thinking about improving patient care outcomes.

REFERENCES:

1. Upper Limb Neural Tension and Seated Slump Tests: The False Positive Rate among Healthy Young Adults without Cervical or Lumbar Symptoms
J Man Manip Ther. 2009; 17 (3): e104-105

A recent trial, involving healthy young adults with no history of cervical, lumbar, or peripheral symptoms, revealed a false-positive response of 86.9% in the ULNTT test at some point in the available range of elbow extension. Because of this finding, this JMPT study may have inadvertently ruled out some candidates who would have responded positively to manipulative care.

Filed Under: chiropractic, Research
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