Since Michael Sokolove’s “Warrior Girls” brought the matter public attention, many people know that young women athletes are in the midst of an epidemic of knee injuries, including the most dreaded of them all: a tear of the  anterior cruciate ligaments (ACL). In fact girls are three to eight times more likely than boys to sustain that injury.

This stunningly high ratio says the issue goes beyond the fact that girls participate in competitive sports as much as boys do. Given only that, the ratio should be even. The real problem, it turns out, has to do with anatomical and physiological differences between girls and boys.

Girls have thinner ACLs for example. And their pelvises are wider, which has the effect of putting more stress on the knee ligaments during both normal and recreational activities. The anatomy of their femurs (the large, upper leg bone) favors fraying of the ACL. And as well, some female reproductive hormones make their ACLs more lax. 

The epidemic has spawned a host of workouts and training programs designed to help prevent knee injuries in young female athletes. These programs focus on strengthening muscles like the quadriceps that help support the knee, and the core muscles which help stabilize the body during stops and starts, which are so often the times when ACL injuries occur.

The programs have different time requirements, but a 45 minute session, twice a week is  typical.  Also included in most sessions are tips about landing softly and using multiple joints (ankle, knee, hip) for bracing against falls and the like.

“You can’t make an ACL bigger,” Trent Nessler, executive director of Baptist Sports Medicine in Nashville told the Washington Post. “So what we tend to look at is what factors can you affect through training.”

Nessler asserts that girls who participate in these programs can reduce their risk of knee injuries by up to 88%…and even if he’s half right, that seems like something worth doing.

“Senior moments” like forgetting someone’s name or where you parked your care are common in elderly and even middle-aged folks, so how does one know whether they represent something more serious such as dementia?

“It’s the degree of the problem,” James Lah, an Emory University neurologist recently explained to the Washington Post. “If you forget where you place your keys, that’s common. But if you put them in the refrigerator repeatedly, that’s a problem.”

Other Examples
NORMAL: Forgetting where you parked.
PROBLEMATIC: Forgetting where you parked once a week.

NORMAL: Forgetting a person’s name.
PROBLEMATIC: Forgetting a person’s name and then repeatedly asking him or her, “What’s your name again?”

NORMAL: Inability to program the cable box.
PROBLEMATIC: Forgetting how to turn on the television.

Fast Facts
People begin having memory lapses in their 20s, though few worry about it until they’re into their 50s. Peak performance for human memory occurs at about age 22. By age 50, most people are aware their memory ain’t what it used to be. But they can take heart in this: people’s general knowledge-base increases until at least age 60.

Just 10 minutes of brisk walking per day reduces memory losss and the risk of developing Alzheimer’s disease. Amazing but true.

There is growing evidence that Gingko biloba does not work, and there is some positive, but very early buzz surrounding omega-3 fatty acids and pomegranate juice, of all things.

Australian scientists have found a correlation between the time spent watching TV and all cause mortality. What is more, the relation holds even among people who exercise regularly. The problem, it seems, is prolonged inactivity.

To reach this surprising conclusion, David Dunstan of Melbourne’s Baker Heart and Diabetes Institute followed 8,800 people who were at least 50 years of age for 6 years. 284 of them died during the study, including 125 from cancer and 87 from cardiovascular disease.

Dunstan found that all cause mortality risk increased by 11% for each hour watching TV per day. The findings held up after adjustments were made for exercise duration, gender, age and waist circumference.

People who watched TV at least 4 hours per day were 46% more likely to die of any cause and 80% more likely to die of cardiovascular disease than those who watched 2 hours per day or less.

“It’s not the sweaty type of exercise we’re losing,” Dunstan told the Wall Street Journal. “It’s the incidental moving around…utilizing muscles that [doesn't happen] when we’re plunked on a couch in front of a television.”

The findings likely apply to other sedentary activities like sitting in front of a computer, driving or reading.

“The implication of these findings is that the extraordinary amount of sitting can undo the good effects that we know are a benefit when we get regular exercise,” Dunstan told the Journal.

A recent study by Neilson Co. found that Americans watch 5 hours of TV per day, on average.

Simple strategies to combat the problem include incorporating household chores like folding laundry into TV-time or (god forbid) getting up to change a TV channel rather than using a clicker.

The article appears in Circulation.

Many people know that regular physical activity can reduce perceived stress, blood pressure, LDL (bad) cholesterol levels and the risk of Type 2 diabetes.

It turns out there are many more benefits than that.

For example, regular exercise can increase the body’s capacity to prevent viral and bacterial infections, and boost the body’s response to the influenza vaccine, making it more effective.

 It probably reduces cancer risk as well.

David Nieman, of Appalachian State University has published several randomized trials showing for example that people who walk briskly for 45 minutes, 5 days per week have fewer and less severe upper respiratory tract infections, and 25-50% fewer sick days than sedentary controls.

“No pill or nutritional supplement has the power of near-daily moderate activity in lowering the number of sick days people take,” Nieman told the Wall Street Journal.

Other studies suggest that regular exercise reduces breast cancer risk by 20-30%, and that for patients with hormone-responsive breast cancer, walking for 3-5 hours per week cuts mortality in half.

Still other research shows that exercise retards aging processes like telomere shortening. Telomeres are DNA strands at the tips of chromosomes. When they become too short, cells can’t divide and trigger biochemical processes associated with aging, cancer formation and death.

Two years ago, the Department of Health and Services issued national exercise guidelines for the first time. The guidelines recommend 2 ½ hours per week of moderate aerobic exercise, or 1 ¼ hour per week of vigorous exercise. The guidelines say that additional health benefits accrue to those who double these amounts. They also call for muscle-strengthening activities at least twice per week.

According to the CDC, 36% of US adults undertook no leisure-time physical activity in 2008.

The Gräfenberg Spot, or G-Spot is, according to popular culture and a few questionable scientific studies, an elusive erogenous zone located in the anterior vagina. When stimulated, the G-spot can lead to intense sexual arousal and hellacious orgasms that rival or surpass those provoked by clitoral stimulation.

Alas, the latest study on the matter suggests it doesn’t exist.

To reach these conclusions, Tim Spector and colleagues at King’s College London asked 1,800 women whether they had a G-spot, and if so, where it was located. All the women were pairs of identical and non-identical twins.

If a G-spot did exist, both identical twins (who have the same genes) would be expected to report having one in the same place. In fact, the scientists found that identical twins were no more likely to share a G-spot than non-identical twins (who share half their genes).

“This is by far the biggest study ever carried out and shows fairly conclusively that the idea of a G-spot is subjective,” Spector told the BBC.

Colleague Andrea Burri voiced concern that women who couldn’t find a G-spot might feel inadequate. “It is rather irresponsible to claim the existence of an entity that has never been proven and pressurize women and men too,” she said.

Commenting on the study, Petra Boynton, a psychologist at University College London, said “it’s fine to go looking for the G-spot but do not worry if you don’t find it. It should not be the only focus. Everyone is different.”

Sexologist Beverley Whipple, who helped popularize the G-spot concept, argued the study was flawed because the scientists failed to account for the impact of different sexual partners and different love-making techniques.

The write-up is in the Journal of Sexual Medicine.

Running in commercially-available athletic footware puts more stress on the hip, knee and ankle joints than running barefoot, according to a new study. In fact, a good jog in those designer statements puts more stress on your joints than a walk in high-heeled shoes.
 
To determine the effect of modern-day running shoes on lower extremity joint torques during running, D. Casey Kerrigan and colleagues from JKM Technologies and the University of Virginia recruited 68 healthy young adult runners (37 women) that used commercially-available running shoes.
Subjects had no history of musculoskeletal injury and ran at least 15 miles per week.

Running shoes with typical design characteristics were provided to all subjects. The subjects ran barefoot and with the shoes. Running speed was controlled by the scientists.

Kerrigan’s team analyzed their subjects’ strides using three-dimensional motion capture and ground reaction force with a tricked-out treadmill.
 
The team found that running shoes increased joint torques at the hip, knee and ankle compared with bare feet. In fact, the shoes were associated with a 54% increase in hip internal rotation torque, a 36% increase in knee flexion torque, and a 38% increase in knee varus torque.

The team also found that running shoes caused pronounced stress at anatomical sites of the knee that are prone to the development of osteoarthritis.

They speculated that their findings were caused by the elevated heel and the padding under the medial arch which are typical of modern running shoes. They also acknowledge that running shoes provide good support and protection for the foot itself.

Reducing joint torques with footwear to that of barefoot running, while providing meaningful footwear functions should be the goal of new footwear designs,” the authors wrote.

The write-up appears in PM&R.

More than half of American adults, 54%, drink coffee regularly. They consume nearly 400 million cups of it each day making its active ingredient, caffeine, by far the most widely consumed drug in the country.

So you’d think we’d have reached some general agreement on how the stuff affects our health by this time, no?

Alas, that’s not the case.

Recent studies of the matter  suggest that coffee has beneficial effects on health. Last month for example, scientists reported that people who consumed 3-4 cups of Joe per day developed Type 2 diabetes 25% less frequently than those who had less than 2 cups per day.

Another group recently reported that men who drank at least six cups per day developed advanced prostate cancer 60% less often than abstainers.

Earlier studies had, in addition, linked coffee consumption to a reduced risk of colon cancer, head and neck cancer, endometrial cancer, cavities, gallstones, Parkinson’s disease, cirrhosis of the liver and Alzheimer’s disease.

On the other hand, many studies show that coffee, and caffeine in particular, raises heart rate and blood pressure as well as homocysteine levels in the blood. The latter is an amino acid that has been associated with stroke and heart disease.  Other studies have linked caffeine to bone loss in elderly women and shown that pregnant women who consume 2 or more cups per day have higher rates of miscarriages and low birth-weight babies.

What explains the confusion? It’s certainly possible that coffee has protean effects on the human body, and a mixed bag of health outcomes. After all, many drugs fall into that category. Another possible reason is that most studies of coffee’s health effects (including the 2 recent ones mentioned above) feature an observational trial design, in which scientists troll large data sets for associations between behavior and health outcomes, without a particular hypothesis in mind at the onset. (more…)

In the last 3 decades, Americans have reaped enormous health benefits by smoking less, but have lost ground due to weight gain and obesity, and their negative impacts on health. Ever wonder how these competing trends interact with each other?

Susan Stewart of Harvard University and colleagues tried to answer this question by forecasting life expectancy for a nationally representative 18-year-old assuming that recent trends in smoking and weight gain continued for the next decade or so.

The scientists estimated cigarette smoking trends over the last 30 years using data from the National Health Interview Survey, and BMI data from the National Health and Nutrition Examination Survey.

It turned out that the negative effects of increasing body mass index swamped the positive effects of cigarette smoking declines.

Specifically, continued declines in cigarette smoking would increase the life expectancy of an 18-year-old by 0.31 year by the year 2020. However, continued escalations in BMI would cut life expectancy by 1.02 years over the same period of time, with an overall net loss in life expectancy 0.71 years.

The scientists did mention that other factors such as better nutrition and education are likely to generate a very modest increase in life expectancy despite the impact of obesity, at least through 2020.

But at some point, the authors concluded, a failure to address continued increases in obesity could erode the steady gains made in health over the last century.

It’s “a bit of a wake-up call,” senior author Allison Rosen told the Los Angeles Times. “We have attributed so many of our health problems to smoking, and we’re getting health improvements from declines in smoking. But changes in the rates of obesity are starting to outweigh the declines in smoking.”

The write-up appears in the New England Journal of Medicine.

This post first appeared on HCPLive.com/Psychiatry.

Women that have been diagnosed with cancer or multiple sclerosis are 6 times more likely to be separated or divorced than their male counterparts, according to a study in Cancer.

To reach this conclusion, Marc Chamberlain and colleagues enrolled 515 patients at 3 medical centers beginning in 2001, and followed them for 5 years.

During the study period, 11.6% of the patients either divorced or separated, a rate similar to that found in the general population.

However, the rate was 20.8% when the woman was the patient and just 2.9% when the patient was male.

The scientists also detected correlations between age and length of marriage, and the risk of divorce or separation. Older woman, it turned out, were more likely to experience a break-up, although longer marriages tended to remain intact.

Regardless of gender, divorced or separated patients were found to have an increased reliance on antidepressants, less frequent participation in clinical trials, more frequent hospitalizations, and failure to complete radiation therapy.

“Female gender was the strongest predictor of separation or divorce in each of the patient groups we studied,” Chamberlain–a professor of neurology and neurosurgery at the University of Washington School of Medicine–told Newswise.

The authors speculated that men were more likely to leave a sick spouse because they were less willing or able to commit to being a caregiver, while women were more able to assume the task of maintaining home and family.

“We recommend that providers be sensitive to early suggestions of marital discord in couples affected by a serious medical illness, especially when the woman is the affected spouse and it occurs early in the marriage. Early identification and psychosocial intervention might reduce the frequency of divorce and separation, and improve quality of life and quality of care,” concluded the authors.

A meta-analysis performed by Italian scientists has shown that reducing salt intake by half in Westernized countries can reduce strokes by 23%, which amounts to about 1.25 million deaths, and reduce cardiovascular disease by 17% which amounts to nearly 3 million additional deaths per year.

Americans consume about 10 grams (or 2 teaspoons) of salt per day.

The  World Health Organization recommends that dietary salt intake should be half that. The US Department of Agriculture recommends just under 6 grams per day.

To reach their astounding conclusions, Pasquale Strazzullo and colleagues at the University of Naples pooled data from 13 prospective studies published between 1966 and 2008. The analysis covered 177,000 subjects who sustained more than 11,000 strokes or cardiovascular events.

The extra power of the meta-analysis proved decisive in reaching the positive conclusions, since only 9 showed a direct positive link between sodium intake and the adverse events (of which only 4 reached statistical significance). Three  actually showed a non-significant inverse relationship.

Studies featuring longer periods of follow-up appeared to strengthen the relationship between salt intake and stroke, although this was not the case for cardiovascular events.

The findings were not impacted by age, sex, and hypertension status.

In an accompanying editorial, Lawrence Appel of Johns Hopkins hailed the study as a “useful and welcome addition” to the confusing literature on the subject.

“At a minimum, Strazzullo and colleagues’ analyses should dispel any residual belief that salt reduction might be harmful (a canard resulting from misinterpretation of studies, often with flawed analyses),” Appel wrote.

Appel probably had in mind long-standing efforts by the food industry to oppose tougher public health policies on dietary salt intake, which have been largely successful because the above-mentioned studies had muddied the waters so completely.

The write-up is in the British Medical Journal.

In the 15 years since communications expert John Gray penned the book, Men are From Mars, Women are from Venus, the concept that the 2 sexes are wired differently has become entrenched in popular culture.

And there’s plenty of evidence to support his observations.

Most recently, a team from Poland used functional magnetic resonance imaging (fMRI) to assess gender differences in brain activity in response to images  designed to evoke various emotional reactions.

Lo and behold, they found plenty!

Andrzej Urbanik and colleagues from Jagiellonian University Hospital in Krakow demonstrated the differences in 40 volunteers, and presented their findings at the recently completed meetings of the Radiological Society of North America.

When the scientists showed women a sequence of negative images, fMRI records showed widespread activity in the left thalamus, an area known to relay sensory information to other parts of the brain that process pain and pleasure.

When the same negative images were shown to men, the fMRI revealed that the left insula lit up like a pinball machine. This region helps control involuntary activities like breathing, heart rate and digestion, and is involved in the so-called “fight or flight response.”

As for the positive images, the fMRI results in women revealed strong activity in areas of the brain associated with memory, while in men strong activity was found in areas associated with visual processing.

In an interview with the BBC, Urbanik postulated that “when confronted with dangerous situations, men are more likely than women to take action.”

As for the differential responses to the positive images, Urbanik suggested the differences imply that women tend to analyze them in a broader social context and associate them with particular memories.

An image of a smiling toddler for example, seems more likely to evoke memories of one’s own child in Venusians than in Martians.

Young adults may be putting themselves at increased risk of unplanned pregnancies and sexually transmitted diseases (STDs) during the upcoming holiday period, according to new independent research conducted by YouGov and published on the Web site of UK-based Marie Stopes International.

Nearly half (48%) of respondents aged 18-34 stated that they drink more alcohol during the holidays than at other times of the year, and 27% admitted having unprotected sex because they were too drunk to remember to use contraception.

In response, Marie Stopes has launched a ‘Wrap it Up’ campaign that urges men and women to carry condoms and practice safe sex during the holidays.

Marie Stopes’ UK centers are also offering an emergency contraceptive pill  (which can be taken up to 3 days after unprotected sex to terminate unwanted pregnancies) at the reduced price of £10 until January 31st 2010 or while stocks last.

The research also showed that of the 18-34 year olds questioned:

- 19% had sex with someone they just met due to the influence of alcohol at a holiday party,
- 45% had sex under the influence of alcohol with someone that they wouldn’t have, had they been sober,
- 41% had sex that they regretted the morning after.

“The combination of alcohol and the festive party spirit may reduce inhibitions, and lead men and women to make decisions about their sexual behavior that they may not have made if sober,” said Lindsay Davey, Sexual Health Nurse at Marie Stopes. “In January and February last year Marie Stopes’  UK centers saw greater numbers of women seeking abortion services than at any other time of the year.”

People thought Columbus was nuts when he set off to find a shorter route to China, so let’s try not to snicker at the scientists who’ve announced plans to develop healthy ice cream.

Ingolf Gruen, a professor of food chemistry at the University of Missouri-Columbia, proposes to add fiber, antioxidants and probiotics to the real thing.

Gruen and his fellow ice cream professors chose these additives because they are known to contribute to good health and because consumers are familiar with them.

The Ice Cream Professor doesn’t anticipate that his concoction can match the seductive flavor or texture of the real stuff, however. 

What he’s after instead is consumers saying, “Oh it’s not as good as the full-fat heavy ice cream, but because it is good for me, and it still tastes good, I will purchase it,” Gruen explained.

“Our major challenges are texture, flavor and psychological acceptance,” Gruen continued.

“The nutrients we add often have bitter tastes and affect the texture of ice cream that we have to mask.”

Luckily for some ice cream fans, “flavors like chocolate are easier to work with because the flavor is so strong that it can overcome other flavors from the nutrients,” Gruen added.

The Ice Cream Professor has decided to include enough fiber to account for 10-15% of the recommended daily allowance, despite the gritty texture it will impart. “We want to make sure if you consume it there is a significant contribution to health benefits from these ingredients,” Gruen reasoned.

Gruen plans to have a prototype ready by spring. We know some denizens of Murray Hill that would be willing to give it a try.

In the last decade, ultra endurance sports like triathlons and cycling marathons have grown in popularity. The granddaddy of these extreme sports is the Western States 100-Mile Endurance Run, which courses through the Western States Trail in Northern California. The first running was held way back in 1976.

Recently, scientists from the Virginia Commonwealth University and the Department of Veterans Affairs Northern California decided to have a look at the 3,500 people who have entered this event over the years.

They found dramatic trends in the demographics and results of the participants.

For example, the average age of race starters was 41 back in 1986, but between 2000 and 2007 the average age had risen to 45-47.

In addition, many more women now compete in the race. From 1986 to 1988, between 10-12% of the competitors were female. Since 2001 however, that percentage has nearly doubled to 20-22% of the competitors.

The scientists attribute this to the fact that more women in their 40s and up, and more men in their 50s and up have signed up for the race, while fewer men who were less than 50 have entered.

And these older runners have delivered. Every year since the inception of the event, the average age of the top 5 finishers has gone up. Initially this number was in the early 30s, but now it is in the late 30s. This phenomenon is mostly attributable to changes in finish times for women, which the scientists say have improved by 37 minutes per decade since 1980.

This means that the finish time difference between the top men and women has been cut by 4% per decade, to a margin of 14% in 2007.

The study appears in Medicine & Science in Sports & Exercise.

This post first appeared on HCPLive.com/Psychiatry.

The Food and Drug Administration has sent a letter to 30 companies warning that it hasn’t approved beverages containing both caffeine and alcohol, and that it intends to begin removing such products from store shelves in 30 days if the companies can’t explain why such products are safe and legal.

The letter cited research showing that the combo drinks increase the risk of motor vehicle accidents and sexual assaults.

In one such study, Mary Claire O’Brien of Wake Forest University found that nearly one quarter of all college students claimed to have consumed such beverages in the last month alone.

O’Brien found that students who consumed alcohol-laced energy drinks were 70% more likely to be taken advantage of sexually (6.4% vs. 3.7%) and more than twice as likely (3.7% vs. 1.7%) to have taken sexual advantage of someone than students who drank alcohol alone.

O’Brien reported similarly appalling statistics for riding with a driver that had been drinking (38.9% vs. 22.5%), being hurt or injured (12.3% vs. 5.9%), and requiring medical treatment (2.6% vs. 1.2%). 
 
Last year, state authorities persuaded Anheuser-Busch and MillerCoors to remove their combo drinks, known as Bud Extra, Tilt, and Sparks from the market.

But at least 30 smaller companies still market the drinks, which contain roughly the same dose of caffeine as a large cup of Joe and nearly 10% alcohol. The provocatively-named beverages include Max Vibe, Moon Shot and Slingshot Party Gel.

In its press release on the matter, the FDA cited regulations that deem as unsafe all substances added to food or alcoholic beverages unless their “particular use has been approved by the FDA, or (they are) ‘Generally Recognized As Safe.’”

In a press conference explaining the FDA’s move, Joshua Sharfstein, the agency’s principal deputy commissioner explained that the “FDA is not aware of the basis on which these manufacturers have concluded that caffeine added to alcoholic beverages is, quote, ‘Generally Recognized As Safe.’” (more…)

Most of us tend to accumulate stuff of one sort or another, and many of our closets and drawers are hopelessly cluttered. But that’s not the same thing as compulsive hoarding, a psychological affliction that some experts estimate affects nearly 2% of the population.

The homes of compulsive hoarders are stuffed with rotten food and sundry what-have-yous that bury sofas, beds, bathtubs and sinks and block doors and hallways.

Their possessions are disorganized, their bills are frequently unpaid (in part because they are lost in the pile) and their household utilities frequently are cut off as a result…an outcome that exacerbates the squalor.

You may even know a hoarder. “Attorneys, surgeons, business executives—some very bright and successful people have this problem,” according to San Francisco psychologist Michael Tompkins, who has written a book on the subject.

In some hoarders, the behavior is thought to be a manifestation of obsessive-compulsive disorder. In others, the underlying condition appears to be dementia, ADD, PTSD or depression. In still others, the loss of a family member or a job triggers the behavior.

Some hoarders focus their attention on household pets, and cases have been reporting involving 1,000 or more in one home. The hoarders don’t notice the animals are filthy or malnourished, and believe they’re saving the critters from something worse.

What can be done to help such people? Experts say it can be profoundly harmful to forcibly clean up the mess. Hoarders perceive this to be a violation and are bound to repeat the behavior. Better to rely on patience and understanding. 

Professional organizers can help, as can antidepressants and behavioral therapy, but all of these are hit-or-miss at best.

As a last resort, Tompkins recommends “harm reduction” strategies: accept that the behavior will continue and minimize the danger it presents by keeping stairways and doors clear and moving flammable objects from space heaters and stoves.