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Biomedical subjects

S Pirozzo

Publications and source records attributed to S Pirozzo.

10 recordsLinked to original sources
PubMed2004

Prolotherapy injections for chronic low-back pain.

BACKGROUND: Prolotherapy is an injection-based treatment for chronic low-back pain. Proponents of prolotherapy suggest that some back pain stems from weakened or damaged ligaments. Repeatedly injecting them with irritant solutions is believed to strengthen the ligaments and reduce pain and disability. Prolotherapy protocols usually include co-interventions to enhance the effectiveness of the injections. OBJECTIVES: To determine the efficacy of prolotherapy injections in adults with chronic low-back pain. SEARCH STRATEGY: We searched CENTRAL (2004, issue 1), MEDLINE, EMBASE, CINAHL and Science Citation Index from their respective beginnings to January 2004, with no restrictions on language. We consulted content experts to ensure we had not missed any references. SELECTION CRITERIA: Randomised and quasi-randomised controlled trials comparing prolotherapy injections to control injections, either alone or in combination with other treatments, were included. Studies had to include measures of pain and disability before and after the intervention. DATA COLLECTION AND ANALYSIS: Two reviewers independently selected the trials and assessed them for methodological quality. Treatment and control group protocols varied from study to study, making meta-analysis impossible. MAIN RESULTS: We included four high quality studies with a total of 344 participants. All trials measured pain and disability levels at six months, three measured the proportion of participants reporting a greater than 50% reduction in pain or disability scores from baseline to six months.Two studies showed significant differences between the treatment and control groups for those reporting over 50% reduction in pain or disability. Their results could not be pooled. In one, co-interventions confounded interpretation of results; in the other, there was no significant difference in mean pain and disability scores between the groups. In the third study, there was little or no difference between groups in the number of individuals who reported over 50% improvement in pain and disability. The fourth study reporting only mean pain and disability scores showed no differences between groups. REVIEWERS' CONCLUSIONS: There is conflicting evidence regarding the efficacy of prolotherapy injections in reducing pain and disability in patients with chronic low-back pain. Conclusions are confounded by clinical heterogeneity amongst studies and by the presence of co-interventions. There was no evidence that prolotherapy injections alone were more effective than control injections alone. However, in the presence of co-interventions, prolotherapy injections were more effective than control injections, more so when both injections and co-interventions were controlled concurrently.

Chronic Disease↗
PubMed2003

Should we recommend low-fat diets for obesity?

Dietary fat intake has been blamed for the increase in adiposity and has led to a worldwide effort to decrease the amount of fat in the diet. However, the comparative efficacy of this approach is debatable. Whilst short-term dietary intervention studies show that low-fat diets lead to weight loss in both healthy and overweight individuals, it is less clear if a reduction in fat intake is more efficacious than other dietary restrictions in the long term. The purpose of this systematic review was to determine the effectiveness of low-fat diets in achieving sustained weight loss when used for the express purpose of weight loss in obese or overweight people. A comprehensive search identified six studies that fulfilled our criteria for inclusion (randomized controlled trial, participants either overweight or obese, comparison of a low-fat diet with another type of weight-reducing diet, follow-up period that was at least 6 months in duration and inclusion of participants 18 years or older without serious disease). There were a total of 594 participants in the six trials. The duration of the intervention varied from 3 to 18 months with follow-up from 6 to 18 months. There were no significant differences between low-fat diets and other weight-reducing diets in terms of sustained weight loss. Furthermore, the overall weight loss at the 12-18-month follow-up in all studies was very small (2-4 kg). In overweight or obese individuals who are dieting for the purpose of weight reduction, low-fat diets are as efficacious as other weight-reducing diets for achieving sustained weight loss, but not more so.

Adolescent↗
PubMed2002

Advice on low-fat diets for obesity.

BACKGROUND: Overweight and obesity are global health problems contributing to an ever increasing noncommunicable disease burden. Calorie restriction can achieve short-term weight loss but the weight loss has not been shown to be sustainable in the long-term. An alternative approach to calorie restriction is to lower the fat content of the diet. However, the long-term effects of fat-restricted diets on weight loss have not been established. OBJECTIVES: To assess the effects of advice on low-fat diets as a means of achieving sustained weight loss, using all available randomised clinical trials. This review focused primarily on participants who were overweight or clinically obese and were dieting for the purpose of weight reduction. Since we were particularly interested in the ability of participants to sustain weight loss over a longer period of time, we focused on studies of 'free living' men and women who were given dietary advice rather than provision of food or money to purchase food. SEARCH STRATEGY: We searched the Cochrane Library (issue 2, 2001), MEDLINE (up to February 20002), and EMBASE (up to February 20002). We also searched the Science Citation Index (up to January 2001) and bibliographies of studies identified. Date of latest search: February 2002. SELECTION CRITERIA: Trials were included if they fulfilled the following criteria: 1) they were randomised controlled clinical trials of low-fat diets versus other weight-reducing diets, 2) the primary purpose of the study was weight loss, 3) participants were followed for at least six months, 4) the study participants were adults (18 years or older) who were overweight or obese (BMI >25 kg/m2) at baseline. Studies including pregnant women or patients with serious medical conditions were excluded. Two people independently applied the inclusion criteria to the studies identified. Disagreement was resolved by discussion or by intervention of a third party. DATA COLLECTION AND ANALYSIS: Data were extracted by three independent reviewers and meta-analysis performed using a random effects model. Weighted mean differences of weight loss were calculated for treatment and control groups at 6, 12 and 18 months. MAIN RESULTS: Four studies were included at the six month follow-up, five studies at the 12 month follow-up and three studies at the 18 month follow-up. There was no significant difference in weight loss between the two groups at six months (WMD 1.7 kg, 95% CI -1.4 to 4.8 kg). The weighted sum of weight loss in the low fat group was -5.08 kg (95% CI -5.9 to -4.3 kg) and in the control group was -6.5 kg, (95% CI -7.3 to -5.7 kg). There was no significant difference in weight loss between the two groups at 12 months (WMD 1.1 kg, 95% CI -1.6 to 3.8 kg). The weighted sum of weight loss in the low fat group was -2.3 kg (95% CI -3.2 to -1.4 kg) and in the control group was -3.4 kg (95% CI -4.2 to -2.6 kg). There was no significant difference in weight loss between the two groups at 18 months (WMD 3.7 kg, 95% CI - 1.8 to 9.2). The weighted sum of weight loss in the control group was -2.3 kg (95% CI -3.5 to -1.2 kg) and in the low fat group there was a weight gain of 0.1 kg (95% CI -0.8 to 1 kg). There was significant heterogeneity in the results for weight loss at six months and 12 months. Apart from one study which showed a slight but statistically significant difference in total cholesterol in the low fat group at one year follow-up, there were no significant differences between the dietary groups for other outcome measures such as serum lipids, blood pressure and fasting plasma glucose. Studies measuring other factors such as perceived wellness and quality of life reported conflicting results. REVIEWER'S CONCLUSIONS: The review suggests that fat-restricted diets are no better than calorie restricted diets in achieving long term weight loss in overweight or obese people. Overall, participants lost slightly more weight on the control diets but this was not significantly different from the weight loss achieved through dietary fat restriction and was so small as to be clinically insignificant.

Diet, Fat-Restricted↗
PubMed2001

Body size and ovarian cancer: case-control study and systematic review (Australia).

OBJECTIVE: Although increased body mass is an established risk factor for a variety of cancers, its relation with cancer of the ovary is unclear. We therefore investigated the association between measures of body mass index (BMI) and ovarian cancer risk. METHODS: Data from an Australian case-control study of 775 ovarian cancer cases and 846 controls were used to examine the association with BMI. We have also summarized the results from a number of other studies that have examined this association. RESULTS: There was a significant increased risk of ovarian cancer with increasing BMI, with women in the top 15% of the BMI range having an odds ratio (OR) of 1.9 (95% confidence interval (CI), 1.3-2.6) compared with those in the middle 30%. Stratifying by physical activity showed a stronger effect among inactive women (OR = 3.0, 95% CI 1.3-6.9). The overall effect was consistent with the findings of most prior population-based case-control studies, while cohort studies reported positive effects closer to the null. Hospital-based studies gave variable results. CONCLUSIONS: Taken together, the evidence is in favor of a small to moderate positive relation between high BMI and occurrence of ovarian cancer.

Adolescent↗
PubMed2001

Long-term care of people below age 65 with severe acquired brain injury: appropriateness of aged care facilities.

OBJECTIVE: To identify the number of people younger than 65 years with acquired brain injury (ABI) living in aged care facilities in Queensland, and to evaluate the appropriateness of this accommodation option. METHODS: A cross-sectional descriptive study of all 493 Commonwealth Department of Health and Aged Care registered aged care facilities in Queensland. Associations between a range of demographic factors, resources, care provision and client needs were examined, from the perspective of service providers. RESULTS: The response rate was 75%. Twenty-six per cent of facilities (n=97) were providing care for 209 people younger than 65 years with ABI. The social, cognitive and rehabilitation aspects of client care were found to be inadequate in facilities where staffing levels, training and funding resources were limited (p< 0.05). Smaller facilities (<60 beds) reported higher levels of family participation in specific aspects of client care (p<0.05). Almost 40% of the facilities indicated they did not adequately meet the specific and complex rehabilitation needs of these clients. Aged care facilities were the least favoured model of care for this client group (8%) compared with the most favoured model of small group homes (46%). CONCLUSIONS: The current use of aged care facilities for housing younger people with high-level care needs resulting from ABI is inappropriate and does not meet client needs.

Adult↗
PubMed2000

Weight loss. The role of low fat diets.

BACKGROUND: Weight loss is theoretically simple: decrease energy intake, increase energy use, or both. As millions of 'yo-yo' dieters can attest, translating this into practice is far from simple. OBJECTIVE: This review will explore the issues surrounding the low fat approach to weight loss and suggest sensible and alternative recommendations for patients. DISCUSSION: Although short term weight loss can be achieved by many diets, sustained behaviour change and long term weight maintenance is far more difficult. Hence the essence of any weight intervention is a change in diet and activity that is sustainable in the long term; to achieve this means encouraging patients to make appropriate lifestyle changes.

Cholesterol↗
PubMed1997

Why immunise. Care giver understanding of childhood immunisation.

Currently in Australia, both the National Health and Medical Research Council (NHMRC) and the Public Health Association have stated that our immunisation uptake levels are not of a high enough percentage within the population to prevent outbreaks of childhood vaccine preventable diseases (1996). While the literature discusses factors that are believed to influence care givers' decisions to vaccinate their children, few Australian studies focus on care giver understanding of childhood diseases and vaccination. The purpose of this descriptive study was to profile care givers who presented their children for vaccination at public health clinics regarding their level of understanding of childhood vaccine preventable diseases. Two hundred and forty eight care givers attending one of six public clinics were asked to respond verbally to a researcher administered questionnaire. Demographic information as well as information related specifically to immunisation was collected from each participant. The major findings of this preliminary study indicate a very low level of knowledge among careers presenting their child for vaccination at the public health clinic. Twenty-three percent of carers had no knowledge regarding the vaccinations that their child was receiving and the disease for which the vaccination was administered. In fact, 18 percent of care givers were unsure of the relationship between vaccination and the likelihood of their child contracting an infectious disease. The personal health record was not found to be useful as an educational resource. Although 99 percent of care givers had the booklet in their possession only 8 percent had referred to it as a source of information. The major sources of information were identified as child health nurses (44%) and hospital midwives (34%). The results of this study highlight the disparity in knowledge levels among care givers with regards to vaccination and the diseases they prevent and the important role of the midwife and child health nurse in disseminating information relating to immunisation.

Adolescent↗