SPORTS INJURY Concussion among youth, children rising in Ontario A study has found that the number of children and youth treated for concussions in both emergency departments and doctors’ offices in Ontario has risen significantly. Between 2003 and 2011, almost 89,000 pediatric concussions were treated in either an emergency department or a physician’s office. The rate of concussions jumped to 754 from 466 per 100,000 for boys, and to 440 from 208 per 100,000 for girls. Researchers at Toronto’s York University and the Institute for Clinical Evaluative Sciences, or ICES, found that falls and hockey and skating injuries were the leading causes of concussion in kids aged three to 18. The study published recently in the journal Paediatrics and Child Health also showed that, over time, more children were being evaluated for concussion in doctors’ offices than in the ER. Study co-author Dr. Astrid Guttmann of ICES said prevention initiatives to help reduce the incidence of concussion are warranted, particularly in sports and recreation programs. G u t t m a n n s a y s sports-related concussions can be minimized by such preventive actions as reducing body checking in hockey or wearing a helmet while cycling. “By examining all of the pediatric concussions evaluated in multiple facilities, we were able to minimize the issue of under-reporting and obtain a more accurate number of concussions treated in Ontario,” added lead author Alison Macpherson, a professor at York’s School of Kinesiology and Health Science. She said future studies could try to differentiate between the true incidence of concussion and an increase in those seeking medical evaluation due to increased awareness of the brain injury and its possible health consequences. - The Canadian Press COLLABORATION CMCC, University of Toronto sign collaboration agreement The Canadian Memorial Chiropractic College (CMCC) has signed an official Memorandum of Understanding with the University of Toronto (U of T), through the Faculty of Medicine, Leslie Dan Faculty of Pharmacy, and the Faculty of Kinesiology and Physical Education to explore education and research collaborations. The memorandum will provide opportunities to foster cooperative relationships in areas of research and education. This cooperation could be realized in such areas as: research and joint applications for funding; joint educational courses; graduate and undergraduate student mobility; exchange of faculty and participation in, and co-hosting of lectures, meetings, seminars, symposia and conferences. “CMCC is deeply committed to developing meaningful partnerships with health-care professionals and educators of all disciplines to study ways and models to improve the care and ultimately the health of our patients. We look forward to developing many collaborative activities with our colleagues at the University of Toronto,” CMCC president Dr. David Wickes said. U of T’s dean of medicine, Catharine Whiteside, said the new partnership demonstrates the schools’ commitment to expanding research and educational opportunities in health care. “We’re delighted to partner with an organization committed to improving health with an evidence- based approach,” Whiteside said about the CMCC. The agreement between CMCC and the three U of T faculties is an important step forward in advancing research initiatives, according to representatives from these institutions. “This agreement formalizes research collaborations which have been ongoing between the two institutions for many years,” Dean of U of T’s Leslie Dan Faculty of Pharmacy Heather Boon said. The representative of the university’s Faculty of Kinesiology and Physical Education said he looks forward to further collaboration with the CMCC. “Our scientists are already engaged in some research collaborations with CMCC colleagues and many of our students use their undergraduate kinesiology degrees as a foundation for subsequent studies in a variety of health disciplines, including chiropractic,” Dean of U of T’s Faculty of Kinesiology and Physical Education Ira Jacobs said. Instrumental in bringing this agreement to fruition is CMCC research scientist and senior advisor to the president Dr. Silvano Mior. Mior spearheaded this partnership as well as many other similar initiatives that continue to build models of collaboration between academic institutions and between chiropractors and physicians in the community primary health care setting, the CMCC said. “We have worked collaboratively with a number of U of T faculty in areas of research and education. This agreement is an acknowledgement of the quality of that work and provides a wonderful opportunity to expand into new areas of mutual benefit,” Dr. Mior added. PREVENTION Resistance training at work helps prevent MSD Allowing workers to do resistance training on the job can help prevent and manage upper extremity musculoskeletal disorders (MSDs), said a recent systematic review conducted by the Institute for Work & Health (IWH). Resistance training refers to exercises that cause the muscles to contract against an external resistance with the expectation of increases in muscle strength, tone, mass and/or endurance. “The studies on the effectiveness of resistance programs that we included in our review varied in the level of detail provided,” said Emma Irvin, head of IWH’s systematic review program and one of the lead investigators of this project. “In those that supplied specifics, the resistance programs ranged from 20 minutes to one hour per week, spread across one or multiple days per week, with and without the involvement of a physiotherapist.” The 2014 review also found: • strong evidence of a positive effect for workplace-based resistance exercise training programs; • moderate evidence of a positive effect for stretching exercise programs (including yoga), workstation forearm supports and vibration feedback on mouse use with computers; • moderate evidence of no effect for job stress management training, electromyographic (EMG) biofeedback (sensor pads that measure activity level in muscles), and workstation adjustments with minimal worker involvement. The findings led the review team, consulting with stakeholders, to craft practical messages for those involved in MSD prevention at work. PAIN MANAGEMENT Ontario earmarks $2.3M for expanded low back pain management initiative The Ontario government is expanding its low back pain strategy through a $2.3 million pilot project aimed at enabling primary care organizations to deliver timely, appropriate , high-quality low back pain services. As part of the expansion of Ontario’s Low Back Pain Strategy, the two-year pilot project will build on efforts to provide better access to appropriate, cost-effective, patient-centred care. Under the initiative, participating health care organizations will be able to provide additional hours for a range of allied health providers such as chiropractors, physiotherapists, occupational therapists, kinesiologists and registered massage therapists. This recent announcement further fuels chiropractic’s role in the development of new primary health care models that focus on providing “the right care, at the right time, in the right place.” “Improving the quality and delivery of treatment for low back pain can make a life-changing difference to thousands of people in the province,” Minister of Health and Long-Term Care Dr. Eric Hoskins said. The Ontario Chiropractic Association (OCA) welcomes this new initiative and sees it as an “incredible opportunity” to increase the number of people seeing chiropractors for their health conditions. Although low back pain is only a portion of the health care chiropractors are able to provide, it is what the profession is best known for and it is what the government is looking for at the moment, chief executive officer of the OCA Bob Haig said. “We are filling that gap right now. Over the last few years, the government and other players in the healthcare system have recognized the valuable role that chiropractors play and the expertise that they have,” he said. Since 2012, the Ontario government has launched a series of initiatives under its Low Back Pain Strategy, and in each of these initiatives, chiropractors have played a prominent role. Among the organizations participating in this new pilot project include: Essex Court Nurse Practitioner-Led Clinic in Essex in partnership with City Centre Health Care in Windsor; a partnership between family health teams in Mount Forest, East Wellington and Minto-Mapleton; Couchiching Family Health Team in Orillia; TAIBU Community Health Centre in Scarborough; Shkagamik-Kwe Aboriginal Health Access Centre in Sudbury; Belleville Nurse Practitioner-Led Clinic, and Centre du santé communautaire de l’Estrie. Through the project, these organizations will be able to: provide faster, more accurate assessment of low back pain problems; use a more holistic approach to treating low back pain; educate patients on self-management techniques, and refer patients to an appropriate health-care provider as needed. Acute low back pain is a common health problem affecting more than half of all Ontarians over the course of their lifetime. About 90 per cent of back pain is benign. Since the launch of the Ontario Low Back Pain Strategy in 2012, there has been an 18.5 per cent decrease in the number of patients being sent for unnecessary x-rays, CT scans or MRIs – resulting in savings of approximately $15 million, according to the ministry. “The old model of dealing with low back pain – at a physician’s office – was largely based on referrals to medical specialists, and doing an awful lot of advanced imaging – MRIs, CT scans – which the evidence all says is not actually the best way to manage these patients. Almost 90 per cent of people who are referred to a specialist or to a surgeon for low back pain are not surgical candidates and they just end up back in their family doctor, anyway,” Haig said. “The beauty of this model is it’s as far upstream as you can get... it’s as close to the patient’s first point of contact with the system as you can get.” - Mari-Len De Guzman PATIENT CARE Patientcentred approach to chronic pain management A panel convened by the U.S. National Institutes of Health concluded that individualized, patient-centered care is needed to treat and monitor people with chronic pain. The panel has urged more research and development around evidence-based, multidisciplinary approaches needed to balance patient perspectives, desired outcomes and safety. “Chronic pain spans a multitude of conditions, presents in different ways, and requires an individualized, multifaceted approach,” said Dr. David Reuben, panel chair and professor of medicine at the David Geffen School of Medicine at the University of California, Los Angeles. Chronic pain is often treated with prescription opioids, but the panel noted widespread concern with this practice. Although some patients benefit from such treatment, there are no long-term studies on the effectiveness of opioids related to pain, function or quality of life. However, there are well-documented potential adverse outcomes, including substantial side effects, physical dependence and overdose, with about 17,000 opioid-related overdose deaths reported in 2011. To address knowledge gaps, the panel cited a need for more research on pain, multidisciplinary interventions, long-term effectiveness and safety of opioids, and optimal opioid management and risk mitigation strategies. However, because well-designed longitudinal studies can be large, expensive and difficult for recruitment, the panel urged the development of new research design and analytic methods to answer important research and clinical questions. NUTRITION Top trends in healthy eating for 2015 The Canadian Health Food Association (CHFA) announced the top five trends Canadians should be aware of when shopping at their local health food store in 2015. “The holidays are a time when Canadians are more focused on spending quality time with friends and family and tend to forget about diets and ease up on exercise,” CHFA president Helen Long said. “The new year is an opportunity to make or renew resolutions and reinvigorate healthy habits or create new ones. By sharing these new trends, we hope to help Canadians discover new, exciting, natural solutions to help them enjoy a healthy 2015.” The top five trends, according to the CHFA, are: New, interesting oils In 2014 coconut oil was all the rage, and while it has many health benefits, we are seeing more and more people using unconventional oils, each offering their own unique health advantages. Some of the oils trending in 2015, include: Avocado Oil - Rich in monounsaturated fats and Vitamin E, and with a high smoke point which makes it better for use in cooking than olive oil. Camelina Oil - Rich in monoand poly-unsaturated fats with high proportion of Omega-3s for cardiovascular health. Flax Seed Oil - Rich in alpha-linolenic Omega-3 fats. Digestive health Increasingly, natural health products that support digestion, including a diversifying probiotic category, are being linked to health benefits beyond digestive and intestinal health, such as mental health, skin health and weight maintenance, among other benefits. In 2015 consumers can expect to see new natural health products focused on supporting the health of the digestive tract, including L-glutamine, new probiotics and different forms of dietary fibre. Fermentation The trend of supporting digestion also extends to fermented foods, which are no longer limited to kimchi, tempeh and sauerkraut. Fermentation can liberate nutrients in foods and help our body better absorb them. The process of fermentation also increases some anti-inflammatory and anti- oxidant compounds in foods. In 2015, consumers should expect to see a plethora of new foods in different fermented forms including bars, powders and capsules. Pumpkin Pumpkin is primed to be the kale of 2015. From oils to seeds, we are going to see an increase in the use of pumpkin in healthy products across the country. This unique vegetable has many health benefits and has been linked to heightened prostate and urinary tract health. Pumpkin seeds are also rich in B vitamins, vitamin E, zinc and essential fatty acids. Pumpkin flesh also touts strong health benefits, as it is rich in nutrients including beta-carotene, a pre-cursor to Vitamin A - crucial for healthy reproduction, immune system, health and vision. GMO labeling In more than 60 countries around the world, including Australia, Japan, and all the countries in the European Union, there are significant restrictions or outright bans on the production and sale of food containing GMOs. In Canada, GMO labeling demands are on the rise as we see an increase in consumers demanding to know where their food comes from and the impact that producing it has on the environment. While the debate surrounding GMO foods continues, suppliers are increasingly stepping up to the plate and offering certified organic products, which is an assurance that foods are produced without the use of GMOs. Through third-party certification, such as Non-GMO Project Verified and Organic Certification, suppliers will continue to voluntarily disclose that their products are produced without the use of GMOs. This trend will continue throughout 2015 in response to consumer demands and increasing labeling activism in Canada. “We hope Canadians embrace these new trends in 2015,” holistic nutritionist Michelle W. Book said. “If they do, they will enjoy a great increase in their well-being, as health is a life-long journey that includes healthy foods, exercise and natural health products.” SUPPLEMENTS Vitamin D offers chronic pain relief: study Some patients with chronic pain could be better served by being prescribed vitamin D supplements by their health-care provider, according to research at the University of Adelaide in Australia. Researchers in the university’s School of Population Health have been studying the treatment of patients with chronic non-specific musculoskeletal pain, and they have found it can vary widely. “Vitamin D supplements are known to help ease the symptoms of people with this type of chronic pain, and there are no known negative side-effects. Vitamin D supplementation is readily available and a relatively cheap option,” a PhD student and medical doctor, Manasi Gaikwad, said. “We found that the Gps (general practitioners) we studied have observed a positive effect of vitamin D supplementation on these patients. However, this can be a slow process, involving repeat visits to the GP, and additional costs such as blood tests. Despite the prevalence of this condition in the community, the diagnosis and treatment of patients with chronic non-specific musculoskeletal pain remains complicated. “Several studies have been conducted showing that patients with chronic non-specific musculoskeletal pain can receive relief after increasing vitamin D intake. But until now there has been no study to understand the clinical reasoning Gps use to decide which patients should or should not receive vitamin D supplementation,” she said. “The research has highlighted that a standardised approach to treatment could be beneficial for both the Gps and patients,” Gaikwad said.