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Nutritional Factors Affecting Postpartum Depression

By Frank M. Painter|August 5, 2014|Nutrient Deficiency, Postpartum Depression, Supplementation|

Nutritional Factors Affecting Postpartum Depression

SOURCE: J Clin Chiropractic Pediatrics 2011 (Jun); 12 (1): 849–860

Lia M. Nightingale, PhD

Assistant Professor, Division of Life Sciences,
Palmer College of Chiropractic,
1000 Brady Street, Davenport, IA 52803, USA.
Email: lia.nightingale@palmer.edu

Pregnancy and lactation represent a period of substantial physiological changes for the mother and increased nutritional requirements to meet these adjustments. A number of nutritional depletions occur during pregnancy. Serum concentrations of iron and folate take months before they normalize to pre-pregnancy levels. Additionally, many micronutrients required during pregnancy interfere with each other, making absorption difficult. Postpartum depression is the primary complication of childbirth, possibly caused by several nutritional and non-nutritional factors. The current review highlights the impact nutrition may have on the etiology of this debilitating disorder, most notably on prevention of inflammation and maintenance of a healthy central nervous system. The most notable nutritional deficiencies associated with postpartum depression include omega-3 fatty acids, folate, iron, and zinc; however, supplementation trials for prevention of postpartum depression are severely lacking. Practical recommendations are given to minimize micronutrient interference and reduce the risk of postpartum depression.

Key Words: postpartum depression, nutrition, diet, folate, essential fatty acids, iron, zinc

From the Full-Text Article:

Introduction

Depression is the second leading cause of disability for those of reproductive age. [1] Although all forms of depression are devastating, postpartum depression (PPD) has long-lasting consequences for all family members involved. Postpartum depression is the most common complication of childbirth, defined as having major or minor depressive episodes that occur within 12 months after delivery. [2, 3] Postpartum depression has been associated with impaired mother-child interactions, poorer child development, and more violent behavior in children with mothers displaying PPD. [4-6]

Pregnancy is a time of increased nutritional requirements to support fetal growth and development. There are several lines of thought concerning the cause of PPD, including the link between nutritional intake and risk of depression. Therefore, the goal of this review is to examine maternal depletion of nutrients, assess whether these nutritional factors may play a role in PPD, and summarize simple recommendations to implement in practice.

Prevalence

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Pre-Eclampsia and the Impact on Chiropractic Management of the Pregnant Patient

By Frank M. Painter|August 3, 2014|Chiropractic Management, Pre-Eclampsia, Pregnancy|

Pre-Eclampsia and the Impact on Chiropractic Management of the Pregnant Patient

The Chiro.Org Blog

SOURCE: J Clinical Chiropractic Pediatrics 2012 (Dec)

Sharon Gordon, BAppSc(Chiro), DICCP and Sherryn Silverthorne, M Clinical Chiro, RN, RM

Sharon Gordon, BAppSc(Chiro), DICCP
Private Practice, Gippsland, Victoria, Australia

Sherryn Silverthorne, M Clinical Chiro, RN, RM
Private Practice, Melbourne, Victoria, Australia

Up to 10% of women develop pre-eclampsia during pregnancy. It is a significant cause of mortality, responsible for 10-15% of maternal deaths. Its diagnosis is based on the presence of hypertension, with or without proteinuria and edema. As primary contact health care providers, chiropractors must be aware of the risk factors, clinical signs of pre-eclampsia, and the need to modify their management appropriately. An open internet search was conducted for current guidelines in scientific journal databases, in the diagnosis and management of pre-eclampsia. Although there is little literature outlining the role of the chiropractor in patient management, it is clear that specific history and examination procedures must be performed for appropriate co-management and referral.

Key Words: pre-eclampsia, eclampsia, toxemia, hypertension, pregnancy, chiropractic

From the Full-Text Article:

Introduction

Pre-eclampsia (also known as toxemia of pregnancy) is one of the major causes of maternal mortality and morbidity. 10%-15% of maternal deaths are directly associated with pre-eclampsia and eclampsia. [1] Up to 10% of pregnant women develop pre-eclampsia. [2] The incidence of pre-eclampsia in the nulliparous woman is cited as being between 3%-7% and for the multiparous woman 1%-3%. [1, 3] This diagnosis is based on the presence of hypertension, proteinuria, with or without edema. As primary contact health care providers, chiropractors must be aware of the risk factors, clinical signs of pre-eclampsia, and the need to modify their management appropriately.

Objective

To review the diagnostic criteria, risk factors and complications of pre-eclampsia, and discuss how this may affect chiropractic management of the pregnant patient.

Methods

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Tracking Low Back Problems in a Major Self-Insured Workforce: Toward Improvement in the Patient’s Journey

By Frank M. Painter|July 31, 2014|Chiropractic Care, Cost-Effectiveness|

Tracking Low Back Problems in a Major Self-Insured Workforce:

Toward Improvement in the Patient’s Journey

The Chiro.Org Blog

SOURCE: J Occup Environ Med. 2014 (Jun); 56 (6): 604-620

Allen, Harris PhD; Wright, Marcia PharmD; Craig, Terri PharmD; Mardekian, Jack PhD; Cheung, Raymond PhD; Sanchez, Robert PhD; Bunn, William B. III MD, JD, MPH; Rogers, William PhD

From the Harris Allen Group, LLC (Dr Allen), Brookline, Mass; US Medical Affairs (Dr Wright), Pfizer Integrated Health, Overland Park, Kans; Pfizer Primary Care Medical Affairs (Dr Craig), Lincoln, Nebr; Pfizer Inc (Dr Mardekian), New York; Pfizer Integrated Health (Drs Cheung and Sanchez), New York; Health, Safety, Security & Productivity, Navistar, Inc (Dr Bunn)

This comprehensive new study from the Journal of Occupational and Environmental Medicine reveals that chiropractic care costs significantly less than other forms of low back care, and appears to comply with guideline recommendations more closely than than any of the other 4 comparison groups.The authors came to these conclusions after an exhaustive analysis of an integrated database belonging to a giant, self-insured Fortune 500 manufacturer covering nine years of claims They evaluated the direct and indirect costs of LBP for all employees, looking in-depth at personnel characteristics, and medical, behavioral health, pharmaceutical, Workers Comp costs, disability, absenteeism, and lost productivity during the 2001 to 2009 period.

Thanks to Dynamic Chiropractic for some of the following comments.

Make sure to read their full article!

The study had four objectives:

Identify all active employees reporting a back problem diagnosis during the study period.
Define and classify their initial patterns of medical care and use of Rx medication.
Track the effect of these patterns on direct and indirect cost outcomes.
Further stratify these treatment patterns by measures of congruence with the previously described guideline aspects for LBP care and determine the effect on cost outcomes.

Through their database review, the authors identified five specific care patterns that were typical of employee experiences

Information and Advice (“TalkInfo”):
information gathering, office visit consults, lab tests, imaging (X-ray, ultrasound, CT, or MRI)
but no other procedures.
(59 percent of employees).
Complex Medical Management (Complex MM):
physician visits for nerve blocks, surgeries, or comparable procedures
(2 percent of employees).
Chiropractic (Chiro):
more than one visit to a DC.
(11 percent of employees)
Physical therapy (PT):
more than one visit to a PT.
(11 percent of employees)
“Dabble”:
episodes with at most one visit for physician, chiropractic, or PT care,
or at most one visit to two or more of these categories.
(17 percent of employees)

The average overall costs for care were a real eye opener

Low Back/Neuro (three-year total)

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Energy Drinks and Adolescents – What Should Health Practitioners Know?

By Frank M. Painter|July 24, 2014|Pediatrics|

Energy Drinks and Adolescents – What Should Health Practitioners Know?

The Chiro.Org Blog

SOURCE: Journal of Clinical Chiropractic Pediatrics 2012 (Dec); 13 (1): 1042-1044

Sharon Gordon, BAppSc(Chiro), DICCP

Private practice, Gippsland, Victoria, Australia.
Email: Sharon.gordon@rmit.edu.au

Energy Drinks are readily available in supermarkets throughout the world. There are currently no restrictions or guidelines on safe consumption by children. Energy drink consumption by adolescents is on the rise, as companies continue to aggressively market their product to this demographic. It has become socially acceptable for children to consume these drinks, as there is a perception that the products are safe. In addition, they have become a popular accessory in the youth extreme-sport culture. Overall, research on adolescent energy drink consumption is lacking, however side effects similar to that seen in adults, have been reported in the adolescent population. The chiropractor must be aware of these side effects, including how they may relate to presenting symptoms, and educate their patients on the dangers of energy drink consumption.

Key Words: energy drink, caffeine, adolescent, chiropractic

Objective

To review the literature on energy drink consumption amongst adolescents, and discuss the physiological effects that may present to the chiropractic office.

Methods

Scientific journal databases were searched, including PubMed, Medline, Proquest, Cochrane, CINAHL, Medscape, and Index to Chiropractic Literature. An open internet search was also performed.

Discussion

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Low Back Pain – part of a whiteboard visual lecture series

By John Wiens DC|July 22, 2014|Video|

Source DocMikeEvans

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Costs of Routine Care for Infant Colic in the UK

By Frank M. Painter|July 21, 2014|Chiropractic Care, Colic, Cost-Effectiveness|

Costs of Routine Care for Infant Colic in the UK and Costs of Chiropractic Manual Therapy as a Management Strategy Alongside a RCT for this Condition

The Chiro.Org Blog

J Clinical Chiropractic Peds 2013 (Jun); 14 (1): 1063–1069

Joyce Miller, DC, FAC O, FCC, FEAC (Paeds)

Anglo-European College of Chiropractic,
Lead Tutor in Advanced Professional Practice (Paediatrics),
Bournemouth University,
United Kingdom

Background: There is a small body of published research (six research studies and a Cochrane review) suggesting that manual therapy is effective in the treatment of infant colic. Research from the UK has shown that the costs of NHS treatment are high (£65million [USD100 million] in 2001) with no alleviation of the condition.

Objectives: The objectives of this study were to: investigate the cost of the inconsolable nocturnal crying infant syndrome which is popularly known as infant colic in the first 20 weeks of life, estimate the costs of different types of treatment commonly chosen by parents for a colicky infant for a week of care or an episode of care, investigate the cost of chiropractic manual therapy intervention aimed at reducing the hours of infant crying alongside a randomised controlled trial (RCT) showing effectiveness of treatment

Design: Economic evaluation incorporating a RCT

Methods: A cost analysis was conducted using data from a RCT conducted in a three-armed single-blinded trial that randomized excessively crying infants into one of three groups: a) routine chiropractic manual therapy (CMT), b) CMT with parent blinded or c) no treatment control group with parent blinded. These costs were compared with costs of caring for infant colic from Unit Costs of Health and Social Care, UK, 2011. It has been widely estimated that 21% of infants in the UK present annually to primary care for excessive crying and this calculated to 167,000 infants (to the nearest 1,000) used in the cost analysis as there were 795,249 infants in the UK in mid-2010 according to the UK Office of National Statistics, 2011.

Results: 100 infants completed the RCT and this resulted in treatment costs of £58/child ($93). An additional cost of GP care of £27.50 was added for initial evaluation of the general health of the child and suitability for chiropractic management, totaling £85.50 per child in the RCT. Clinical outcomes are published elsewhere, but care showed both statistically and clinically significant efficacy in reduced crying time by an average of 2.6 hours resulting in a crying time of less than two hours a day (reaching “normal” levels which could be classified as non-colic behavior). Cost per child’s care was £85.50 extrapolated to £14,278,500 for the full cohort of 167,000. If chiropractic care had been given privately, costs were calculated as £164/child per episode of care and this equalled £27,388,000 for the entire cohort. Medical costs through a normal stream of care amounted to £1089.91 per child or £182,014,970 for the cohort (including all costs of care, not just NHS). No benefits of effectiveness were accrued from any of those types of treatment. If the Morris NHS data were extrapolated to 2010, applying wage inflation, the cost would be £118 million (USD180 million) yearly. An episode of an average of four treatments of chiropractic manual therapy with documented efficacy of CMT cost from 8% to 24% of NHS care or routine care.

Conclusion: chiropractic manual therapy was a cost-effective option in this study. A much larger randomized study of routine medical care versus routine chiropractic care is recommended to determine whether there is confirmation of these findings.

From the Full-Text Article:

Introduction

As effective treatment for children with infant colic remains elusive, the costs of managing the condition is gaining increasing attention. Although it is uncommon for clinicians to be quizzed about the cost-effectiveness of their treatments, [1] particularly where the clinicians’ services are covered by a national health plan, it is increasingly appropriate to ask this question, when prudence in health care expenditure is required.

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