tag:blogger.com,1999:blog-40879173279354318692024-03-13T23:37:51.414-07:00International MedicineMD Endocrinology MSc Medical Anthropologyhttp://www.blogger.com/profile/09396525904668204911noreply@blogger.comBlogger173125tag:blogger.com,1999:blog-4087917327935431869.post-30265588220800309442016-10-03T09:32:00.000-07:002016-10-03T09:32:27.175-07:00TO HELP THE DOCTORS WITH THE ART OF MEDICINE <div dir="ltr" style="text-align: left;" trbidi="on">
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<span style="font-size: large;"><b>FRIDAY, Dec. 11, 2015 (HealthDay News) -- Seven behaviors should be implemented to improve the art of medicine, which can help improve relationships with patients, according to an article published in <i style="box-sizing: border-box;">Family Practice Management</i>.</b></span></div>
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<span style="font-size: large;"><b>Thomas R. Egnew, Ed.D., from the University of Washington School of Medicine in Seattle, reviewed the literature and delineated seven behaviors that promote more consistent practice of the interpersonal aspects of medicine.</b></span></div>
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<span style="font-size: large;"><b>Egnew describes seven behaviors that include focusing on the patient, ideally taking a moment to prepare before entering the office, and establishing a connection with the patient, preferably before opening the electronic medical record in the first few minutes of the consultation. Other tips include assessing the patient's response to illness and suffering, use of communication to foster healing, use of the power of touch, use of humor and laughter, and showing empathy.</b></span></div>
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<span style="font-size: large;"><b>"The behaviors recommended are based on empirical data," Egnew writes. "They incorporate a patient-centered approach to communicating with patients, which has been shown to improve health outcomes, increase patient satisfaction, and decrease malpractice liability."</b></span></div>
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MD Endocrinology MSc Medical Anthropologyhttp://www.blogger.com/profile/09396525904668204911noreply@blogger.comtag:blogger.com,1999:blog-4087917327935431869.post-54776810202546763912014-08-11T19:09:00.000-07:002014-08-11T19:09:26.086-07:00SAD STATE OF INTERNATIONAL MEDICINE <h3 class="post-title entry-title" style="background-color: #fff9ee; color: #222222; font-family: Georgia, Utopia, 'Palatino Linotype', Palatino, serif; font-size: 24px; font-weight: normal; margin: 0.75em 0px 0px; position: relative;">
<a href="http://www.medicoanthropologist.blogspot.be/2014/07/medical-care-in-underdeveloped-country.html" style="color: #888888; text-decoration: none;">MEDICAL CARE IN AN UNDERDEVELOPED COUNTRY: STORY OF IGNORANCE, GREED AND SUFFERING</a></h3>
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<span style="font-size: medium;">MEDICAL CARE IN AN UNDERDEVELOPED COUNTRY</span><br /><span style="font-size: medium;">STORY OF IGNORANCE, GREED AND SUFFERING</span><br /><span style="font-size: medium;">Let us call this South East Asian country, Srivijaya. Charming people, wonderful smiles, tolerant of others, they had suffered greatly through colonial and postcolonial brutalities.</span><br /><span style="font-size: medium;">In the last 10 years, there has been unbridled, uncontrolled, ill charted growth and development, mired in corruption and non-transparency.</span><br /><span style="font-size: medium;">Infrastructure that allows the bourgeoisie and politicians to increase their wealth, in tandem with the total, wanton neglect of the welfare of the poor, who constitute the majority of the population.</span><br /><span style="font-size: medium;">Health care was totally neglected, and those who had a little income (average wages are below 100 USD per month) could see a doctor in private practice who may give injections or fluid therapy, at proportionately tremendous costs. Among those with access to money, they fly off to KL, Singapore or Bangkok for their medical care, without realizing that these places offer better technical medical care than is available in Srivijaya but not better humanitarian care. I am told of many stories of those who went off to Singapore or Bangkok, only to return with a slew of new medications and investigations that the local doctors couldn't follow through.</span><br /><span style="font-size: medium;">I give a case history of suffering but of successful outcome of a Srivijaya resident, thanks to my friends, Drs W and H, in Miami.</span><br /><span style="font-size: medium;">This 42-year-old man, who has been in perfect health, began noticing increasing fatigue and weight loss, towards the end of 2013. The city where he lived, which is very popular with western tourists, lacks easy access to medical care, except for a private hospital staffed by Australian doctors with a very bad reputation. He decided to go to the capital city where he was advised to see a Gastroenterologist, since his complaints were weight loss, vague abdominal pains and fatigue.</span><br /><span style="font-size: medium;">The Specialist physician carried out an Upper GI (stomach) and a lower GI (colon). As is the case with many people who are leading lives peppered with low fibre, high sugar food, the specialist found Gastritis and Diverticulosis. As he had noticed a high White Cell count, the specialist prescribed in addition to Proton Pump Inhibitors (Prevacid is the name of the medication in the USA) and also triple antibiotics for presumed Diverticulitis! My friend took these medications faithfully but found that at the end of the month, his symptoms had not improved. The specialist had requested some blood tests and once again it was noticed that the White Blood Cell counts were inappropriately elevated (close to ten times the normal). At that time, he got in touch with me through email and I talked to him on the telephone and I suspected that this did not sound like Diverticulitis but something more sinister in which faulty production of the White Blood Cells were involved. I encouraged him to go Bangkok for further investigations. He referred himself to a doctor in Bangkok (I do not have any medical contacts in Bangkok), who turned out to be a GI specialist, since my friend was thinking that the problems lay in his Gut, who repeated the endoscopic studies done in the capital city of Srivijaya, and proudly confirmed the diagnosis. But the concerned doctor noticed that the White Blood Cell count now exceeded over 100,000, abnormally high and referred the patient to a Haematologist, who admitted the patient to a hospital and within a day had the correct diagnosis, after a bone marrow biopsy.</span><br /><span style="font-size: medium;">My friend waited out the results in a hotel in Bangkok, only to be told that his condition was,</span><br /><span style="font-size: medium;">Chronic Myelogenous Leukaemia, with Ph+ positive, with BCR-CHL divergence of 90% (these are extremely sophisticated studies).</span><br /><span style="font-size: medium;">The haematologist prescribed Hydroxyurea as a stopgap measure to bring down the white blood cell count while waiting for the definitive treatment with expensive medications that were available in all the countries in South East Asia with the exception of Srivijaya. The doctor did give hope that if he were to take these medications on a regular basis, there is a high chance he would be cured.</span><br /><span style="font-size: medium;">I was in touch with him through this period on email and telephone. Surprise was in store for my friend when he enquired at the pharmacy about the medication prescribed for him, back in Srivijaya. He was told that they could procure the medication for him for $175 per pill! And the payment has to be in cash!</span><br /><span style="font-size: medium;">The price of the medication was similar in Singapore, Kuala Lumpur or Bangkok!</span><br /><span style="font-size: medium;">Like many busy administrators, he was not aware of the seriousness of his condition and once again we talked. He wondered whether he could just take Hydroxyurea and not worry about the new medication prescribed for him. He has been feeling better since he began taking it.</span><br /><span style="font-size: medium;">Right about this time, I had read about a court case in India, where a western pharmaceutical company had given up suing the government for breach of patent. The lifesaving medication, the name I couldn't remember was being distributed as a generic in India.</span><br /><span style="font-size: medium;">Once I had all the investigations, scanned to me, on hand, I contacted two good friends of mine in Miami, Drs W and H, one of whom is a professor of Haematology at the University of Miami.</span><br /><span style="font-size: medium;">Where could we get the life saving medication for our Srivijaya friend? A telephone call to a pharmacist in Bangalore in India gave us the breath of life, I clearly remember the relief I felt when the pharmacist told me that this medication is available in blisters of 10 for 1523 INR (about 25 dollars, i.e. $2.5 dollars each!), a fraction of the price in the pharmacies of the south east Asian nations! Thank you, India!</span><br /><span style="font-size: medium;">The name of the medication is Imatinib, 400 mg in strength, marketed as Gleevac in the USA.</span><br /><span style="font-size: medium;">Imatinib was invented in the late 1990s by scientists at Ciba-Geigy (which merged with Sandoz in 1996 to become Novartis), in a team led by biochemist Nicholas Lydon and that included Elisabeth Buchdunger and Jürg Zimmerman and its use to treat CML was driven by oncologist Brian Druker of Oregon Health & Science University (OHSU). Other major contributions to imatinib development were made by Carlo Gambacorti-Passerini, a physician scientist and hematologist at University of Milano Bicocca, Italy, John Goldman at Hammersmith Hospital in London, UK, and later on by Charles Sawyers of Memorial Sloan-Kettering Cancer Center. Druker led the clinical trials confirming its efficacy in CML</span><br /><span style="font-size: medium;"><br /></span><span style="font-size: medium;">In 2013, more than 100 cancer specialists published a letter in Blood saying that the prices of many new cancer drugs, including imatinib, are so high that U.S. patients couldn't afford them, and that the level of prices, and profits, was so high as to be immoral. [They stated that in 2001, imatinib was priced at $30,000 a year, which was based on the price of interferon, then the standard treatment, and that at this price Novartis would have recouped its initial development costs in two years. They stated that after unexpectedly becoming a blockbuster, Novartis increased the price to $92,000 per year in 2012, with annual revenues of $4.7 billion. Other doctors have complained about the cost.</span><br /><span style="font-size: medium;">We were able to arrange the delivery of medications on a regular basis to Srivijaya at $40 per blister pack of 10 tablets. He gets 50 tablets at a time, delivered to him by air, he has never ran out of medications.</span><br /><span style="font-size: medium;">I made arrangements to visit him at Srivijaya in March 2014, adding a side trip to my visit to SE Asia. I reviewed his laboratory tests and was very pleased to see that the white cell count has steadily decreased and now hovered around 6000! </span><br /><span style="font-size: medium;">Two months later (May 2014) the patient from Srivijaya got in touch with me again with a slew of questions.</span><br /><span style="font-size: medium;">How long do I have to take Imatinib?</span><br /><span style="font-size: medium;">When do I need another Bone Marrow Biopsy?</span><br /><span style="font-size: medium;">Should I go back to the doctor in Bangkok who did the bone marrow biopsy?</span><br /><span style="font-size: medium;">During the last week of May 2014, I had scheduled a visit to my good friend in Indonesia, the humble man of Bogor. American Indians say that things happen for a reason, and that we are not smart enough to decipher why most of the time! Few days before my appointed travel towards Singapore and Jakarta, my friend was summoned by the Ministry of Agriculture to be present at the meetings of visiting specialists, that would take him away from his home and work. Visiting him and his family and staff is one of my highlights of a visit to South East Asia. As I had already booked my tickets to Singapore, I decided to go to Srivijaya instead to visit and counsel my friend with CML who was taking Imatinib! I tried to visit a project I was involved in another country but the coordinator was out of the country during that period.</span><br /><span style="font-size: medium;">I had an uneventful flight from Havana. Havana-Miami-Newark-Hong Kong-Singapore. After arriving in Singapore at 12 30 AM, I was able to book a ticket to his city that very same morning.</span><br /><span style="font-size: medium;">It was as if I was supposed to be here, I had been there two months before. I spent time visiting friends, old and new. This visit was more than a social visit.</span><br /><span style="font-size: medium;">With the help of my friends in Miami, we were able to chart a course of treatment for him, with follow up tests to be carried out at regular intervals. Since there were no adult haematologists in all of Srivijaya, and the country does not have infrastructure to do the sophisticated blood tests (called FISH), we found out that it is possible to get the tests done in Ho Chi Minh City in Vietnam! His Family Practitioner in Srivijaya was a retired French doctor who confessed that he knew nothing about his illness. I left Srivijaya leaving detailed instructions for him for follow up (as given by my friend in Miami). And to find a concerned and interested Family Practitioner in his town!</span><br /><span style="font-size: medium;">Dr H was head of Haematology as well as Internal Medicine at the University of Miami/Jackson Memorial Hospital when I was a student there. His dedication to International medicine was exemplary, and I was influenced by it. I had a chance to work with him a little, organizing a connection to Jamaica.</span><br /><span style="font-size: medium;">The doctor friend who helped me in Miami was none other than the son of the above professor!</span><br /><span style="font-size: medium;">I sat down on banks of the river not too far from the river and offered a prayer of gratitude. I felt so humble and elevated in spirit, that I had to hold back my tears!</span><br /><span style="font-size: medium;">A Kaddish for all my illustrious teachers: Dr H, Haematology, Dr L, Oncology, Dr R, Endocrinology all from University of Miami and Dr H, Medical Anthropology from London</span><br /><span style="font-size: medium;"><br /></span><span style="font-size: medium;">Just this morning, I received eCopy of NEJM for July 3, 2014</span><br /><span style="font-size: medium;">There is an article on Putting quality on the Global Health Agenda</span><br /><span style="font-size: medium;">from Harvard University. An Interesting article. I would just quote one line from it.</span><br /><span style="font-size: medium;">In a study involving standardized patients in INDIA, nearly 7 out of 10 medical providers failed to ascertain the basic pertinent history for common ailments such as angina, asthma, and childhood diarrhea and incorrectly diagnosed a large majority of cases!</span></div>
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MD Endocrinology MSc Medical Anthropologyhttp://www.blogger.com/profile/09396525904668204911noreply@blogger.comtag:blogger.com,1999:blog-4087917327935431869.post-85320446543250791102014-06-09T23:30:00.003-07:002014-06-09T23:32:20.173-07:00OLIVE OIL AND SALAD COMBINED MAY EXPLAIN THE MEDITERRANEAN DIET SUCCESS <div dir="ltr" style="text-align: left;" trbidi="on">
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Olive oil and salad combined 'explain' Med diet success</span></h1>
<span class="byline" style="background-color: white; border-top-color: black; border-top-style: dotted; border-top-width: 1px; display: block; font-family: Arial, Helmet, Freesans, sans-serif; line-height: 16px; margin-bottom: 26px; overflow: auto; padding-top: 11px; position: relative;"><span class="byline-name" style="display: block; text-rendering: optimizelegibility;"><span style="color: red; font-size: large;">By Michelle Roberts</span></span><span class="byline-title" style="color: red; font-size: large;">Health editor, BBC News online</span></span><br />
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<span style="color: red; font-size: large;">The combination of olive oil and leafy salad or vegetables is what gives the Mediterranean diet its healthy edge, say scientists.</span></div>
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<span style="color: red; font-size: large;">When these two food groups come together they form nitro fatty acids which lower blood pressure, they told PNAS journal.</span></div>
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<span style="color: red; font-size: large;">The unsaturated fat in olive oil joins forces with the nitrite in the vegetables, the study of mice suggests.</span></div>
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<span style="color: red; font-size: large;">Nuts and avocados along with vegetables should work too, they say.</span></div>
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<span style="color: red; font-size: large;">Inspired by traditional cuisine of countries such as Greece, Spain and Italy, the Mediterranean diet has long been associated with good health and fit hearts.</span></div>
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<span style="color: red; font-size: large;">Typically, it consists of an abundance of vegetables, fresh fruit, wholegrain cereals, olive oil and nuts, as well as poultry and fish, rather than lots of red meat and butter or animal fats.</span></div>
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<span style="color: red; font-size: large;">While each component of the Mediterranean diet has obvious nutritional benefits, researchers have been puzzled about what precisely makes the diet as a whole so healthy.</span></div>
<span class="cross-head" style="background-color: white; display: block; font-family: Arial, Helmet, Freesans, sans-serif; line-height: 16px; text-rendering: optimizelegibility;"><span style="color: red; font-size: large;">Chemical reaction</span></span><br />
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<span style="color: red; font-size: large;">Prof Philip Eaton, from King's College London, and colleagues from the University of California in the US believe it is the fusion of the diet's ingredients that make nitro fatty acids.</span></div>
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<span style="color: red; font-size: large;">In their study, part-funded by the British Heart Foundation, the researchers used genetically engineered mice to see what impact nitro fatty acids had on the body.</span></div>
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<span style="color: red; font-size: large;">Nitro fatty acids helped lower blood pressure by blocking an enzyme called epoxide hydrolase.</span></div>
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<span style="color: red; font-size: large;">Prof Eaton said: "Humans have this same enzyme so we think the same happens in people."</span></div>
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<span style="color: red; font-size: large;">This explains why a Mediterranean diet is healthy, even though it contains fat, he says.</span></div>
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<span style="color: red; font-size: large;">"With the fats in the Med diet, if taken together with nitrates or nitrites, there's a chemical reaction and these combine to form nitro fatty acids.</span></div>
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<span style="color: red; font-size: large;">"It's nature's protective mechanism. If we can tap into this we could make new drugs for treating high blood pressure and preventing heart disease," he said.</span></div>
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<span style="color: red; font-size: large;">He said human trials were planned.</span></div>
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<span style="color: red; font-size: large;">Dr Sanjay Thakrar of the British Heart Foundation said: "This interesting study goes some way to explain why a Mediterranean diet appears to be good for your heart health. The results showed a way in which a particular compound could combat high blood pressure, which is a major risk factor for heart disease.</span></div>
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<span style="color: red; font-size: large;">"However, more work is necessary as these experiments were conducted in mice and this compound could also be having its effect through other pathways."</span></div>
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MD Endocrinology MSc Medical Anthropologyhttp://www.blogger.com/profile/09396525904668204911noreply@blogger.comtag:blogger.com,1999:blog-4087917327935431869.post-9237350007814861062014-06-09T08:13:00.004-07:002014-06-09T08:13:51.212-07:00BAD SLEEP ALTERS THE BADY DRAMATICALLY <div dir="ltr" style="text-align: left;" trbidi="on">
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<span style="font-size: large;">Bad sleep 'dramatically' alters body</span></h1>
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A run of poor sleep can have a potentially profound effect on the internal workings of the human body, say UK researchers.</div>
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The activity of hundreds of genes was altered when people's sleep was cut to less than six hours a day for a week.</div>
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Writing in the journal <a href="http://www.pnas.org/cgi/doi/10.1073/pnas.1217154110" style="color: blue !important; font-weight: bold; line-height: 16px;">PNAS</a>, the researchers said the results helped explain how poor sleep damaged health.</div>
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Heart disease, diabetes, obesity and poor brain function have all been linked to substandard sleep.</div>
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What missing hours in bed actually does to alter health, however, is unknown.</div>
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So researchers at the University of Surrey analysed the blood of 26 people after they had had plenty of sleep, up to 10 hours each night for a week, and compared the results with samples after a week of fewer than six hours a night.</div>
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More than 700 genes were altered by the shift. Each contains the instructions for building a protein, so those that became more active produced more proteins - changing the chemistry of the body.</div>
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Meanwhile the natural body clock was disturbed - some genes naturally wax and wane in activity through the day, but this effect was dulled by sleep deprivation.</div>
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Prof Colin Smith, from the University of Surrey, told the BBC: "There was quite a dramatic change in activity in many different kinds of genes."</div>
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Areas such as the immune system and how the body responds to damage and stress were affected.</div>
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Prof Smith added: "Clearly sleep is critical to rebuilding the body and maintaining a functional state, all kinds of damage appear to occur - hinting at what may lead to ill health.</div>
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"If we can't actually replenish and replace new cells, then that's going to lead to degenerative diseases."</div>
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He said many people may be even more sleep deprived in their daily lives than those in the study - suggesting these changes may be common.</div>
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Dr Akhilesh Reddy, a specialist in the body clock at the University of Cambridge, said the study was "interesting".</div>
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He said the key findings were the effects on inflammation and the immune system as it was possible to see a link between those effects and health problems such as diabetes.</div>
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The findings also tie into research attempting to do away with sleep, such as by finding a drug that could eliminate the effects of sleep deprivation.</div>
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Dr Reddy said: "We don't know what the switch is that causes all these changes, but theoretically if you could switch it on or off, you might be able to get away without sleep.</div>
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"But my feeling is that sleep is fundamentally important to regenerating all cells."</div>
</div>
MD Endocrinology MSc Medical Anthropologyhttp://www.blogger.com/profile/09396525904668204911noreply@blogger.comtag:blogger.com,1999:blog-4087917327935431869.post-33316789177216469652014-02-21T01:56:00.000-08:002014-02-21T01:56:27.044-08:00STRENGTH TRAINING FOR CHILDREN AND ADOLESCENTS : BENEFITS AND RISKS<div dir="ltr" style="text-align: left;" trbidi="on">
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<span style="font-size: large;">Coll. Antropol. <b>37 </b>(2013) Suppl. 2: 219–225</span></div>
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<span style="font-size: large;">Review</span></div>
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<b><span style="font-size: large;">Strength Training for Children and Adolescents:</span></b></div>
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<b><span style="font-size: large;">Benefits and Risks</span></b></div>
<div style="color: #2f2a2b; font-family: Helvetica; text-align: center;">
<b><span style="font-size: large;">Davide Barbieri and Luciana Zaccagni</span></b></div>
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<span style="font-size: large;">University of Ferrara, Department of Biomedical and Specialty Surgical Sciences, Ferrara, Italy</span></div>
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<b><span style="font-size: large;">A B S T R A C T</span></b></div>
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<i><span style="font-size: large;">Physical activity has proved to be an effective means of preventing several diseases and improving general health. In</span></i></div>
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<i><span style="font-size: large;">most cases, though, light to moderate efforts are suggested, for both youngsters and adults. Common sense advices call</span></i></div>
<div style="color: #2f2a2b; font-family: Helvetica; text-align: center;">
<i><span style="font-size: large;">for late inception of intense, strength training-related activities, like weight lifting and plyometrics, which are usually</span></i></div>
<div style="color: #2f2a2b; font-family: Helvetica; text-align: center;">
<i><span style="font-size: large;">postponed at the end of the growth age, even among sport practitioners. However, such advices seem to have a mainly anecdotal</span></i></div>
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<i><span style="font-size: large;">nature. The purpose of this review is to evaluate risks and benefits of early inception of strength training, at adolescence</span></i></div>
<div style="color: #2f2a2b; font-family: Helvetica; text-align: center;">
<i><span style="font-size: large;">or even earlier, and to verify whether concerns can be grounded scientifically. Current literature does not seem to</span></i></div>
<div style="color: #2f2a2b; font-family: Helvetica; text-align: center;">
<i><span style="font-size: large;">have any particular aversion against the practice of strength training by children and adolescents, provided that some</span></i></div>
<div style="color: #2f2a2b; font-family: Helvetica; text-align: center;">
<i><span style="font-size: large;">safety rules are followed, like medical clearance, proper instruction from a qualified professional and progressive overload.</span></i></div>
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<i><span style="font-size: large;">At the same time, several studies provide consistent findings supporting the benefits of repeated, intense physical efforts</span></i></div>
<div style="color: #2f2a2b; font-family: Helvetica; text-align: center;">
<i><span style="font-size: large;">in young subjects. Improved motor skills and body composition, in terms of increased fat free mass, reduced fat</span></i></div>
<div style="color: #2f2a2b; font-family: Helvetica; text-align: center;">
<i><span style="font-size: large;">mass and enhanced bone health, have been extensively documented, especially if sport practice began early, when the subjects</span></i></div>
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<i><span style="font-size: large;">were pubescent. It can be therefore concluded that strength training is a relatively safe and healthy practice for children</span></i></div>
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<i><span style="font-size: large;">and adolescents.</span></i></div>
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<span style="font-size: large;"><b><i>Key words</i></b><i>: strength training, weight lifting, adolescents, growth, body composition</i></span></div>
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<b><span style="font-size: large;">Introduction</span></b></div>
<div style="color: #2f2a2b; font-family: Helvetica; text-align: center;">
<span style="font-size: large;">Modern Western societies imply increasingly sedentary</span></div>
<div style="color: #2f2a2b; font-family: Helvetica; text-align: center;">
<span style="font-size: large;">life styles and reduced physical exercise. Technological</span></div>
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<span style="font-size: large;">progress, limited outdoor activities and economic improvement</span></div>
<div style="color: #2f2a2b; font-family: Helvetica; text-align: center;">
<span style="font-size: large;">have modified dietary habits and reduced the</span></div>
<div style="color: #2f2a2b; font-family: Helvetica; text-align: center;">
<span style="font-size: large;">amount of exercise performed by children and adolescents1.</span></div>
<div style="color: #2f2a2b; font-family: Helvetica; text-align: center;">
<span style="font-size: large;">It is well known that regular moderate intensity</span></div>
<div style="color: #2f2a2b; font-family: Helvetica; text-align: center;">
<span style="font-size: large;">physical activity – such as walking, cycling, or participating</span></div>
<div style="color: #2f2a2b; font-family: Helvetica; text-align: center;">
<span style="font-size: large;">in sports – has significant benefits for health. According</span></div>
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<span style="font-size: large;">to the 2008 guidelines of the European Commission2,</span></div>
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<span style="font-size: large;">school-aged youth should participate in moderate to vigorous</span></div>
<div style="color: #2f2a2b; font-family: Helvetica; text-align: center;">
<span style="font-size: large;">daily physical activity for 60 minutes or more. Obesity,</span></div>
<div style="color: #2f2a2b; font-family: Helvetica; text-align: center;">
<span style="font-size: large;">sedentary lifestyle and poor cardio-respiratory fitness</span></div>
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<span style="font-size: large;">in childhood and adolescence may increase the risk</span></div>
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<span style="font-size: large;">of health problems later in life. The teenage years bring</span></div>
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<span style="font-size: large;">many physical, social and psychological changes for the</span></div>
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<span style="font-size: large;">individual. From infancy to adulthood, growth, maturation</span></div>
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<span style="font-size: large;">and development occur simultaneously and interact:</span></div>
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<span style="font-size: large;">growth consists in the increase of the size of the body as a</span></div>
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<span style="font-size: large;">whole and of its parts, maturation refers to progress towards</span></div>
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<span style="font-size: large;">the biologically mature state and development refers</span></div>
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<span style="font-size: large;">to the acquisition of behavioral competence3.</span></div>
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<span style="font-size: large;">Changes in body dimensions and composition during</span></div>
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<span style="font-size: large;">growth and maturation are factors affecting strength</span></div>
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<span style="font-size: large;">and motor performance4. Some changes in anthropometric</span></div>
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<span style="font-size: large;">traits and strength in a sample of Italian adolescents</span></div>
<div style="color: #2f2a2b; font-family: Helvetica; text-align: center;">
<span style="font-size: large;">studied by Gualdi-Russo and Toselli5 are reported in Figures</span></div>
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<span style="font-size: large;">1–4.</span></div>
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<span style="font-size: large;">The strength and motor performance varies during</span></div>
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<span style="font-size: large;">childhood and adolescence in relation to biological and</span></div>
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<span style="font-size: large;">environmental factors. Among biological factors the specific</span></div>
<div style="color: #2f2a2b; font-family: Helvetica; text-align: center;">
<span style="font-size: large;">contribution of maturity status is apparent: the</span></div>
<div style="color: #2f2a2b; font-family: Helvetica; text-align: center;">
<span style="font-size: large;">strength advantage of early-maturing subjects is related</span></div>
<div style="color: #2f2a2b; font-family: Helvetica; text-align: center;">
<span style="font-size: large;">to their larger body size in comparison to late-maturing</span></div>
<div style="color: #2f2a2b; font-family: Helvetica; text-align: center;">
<span style="font-size: large;">ones. These differences are more marked in boys than in</span></div>
<div style="color: #2f2a2b; font-family: Helvetica; text-align: center;">
<span style="font-size: large;">girls. Regular physical activity is an important factor</span></div>
<div style="color: #2f2a2b; font-family: Helvetica; text-align: center;">
<span style="font-size: large;">during growth and maturation, regulating body weight</span></div>
<div style="color: #2f2a2b; font-family: Helvetica; text-align: center;">
<span style="font-size: large;">and, particularly, fatness.</span></div>
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<span style="font-size: large;">219</span></div>
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<span style="font-size: large;">Received for publication October 15, 2011</span></div>
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<span style="font-size: large;"><br /></span></div>
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<b><span style="font-size: large;">Strength Training: Concepts and Objectives</span></b></div>
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<span style="font-size: large;">Strength training is a form of physical activity, usually</span></div>
<div style="color: #2f2a2b; font-family: Helvetica; text-align: center;">
<span style="font-size: large;">structured and planned, involving intense efforts</span></div>
<div style="color: #2f2a2b; font-family: Helvetica; text-align: center;">
<span style="font-size: large;">against a resistance. Its main aim is to increase muscular</span></div>
<div style="color: #2f2a2b; font-family: Helvetica; text-align: center;">
<span style="font-size: large;">strength, in order to improve performance, at least in</span></div>
<div style="color: #2f2a2b; font-family: Helvetica; text-align: center;">
<span style="font-size: large;">case a sport is practiced. It is extensively adopted in</span></div>
<div style="color: #2f2a2b; font-family: Helvetica; text-align: center;">
<span style="font-size: large;">power-oriented sports, like sprinting6 and soccer7, even if</span></div>
<div style="color: #2f2a2b; font-family: Helvetica; text-align: center;">
<span style="font-size: large;">its benefits are recognized also in endurance sports, like</span></div>
<div style="color: #2f2a2b; font-family: Helvetica; text-align: center;">
<span style="font-size: large;">long distance running8,9 and cross country skiing10,11. In</span></div>
<div style="color: #2f2a2b; font-family: Helvetica; text-align: center;">
<span style="font-size: large;">a non-competitive environment instead, strength training</span></div>
<div style="color: #2f2a2b; font-family: Helvetica; text-align: center;">
<span style="font-size: large;">is adopted for many different purposes. For example,</span></div>
<div style="color: #2f2a2b; font-family: Helvetica; text-align: center;">
<span style="font-size: large;">strength training may be used to improve overall fitness,</span></div>
<div style="color: #2f2a2b; font-family: Helvetica; text-align: center;">
<span style="font-size: large;">increasing muscle hypertrophy and reducing body fatness</span></div>
<div style="color: #2f2a2b; font-family: Helvetica; text-align: center;">
<span style="font-size: large;">at the same time. In fact, strength training can be</span></div>
<div style="color: #2f2a2b; font-family: Helvetica; text-align: center;">
<span style="font-size: large;">an effective means to improve body composition12. In</span></div>
<div style="color: #2f2a2b; font-family: Helvetica; text-align: center;">
<span style="font-size: large;">other cases, some individuals may adopt it in order to accomplish</span></div>
<div style="color: #2f2a2b; font-family: Helvetica; text-align: center;">
<span style="font-size: large;">some professional goal, like achieving the degree</span></div>
<div style="color: #2f2a2b; font-family: Helvetica; text-align: center;">
<span style="font-size: large;">of physical fitness which is required in the military</span></div>
<div style="color: #2f2a2b; font-family: Helvetica; text-align: center;">
<span style="font-size: large;">or to join the fire brigade.</span></div>
<div style="color: #2f2a2b; font-family: Helvetica; text-align: center;">
<span style="font-size: large;">To train strength, muscular force is applied against</span></div>
<div style="color: #2f2a2b; font-family: Helvetica; text-align: center;">
<span style="font-size: large;">some kind of resistance. In most cases, especially when</span></div>
<div style="color: #2f2a2b; font-family: Helvetica; text-align: center;">
<span style="font-size: large;">the individual is healthy, resistance is provided by free</span></div>
<div style="color: #2f2a2b; font-family: Helvetica; text-align: center;">
<span style="font-size: large;">weights, like barbells, dumbbells or the athlete’s own</span></div>
<div style="color: #2f2a2b; font-family: Helvetica; text-align: center;">
<span style="font-size: large;">body weight, or by weight machines, like the leg press,</span></div>
<div style="color: #2f2a2b; font-family: Helvetica; text-align: center;">
<span style="font-size: large;">the lat machine etc. This kind of training is usually</span></div>
<div style="color: #2f2a2b; font-family: Helvetica; text-align: center;">
<span style="font-size: large;">adopted in sport conditioning, because the load can be increased</span></div>
<div style="color: #2f2a2b; font-family: Helvetica; text-align: center;">
<span style="font-size: large;">progressively according to the athlete’s strength,</span></div>
<div style="color: #2f2a2b; font-family: Helvetica; text-align: center;">
<span style="font-size: large;">which can be considerable. Athletes employ gravity also</span></div>
<div style="color: #2f2a2b; font-family: Helvetica; text-align: center;">
<span style="font-size: large;">in other ways in order to improve their performances,</span></div>
<div style="color: #2f2a2b; font-family: Helvetica; text-align: center;">
<span style="font-size: large;">like in plyometrics or high-impact training, where body</span></div>
<div style="color: #2f2a2b; font-family: Helvetica; text-align: center;">
<span style="font-size: large;">mass is accelerated dropping from a pre-determined</span></div>
<div style="color: #2f2a2b; font-family: Helvetica; text-align: center;">
<span style="font-size: large;">height, according to the athlete’s ability and conditioning</span></div>
<div style="color: #2f2a2b; font-family: Helvetica; text-align: center;">
<span style="font-size: large;">level. This kind of strength training is usually considered</span></div>
<div style="color: #2f2a2b; font-family: Helvetica; text-align: center;">
<span style="font-size: large;">the most dangerous, because the real impact forces applied</span></div>
<div style="color: #2f2a2b; font-family: Helvetica; text-align: center;">
<span style="font-size: large;">to the athlete’s body (bones, muscles, tendons, ligaments</span></div>
<div style="color: #2f2a2b; font-family: Helvetica; text-align: center;">
<span style="font-size: large;">etc.) are not easily measured, as in weight lifting.</span></div>
<div style="color: #2f2a2b; font-family: Helvetica; text-align: center;">
<span style="font-size: large;">Since force is defined as mass times acceleration, we can</span></div>
<div style="color: #2f2a2b; font-family: Helvetica; text-align: center;">
<span style="font-size: large;">say that weights mainly focus on the first factor, while</span></div>
<div style="color: #2f2a2b; font-family: Helvetica; text-align: center;">
<span style="font-size: large;">plyometrics relies on the second to increase force. Nonetheless,</span></div>
<div style="color: #2f2a2b; font-family: Helvetica; text-align: center;">
<span style="font-size: large;">also weights can be accelerated, in order to increase</span></div>
<div style="color: #2f2a2b; font-family: Helvetica; text-align: center;">
<span style="font-size: large;">force production without adding kilograms, and</span></div>
<div style="color: #2f2a2b; font-family: Helvetica; text-align: center;">
<span style="font-size: large;">advanced plyometrics may imply added weight by means</span></div>
<div style="color: #2f2a2b; font-family: Helvetica; text-align: center;">
<span style="font-size: large;">of weighted belts or vests.</span></div>
<div style="color: #2f2a2b; font-family: Helvetica; text-align: center;">
<span style="font-size: large;">It must be considered, though, that similar strength</span></div>
<div style="color: #2f2a2b; font-family: Helvetica; text-align: center;">
<span style="font-size: large;">training effects can be found in sport practices other</span></div>
<div style="color: #2f2a2b; font-family: Helvetica; text-align: center;">
<span style="font-size: large;">than weight lifting or plyometrics, like sprinting, gymnastics</span></div>
<div style="color: #2f2a2b; font-family: Helvetica; text-align: center;">
<span style="font-size: large;">and other kinds of power-oriented sports, or team</span></div>
<div style="color: #2f2a2b; font-family: Helvetica; text-align: center;">
<span style="font-size: large;">sports involving leaping and bouncing, like volleyball and</span></div>
<div style="color: #2f2a2b; font-family: Helvetica; text-align: center;">
<span style="font-size: large;">basketball. These types of physical efforts produce great</span></div>
<div style="color: #2f2a2b; font-family: Helvetica; text-align: center;">
<span style="font-size: large;">acceleration, which, applied to the athlete’s body mass,</span></div>
<div style="color: #2f2a2b; font-family: Helvetica; text-align: center;">
<span style="font-size: large;">produce great force. Nonetheless, these intense efforts</span></div>
<div style="color: #2f2a2b; font-family: Helvetica; text-align: center;">
<span style="font-size: large;">are usually practiced by children, even outside a sport</span></div>
<div style="color: #2f2a2b; font-family: Helvetica; text-align: center;">
<span style="font-size: large;">environment, simply while playing with their peers.</span></div>
<div style="color: #2f2a2b; font-family: Helvetica; text-align: center;">
<span style="font-size: large;">Strength training has in important role in rehabilitation</span></div>
<div style="color: #2f2a2b; font-family: Helvetica; text-align: center;">
<span style="font-size: large;">after injuries, especially those which involve surgery</span></div>
<div style="color: #2f2a2b; font-family: Helvetica; text-align: center;">
<span style="font-size: large;">and/or a long period of immobilization, in order to re-gain</span></div>
<div style="color: #2f2a2b; font-family: Helvetica; text-align: center;">
<span style="font-size: large;">the physiological muscle hypertrophy and joint range of</span></div>
<div style="color: #2f2a2b; font-family: Helvetica; text-align: center;">
<span style="font-size: large;">motion13–18. In case of injuries to lower limbs, when the</span></div>
<div style="color: #2f2a2b; font-family: Helvetica; text-align: center;">
<span style="font-size: large;">patient is still lying in bed, body weight can be excessive</span></div>
<div style="color: #2f2a2b; font-family: Helvetica; text-align: center;">
<span style="font-size: large;">and not suitable for post-surgery rehabilitation. Therefore,</span></div>
<div style="color: #2f2a2b; font-family: Helvetica; text-align: center;">
<span style="font-size: large;">non-bodyweight bearing exercises can be used, by</span></div>
<div style="color: #2f2a2b; font-family: Helvetica; text-align: center;">
<span style="font-size: large;">means of cables and/or small weights, attached to the ankles</span></div>
<div style="color: #2f2a2b; font-family: Helvetica; text-align: center;">
<span style="font-size: large;">of the patient, like in leg raises and knee extensions.</span></div>
<div style="color: #2f2a2b; font-family: Helvetica; text-align: center;">
<span style="font-size: large;">Body weight can be excessive also for healthy individuals</span></div>
<div style="color: #2f2a2b; font-family: Helvetica; text-align: center;">
<span style="font-size: large;">who have a low relative strength, that is a low</span></div>
<div style="color: #2f2a2b; font-family: Helvetica; text-align: center;">
<span style="font-size: large;">strength-to-body weight ratio. A push up, a pull up or</span></div>
<div style="color: #2f2a2b; font-family: Helvetica; text-align: center;">
<span style="font-size: large;">even a body weight squat can be a demanding task for</span></div>
<div style="color: #2f2a2b; font-family: Helvetica; text-align: center;">
<span style="font-size: large;">people who are too young, elderly, overweight or out of</span></div>
<div style="color: #2f2a2b; font-family: Helvetica; text-align: center;">
<span style="font-size: large;">shape. Free weights or machines can provide a controlled</span></div>
<div style="color: #2f2a2b; font-family: Helvetica; text-align: center;">
<span style="font-size: large;">and adjustable source of resistance. For example, a push</span></div>
<div style="color: #2f2a2b; font-family: Helvetica; text-align: center;">
<span style="font-size: large;">up can be effectively substituted by a bench press, a pull</span></div>
<div style="color: #2f2a2b; font-family: Helvetica; text-align: center;">
<span style="font-size: large;">up by a lat pull down using a lat machine, a body weight</span></div>
<div style="color: #2f2a2b; font-family: Helvetica; text-align: center;">
<span style="font-size: large;">squat by a leg press, involving more or less the same</span></div>
<div style="color: #2f2a2b; font-family: Helvetica; text-align: center;">
<span style="font-size: large;">muscle groups. Weights can be adapted to the individuals’</span></div>
<div style="color: #2f2a2b; font-family: Helvetica; text-align: center;">
<span style="font-size: large;">actual strength, which may be relatively low compared</span></div>
<div style="color: #2f2a2b; font-family: Helvetica; text-align: center;">
<span style="font-size: large;">to their own body weight.</span></div>
<div style="color: #2f2a2b; font-family: Helvetica; text-align: center;">
<span style="font-size: large;">Other kinds of resistance than weights may be applied</span></div>
<div style="color: #2f2a2b; font-family: Helvetica; text-align: center;">
<span style="font-size: large;">in order to increase muscular strength, like elastic</span></div>
<div style="color: #2f2a2b; font-family: Helvetica; text-align: center;">
<span style="font-size: large;">bands, or friction, as in water or on a steady bike. In fact,</span></div>
<div style="color: #2f2a2b; font-family: Helvetica; text-align: center;">
<span style="font-size: large;">gravity is not necessarily present (e.g. astronauts during</span></div>
<div style="color: #2f2a2b; font-family: Helvetica; text-align: center;">
<span style="font-size: large;">space missions are at risk of losing considerable amounts</span></div>
<div style="color: #2f2a2b; font-family: Helvetica; text-align: center;">
<span style="font-size: large;">of muscle mass19,20) or not fully applicable. Orthopedics</span></div>
<div style="color: #2f2a2b; font-family: Helvetica; text-align: center;">
<span style="font-size: large;">patients may have access to a swimming pool, where the</span></div>
<div style="color: #2f2a2b; font-family: Helvetica; text-align: center;">
<span style="font-size: large;">weight-bearing effort of an injured knee, ankle or hip can</span></div>
<div style="color: #2f2a2b; font-family: Helvetica; text-align: center;">
<span style="font-size: large;">be reduced. At the same time, also competitive swimmers</span></div>
<div style="color: #2f2a2b; font-family: Helvetica; text-align: center;">
<span style="font-size: large;">may use swim paddles to increase the resistance provided</span></div>
<div style="color: #2f2a2b; font-family: Helvetica; text-align: center;">
<span style="font-size: large;">by water.</span></div>
<div style="color: #2f2a2b; font-family: Helvetica; text-align: center;">
<span style="font-size: large;">Exercises are usually performed in sets of several repetitions</span></div>
<div style="color: #2f2a2b; font-family: Helvetica; text-align: center;">
<span style="font-size: large;">(i.e. consecutive lifts). If heavy loads are employed,</span></div>
<div style="color: #2f2a2b; font-family: Helvetica; text-align: center;">
<span style="font-size: large;">providing stimulus for maximal strength, then</span></div>
<div style="color: #2f2a2b; font-family: Helvetica; text-align: center;">
<span style="font-size: large;">repetitions are necessarily low in numbers. When the</span></div>
<div style="color: #2f2a2b; font-family: Helvetica; text-align: center;">
<span style="font-size: large;">load is moderate, in order to improve body composition</span></div>
<div style="color: #2f2a2b; font-family: Helvetica; text-align: center;">
<span style="font-size: large;">and cardiovascular fitness, then the overall number of</span></div>
<div style="color: #2f2a2b; font-family: Helvetica; text-align: center;">
<span style="font-size: large;">repetitions can be considerably high. The main training</span></div>
<div style="color: #2f2a2b; font-family: Helvetica; text-align: center;">
<span style="font-size: large;">parameters are intensity and volume. Intensity is given</span></div>
<div style="color: #2f2a2b; font-family: Helvetica; text-align: center;">
<span style="font-size: large;">as percentage of the maximal load which can be lifted for</span></div>
<div style="color: #2f2a2b; font-family: Helvetica; text-align: center;">
<span style="font-size: large;">the prescribed number of repetitions: 1 repetition-maximum</span></div>
<div style="color: #2f2a2b; font-family: Helvetica; text-align: center;">
<span style="font-size: large;">(RM) is the load which can be lifted just once, 10</span></div>
<div style="color: #2f2a2b; font-family: Helvetica; text-align: center;">
<span style="font-size: large;">RM is the load which can be lifted 10 times within one</span></div>
<div style="color: #2f2a2b; font-family: Helvetica; text-align: center;">
<span style="font-size: large;">set. Strength training implies relatively heavy loads, between</span></div>
<div style="color: #2f2a2b; font-family: Helvetica; text-align: center;">
<span style="font-size: large;">60% and 100% of 1 RM, the so-called »strength</span></div>
<div style="color: #2f2a2b; font-family: Helvetica; text-align: center;">
<span style="font-size: large;">training zone«21. For example, the 90% of 1 RM is a quasi</span></div>
<div style="color: #2f2a2b; font-family: Helvetica; text-align: center;">
<span style="font-size: large;">maximal load, allowing for small volume (i.e. low repetitions).</span></div>
<div style="color: #2f2a2b; font-family: Helvetica; text-align: center;">
<span style="font-size: large;">Volume is the total number of repetitions per exercise.</span></div>
<div style="color: #2f2a2b; font-family: Helvetica; text-align: center;">
<span style="font-size: large;">For example, performing 3 sets of 10 repetitions in</span></div>
<div style="color: #2f2a2b; font-family: Helvetica; text-align: center;">
<span style="font-size: large;">one given exercise determines a volume of 30 repetitions.</span></div>
<div style="color: #2f2a2b; font-family: Helvetica; text-align: center;">
<span style="font-size: large;">D. Barbieri and L. Zaccagni: Resistance Training before and during Adolescence, Coll. Antropol. <b>37 </b>(2013) Suppl. 2: 219–225</span></div>
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<span style="font-size: large;">221</span></div>
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<span style="font-size: large;">The most common strength training exercises are</span></div>
<div style="color: #2f2a2b; font-family: Helvetica; text-align: center;">
<span style="font-size: large;">listed in Table 1, with the discipline in which they are</span></div>
<div style="color: #2f2a2b; font-family: Helvetica; text-align: center;">
<span style="font-size: large;">usually practiced, even if in most cases athletes involved</span></div>
<div style="color: #2f2a2b; font-family: Helvetica; text-align: center;">
<span style="font-size: large;">in different sports may use a blend of them. This is especially</span></div>
<div style="color: #2f2a2b; font-family: Helvetica; text-align: center;">
<span style="font-size: large;">true in body building, where the overall balanced</span></div>
<div style="color: #2f2a2b; font-family: Helvetica; text-align: center;">
<span style="font-size: large;">development of muscle mass is of great importance.</span></div>
<div style="color: #2f2a2b; font-family: Helvetica; text-align: center;">
<span style="font-size: large;">Therefore, body builders use most of the listed exercises</span></div>
<div style="color: #2f2a2b; font-family: Helvetica; text-align: center;">
<span style="font-size: large;">(and even more than those), while strength training for</span></div>
<div style="color: #2f2a2b; font-family: Helvetica; text-align: center;">
<span style="font-size: large;">athletes usually comprises a small set of exercises, like</span></div>
<div style="color: #2f2a2b; font-family: Helvetica; text-align: center;">
<span style="font-size: large;">the clean, the squat and the bench press, involving most</span></div>
<div style="color: #2f2a2b; font-family: Helvetica; text-align: center;">
<span style="font-size: large;">skeletal muscles in a coordinated fashion.</span></div>
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<b><span style="font-size: large;">Benefits and Risks of Strength Training</span></b></div>
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<b><span style="font-size: large;">for Children and Adolescents</span></b></div>
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<span style="font-size: large;">For reasons which have been mainly reported anecdotally,</span></div>
<div style="color: #2f2a2b; font-family: Helvetica; text-align: center;">
<span style="font-size: large;">strength training, especially if involving weight</span></div>
<div style="color: #2f2a2b; font-family: Helvetica; text-align: center;">
<span style="font-size: large;">lifting, has been considered dangerous for children and</span></div>
<div style="color: #2f2a2b; font-family: Helvetica; text-align: center;">
<span style="font-size: large;">adolescents, and at risk of limiting their growth. However,</span></div>
<div style="color: #2f2a2b; font-family: Helvetica; text-align: center;">
<span style="font-size: large;">the American College of Sports Medicine highlights</span></div>
<div style="color: #2f2a2b; font-family: Helvetica; text-align: center;">
<span style="font-size: large;">that there is no current scientific evidence of the fact</span></div>
<div style="color: #2f2a2b; font-family: Helvetica; text-align: center;">
<span style="font-size: large;">that strength training and weight lifting are inherently</span></div>
<div style="color: #2f2a2b; font-family: Helvetica; text-align: center;">
<span style="font-size: large;">dangerous or can restrain the growth of children and adolescents.</span></div>
<div style="color: #2f2a2b; font-family: Helvetica; text-align: center;">
<span style="font-size: large;">Like any other kind of sport practice, there are</span></div>
<div style="color: #2f2a2b; font-family: Helvetica; text-align: center;">
<span style="font-size: large;">some risks which can be considerably diminished following</span></div>
<div style="color: #2f2a2b; font-family: Helvetica; text-align: center;">
<span style="font-size: large;">a small set of suggestions: proper supervision form</span></div>
<div style="color: #2f2a2b; font-family: Helvetica; text-align: center;">
<span style="font-size: large;">an expert adult, warm up and stretching before lifting,</span></div>
<div style="color: #2f2a2b; font-family: Helvetica; text-align: center;">
<span style="font-size: large;">focus on proper form rather than load, gradual resistance</span></div>
<div style="color: #2f2a2b; font-family: Helvetica; text-align: center;">
<span style="font-size: large;">increases as technique, strength and control improve22.</span></div>
<div style="color: #2f2a2b; font-family: Helvetica; text-align: center;">
<span style="font-size: large;">The American Academy of Pediatrics gives comparable</span></div>
<div style="color: #2f2a2b; font-family: Helvetica; text-align: center;">
<span style="font-size: large;">guidelines, implying that strength training can be</span></div>
<div style="color: #2f2a2b; font-family: Helvetica; text-align: center;">
<span style="font-size: large;">safe and effective for children and adolescents, provided</span></div>
<div style="color: #2f2a2b; font-family: Helvetica; text-align: center;">
<span style="font-size: large;">that medical clearance is granted. At the same time, it</span></div>
<div style="color: #2f2a2b; font-family: Helvetica; text-align: center;">
<span style="font-size: large;">discourages them from practicing sports, like Olympic</span></div>
<div style="color: #2f2a2b; font-family: Helvetica; text-align: center;">
<span style="font-size: large;">weightlifting and powerlifting, which involve maximal</span></div>
<div style="color: #2f2a2b; font-family: Helvetica; text-align: center;">
<span style="font-size: large;">lifts23–25.</span></div>
<div style="color: #2f2a2b; font-family: Helvetica; text-align: center;">
<span style="font-size: large;">A similar position has been taken by the National</span></div>
<div style="color: #2f2a2b; font-family: Helvetica; text-align: center;">
<span style="font-size: large;">Strength and Conditioning Association, which is in favor</span></div>
<div style="color: #2f2a2b; font-family: Helvetica; text-align: center;">
<span style="font-size: large;">of supervised and appropriately prescribed strength</span></div>
<div style="color: #2f2a2b; font-family: Helvetica; text-align: center;">
<span style="font-size: large;">training for both pre-adolescents and adolescents26.</span></div>
<div style="color: #2f2a2b; font-family: Helvetica; text-align: center;">
<span style="font-size: large;">In strength training, the gains in muscular strength</span></div>
<div style="color: #2f2a2b; font-family: Helvetica; text-align: center;">
<span style="font-size: large;">are often associated with improvements in body composition.</span></div>
<div style="color: #2f2a2b; font-family: Helvetica; text-align: center;">
<span style="font-size: large;">In a study by Faigenbuam et al.27 a group of boys</span></div>
<div style="color: #2f2a2b; font-family: Helvetica; text-align: center;">
<span style="font-size: large;">and girls aged between 8 and 12 followed a twice-a-week</span></div>
<div style="color: #2f2a2b; font-family: Helvetica; text-align: center;">
<span style="font-size: large;">resistance training program for 8 weeks. After warm up</span></div>
<div style="color: #2f2a2b; font-family: Helvetica; text-align: center;">
<span style="font-size: large;">and stretching, the training group performed the following</span></div>
<div style="color: #2f2a2b; font-family: Helvetica; text-align: center;">
<span style="font-size: large;">5 exercises: leg extension, leg curl, bench press, overhead</span></div>
<div style="color: #2f2a2b; font-family: Helvetica; text-align: center;">
<span style="font-size: large;">press and biceps curl. Both training and control</span></div>
<div style="color: #2f2a2b; font-family: Helvetica; text-align: center;">
<span style="font-size: large;">groups continued physical education at school. As expected,</span></div>
<div style="color: #2f2a2b; font-family: Helvetica; text-align: center;">
<span style="font-size: large;">strength gains in the training group were significant</span></div>
<div style="color: #2f2a2b; font-family: Helvetica; text-align: center;">
<span style="font-size: large;">compared to both pre-training and control. Also improvements</span></div>
<div style="color: #2f2a2b; font-family: Helvetica; text-align: center;">
<span style="font-size: large;">in body composition were significant:</span></div>
<div style="color: #2f2a2b; font-family: Helvetica; text-align: center;">
<span style="font-size: large;">skinfold thickness decreased of 2.3% on average, compared</span></div>
<div style="color: #2f2a2b; font-family: Helvetica; text-align: center;">
<span style="font-size: large;">to an increase of 1.7% in control group. It is interesting</span></div>
<div style="color: #2f2a2b; font-family: Helvetica; text-align: center;">
<span style="font-size: large;">to note that upper arm, chest and hip girths did</span></div>
<div style="color: #2f2a2b; font-family: Helvetica; text-align: center;">
<span style="font-size: large;">not change significantly. The only exception was the</span></div>
<div style="color: #2f2a2b; font-family: Helvetica; text-align: center;">
<span style="font-size: large;">thigh girth, which anyway increased relatively less than</span></div>
<div style="color: #2f2a2b; font-family: Helvetica; text-align: center;">
<span style="font-size: large;">control (+2.4% <i>vs</i>. +3.9%).</span></div>
<div style="color: #2f2a2b; font-family: Helvetica; text-align: center;">
<span style="font-size: large;">The volume-intensity schema adopted was the popular</span></div>
<div style="color: #2f2a2b; font-family: Helvetica; text-align: center;">
<span style="font-size: large;">Delorme method: 3 sets of 10 repetitions each, the</span></div>
<div style="color: #2f2a2b; font-family: Helvetica; text-align: center;">
<span style="font-size: large;">first one with 50% of 10 RM, the second one with 75% of</span></div>
<div style="color: #2f2a2b; font-family: Helvetica; text-align: center;">
<span style="font-size: large;">10 RM and the third one with 100% of 10 RM. Delorme</span></div>
<div style="color: #2f2a2b; font-family: Helvetica; text-align: center;">
<span style="font-size: large;">was among the first physicians who realized the importance</span></div>
<div style="color: #2f2a2b; font-family: Helvetica; text-align: center;">
<span style="font-size: large;">of strength training – and weight lifting in particular</span></div>
<div style="color: #2f2a2b; font-family: Helvetica; text-align: center;">
<span style="font-size: large;">– in rehabilitation after injuries28.</span></div>
<div style="color: #2f2a2b; font-family: Helvetica; text-align: center;">
<span style="font-size: large;">A similar pyramiding method was adopted in a study</span></div>
<div style="color: #2f2a2b; font-family: Helvetica; text-align: center;">
<span style="font-size: large;">by Schwingshandl et al.29. Obese children and adolescents</span></div>
<div style="color: #2f2a2b; font-family: Helvetica; text-align: center;">
<span style="font-size: large;">were prescribed a diet with caloric restriction. Unfortunately,</span></div>
<div style="color: #2f2a2b; font-family: Helvetica; text-align: center;">
<span style="font-size: large;">diet alone may reduce both fat and fat free</span></div>
<div style="color: #2f2a2b; font-family: Helvetica; text-align: center;">
<span style="font-size: large;">mass. Subjects were therefore divided into 2 groups:</span></div>
<div style="color: #2f2a2b; font-family: Helvetica; text-align: center;">
<span style="font-size: large;">training and control. After some light aerobics and stretching</span></div>
<div style="color: #2f2a2b; font-family: Helvetica; text-align: center;">
<span style="font-size: large;">as a warm up, the training group performed 3 to 4</span></div>
<div style="color: #2f2a2b; font-family: Helvetica; text-align: center;">
<span style="font-size: large;">sets, 10 repetitions each, of the prescribed exercises,</span></div>
<div style="color: #2f2a2b; font-family: Helvetica; text-align: center;">
<span style="font-size: large;">which were chosen to involve all major muscle groups.</span></div>
<div style="color: #2f2a2b; font-family: Helvetica; text-align: center;">
<span style="font-size: large;">The first set was performed using the 50% of 10 RM.</span></div>
<div style="color: #2f2a2b; font-family: Helvetica; text-align: center;">
<span style="font-size: large;">Load was increased progressively in each set, until muscle</span></div>
<div style="color: #2f2a2b; font-family: Helvetica; text-align: center;">
<span style="font-size: large;">failure because of fatigue. When the child was able to</span></div>
<div style="color: #2f2a2b; font-family: Helvetica; text-align: center;">
<span style="font-size: large;">complete more than the prescribed 10 repetitions in the</span></div>
<div style="color: #2f2a2b; font-family: Helvetica; text-align: center;">
<span style="font-size: large;">last set, the load was increased in the following training</span></div>
<div style="color: #2f2a2b; font-family: Helvetica; text-align: center;">
<span style="font-size: large;">session. After 12 weeks, weight change was not significant</span></div>
<div style="color: #2f2a2b; font-family: Helvetica; text-align: center;">
<span style="font-size: large;">in both groups, while the increase in fat free mass</span></div>
<div style="color: #2f2a2b; font-family: Helvetica; text-align: center;">
<span style="font-size: large;">was significantly higher in the training group than in</span></div>
<div style="color: #2f2a2b; font-family: Helvetica; text-align: center;">
<span style="font-size: large;">control, implying that resistance training may have a</span></div>
<div style="color: #2f2a2b; font-family: Helvetica; text-align: center;">
<span style="font-size: large;">positive effect on body composition in fat reduction programs</span></div>
<div style="color: #2f2a2b; font-family: Helvetica; text-align: center;">
<span style="font-size: large;">for obese children and adolescents.</span></div>
<div style="color: #2f2a2b; font-family: Helvetica; text-align: center;">
<span style="font-size: large;">Supervised strength training, involving weight lifting</span></div>
<div style="color: #2f2a2b; font-family: Helvetica; text-align: center;">
<span style="font-size: large;">(bench press, leg extension, lat pull down etc.) and stretching,</span></div>
<div style="color: #2f2a2b; font-family: Helvetica; text-align: center;">
<span style="font-size: large;">after an adequate warm up, has proved to be effective</span></div>
<div style="color: #2f2a2b; font-family: Helvetica; text-align: center;">
<span style="font-size: large;">in a group of children, males and females, increasing</span></div>
<div style="color: #2f2a2b; font-family: Helvetica; text-align: center;">
<span style="font-size: large;">strength, reducing skinfold thickness, improving</span></div>
<div style="color: #2f2a2b; font-family: Helvetica; text-align: center;">
<span style="font-size: large;">body composition, motor skills and flexibility30.</span></div>
<div style="color: #2f2a2b; font-family: Helvetica; text-align: center;">
<span style="font-size: large;">In a study by Watts et al.31 obese adolescents were involved</span></div>
<div style="color: #2f2a2b; font-family: Helvetica; text-align: center;">
<span style="font-size: large;">for 8 weeks in a strength training program consisting</span></div>
<div style="color: #2f2a2b; font-family: Helvetica; text-align: center;">
<span style="font-size: large;">in 1 hour of circuit training, 3 times per week, including</span></div>
<div style="color: #2f2a2b; font-family: Helvetica; text-align: center;">
<span style="font-size: large;">both cycle ergometer and resistance training.</span></div>
<div style="color: #2f2a2b; font-family: Helvetica; text-align: center;">
<span style="font-size: large;">Since the program was primarily designed to treat obesity</span></div>
<div style="color: #2f2a2b; font-family: Helvetica; text-align: center;">
<span style="font-size: large;">rather than improving strength, exercise intensity</span></div>
<div style="color: #2f2a2b; font-family: Helvetica; text-align: center;">
<span style="font-size: large;">was kept between 55–70% of pre-training 1 RM. Training</span></div>
<div style="color: #2f2a2b; font-family: Helvetica; text-align: center;">
<span style="font-size: large;">reduced abdominal and trunk fat, thus diminishing cardiovascular</span></div>
<div style="color: #2f2a2b; font-family: Helvetica; text-align: center;">
<span style="font-size: large;">and metabolic risks, and increased strength,</span></div>
<div style="color: #2f2a2b; font-family: Helvetica; text-align: center;">
<span style="font-size: large;">body composition and overall fitness at the same time.</span></div>
<div style="color: #2f2a2b; font-family: Helvetica; text-align: center;">
<span style="font-size: large;">Even if the main purpose of strength training is to increase</span></div>
<div style="color: #2f2a2b; font-family: Helvetica; text-align: center;">
<span style="font-size: large;">muscle strength, it seems to have a positive carry</span></div>
<div style="color: #2f2a2b; font-family: Helvetica; text-align: center;">
<span style="font-size: large;">D. Barbieri and L. Zaccagni: Resistance Training before and during Adolescence, Coll. Antropol. <b>37 </b>(2013) Suppl. 2: 219–225</span></div>
<div style="color: #2f2a2b; font-family: Helvetica; text-align: center;">
<span style="font-size: large;">222</span></div>
<div style="color: #2f2a2b; font-family: Helvetica; text-align: center;">
<b><span style="font-size: large;">TABLE 1</span></b></div>
<div style="color: #2f2a2b; font-family: Helvetica; text-align: center;">
<span style="font-size: large;">COMMON STRENGTH TRAINING EXERCISES</span></div>
<div style="color: #2f2a2b; font-family: Helvetica; text-align: center;">
<span style="font-size: large;">Olympic</span></div>
<div style="color: #2f2a2b; font-family: Helvetica; text-align: center;">
<span style="font-size: large;">weightlifting</span></div>
<div style="color: #2f2a2b; font-family: Helvetica; text-align: center;">
<span style="font-size: large;">Powerlifting Body</span></div>
<div style="color: #2f2a2b; font-family: Helvetica; text-align: center;">
<span style="font-size: large;">building</span></div>
<div style="color: #2f2a2b; font-family: Helvetica; text-align: center;">
<span style="font-size: large;">Body weight</span></div>
<div style="color: #2f2a2b; font-family: Helvetica; text-align: center;">
<span style="font-size: large;">training</span></div>
<div style="color: #2f2a2b; font-family: Helvetica; text-align: center;">
<span style="font-size: large;">Snatch</span></div>
<div style="color: #2f2a2b; font-family: Helvetica; text-align: center;">
<span style="font-size: large;">Clean and</span></div>
<div style="color: #2f2a2b; font-family: Helvetica; text-align: center;">
<span style="font-size: large;">jerk</span></div>
<div style="color: #2f2a2b; font-family: Helvetica; text-align: center;">
<span style="font-size: large;">Squat</span></div>
<div style="color: #2f2a2b; font-family: Helvetica; text-align: center;">
<span style="font-size: large;">Bench press</span></div>
<div style="color: #2f2a2b; font-family: Helvetica; text-align: center;">
<span style="font-size: large;">Deadlift</span></div>
<div style="color: #2f2a2b; font-family: Helvetica; text-align: center;">
<span style="font-size: large;">Overhead</span></div>
<div style="color: #2f2a2b; font-family: Helvetica; text-align: center;">
<span style="font-size: large;">presses</span></div>
<div style="color: #2f2a2b; font-family: Helvetica; text-align: center;">
<span style="font-size: large;">Biceps curls</span></div>
<div style="color: #2f2a2b; font-family: Helvetica; text-align: center;">
<span style="font-size: large;">Leg extensions</span></div>
<div style="color: #2f2a2b; font-family: Helvetica; text-align: center;">
<span style="font-size: large;">Leg curls</span></div>
<div style="color: #2f2a2b; font-family: Helvetica; text-align: center;">
<span style="font-size: large;">Rowers</span></div>
<div style="color: #2f2a2b; font-family: Helvetica; text-align: center;">
<span style="font-size: large;">Push ups</span></div>
<div style="color: #2f2a2b; font-family: Helvetica; text-align: center;">
<span style="font-size: large;">Pull ups</span></div>
<div style="color: #2f2a2b; font-family: Helvetica; text-align: center;">
<span style="font-size: large;">Parallel dips</span></div>
<div style="color: #2f2a2b; font-family: Helvetica; text-align: center;">
<span style="font-size: large;">Body weight</span></div>
<div style="color: #2f2a2b; font-family: Helvetica; text-align: center;">
<span style="font-size: large;">squats</span></div>
<div style="color: #2f2a2b; font-family: Helvetica; text-align: center;">
<span style="font-size: large;">One-leg squats</span></div>
<div style="color: #2f2a2b; font-family: Helvetica; text-align: center;">
<span style="font-size: large;">Sit ups</span></div>
<div style="color: #2f2a2b; font-family: Helvetica; text-align: center;">
<span style="font-size: large;">over also in bone density and therefore it qualifies as an</span></div>
<div style="color: #2f2a2b; font-family: Helvetica; text-align: center;">
<span style="font-size: large;">interesting means for preventing and reducing osteoporosis.</span></div>
<div style="color: #2f2a2b; font-family: Helvetica; text-align: center;">
<span style="font-size: large;">This is particularly true for children: if strength</span></div>
<div style="color: #2f2a2b; font-family: Helvetica; text-align: center;">
<span style="font-size: large;">training is adopted early, bone mass gains last longer.</span></div>
<div style="color: #2f2a2b; font-family: Helvetica; text-align: center;">
<span style="font-size: large;">Skeletal exposure to mechanical loading during growth</span></div>
<div style="color: #2f2a2b; font-family: Helvetica; text-align: center;">
<span style="font-size: large;">seems to be an effective strategy to increase bone mass</span></div>
<div style="color: #2f2a2b; font-family: Helvetica; text-align: center;">
<span style="font-size: large;">and density, according to Khan et al.32. In a study by</span></div>
<div style="color: #2f2a2b; font-family: Helvetica; text-align: center;">
<span style="font-size: large;">Fuchs et al.33, high impact training is used to verify its efficacy</span></div>
<div style="color: #2f2a2b; font-family: Helvetica; text-align: center;">
<span style="font-size: large;">in improving skeletal mass in a group of elementary</span></div>
<div style="color: #2f2a2b; font-family: Helvetica; text-align: center;">
<span style="font-size: large;">school children. Bone mineral content, bone area</span></div>
<div style="color: #2f2a2b; font-family: Helvetica; text-align: center;">
<span style="font-size: large;">and bone mineral density were adopted as indices of bone</span></div>
<div style="color: #2f2a2b; font-family: Helvetica; text-align: center;">
<span style="font-size: large;">health. The training protocol consisted in 100 drop</span></div>
<div style="color: #2f2a2b; font-family: Helvetica; text-align: center;">
<span style="font-size: large;">jumps form a 61 cm box, 3 times per week for 7 months,</span></div>
<div style="color: #2f2a2b; font-family: Helvetica; text-align: center;">
<span style="font-size: large;">implying ground reaction forces up to 8 times body</span></div>
<div style="color: #2f2a2b; font-family: Helvetica; text-align: center;">
<span style="font-size: large;">weight. However, the adopted method proved to be safe</span></div>
<div style="color: #2f2a2b; font-family: Helvetica; text-align: center;">
<span style="font-size: large;">and effective in improving the above mentioned parameters</span></div>
<div style="color: #2f2a2b; font-family: Helvetica; text-align: center;">
<span style="font-size: large;">at the femoral neck and lumbar spine. Actually, in a</span></div>
<div style="color: #2f2a2b; font-family: Helvetica; text-align: center;">
<span style="font-size: large;">popular sport like gymnastics, impact forces in drop</span></div>
<div style="color: #2f2a2b; font-family: Helvetica; text-align: center;">
<span style="font-size: large;">landings range from 8.2 to 11.6 times body weight, according</span></div>
<div style="color: #2f2a2b; font-family: Helvetica; text-align: center;">
<span style="font-size: large;">to a study by Ozguven and Berme34.</span></div>
<div style="color: #2f2a2b; font-family: Helvetica; text-align: center;">
<span style="font-size: large;">Even if the authors say that the program could be introduced</span></div>
<div style="color: #2f2a2b; font-family: Helvetica; text-align: center;">
<span style="font-size: large;">in physical education classes, its main limitation</span></div>
<div style="color: #2f2a2b; font-family: Helvetica; text-align: center;">
<span style="font-size: large;">may be in the fact that high-impact training may result</span></div>
<div style="color: #2f2a2b; font-family: Helvetica; text-align: center;">
<span style="font-size: large;">in an excessive effort for overweight children. Still,</span></div>
<div style="color: #2f2a2b; font-family: Helvetica; text-align: center;">
<span style="font-size: large;">in the training group no injuries occurred during the</span></div>
<div style="color: #2f2a2b; font-family: Helvetica; text-align: center;">
<span style="font-size: large;">whole duration of the study. Actually, selected children</span></div>
<div style="color: #2f2a2b; font-family: Helvetica; text-align: center;">
<span style="font-size: large;">had to be within the 20% of the recommended weight for</span></div>
<div style="color: #2f2a2b; font-family: Helvetica; text-align: center;">
<span style="font-size: large;">height and age. The benefits at the femoral neck persisted</span></div>
<div style="color: #2f2a2b; font-family: Helvetica; text-align: center;">
<span style="font-size: large;">even after several months of detraining, when the</span></div>
<div style="color: #2f2a2b; font-family: Helvetica; text-align: center;">
<span style="font-size: large;">same bone health parameters were re-assessed in both</span></div>
<div style="color: #2f2a2b; font-family: Helvetica; text-align: center;">
<span style="font-size: large;">exercise and control group35.</span></div>
<div style="color: #2f2a2b; font-family: Helvetica; text-align: center;">
<span style="font-size: large;">Significant positive effects of impact training on bone</span></div>
<div style="color: #2f2a2b; font-family: Helvetica; text-align: center;">
<span style="font-size: large;">mineral content at the hip was also found by Gunter et</span></div>
<div style="color: #2f2a2b; font-family: Helvetica; text-align: center;">
<span style="font-size: large;">al.36 in a longitudinal study. The benefits of 7 months of</span></div>
<div style="color: #2f2a2b; font-family: Helvetica; text-align: center;">
<span style="font-size: large;">impact training on a group of school children were partially</span></div>
<div style="color: #2f2a2b; font-family: Helvetica; text-align: center;">
<span style="font-size: large;">maintained up to 8 years later.</span></div>
<div style="color: #2f2a2b; font-family: Helvetica; text-align: center;">
<span style="font-size: large;">Osteoporosis is a major problem especially for adult</span></div>
<div style="color: #2f2a2b; font-family: Helvetica; text-align: center;">
<span style="font-size: large;">women. Even if considerable improvements in terms of</span></div>
<div style="color: #2f2a2b; font-family: Helvetica; text-align: center;">
<span style="font-size: large;">bone health can be assessed in adults engaging in some</span></div>
<div style="color: #2f2a2b; font-family: Helvetica; text-align: center;">
<span style="font-size: large;">form of strength training, the benefits do not seem to</span></div>
<div style="color: #2f2a2b; font-family: Helvetica; text-align: center;">
<span style="font-size: large;">persist as long as in children or adolescents, suggesting</span></div>
<div style="color: #2f2a2b; font-family: Helvetica; text-align: center;">
<span style="font-size: large;">that early inception of intense physical exercise may be</span></div>
<div style="color: #2f2a2b; font-family: Helvetica; text-align: center;">
<span style="font-size: large;">prescribed for long-lasting improvements. A study by</span></div>
<div style="color: #2f2a2b; font-family: Helvetica; text-align: center;">
<span style="font-size: large;">Winters and Snow37 assessed bone mineral density in a</span></div>
<div style="color: #2f2a2b; font-family: Helvetica; text-align: center;">
<span style="font-size: large;">group of females aged 30–45, before and after a 12 month</span></div>
<div style="color: #2f2a2b; font-family: Helvetica; text-align: center;">
<span style="font-size: large;">training period. The training program included both</span></div>
<div style="color: #2f2a2b; font-family: Helvetica; text-align: center;">
<span style="font-size: large;">high impact and resistance training (squats, lunges and</span></div>
<div style="color: #2f2a2b; font-family: Helvetica; text-align: center;">
<span style="font-size: large;">calf raises). Drop jumps off a box generated ground reaction</span></div>
<div style="color: #2f2a2b; font-family: Helvetica; text-align: center;">
<span style="font-size: large;">forces of 4 to 5 times body weight. Intensity was</span></div>
<div style="color: #2f2a2b; font-family: Helvetica; text-align: center;">
<span style="font-size: large;">gradually increased using weighted vests. After the training</span></div>
<div style="color: #2f2a2b; font-family: Helvetica; text-align: center;">
<span style="font-size: large;">period, exercisers improved their bone mineral density</span></div>
<div style="color: #2f2a2b; font-family: Helvetica; text-align: center;">
<span style="font-size: large;">and strength significantly, with respect to both baseline</span></div>
<div style="color: #2f2a2b; font-family: Helvetica; text-align: center;">
<span style="font-size: large;">(pre-training) and control values. Unfortunately</span></div>
<div style="color: #2f2a2b; font-family: Helvetica; text-align: center;">
<span style="font-size: large;">though, after 6 months of detraining, values decreased</span></div>
<div style="color: #2f2a2b; font-family: Helvetica; text-align: center;">
<span style="font-size: large;">significantly towards baseline values.</span></div>
<div style="color: #2f2a2b; font-family: Helvetica; text-align: center;">
<span style="font-size: large;">A study by Kannus et al.38 evaluated the effects of</span></div>
<div style="color: #2f2a2b; font-family: Helvetica; text-align: center;">
<span style="font-size: large;">playing starting age on bone mineral content of the dominant</span></div>
<div style="color: #2f2a2b; font-family: Helvetica; text-align: center;">
<span style="font-size: large;">arm in a group of female tennis players. Athletes</span></div>
<div style="color: #2f2a2b; font-family: Helvetica; text-align: center;">
<span style="font-size: large;">had a significantly higher difference in bone mineral content</span></div>
<div style="color: #2f2a2b; font-family: Helvetica; text-align: center;">
<span style="font-size: large;">between dominant and non-dominant arm compared</span></div>
<div style="color: #2f2a2b; font-family: Helvetica; text-align: center;">
<span style="font-size: large;">to control. The difference was 2 to 4 times greater</span></div>
<div style="color: #2f2a2b; font-family: Helvetica; text-align: center;">
<span style="font-size: large;">in individuals who had started playing tennis before or at</span></div>
<div style="color: #2f2a2b; font-family: Helvetica; text-align: center;">
<span style="font-size: large;">menarche, compared to those who had started 15 years</span></div>
<div style="color: #2f2a2b; font-family: Helvetica; text-align: center;">
<span style="font-size: large;">after menarche. Tennis resembles strength training and</span></div>
<div style="color: #2f2a2b; font-family: Helvetica; text-align: center;">
<span style="font-size: large;">may carry over similar effects on the bones since it consists</span></div>
<div style="color: #2f2a2b; font-family: Helvetica; text-align: center;">
<span style="font-size: large;">of ballistic and explosive movements, handling a</span></div>
<div style="color: #2f2a2b; font-family: Helvetica; text-align: center;">
<span style="font-size: large;">light implement. Even if the involved masses are small</span></div>
<div style="color: #2f2a2b; font-family: Helvetica; text-align: center;">
<span style="font-size: large;">(ball and racquet), the acceleration produced during the</span></div>
<div style="color: #2f2a2b; font-family: Helvetica; text-align: center;">
<span style="font-size: large;">impact may be very large, producing great force against</span></div>
<div style="color: #2f2a2b; font-family: Helvetica; text-align: center;">
<span style="font-size: large;">the dominant arm.</span></div>
<div style="color: #2f2a2b; font-family: Helvetica; text-align: center;">
<span style="font-size: large;">Similar positive effects on bone mineral density of female</span></div>
<div style="color: #2f2a2b; font-family: Helvetica; text-align: center;">
<span style="font-size: large;">gymnasts were found by Proctor et al.39 in the</span></div>
<div style="color: #2f2a2b; font-family: Helvetica; text-align: center;">
<span style="font-size: large;">whole body and in particular in the upper limbs, without</span></div>
<div style="color: #2f2a2b; font-family: Helvetica; text-align: center;">
<span style="font-size: large;">any significant bilateral differences, which is a major advantage</span></div>
<div style="color: #2f2a2b; font-family: Helvetica; text-align: center;">
<span style="font-size: large;">compared to tennis. Gymnastics exercises, like</span></div>
<div style="color: #2f2a2b; font-family: Helvetica; text-align: center;">
<span style="font-size: large;">pull ups and ring or parallel dips, are often employed in</span></div>
<div style="color: #2f2a2b; font-family: Helvetica; text-align: center;">
<span style="font-size: large;">body weight strength training, for their carry over to upper</span></div>
<div style="color: #2f2a2b; font-family: Helvetica; text-align: center;">
<span style="font-size: large;">body muscle strength.</span></div>
<div style="color: #2f2a2b; font-family: Helvetica; text-align: center;">
<span style="font-size: large;">Swimming and cycling are among the most popular</span></div>
<div style="color: #2f2a2b; font-family: Helvetica; text-align: center;">
<span style="font-size: large;">sports and bring several health benefits. However, bones</span></div>
<div style="color: #2f2a2b; font-family: Helvetica; text-align: center;">
<span style="font-size: large;">seem to be less directly addressed by these activities, because</span></div>
<div style="color: #2f2a2b; font-family: Helvetica; text-align: center;">
<span style="font-size: large;">of their non-weight-bearing nature, which limits</span></div>
<div style="color: #2f2a2b; font-family: Helvetica; text-align: center;">
<span style="font-size: large;">the loading on the skeleton. A group of well trained adolescent</span></div>
<div style="color: #2f2a2b; font-family: Helvetica; text-align: center;">
<span style="font-size: large;">females (track and field athletes, gymnasts and</span></div>
<div style="color: #2f2a2b; font-family: Helvetica; text-align: center;">
<span style="font-size: large;">water polo players) were assessed by Greene et al.40. Although</span></div>
<div style="color: #2f2a2b; font-family: Helvetica; text-align: center;">
<span style="font-size: large;">all the selected sports require intense physical</span></div>
<div style="color: #2f2a2b; font-family: Helvetica; text-align: center;">
<span style="font-size: large;">work, gymnastics involves weight-bearing in both the upper</span></div>
<div style="color: #2f2a2b; font-family: Helvetica; text-align: center;">
<span style="font-size: large;">and lower body, track-and-field (sprints and jumps)</span></div>
<div style="color: #2f2a2b; font-family: Helvetica; text-align: center;">
<span style="font-size: large;">only in the lower body, and water polo has no weight-</span></div>
<div style="color: #2f2a2b; font-family: Helvetica; text-align: center;">
<span style="font-size: large;">-bearing component. Water polo players did not show</span></div>
<div style="color: #2f2a2b; font-family: Helvetica; text-align: center;">
<span style="font-size: large;">greater bone strength or muscle size in the lower leg</span></div>
<div style="color: #2f2a2b; font-family: Helvetica; text-align: center;">
<span style="font-size: large;">compared to controls. On the contrary, gymnasts showed</span></div>
<div style="color: #2f2a2b; font-family: Helvetica; text-align: center;">
<span style="font-size: large;">significantly greater bone strength than non active females.</span></div>
<div style="color: #2f2a2b; font-family: Helvetica; text-align: center;">
<span style="font-size: large;">Also track-and-field athletes displayed greater</span></div>
<div style="color: #2f2a2b; font-family: Helvetica; text-align: center;">
<span style="font-size: large;">bone strength in the lower leg, compared to controls. The</span></div>
<div style="color: #2f2a2b; font-family: Helvetica; text-align: center;">
<span style="font-size: large;">gymnasts showed the greatest musculoskeletal benefits</span></div>
<div style="color: #2f2a2b; font-family: Helvetica; text-align: center;">
<span style="font-size: large;">in the upper body. Despite intense training, water polo</span></div>
<div style="color: #2f2a2b; font-family: Helvetica; text-align: center;">
<span style="font-size: large;">players showed no significant benefits in musculoskeletal</span></div>
<div style="color: #2f2a2b; font-family: Helvetica; text-align: center;">
<span style="font-size: large;">health in the lower body and only limited benefits in</span></div>
<div style="color: #2f2a2b; font-family: Helvetica; text-align: center;">
<span style="font-size: large;">the upper body when compared with non active girls.</span></div>
<div style="color: #2f2a2b; font-family: Helvetica; text-align: center;">
<span style="font-size: large;">Ferry et al.41 investigated bone mineral density in female</span></div>
<div style="color: #2f2a2b; font-family: Helvetica; text-align: center;">
<span style="font-size: large;">adolescent soccer players, swimmers and control</span></div>
<div style="color: #2f2a2b; font-family: Helvetica; text-align: center;">
<span style="font-size: large;">group. Bone mineral density was significantly higher in</span></div>
<div style="color: #2f2a2b; font-family: Helvetica; text-align: center;">
<span style="font-size: large;">soccer players compared with swimmers. In contrast,</span></div>
<div style="color: #2f2a2b; font-family: Helvetica; text-align: center;">
<span style="font-size: large;">swimmers had weaker bones than controls, despite the</span></div>
<div style="color: #2f2a2b; font-family: Helvetica; text-align: center;">
<span style="font-size: large;">fact that female swimmers cannot be considered sedentary</span></div>
<div style="color: #2f2a2b; font-family: Helvetica; text-align: center;">
<span style="font-size: large;">subjects.</span></div>
<div style="color: #2f2a2b; font-family: Helvetica; text-align: center;">
<span style="font-size: large;">Effects of strength training on connective tissues (ligaments</span></div>
<div style="color: #2f2a2b; font-family: Helvetica; text-align: center;">
<span style="font-size: large;">and tendons in particular) have not been as</span></div>
<div style="color: #2f2a2b; font-family: Helvetica; text-align: center;">
<span style="font-size: large;">widely assessed as those on bones. However, a recent</span></div>
<div style="color: #2f2a2b; font-family: Helvetica; text-align: center;">
<span style="font-size: large;">study42 has found a positive correlation between resistance</span></div>
<div style="color: #2f2a2b; font-family: Helvetica; text-align: center;">
<span style="font-size: large;">training (in particular Olympic weightlifting) and</span></div>
<div style="color: #2f2a2b; font-family: Helvetica; text-align: center;">
<span style="font-size: large;">cruciate ligaments’ cross sectional areas. The authors</span></div>
<div style="color: #2f2a2b; font-family: Helvetica; text-align: center;">
<span style="font-size: large;">conclusions are that the benefits were induced by early</span></div>
<div style="color: #2f2a2b; font-family: Helvetica; text-align: center;">
<span style="font-size: large;">inception of heavy training at the age of puberty.</span></div>
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<span style="font-size: large;">D. Barbieri and L. Zaccagni: Resistance Training before and during Adolescence, Coll. Antropol. <b>37 </b>(2013) Suppl. 2: 219–225</span></div>
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<span style="font-size: large;">223</span></div>
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<b><span style="font-size: large;">Discussion and Conclusions</span></b></div>
<div style="color: #2f2a2b; font-family: Helvetica; text-align: center;">
<span style="font-size: large;">An meaningful distinction should be made between</span></div>
<div style="color: #2f2a2b; font-family: Helvetica; text-align: center;">
<span style="font-size: large;">weight lifting for strength training and Olympic weightlifting.</span></div>
<div style="color: #2f2a2b; font-family: Helvetica; text-align: center;">
<span style="font-size: large;">The latter implies competitions in which maximal</span></div>
<div style="color: #2f2a2b; font-family: Helvetica; text-align: center;">
<span style="font-size: large;">or even supra-maximal (when the lift fails) loads are employed,</span></div>
<div style="color: #2f2a2b; font-family: Helvetica; text-align: center;">
<span style="font-size: large;">as in powerlifting. In strength training instead,</span></div>
<div style="color: #2f2a2b; font-family: Helvetica; text-align: center;">
<span style="font-size: large;">sub-maximal weights, which can be lifted more than</span></div>
<div style="color: #2f2a2b; font-family: Helvetica; text-align: center;">
<span style="font-size: large;">once, are used. This distinction may account for a different</span></div>
<div style="color: #2f2a2b; font-family: Helvetica; text-align: center;">
<span style="font-size: large;">risk factor between the aforementioned disciplines.</span></div>
<div style="color: #2f2a2b; font-family: Helvetica; text-align: center;">
<span style="font-size: large;">In general, whenever a maximal effort is required, as in</span></div>
<div style="color: #2f2a2b; font-family: Helvetica; text-align: center;">
<span style="font-size: large;">competitive sport, it is believed that risks tend to be present</span></div>
<div style="color: #2f2a2b; font-family: Helvetica; text-align: center;">
<span style="font-size: large;">in a higher percentage than in recreational activities.</span></div>
<div style="color: #2f2a2b; font-family: Helvetica; text-align: center;">
<span style="font-size: large;">More specifically, even if strength training may be strenuous</span></div>
<div style="color: #2f2a2b; font-family: Helvetica; text-align: center;">
<span style="font-size: large;">and intense, if no maximal loads are employed, than</span></div>
<div style="color: #2f2a2b; font-family: Helvetica; text-align: center;">
<span style="font-size: large;">it can be considered a safe and effective form of physical</span></div>
<div style="color: #2f2a2b; font-family: Helvetica; text-align: center;">
<span style="font-size: large;">activity for most individuals, including children and adolescents,</span></div>
<div style="color: #2f2a2b; font-family: Helvetica; text-align: center;">
<span style="font-size: large;">provided that proper instruction and supervision</span></div>
<div style="color: #2f2a2b; font-family: Helvetica; text-align: center;">
<span style="font-size: large;">are given.</span></div>
<div style="color: #2f2a2b; font-family: Helvetica; text-align: center;">
<span style="font-size: large;">However, a study by Hamill43 questions the common</span></div>
<div style="color: #2f2a2b; font-family: Helvetica; text-align: center;">
<span style="font-size: large;">belief that resistance training is safer than Olympic</span></div>
<div style="color: #2f2a2b; font-family: Helvetica; text-align: center;">
<span style="font-size: large;">weightlifting, since both appear to be relatively safe according</span></div>
<div style="color: #2f2a2b; font-family: Helvetica; text-align: center;">
<span style="font-size: large;">to his findings, especially if compared to other</span></div>
<div style="color: #2f2a2b; font-family: Helvetica; text-align: center;">
<span style="font-size: large;">sports. The surveyed subjects were UK students, aged 13</span></div>
<div style="color: #2f2a2b; font-family: Helvetica; text-align: center;">
<span style="font-size: large;">to 16. Practicing both Olympic weightlifting and weight</span></div>
<div style="color: #2f2a2b; font-family: Helvetica; text-align: center;">
<span style="font-size: large;">training had an injury rate of only 0.0012 per 100 participation</span></div>
<div style="color: #2f2a2b; font-family: Helvetica; text-align: center;">
<span style="font-size: large;">hours. Individually, both disciplines scored well</span></div>
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<span style="font-size: large;">below other popular British sports, like soccer, rugby or</span></div>
<div style="color: #2f2a2b; font-family: Helvetica; text-align: center;">
<span style="font-size: large;">even athletics.</span></div>
<div style="color: #2f2a2b; font-family: Helvetica; text-align: center;">
<span style="font-size: large;">In a study by Risser et al.44 muscle strain, a non-disabling</span></div>
<div style="color: #2f2a2b; font-family: Helvetica; text-align: center;">
<span style="font-size: large;">injury, was reported to be the most common accident</span></div>
<div style="color: #2f2a2b; font-family: Helvetica; text-align: center;">
<span style="font-size: large;">among high school American football players practicing</span></div>
<div style="color: #2f2a2b; font-family: Helvetica; text-align: center;">
<span style="font-size: large;">weight lifting as a form of strength training. The</span></div>
<div style="color: #2f2a2b; font-family: Helvetica; text-align: center;">
<span style="font-size: large;">cumulative percentage of injuries among all athletes was</span></div>
<div style="color: #2f2a2b; font-family: Helvetica; text-align: center;">
<span style="font-size: large;">a reasonable 7.6%, corresponding to 0.082 injuries per</span></div>
<div style="color: #2f2a2b; font-family: Helvetica; text-align: center;">
<span style="font-size: large;">person/year. Much higher rates can be found in adolescent45</span></div>
<div style="color: #2f2a2b; font-family: Helvetica; text-align: center;">
<span style="font-size: large;">or amateur46 soccer players. However, the study</span></div>
<div style="color: #2f2a2b; font-family: Helvetica; text-align: center;">
<span style="font-size: large;">did not specify whether injuries were caused by maximal</span></div>
<div style="color: #2f2a2b; font-family: Helvetica; text-align: center;">
<span style="font-size: large;">lifts (i.e. excessive load) or poor form, as it may happen in</span></div>
<div style="color: #2f2a2b; font-family: Helvetica; text-align: center;">
<span style="font-size: large;">a competitive environment, where fatigue and strive for</span></div>
<div style="color: #2f2a2b; font-family: Helvetica; text-align: center;">
<span style="font-size: large;">performance may lead to an excessive demand on the</span></div>
<div style="color: #2f2a2b; font-family: Helvetica; text-align: center;">
<span style="font-size: large;">athlete's physical capabilities.</span></div>
<div style="color: #2f2a2b; font-family: Helvetica; text-align: center;">
<span style="font-size: large;">The topic of growth and strength training could be</span></div>
<div style="color: #2f2a2b; font-family: Helvetica; text-align: center;">
<span style="font-size: large;">further assessed from an endocrine point of view, considering</span></div>
<div style="color: #2f2a2b; font-family: Helvetica; text-align: center;">
<span style="font-size: large;">the relationship between exercise and hormonal responses.</span></div>
<div style="color: #2f2a2b; font-family: Helvetica; text-align: center;">
<span style="font-size: large;">A review by Kraemer and Ratamess47 highlights</span></div>
<div style="color: #2f2a2b; font-family: Helvetica; text-align: center;">
<span style="font-size: large;">the well established finding that resistance training and</span></div>
<div style="color: #2f2a2b; font-family: Helvetica; text-align: center;">
<span style="font-size: large;">growth hormone are positively correlated, but further research</span></div>
<div style="color: #2f2a2b; font-family: Helvetica; text-align: center;">
<span style="font-size: large;">is needed in order to verify whether strength</span></div>
<div style="color: #2f2a2b; font-family: Helvetica; text-align: center;">
<span style="font-size: large;">training could induce positive endocrine responses in adolescents.</span></div>
<div style="color: #2f2a2b; font-family: Helvetica; text-align: center;">
<span style="font-size: large;">In conclusion, early inception of strength training, at</span></div>
<div style="color: #2f2a2b; font-family: Helvetica; text-align: center;">
<span style="font-size: large;">adolescence or even earlier, does not seem to imply higher</span></div>
<div style="color: #2f2a2b; font-family: Helvetica; text-align: center;">
<span style="font-size: large;">risks than other popular sport disciplines, provided</span></div>
<div style="color: #2f2a2b; font-family: Helvetica; text-align: center;">
<span style="font-size: large;">that the young athletes follow the aforementioned guidelines.</span></div>
<div style="color: #2f2a2b; font-family: Helvetica; text-align: center;">
<span style="font-size: large;">In particular, supervision by an expert instructor,</span></div>
<div style="color: #2f2a2b; font-family: Helvetica; text-align: center;">
<span style="font-size: large;">focus on proper technique and cautious progression in increasing</span></div>
<div style="color: #2f2a2b; font-family: Helvetica; text-align: center;">
<span style="font-size: large;">loads are the most common advices which must</span></div>
<div style="color: #2f2a2b; font-family: Helvetica; text-align: center;">
<span style="font-size: large;">be adhered to. On the positive side, resistance training</span></div>
<div style="color: #2f2a2b; font-family: Helvetica; text-align: center;">
<span style="font-size: large;">has proved to increase basic motor skills, like muscle</span></div>
<div style="color: #2f2a2b; font-family: Helvetica; text-align: center;">
<span style="font-size: large;">strength, coordination and flexibility, but also body composition,</span></div>
<div style="color: #2f2a2b; font-family: Helvetica; text-align: center;">
<span style="font-size: large;">in terms of improved fat free to fat mass ratio</span></div>
<div style="color: #2f2a2b; font-family: Helvetica; text-align: center;">
<span style="font-size: large;">and increased bone health.</span></div>
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MD Endocrinology MSc Medical Anthropologyhttp://www.blogger.com/profile/09396525904668204911noreply@blogger.comtag:blogger.com,1999:blog-4087917327935431869.post-36069445903403621302014-02-21T01:50:00.002-08:002014-02-21T01:50:06.959-08:00LOWER VITAMIN D AS YET ANOTHER INFLAMMATORY MARKER FOR CARDIOMETABOLIC DISEASES <div dir="ltr" style="text-align: left;" trbidi="on">
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Published: 20 February 2014</div>
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Abstract (provisional)</h3>
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Background</h4>
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A plasma glucose value >=155 mg/dl for 1-hour post-load plasma glucose during an oral glucose tolerance test (OGTT) is able to identify subjects with normal glucose tolerance (NGT) at high-risk for type-2 diabetes and with subclinical organ damage. We designed this study to address if 25-hydroxyvitamin D [25(OH)D] circulating levels are associated with glucose tolerance status, and in particular with 1-hour post-load plasma glucose levels.</div>
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Methods</h4>
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We enrolled 300 consecutive Caucasian hypertensive never-treated outpatients (160 men and 140 women, aged 52.9 +/- 9.2 years) Subjects underwent OGTT and measurements of 25(OH)D and standard laboratory tests. Estimated glomerular filtration rate (e-GFR) was calculated by CKD-Epi formula and insulin sensitivity was assessed by Matsuda-index.</div>
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Results</h4>
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Among participants, 230 were NGT, 44 had impaired glucose tolerance (IGT) and 26 had type-2 diabetes. According to 1-h post-load plasma glucose cut-off point of 155 mg/dL, we divided NGT subjects into: NGT < 155 (n = 156) and NGT > 155 mg/dL (n = 74).</div>
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NGT >= 155 had higher significant fasting and post-load glucose and insulin, parathyroid hormone and hs-CRP levels than NGT < 155. On the contrary, Matsuda-index, e-GFR, and 25(OH)D were significantly lower in NGT > 155 than NGT < 155 subjects. In the multiple regression analysis, 25(OH)D levels resulted the major determinant of 1-h post-load plasma glucose in all population and in the four groups of glucose tolerance status. In the whole population, Matsuda-index, hs-CRP and e-GFR explained another 12.2%, 6.7% and 1.7% of its variation.</div>
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Conclusions</h4>
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Our data demonstrate a significant and inverse relationship between 25(OH)D levels and glucose tolerance status, particularly with 1-h post-load glucose.</div>
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MD Endocrinology MSc Medical Anthropologyhttp://www.blogger.com/profile/09396525904668204911noreply@blogger.comtag:blogger.com,1999:blog-4087917327935431869.post-86871151392023039692013-03-28T08:06:00.003-07:002013-03-28T08:06:50.519-07:00IT IS ALL IN THE GUTS<div dir="ltr" style="text-align: left;" trbidi="on">
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<b>A study conducted in collaboration with researchers at Harvard-affiliated Massachusetts General Hospital hints at a future where doctors could deliver the weight-loss benefits of gastric bypass surgery without the surgery. In a study described in a March 27 paper in Science Translational Medicine, researchers found that the surgery caused drastic changes to microbes in the guts of mice. When those microbes were transferred into the guts of sterile mice, the result was rapid weight loss.</b></div>
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<b>“Simply by colonizing mice with the altered microbial community, the mice were able to maintain a lower body fat, and lose weight — about 20 percent as much as they would if they underwent surgery,” said Peter Turnbaugh, a Bauer Fellow at the Faculty of Arts and Sciences’ <a href="http://sysbio.harvard.edu/csb/index.html" style="border: 0px; color: #0283a0; font-family: inherit; font-style: inherit; margin: 0px; outline: 0px; padding: 0px; text-decoration: none; vertical-align: baseline;">Center for Systems Biology</a>, and one of two senior authors of the paper.</b></div>
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<b>As striking as the results were, they weren’t as dramatic as they might have been.</b></div>
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<b>“In some ways we were biasing the results against weight loss,” Turnbaugh said, explaining that the mice used in the study hadn’t been given a high-fat, high-sugar diet to increase their weight beforehand. “The question is whether we might have seen a stronger effect if they were on a different diet.”</b></div>
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<b>“Our study suggests that the specific effects of gastric bypass on the microbiota contribute to its ability to cause weight loss, and that finding ways to manipulate microbial populations to mimic those effects could become a valuable new tool to address obesity,” said the other senior author, Lee Kaplan, director of the Obesity, Metabolism & Nutrition Institute at MGH.</b></div>
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<b>“We need to learn a good deal more about the mechanisms by which a microbial population changed by gastric bypass exerts its effects, and then we need to learn if we can produce these effects — either the microbial changes or the associated metabolic changes — without surgery,” added Kaplan, an associate professor of medicine at <a href="http://hms.harvard.edu/" style="border: 0px; color: #0283a0; font-family: inherit; font-style: inherit; margin: 0px; outline: 0px; padding: 0px; text-decoration: none; vertical-align: baseline;">Harvard Medical School</a>. “The ability to achieve even some of these effects without surgery would give us an entirely new way to treat the critical problem of obesity, one that could help patients unable or unwilling to have surgery.”</b></div>
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<b>Turnbaugh warned that it could be years before the research contributes to treatment, and that any procedure tied to it would likely not be for someone looking to lose those stubborn last 10 pounds. Rather, the technique may one day help dangerously obese people who want to lose weight without the trauma of surgery.</b></div>
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<b>“It may not be that we will have a magic pill that will work for everyone who’s slightly overweight,” he said. “But if we can, at a minimum, provide some alternative to gastric bypass surgery that produces similar effects, it would be a major advance.”</b></div>
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<b>While there had been hints that the microbes in the gut might change after bypass surgery, the speed and extent of the change came as a surprise.</b></div>
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<b>In earlier experiments, researchers had shown that the guts of both lean and obese mice were populated by varying amounts of two types of bacteria — firmicutes and bacteroidetes. When mice undergo gastric bypass surgery, however, it “resets the whole picture,” Turnbaugh said.</b></div>
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<b>“The post-bypass community was dominated by proteobacteria and verrucomicrobia, and had relatively low levels of firmicutes,” he said. What’s more, Turnbaugh said, those changes occurred within a week of the surgery, and were lasting — the altered gut microbial community remained stable for months afterward.</b></div>
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<b>There is plenty left to uncover about what exactly is driving the weight loss in mice, the researchers said.</b></div>
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<b>“A major gap in our knowledge is the underlying mechanism linking microbes to weight loss,” Turnbaugh said. “There were certain microbes that we found at higher abundance after surgery, so we think those are good targets for beginning to understand what’s taking place.”</b></div>
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<b>In fact, he said, the answer may not be the specific types of microbes, but a by-product they excrete.</b></div>
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<b>In addition to changes in the microbes found in the gut, researchers found changes in the concentration of certain short-chain fatty acids. Other studies have suggested that those molecules may be critical in signaling to the host to speed up metabolism.</b></div>
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<b>“To some degree, what we’re learning is a comfort for people who have an issue with their weight, because more and more we’re learning that the story is more complicated than just how much you exercise and how much you eat,” Kaplan said.</b></div>
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MD Endocrinology MSc Medical Anthropologyhttp://www.blogger.com/profile/09396525904668204911noreply@blogger.comtag:blogger.com,1999:blog-4087917327935431869.post-26232826880946198682013-02-10T00:44:00.001-08:002013-02-10T00:44:27.774-08:00VITAMIN D AND OBESITY ..Obesity causes vit D deficiency and not the other way around<span style="-webkit-text-size-adjust: none; background-color: white; color: #505050; display: block; float: left; font-family: Arial, Helmet, Freesans, sans-serif; font-size: 14px; line-height: 16px; padding: 13px 0px 8px; width: 290px;"><span style="font-weight: bold; line-height: 16px;">6 February 2013</span> <span style="color: #666666; line-height: 16px;">Last updated at </span><span style="line-height: 16px;">01:45 GMT</span></span><br />
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Study finds obesity can 'lead to lack of vitamin D'</h1>
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<img alt="Obese" class="en-media" height="171" name="a6e29ab8-2146-4f9b-945b-3905e41de31c" src="https://www.evernote.com/shard/s199/res/a6e29ab8-2146-4f9b-945b-3905e41de31c.jpg?resizeSmall&width=800" style="-webkit-user-select: none; border: 0px; font-size: 13px; font-style: italic; height: auto; letter-spacing: 0px; line-height: 16px; margin: 0px 0px 1.286em; max-width: 100%; padding: 0px; position: relative;" width="304" /><span style="display: block; line-height: 16px; width: 304px;">Should obese people be treated for vitamin D deficiency?</span></div>
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Obesity can lower vitamin D levels in the body, a study suggests.</div>
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The report, in the journal PLOS Medicine, analysed genetic data from 21 studies - a total of 42,000 people.</div>
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It found every 10% rise in body mass index (BMI) - used as an indicator of body fat - led to a 4% drop of available vitamin D in the body.</div>
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As vitamin D is stored in fatty tissue, the authors suggest the larger storage capacity in obese people may prevent it from circulating in the bloodstream.</div>
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BMI it is calculated by taking weight (in kilograms) and dividing it by height (in metres) squared. Those with a BMI of 30 or above are considered obese.</div>
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Lead author Dr Elina Hypponen, from the University College London Institute of Child Health, said the study "highlights the importance of monitoring and treating vitamin D deficiency in people who are overweight or obese".</div>
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Vitamin D is made in the skin after sun exposure and can be taken in dietary supplements.</div>
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Healthy levels are about 50 nanomole per litre - less than 30 nanomole per litre can cause the softening and weakening of bones, leading to rickets in children and osteomalacia in adults.</div>
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Prof David Haslam, from the National Obesity Forum, said: "Food intake and genetics all play a part in obesity - but this research is a reminder that physical activity, like walking the dog or going for a run out in the sunshine, shouldn't be forgotten and can help correct both weight and lack of vitamin D."</div>
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MD Endocrinology MSc Medical Anthropologyhttp://www.blogger.com/profile/09396525904668204911noreply@blogger.comtag:blogger.com,1999:blog-4087917327935431869.post-51874113853029097932013-01-25T23:55:00.001-08:002013-01-25T23:55:25.559-08:00I dont use Diuretics for HTN among Native Americans<div dir="ltr" style="text-align: left;" trbidi="on">
<br />
<div class="p1">
<b>Mechanistic Insights into Diuretic-Induced Insulin Resistance</b></div>
<ul class="ul1">
<li class="li2"><b></b><a href="http://hyper.ahajournals.org/search?author1=Suma+Dronavalli&sortspec=date&submit=Submit"><b>Suma Dronavalli</b></a><b>, </b><a href="http://hyper.ahajournals.org/search?author1=George+L.+Bakris&sortspec=date&submit=Submit"><b>George L. Bakris</b></a></li>
</ul>
<div class="p3">
<a href="http://hyper.ahajournals.org/content/52/6/1009.full#"><b>+</b></a></div>
<div class="p4">
Author Affiliations</div>
<div class="p5">
<br /></div>
<ul class="ul1">
<li class="li6">From the Pritzker School of Medicine, Department of Medicine, Hypertensive Diseases Unit, Section of Endocrinology, Diabetes, and Metabolism, University of Chicago, Chicago, Ill.</li>
</ul>
<ul class="ul1">
<li class="li6">Correspondence to George L. Bakris, Hypertensive Diseases Unit, University of Chicago School of Medicine, 5841 S Maryland Ave, MC 1027, Chicago, IL 60637. E-mail <a href="mailto:gbakris@gmail.com"><span class="s1">gbakris@gmail.com</span></a></li>
</ul>
<div class="p4">
The incidence of diabetes mellitus and hypertension continues to rise worldwide. The proportion of patients with hypertension at risk for developing diabetes mellitus is also growing secondary to aging and increased obesity rates.<a href="http://hyper.ahajournals.org/content/52/6/1009.full#ref-1"><span class="s2"><sup>1</sup></span></a> Several guidelines recommend thiazide diuretics as either first-line or add-on antihypertensive therapy to achieve blood pressure goals.<a href="http://hyper.ahajournals.org/content/52/6/1009.full#ref-2"><span class="s2"><sup>2</sup></span></a> Concern over negative metabolic effects associated with thiazide diuretics, however, dates back >3 decades.<a href="http://hyper.ahajournals.org/content/52/6/1009.full#ref-3"><span class="s2"><sup>3</sup></span></a> A substantial fraction of patients with hypertension have additional cardiovascular risk factors, and many have elevated fasting glucose and are at risk for developing diabetes mellitus.<a href="http://hyper.ahajournals.org/content/52/6/1009.full#ref-4"><span class="s2"><sup>4</sup></span></a> Impaired fasting glucose itself increases the risk for cardiovascular events.<a href="http://hyper.ahajournals.org/content/52/6/1009.full#ref-5"><span class="s2"><sup>5</sup></span></a></div>
<div class="p4">
Any medication that worsens insulin sensitivity, ie, thiazide diuretics or most β-blockers will hasten the development of diabetes mellitus in those with impaired fasting glucose.<a href="http://hyper.ahajournals.org/content/52/6/1009.full#ref-6"><span class="s2"><sup>6</sup></span></a> Large observational studies demonstrate that thiazide diuretics and most β-blockers increase the incidence of new-onset diabetes mellitus compared with renin-angiotensin system (RAS) blockers or calcium channel blockers.<a href="http://hyper.ahajournals.org/content/52/6/1009.full#ref-7"><span class="s2"><sup>7</sup></span></a> To further support this observation, a network-based meta-analysis of hypertensive agents showed that RAS blockers were the agents least likely to be associated with the development of diabetes mellitus, whereas thiazides had a higher incidence of diabetes mellitus compared with placebo.<a href="http://hyper.ahajournals.org/content/52/6/1009.full#ref-7"><span class="s2"><sup>7</sup></span></a></div>
<div class="p4">
The mechanism traditionally associated with this increased risk of diuretic-associated diabetes mellitus is a reduction in serum potassium. A meta-analysis of 59 studies involving 83 thiazide diuretic treatment arms found a significant correlation between the degree of diuretic-induced hypokalemia and an increase in plasma glucose.<a href="http://hyper.ahajournals.org/content/52/6/1009.full#ref-8"><span class="s2"><sup>8</sup></span></a> Moreover, there is evidence that prevention of hypokalemia with K<span class="s3"><sup>+</sup></span> supplementation or potassium-sparing agents lessens the degree to which plasma glucose is increased consequent to diuretic therapy.<a href="http://hyper.ahajournals.org/content/52/6/1009.full#ref-8"><span class="s2"><sup>8</sup></span></a> The mechanism of this glucose increase by diuretics may relate to insulin secretion. Mechanisms related to insulin release were reviewed recently, and it was noted that hyperkalemia stimulates insulin secretion and induces cellular uptake of potassium.<a href="http://hyper.ahajournals.org/content/52/6/1009.full#ref-9"><span class="s2"><sup>9</sup></span></a> This suggests that low plasma potassium could impair insulin secretion and thereby increase plasma glucose. Ironically, the significant hypokalemia associated with hyperaldosteronism is not associated with hyperglycemia. The presence of insulin resistance and an impaired glucose response to an oral glucose load, however, are reported in hyperaldosteronism.<a href="http://hyper.ahajournals.org/content/52/6/1009.full#ref-9"><span class="s2"><sup>9</sup></span></a> Thus, the exact relationship between hypokalemia and worsening of insulin resistance is unclear but appears most pronounced in those with preexisting impaired glucose tolerance and not all people.</div>
<div class="p4">
Given this background, combining an agent that reduces potassium loss, ie, an RAS blocker with a thiazide diuretic, should reduce the risk of new-onset diabetes mellitus. Unfortunately, the Study of Trandolapril/Verapamil SR and Insulin Resistance failed to support this hypothesis. It demonstrated a 4-fold increase in diabetes mellitus at 1 year in comparison with a fixed-dose combination of an RAS blocker with a calcium channel blocker.<a href="http://hyper.ahajournals.org/content/52/6/1009.full#ref-10"><span class="s2"><sup>10</sup></span></a> This result was not attributable to differences in serum potassium between groups, because serum potassium values were >4.0 mEq/L in both groups. Thus, mechanisms other than changes in potassium may be operative to worsen glycemic control and are summarized elsewhere.<a href="http://hyper.ahajournals.org/content/52/6/1009.full#ref-9"><span class="s2"><sup>9</sup></span></a></div>
<div class="p4">
One mechanism proposed for the prevention of worsening glycemic control by RAS blockers is their peroxisome proliferator-activated receptor-γ stimulating effects; however, this was not observed in this or any other trial, because candesartan had a neutral effect on glucose.<a href="http://hyper.ahajournals.org/content/52/6/1009.full#ref-11"><span class="s2"><sup>11</sup></span></a> Moreover, the peroxisome proliferator-activated receptor-γ stimulating effect observed by some RAS blockers appears relevant only in animal models or at a cellular level.<a href="http://hyper.ahajournals.org/content/52/6/1009.full#ref-12"><span class="s2"><sup>12</sup></span></a></div>
<div class="p4">
The current study by Eriksson et al<a href="http://hyper.ahajournals.org/content/52/6/1009.full#ref-13"><span class="s2"><sup>13</sup></span></a> provides a potentially novel mechanism by which diuretics worsen insulin resistance. Twenty-six obese, hypertensive subjects were randomly assigned to candesartan, hydrochlorothiazide (HCTZ), or placebo (in random sequence), each for 12 weeks, using a 3-way crossover design. Insulin sensitivity and secretion, hepatic fat accumulation, inflammatory markers, and the ratio of subcutaneous:visceral abdominal fat were measured. Insulin sensitivity was assessed using a hyperinsulinemic, euglycemic clamp. Significant reductions in insulin sensitivity were present with HCTZ compared with candesartan. Serum potassium levels were within the normal range in all of the groups but 0.3 mEq/L lower among those randomly assigned to HCTZ. The authors reported that differences in potassium level between groups did not correlate with changes in insulin sensitivity. The epidemiological data, however, suggest that the risk for new-onset diabetes mellitus is increased if the serum potassium levels fall below 3.5 mEq/L<a href="http://hyper.ahajournals.org/content/52/6/1009.full#ref-7"><span class="s2"><sup>7,9</sup></span></a>; levels in the current study were well above this value.</div>
<div class="p4">
Perhaps the most interesting finding in this study was the increase in hepatic fat content after treatment with HCTZ; this fat increase correlated with the magnitude of insulin sensitivity decrease. Insulin secretion was not affected by HCTZ or candesartan, despite older studies implying decreased insulin secretion with HCTZ as the mechanism for worsened metabolic control.<a href="http://hyper.ahajournals.org/content/52/6/1009.full#ref-9"><span class="s2"><sup>9</sup></span></a></div>
<div class="p4">
Given this new information, an additional mechanism to explain why thiazide diuretics worsen insulin resistance needs consideration. Before we embrace this concept, however, one needs to ask why this occurred. The increased shift of fat in liver, with resultant relative increases in visceral adiposity, is an intriguing perspective of this study. Hepatic fat accumulation is associated with insulin resistance, at the level of liver and skeletal muscle.<a href="http://hyper.ahajournals.org/content/52/6/1009.full#ref-14"><span class="s2"><sup>14</sup></span></a> The changes in content of visceral and hepatic fat could contribute to worsening of insulin sensitivity, but which occurs first? Is it possible that decreased insulin sensitivity and elevated insulin levels promote hepatic fat storage and visceral fat accumulation? In the Mechanisms for the Diabetes Preventing Effect of Candesartan Study, there was some correlation (<i>r</i><span class="s3"><sup>2</sup></span>=0.26; <i>P</i>=0.04) between the increased hepatic fat content and the observed decrease in insulin sensitivity.<a href="http://hyper.ahajournals.org/content/52/6/1009.full#ref-13"><span class="s2"><sup>13</sup></span></a></div>
<div class="p4">
Other possible mechanisms that contributed to decreases in insulin sensitivity include increased inflammatory response or oxidative stress with diuretics, resulting in altered adipocyte activity.<a href="http://hyper.ahajournals.org/content/52/6/1009.full#ref-15"><span class="s2"><sup>15</sup></span></a> Inflammatory markers, such as high-sensitivity C-reactive protein and serum amyloid A, were higher in the diuretic group compared with the other groups. Changes in adiponectin levels may have also contributed to this shift in fat; however, adiponectin levels were not different between groups. Thus, there is no clear reason why this shift in fat occurred with HCTZ, but, if confirmed, this would provide another reason for the higher risk of new-onset diabetes.</div>
<div class="p4">
Apart from the cost and inconvenience of new medications now required to treat the diabetes mellitus, the main concern is whether the cardiovascular risk–reduction that diuretics confer is lost in this subgroup of obese older patients who prematurely develop diabetes mellitus. Three posthoc analyses of large cardiovascular outcome trials evaluated whether the development of new-onset diabetes mellitus predicted a higher cardiovascular event rate.<a href="http://hyper.ahajournals.org/content/52/6/1009.full#ref-16"><span class="s2"><sup>16–18</sup></span></a> The results of 2 these analyses demonstrated no significant increase in risk, whereas another showed that those who developed diabetes mellitus had an intermediate cardiovascular risk less than those with diabetes mellitus but higher than those who did not develop diabetes mellitus.<a href="http://hyper.ahajournals.org/content/52/6/1009.full#ref-18"><span class="s2"><sup>18</sup></span></a> These analyses have major limitations, however, not the least of which is that they are posthoc, and most people in the analysis were not obese. There is, however, one ongoing trial that will address this issue and is due to be completed by 2010.<a href="http://hyper.ahajournals.org/content/52/6/1009.full#ref-19"><span class="s2"><sup>19</sup></span></a></div>
<div class="p4">
In short, thiazide diuretics are associated with decreased insulin sensitivity over a relatively short time period in obese subjects with impaired fasting glucose. The mechanisms by which this occurs appear to be multifactorial. The current study provides new data to help us understand the interaction between thiazide diuretics and the adipocyte. This information, coupled with the results of a large multicentered cardiovascular outcome study that favors RAS blockade combined with a calcium channel blocker rather than a diuretic, may provide an option other than diuretics as initial agents in high-risk patients.<a href="http://hyper.ahajournals.org/content/52/6/1009.full#ref-20"><span class="s2"><sup>20</sup></span></a> Nevertheless, more detailed mechanistic studies are needed to explain further why insulin resistance is worsened with thiazide diuretics.</div>
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<li class="li10">The opinions expressed in this editorial are not necessarily those of the editors or of the American Heart Association. </li>
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<b>References</b></div>
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MD Endocrinology MSc Medical Anthropologyhttp://www.blogger.com/profile/09396525904668204911noreply@blogger.comtag:blogger.com,1999:blog-4087917327935431869.post-61662385849173835202013-01-04T06:53:00.001-08:002013-01-04T06:53:37.994-08:00Corn syrup/Fructose Eat it and be FAT<br />
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Consuming fructose appears to cause changes in the brain that may lead to overeating, a new study suggests.</div>
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"Increases in fructose consumption have paralleled the increasing prevalence of obesity, and high-fructose diets are thought to promote weight gain and insulin resistance," lead author Kathleen A. Page, MD, and colleagues from Yale University in New Haven, Connecticut, write.</div>
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In this study, they showed in healthy volunteers that although glucose ingestion resulted in reduced activation of the hypothalamus, insula, and striatum on MRI — areas that regulate appetite, motivation, and reward processing — as well as increased functional connections between the hypothalamic striatal network and increased satiety. Fructose ingestion had none of these effects.</div>
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"The disparate responses to fructose were associated with reduced systemic levels of the satiety-signaling hormone insulin and were not likely attributable to an inability of fructose to cross the blood-brain barrier into the hypothalamus or to a lack of hypothalamic expression of genes necessary for fructose metabolism," they conclude.</div>
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Their findings <a href="http://jama.jamanetwork.com/article.aspx?articleID=1555133" style="color: #5757a6; text-decoration: initial;" target="_blank">are published</a> in the January 2 issue of the Journal of the American Medical Association.</div>
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<b>Glucose vs Fructose</b></div>
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Fructose ingestion produces smaller increases in circulating satiety hormones compared with glucose ingestion, and central administration of fructose provokes feeding in rodents, whereas centrally administered glucose promotes satiety, the authors write. "Thus, fructose possibly increases food-seeking behavior and increases food intake."</div>
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In this study, the researchers used arterial spin labeling MRI to quantify regional cerebral blood flow in 20 healthy normal-weight adult volunteers before and after drinking a 75-g beverage of pure glucose or fructose.</div>
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They observed that glucose (but not fructose) ingestion reduced activation of the hypothalamus, insula, and striatum. Glucose ingestion also increased functional connections between the hypothalamic-striatal network and increased ratings of satiety and fullness.</div>
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Brain responses were markedly different after ingestion of an equal amount of fructose. Not only did fructose fail to diminish hypothalamic activity, but it also induced a small, transient increase in hypothalamic activity.</div>
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The striatum, as with the hypothalamus, also did not deactivate with fructose ingestion, which may cause decreased inhibitory responses. Fructose ingestion was also associated with reduced systemic levels of the satiety-signaling hormone insulin.</div>
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<b>Appetite Regulation</b></div>
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"These findings support the conceptual framework that when the human brain is exposed to fructose, neurobiological pathways involved in appetite regulation are modulated, thereby promoting increased food intake," Jonathan Q. Purnell, MD, and Damien A. Fair, PhD, from Oregon Health & Science University, Portland, write in an <a href="http://jama.jamanetwork.com/article.aspx?articleid=1555104" style="color: #5757a6; text-decoration: initial;" target="_blank">accompanying editorial</a>.</div>
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They say the implications of this study, coupled with mounting evidence from epidemiologic, metabolic feeding, and animal studies, are that the "advances in food processing and economic forces leading to increased intake of added sugar and accompanying fructose in U.S. society are indeed extending the supersizing concept to the population's collective waistlines."</div>
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<em>The study was supported in part by grants from the National Institutes of Health and the Yale Center for Clinical Investigation. The authors and editorialists have disclosed no relevant financial relationships.</em></div>
MD Endocrinology MSc Medical Anthropologyhttp://www.blogger.com/profile/09396525904668204911noreply@blogger.comtag:blogger.com,1999:blog-4087917327935431869.post-3176132797007391352013-01-03T09:31:00.001-08:002013-01-03T09:31:44.920-08:00INFANT MORTALITY IN CUBA<br />
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<span style="background-color: white; color: #222222; font-family: verdana, arial, helvetica, sans-serif; font-size: 10pt;"><b>Cuba Maintains Infant Mortality Rate under Five </b> <div>
<br />HAVANA, Cuba, Jan 3 (ACN) For five years in a row, Cuba has reported its infant mortality rate at less than five deaths in every one thousand live births, with 4.6 in 2012. The achievement reveals the human development level reached by the country.</div>
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<br />According to Granma newspaper, the important indicator reached only 4.7 in 2008; 4.8 in 2010; 4.5 in 2011 and 4.6 in 2012.</div>
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<br />This public health achievement makes Cuba one of the countries with the lowest infant mortality rates in the Americas and it is the result of the Cuban government’s political will and decision to maintain free of charge and accessible health services for all citizens, the paper explains.</div>
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<br />The lowest infant mortality level was reported in central Sancti Spiritus province, with only 2.8, while another four territories reported indicators below the 4.6 national rate, such as Artemisa (west), 3.8; Holguin (east) and Cienfuegos (Center) both with 3.9; and Granma (east), 4.1.</div>
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<br />Preliminary statistics released on Wednesday by the Public Health Ministry say that some 125 thousand 661 births took place in 2012, seven thousand 406 less births than in 2011.</div>
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<br />The major cause for death in children below one year of age is the infection during the delivery process, particularly infections linked to premature babies, who are born before the 34th week.</div>
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<br />Medical specialists told Granma newspaper that the rate of low weight at birth was kept at 6 percent in 2012, which is a favorable level, they said. This means that only six babies in every 100 births weigh less than 2500 grams (5.5 pounds). However, 3.8 percent of children still are born before complete pregnancy period.</div>
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<br />The infant mortality rate is a demographic indicator telling the number of deaths of children before the first year of living, which is the most critical period in human survival. The indicator is an international tool to measure the quality of the assistance given to children in every country.</div>
</span>MD Endocrinology MSc Medical Anthropologyhttp://www.blogger.com/profile/09396525904668204911noreply@blogger.comtag:blogger.com,1999:blog-4087917327935431869.post-43608852329872360632013-01-03T07:59:00.001-08:002013-01-03T07:59:38.309-08:00HEALTH RISKS OF ENERGY DRINKS<br />
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<span id="scm6MainContent_lblArticleTitle" style="border: 0px; font-size: 27px; font: inherit; margin: 0px; padding: 0px; vertical-align: baseline;"><br class="Apple-interchange-newline" />Energy Drinks</span> <span class="flag freeArticle" id="scm6MainContent_lblFreeArticle" style="background-color: #a40002; background-image: -webkit-linear-gradient(top, rgb(215, 22, 53), rgb(164, 0, 2)); background-repeat: repeat no-repeat; border: 0px; color: white; font-size: 0.625em; font-weight: bold; font: inherit; line-height: 2em; margin: 0px 0px 0px 0.5em; padding: 0.2em 0.5em; position: relative; text-transform: uppercase; top: -0.15em; vertical-align: baseline; word-wrap: normal;">FREE</span> <span class="flag onlineFirst" id="scm6MainContent_lblOnlineFirst" style="background-color: #666666; background-image: -webkit-linear-gradient(top, rgb(153, 153, 153), rgb(102, 102, 102)); background-repeat: repeat no-repeat; border: 0px; color: white; font-size: 0.625em; font-weight: bold; font: inherit; line-height: 2em; margin: 0px 0px 0px 0.5em; padding: 0.2em 0.5em; position: relative; text-transform: uppercase; top: -0.15em; vertical-align: baseline; word-wrap: normal;">ONLINE FIRST</span></h1>
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<span class="authorNames" id="scm6MainContent_lblAuthors" style="border: 0px; font-size: 15px; font: inherit; margin: 0px; padding: 0px; vertical-align: baseline;">Janet M. Torpy, MD; Edward H. Livingston, MD</span></div>
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Beverages called energy drinks are popular, especially with teenagers and young adults. These energy drinks are advertised to give individuals a higher energy level, to make a person feel more awake, and to boost attention span.</div>
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Energy drinks are marketed in different serving sizes and have varying amounts of caffeine. Sodas (also known as pop, colas, or soft drinks) may contain sugar and caffeine, although most sodas contain less caffeine than energy drinks on an ounce-by-ounce basis. As a comparison, an 8-oz cup of coffee has about 100 mg of caffeine (see table at right, and expanded table online at <a class="externalLink" href="http://www.jama.com/" style="border: 0px; color: #3399cc; cursor: pointer; font-size: 15px; font-style: italic; font: inherit; margin: 0px; padding: 0px; vertical-align: baseline;" target="_blank">www.jama.com</a>). The January 16, 2013, issue of <em style="border: 0px; font-size: 15px; font: inherit; margin: 0px; padding: 0px; vertical-align: baseline;">JAMA</em> contains 2 articles discussing the harms associated with energy drinks.<a href="http://jama.jamanetwork.com/article.aspx?articleid=1487122#jpg120082fa" style="border: 0px; color: #3399cc; cursor: pointer; font-size: 15px; font: inherit; margin: 0px; padding: 0px; vertical-align: baseline;" xmlns:ml="http://www.w3.org/1998/Math/MathML"></a></div>
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<span id="scm6MainContent_rptSections_lblSectionTitle_3" style="border: 0px; font-size: 25px; font: inherit; margin: 0px; padding: 0px; vertical-align: baseline;">COMMON INGREDIENTS IN ENERGY DRINKS</span></h2>
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Caffeine</div>
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Sugar</div>
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Guarana (a plant with seeds that contain caffeine)</div>
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Cocoa</div>
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B vitamins</div>
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Herbs, including ginseng, licorice, and kola nut</div>
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<span id="scm6MainContent_rptSections_lblSectionTitle_5" style="border: 0px; font-size: 25px; font: inherit; margin: 0px; padding: 0px; vertical-align: baseline;">HEALTH RISKS ASSOCIATED WITH ENERGY DRINKS</span></h2>
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Increased heart rate</div>
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Irregular heart rate and palpitations</div>
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Increased blood pressure</div>
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Sleep disturbances, including insomnia</div>
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<strong style="border: 0px; font-size: 14px; font: inherit; margin: 0px; padding: 0px; vertical-align: baseline;">Diuresis</strong> (increased urine production)</div>
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<strong style="border: 0px; font-size: 14px; font: inherit; margin: 0px; padding: 0px; vertical-align: baseline;">Hyperglycemia</strong> (increased blood sugar) is related to all beverages with high sugar content. This can be harmful for individuals with diabetes or other metabolic health problems.</div>
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The American Academy of Pediatrics recommends that young children should not consume energy drinks. Caffeine may be especially harmful for children. Adolescents should not have more than 100 mg of caffeine each day. Parents should monitor how much soda or coffee (or other beverages containing caffeine, including energy drinks of any kind) their teenagers drink and help them understand the risks associated with taking in large amounts of caffeine.</div>
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Adults should limit their caffeine intake to 500 mg per day. Individuals who have heart problems, high blood pressure, or trouble sleeping or who are taking medications should be careful to limit the amount of caffeine they drink. Older persons may be more sensitive to the effects of caffeine.</div>
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Energy drinks are not regulated by the US Food and Drug Administration. However, the ingredients in energy drinks may be harmful to some individuals. It is important to read labels for any food or drink product that you consume. If you choose to use energy drinks, make sure you understand the ingredients and serving sizes listed on the label.</div>
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MD Endocrinology MSc Medical Anthropologyhttp://www.blogger.com/profile/09396525904668204911noreply@blogger.comtag:blogger.com,1999:blog-4087917327935431869.post-47077087837542040232012-12-22T03:20:00.002-08:002012-12-22T03:20:55.085-08:00DIABETES SELF MANAGEMENT: MEN VS WOMEN<div dir="ltr" style="text-align: left;" trbidi="on">
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Self-management experiences among men and women with type 2 diabetes mellitus: a qualitative analysis</h1>
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<b><span style="border: 0px; font-family: inherit; font-size: 15px; font-style: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">Rebecca Mathew</span>, <span style="border: 0px; font-family: inherit; font-size: 15px; font-style: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">Enza Gucciardi</span>, <span style="border: 0px; font-family: inherit; font-size: 15px; font-style: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">Margaret De Melo</span> and <span style="border: 0px; font-family: inherit; font-size: 15px; font-style: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">Paula Barata</span></b></div>
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<b><em style="border: 0px; font-family: inherit; font-size: 15px; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">BMC Family Practice</em> 2012, <span style="border: 0px; font-family: inherit; font-size: 15px; font-style: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">13</span>:122 <span class="pseudotab" style="border: 0px; font-family: inherit; font-size: 15px; font-style: inherit; margin: 0px 0px 0px 20px; outline: 0px; padding: 0px 5px; vertical-align: baseline;">doi:10.1186/1471-2296-13-122</span></b></div>
<b>Published: 19 December 2012</b></div>
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<b><a href="" name="abstract" style="background-color: white; border: 0px; color: #008b91; font-family: Verdana, Arial, Helvetica, sans-serif; font-size: 15px; line-height: 18px; margin: 0px; outline: 0px; padding: 0px; text-decoration: underline; vertical-align: baseline;"></a></b><h3 style="background-color: white; border-bottom-color: rgb(211, 209, 209); border-bottom-style: solid; border-width: 0px 0px 1px; color: #008b91; font-family: Verdana, Arial, Helvetica, sans-serif; font-size: 1.4em; line-height: 1.2em; margin: 1.5em 0px 0.5em; outline: 0px; padding: 0px 0px 7px; vertical-align: baseline;">
Abstract (provisional)</h3>
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Background</h4>
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<b>The purpose of this study is to better understand differences in diabetes self-management, specifically needs, barriers and challenges among men and women living with type 2 diabetes mellitus (T2DM).</b></div>
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Methods</h4>
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<b>35 participants were recruited from a diabetes education center (DEC) in Toronto, Canada. Five focus groups and nine individual interviews were conducted to explore men and women's diabetes self-management experiences.</b></div>
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Results</h4>
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<b>The average age of participants was 57 years and just over half (51.4%) were female. Analyses revealed five themes: disclosure and identity as a person living with diabetes; self-monitoring of blood glucose (SMBG); diet struggles across varying contexts; utilization of diabetes resources; and social support. Women disclosed their diabetes more readily and integrated management into their daily lives, whereas men were more reluctant to tell friends and family about their diabetes and were less observant of self-management practices in social settings. Men focused on practical aspects of SMBG and experimented with various aspects of management to reduce reliance on medications whereas women focused on affective components of SMBG. Women restricted foods from their diets perceived as prohibited whereas many men moderated their intake of perceived unhealthy foods, except in social situations. Women used socially interactive resources, like education classes and support groups whereas men relied more on self-directed learning but also described wanting more guidance to help navigate the healthcare system. Finally, men and women reported wanting physician support for both affective and practical aspects of self-management.</b></div>
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Conclusions</h4>
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<b>Our findings highlight the differences in needs and challenges of diabetes self-management among men and women, which may inform gender-sensitive diabetes, care, counseling and support.</b></div>
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MD Endocrinology MSc Medical Anthropologyhttp://www.blogger.com/profile/09396525904668204911noreply@blogger.comtag:blogger.com,1999:blog-4087917327935431869.post-68358545485414089792012-12-22T03:18:00.003-08:002012-12-22T03:18:40.081-08:00EXERCISE THERAPY FOR MUSCULOSKELETAL DISEASES<div dir="ltr" style="text-align: left;" trbidi="on">
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Exercise therapy for bone and muscle health: an overview of systematic reviews</h1>
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<strong style="border: 0px; font-family: inherit; font-size: 15px; font-style: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">Kare B Hagen</strong>, <strong style="border: 0px; font-family: inherit; font-size: 15px; font-style: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">Hanne Dagfinrud</strong>, <strong style="border: 0px; font-family: inherit; font-size: 15px; font-style: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">Rikke H Moe</strong>, <strong style="border: 0px; font-family: inherit; font-size: 15px; font-style: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">Nina Osteras</strong>, <strong style="border: 0px; font-family: inherit; font-size: 15px; font-style: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">Ingvild Kjeken</strong>, <strong style="border: 0px; font-family: inherit; font-size: 15px; font-style: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">Margreth Grotle</strong> and <strong style="border: 0px; font-family: inherit; font-size: 15px; font-style: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">Geir Smedslund</strong></div>
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<em style="border: 0px; font-family: inherit; font-size: 15px; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">BMC Medicine</em> 2012, <strong style="border: 0px; font-family: inherit; font-size: 15px; font-style: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">10</strong>:167 <span class="pseudotab" style="border: 0px; font-family: inherit; font-size: 15px; font-style: inherit; margin: 0px 0px 0px 20px; outline: 0px; padding: 0px 5px; vertical-align: baseline;">doi:10.1186/1741-7015-10-167</span></div>
Published: 19 December 2012</div>
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<a href="" name="abstract" style="background-color: white; border: 0px; color: #008b91; font-family: Verdana, Arial, Helvetica, sans-serif; font-size: 15px; line-height: 18px; margin: 0px; outline: 0px; padding: 0px; text-decoration: underline; vertical-align: baseline;"></a><h3 style="background-color: white; border-bottom-color: rgb(211, 209, 209); border-bottom-style: solid; border-width: 0px 0px 1px; color: #008b91; font-family: Verdana, Arial, Helvetica, sans-serif; font-size: 1.4em; line-height: 1.2em; margin: 1.5em 0px 0.5em; outline: 0px; padding: 0px 0px 7px; vertical-align: baseline;">
Abstract (provisional)</h3>
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Background</h4>
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Musculoskeletal conditions (MSCs) are widely prevalent in present-day society, with resultant high healthcare costs and substantial negative effects on patient health and quality of life. The main aim of this overview was to synthesize evidence from systematic reviews on the effects of exercise therapy (ET) on pain and physical function for patients with MSCs. In addition, the evidence for the effect of ET on disease pathogenesis, and whether particular components of exercise programs are associated with the size of the treatment effects, was also explored.</div>
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Methods</h4>
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We included four common conditions: fibromyalgia (FM), low back pain (LBP), neck pain (NP), and shoulder pain (SP), and four specific musculoskeletal diseases: osteoarthritis (OA), rheumatoid arthritis (RA), ankylosing spondylitis (AS), and osteoporosis (OP). We first included Cochrane reviews with the most recent update being January 2007 or later, and then searched for non-Cochrane reviews published after this date. Pain and physical functioning were selected as primary outcomes.</div>
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Results</h4>
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We identified 9 reviews, comprising a total of 224 trials and 24,059 patients. In addition, one review addressing the effect of exercise on pathogenesis was included. Overall, we found solid evidence supporting ET in the management of MSCs, but there were substantial differences in the level of research evidence between the included diagnostic groups. The standardized mean differences for knee OA, LBP, FM, and SP varied between 0.30 and 0.65 and were significantly in favor of exercise for both pain and function. For NP, hip OA, RA, and AS, the effect estimates were generally smaller and not always significant. There was little or no evidence that ET can influence disease pathogenesis. The only exception was for osteoporosis, where there was evidence that ET increases bone mineral density in postmenopausal women, but no significant effects were found for clinically relevant outcomes (fractures). For LBP and knee OA, there was evidence suggesting that the treatment effect increases with the number of exercise sessions.</div>
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Conclusions</h4>
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There is empirical evidence that ET has beneficial clinical effects for most MSCs. Except for osteoporosis, there seems to be a gap in the understanding of the ways in which ET influences disease mechanisms.</div>
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MD Endocrinology MSc Medical Anthropologyhttp://www.blogger.com/profile/09396525904668204911noreply@blogger.comtag:blogger.com,1999:blog-4087917327935431869.post-72992260604593871132012-12-22T03:14:00.001-08:002012-12-22T03:14:07.482-08:00CYCLING AND BONE HEALTH<div dir="ltr" style="text-align: left;" trbidi="on">
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<em style="border: 0px; font-family: inherit; font-size: 15px; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">cine</em> 2012, <strong style="border: 0px; font-family: inherit; font-size: 15px; font-style: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">10</strong>:168 <span class="pseudotab" style="border: 0px; font-family: inherit; font-size: 15px; font-style: inherit; margin: 0px 0px 0px 20px; outline: 0px; padding: 0px 5px; vertical-align: baseline;">doi:10.1186/1741-7015-10-168</span></div>
Published: 20 December 2012</div>
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<a href="" name="abstract" style="background-color: white; border: 0px; color: #008b91; font-family: Verdana, Arial, Helvetica, sans-serif; font-size: 15px; line-height: 18px; margin: 0px; outline: 0px; padding: 0px; text-decoration: underline; vertical-align: baseline;"></a><h3 style="background-color: white; border-bottom-color: rgb(211, 209, 209); border-bottom-style: solid; border-width: 0px 0px 1px; color: #008b91; font-family: Verdana, Arial, Helvetica, sans-serif; font-size: 1.4em; line-height: 1.2em; margin: 1.5em 0px 0.5em; outline: 0px; padding: 0px 0px 7px; vertical-align: baseline;">
Abstract (provisional)</h3>
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Background</h4>
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Cycling is considered to be a highly beneficial sport for significantly enhancing cardiovascular fitness in individuals, yet studies show little or no corresponding improvements in bone mass.</div>
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Methods</h4>
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A scientific literature search on studies discussing bone mass and bone metabolism in cyclists was performed to collect all relevant published material up to April 2012. Descriptive, cross-sectional, longitudinal and interventional studies were all reviewed. Inclusion criteria were met by 31 studies.</div>
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Results</h4>
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Heterogeneous studies in terms of gender, age, data source, group of comparison, cycling level or modality practiced among others factors showed minor but important differences in results. Despite some controversial results, it has been observed that adult road cyclists participating in regular training have low bone mineral density in key regions (for example, lumbar spine). Conversely, other types of cycling (such as mountain biking), or combination with other sports could reduce this unsafe effect. These results cannot yet be explained by differences in dietary patterns or endocrine factors.</div>
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Conclusions</h4>
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From our comprehensive survey of the current available literature it can be concluded that road cycling does not appear to confer any significant osteogenic benefit. The cause of this may be related to spending long hours in a weight-supported position on the bike in combination with the necessary enforced recovery time that involves a large amount of time sitting or lying supine, especially at the competitive level. See related commentary http://www.biomedcentral.com/1741-7015/10/169.</div>
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MD Endocrinology MSc Medical Anthropologyhttp://www.blogger.com/profile/09396525904668204911noreply@blogger.comtag:blogger.com,1999:blog-4087917327935431869.post-48657068421457932612012-12-22T03:04:00.001-08:002012-12-22T03:04:57.269-08:00FRAIL HEALTH OF THE ABORIGINAL CANADIANS <div dir="ltr" style="text-align: left;" trbidi="on">
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<em style="border: 0px; font-family: inherit; font-size: 15px; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">BMC Public Health</em> 2012, <strong style="border: 0px; font-family: inherit; font-size: 15px; font-style: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">12</strong>:1098 <span class="pseudotab" style="border: 0px; font-family: inherit; font-size: 15px; font-style: inherit; margin: 0px 0px 0px 20px; outline: 0px; padding: 0px 5px; vertical-align: baseline;">doi:10.1186/1471-2458-12-1098</span></div>
Published: 20 December 2012</div>
</section></div>
<a href="" name="abstract" style="background-color: white; border: 0px; color: #008b91; font-family: Verdana, Arial, Helvetica, sans-serif; font-size: 15px; line-height: 18px; margin: 0px; outline: 0px; padding: 0px; text-decoration: underline; vertical-align: baseline;"></a><h3 style="background-color: white; border-bottom-color: rgb(211, 209, 209); border-bottom-style: solid; border-width: 0px 0px 1px; color: #008b91; font-family: Verdana, Arial, Helvetica, sans-serif; font-size: 1.4em; line-height: 1.2em; margin: 1.5em 0px 0.5em; outline: 0px; padding: 0px 0px 7px; vertical-align: baseline;">
Abstract (provisional)</h3>
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The disproportionate effects of the 2009 H1N1 pandemic on many Canadian Aboriginal communities have drawn attention to the vulnerability of these communities in terms of health outcomes in the face of emerging and reemerging infectious diseases. Exploring the particular challenges facing these communities is essential to improving public health planning. In alignment with the objectives of the Pandemic Influenza Outbreak Research Modelling (Pan-InfORM) team, a Canadian public health workshop was held at the Centre for Disease Modelling (CDM) to: (i) evaluate post-pandemic research findings; (ii) identify existing gaps in knowledge that have yet to be addressed through ongoing research and collaborative activities; and (iii) build upon existing partnerships within the research community to forge new collaborative links with Aboriginal health organizations. The workshop achieved its objectives in identifying main research findings and emerging information post pandemic, and highlighting key challenges that pose significant impediments to the health protection and promotion of Canadian Aboriginal populations. The health challenges faced by Canadian indigenous populations are unique and complex, and can only be addressed through active engagement with affected communities. The academic research community will need to develop a new interdisciplinary framework, building upon concepts from 'Communities of Practice', to ensure that the research priorities are identified and targeted, and the outcomes are translated into the context of community health to improve policy and practice.</div>
</div>
MD Endocrinology MSc Medical Anthropologyhttp://www.blogger.com/profile/09396525904668204911noreply@blogger.comtag:blogger.com,1999:blog-4087917327935431869.post-82786314071462092552012-12-14T23:49:00.000-08:002012-12-14T23:49:29.757-08:00FORMULA TO LIVE LONGER..ride bicycle to work <br />
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhCmH9cQl_zIknzyMUcKm5cdbcfvzZnvc-3KalN2TZQN-RtVhK_NQedt8E_c2ked1pm8argPWLw8f3IMGx8MK-Ey2oCD7mWGK4dMplrtOtH4mv42T3W52zXbBK0pXkZPdh63HKus9iit0tS/s1600/P1080078.JPG" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="480" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhCmH9cQl_zIknzyMUcKm5cdbcfvzZnvc-3KalN2TZQN-RtVhK_NQedt8E_c2ked1pm8argPWLw8f3IMGx8MK-Ey2oCD7mWGK4dMplrtOtH4mv42T3W52zXbBK0pXkZPdh63HKus9iit0tS/s640/P1080078.JPG" width="640" /></a></div>
<div class="introduction" id="story_continues_1" style="background-color: white; clear: left; color: #333333; font-family: Arial, Helmet, Freesans, sans-serif; font-size: 1.077em; font-weight: bold; line-height: 18px; margin-bottom: 18px; padding: 0px; text-rendering: auto;">
The longevity Olympians enjoy is within the reach of everyone, experts say.</div>
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Research published on the British Medical Journal (BMJ) website suggests athletes live 2.8 years longer on average than the average lifespan.</div>
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The research indicated those who took part in non-contact sports such as cycling, rowing and tennis enjoyed the longest life of all.</div>
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But the general population could have a similar "survival advantage" by doing a little more exercise, experts said.</div>
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The conclusion by two public health professors came after they reviewed two studies of Olympic athletes published by the BMJ website.</div>
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The studies looked at the lifespan and health of 25,000 athletes who competed in Games dating back to 1896.</div>
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Those taking part in contact sports such as boxing had the least advantage, while cyclists and rowers enjoyed the best health.</div>
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But the researchers also found those who played lower intensity sports such as golf enjoyed a boost.</div>
<span class="cross-head" style="background-color: white; color: #505050; display: block; font-family: Arial, Helmet, Freesans, sans-serif; font-size: 1.231em; font-weight: bold; line-height: 16px; margin: 0px 0px 16px; text-rendering: optimizelegibility;">'Public health failure'</span><div style="background-color: white; clear: left; color: #333333; font-family: Arial, Helmet, Freesans, sans-serif; font-size: 1.077em; line-height: 18px; margin-bottom: 18px; padding: 0px; text-rendering: auto;">
Possible explanations put forward for the finding included genetic and lifestyle factors and the wealth and status that comes with sporting success.</div>
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However, the findings prompted public health experts Prof Adrian Bauman, from Australia's Sydney University, and Prof Steven Blair, from South Carolina University in the US, to suggest others could live as long as Olympic athletes.</div>
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The recommended level of physical activity for adults is 150 minutes of moderate to vigorous exercise each week.</div>
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Studies suggest people who manage that amount or more live for up to several years longer than those that do not.</div>
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Writing for the BMJ website, the professors said: "Although the evidence points to a small survival effect of being an Olympian, careful reflection suggests that similar health benefits and longevity could be achieved by all of us through regular physical activity.</div>
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"We could and should all award ourselves that personal gold medal."</div>
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But they said governments were still not doing enough to promote the benefits of physical activity, calling it a "public health failure".</div>
MD Endocrinology MSc Medical Anthropologyhttp://www.blogger.com/profile/09396525904668204911noreply@blogger.comtag:blogger.com,1999:blog-4087917327935431869.post-65217042047528319022012-10-28T19:31:00.002-07:002012-10-28T19:32:23.219-07:00Sharing a drink with friends.. more than the alcohol<!--[if gte mso 9]><xml>
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<!--StartFragment-->
<br />
<div class="MsoNormal">
<span lang="EN-GB"><span style="font-family: Verdana, sans-serif; font-size: large;"><b>KNOW YOUR BRAND.. <o:p></o:p></b></span></span></div>
<div class="MsoNormal">
<span lang="EN-GB"><span style="font-family: Verdana, sans-serif; font-size: large;"><b>Yellow Tail is without doubt the most
popular Australian brand of wine known in the USA and UK.. But it was virtually
unknown before 2000. <o:p></o:p></b></span></span></div>
<div class="MsoNormal">
<span lang="EN-GB"><span style="font-family: Verdana, sans-serif; font-size: large;"><b>The top 10 popular brands in the Liquor
industry are all spirits and they all have wonderful histories. Branding rather
than country or region of origin.<o:p></o:p></b></span></span></div>
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh1F_nMopZFUVXnKvg6sryYcDu9hZVVacreEyCkJnGbLO-l1qdkWkOja-wRXib2sS8a_saMD8PwWqy95aM2Z0PGi7gpolf84v4Yi3axG4AssGFh-v-q8biu5PrMqcrm-wgA-CVETHXsw9_I/s1600/with+brother+in+la+bodeguita+in+BA.jpeg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="480" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh1F_nMopZFUVXnKvg6sryYcDu9hZVVacreEyCkJnGbLO-l1qdkWkOja-wRXib2sS8a_saMD8PwWqy95aM2Z0PGi7gpolf84v4Yi3axG4AssGFh-v-q8biu5PrMqcrm-wgA-CVETHXsw9_I/s640/with+brother+in+la+bodeguita+in+BA.jpeg" width="640" /></a></div>
<div class="MsoNormal">
<span lang="EN-GB"><span style="font-family: Verdana, sans-serif; font-size: large;"><b><br /></b></span></span></div>
<div class="MsoNormal">
<span lang="EN-GB"><span style="font-family: Verdana, sans-serif; font-size: large;"><b> ( with my brother Eliyahu at Resto La Bodeguita in Buenos Aires, tasting a wonderful bottle of Malbec from Mendoza, Argentina)</b></span></span></div>
<div class="MsoNormal">
<span lang="EN-GB"><span style="font-family: Verdana, sans-serif; font-size: large;"><b><br /></b></span></span></div>
<div class="MsoNormal">
<span lang="EN-GB"><span style="font-family: Verdana, sans-serif; font-size: large;"><b>The best-known brand is Smirnoff, which has
nothing to do with Russia; it is owned and produced by a British Company.<o:p></o:p></b></span></span></div>
<div class="MsoNormal">
<span lang="EN-GB"><span style="font-family: Verdana, sans-serif; font-size: large;"><b>Captain Morgan Rum Company has nothing to do with
Jamaica except historically for being a pirate in that turbulent region.
Bronfman, a Canadian Jew bought the recipe for spiced rum from two Jewish
pharmacists in Jamaica, the Levy Brothers and began manufacturing and selling
it. It is the most recognized brand of rum around the world.<o:p></o:p></b></span></span></div>
<div class="MsoNormal">
<span lang="EN-GB"><span style="font-family: Verdana, sans-serif; font-size: large;"><b>Bacardi Rum is not made in Cuba but in
Bahamas, Puerto Rico or elsewhere. But the association is always with Cuba. The
original factory in Santiago de Cuba still stands and produces Havana Club,
which is a far superior product than the weak Bacardi rum sold abroad.<o:p></o:p></b></span></span></div>
<div class="MsoNormal">
<span lang="EN-GB"><span style="font-family: Verdana, sans-serif; font-size: large;"><b>Coming back to Yellow Tail, most of its
wine and their grapes come not from their vineyard but is gathered from all
around Australia, not from Riverina where the owner is located!<o:p></o:p></b></span></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span lang="EN-GB"><span style="font-family: Verdana, sans-serif; font-size: large;"><b>This is a trend which began in 1940s and
now well entrenched. If you want a good sauvignon Blanc, buy a bottle of Kim
Crawford at a reputable store. If you fall for Marlborough Valley label on the
wine, you may be falling for origin of the grapes from various parts of the
valley and is not even bottled in a winery in the region. I have seen this over
and over again on wine bottles from South Africa with strange sounding African names
or from Chile with imitated mapuche Indian names. So I have learned that if the
name sounds a little strange, the wine origins are also a bit strange.<o:p></o:p></b></span></span></div>
<div class="MsoNormal">
<span lang="EN-GB"><span style="font-family: Verdana, sans-serif; font-size: large;"><b>I am off to Cuba where the drinking culture
is purely rum locally produced to satisfy the population. Havana Club White,
which is sold for about 4 dollars a bottle, is excellent to make a Cuba Libre,
and Anejo 7 year old is good to sip…<o:p></o:p></b></span></span></div>
<div class="MsoNormal">
<span lang="EN-GB"><span style="font-family: Verdana, sans-serif; font-size: large;"><b>While I am there, drinking a good glass of
wine is just a hope and a dream… but there is a difference. In Cuba, drinking
Rum, you do it with friends and incessant conversations. So it is very social
and very satisfying from a personal point of view.<o:p></o:p></b></span></span></div>
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj-4oH5tXxsTMtS4MUMyORoKTbINohrKtS2OP2RC4kz-Ho0sIZEh82OTGYcqjvTDFZ5dc3qlBqKhiUHvyv5Wp1sq9RrmKmQ-k6tcrHqsxgyuNvBgiHOQcSsXDe_yMat2ovXG8WmIhwSN6mH/s1600/IMG_0603.JPG" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="640" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj-4oH5tXxsTMtS4MUMyORoKTbINohrKtS2OP2RC4kz-Ho0sIZEh82OTGYcqjvTDFZ5dc3qlBqKhiUHvyv5Wp1sq9RrmKmQ-k6tcrHqsxgyuNvBgiHOQcSsXDe_yMat2ovXG8WmIhwSN6mH/s640/IMG_0603.JPG" width="480" /></a></div>
<div class="MsoNormal">
<span lang="EN-GB"><span style="font-family: Verdana, sans-serif; font-size: large;"><b><br /></b></span></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span lang="EN-GB"><span style="font-family: Verdana, sans-serif; font-size: large;"><b>So, with a sauvignon Blanc from 360 degrees
from Santa Ana in hand, I salute you… LChaim. To life…<o:p></o:p></b></span></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span lang="EN-GB"><span style="font-family: Verdana, sans-serif; font-size: large;"><b>Drinking wine, a glass or two with your
meals, is certainly good for your health; I recommend it as an Endocrinologist
and specialist in Nutrition…</b></span><o:p></o:p></span></div>
<!--EndFragment-->MD Endocrinology MSc Medical Anthropologyhttp://www.blogger.com/profile/09396525904668204911noreply@blogger.comtag:blogger.com,1999:blog-4087917327935431869.post-38503797719460698082012-09-28T14:51:00.001-07:002012-09-28T14:51:09.123-07:00HOW DRUG COMPANIES MISLEAD DOCTORS AND HARM THE PUBLIC<div dir="ltr" style="text-align: left;" trbidi="on">
<br />
<div id="article-header" style="background-color: white; background-repeat: no-repeat no-repeat; border-collapse: collapse; border-color: rgb(74, 100, 217); clear: left; color: #333333; font-family: arial, sans-serif; font-size: 15px; line-height: 15px; margin: 0px; min-height: 68px; padding: 0px; position: relative;">
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<h1 itemprop="name headline" style="background-repeat: no-repeat no-repeat; border-bottom-color: rgb(74, 100, 217); border-collapse: collapse; border-left-color: rgb(74, 100, 217); border-right-color: rgb(74, 100, 217); border-top-width: 0px; font-family: georgia, serif; font-size: 2.166em; font-weight: normal; line-height: 1.154; margin: 0px 0px 2px; padding: 0px; width: 460px;">
The drugs don't work: a modern medical scandal</h1>
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The doctors prescribing the drugs don't know they don't do what they're meant to. Nor do their patients. The manufacturers know full well, but they're not telling.</div>
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<span itemprop="author" itemscope="" itemtype="http://schema.org/Person" style="background-repeat: no-repeat no-repeat; border-collapse: collapse; font-weight: bold; margin: 0px; padding: 0px;"><span itemprop="name" style="background-repeat: no-repeat no-repeat; border-collapse: collapse; margin: 0px; padding: 0px;"><a class="contributor" href="http://www.guardian.co.uk/profile/bengoldacre" itemprop="url" rel="author" style="background-repeat: no-repeat no-repeat; border-collapse: collapse; color: #005689; margin: 0px; padding: 0px; text-decoration: none;">Ben Goldacre</a></span></span></div>
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Drugs are tested by their manufacturers, in poorly designed trials, on hopelessly small numbers of weird, unrepresentative patients, and analysed using techniques that exaggerate the benefits. Photograph: Photograph: Getty Images. Digital manipulation: Phil Partridge for GNL Imaging</div>
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Reboxetine is a drug I have prescribed. Other <a href="http://www.guardian.co.uk/science/drugs" style="background-repeat: no-repeat no-repeat; border-collapse: collapse; color: #005689; margin: 0px; padding: 0px; text-decoration: none;" title="More from guardian.co.uk on Drugs">drugs</a> had done nothing for my patient, so we wanted to try something new. I'd read the trial data before I wrote the prescription, and found only well-designed, fair tests, with overwhelmingly positive results. Reboxetine was better than a placebo, and as good as any other antidepressant in head-to-head comparisons. It's approved for use by the Medicines and Healthcare products Regulatory Agency (the <a href="http://www.mhra.gov.uk/#page=DynamicListMedicines" style="background-repeat: no-repeat no-repeat; border-collapse: collapse; color: #005689; margin: 0px; padding: 0px; text-decoration: none;" title="">MHRA</a>), which governs all drugs in the UK. Millions of doses are prescribed every year, around the world. Reboxetine was clearly a safe and effective treatment. The patient and I discussed the evidence briefly, and agreed it was the right treatment to try next. I signed a prescription.</div>
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But we had both been misled. In October 2010, a group of researchers was finally able to bring together all the data that had ever been collected on reboxetine, both from trials that were published and from those that had never appeared in academic papers. When all this trial data was put together, it produced a shocking picture. Seven trials had been conducted comparing reboxetine against a placebo. Only one, conducted in 254 patients, had a neat, positive result, and that one was published in an academic journal, for <a href="http://www.guardian.co.uk/society/doctors" style="background-repeat: no-repeat no-repeat; border-collapse: collapse; color: #005689; margin: 0px; padding: 0px; text-decoration: none;" title="More from guardian.co.uk on Doctors">doctors</a>and researchers to read. But six more trials were conducted, in almost 10 times as many patients. All of them showed that reboxetine was no better than a dummy sugar pill. None of these trials was published. I had no idea they existed.</div>
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It got worse. The trials comparing reboxetine against other drugs showed exactly the same picture: three small studies, 507 patients in total, showed that reboxetine was just as good as any other drug. They were all published. But 1,657 patients' worth of data was left unpublished, and this unpublished data showed that patients on reboxetine did worse than those on other drugs. If all this wasn't bad enough, there was also the side-effects data. The drug looked fine in the trials that appeared in the academic literature; but when we saw the unpublished studies, it turned out that patients were more likely to have side-effects, more likely to drop out of taking the drug and more likely to withdraw from the trial because of side-effects, if they were taking reboxetine rather than one of its competitors.</div>
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I did everything a doctor is supposed to do. I read all the papers, I critically appraised them, I understood them, I discussed them with the patient and we made a decision together, based on the evidence. In the published data, reboxetine was a safe and effective drug. In reality, it was no better than a sugar pill and, worse, it does more harm than good. As a doctor, I did something that, on the balance of all the evidence, harmed my patient, simply because unflattering data was left unpublished.</div>
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Nobody broke any law in that situation, reboxetine is still on the market and the system that allowed all this to happen is still in play, for all drugs, in all countries in the world. Negative data goes missing, for all treatments, in all areas of science. The regulators and professional bodies we would reasonably expect to stamp out such practices have failed us. These problems have been protected from public scrutiny because they're too complex to capture in a soundbite. This is why they've gone unfixed by politicians, at least to some extent; but it's also why it takes detail to explain. The people you should have been able to trust to fix these problems have failed you, and because you have to understand a problem properly in order to fix it, there are some things you need to know.</div>
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Drugs are tested by the people who manufacture them, in poorly designed trials, on hopelessly small numbers of weird, unrepresentative patients, and analysed using techniques that are flawed by design, in such a way that they exaggerate the benefits of treatments. Unsurprisingly, these trials tend to produce results that favour the manufacturer. When trials throw up results that companies don't like, they are perfectly entitled to hide them from doctors and patients, so we only ever see a distorted picture of any drug's true effects. Regulators see most of the trial data, but only from early on in a drug's life, and even then they don't give this data to doctors or patients, or even to other parts of government. This distorted evidence is then communicated and applied in a distorted fashion.</div>
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In their 40 years of practice after leaving medical school, doctors hear about what works ad hoc, from sales reps, colleagues and journals. But those colleagues can be in the pay of drug companies – often undisclosed – and the journals are, too. And so are the patient groups. And finally, academic papers, which everyone thinks of as objective, are often covertly planned and written by people who work directly for the companies, without disclosure. Sometimes whole academic journals are owned outright by one drug company. Aside from all this, for several of the most important and enduring problems in medicine, we have no idea what the best treatment is, because it's not in anyone's financial interest to conduct any trials at all.</div>
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Now, on to the details.</div>
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In 2010, researchers from Harvard and Toronto found all the trials looking at five major classes of drug – antidepressants, ulcer drugs and so on – then measured two key features: were they positive, and were they funded by industry? They found more than 500 trials in total: 85% of the industry-funded studies were positive, but only 50% of the government-funded trials were. In 2007, researchers looked at every published trial that set out to explore the benefits of a statin. These cholesterol-lowering drugs reduce your risk of having a heart attack and are prescribed in very large quantities. This study found 192 trials in total, either comparing one statin against another, or comparing a statin against a different kind of treatment. They found that industry-funded trials were 20 times more likely to give results favouring the test drug.</div>
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These are frightening results, but they come from individual studies. So let's consider systematic reviews into this area. In 2003, two were published. They took all the studies ever published that looked at whether industry funding is associated with pro-industry results, and both found that industry-funded trials were, overall, about four times more likely to report positive results. A further review in 2007 looked at the new studies in the intervening four years: it found 20 more pieces of work, and all but two showed that industry-sponsored trials were more likely to report flattering results.</div>
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It turns out that this pattern persists even when you move away from published academic papers and look instead at trial reports from academic conferences. James Fries and Eswar Krishnan, at the Stanford University School of Medicine in California, studied all the research abstracts presented at the 2001 American College of Rheumatology meetings which reported any kind of trial and acknowledged industry sponsorship, in order to find out what proportion had results that favoured the sponsor's drug.</div>
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In general, the results section of an academic paper is extensive: the raw numbers are given for each outcome, and for each possible causal factor, but not just as raw figures. The "ranges" are given, subgroups are explored, statistical tests conducted, and each detail is described in table form, and in shorter narrative form in the text. This lengthy process is usually spread over several pages. In <a href="http://www.biomedcentral.com/content/pdf/ar1170.pdf" style="background-repeat: no-repeat no-repeat; border-collapse: collapse; color: #005689; margin: 0px; padding: 0px; text-decoration: none;" title="">Fries and Krishnan</a>(2004), this level of detail was unnecessary. The results section is a single, simple and – I like to imagine – fairly passive-aggressive sentence:</div>
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"The results from every randomised controlled trial (45 out of 45) favoured the drug of the sponsor."</div>
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How does this happen? How do industry-sponsored trials almost always manage to get a positive result? Sometimes trials are flawed by design. You can compare your new drug with something you know to be rubbish – an existing drug at an inadequate dose, perhaps, or a placebo sugar pill that does almost nothing. You can choose your patients very carefully, so they are more likely to get better on your treatment. You can peek at the results halfway through, and stop your trial early if they look good. But after all these methodological quirks comes one very simple insult to the integrity of the data. Sometimes, drug companies conduct lots of trials, and when they see that the results are unflattering, they simply fail to publish them.</div>
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Because researchers are free to bury any result they please, patients are exposed to harm on a staggering scale throughout the whole of medicine. Doctors can have no idea about the true effects of the treatments they give. Does this drug really work best, or have I simply been deprived of half the data? No one can tell. Is this expensive drug worth the money, or has the data simply been massaged? No one can tell. Will this drug kill patients? Is there any evidence that it's dangerous? No one can tell. This is a bizarre situation to arise in medicine, a discipline in which everything is supposed to be based on evidence.</div>
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And this data is withheld from everyone in medicine, from top to bottom. Nice, for example, is the <a href="http://www.nice.org.uk/" style="background-repeat: no-repeat no-repeat; border-collapse: collapse; color: #005689; margin: 0px; padding: 0px; text-decoration: none;" title="">National Institute for Health and Clinical Excellence</a>, created by the British government to conduct careful, unbiased summaries of all the evidence on new treatments. It is unable either to identify or to access data on a drug's effectiveness that's been withheld by researchers or companies: Nice has no more legal right to that data than you or I do, even though it is making decisions about effectiveness, and cost-effectiveness, on behalf of the NHS, for millions of people.</div>
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In any sensible world, when researchers are conducting trials on a new tablet for a drug company, for example, we'd expect universal contracts, making it clear that all researchers are obliged to publish their results, and that industry sponsors – which have a huge interest in positive results – must have no control over the data. But, despite everything we know about industry-funded research being systematically biased, this does not happen. In fact, the opposite is true: it is entirely normal for researchers and academics conducting industry-funded trials to sign contracts subjecting them to gagging clauses that forbid them to publish, discuss or analyse data from their trials without the permission of the funder.</div>
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This is such a secretive and shameful situation that even trying to document it in public can be a fraught business. In 2006, a paper was published in the <a href="http://jama.jamanetwork.com/journal.aspx" style="background-repeat: no-repeat no-repeat; border-collapse: collapse; color: #005689; margin: 0px; padding: 0px; text-decoration: none;" title="">Journal of the American Medical Association</a> (Jama), one of the biggest medical journals in the world, describing how common it was for researchers doing industry-funded trials to have these kinds of constraints placed on their right to publish the results. The study was conducted by the <a href="http://www.cochrane.dk/" style="background-repeat: no-repeat no-repeat; border-collapse: collapse; color: #005689; margin: 0px; padding: 0px; text-decoration: none;" title="">Nordic Cochrane Centre</a> and it looked at all the trials given approval to go ahead in Copenhagen and Frederiksberg. (If you're wondering why these two cities were chosen, it was simply a matter of practicality: the researchers applied elsewhere without success, and were specifically refused access to data in the UK.) These trials were overwhelmingly sponsored by the pharmaceutical industry (98%) and the rules governing the management of the results tell a story that walks the now familiar line between frightening and absurd.</div>
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For 16 of the 44 trials, the sponsoring company got to see the data as it accumulated, and in a further 16 it had the right to stop the trial at any time, for any reason. This means that a company can see if a trial is going against it, and can interfere as it progresses, distorting the results. Even if the study was allowed to finish, the data could still be suppressed: there were constraints on publication rights in 40 of the 44 trials, and in half of them the contracts specifically stated that the sponsor either owned the data outright (what about the patients, you might say?), or needed to approve the final publication, or both. None of these restrictions was mentioned in any of the published papers.</div>
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When the paper describing this situation was published in Jama, Lif, the Danish pharmaceutical industry association, responded by announcing, in the Journal of the Danish Medical Association, that it was "both shaken and enraged about the criticism, that could not be recognised". It demanded an investigation of the scientists, though it failed to say by whom or of what. Lif then wrote to the Danish Committee on Scientific Dishonesty, accusing the Cochrane researchers of scientific misconduct. We can't see the letter, but the researchers say the allegations were extremely serious – they were accused of deliberately distorting the data – but vague, and without documents or evidence to back them up.</div>
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Nonetheless, the investigation went on for a year. <a href="http://en.wikipedia.org/wiki/Peter_C._G%C3%B8tzsche" style="background-repeat: no-repeat no-repeat; border-collapse: collapse; color: #005689; margin: 0px; padding: 0px; text-decoration: none;" title="">Peter Gøtzsche</a>, director of the Cochrane Centre, told the British Medical Journal that only Lif's third letter, 10 months into this process, made specific allegations that could be investigated by the committee. Two months after that, the charges were dismissed. The Cochrane researchers had done nothing wrong. But before they were cleared, Lif copied the letters alleging scientific dishonesty to the hospital where four of them worked, and to the management organisation running that hospital, and sent similar letters to the Danish medical association, the ministry of health, the ministry of science and so on. Gøtzsche and his colleagues felt "intimidated and harassed" by Lif's behaviour. Lif continued to insist that the researchers were guilty of misconduct even after the investigation was completed.</div>
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Paroxetine is a commonly used antidepressant, from the class of drugs known as selective serotonin reuptake inhibitors or SSRIs. It's also a good example of how companies have exploited our long-standing permissiveness about missing trials, and found loopholes in our inadequate regulations on trial disclosure.</div>
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To understand why, we first need to go through a quirk of the licensing process. Drugs do not simply come on to the market for use in all medical conditions: for any specific use of any drug, in any specific disease, you need a separate marketing authorisation. So a drug might be licensed to treat ovarian cancer, for example, but not breast cancer. That doesn't mean the drug doesn't work in breast cancer. There might well be some evidence that it's great for treating that disease, too, but maybe the company hasn't gone to the trouble and expense of getting a formal marketing authorisation for that specific use. Doctors can still go ahead and prescribe it for breast cancer, if they want, because the drug is available for prescription, it probably works, and there are boxes of it sitting in pharmacies waiting to go out. In this situation, the doctor will be prescribing the drug legally, but "off-label".</div>
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Now, it turns out that the use of a drug in children is treated as a separate marketing authorisation from its use in adults. This makes sense in many cases, because children can respond to drugs in very different ways and so research needs to be done in children separately. But getting a licence for a specific use is an arduous business, requiring lots of paperwork and some specific studies. Often, this will be so expensive that companies will not bother to get a licence specifically to market a drug for use in children, because that market is usually much smaller.</div>
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So it is not unusual for a drug to be licensed for use in adults but then prescribed for children. Regulators have recognised that this is a problem, so recently they have started to offer incentives for companies to conduct more research and formally seek these licences.</div>
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When GlaxoSmithKline applied for a marketing authorisation in children for paroxetine, an extraordinary situation came to light, triggering the longest investigation in the history of UK drugs regulation. Between 1994 and 2002, GSK conducted nine trials of paroxetine in children. The first two failed to show any benefit, but the company made no attempt to inform anyone of this by changing the "drug label" that is sent to all doctors and patients. In fact, after these trials were completed, an internal company management document stated: "It would be commercially unacceptable to include a statement that efficacy had not been demonstrated, as this would undermine the profile of paroxetine." In the year after this secret internal memo, 32,000 prescriptions were issued to children for paroxetine in the UK alone: so, while the company knew the drug didn't work in children, it was in no hurry to tell doctors that, despite knowing that large numbers of children were taking it. More trials were conducted over the coming years – nine in total – and none showed that the drug was effective at treating depression in children.</div>
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It gets much worse than that. These children weren't simply receiving a drug that the company knew to be ineffective for them; they were also being exposed to side-effects. This should be self-evident, since any effective treatment will have some side-effects, and doctors factor this in, alongside the benefits (which in this case were nonexistent). But nobody knew how bad these side-effects were, because the company didn't tell doctors, or patients, or even the regulator about the worrying safety data from its trials. This was because of a loophole: you have to tell the regulator only about side-effects reported in studies looking at the specific uses for which the drug has a marketing authorisation. Because the use of paroxetine in children was "off-label", GSK had no legal obligation to tell anyone about what it had found.</div>
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People had worried for a long time that paroxetine might increase the risk of suicide, though that is quite a difficult side-effect to detect in an antidepressant. In February 2003, GSK spontaneously sent the MHRA a package of information on the risk of suicide on paroxetine, containing some analyses done in 2002 from adverse-event data in trials the company had held, going back a decade. This analysis showed that there was no increased risk of suicide. But it was misleading: although it was unclear at the time, data from trials in children had been mixed in with data from trials in adults, which had vastly greater numbers of participants. As a result, any sign of increased suicide risk among children on paroxetine had been completely diluted away.</div>
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Later in 2003, GSK had a meeting with the MHRA to discuss another issue involving paroxetine. At the end of this meeting, the GSK representatives gave out a briefing document, explaining that the company was planning to apply later that year for a specific marketing authorisation to use paroxetine in children. They mentioned, while handing out the document, that the MHRA might wish to bear in mind a safety concern the company had noted: an increased risk of suicide among children with depression who received paroxetine, compared with those on dummy placebo pills.</div>
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This was vitally important side-effect data, being presented, after an astonishing delay, casually, through an entirely inappropriate and unofficial channel. Although the data was given to completely the wrong team, the MHRA staff present at this meeting had the wit to spot that this was an important new problem. A flurry of activity followed: analyses were done, and within one month a letter was sent to all doctors advising them not to prescribe paroxetine to patients under the age of 18.</div>
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How is it possible that our systems for getting data from companies are so poor, they can simply withhold vitally important information showing that a drug is not only ineffective, but actively dangerous? Because the regulations contain ridiculous loopholes, and it's dismal to see how GSK cheerfully exploited them: when the investigation was published in 2008, it concluded that what the company had done – withholding important data about safety and effectiveness that doctors and patients clearly needed to see – was plainly unethical, and put children around the world at risk; but our laws are so weak that GSK could not be charged with any crime.</div>
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After this episode, the MHRA and EU changed some of their regulations, though not adequately. They created an obligation for companies to hand over safety data for uses of a drug outside its marketing authorisation; but ridiculously, for example, trials conducted outside the EU were still exempt. Some of the trials GSK conducted were published in part, but that is obviously not enough: we already know that if we see only a biased sample of the data, we are misled. But we also need all the data for the more simple reason that we need lots of data: safety signals are often weak, subtle and difficult to detect. In the case of paroxetine, the dangers became apparent only when the adverse events from all of the trials were pooled and analysed together.</div>
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That leads us to the second obvious flaw in the current system: the results of these trials are given in secret to the regulator, which then sits and quietly makes a decision. This is the opposite of science, which is reliable only because everyone shows their working, explains how they know that something is effective or safe, shares their methods and results, and allows others to decide if they agree with the way in which the data was processed and analysed. Yet for the safety and efficacy of drugs, we allow it to happen behind closed doors, because drug companies have decided that they want to share their trial results discretely with the regulators. So the most important job in evidence-based medicine is carried out alone and in secret. And regulators are not infallible, as we shall see.</div>
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Rosiglitazone was first marketed in 1999. In that first year, Dr John Buse from the University of North Carolina discussed an increased risk of heart problems at a pair of academic meetings. The drug's manufacturer, GSK, made direct contact in an attempt to silence him, then moved on to his head of department. Buse felt pressured to sign various legal documents. To cut a long story short, after wading through documents for several months, in 2007 the US Senate committee on finance released a report describing the treatment of Buse as "intimidation".</div>
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But we are more concerned with the safety and efficacy data. In 2003 the <a href="http://en.wikipedia.org/wiki/Uppsala_Monitoring_Centre" style="background-repeat: no-repeat no-repeat; border-collapse: collapse; color: #005689; margin: 0px; padding: 0px; text-decoration: none;" title="">Uppsala drug monitoring group</a> of the World Health Organisation contacted GSK about an unusually large number of spontaneous reports associating rosiglitazone with heart problems. GSK conducted two internal meta-analyses of its own data on this, in 2005 and 2006. These showed that the risk was real, but although both GSK and the FDA had these results, neither made any public statement about them, and they were not published until 2008.</div>
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During this delay, vast numbers of patients were exposed to the drug, but doctors and patients learned about this serious problem only in 2007, when cardiologist Professor Steve Nissen and colleagues published a landmark meta-analysis. This showed a 43% increase in the risk of heart problems in patients on rosiglitazone. Since people with diabetes are already at increased risk of heart problems, and the whole point of treating diabetes is to reduce this risk, that finding was big potatoes. Nissen's findings were confirmed in later work, and in 2010 the drug was either taken off the market or restricted, all around the world.</div>
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Now, my argument is not that this drug should have been banned sooner because, as perverse as it sounds, doctors do often need inferior drugs for use as a last resort. For example, a patient may develop idiosyncratic side-effects on the most effective pills and be unable to take them any longer. Once this has happened, it may be worth trying a less effective drug if it is at least better than nothing.</div>
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The concern is that these discussions happened with the data locked behind closed doors, visible only to regulators. In fact, Nissen's analysis could only be done at all because of a very unusual court judgment. In 2004, when GSK was caught out withholding data showing evidence of serious side-effects from paroxetine in children, their bad behaviour resulted in a US court case over allegations of fraud, the settlement of which, alongside a significant payout, required GSK to commit to posting clinical trial results on a public website.</div>
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Nissen used the rosiglitazone data, when it became available, and found worrying signs of harm, which they then published to doctors – something the regulators had never done, despite having the information years earlier. If this information had all been freely available from the start, regulators might have felt a little more anxious about their decisions but, crucially, doctors and patients could have disagreed with them and made informed choices. This is why we need wider access to all trial reports, for all medicines.</div>
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Missing data poisons the well for everybody. If proper trials are never done, if trials with negative results are withheld, then we simply cannot know the true effects of the treatments we use. Evidence in medicine is not an abstract academic preoccupation. When we are fed bad data, we make the wrong decisions, inflicting unnecessary pain and suffering, and death, on people just like us.</div>
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• This is an edited extract from Bad Pharma, by Ben Goldacre, published next week by Fourth Estate at £13.99. To order a copy for £11.19, including UK mainland p&p, call 0330 333 6846, or go to<a href="http://www.guardianbookshop.co.uk/BerteShopWeb/viewProduct.do?ISBN=9780007350742" style="background-repeat: no-repeat no-repeat; border-collapse: collapse; color: #005689; margin: 0px; padding: 0px; text-decoration: none;" title="">guardian.co.uk/bookshop</a>.</div>
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MD Endocrinology MSc Medical Anthropologyhttp://www.blogger.com/profile/09396525904668204911noreply@blogger.comtag:blogger.com,1999:blog-4087917327935431869.post-22948549020919731602012-08-03T13:09:00.001-07:002012-08-03T13:09:07.589-07:00BUKA BERSAMAN.. BREAKING THE RAMADAN FAST IN BOGOR, INDONESIA<span style="font-family: Verdana, sans-serif; font-size: large;">Exactly 44 hours after leaving the Blue House among the Indians, I walked out of the customs hall at the Soekarno-Hatta International Airport at CGK in Jakarta..Visa on arrival, you pay them 25 dollars and they give you a stamp and the immigration official affixes the stamp on your passport and within a minute or so you are out of the immigration and customs hall.</span><br />
<span style="font-family: Verdana, sans-serif; font-size: large;">The Flight was a Qatar Airways Flight from Doha to Jakarta, a nine hour flight, very similar to Miami to Paris. The breakfast had been exceptionally good, even by QR Qatar Airways standards..</span><br />
<span style="font-family: Verdana, sans-serif; font-size: large;">My friends were waiting at the airport and very soon we were on our way to Bogor, Friday and it was around 430 pm and within one hour it is the time for Buka Bersaman, eating together, a metaphor for breaking the Ramadan Fast.</span><br />
<span style="font-family: Verdana, sans-serif; font-size: large;">Jakarta is a very congested city and depending upon the time of the day, you can be in traffic for hours on end. We were not unlucky and within one hour and half we arrived at the Resto Gunung Mas, a family seafood restaurant in Sentul City which is in the outskirts of Bogor.</span><br />
<span style="font-family: Verdana, sans-serif; font-size: large;">There were six of them, Javanese names do not give you a clue about their religious affiliation.. even though one has to assume that most people are moslem in this populous islamic country.</span><br />
<span style="font-family: Verdana, sans-serif; font-size: large;">You know enough about Indonesian food, so what would you like? asked my friend, who is in charge of the Travel Agency here in Bogor.</span><br />
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiBFeL_ITyNDe8TMSHpkuXRxIu-t9heqIWjtK3Oh-PGZy3xfGudjdb7sCoEkOGJlJHzPf0DwQGQDbeRjRS2K9ea6ZPuumbX99-ZWqvO7Y-10D1XHlWD1PqMQQWQuRViTCjei_OSCknM23_z/s1600/20120803-165749.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="398" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiBFeL_ITyNDe8TMSHpkuXRxIu-t9heqIWjtK3Oh-PGZy3xfGudjdb7sCoEkOGJlJHzPf0DwQGQDbeRjRS2K9ea6ZPuumbX99-ZWqvO7Y-10D1XHlWD1PqMQQWQuRViTCjei_OSCknM23_z/s640/20120803-165749.jpg" width="640" /></a></div>
<span style="font-family: Verdana, sans-serif; font-size: large;">A typical Indo meal was requested: fish, chicken, shrimp, green vegetables. Time passed quickly enough and i noticed that no one was gorging themselves but eating just enough to satisfy their apetite. </span><br />
<span style="font-family: Verdana, sans-serif; font-size: large;">We went upstairs to the offices of my friend, whom I had come to visit, the humble man of Bogor.</span><br />
<span style="font-family: Verdana, sans-serif; font-size: large;">He has Nespresso coffee machine and it was nice to drink a familiar drink and it was time to repair to the hotel room to fall asleep.</span><br />
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<span style="font-family: Verdana, sans-serif; font-size: large;">I must say that there was not a single discussion about Religion or Ramadan but mainly the conversation was centered around the purpose of my visit to Bogor and Jakarta: Health and Happiness and Compassion towards others...</span>MD Endocrinology MSc Medical Anthropologyhttp://www.blogger.com/profile/09396525904668204911noreply@blogger.comtag:blogger.com,1999:blog-4087917327935431869.post-69252425591690169392012-07-17T00:41:00.002-07:002012-07-17T00:41:47.992-07:00OBESITY AND SOCIAL STIGMA<br />
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Stigmatization of obese individuals by human resource professionals: an experimental study</h1>
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<strong style="border: 0px; font-family: inherit; font-size: 15px; font-style: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">Katrin E Giel</strong>, <strong style="border: 0px; font-family: inherit; font-size: 15px; font-style: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">Stephan Zipfel</strong>, <strong style="border: 0px; font-family: inherit; font-size: 15px; font-style: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">Manuela Alizadeh</strong>, <strong style="border: 0px; font-family: inherit; font-size: 15px; font-style: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">Norbert Schäffeler</strong>, <strong style="border: 0px; font-family: inherit; font-size: 15px; font-style: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">Carmen Zahn</strong>, <strong style="border: 0px; font-family: inherit; font-size: 15px; font-style: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">Daniel Wessel</strong>, <strong style="border: 0px; font-family: inherit; font-size: 15px; font-style: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">Friedrich W Hesse</strong>, <strong style="border: 0px; font-family: inherit; font-size: 15px; font-style: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">Syra Thiel</strong> and <strong style="border: 0px; font-family: inherit; font-size: 15px; font-style: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">Ansgar Thiel</strong></div>
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<em style="border: 0px; font-family: inherit; font-size: 15px; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">BMC Public Health</em> 2012, <strong style="border: 0px; font-family: inherit; font-size: 15px; font-style: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">12</strong>:525 <span class="pseudotab" style="border: 0px; font-family: inherit; font-size: 15px; font-style: inherit; margin: 0px 0px 0px 20px; outline: 0px; padding: 0px 5px; vertical-align: baseline;">doi:10.1186/1471-2458-12-525</span></div>
Published: 16 July 2012</div>
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Abstract (provisional)</h3>
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Background</h4>
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Weight-related stigmatization is as a public health problem. It impairs the psychological well-being of obese individuals and hinders them from adopting weight-loss behaviors. We conducted an experimental study to investigate weight stigmatization in work settings using a sample of experienced human resource (HR) professionals from a real-life employment setting.</div>
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Methods</h4>
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In a cross-sectional, computer-based experimental study, a volunteer sample of 127 HR professionals (age: 41.1 +/- 10.9 yrs., 56% female), who regularly make career decisions about other people, evaluated individuals shown in standardized photographs regarding work-related prestige and achievements. The photographed individuals differed with respect to gender, ethnicity, and Body Mass Index (BMI).</div>
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Results</h4>
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Participants underestimated the occupational prestige of obese individuals and overestimated it for normal-weight individuals. Obese people were more often disqualified from being hired and less often nominated for a supervisory position, while non-ethnic normal-weight individuals were favored. Stigmatization was most pronounced in obese females.</div>
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Conclusions</h4>
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The data suggest that HR professionals are prone to pronounced weight stigmatization, especially in women. This highlights the need for interventions targeting this stigmatization as well as stigma-management strategies for obese individuals. Weight stigmatization and its consequences needs to be a topic that is more strongly addressed in clinical obesity care.</div>
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<br /></div>MD Endocrinology MSc Medical Anthropologyhttp://www.blogger.com/profile/09396525904668204911noreply@blogger.comtag:blogger.com,1999:blog-4087917327935431869.post-51259785810743729222012-07-02T21:47:00.001-07:002012-07-02T21:47:10.881-07:00AVANDIA, WELBUTRIN,PAXIL AND THE DRUG COMPANY GSK<div dir="ltr" style="text-align: left;" trbidi="on">
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<span class="s1"><b><span style="font-family: 'Trebuchet MS', sans-serif; font-size: large;">GlaxoSmithKline to pay $3bn in US drug fraud scandal</span></b></span></div>
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<span style="font-family: 'Trebuchet MS', sans-serif; font-size: large;"> </span></div>
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<span style="font-family: 'Trebuchet MS', sans-serif; font-size: large;">Diabetes medication Avandia is one of the three drugs concerned in the fraud case</span></div>
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<b><span style="font-family: 'Trebuchet MS', sans-serif; font-size: large;">GlaxoSmithKline (GSK) is to pay $3bn (£1.9bn) in the largest healthcare fraud settlement in US history.</span></b></div>
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<b><span style="font-family: 'Trebuchet MS', sans-serif; font-size: large;"><br /></span></b></div>
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<span style="font-family: 'Trebuchet MS', sans-serif; font-size: large;">The drug giant is to plead guilty to promoting two drugs for unapproved uses and failing to report safety data about a diabetes drug to the Food and Drug Administration (FDA).</span></div>
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<span style="font-family: 'Trebuchet MS', sans-serif; font-size: large;">The settlement will cover criminal fines as well as civil settlements with the federal and state governments.</span></div>
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<span style="font-family: 'Trebuchet MS', sans-serif; font-size: large;">The case concerns the drugs Paxil, Wellbutrin and Avandia.</span></div>
<div class="p5">
<span style="font-family: 'Trebuchet MS', sans-serif; font-size: large;">Deputy US Attorney General James Cole told a news conference in Washington DC that the settlement was "unprecedented in both size and scope".</span></div>
<div class="p6">
<b><span style="font-family: 'Trebuchet MS', sans-serif; font-size: large;">Doctors bribed</span></b></div>
<div class="p5">
<span style="font-family: 'Trebuchet MS', sans-serif; font-size: large;">GSK, one of the world's largest healthcare and pharmaceuticals companies, <a href="http://us.gsk.com/html/media-news/settlement-press-kit.html#statements"><span class="s2"><b>admitted </b></span></a>to promoting antidepressants Paxil and Wellbutrin for unapproved uses, including treatment of children and adolescents.</span></div>
<div class="p4">
<span style="background-color: white;"><span style="font-family: 'Trebuchet MS', sans-serif; font-size: large;">The illegal practice is known as off-label marketing.</span></span></div>
<div class="p8">
<span style="font-family: 'Trebuchet MS', sans-serif; font-size: large;"><b></b></span></div>
<div class="p9">
<b><span style="font-family: 'Trebuchet MS', sans-serif; font-size: large;">The company also conceded charges that it held back data and made unsupported safety claims over its diabetes drug Avandia.</span></b></div>
<div class="p9">
<b><span style="font-family: 'Trebuchet MS', sans-serif; font-size: large;">In addition, GSK has been found guilty of paying kickbacks to doctors.</span></b></div>
<div class="p9">
<b><span style="font-family: 'Trebuchet MS', sans-serif; font-size: large;">"The sales force bribed physicians to prescribe GSK products using every imaginable form of high-priced entertainment, from Hawaiian vacations [and] paying doctors millions of dollars to go on speaking tours, to tickets to Madonna concerts," said US attorney Carmin Ortiz.</span></b></div>
<div class="p5">
<span style="font-family: 'Trebuchet MS', sans-serif; font-size: large;">As part of the settlement, GSK agreed to be monitored by government officials for five years.</span></div>
<div class="p5">
<span style="font-family: 'Trebuchet MS', sans-serif; font-size: large;">GSK said in a statement it would pay the fines through existing cash resources.</span></div>
<div class="p5">
<span style="font-family: 'Trebuchet MS', sans-serif; font-size: large;">Andrew Witty, the firm's chief executive, said procedures for compliance, marketing and selling had been changed at GSK's US unit.</span></div>
<div class="p5">
<span style="font-family: 'Trebuchet MS', sans-serif; font-size: large;">"We have learnt from the mistakes that were made," Mr Witty said. "When necessary, we have removed employees who have engaged in misconduct."</span></div>
</div>MD Endocrinology MSc Medical Anthropologyhttp://www.blogger.com/profile/09396525904668204911noreply@blogger.comtag:blogger.com,1999:blog-4087917327935431869.post-52334217957181519702012-06-29T13:25:00.003-07:002012-06-29T13:30:08.115-07:00MEDICAL TERMS USED IN SOUTH TEXAS, USA<div dir="ltr" style="text-align: left;" trbidi="on">
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<br /></div>MD Endocrinology MSc Medical Anthropologyhttp://www.blogger.com/profile/09396525904668204911noreply@blogger.comtag:blogger.com,1999:blog-4087917327935431869.post-78355596537423424742012-06-17T12:42:00.002-07:002012-06-17T12:42:51.990-07:00PANCREATIC REST FOR NEWLY DIAGNOSED TYPE 2 DIABETES<br />
<div class="p1">
<b>Early and intensive therapy preserved beta-cell function long term in type 2 diabetes</b></div>
<div class="p2">
<br /></div>
<div class="p3">
<br /></div>
<ul class="ul1">
<li class="li4">June 13, 2012</li>
</ul>
<div class="p5">
AllPHILADELPHIA — Initiating intensive therapy in treatment-naïve, newly-diagnosed patients with type 2 diabetes preserved beta-cell function for 3.5 years, according to data presented at the American Diabetes Association’s 72nd Scientific Sessions.</div>
<div class="p5">
“Everybody knows that type 2 diabetes is a progressive disease and this progression is determined by a progressive decline in beta-cell function over time,” <b>Ildiko Lingvay, MD, </b>assistant professor of internal medicine at University of Texas Southwestern Medical Center, said during her presentation. “Our ideal goal as physicians when we treat our patients is to preserve beta-cell function, either by decreasing the slope of decline or, ideally, by stabilizing beta-cell function over time — a disease-modifying effect.”</div>
<div class="p5">
In light of data from the UKPDS and ADOPT studies, Lingvay and colleagues developed a treatment strategy that they hoped would preserve beta-cell function in treatment-naïve patients who were newly diagnosed with type 2 diabetes. They randomly assigned patients to insulin-based treatment or triple oral therapy preceded by a short, 3-month course of insulin-based therapy.</div>
<div class="p5">
patients were treated with insulin and metformin during the 3-month run-in, after which they were randomly assigned to treatment continuation or triple oral therapy. The goal of the run-in period, according to Lingvay was to remove the transient stunning of beta-cell function due to glucotoxicity.</div>
<div class="p5">
All patients were treated with Novolog 70/30 at 0.2 U/kg or metformin at 500 mg daily, which was titrated weekly to 1,000 mg twice daily. Triple oral therapy included glyburide 1.25 mg twice daily, which was titrated throughout the study; metformin 1,000 mg twice daily and pioglitazone (Actos, Takeda) 15 mg titrated during 3 months to 45 mg.</div>
<div class="p5">
Treatment failure was defined as HbA1c ≥8%. If patients in the triple oral arm achieved this target, they were switched to the insulin group. Similarly, if patients in the insulin group achieved this target, they remained on insulin with the option to change the frequency or type of treatment.</div>
<div class="p5">
Lingvay and colleagues screened 67 patients; 63 enrolled and 58 finished the 3-month run-in and were randomized in a 1:1 fashion with continued insulin or were switched to triple oral therapy.</div>
<div class="p5">
At the time of diagnosis, the average HbA1c was 10.6%; after the 3 months of the run-in period, HbA1c was reduced to 5.9% and 100% of participants achieved the ADA-recommended goal of HbA1c ≤7%.</div>
<div class="p5">
At the time of randomization, age was about 45 years, 80% were minorities, average BMI was 36 and the insulin dose was 0.6 U/kg, which was three times the initial dose patients.</div>
<div class="p5">
There was a rapid improvement in glycemic control within the first 3 months, with normalization of glucose then sustained glycemic control through 3.5 years, regardless of treatment assignment. </div>
<div class="p5">
Treatment failure occurred in three patients in the insulin group and five in the triple oral therapy group.</div>
<div class="p5">
In regards to the main outcome of beta-cell function, C-peptide AUC/glucose AUC did not show the expected decline, Lingvay said. Stabilization of beta-cell function occurred in both treatment groups.</div>
<div class="p5">
Weight increased in both groups, but there was no statistically significant difference. Mild hypoglycemia was defined conservatively (any home glucose measurement of <70 mg/dl associated with any symptoms suggestive of hypoglycemia) and occurred at a rate of one per month during the first 4 months. According to Lingvay, the rate decreased to less than 0.5 events per month and remained low during the course of the study.</div>
<div class="p5">
“This is a very important finding, in light of a very low HbA1c achieved and maintained throughout the study; and the fact that; all patients were treated with insulin or sulfonylurea.”</div>
<div class="p5">
Lingvay said follow-up continues and 6-year results will be available soon.</div>
<div class="p5">
Before concluding, however, she shared some lessons learned while conducting this study.</div>
<div class="p5">
“I suggest we try to achieve glycemic normalization as quickly as possible after diagnosis. Additionally, I recommend we maintain glycemic control long-term. Because diabetes is such a multifactorial disease with so many underlying pathophysiological components, I don’t personally think monotherapy is the answer to change the course of the disease. I recommend combination treatment with complimentary mechanisms of action. Also, [we should] anticipate disease progression. Treatment intensification should be done while the patient’s glycemic control is still within the target range; I would not recommend waiting until HbA1c go above target before intensifying treatment.” – <i>by Stacey L. Fisher</i></div>
<div class="p5">
<b>For more information:</b></div>
<div class="p8">
<span class="s1">Lingvay I. CT-SY26. Presented at: <a href="http://professional.diabetes.org/Congress_Display.aspx?TYP=9&CID=85274"><span class="s2">the American Diabetes Association’s Scientific Sessions; June 8-12; Philadelphia.</span></a></span></div>
<div class="p5">
<b>Disclosure:</b> Dr. Lingvay serves on medical advisory board for NovoNordisk, and the study was sponsored through and investigator-initiated trial grant from NovoNordisk.</div>MD Endocrinology MSc Medical Anthropologyhttp://www.blogger.com/profile/09396525904668204911noreply@blogger.comtag:blogger.com,1999:blog-4087917327935431869.post-26108757149585305162012-05-12T11:50:00.001-07:002012-05-12T11:50:20.659-07:00Run for your life! Study finds joggers live an average of six years longer<div dir="ltr" style="text-align: left;" trbidi="on">
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<span style="font-family: Arial; font-size: 22.0pt; mso-ansi-language: EN-US;">Need a solid excuse to dust off your running shoes?
Joggers have been found to live an average of six years longer than those who
don't jog. </span><span style="font-family: Arial; mso-ansi-language: EN-US;"><o:p></o:p></span></div>
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<span style="font-family: Arial; font-size: 22.0pt; mso-ansi-language: EN-US;">However, you’ll have to run for at least one hour a
week for benefit, according to a new study in Denmark. </span><span style="font-family: Arial; mso-ansi-language: EN-US;"><o:p></o:p></span></div>
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<span style="font-family: Arial; font-size: 22.0pt; mso-ansi-language: EN-US;">Researchers found that jogging was associated with a
44 per cent reduction in the relative risk of death for those over 35 years
compared with deaths among those who did not run. </span><span style="font-family: Arial; mso-ansi-language: EN-US;"><o:p></o:p></span></div>
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<span style="font-family: Arial; font-size: 22.0pt; mso-ansi-language: EN-US;">The same benefit applied to both men and women. </span><span style="font-family: Arial; mso-ansi-language: EN-US;"><o:p></o:p></span></div>
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<span style="font-family: Arial; font-size: 22.0pt; mso-ansi-language: EN-US;">The 44 per cent reduction translates to an
‘age-adjusted survival benefit’ of 6.2 years in men and 5.6 years in women,
according to Dr. Peter Schnohr, chief cardiologist from the Copenhagen City
Heart study.</span><span style="font-family: Arial; mso-ansi-language: EN-US;"><o:p></o:p></span></div>
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<span style="font-family: Arial; font-size: 22.0pt; mso-ansi-language: EN-US;">Furthermore, the jogger’s lives are not only longer
but happier too as those who ran reported an overall sense of well-being, said
Schnohr. </span><span style="font-family: Arial; mso-ansi-language: EN-US;"><o:p></o:p></span></div>
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg1s9FkzBxsOdgpCTYIC2hSBTrU6_QjgtL72kgQuTbX9sM0yeh2aV19Wr9tUj5p2VokT6tym2W7pn0tkEUYLdttPVF3_RYrHvlZLxW_kzbuQlOF0TXeKINOdPijntsaZFKgw1vECsAowofG/s1600/man+jogging" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="640" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg1s9FkzBxsOdgpCTYIC2hSBTrU6_QjgtL72kgQuTbX9sM0yeh2aV19Wr9tUj5p2VokT6tym2W7pn0tkEUYLdttPVF3_RYrHvlZLxW_kzbuQlOF0TXeKINOdPijntsaZFKgw1vECsAowofG/s640/man+jogging" width="349" /></a></div>
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<br /></div>
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<br /></div>
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<span style="font-family: Arial; font-size: 22.0pt; mso-ansi-language: EN-US;">'The results of our research allow us to definitively
answer the question of whether jogging is good for your health,' Schnohr said
in a statement.</span><span style="font-family: Arial; mso-ansi-language: EN-US;"><o:p></o:p></span></div>
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<span style="font-family: Arial; font-size: 22.0pt; mso-ansi-language: EN-US;">'We can say with certainty that regular jogging
increases longevity. The good news is that you don't actually need to do that
much to reap the benefits,' he continued. </span><span style="font-family: Arial; mso-ansi-language: EN-US;"><o:p></o:p></span></div>
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiXwzXgh6kHqrnSKytKtpgSdDEOAAR0OVYWsb_EhetPy-EBgi6EDIOPmbyG6VhDugu_DFUmol4z1dB2YGCj2LhqdeOz0e3miARg5_rMt9B9QBVD5-qa_zPBkaA1FpNpgWojioy5Nv-x9IOZ/s1600/woman+jogging" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="397" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiXwzXgh6kHqrnSKytKtpgSdDEOAAR0OVYWsb_EhetPy-EBgi6EDIOPmbyG6VhDugu_DFUmol4z1dB2YGCj2LhqdeOz0e3miARg5_rMt9B9QBVD5-qa_zPBkaA1FpNpgWojioy5Nv-x9IOZ/s640/woman+jogging" width="640" /></a></div>
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<br /></div>
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<br /></div>
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<b><span style="font-family: Arial; mso-ansi-language: EN-US;">Fighting fit: The study also found that joggers
led happier lives<o:p></o:p></span></b></div>
<div class="MsoNormal" style="margin-bottom: 8.0pt; mso-layout-grid-align: none; mso-pagination: none; text-autospace: none;">
<span style="font-family: Arial; font-size: 22.0pt; mso-ansi-language: EN-US;">The study also found that the optimum benefit of
jogging was for those who jogged at a slow-to-average pace for between an hour
and two and a half hours spread over two or three weekly sessions.</span><span style="font-family: Arial; mso-ansi-language: EN-US;"><o:p></o:p></span></div>
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<span style="font-family: Arial; font-size: 22.0pt; mso-ansi-language: EN-US;">The revelations are the latest to come out of the
Copenhagen City Heart Study which began in 1976. At the beginning of the
programme the study’s 19,329 participants’ age ranged from 20 to 79. </span><span style="font-family: Arial; mso-ansi-language: EN-US;"><o:p></o:p></span></div>
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<span style="font-family: Arial; font-size: 22.0pt; mso-ansi-language: EN-US;">The 1,878 participants in the most recent study were
asked how often and how quickly they ran. </span><span style="font-family: Arial; mso-ansi-language: EN-US;"><o:p></o:p></span></div>
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<span style="font-family: Arial; font-size: 22.0pt; mso-ansi-language: EN-US;">Researchers then compared deaths among the joggers
among the non-joggers in the main study pool of almost 20,000.</span><span style="font-family: Arial; mso-ansi-language: EN-US;"><o:p></o:p></span></div>
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<span style="font-family: Arial; font-size: 22.0pt; mso-ansi-language: EN-US;">Over 35 years, 122 joggers died compared with 10,158
non-joggers.</span><span style="font-family: Arial; mso-ansi-language: EN-US;"><o:p></o:p></span></div>
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<!--EndFragment--></div>MD Endocrinology MSc Medical Anthropologyhttp://www.blogger.com/profile/09396525904668204911noreply@blogger.com