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Using Multivariate Statistics

Global strategy for asthma management and prevention

SOURCES AND EFFECTS OF IONIZING RADIATION : United Nations Scientific Committee on the Effects of Atomic Radiation UNSCEAR 2000 Report to the General Assembly, with Scientific Annexes

The purpose of this Position Stand is to provide guidance to professionals who counsel and prescribe individualized exercise to apparently healthy adults of all ages. These recommendations also may apply to adults with certain chronic diseases or disabilities, when appropriately evaluated and advised by a health professional. This document supersedes the 1998 American College of Sports Medicine (ACSM) Position Stand, "The Recommended Quantity and Quality of Exercise for Developing and Maintaining Cardiorespiratory and Muscular Fitness, and Flexibility in Healthy Adults." The scientific evidence demonstrating the beneficial effects of exercise is indisputable, and the benefits of exercise far outweigh the risks in most adults. A program of regular exercise that includes cardiorespiratory, resistance, flexibility, and neuromotor exercise training beyond activities of daily living to improve and maintain physical fitness and health is essential for most adults. The ACSM recommends that most adults engage in moderate-intensity cardiorespiratory exercise training for ≥30 min·d on ≥5 d·wk for a total of ≥150 min·wk, vigorous-intensity cardiorespiratory exercise training for ≥20 min·d on ≥3 d·wk (≥75 min·wk), or a combination of moderate- and vigorous-intensity exercise to achieve a total energy expenditure of ≥500-1000 MET·min·wk. On 2-3 d·wk, adults should also perform resistance exercises for each of the major muscle groups, and neuromotor exercise involving balance, agility, and coordination. Crucial to maintaining joint range of movement, completing a series of flexibility exercises for each the major muscle-tendon groups (a total of 60 s per exercise) on ≥2 d·wk is recommended. The exercise program should be modified according to an individual's habitual physical activity, physical function, health status, exercise responses, and stated goals. Adults who are unable or unwilling to meet the exercise targets outlined here still can benefit from engaging in amounts of exercise less than recommended. In addition to exercising regularly, there are health benefits in concurrently reducing total time engaged in sedentary pursuits and also by interspersing frequent, short bouts of standing and physical activity between periods of sedentary activity, even in physically active adults. Behaviorally based exercise interventions, the use of behavior change strategies, supervision by an experienced fitness instructor, and exercise that is pleasant and enjoyable can improve adoption and adherence to prescribed exercise programs. Educating adults about and screening for signs and symptoms of CHD and gradual progression of exercise intensity and volume may reduce the risks of exercise. Consultations with a medical professional and diagnostic exercise testing for CHD are useful when clinically indicated but are not recommended for universal screening to enhance the safety of exercise.

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Quantity and Quality of Exercise for Developing and Maintaining Cardiorespiratory, Musculoskeletal, and Neuromotor Fitness in Apparently Healthy Adults: Guidance for Prescribing Exercise

Considerable advances have occurred in recent years in the scientific knowledge of the benefits of breastfeeding, the mechanisms underlying these benefits, and in the clinical management of breastfeeding. This policy statement on breastfeeding replaces the 1997 policy statement of the American Academy of Pediatrics and reflects this newer knowledge and the supporting publications. The benefits of breastfeeding for the infant, the mother, and the community are summarized, and recommendations to guide the pediatrician and other health care professionals in assisting mothers in the initiation and maintenance of breastfeeding for healthy term infants and high-risk infants are presented. The policy statement delineates various ways in which pediatricians can promote, protect, and support breastfeeding not only in their individual practices but also in the hospital, medical school, community, and nation.

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Breastfeeding and the Use of Human Milk

Background: Falls are one of the most common health problems among older people and pose a major economic burden on health care systems. Exercise is an accepted stand-alone fall prevention strategy particularly if it is balance training or regular participation in Tai chi. Dance shares the ‘holistic’ approach of practices such as Tai chi. It is a complex sensorimotor rhythmic activity integrating multiple physical, cognitive and social elements. Small-scale randomised controlled trials have indicated that diverse dance styles can improve measures of balance and mobility in older people, but none of these studies has examined the effect of dance on falls or cognition. This study aims to determine whether participation in social dancing: i) reduces the number of falls; and ii) improves cognitive functions associated with fall risk in older people. Methods/design: A single-blind, cluster randomised controlled trial of 12 months duration will be conducted. Approximately 450 participants will be recruited from 24 self-care retirement villages that house at least 60 residents each in Sydney, Australia. Village residents without cognitive impairment and obtain medical clearance will be eligible. After comprehensive baseline measurements including physiological and cognitive tests and self-completed questionnaires, villages will be randomised to intervention sites (ballroom or folk dance) or to a wait-listed control using a computer randomisation method that minimises imbalances between villages based on two baseline fall risk measures. Main outcome measures are falls, prospectively measured, and the Trail Making cognitive function test. Cost-effectiveness and cost-utility analyses will be performed. Discussion: This study offers a novel approach to balance training for older people. As a community-based approach to fall prevention, dance offers older people an opportunity for greater social engagement, thereby making a major contribution to healthy ageing. Providing diversity in exercise programs targeting seniors recognises the heterogeneity of multicultural populations and may further increase the number of taking part in exercise. Trial registration: Australian New Zealand Clinical Trials Registry ACTRN12612000889853 The trial is now in progress with 12 villages already have been randomised.

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Can social dancing prevent falls in older adults? a protocol of the Dance, Aging, Cognition, Economics (DAnCE) fall prevention randomised controlled trial

The objective of this population-based case-control study was to identify risk factors for hip fracture among elderly women and men, particularly factors during young and middle adult life. The study base comprised people aged 65 years and over living in a defined region in Sydney, Australia, during 1990-1991. Cases were recruited from 12 hospitals, and controls were selected using an area probability sampling method, with additional sampling from nursing homes. There were 416 subjects (209 cases and 207 controls); proxy respondents were needed for 27 percent of the subjects. Smoking, underweight in old age, overweight at age 20 years, and weight loss were associated with an increased risk of hip fracture. Consumption of dairy products, particularly at age 20 years, was associated with an increased risk of hip fracture in old age. Multivariate-adjusted odds ratios for quintiles of dairy product consumption at age 20 years were 1.0 (lowest quintile), 0.8, 1.8, 3.4, 2.9 (highest quintile). Caffeine and alcohol intake were not associated with hip fracture risk. Some of the results of this study were unanticipated and may be due to chance or bias. If confirmed by other studies, these results would challenge some current approaches to hip fracture prevention.

Case-Control Study of Risk Factors for Hip Fractures in the Elderly

CLINICAL SCENARIO You are a family physician seeing a 47year-old woman and her husband of the same age. They are concerned because a friend recently found out that she had bowel cancer and has urged them both to undergo screening with fecal occult blood tests (FOBTs) because, she says, prevention is much better than the cure she is now undergoing. Both your patients have no family history of bowel cancer and no change in bowel habit. They ask whether you agree that they should be screened. You know that trials of FOBT screening have demonstrated that screening can reduce mortality from colorectal cancer (CRC), but you also recall that FOBTs can have a high false-positive rate that then requires investigation by colonoscopy. You are unsure whether screening these relatively young, asymptomatic people at average risk of bowel cancer is likely to do more good than harm. You decide to check the literature to see if there are any guidelines or recommendations about screening for CRC that might help you.

Users' guides to the medical literature. XVII. How to use guidelines and recommendations about screening

The objective of this population-based case-control study was to clarify the relationships between parity, breastfeeding and ages at menarche and menopause and the risk of hip fracture among elderly women. The study base comprised women aged 65 years and over living in a defined region in Sydney, Australia, during 1990-1991. Cases (n = 174) were recruited from 12 hospitals and controls (n = 137) were selected using an area probability sampling method, with additional sampling from nursing homes. The age- and proxy-adjusted odds ratio (OR) comparing parous women who had never breastfed with nulliparous women was 2.11 (95% confidence interval (CI): 0.85-5.25). Among parous women, the age- and proxy-adjusted OR for ever versus never breastfeeding was 0.47 (95% CI: 0.22-0.99). There was a dose-response relationship between average duration of breastfeeding per child and risk of hip fracture (test for trend: P < 0.01). Age at menopause and age at menarche were only weakly associated with hip fracture risk. This study suggests that breastfeeding may protect parous women against hip fracture in old age.

Robert G. Cumming

Papers

Can social dancing prevent falls in older adults? a protocol of the Dance, Aging, Cognition, Economics (DAnCE) fall prevention randomised controlled trial

Case-Control Study of Risk Factors for Hip Fractures in the Elderly

Users' guides to the medical literature. XVII. How to use guidelines and recommendations about screening

Breastfeeding and Other Reproductive Factors and the Risk of Hip Fractures in Elderly Women

Smoking and passive smoking.