Chiropractic + Naturopathic Doctor • February 2017 • Roundup

NEW YORK – Don’t count on smartphone health apps in an emergency. A review shows many don’t warn when you’re in danger.

The study published in the journal Health Affairs found problems even with apps considered to be among the highest-quality offerings on the market.

There’s been a proliferation of health apps for mobile phones. According to the IMS Institute for Healthcare Informatics, there are more than 165,000 health apps out there.

“The state of health apps is even worse than we thought,” said Dr. James Madara, chief executive of the American Medical Association, who was not involved in the study.

This wasn’t a survey of step-counting fitness apps. The research team reviewed 137 apps designed for patients with serious ongoing health problems, including asthma, cancer, diabetes, heart disease, and depression.

The health apps, for example, help those with diabetes track and record every blood sugar reading and insulin injection. One invites users to photograph their moles, and offers analysis on whether they are changing in a way that signals skin cancer.

Perhaps most concerning was what happened when doctor reviewers entered information that should have drawn warnings from the app – like selecting “yes” when the app asked if the user was feeling suicidal, or entering extremely abnormal levels for blood sugar levels.

Only 28 of 121 apps responded appropriately to such red-flag information, researchers said.

Health apps “should have some common-sense standards,” said lead author Dr. Karandeep Singh, a University of Michigan internist. “The vast majority of apps do not have any kind of response.”

Another issue is the safeguarding of medical privacy. While patients commonly enter health information into apps, a lot of the information is shared through insecure methods like text message or emailing, the researchers said.

The reviewed apps came from Apple iTunes and Google Play app stores – most of them free. Each app was reviewed by a doctor and a tech expert. The researchers named most of the apps but didn’t publish their reviews. Instead, they shared them with the app companies.

Singh said they were interested in “identifying gaps that need to be filled” instead of naming winners and losers. Overall, the industry needs to do more work to improve safety and privacy, he said. And patients need to go beyond consumer ratings on websites before depending on apps to make crucial decisions about their health.

Getting physical exercise within a week of suffering a concussion may reduce a young person’s risk of experiencing ongoing symptoms, say researchers, whose finding runs counter to conventional guidelines calling for strict mental and physical rest following the common brain injury.

“Exercise is probably a good medicine,” said Dr. Roger Zemek of the Children’s Hospital of Eastern Ontario, who led the study of Canadian children and teens conducted at nine pediatric hospitals across the country.

Those who said they resumed light to moderate activity soon after a concussion – such as walking, swimming and stationary cycling – were found to be less likely to have such symptoms as nausea, headaches and dizziness a month later.

Exercise increases blood flow to the brain and could help speed up healing and improve cognitive function, which is often altered as the result of a concussion, researchers said.

“We also know that by getting outside and doing this, patients are taken away from that negative cycle of ‘I’m sick’ and being stuck in that sick role,” Zemek said from Ottawa. “And perhaps they’re seeing something they can do to help them improve.”

To conduct the study, published in the Journal of the American Medical Association, researchers surveyed almost 2,400 kids ranging in age from five up to 18 who were treated for concussion in hospital emergenc y departments. About 70 per cent of the brain injuries occurred while playing sports or doing other recreational activities.

Patients and their parents were asked about symptoms and physical activity at seven and 28 days after the concussion. In the early-exercise group, 29 per cent reported ongoing or worsening symptoms 28 days after their concussion, compared with 43 per cent of those who avoided physical activity.

Among children and teens who reported having three or more symptoms that first week, those who engaged in early physical activity were 25 per cent less likely to have ongoing or worsening problems at one month – “regardless of the intensity” – compared to those who chose rest over exercise, Zemek said.

He believes the findings suggest guidelines mandating strict rest until concussion symptoms disappear need to be reconsidered – with one caveat.

“I do feel we need to be prudent and really make sure this is not taken as a free pass to go back to competition ... (not) until they’re medically cleared.”

Dr. Paul Echlin, a Burlington, Ont., sports medicine physician who treats young athletes with brain trauma, said getting a patient active at a low level without exacerbating their injury makes sense.

Echlin, who was not involved in the research, said he encourages his concussion patients to be as active as symptoms allow.

“If you don’t isolate or don’t immobilize somebody, then you’re going to have a better result.”

While the premise of this study is reasonable, it doesn’t show how complex concussions can be, he said.

“Rest and activity are both important in the essential recovery of a person with traumatic brain injury, but so are the diagnosis of all the other components – and not to centre it around just one or the other, but to say (physical activity) is one of the many things that will help a person recover.”

Despite a 50 per cent increase in hospitalization of children and youth with mental-health problems since 2008/09, the province of Ontario has not analyzed the reasons for the increase or taken steps to address it, the province’s Auditor General Bonnie Lysyk said in her 2016 Annual Report.

One in five Ontarians will experience a mental-health problem in their lifetime, and most problems begin in childhood or adolescence.

“It is crucial that the government do its best to understand the reasons for these troubling statistics and that it can provide timely and appropriate treatment and avoid the potential high social and financial cost of not dealing proactively with the issue,” Lysyk said.

The Ministry of Children and Youth Services provided $438 million to more than 400 child and youth mental health service providers in 2015/16 to fund services to 120,000 registered clients.

The auditor general found that despite the 50 per cent increase in hospitalization of children and youth with mental-health problems, the ministry has not worked with other ministries involved in the government’s Comprehensive Mental Health and Addictions Strategy to analyze the reasons for the increase, and to address it.

The report also found the ministry does not monitor the performance of the Child and Youth Mental Health Program and agencies to ensure they are providing cost-effective mental-health services.

A new study led by investigators at the University of Utah School of Medicine finds that individuals with symptoms that put them at increased risk for heart disease could be more likely to have shoulder problems, including joint pain and rotator cuff injury.

“If someone has rotator cuff problems, it could be a sign that there is something else going on. They may need to manage risk factors for heart disease,” said the study’s lead author Dr. Kurt Hegmann, professor of family and preventive medicine and director of the Rocky Mountain Center for Occupational and Environmental Health. The research was published in the Journal of Occupational and Environmental Medicine.

Repeated physical stress is most frequently blamed for aggravating shoulder joints and the muscles and tendons that surround them. Think about a pitcher who throws a baseball 100 times a day. While physical exertion can certainly be an irritant, accumulating evidence points to other factors that could also be at play. Previous research found that people who had an increased risk for heart disease also had a tendency toward carpal tunnel syndrome, Achilles tendinitis, and tennis elbow – all musculoskeletal disorders.

The current study by Hegmann and colleagues adds shoulder problems to the list and takes the connection one step further. The more heart disease risk factors that each of the study participants had racked up – including high blood pressure, high cholesterol, diabetes – the more likely they were to have had shoulder trouble.

Thirty-six participants with the most severe collection of risk factors were 4.6 times more Likely than those with none of the risk factors to have had shoulder joint pain. They were also nearly six times more likely to have had a second shoulder condition, rotator cuff tendinopathy.

Participants with mid-level heart risk were less likely to have had either shoulder condition, at 1.5 to 3-fold. Shared trends bolster that there could be a relationship between heart risk and shoulder problems, but researchers will need to follow up with a prospective study to prove cause and effect.

It may seem like physical strain would be at least just as likely to cause shoulder pain but data from the 1,226 skilled labourers who took part in the study suggest otherwise. Ergonomists carefully monitored airbag manufacturers, meat processors, cabinetmakers and skilled laborers. Every forceful twist, push and pull was factored into a strain index assigned to each worker. But a more straining job did not translate to an uptick in shoulder difficulties. Nor did more time spent doing other physical activities.

“What we think we are seeing is that high force can accelerate rotator cuff issues but is not the primary driver,” Hegmann said. “Cardiovascular disease risk factors could be more important than job factors for incurring these types of problems.”

He said it’s possible that controlling blood pressure and other heart risk factors could alleviate shoulder discomfort, too.

The research was supported by the National Institute on Occupational Safety and Health and published as, “Association Between Cardiovascular Disease Risk Factors and Rotator Cuff Tendinopathy”.

Astronauts on long missions in space have atrophy of the muscles supporting the spine – which don’t return to normal even several weeks after their return to Earth, reports a study published in Spine.

The results provide new insights into the elevated rates of back pain and spinal disc disease associated with prolonged spaceflight, report Dr. Douglas Chang of University of California, San Diego, and colleagues. The data were obtained as part of a NASA-funded research study, led by Drs. Alan Hargens and Jeffrey Lotz.

Six NASA crewmembers were studied before and after spending four to seven months in “microgravity” conditions on the International Space Station. Each astronaut underwent MRI scans of the spine before their mission, immediately after their return to Earth, and again one to two months later.

The goal was to understand factors affecting lumbar spine strength and low back pain during long-duration spaceflight, as well as the spine’s response after returning to Earth gravity. Back pain is common during prolonged missions, with more than half of crew members reporting spinal pain. Astronauts are also at increased risk of spinal disc herniation in the months after returning from spaceflight – about four times higher than in matched controls.

These changes are accompanied by an increase in body height (about two inches), thought to result from spinal “unloading” and other changes related to the lack of gravity. The researchers used an image “thresh-holding” technique to estimate lean muscle separated from non-lean muscle components.

The MRI scans indicated significant atrophy of the paraspinal lean muscle mass – which plays a critical role in spinal support and movement – during the astronauts’ time in space. The lean muscle, or “functional,” cross-sectional area of the lumbar paraspinal muscles decreased by an average of 19 per cent from preflight to immediate postflight scans. A month or two later, only about two-thirds of the reduction had recovered.

There was an even more dramatic reduction in the functional cross-sectional area of the paraspinal muscles relative to total paraspinal cross-sectional area. The ratio of lean muscle decreased from 86 per cent preflight to 72 per cent immediately postflight. At follow-up, the ratio recovered to 81 per cent, but was still less than the preflight value.

In contrast, there was no consistent change in the height of the spinal intervertebral discs.

Further studies will be needed to clarify the effects on disc height, and whether they contribute to the increase in body height during space missions, and to the increased risk of herniated disc disease.