Studies have shown fathers who are active in their children’s upbringing can significantly benefit their children’s early development, academic achievement and well being. Now, a new study by University of South Florida researchers suggests that a father’s involvement before his child is born may play an important role in preventing death during the first year of life – particularly if the infant is black.

The USF team sought to evaluate whether the absence of fathers during pregnancy contributes to racial and ethnic disparities in infant survival and health. Their findings were recently reported online in the Journal of Community Health.

“Our study suggests that lack of paternal involvement during pregnancy is an important and potentially modifiable risk factor for infant mortality,” concluded the study’s lead author Amina Alio, PhD, research assistant professor of community and family health at the USF College of Public Health. “A significant proportion of infant deaths could be prevented if fathers were to become more involved.”

The researchers examined the records of all births in Florida from 1998 to 2005 – more than 1.39 million live births. Father involvement was defined by the presence of the father’s name on the infant’s birth certificate. While this measure does not assess the extent or quality of a father’s involvement during pregnancy, other studies have established a link between paternal information on a birth record and prenatal paternal involvement.

Among the study’s findings:
Infants with absent fathers were more likely to be born with lower birth weights, to be preterm and small for gestational age.
Regardless of race or ethnicity, the neonatal death rate of father-absent infants was nearly four times that of their counterparts with involved fathers.
The risk of poor birth outcomes was highest for infants born to black women whose babies’ fathers were absent during their pregnancies. Even after adjusting for socioeconomic differences, these babies were seven times more likely to die in infancy than babies born to Hispanic and white women in the same situation.
Obstetric complications contributing to premature births, such as anemia, chronic high blood pressure, eclampsia and placental abruption, were more prevalent among women whose babies’ fathers were absent during pregnancy.
Expectant mothers in the father-absent group tended to be younger, more educated, more likely to never have given birth, more likely to be black, and had a higher percentage of risk factors like smoking and inadequate prenatal care than mothers in the father-involved group.

Paternal support may decrease the mother’s emotional stress, which has been linked to poor pregnancy outcomes, or promote healthy prenatal behavior, Dr. Alio suggested. For instance, some studies, including USF’s, indicate that pregnant women with absent partners are more likely to report smoking during pregnancy and get inadequate prenatal care. Barriers to expectant fathers’ involvement in the lives of their pregnant partners, including issues like unemployment, relationship status, and participation in prenatal visits, must be examined to increase the role of men during pregnancy, she said.

Improving the involvement of expectant fathers holds promise for reducing costly medical treatments for the complications of premature births as well as reducing infant mortality rates, particularly in black communities, Dr. Alio said. “When fathers are involved, children thrive in school and in their development. So, it should be no surprise that when fathers are present in the lives of pregnant mothers, babies fare much better.”

Dr. Alio was recently named a member of the Joint Center for Political and Economic Studies’ National Commission on Paternal Involvement in Pregnancy Outcomes. The other USF study authors were Alfred Mbah, Jennifer Kornosky, Deanna Wathington, Phillip Marty, and Hamisu Salihu.

Source:
Anne DeLotto Baier
University of South Florida (USF Health)

Patients with chronic obstructive pulmonary disease (COPD) who are in their final years of survival do not get the same benefits from pulmonary rehabilitation (PR) as patients who have more years left to live – regardless of their age, complicating illnesses or lung function, according to new research funded by the Veteran’s Administration, which was presented at the American Thoracic Society’s 2008 International Conference in Toronto on Tuesday, May 20.

The researchers recruited 106 patients with COPD who completed an eight-week course of PR. Each patient was evaluated at the beginning and the conclusion of the course for exercise capacity, dyspnea in daily activities, such as walking and carrying groceries, fatigue, quality of life, and other indices of health. The researchers then compared the results of patients who died within two years of the program to those who survived longer and found that even after controlling for potentially complicating factors – such as lung function, age and other present illnesses – patients who lived longer than two years were able to obtain more positive results from their PR program than those who had end-stage COPD (defined retrospectively as having died within two years of the program).

“Although people who died within two years after entering a pulmonary rehabilitation program improved their exercise capacity during the program, they improved less on this and other key variables than did those who lived longer,” said Bonnie Steele, A.R.N.P., Ph.D., a respiratory clinical nurse specialist at the VA Puget Sound Health Care System in Seattle. “The finding was independent of age, lung function and the number of other illnesses they had.”

The researchers anticipated that those with end-stage COPD would be more ill with lung or other diseases. “Previous work has taught us that even with severe obstructive lung disease based upon pulmonary function, people can derive significant benefits from PR,” said Dr. Steele, “but our limited findings suggest that other, presently unappreciated factors present at end of life may contribute to poorer outcomes in end-stage patients with respect to exercise capacity and quality of life.”

There are several possible explanations for the findings, including the possibility that patients in end-stage disease have overall poorer muscle function and greater levels of deconditioning and the possible specific impact of selected co-morbidities, such as heart failure.

“Our sample was too small to explicate this fully,” said Dr. Steele, “but it suggests that treatments for end-stage patients with COPD may still be effective and introducing exercise training sooner in the course of their disease results in more improvement.”

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Source: Keely Savoie

American Thoracic Society

Researchers from the Frances Payne Bolton School of Nursing at Case Western Reserve University found that one year after 248 individuals completed a 12-week cardiac rehabilitation program following a heart attack, bypass surgery or angioplasty, only 37% exercised three times a week to keep their hearts healthy.

Women across the age groups were less inclined to make the healthy changes in comparison to men. Although all groups had a decline between months 9 and 12, younger men sustained healthy exercise patterns better than all the other groups.

“The study points out that interventions are needed to keep people exercising,” said Mary Dolansky, assistant professor of nursing and the lead investigator on the study.

The research follows up on an assessment of individuals as they left a 12-week rehabilitation program to help cardiac patients make lifestyle changes in the area of exercise-a major factor in improving heart health.

The nursing school’s Associate Dean for Research Shirley Moore, the Edward J. & Louise Mellen Professor of Nursing and a member of the current research team, led the original study.

Both studies are projects of the SMART (Self-Management Advancement through Research Translation Center, a National Institute of Nursing Research/National Institute of Health funded Center of Excellence to build the Science of Self-Management). This NIH-funded study is part of a longitudinal look at how people manage their chronic illnesses.

The follow-up findings were reported in the article, “Women’s and Men’s Exercise Adherence After a Cardiac Event: Does Age Make a Difference?” for GeroNurseResearch.

Dolansky said the new research study examined gender differences in three age groups: 60 years and younger, 61 to 71 years, and older than 71. Exercise patterns were recorded through heart monitors worn by the participants.

It was found that across the age groups women exercised less than men.

“Many women traditionally put caretaking of their families before their health needs,” she said.

The oldest group of men exercised less than younger men.

“The downward trend over time concerns us-especially since current guidelines suggest exercising five times a week,” she said.

What might contribute to the decline in exercise over time for women is the initial optimistic outlook that exercise barriers, like care giving for family members, can be overcome, but in fact prevent them in time from continuing an exercise program.

“We need to understand why they stop exercising,” she said.

Patients may need new interventions to realize this is a necessary lifelong change, Dolansky said.

Also contributing to the research were Jacqueline M. Charvat, project director, and Beth Stepanczuk, a medical student at CWRU. In addition to the NIH funding, support came through the American Federation of Aging Research’s Medical Student Training in Aging Research Program Scholars and the National Center for Research Resources at NIH.

Source
Case Western Reserve University

British researchers have found that avoiding certain foods and dust mites during our first months of life may help prevent asthma. Professor Syed Hasan Arshad and colleages from the David Hide Asthma and Allergy Centre, Isle of Wight, England have been tracking 120 children since 1990 in the Isle of Wight Primary Prevention Study. The children – having two or more family members had an allergic disorder – were considered to be at high risk of developing allergic disease on the basis.

Professor Arshad said:

The 58 infants up to one year old and their mothers in the prevention group followed a diet that avoided dairy products, soya and nuts. We checked their compliance by randomly testing breast milk.

The infants were also given vinyl mattresses and covers, and acracide was used to reduce the level of house dust mite. The mothers of the 62 infants in the control group did not make these changes to their diet and bedding.

The results of the 18-year follow-up of the children were presented at the congress of the European Academy of Allergy and Clinical Immunology by Dr. Martha Scott, who had conducted the follow-up.

The researchers found that at one, two, four and eight years old, there was a consistent reduction in atopy (an immediate allergic reaction) in those children in the prevention group. At the age of 18 years, there was considerably less asthma in the prevention group compared to the control group. A further analysis of allergic and non-allergic asthma found lower rates of allergic asthma in the prevention group.

Research carried out previously had shown the complexity of asthma and the importance of the interaction between genetic and environmental factors particularly, but not exclusively, in the early years of life. Atopy is arguably the most significant genetic risk factor for asthma. Despite intensive efforts to develop new treatments, asthma is still an incurable disease.

Evidence of changes in the child’s airways consistent with asthma indicates that early intervention during early infancy (within the first few months of life) is likely to be key in preventing the remodelling of airways which is the main characteristic of asthma.

Dr. Scott said:

Whilst this study is small it does suggest that it is possible to prevent the onset of asthma in high-risk individuals by instituting a strict regime that avoids some of the common triggers for asthma in the first year of life. We have shown that the beneficial effect lasts for many years

This study is important as a proof of the concept that environmental manipulation in early life lowers the prevalence of asthma in high risk people.

The researchers say a further, larger-scale study to identify who is most likely to benefit from this type of intervention strategy is required.

Source: The European Academy of Allergy and Clinical Immunology

As the leading professional society devoted exclusively to pain, pain management and pain research, the American Pain Society sponsors the Kathleen M. Foley Journalist Award to recognize excellence in reporting pain-related topics. The award is designed to honor the work of journalists whose coverage of events, scientific discoveries, patient care, issues and policies contribute to furthering public awareness and understanding of pain and pain-related issues.

APS is accepting applications for the 2010 Foley Award, which will be presented at the APS Annual Scientific Meeting in Baltimore, May 6-8. Nominations will be accepted until Feb. 15. Eligibility is limited to work published or broadcast from Jan.1 to Dec. 31, 2009 by journalists who receive at least 50 percent of their income from journalistic activity, either as an employee of an independent media outlet or free-lancer. Entrants are allowed to submit a single article or broadcast piece or a series of stories or columns on specific pain, pain research and pain-management topics.

The APS award is named for Dr. Foley in recognition of her contributions to furthering professional and public understanding about the need for effective cancer and end-of-life pain management. She is an attending neurologist for the Pain and Palliative Care Service at Memorial Sloan Kettering Cancer Center in New York and director of the Project on Death in America sponsored by the Open Society Institute.

Nominations can be submitted by journalists and by APS members on behalf of a journalist. Applications are reviewed by an independent panel of APS leaders.

Source
American Pain Society

The American Physical Therapy Association (APTA) has endorsed The WalkAide System, developed by Innovative Neurotronics, Inc.

WalkAide is an intelligent functional electrical stimulation (FES) system that restores mobility to people who experience a form of lower leg paralysis known as foot drop. About the size of an iPod, and worn around the calf just below the knee, the device sends low level electrical signals directly to a motor nerve in the leg, stimulating the muscles to raise the foot at the appropriate time in the gait cycle. WalkAide uses Bluetooth technology to communicate during programming and a patented tilt accelerometer.

“As experts in restoring and improving motion in people’s lives, physical therapists are pleased to endorse WalkAide,” said APTA President R. Scott Ward, PT, PhD. “Because the device simulates the typical nerve-to-muscle signals in the leg and foot, patients who have experienced damage to the central nervous system such as through stroke, incomplete spinal cord injury, traumatic brain injury, cerebral palsy, and multiple sclerosis can greatly benefit from this technology.”

Source
American Physical Therapy Association

Mary Harney TD, Minister for Health and Children yesterday, 20th May, 2008, welcomed the major consultation programme being undertaken by the National Rehabilitation Hospital which is taking place today, Tuesday, 20th May, 2008. The Minister said “I believe that it will give the hospital an excellent opportunity to obtain the views of key stakeholders and will help to deliver the best possible facility for patients” The consultation programme is part of the planning process for the redevelopment of the National Rehabilitation Hospital (NRH) which was committed to in the Programme for Government. When completed, the new NRH will provide additional treatment and diagnostic capacity.

The consultation day is being held in the Rochestown Lodge Hotel in Dun Laoghaire and participants will include members of the Hospital’s staff, local public representatives as well as the general public.

“This is an important step in the planning of the new National Rehabilitation Hospital and I would encourage all those with views on the redevelopment to participate in the consultation process” concluded Minister Harney.

Department of Health and Children

An active 72-year-old woman, Claire Mitchell had always enjoyed cooking. However, after breast cancer surgery she found that she had less freedom of movement and reaching jars on high shelves became quite painful. Her plight is common.

A new Cochrane review finds that exercise programs help patients recover shoulder movement and minimize loss of arm or shoulder function after breast cancer surgery.

Many breast cancer survivors develop pain, shoulder stiffness and arm swelling after treatment. These problems often persist for years. Physicians usually prescribe arm and shoulder exercises after surgery to prevent pain and stiffness in those areas on the side of the cancer. However, the best type of exercise or how soon it should begin have been debated.

“There has been some concern that too much aggressive movement soon after surgery might cause pain, delay healing, and increase the risk of arm swelling,” said lead review author Margaret McNeely, an assistant professor of physical therapy at the University of Alberta and clinical researcher at the Cross Cancer Institute, in Canada.

McNeely’s team examined 24 research studies comprising 2,132 women with a confirmed breast cancer diagnosis and who had undergone surgery such as a radical mastectomy, modified radical mastectomy, or a local wide excision or lumpectomy. They had also all had surgery removing lymph nodes from the axilla, or armpit, to determine the extent of the cancer.

Specially designed programs included range-of-motion movements for the shoulders and stretching exercises.

The review showed that starting exercise early after surgery – within the first to third day – might result in better shoulder movement in the early weeks following surgery.

However, “starting exercise that soon after surgery may cause more wound drainage and require drains to remain in place longer than if exercise is delayed by about one week,” McNeely said. Early exercise lengthened wound-healing time by about one day.

The review was published by The Cochrane Collaboration, an international organization that evaluates medical research. Systematic reviews draw evidence-based conclusions about medical practice after considering both the content and quality of existing medical trials on a topic.

Fourteen studies compared the effect of structured exercise to usual care, in which women received an exercise pamphlet or no exercise instruction at all.

Of these, structured programs including physical therapy regimens in the early postoperative period led to a significant improvement in shoulder range of motion over the short and long term.

One problem that can affect women after breast surgery is lymphedema, which is swelling caused by fluid buildup. This swelling begins in the underarm area but can affect the entire arm, usually on the side of the breast surgery, and can be uncomfortable or even painful.

Several persistent complications can greatly diminish a patient’s quality of life, said Douglas Blayney, M.D., medical director at the University of Michigan’s Comprehensive Cancer Center.

Blayney said that although current surgical treatment is attempting to move away from disturbing the axilla, more women, especially younger women, are choosing mastectomy over breast conserving surgery. Mastectomy has a higher incidence of swelling and limited shoulder motion. There is a trend now toward increasing use of radiation therapy to the axilla and this approach also might increase the risk of swelling, he said.

“Combined, these trends in primary treatment of breast cancer make this review highly relevant,” said Blayney, who has no affiliation with the review. Nevertheless, he noted that making suitable exercise programs widely available to breast cancer patients in a timely manner would be a challenge.

He said optimal breast cancer care now involves a team with a wide range of health specialists: surgeons, radiation oncologists, medical oncologists, reconstructive surgeons and others. “This review demonstrates that early involvement of a new team member who manages exercise or physical therapy is also useful for the best outcome,” he said.

Blayney added that he finds few things as disheartening as seeing a breast cancer survivor in long-term follow-up who is cured yet burdened with a “frozen” shoulder or daily use of a lymphedema sleeve, an elastic compression garment worn over the arm to help move fluid and reduce swelling.

“Implementation of modern primary treatment strategies — including early intervention with suitable exercises – should reduce the incidence of these heartbreaking complications,” Blayney said.

The Cochrane Library contains high quality health care information, including Systematic Reviews from The Cochrane Collaboration. These reviews bring together research on the effects of health care and are considered the gold standard for determining the relative effectiveness of different interventions. The Cochrane Collaboration is an international nonprofit, independent organization that produces and disseminates systematic reviews of health care interventions and promotes the search for evidence in the form of clinical trials and other studies of interventions.

“Exercise interventions for upper-limb dysfunction due to breast cancer
treatment.”

McNeely ML, et al.
The Cochrane Database of Systematic Reviews 2010, Issue 6.

Source: Health Behavior News Service

Statement by APTA President R. Scott Ward, PT, PhD

The Medicare Payment Advisory Commission (MedPAC) released its June 2010 Report to the Congress: Aligning Incentives in Medicare recommending a policy option to exclude physical therapy from the in-office ancillary services (IOAS) exception. APTA commends the Commission on its analysis and wholeheartedly agrees with its findings.

APTA strongly supports the federal government’s efforts to prohibit physician self-referral, as evidenced by the association’s extensive work with the Centers for Medicare and Medicaid Services toward the goal of eliminating abusive financial patterns created by physician self-referral. APTA strongly believes that the first plausible step to eliminating these abusive financial arrangements is to tighten restrictions under the IOAS exception of the Stark law. Furthermore, APTA will be proactively working with MedPAC as it continues its research of physician referral of physical therapy services in which the physician has a financial interest. We strongly encourage the Commission to adopt the policy options as laid out in this June 2010 report as formal recommendations to Congress.

In chapter 8 of the report, MedPAC analyzes the expansion of ancillary services, such as diagnostic imaging, clinical laboratory testing, physical therapy, and radiation therapy under the IOAS exception of the Stark law in physician offices over the past 5 years. The report highlights the rapid growth of physical therapy services provided in physicians’ offices and presents evidence that shows that some of the ancillary services ordered by physicians are not clinically appropriate.

Specifically, the report states that “Many services covered under the IOAS exception experienced rapid volume growth under the physician fee schedule from 2003 to 2008… the volume of outpatient therapy services (which includes physical therapy, occupational therapy, and speech-language pathology services) rose by an average of 11.4% per beneficiary per year… .” MedPAC points to studies that have found physicians with a financial interest in physical therapy initiated therapy for patients with musculoskeletal injuries more frequently than other physicians and that physical therapy clinics with physician ownership provided more visits per patient than non-physician-owned clinics.

In addition, the Commission discusses the inherent financial incentives that are created by physician self-referral of ancillary services. Throughout the report, MedPAC lays out several options to mitigate abusive and fraudulent physician self-referral practices. Recommendations specific to physical therapy are: excluding therapeutic services such as physical therapy and radiation therapy from the IOAS exception of the Stark law; limiting the exception to physician practices that are clinically integrated; and improving payment accuracy and expanding payment rates to include multiple related services. The Commission indicates that it plans to further analyze the growth of these services and offer policy recommendations in a future report.

Source
American Physical Therapy Association

A recent study shows that pre-operative assessments of breast cancer patients by physical therapists allow for early diagnosis and successful treatment of lymphedema.

The study, conducted by the National Naval Medical Center (NNMC) and the National Institutes of Health (NIH) and in collaboration with the University of Michigan-Flint and George Mason University, was published in the journal, Cancer (April 25, 2008). The authors demonstrated the effectiveness of a surveillance program that included pre-operative limb volume measurement and interval post-operative follow-up to successfully detect and treat lymphedema, a chronic and often irreversible condition that can cause significant swelling of the upper and lower extremities due to the build-up of excess lymph fluid.

“This study is significant for several reasons, but none more so than it showing that detection and management of lymphedema at early stages may prevent the condition from progressing to a chronic, disabling stage and may enable a more cost-effective, conservative intervention,” said American Physical Therapy Association (APTA) spokesperson and the study’s lead author, Nicole L Stout Gergich, PT, MPT, CLT-LANA, of the National Naval Medical Center (NNMC) Breast Care Center, in Bethesda, Maryland.

Breast cancer related lymphedema is associated with decreased arm function, disability and diminished quality of life. If the condition is not diagnosed early and managed, it can progress to a situation where the patient is at risk for infection and further shoulder complications. The swelling is disfiguring and many times prohibits patients from finding clothes that fit properly.

Stout noted that the baseline pre-operative assessment of 196 breast cancer patients participating in the study – which was conducted from 2001 to 2005 – included basic strength, range of motion, limb volume, and physical activity level. “To measure limb volume, we employed infra-red technology that scans the limbs using beams and sensors, providing us with very accurate information,” she said. All study participants were monitored one month post-surgery and at three-month intervals thereafter for one year even if they exhibited no swelling. “Using both the pre- and post-operative assessments enabled us to diagnose lymphedema before it became visible, which is an unprecedented accomplishment,” Stout noted.

Once lymphedema was diagnosed in 43 of the patients participating in the study, the condition was managed using a conservative compression garment, atypical of lymphedema treatment, observed Stout. A light-grade compression sleeve and gauntlet, fitted by the physical therapist, were prescribed for daily wear. “Lymphedema is normally treated with more aggressive and often costly and time-consuming techniques, such as complete decongestive therapy, which requires the patient to attend daily therapy sessions for weeks and wear bulky compression bandages. This study clearly demonstrates that the condition can be managed with a more conservative treatment option when it is diagnosed at its earliest presentation, which will be good news to breast cancer patients,” she added.

“What we hope to garner from publicizing this study is that it will encourage breast cancer patients to ask the questions that need to be asked regarding their treatment, as well as galvanize physicians, surgeons, oncologists and other physical therapists to make early intervention and conservative treatment of lymphedema the standard of care in breast cancer care,” Stout concluded.

Physical therapists are health care professionals who diagnose and manage individuals of all ages, from newborns to elders, who have medical problems or other health-related conditions that limit their abilities to move and perform functional activities in their daily lives. Physical therapists examine each individual and develop a plan of care using treatment techniques to promote the ability to move, reduce pain, restore function, and prevent disability. Physical therapists also work with individuals to prevent the loss of mobility by developing fitness- and wellness-oriented programs for healthier and more active lifestyles.

The American Physical Therapy Association is a national organization representing physical therapists, physical therapist assistants, and students nationwide. Its goal is to foster advancements in physical therapist education, practice, and research. Consumers can visit findapt.us to find a physical therapist in their area, as well as apta/consumer for physical therapy news and information.

American Physical Therapy Association