Relationship Between Falls and Complementary and Alternative Medicine Use Among Community-Dwelling Older Adults.

OBJECTIVES: The objective of this study was to examine the potential relationship between different forms of complementary and alternative medicine (CAM) use and falls among older adults in New York City (NYC). DESIGN: This cross-sectional study of data from the NYC Health Indicators Project survey used modified questionnaire items from several national surveys. SETTINGS: Participants were recruited from 56 senior centers located in the 5 boroughs of NYC. PARTICIPANTS: There were 1273 participants aged 60 years or older included in the final analysis. OUTCOME MEASURES: Of particular interest to the researchers was a dichotomous outcome variable for falls, indicating that an individual had experienced no falls during the past year or one or more falls. Also of interest in the analyses were five CAM therapy types: alternative medical systems, biologically based therapies, manipulative and body-based therapies, mind-body therapies, and movement therapies. RESULTS: Prevalence of falls in NYC was 26.8%, which is consistent with the national average. Prevalence of CAM use was 92%. Participants who had tried manipulative and body-based therapies were more likely to report falling in the past 12 months (odds ratio, 1.65; 95% confidence interval, 1.26-2.15), after adjustment for age and sex. This observed association may reflect older adults with chronic pain who are already at risk for falling and are seeking therapy for this pain. None of the other CAM types were significantly associated with falls. CONCLUSIONS: Because of the growing popularity of CAM use within this population, CAM practitioners should be included in falls prevention strategies. Particular attention should be taken to include practitioners who provide manipulative and body-based therapies (e.g., chiropractors, osteopaths, physical and massage therapists) because of the high risk for falls observed among individuals who use these therapies.

Treatment of vulvodynia with tricyclic antidepressants: efficacy and associated factors.

OBJECTIVE: To determine the efficacy of tricyclic antidepressants (TCAs) as treatment for vulvodynia, and to identify demographic factors and pain characteristics associated with improvement. MATERIALS AND METHODS: Between January 2001 and April 2004, women diagnosed with vulvodynia were offered TCA therapy. The patients rated their worst recent pain on a 10-point scale at baseline and at follow-up; improvement was classified as at least 50% reduction in reported pain from baseline. RESULTS: Of 271 women diagnosed with vulvodynia, 209 (77.1%) were treated initially with a TCA (amitriptyline [n = 183], desipramine [n = 23], and other tricyclic medications [n = 3]). One hundred sixty-two (59.8%) of the women were followed up at a median period of 3.2 months after their initial visit, including 122 women who had started on a TCA. Of 83 women taking a TCA at the first follow-up, 49 (59.3%) improved by more than 50%, compared with 30 of 79 women not taking TCA at follow-up (improvement rate = 38.0%; p =.007; odds ratio = 2.35; 95% CI = 1.23-4.42). Multivariate analysis indicated that age, severity of pain, diagnosis (localized vs generalized vulvar pain), length of time with pain before treatment, age at menarche, use of oral contraceptives, and the number of previous pregnancies were not associated with the outcome; however, taking a TCA at the time of the first follow-up was strongly associated with improvement (p <.001; odds ratio = 4.23; 95% CI = 1.98-9.01). Repeated analysis including only those women prescribed with amitriptyline rather than any tricyclic revealed similar results. CONCLUSIONS: Women with vulvodynia who were prescribed a TCA in general (or amitriptyline, specifically) were more likely to have pain improvement compared with those women not taking these medications at follow-up. Randomized, controlled studies of TCAs versus other treatments are needed to clarify the overall effectiveness of these drugs.

Residence near a major road and respiratory symptoms in U.S. Veterans.

BACKGROUND: There is evidence that exposure to motor vehicle exhaust is associated with respiratory disease. Studies in children have observed associations with wheeze, hospital admissions for asthma, and decrements in pulmonary function. However, a relationship of adult respiratory disease with exposure to vehicular traffic has not been established. METHODS: We studied a sample of U.S. male veterans drawn from the general population of southeastern Massachusetts. Information on respiratory symptoms and potential risk factors was collected by questionnaire. We assessed distance from residential addresses to major roadways using geographic information system methodology. RESULTS: Adjusting for cigarette smoking, age, and occupational exposure to dust, men living within 50 m of a major roadway were more likely to report persistent wheeze (odds ratio [OR] = 1.3; 95% confidence interval [CI] = 1.0-1.7) compared with those living more than 400 m away. The risk was observed only for those living within 50 m of heavily trafficked roads (>/=10,000 vehicles/24 h): OR = 1.7; CI = 1.2-2.4). The risk of patients experiencing chronic phlegm while living on heavily trafficked roads also increased (OR = 1.4; CI = 1.0-2.0), although there was little evidence for an association with chronic cough. This association was not dependent on preexisting doctor-diagnosed chronic respiratory or heart disease. CONCLUSIONS: Exposure to vehicular emissions by living near busy roadways might contribute to symptoms of chronic respiratory disease in adults.