Penn Elm Medical Group
488 E. Valley Parkway
Suite 411
Escondido, CA 92025
(760) 745-2000

NEWS YOU CAN USE
Heart Risk Higher for Those Whose Siblings Already Have It
FRAMINGHAM, Mass.—A sibling's heart disease should be a wake-up call for those in middle age, according to researchers. Brothers or sisters have a sharply increased risk of heart trouble themselves. The risk is about 45% higher than for people whose siblings don't have cardiovascular disease, Joanne Murabito, M.D., Sc.M., of the National Heart, Lung, and Blood Institute's Framingham Heart Study here reported in the December 28th issue of the Journal of the American Medical Association.

Dr. Murabito and colleagues analyzed 2,475 participants in the Framingham Offspring Study, a spin-off involving children of the original participants. For this analysis, Dr. Murabito and colleagues studied participants who were 30 or older, free of cardiovascular disease at baseline, and had at least one sibling in the study. Participants were followed for eight years, with regular physical examinations. All cardiovascular disease events were validated by cardiologists or neurologists. After adjusting for age, sex, and cardiovascular disease risk factors, the researchers found that the sibling cardiovascular disease group had a significantly increased risk for cardiac events.

The researchers also looked at the impact of premature parental cardiovascular disease in the subgroup of participants both of whose parents had been in the original study. In that group, sibling cardiovascular disease remained a significant predictor of cardiovascular events. That was a stronger risk than having a parent with premature cardiovascular disease, the researchers found, or both a parent with premature cardiovascular disease and a sibling with cardiovascular disease.

The lower risk among people with both parents and siblings affected by cardiovascular disease might be explained by risk factors, including diabetes and treatment for hypertension, that were higher in the group, the researchers suggest. The study implies that sibling cardiovascular disease is an important risk factor for cardiovascular disease and can serve as a useful marker for familial risk to heart disease, the researchers argue.

Yoga More Effective for Lower Back Pain than Aerobic Exercise
The ancient practice of yoga proved to be more effective in reducing chronic back pain than either aerobic exercise or a self-help book. So says a study in the Annals of Internal Medicine in which investigators compared three types of treatment among 101 chronic back pain patients. They found a gentle form of yoga called viniyoga proved to be more beneficial in alleviating back pain symptoms and improving function. The benefits also lingered weeks after the study was over. Fourteen weeks after the study had ended, the yoga participants still showed greater improvement than the self-help book patients.

Karen J. Sherman, Ph.D., a researcher at the Group Health Cooperative Center for Health Studies in Seattle, WA, said yoga's emphasis on toning muscles, flexibility, strength, relieving muscle tension, and also the mind-body connection may explain why this particular exercise is so effective. An estimated 14 million Americans practice yoga, including more than one million who use yoga to minimize back pain, Dr. Sherman said. "Yoga may be beneficial for back pain because it involves physical movement, but it may also exert benefits through its effects on mental focus," Dr. Sherman and her colleagues wrote. "We do not know whether a different yoga regimen would have reaped similar benefits." It's also possible that different instructors could have yielded different results, the authors noted. A single instructor led the yoga group. The exercise class was designed by a physical therapist and also taught by an individual instructor.

The researchers randomly assigned 101 patients to one of the three treatment groups between June and December 2003. The yoga and exercise groups attended 12 weekly 75-minute sessions. The self-help care group received by mail a copy of The Back Pain Helpbook by Jim Moore (Perseus Books; 1999). All patients were allowed to take medications as needed, including anti-inflammatory agents like acetaminophen. The average participant was a gainfully employed, college-educated white woman between the ages of 40 and 50. Most participants had experienced back pain for more than one year prior to the study.

During the 12-week treatment period, 11% of the yoga patients reported visiting healthcare providers for back pain treatment compared with 23% in the aerobic exercise group and 10% in the self-help book group.
At 26 weeks, but not 12 weeks, the yoga group was also significantly superior to the other two groups in how much their symptoms bothered them. Medication use was similar between the groups at baseline, but dropped significantly for the yoga patients. Only 21% of the yoga participants reported using medication to treat their back pain one week before the 26-week interview, compared with 50% in the exercise group and 59% in the self-help book group.

Dr. Sherman said while yoga appears to be promising, not all forms of yoga are the same. "Some styles, such as Bikram and vinyasa, may be too vigorous for patients with back pain who are unfamiliar with yoga, whereas other styles (for example Iyengar) may need modification from normal practice to be appropriate for patients with back pain," she wrote.

"Presenteeism," Working When Sick and Contagious, Called Growing Issue
Sometimes it's better for everyone if dedicated, hard-working employees stay home from the job if they're under the weather. We're not just talking about use of the occasional "mental health day"—calling in sick even though there's really nothing much wrong but the worker just can't take it any more... we are also looking at the flip side of the equation, the employee who grits his or her teeth and marches into the office, despite chronic or acute illness.

In the best-case scenario, "presenteeism"—coming to work when you shouldn't—results in a job that's not done as well as it could be. In the worst case, it causes a cascade of illness that depopulates the office—and the job is still not well done. "It's really perverse," said Graham Lowe, Ph.D., a sociologist and consultant whose Kelowna-based company analyzes workplace health issues.

The phenomenon extends to physicians and nurses. During his research career at the University of Alberta, Dr. Lowe found that the positive motivations that drive medical professionals also lead them to come in when they're sick. "Nurses on teams feel an incredible commitment to their patients and to their co-workers," Dr. Lowe says. "And it's good that they're committed to their patients, good that they have strong bonds with their co-workers." But "the unintended consequence is that they put their own health as a second priority."

It's pretty easy to see why absenteeism is a concern to employers. According to one survey, unscheduled absences cost the boss nearly $700 a year for every employee. "Presenteeism" is a lot harder to nail down, although the Harvard Business Review last year estimated that the cost could be as high as $150 billion a year in the U.S., with workers fighting through a range of illnesses including allergies, asthma, headaches, depression, back pain, arthritis, and gastrointestinal disorders. In some cases, Dr. Lowe said, presenteeism can be strikingly high: In a study he carried out in a provincial social services department in Canada, employees typically went to work 6.7 days in the previous year when they were ill or injured. The main reasons were not wanting to fall behind, heavy workloads or caseloads, and a commitment and feeling of responsibility to clients, Dr. Lowe says. The workers also took a lot of sick days, he said, but the rate of presenteeism was about half the absenteeism rate.

In the U.S., employers increasingly think presenteeism is an issue, according to a survey carried out by CCH Inc., a human resources company in Riverwoods, IL. The survey found that 48% of employers are concerned about the issue, up from 39% last year, said Tulay Turan, J.D., an analyst with the company. The survey also found that employers are doing something about it—62% said they send workers home if they're sick, 41% educate workers about the danger of coming in sick, and 36% try to foster a culture that encourages workers to stay home when ill. (The percentages add to more than 100% because some companies use multiple approaches, Turan said.) The CCH survey, now in its 15th year, found that the cost of absenteeism is rising—$660 per employee per year in 2005, compared with $610 in 2004—but wasn't able to pin down the cost of presenteeism. "The hit to the bottom line is not really all that evident," Turan said. "But when people are sick, coughing and passing on germs to other people, that can definitely affect the workplace (by) making other people sick, not to mention the productivity of the first employee," Turan said.

A key factor in both absenteeism and presenteeism is stress, said Dr. Lowe. "If you look at the incidence of self-reported illness among workers, roughly a third of them say they're under high levels of stress," he said. "You can expect that when they show up for work, they're not going to be at 100% of their capability." And when workers go on long-term disability, he said, it's increasingly for mental health, rather than physical health. Indeed, the CCH survey showed that the reasons workers take what Turan calls "unscheduled absences" increasingly are to cope with stress: 12% in 2004, compared with 11% in the two previous years.
The bottom line may be that when Joe at the next office is taking a "mental health day," he may know exactly what he's doing. Overall, Turan says, only 35% of unscheduled absences are for illness and the remainder is for other reasons, including personal needs, family issues, and a sense of entitlement.

The online employment register CareerBuilder.com, surveyed 2,450 workers and 875 employers in August and found that 43% of workers who called in sick were actually healthy. That number is up from 39% last year, said Michael Irwin, a senior career adviser with the company. Interestingly, the survey compiled a list of excuses given by workers, including:
• "I'm too drunk to drive to work."
• "I had to help deliver a baby on my way to work."
• "I cut my fingernails too short, they're bleeding, and I have to go to the doctor."
• "The ghosts in my house kept me up all night."
• "I forgot I was getting married today."

WHAT'S NEW AT PENN ELM
Welcome Dr. Reyes
We welcome our new physician, Dr. Veronica Reyes, who joined Penn Elm last month. She is an experienced physician who came to us from the Kaiser Health system. Dr. Reyes is fluent in Spanish and open for new patients.

Summer is a Good Time to Schedule Appointments
Now is a GREAT time to schedule your annual physical, pap smear, bone density exam, or your kids' school and sports physicals. This is the quietest time of year, so it's easier to schedule appointments now, before the fall rush.

ANNOUNCEMENTS
Dr. Prabhakar's Baby Arrives
Congratulations to our Dr. Prabhakar who gave birth to her second daughter, Mia. We are very happy for the new addition to their growing family!

 

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