Differences in BMI obesity measures in a workers compensation population: a cross-sectional study.

To assess the accuracy of BMI compared to directly measured dual-energy X-ray absorptiometry percent body fat (DEXA %BF) among a worker compensation population. Methods: The agreement between BMI and DEXA %BF was assessed by the Pearson correlation coefficient among 1394 evaluable patients over a 5-year period. Sensitivity and specificity were calculated to measure how well BMI can identify true obese and nonobese individuals. Results: Using at least 30kg/m2 to identify obesity, BNI had a specificity of 0.658 and a sensitivity of 0.735. The correlation was better in females at 0.66, compared to males at 0.55, and weaker in older age groups at 0.42, as compared to the youngest age group at 0.59. Overall, 29.8% of the population was reclassified based on their DEXA %BF measures. Conclusions: In a 5-year cohort worker compensation population, BMI was an inaccurate measure of true obesity.

Food, Medicine, and Function: Food Is Medicine Part 1.

Food is not just calories; food is information. Food is a complex array of macronutrients, vitamins, minerals, and phytochemicals that upgrade or downgrade our biological software with every bite. The standard American diet lacks essential nutrients and is rich in refined flour, sugar, and inflammatory oils that drive dysbiosis, metabolic dysfunction, and chronic disease. Modern medicine focuses on diagnosing and treating disease with drugs, not creating health. Functional medicine organizes the body into a network of interconnected systems. It focuses on correcting the underlying functional imbalances that drive disease while restoring health using personalized diet, lifestyle, and nutrition interventions.

Food, Medicine, and Function: Food is Medicine Part 2.

The food we eat becomes the basic building blocks of our biology. A poor diet creates poor-functioning cells, tissues, organs, and biological systems and leads to disease. A nutrient-rich whole foods diet does the opposite. Inflammation is a common denominator in most chronic diseases, and our modern-day lifestyle is primarily to blame. An overload of processed foods, sugar, starch, and exposure to toxic chemicals damages our mitochondria, overwhelms our detox organs, creates oxidative stress, hormonal and mood imbalances, cognitive decline, and so much more. Functional Medicine treats disease by removing what is causing damage and providing the body with what it needs to repair itself to regain proper functionality.

Patient outcomes and costs associated with functional medicine-based care in a shared versus individual setting for patients with chronic conditions: a retrospective cohort study.

OBJECTIVE: To compare outcomes and costs associated with functional medicine-based care delivered in a shared medical appointment (SMA) to those delivered through individual appointments. DESIGN: A retrospective cohort study was performed to assess outcomes and cost to deliver care to patients in SMAs and compared with Propensity Score (PS)-matched patients in individual appointments. SETTING: A single-centre study performed at Cleveland Clinic Center for Functional Medicine. PARTICIPANTS: A total of 9778 patients were assessed for eligibility and 7323 excluded. The sample included 2455 patients (226 SMAs and 2229 individual appointments) aged ≥18 years who participated in in-person SMAs or individual appointments between 1 March 2017 and 31 December 2019. Patients had a baseline Patient-Reported Outcome Measurement Information System (PROMIS) Global Physical Health (GPH) score and follow-up score at 3 months. Patients were PS-matched 1:1 with 213 per group based on age, sex, race, marital status, income, weight, body mass index, blood pressure (BP), PROMIS score and functional medicine diagnostic category. PRIMARY AND SECONDARY OUTCOME MEASURES: The primary outcome was change in PROMIS GPH at 3 months. Secondary outcomes included change in PROMIS Global Mental Health (GMH), biometrics, and cost. RESULTS: Among 213 PS-matched pairs, patients in SMAs exhibited greater improvements at 3 months in PROMIS GPH T-scores (mean difference 1.18 (95% CI 0.14 to 2.22), p=0.03) and PROMIS GMH T-scores (mean difference 1.78 (95% CI 0.66 to 2.89), p=0.002) than patients in individual appointments. SMA patients also experienced greater weight loss (kg) than patients in individual appointments (mean difference -1.4 (95% CI -2.15 to -0.64), p<0.001). Both groups experienced a 5.5 mm Hg improvement in systolic BP. SMAs were also less costly to deliver than individual appointments. CONCLUSION: SMAs deliver functional medicine-based care that improves outcomes more than care delivered in individual appointments and is less costly to deliver.

The impact of functional medicine on patient-reported outcomes in inflammatory arthritis: A retrospective study.

BACKGROUND: Despite treatment advances for inflammatory arthritis, a significant amount of patients fail to achieve remission. Other modifiable factors such as diet, physical activity and environmental exposures may be an important area of focus to help patients achieve disease remission and greater overall health. Functional medicine focuses on these lifestyle factors and may be an important adjunctive therapy. In this study, we examined the impact of functional medicine on patient-reported outcomes in patients with inflammatory arthritis. MATERIALS AND METHODS: In this 12-week, retrospective study, patients with confirmed diagnoses of rheumatoid arthritis (RA) or psoriatic arthritis (PsA) were treated according to guidelines from the American College of Rheumatology for RA or PSA respectively. Those in the functional medicine group underwent a functional medicine program adjunctive to the standard of care. Patient reported outcomes, such as PROMIS (Patient Reported Outcomes Measurement Information System) global physical health, mental health and pain scores were collected at baseline and 12 weeks. Multivariable statistical modeling was used to identify the impact of functional medicine on patient-reported outcomes. RESULTS: 318 patients were screened and 54 patients (mean age 52.9±11.3 years, females 74(67.9%)), were included. Baseline characteristics were similar in both patient groups with the exception of PROMIS global physical health and pain (PROMIS global physical health score 43·2 ± 6·6 and 39·7 ± 8·7 and pain scores of 3·5 ± 1·9 and 5·2 ± 2·7 in the functional medicine group vs. standard of care group respectively). Using multivariable model to account for these differences, patients in the functional medicine group had a statistically significant reduction in pain (0.92, p-value = 0.007) and change in PROMIS physical health score (2·84, p-value = 0.001) as compared to the standard of care. Changes in PROMIS global mental health scores were also significant and were dependent on age and were greatest in those older than 55. LIMITATIONS: Retrospective design, baseline difference in patient reported outcomes. CONCLUSIONS: Functional medicine may have an important role as adjunctive therapy to improve patients' pain, physical and mental health in those who do not see improvement with conventional therapy alone.

Evaluating Covid-19 Injury Claims With a Focus on Workers' Compensation.

: COVID-19 illness can cause multiorgan illness. Some States have passed legislation granting a rebuttable presumption of causation by workplace exposure in certain occupations. This paper summarizes methodology for evaluating claimants utilizing known science and as well as information from the American Medical Association Guides resources.

Association between relative age effect and organisational practices of American youth football.

The popular method of organising youth sport participants into age divisions, based solely on their birthdate, can result in an imbalance of the distribution of players. This is known as relative age effect (RAE), which inadvertently creates bias and is associated with deleterious short and long-term consequences. The overall purpose of this study was to examine how the potential for RAE is mitigated when simultaneously accounting for additional player criterion, supplementary to age. A mid-Atlantic American youth football registration database was acquired, including chronological (age), anthropometric (weight), and competency (skill) factors. Player (n = 1,265) data were classified into quartiles and multiple chi-square goodness of fit tests were conducted using proportions of live births as expected theoretical distribution values. When data were categorised by a single developmental criterion (e.g. age), results indicated significant departures (p ≤ 0.002) from expected proportions. However, when categorised using multiple criteria (i.e. age, weight, and skill), equitable birthdate distributions were observed. Findings from this study indicate using only one developmental criterion for organising players is associated with RAE, whereas approaches accounting for multiple variables are not associated with RAE. This study provides youth football programs with early evidence for considering alternative methods of organising players.

Work-Related Asthma.

OBJECTIVE: Summarize developed evidence-based diagnostic and treatment guidelines for work-related asthma (WRA). METHODS: Comprehensive literature reviews conducted with article critiquing and grading. Guidelines developed by a multidisciplinary expert panel and peer-reviewed. RESULTS: Evidence supports spirometric testing as an essential early test. Serial peak expiratory flow rates measurement is moderately recommended for employees diagnosed with asthma to establish work-relatedness. Bronchial provocation testing is moderately recommended. IgE and skin prick testing for specific high-molecular weight (HMW) antigens are highly recommended. IgG testing for HMW antigens, IgE testing for low-molecular weight antigens, and nitric oxide testing for diagnosis are not recommended. Removal from exposure is associated with the highest probability of improvement, but may not lead to complete recovery. CONCLUSION: Quality evidence supports these clinical practice recommendations. The guidelines may be useful to providers who diagnose and/or treat WRA.

Differences in obesity measures and selected comorbidities in former National Football League professional athletes.

OBJECTIVE: To assess the accuracy of body mass index (BMI) as a measure of obesity compared with percent body fat (%BF) directly measured by dual energy x-ray absorptiometry among retired football players. METHODS: The level of agreement between BMI and %BF as measures of obesity was assessed by sensitivity, specificity, and the kappa statistic among 129 retired football players. Logistic regression was used to investigate the association between obesity and selected comorbidities. RESULTS: Using BMI 30 kg/m or higher to identify obesity had poor specificity (0.36): 87 of 129 subjects were classified as obese, yet only 13 were truly obese based on %BF. Although BMI did not reliably indicate true %BF-obesity, BMI-obesity was significantly correlated with lineman position (P < 0.0001), years played (P = 0.03), and obstructive sleep apnea (P = 0.0005). CONCLUSIONS: Percent body fat measured by dual energy x-ray absorptiometry provides a more accurate measure of obesity than does BMI among retired football players.

Screening for addictive disorders within a workers' compensation clinic: an exploratory study.

We conducted a cross-sectional study investigating the extent of addictive disorders within a workers' compensation (WC) clinic. We also examined the feasibility of substance abuse screening within the same clinic. In 2009 , 100 patients were asked to complete the World Health Organization's Alcohol, Smoking, Substance Involvement Screening Test (WHO-ASSIST) and the Current Opioid Misuse Measure (COMM). According to the WHO-ASSIST, we found that 46% of WC patients required intervention for at least one substance-related disorder (25% tobacco, 23% sedatives, 8% opioids), and according to the COMM, 46% screened positive for prescription opioid misuse. Importantly, the addition of this screening was brief, economical, and well accepted by patients. Further research should analyze the costs and benefits of detection and intervention of substance-related disorders in this setting.

Psoriatic arthritis.

Autoimmune diseases (ADs) are chronic, often debilitating and potentially life-threatening conditions that collectively affect up to 23.5 million Americans, and their incidence is rising.(1) They are heterogeneous in pathology but share common etiopathogenic factors such as intestinal hyperpermeability.(2) Although up to 100 ADs have been identified, there are likely more.(1) Genetics plays a clear role in the predisposition for the development and phenotype of AD, but various combinations of factors, such as toxins, endogenous hormone imbalances, microbes (including of GI origin), infections, stress and food antigens, are involved in disease expression.(2-5) Standard treatments include NSAIDs, steroids, antineoplastic agents and tumor necrosis factor-alpha antagonists. These tools have potentially devastating side effects and are often applied regardless of the diagnosis. Frequently, they are only modestly effective in relieving symptoms and limiting the advancing disease process. Direct health-care costs of AD are estimated at around 100 billion dollars per year in the United States. By comparison, cancer care costs about 57 billion dollars per year.(1) The rising incidence of this debilitating and costly group of conditions dictates that safe, alternative approaches to treatment be considered now.

Las enfermedades autoinmunitarias (EA) son enfermedades crónicas, a menudo debilitantes y potencialmente mortales que, en su conjunto, afectan a 23,5 millones de estadounidenses, y su incidencia continúa en aumento.1 Su patología es heterogénea, pero todas comparten factores etiopatogénicos comunes, como la hiperpermeabilidad intestinal.2 Aunque se han identificado hasta 100 EA, posiblemente existan más.1 La genética desempeña un papel claro en la predisposición a la aparición y el fenotipo de una EA; sin embargo, diversas combinaciones de factores, como las toxinas, los desequilibrios de las hormonas endógenas, los microorganismos (incluidos los de origen GI), las infecciones, el estrés y los antígenos alimentarios están implicados en la expresión de la enfermedad.2­5 Los tratamientos habituales son los siguientes: AINE, esteroides, agentes antineoplásicos y antagonistas del factor de necrosis tumoral alfa. Estas herramientas tienen efectos secundarios potencialmente devastadores y, a menudo, se aplican con independencia del diagnóstico. Con frecuencia, solo tienen una eficacia moderada para aliviar los síntomas y limitar el avance del proceso patológico. Se calcula que los costes sanitarios directos de las EA ascienden a unos 100 000 millones de dólares al año en los Estados Unidos. En comparación, los costes sanitarios relacionados con el cáncer ascienden a aproximadamente 57 000 millones de dólares al año.1 El incremento de la incidencia de este grupo de enfermedades debilitantes y costosas exige que se estudien planteamientos terapéuticos alternativos.

Autism spectrum disorders.

Autism spectrum disorders (ASDs) are collectively the most commonly diagnosed pediatric neurodevelopmental condition. ASDs include autism, pervasive developmental disorder-not otherwise specified (PDD-NOS), Rett syndrome and Asperger disorder. ASD is characterized by impaired communication and social interaction and may involve developmental delays and seizure disorders. Recent parent-reported diagnosis of ASD in the United States put it at higher levels (1:91) than previously thought, with its diagnosis in boys occurring 4 to 5 times more frequently than in girls (1:58).(1) CDC estimates are currently 1:110;(1) up from 1:150 in 2007.(2) Annual medical expenditures for those affected are generally four to six times greater than for those without ASD.(1) While twin studies demonstrate that genetics play a significant role in ASD, the impact of environment should not be underestimated, given the approximate 20-fold increase in incidence over the last 20 years.(3.)

Los trastornos del espectro autista (TEA) son, en su conjunto, una de las enfermedades pediátricas del desarrollo neurológico diagnosticadas con más frecuencia. Los TEA incluyen el autismo, el trastorno generalizado del desarrollo no especificado (TGD-NE), el síndrome de Rett y el síndrome de Asperger. Los TEA se caracterizan por los problemas de comunicación y de interacción social y pueden incluir retrasos del desarrollo y trastornos convulsivos. Según la información aportada recientemente por progenitores en relación con el diagnóstico de TEA en Estados Unidos, el diagnóstico de TEA se sitúa en niveles superiores (1:91) de lo que se creía previamente; el diagnóstico en varones es de 4 a 5 veces más frecuente que en mujeres (1:58).1 Los CDC calculan que en la actualidad es de 1:110;1 hasta 1:150 en 2007.2 Los gastos médicos anuales de los afectados son, por lo general, de cuatro a seis veces superiores a los de los que no padecen TEA.1 Mientras que estudios en gemelos muestran que la genética desempeña un papel fundamental en los TEA, el efecto del entorno no debe infravalorarse, dado el aumento de la incidencia, que aproximadamente se ha multiplicado por 20 a lo largo de los últimos 20 años.3.