Indian Medicine

NEW YORK (Reuters Health) - Surgical repair of a ruptured hamstring offers the most promise for individuals who want to return to high or full activity levels, researchers report.

Individuals who have suffered a hamstring detachment may "feel a pop in the buttock area that is followed by bruising over the posterior thigh and knee," Dr. Christopher M. Larson told Reuters Health.

Rehabilitation alone may result in persistent weakness, poor leg control, and difficulty returning to higher levels of activity. By contrast, surgery results in improved strength and a high return to sports, said Larson, of the Minnesota Sports Medicine Orthopaedic Sports Medicine Fellowship, in Eden Prairie.

In the American Journal of Sports Medicine, he and colleagues describe outcomes for 12 men and 14 women ranging from 16 to 58 years old who had surgery between 2002 and 2005 to repair hamstring ruptures.

They repaired the 21 acute ruptures within 4 weeks of injury. In the 5 chronic injuries, reconstruction occurred from 4 to 116 months after injury, and involved a new technique that used an Achilles tendon from a non-identical human donor to complete the hamstring reconstruction.

Five of the 26 patients were high-level recreational athletes, 2 were elite athletes, and the remaining participated at least weekly in jogging, cycling, weight training, aerobics, yoga, or rollerblading. Sixty-five percent of the hamstring ruptures occurred while water skiing.

At about 20 months post surgery, 96 percent of the patients said they would have the surgery again and reported good leg control. Eighty percent reported no pain.

In the acute group, 45 percent reported a full recovery, and 75 percent were able to return to sporting activities. The 5 patients unable to resume sports cited the hamstring injury as the cause. One patient was lost to follow up.

In the chronic group, 60 percent reported full recovery with no restricted activity, while the others resumed activities with limitations.

Superficial wound infections occurred in 5 patients and 3 patients each suffered re-rupture due to a fall, a deep infection requiring operative irrigation, and chronic pain and muscle spasm.

The investigators conclude that surgery for acute or chronic hamstring rupture results in a fairly reliable return to function for recreationally active adults.

SOURCE: American Journal of Sports Medicine, January 2008

Copyright © 2008 Reuters Limited.

LONDON (Reuters) - People with age-related macular degeneration, a leading cause of severe vision loss, have double the usual risk of dying from a heart attack or stroke, Australian researchers reported on Thursday.

They found that for people under the age of 75 when the study began, those who developed early age-related macular degeneration had twice the risk of dying from a heart attack or stroke within the next decade.

People with the late stage of the incurable disease at the start of the study had five times the risk of dying from a heart attack, and 10 times the risk of dying from a stroke, Paul Mitchell of the Centre for Vision Research at the University of Sydney and colleagues found.

"However, our finding that late age-related macular degeneration predicts stroke or cardiovascular mortality was based on relatively small numbers and should be interpreted cautiously," they wrote.

The researchers, who reported their findings in the British Journal of Ophthalmology, studied more than 3,000 people all older than 49 years old at the beginning of the study between 1992 and 1994.

Over the following 10 years, the researchers conducted two general health and eye exams five years apart that included physical checks and photographs of the retina.

Age-related macular degeneration is a chronic disease that affects the central part of the retina of the eye, resulting in blurred central vision or a blind spot in the centre of one's visual field.

It does not affect peripheral vision, but the loss of clear central vision can rob a person of the ability to read, drive and recognise people's faces even without causing total blindness.

The researchers do not know what is actually triggering the elevated risk but said one explanation may be that the eye disease is simply a sign of older age when people are more prone to heart attacks and strokes.

The findings could also have important implications for doctors because of concerns that some current treatments for the eye disease may increase stroke risk, the researchers said.

Copyright © 2008 Reuters Limited.

NEW YORK (Reuters Health) - Spending time in gym class is unlikely to detract from elementary school children's academic pursuits, a U.S. study suggests.

In fact, government researchers found girls who spent more time in gym class showed a higher average performance in math and reading than girls who got little to no physical education.

Susan A. Carlson and colleagues at the Centers for Disease Control and Prevention in Atlanta say their findings suggest that concerns about hurting children's academic achievement "may not be legitimate reasons to limit physical education programs."

They report the results in the American Journal of Public Health.

The growing problem of childhood inactivity and obesity has prompted calls to bring more physical education (PE) back to the schools. While there is no evidence that doing so detracts from children's classroom learning, there are some concerns this could be the case, according to Carlson's team.

To study the question, they used data from a nationally representative sample of 5,316 children who entered kindergarten in 1998 and were followed through fifth grade. Teachers reported the number of minutes per week the students spent in PE, and the children took standard tests to measure their math and reading skills.

Overall, the study found, time spent in gym class had no effect on boys' math and reading performance. On the other hand, girls who spent an average of one to five hours in gym class each week performed better on the academic tests than did girls who spent 35 minutes or less in PE each week.

Besides improving children's fitness, Carlson's team notes, physical education may help boost their self-esteem, ease stress and help develop their social skills and ability to think and reason.

Other studies, they add, have suggested that gym class particularly improves girls' fitness levels, since they are typically less active and fit than boys. This may help explain why PE was related to better academic performance among girls, but not boys, the researchers speculate.

Whatever the reason for the gender difference, the findings suggest that gym class is unlikely to harm, and may in fact benefit, academic performance, Carlson and her colleagues conclude.

"Schools should strive to meet the national health objective of daily physical education," they write, "and offer students a balanced academic program that includes opportunities for physical activity."

SOURCE: American Journal of Public Health, April 2008.

Copyright © 2008 Reuters Limited.

NEW YORK (Reuters Health) - Women who are physically abused during pregnancy may be at increased risk of delivering prematurely, researchers found.

The findings suggest that obstetricians should routinely ask women about domestic violence, they note in a report in the American Journal of Obstetrics & Gynecology.

The study included 2,660 Portuguese women who were interviewed shortly after giving birth between 1999 and 2000. Of the 217 women who delivered prematurely, one-quarter acknowledged that they had ever been hit, slapped, kicked or otherwise physically abused -- usually by their partner.

That compared with 8 percent of women whose pregnancies had gone to term.

In Portugal, as in many countries, pregnant women are not routinely screened for domestic abuse, note the researchers, led by Dr. Teresa Rodrigues of the University of Porto Medical School.

However, they say, the new findings suggest that abuse should be considered a risk factor for preterm birth, and that doctors should ask pregnant about it.

The American College of Obstetricians and Gynecologists recommends that obstetricians routinely screen pregnant women for domestic abuse. But at least one survey has found that many doctors don't ask those questions, though they are more likely to when they suspect abuse.

According to Rodrigues and her colleagues, physical abuse may sometimes lead to preterm delivery directly, from trauma to the abdominal area, for instance. But severe psychological distress may be a significant factor as well.

Such stress may cause hormonal changes that contribute to preterm delivery, the researchers explain. On the other hand, abused pregnant women may be more likely to drink, smoke or use illegal drugs, all of which could raise the risk of premature birth.

SOURCE: American Journal of Obstetrics & Gynecology, February 2008.

Copyright © 2008 Reuters Limited.

BOSTON (Reuters) - Massachusetts researchers have seen a dramatic statewide drop in the number of newborns with cystic fibrosis, and said on Wednesday the decline may be due to a national effort to screen for the genetic disease.

Cystic fibrosis or CF, which produces a thicker-than-normal mucus that clogs the lungs and other organs, affects about 30,000 children in the United States each year, or 70,000 worldwide, according to the Cystic Fibrosis Foundation.

It is caused by a small genetic mutation, and children who inherit defective copies of the gene from both parents develop the disease. People who carry just one copy are usually unaware of it.

Newborn screening has been done throughout Massachusetts since 1999. Researchers there have documented a significant decrease in cases after a 2001 recommendation from the National Institutes of Health that a screening test be used for prospective parents to identify carriers of the CF gene.

Dr. Jaime Hale of the New England Newborn Screening Program in Jamaica Plain, Massachusetts, said in a letter to the New England Journal of Medicine that gradual implementation of the recommendation probably produced the decline, first observed in the state in 2003.

"It used to be 30 babies born a year with CF, and now we're seeing, on average, 15," Anne Marie Comeau, deputy director of the program, said in a telephone interview. "This kind of fluctuation over four years would not be expected at all."

Most of the decline among the 80,000 births in the state each year came because of a reduction in the number of cases involving the most common CF mutation.

Comeau said she can only speculate on the reason for the decline because her program only looks at newborn screening, not prenatal testing, pre-conception testing, or any survey of whether women at risk for a CF baby are having abortions.

"We do not have data about decisions. There are numerous explanations. It could be a change in reproductive technology, people having sperm donors or different surrogate parents, or it could be termination," she said.

Copyright © 2008 Reuters Limited.