I'm a bit slow on reporting this, but at the end of May the UK's National Institute for Health and Clinical Excellence (NICE) published a guideline on "Early management of persistent non-specific low back pain".   I've blogged before about NICE.  They publish very widely with, for example, 82 guidelines on musculoskeletal disorders generally.  They have also recently launched NHS evidence which aims " ... to provide easy access to a comprehensive evidence base for everyone in health and social care who takes decisions about treatments or the use of resources - including clinicians, public health professionals, commissioners and service managers - thus improving health and patient care. It will build on NICE's significant international reputation for developing high quality evidence-based guidance.

I read a lot of research.  When I find an article of particular interest I download it to my bibliographic database - EndNote - which currently contains over 13,000 abstracts. 

In 2001 the World Cancer Research Fund (WCRF) and the American Institute for Cancer Research (AICR) WCRF/AICR set themselves the task of systematically assessing all good research on diet, physical activity and cancer and publishing a report that would be the largest study of its kind with conclusions that would be best the evidence could demonstrate.  Over 100 scientists from 30 countries were involved.  An expert panel of 21 of these scientists worked for 5 years to produce the report "Food, Nutrition, Physical Activity, and the Prevention of Cancer: a Global Perspective."  The follow-up companion Policy Report "Policy and Action for Cancer Prevention"  was published a little over a month ago and has recommendations for a series of different groups and organizations including government, industry, the media, schools, and work places. 

Here are five papers on lifestyle and the benefits of making healthy choices.  The first by Cohen et al on sleep habits and susceptibility to the common cold, showed increased risk of developing a cold after infection for those with shorter sleep duration.  Interestingly the increased risk was even greater for those with poor sleep efficiency.  Sleep efficiency is calculated by dividing the time spent asleep by the time spent in bed trying to sleep.  The Good Knowledge section of this website contains useful information on assessing and treating sleep difficulties.

Yesterday NICE - the National Institute for Health and Clinical Excellence in England & Wales - published guidance on a diverse range of fifteen clinical, technology, interventional and public health subjects.  Their clinical guidance on Medicines Adherence  interested me, as too did their public health guidance on Promoting Physical Activity for Children and Young People.  The subject of this post is the clinical guidance on Antisocial Personality Disorder and in my next post, I'll talk about their guidance on Borderline Personality Disorder.  As Dr Tim Kendall, Joint Director, National Collaborating Centre for Mental Health, states: "Approximately 2 million people in the UK have personality disorders, with antisocial and borderline disorders being the most common.

Here's a gutsy, nutritional, low sunlight kind of blog post to suit our post-holiday season.  First the gutsy bit.  Irritable bowel syndrome (IBS) - with its characteristic symptoms of abdominal pain, altered bowel habit, and possibly bloating - is very common, affecting about 15% of the population.  Ford et al systematically reviewed all research on treating IBS with fibre, antispasmodics, or peppermint oil.  Fibre was some use, but only in the form of ispaghula (UK Fybogel, Isogel).  The antispasmodics otilonium and hysocine (UK Buscopan) seemed also to be of help.  But what attracted me to the study was the finding that most helpful of the three treatments seemed to be the old-fashioned remedy of taking peppermint oil. 

Here are six studies on eating and weight.  The first, by Maruyama and colleagues, demonstrates a strong association between both "eating until full" and "eating quickly" and the chances of being overweight.  The linked BMJ editorial by Denney-Wilson & Campbell discusses these findings further, including suggesting that "Clinicians should encourage parents to adopt a child led feeding strategy that acknowledges a child's desire to stop eating that begins from birth. Reassure parents that well children don't starve."  Unfortunately Llewellyn et al show that eating rate seems to be partly genetically determined - an even stronger reason to work hard to go against any tendency to gobble food.  The Denney-Wilson editorial gives other ways to encourage weight loss, and Leahy and colleagues underlines the value of one such approach - reducing the energy density (ED) of diets " ...  by decreasing fat and sugar and by increasing fruit and vegetables."  Children whose diet was changed in this way " ...

Here are five studies on the loose theme of how the mind affects the body, and the body affects the mind ... and that the distinction between mind and body is pretty arbitrary anyway.  Using meta-analysis, Chida & colleagues highlight considerable evidence suggesting that stress-related psychosocial factors have an adverse effect on cancer incidence and survival.  Andersen & colleagues report a randomized controlled trial to respond to this in women diagnosed with breast cancer.  Women in the stress management arm of the study received an initial one-year, 26 session intervention in groups of 8 to 12 people.  The aim was to reduce distress and improve quality of life, improve health behaviors (diet, exercise, smoking cessation), and facilitate cancer treatment compliance and medical follow-up.

Last month's BMJ published another in the long line of research articles that highlight the huge importance of lifestyle choices for our health:

Dam, R. M. v., T. Li, et al. (2008). "Combined impact of lifestyle factors on mortality: prospective cohort study in US women." BMJ 337(sep16_2): a1440-  [Free Full Text]

Back in January I wrote a blog post entitle "Does a healthy lifestyle really make a difference? "   I highlighted that it makes a hell of a lot of a difference.  At around that time another major study was published that hammered this point home even more thoroughly and I've been meaning to mention it in a post ever since.  The recent publicity on poor fruit and veg intake in the UK population triggered me into looking the earlier study out.