news

Obama wins historic US election

Wed, 05 Nov 2008 09:45:39 +0100

Barack Obama was elected the nation's first black president today in a historic triumph that overcame racial barriers as old as America itself.

The son of a black father from Kenya and a white mother from Kansas, the Democratic senator from Illinois sealed his victory by defeating Republican Sen John McCain in a string of wins in hard-fought battleground states — Ohio, Florida, Virginia and Iowa.

A huge crowd in Grant Park in Chicago erupted in jubilation at the news of Obama's victory. Some wept.

McCain called his former rival to concede defeat — and the end of his own 10-year quest for the White House. "The American people have spoken, and spoken clearly," McCain told disappointed supporters in Arizona.

Obama and his running mate, Sen Joseph Biden of Delaware, will take their oaths of office as president and vice president on Jan 20, 2009.

As the 44th president, Obama will move into the Oval Office as leader of a country that is almost certainly in recession, and fighting two long wars, one in Iraq and the other in Afghanistan.

The popular vote was close, but not the count in the Electoral College, where it mattered most.

There, Obama's audacious decision to contest McCain in states that hadn't gone Democratic in years paid rich dividends.

Obama has said his first order of presidential business will be to tackle the economy. He has also pledged to withdraw most US combat troops from Iraq within 16 months.

Fellow Democrats rode his coattails to larger majorities in both houses of Congress. They defeated incumbent Republicans and won open seats by turn.

The 47-year-old Illinois senator was little known just four years ago. A widely praised speech at the Democratic National Convention, delivered when he was merely a candidate for the Senate, changed that.

Overnight he became a sought-after surrogate campaigner, and he had scarcely settled into his Senate seat when he began preparing for his run for the White House.

A survey of voters leaving polling places on Tuesday showed the economy was by far the top Election Day issue. Six in 10 voters said so, and none of the other top issues — energy, Iraq, terrorism and health care — was picked by more than one in 10.

"May God bless whoever wins tonight," President Bush told dinner guests at the White House, where his tenure runs out on Jan 20.

The Democratic leaders of Congress celebrated in Washington.

"It is not a mandate for a party or ideology but a mandate for change," said Senate Majority leader Harry reid of Nevada.

Speaker Nancy Pelosi of California said, "Tonight the American people have called for a new direction. They have called for change in America."

Activity after Joint Replacement

Mon, 03 Nov 2008 11:27:08 +0100

After joint replacement many people feel they have been given a new lease of life. Many want to go back to the sporting activities they followed before their joint became painful. This may be a risk and a recent study in the Journal of Bone and Joint Surgery has shown that patients usually do not go back to their previous levels.

Pain relief has always been the primary purpose of replacing a joint but recent generations have concentrated more on what they can do with their joint as well.

Orthopaedic surgeons are not clear about the level of activity which is safe for major joint replacement, citing wear, loosening and formation of wear debris. Wear is related to the amount the joint is used and not just to how long it has been in situ.

Surgeons look at this from the perspective of the health of the joint and surrounding tissues while patients may look at the increased activity they can perform for a certain length of time. The joint may need to be replaced again at some point but perhaps they have had the use they wanted from it.

Research needs to continue into the wisdom of sporting activities with joint replacement. I know of one man who has done 5000 miles cycling since his new hip and shows no adverse features so there may be more leeway to resume normal activity than is currently realised.

Physiotherapy Helps Reduce Post-Partum Incontinence

Mon, 03 Nov 2008 11:09:02 +0100

British Medical Journal (BMJ)

05/27/2002
By Harvey McConnell

Physiotherapy training can reduce the prevalence of urinary incontinence in women after giving birth, reducing the severity of incontinence and helping women learn to perform pelvic floor exercises at adequate levels.

Researchers tracked incontinence in 676 women three months after they had forceps or ventouse deliveries or gave birth to babies weighing 4,000 grams or more. Births took place at one of three tertiary teaching hospitals in New South Wales, Australia.

Investigators from the University of Newcastle in Callaghan assigned 348 of the women to an intervention group and 328 to usual care. Women in the intervention group received a 20-minute visit from a physiotherapist while in hospital followed by another session eight weeks after delivery. The follow-up session was 30 minutes long and given at home by the same physiotherapist.

Women in the usual care group received routine postpartum care which did not include a visit from a physiotherapist.

While in hospital, participants in both groups received a brochure outlining general postpartum and pelvic floor exercises. They were also invited to join routine physiotherapy postnatal classes held in the wards.

At three months post-delivery, prevalence of incontinence in women in the intervention group was 31.0 percent. In the usual care group, it was 38.4 percent. Significantly fewer incontinent women in the intervention group were classified as severe (10.1 percent) compared with those in the usual care group (17.0 percent).

Approximately 84 percent of women in the intervention group reported doing pelvic floor exercises at adequate levels. Only 58 percent of women in the usual care group did.

"This is the first study to show that an intervention delivered to women in the immediate and early postpartum reduces the likelihood of urinary incontinence three months later," the investigators state.

They say the results have several important implications. One, many women experience incontinence after delivery. Two, the intervention helped women with severe mixed incontinence the most. Three, the intervention succeeded because it was based on established theories of behavioural change and incorporated input from patients themselves.

Researchers suggest other health professionals such as midwives and primary-care doctors could be trained to deliver the intervention: midwives immediately after delivery and doctors at a postpartum visit.
BMJ, 2002; 324: 1241-1243. "Promoting urinary continence in women after delivery: randomised controlled trial"