Effectiveness of nonsurgical treatment for idiopathic scoliosis. Overview of available evidence.

To define further the effectiveness of nonsurgical therapy for idiopathic scoliosis, predefined criteria were established for selection and data retrieval from studies of therapy and natural history, and the results were synthesized quantitatively. Only studies of patients with no more than a 50 degree Cobb angle scoliosis were considered. Twenty-four reports were eligible. There was a fivefold proportion of failures among patients with scoliosis greater than 30 degrees at the start of therapy but no difference in progression between different kinds of nonsurgical therapies or between treated and untreated patients; these were the main findings of this quantitative analysis. These data cannot be used to prove the effectiveness or ineffectiveness of nonsurgical therapy for idiopathic scoliosis, and experimental controlled studies of different therapies seem to be justified both on ethical and scientific grounds. The findings of this overview can be used for their planning.

[Protocol and feasibility of a randomized controlled study on preventing the smoking habit in adolescents]. / Protocollo e fattibilità di uno studio controllato randomizzato sulla prevenzione dell'abitudine al fumo negli adolescenti.

As no similar study has been conducted in Italy, the Local Health District (USL) of Rozzano (Milano), decided to carry on a randomized controlled trial on the efficacy of a Smoking Prevention Program. In this article we describe study protocol and give data related to program steps already carried out. A team of four MDs involved in school health and a Health Research consultant were in charge for the study. 1013 students from the second class of the secondary school (12y age) were stratified into four subgroups, according to their risk of becoming a smoker and their teachers smoking status. They were subsequently randomized (with blocking) to two groups: the smoking prevention (which was based on the Waterloo Smoking Program) and the cardiovascular risk prevention (based on an ad hoc program by the USL) which was the control group. Both interventions consisted in six weekly lessons which were delivered in 37 classrooms (777 students or 61% of all the eligible student population, 72% of randomized students) by an equal number of teacher who voluntarily joined the program, during school hours. A larger number of teachers (53) formerly joined the program but not all accomplished it. Problems with program planning and delivering are described, together with the criteria which guided this approach.