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Food Crisis And Global Health Workshop July 14-16
The worldwide economic downturn has exacerbated a global food crisis that started in 2007, leading to a significant increase in the number of people who are malnourished. The Institute of Medicine will convene top experts at a three-day workshop to explore the implications of the food crisis on nutrition and health. Participants will discuss the effects of the economic crisis and escalating food prices on nutrition, country and global responses, U.S. policies, and actions to mitigate food crises now and in the future. Speakers include representatives from the World Bank, World Food Program, UN Task Force on Global Food Security Crisis, academic health centers, and organizations from Bangladesh, China, Ethiopia, Kenya, Mexico, and other countries.
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USAID Programs Used Biblical Lessons To Teach Abstinence In Africa, Audit Finds
The U.S. Agency for International Development funded programs that used biblical lessons to promote sexual abstinence in Africa, despite a prohibition on the use of taxpayer funds to support "inherently religious activities," according to a recent audit by the agency"s inspector general, the Washington Post reports.The audit focused on projects initiated from 2006 to 2007 during the administration of President George W. Bush. According to the audit, the use of Christian stories in HIV/AIDS prevention programs in Africa could be seen as showing a "USAID-funded preference for Christianity." The audit also found that officials in one faith-based abstinence program in Africa urged youth to memorize and recite a passage from the Bible"s book of Psalms. Participants were then instructed to recite the passage"s "key concept": "God has a plan for sex and this plan will help you and protect you from harm."USAID challenged the findings in a written response that said its African programs" main goals are secular in nature. It acknowledged that some of its abstinence programs included "religiously infused materials" but said that the materials showed no preference for Christian groups.According to the Post, the issue has been complicated by legal ambiguities over whether the separation of church and state applies to programs for promoting U.S. foreign policy abroad. The inspector general"s report said the Department of Justice is considering a request from USAID to determine the legality of its practices (Lynch, Washington Post, 7/23).
News of the day
During Pregnancy, Women With Endometriosis Need Special Care To Avoid Risk Of Premature Birth
The largest study to date of endometriosis in pregnant women has found that the condition is a major risk factor for premature birth, the 25th annual conference of the European Society of Human Reproduction and Embryology heard. Dr. Henrik Falconer, of the Department of Woman and Child Health, Karolinska Institute, Stockholm, Sweden, said that his team had found that women with endometriosis also had a higher risk of other pregnancy complications, as well as being more likely to give birth through Caesarean section. The research is published on-line in the journal Human Reproduction*.
Mental Health

New Guideline For Low-Back Pain Interventions, Surgery Issued By The American Pain Society

The American Pain Society (APS) has issued a new clinical practice guideline for low back pain that emphasizes the use of noninvasive treatments over interventional procedures, as well as shared decision making between provider and patient. The findings are published in the current (May 1, 2009) issue of the journal Spine. The new APS guideline, based on an extensive review of existing research, provides clinicians with eight recommendations to help determine the best way to treat patients with low-back pain. It also expands its current and previously published guideline for initial evaluation and management of this chronic condition. "These recommendations are based on an even more complete body of evidence than was available just a few years ago. Consequently, we believe these recommendations will give physicians more confidence when treating patients with persistent back pain," said Roger Chou, M.D., lead author, director of the APS Clinical Practice Guideline Program, and associate professor of medicine (general internal medicine), Oregon Evidence-based Practice Center, Oregon Health & Science University. "Unfortunately, randomized trials for a number of commonly used interventional procedures are still too limited to generate evidence-based recommendations, and our review also highlights the need for more research," Chou added. Low-back pain is the fifth most common reason for doctor"s visits and accounts for more than $26 billion in direct health care costs nationwide each year. While a number of interventional diagnostic tests and therapies, and surgery are available, and their use is increasing, in some cases their usefulness remains uncertain. "We have advocated strongly in many of our recommendations for physicians to use shared decision making because of the relatively close trade-offs between potential benefits relative to harms, as well as costs and burdens of these various treatment options," Chou explained. Shared decision making involves a patient"s full participation in medical choices after receiving comprehensive information about the impact of all options on his or her particular life situation. To develop the guideline, a multidisciplinary APS panel, augmented by experts on interventional therapies, reviewed 3,348 abstracts and analyzed 161 relevant clinical trials. The panel found that the evidence for the use of these interventions was mixed, sparse or not available. Based on the data the panel gathered, the APS now recommends: * Against the use of provocative discography (injection of fluid into the disc in order to determine if it is the of back pain) for patients with chronic nonradicular low-back pain. * The consideration of intensive interdisciplinary rehabilitation with a cognitive/behavioral emphasis for patients with nonradicular low-back pain who do not respond to usual, non-interdisciplinary therapies. * Against facet joint corticosteroid injection, prolotherapy, and intradiscal corticosteroid injections for patients with persistent nonradicular low-back pain, and insufficient evidence to guide use of other interventional therapies. * A discussion of risks and benefits of surgery and the use of shared decision making with reference to rehabilitation as a similarly effective option for patients with nonradicular low-back pain, common degenerative spinal changes, and persistent and disabling symptoms. * Insufficient evidence to guide recommendations for vertebral disc replacement. * A discussion of the risks and benefits of epidural steroid injections and shared decision making, including specific review of evidence of lack of long-term benefit for patients with persistent radiculopathy due to herniated lumbar disc. * A discussion of the risks and benefits of surgery and use of shared decision making that references moderate benefits that decrease over time for patients with persistent and disabling radiculopathy due to herniated lumbar disc or persistent and disabling leg pain. * Discussion of risks and benefits of spinal cord stimulation and shared decision making, including reference to the high rate of complications following stimulator placement for patients with persistent and disabling radicular pain following surgery for herniated disc and no evidence of a persistently compressed nerve root. Chou and his colleagues also reaffirm their previous recommendation that all low-back pain patients stay active and talk honestly with their physicians about self care and other interventions. "In general, noninvasive therapies supported by evidence showing benefits should be tried before considering interventional therapies or surgery," said Chou. Recommendations from the first APS Clinical Practice Guideline on Low-Back Pain are intended for primary care physicians and appeared in the Oct, 2, 2007, issue of the Annals of Internal Medicine. For diagnosis, the first APS low-back pain guideline advises clinicians to minimize routine use of X-rays or other diagnostic tests except for patients known or believed to have underlying neurological or spinal disorders. Tamara Hargens-Bradley Oregon Health & Science University


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