New evidence: Vitamin D helps prevent falls

Vitamin D is one of those supplements that makes it into the news media frequently. Here on EBL, we’ve written before about the U.S. Institute of Medicine’s recommendations on Vitamin D intake.

Now there is a new recommendation that taking Vitamin D supplements can help prevent falls in people over 65 years old with a higher risk of falling.

In a review of nine separate studies, the United States Preventative Services Task Force came to the conclusion a daily dose of 800 international units reduced the risk of falling by about 17 percent, compared with those who did not take the vitamin.

“The exact mechanism is not known, but it seems to help muscle strength and balance,” Dr. Al Siu, vice chairman of the task force and chairman of the geriatrics and palliative medicine department at Mount Sinai School of Medicine, told the New York Times.

The panel also made two other recommendations.  Doctors should do a comprehensive assessment of patients’ risk of falling – including asking about falling history and observing patients stand up and walk – to identify those at higher risk. And patients’ should exercise to improve strength and balance.

Falls are the leading cause of injury in adults 65 and older. While there’s no sure-fire way to prevent them, we have evidence that some interventions do work. That’s important information for all of us to know.

Move it or lose it: Real evidence on physical activity

In honor of the 2012 London Olympics, the British medical journal The Lancet published a series of publications about the state of physical fitness across the globe.

The series includes a plethora of new evidence:

  • One large-scale report collected data on physical activity levels for adults 15 years or older from 122 countries worldwide. It found that more than 31 percent of adults are physically inactive. The researchers found that inactivity levels rise as people get older, and the women are less likely to be active than men. It also found that physical inactivity is more problematic in higher-income nations.
  • A far-reaching analysis in the series uses advanced statistical methods of quantify the health implications of physical inactivity on the major non-communicable diseases in 122 countries across the globe. The authors concluded inactivity was a contributing factor to heart disease, diabetes, breast cancer and colon cancer. The estimated that 9 percent of premature death across the word were related to physical inactivity.
  • Another article provides a comprehensive review of evidence-based strategies for promoting physical activity. The review found that community and mass media informational campaigns helped encourage people to get moving. It also found that schools and worksites are good venues for promoting physical activity through education, sports and social groups. Finally, the authors found that finding ways to encourage activity within a community – including building sidewalks, implementing policies that encourage active transportation and building parks and gyms – are all good ways to improve physical fitness.

While the Lancet provides a wide range of data about physical activity across the world, the take-home message is a simple one:  It’s important to get moving, no matter what your age. Policy makers at all levels around the world should make it a priority to increase physical activity levels in their communities and countries.

Disney takes its cues from the evidence

In major news this week, the Walt Disney Co. banned the advertising of junk foods from its television, radio and Internet programming. Under the new guidelines, advertisers who want to promote food and beverages on Disney programming for children must meet guidelines on serving size, calories, and fat and sugar content.

While it’s inspiring that such a large company is interested in promoting health among kids, I was even more inspired that Disney created a policy based on real evidence. Because, in fact, there is a growing body of evidence that links media consumption – and specifically advertisements – with negative health outcomes for children.

This systematic review, for example, looked at 173 studies examining the relationship between media consumption and health outcomes among children. In 80 percent of the studies, more media exposure was associated with a negative health outcome, and childhood obesity had the strongest correlation. This analysis considered the quantity of media that children watched, but not the content.

Another meta-analysis found a significant association between the proportion of children overweight and the number commercials per hour on children’s television, especially ads that promoting junk foods. The study used data from surveys of advertising on children’s television and estimates of the prevalence of overweight among children, in the U.S., Australia and eight European countries. It concluded the quantity and content of advertising on children’s television programs has a specific effect on children.

It’s great to see a major company taking cues from the evidence in an effort to improve the health of children!

A clearinghouse of education evidence

Parents across the nation send their children to public schools with the confidence that principals and teachers are providing an environment where children can learn, grow and thrive.

We hear so much about in the news about ways to improve our education system – especially in this presidential election year, when candidates are offering proposals and counter-proposals to fix our schools.

But is there any evidence as to what really works?  As a parent of young children, our schools are one important place where I want to see evidence-based guidelines put in place.

The best place I’ve found for evidence-based information on education is called the What Works Clearinghouse, an initiative by the U.S. Department of Education that conducts systematic reviews on education research to provide educators with the information they need to make evidence-based decisions.

The project is a true treasure trove of information, with research reviews on a myriad of topics including dropout prevention, school choice, early childhood education and student behavior, to name just a few.

On a recent cruise through the site, several topics piqued my interested including:

I’m certainly going to share this amazing resource with my son’s teachers, and use to gather information about the curriculums he’ll be learning in elementary school.  As a parent, it’s a relief to know there’s a place to look for reliable, evidence-based information on education.

Stuck in a jam? The science behind traffic

?  So a recent story in the Washington Post about the science of traffic piqued my interest.  It turns out (of course!) there’s an entire field of study around alleviating traffic problems that spans city planning, human behavior and health topics.

There are mathematical models that explain why traffic slows for seemingly no reason at all.  (It turns out these traffic jams are self-sustaining waves, similar to the detonation waves produced by explosions.

Another study has found that it’s actually the rate of merging that contributions to slow-downs on freeways, instead of the capacity of the road.

While there’s much evidence on the causes of traffic congestion, research has pointed to proven solution to solve the problem. But it’s good to know that scientists are working on it.

On a related note, there  is plenty of evidence available on the topic of preventing traffic accidents that lead to injury or death. The Cochrane Collaboration has put together a list of systematic review on various methods to reduce injuries and deaths caused by cars and trucks.  Among them:

Solving issues related to traffic congestion and accidents is just another area where it pays to consult the research.

New evidence on global warming

An international team of researchers have developed a new plan to slow climate change – one that involves reducing levels of two of the lesser-known contributors to global warming.

Their paper, published this week in the journal Science, recommends 14 actions to reduce emissions of methane gas – a greenhouse gas more powerful than carbon dioxide – and black carbon – the technical term for soot, which absorbs heat from the sun’s rays.

Among the measures they suggest are:

  • encouraging people to use switch cleaner diesel engines and cookstoves
  • building more efficient kilns and coke ovens
  • capturing methane at landfills and oil wells
  • reducing methane emissions from rice paddies by draining them more often.

Adopting the study’s recommendations would reduce projected temperatures by approximately 0.5°C by 2050, as well as avoiding millions of premature deaths due to air pollution and increasing crop yields thanks to reductions in ozone.

The proposal is a projection, to be sure.  But there is a large body of evidence available that shows there are many benefits to reducing these contaminants.

Systematic reviews show that reducing soot levels improves lung function and pregnancy outcomes. And it’s been clearly documented that methane gas warms the atmosphere, and that reducing its levels will boost agricultural yields.

So, in fact, the new study delivers another benefit, as noted in this New York Times column: it offers practical solutions with the immediate benefits of improving health and helping farmers produce more.

To us, it seems like a proposal worth putting into practice.

More evidence supporting the systematic review

Frequent EBL readers are well aware of the importance we put on systematic reviews, studies that synthesize many articles on a given topic and draw a conclusion about what the body of evidence shows.

So we were excited this week to stumble across a paper funded by the Milbank Memorial Fund and the U.S. Centers for Disease Control extolling the virtues of the systematic review for improving health across populations – especially for our policymakers.

The paper includes case studies on a wide range of topics — underage drinking, tobacco use and traffic safety interventions, to name a few.

And it draws the following conclusions about systematic reviews, in general:

  • Policymakers should feel confident about the findings of systematic reviews because, by definition, they help reduce the bias often present in single studies.
  • Systematic reviews help policymakers work efficiently and reduce the influence of outside interests.
  • Researchers in all fields must make strategic efforts to publicize and implement review findings. (Here at EBL, we’re doing our best in this area!)
  • Enhancing the “literacy” of decision makers and the public about the strengths and weaknesses of different types of evidence can help improve population health policy.

So there you have it: More evidence in support of the systematic review.  The next time you’re thinking about making a health decision, considering checking the body of evidence. Just Google “systematic review” along with the topic you’re interested in and see what you can find.

The real story on unemployment

Since late in 2007, people across the globe have been coping with an economic downturn that’s led to decreased house values, falling stock prices and higher unemployment rates. The financial crisis has impacted people across the world in different ways.

In the United States, unemployment has been especially troublesome.  And a new report from the University of New Hampshire’s Carsey Institute details exactly who has been hit the hardest.

Although all groups of Americans have experienced rising unemployment, increases have been significantly larger for men, young adults, the least educated, and single parents.

The report shows that unemployment has rose more in central cities and suburban places than in rural places, most likely because rural unemployment was already high prior to the start of the recession.

Rural areas have continued to suffer from the highest unemployment rates for unmarried people. Single fathers in rural areas registered the single larg­est increase in unemployment throughout the recession, rising almost 11 percentage points to 23 percent in 2010.

Young adults who finished high school since 2007 have been some of the hardest hit.

“This is particularly disturbing in that not only are these youths losing income in the short term, but may also suffer from long-term ‘scarring’ in terms of lost wages,” the report says. “In most cases, unemployment was high among the young and less-educated groups in 2007, only to increase rapidly by 2010.”

The report used data from the Annual Social and Economic Supplement of the Current Population Survey, a monthly survey of about 50,000 households conducted by the Bureau of the Census for the U.S. Bureau of Labor Statistics.

What does the evidence say about risk communication?

The U.S. Food and Drug Administration has published a new report that’s right up our alley. It’s called Communicating Risks and Benefits: An Evidence-Based User’s Guide.

The introduction offers an explanation of evidence-based health communications that we believe should be the standard for all organizations, from corporations to government agencies to universities.

“…Sound communications must be evidence-based in two related ways. One is that communications should be consistent with the science — and not do things known not to work nor ignore known problems. The second is communications should be evaluated — because even the best science cannot guarantee results. Rather, the best science produces the best-informed best guesses about how well communications will work. However, even these best guesses can miss the mark, meaning that they must be evaluated to determine how good they are and how they can be improved.”

The report goes onto address the concept of communicating risks and benefits across a wide range of fields – in health provider settings, news coverage and corporate communications to name a few – and offer practical tips about using evidence in all sorts of communications.

Cornell’s own Valerie Reyna, whom we’ve written about before, authored Chapter 12 about communicating risks and benefits to people of all ages, and her work is extensively quoted in other chapters of the report.

The report is chock-full of useful recommendations.  Among them are:

  • Health professionals should receive specific training on how to communicate the risks and benefits of medical procedures and medicines.
  • Provide information along with explaining meaning to help consumers make good decisions.
  • Test the readability of health care messages to ensure they use plain language.

If you work in the field of health care, this report is a must-read!

MyPlate: A healthy diet in a glance

MyPlateYou may have noticed that the federal government launched a new food icon called MyPlate last week. The diagram is as part of a new, evidence-based initiative to improve the diets of Americans that we’ve written about before here on EBL.

The plate is a graphic representation of new dietary guidelines based on an extensive review by 13 nationally-recognized experts in nutrition and health.  While that sounds good, we wondered what the nutrition experts at Cornell think about the new icon.

Senior extension associate, Jennifer Wilkins, Ph.D., R.D., is the community coordinator for Cornell’s Dietetic Internship Program and director of Cornell’s Farm to School Research and Outreach program. On the whole, she’s a fan of the MyPlate graphic.

For one, the plate does a better job of conveying proportionality, she says.  “Advice to ‘make half of your plate fruits and vegetables’ couldn’t be clearer,” Wilkins said. And there’s clear evidence that taking this step alone will lead to a healthier diet.

The guidelines issued along with the plate – such as avoid oversized portions and sugary drinks – are simply worded and convey important steps to take to improving Americans diets.

But there is one aspect missing from the new icon, Wilkins said.

“The important reality is that food quality varies dramatically within each group,” she said. “ It really does matter how much of the grains are whole grains. It matters how, and to what extent fruits and vegetables, and grains are processed. And it matters if chicken is a breast or McNuggetized.”

The bottom line: MyPlate is a step in the right direction, but Americans should make sure they gather even more evidence about a healthy diet.

You can read more of Wilkins’ ideas about MyPlate and healthy eating in her column published in the Albany Times-Union.

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