When should kids be kept home from school because they are ill?

Posted on January 8, 2013 by Stone Hearth News

Newswise — PRAIRIE DU CHIEN, Wis. — Children are bound to come down with the occasional cold or other viral illness, especially when cold weather keeps a whole class cooped up inside all day. Whether or not to keep your sick child home from school or daycare can be a difficult decision to make, and may also depend on your child’s school or daycare policies. A Mayo physician offers tips on how to decide.

“Young children’s immune systems haven’t learned to recognize and resist most common viruses,” explains Robert Key, M.D., family physician at Mayo Clinic Health System in Prairie du Chien. “That’s why, until they’re 8 or so, kids seem to bring home everything that’s making the rounds at school. Children can typically have six to 10 colds per year.”

“In general, children should stay home when they don’t feel well enough to participate in normal daily activities and lack sufficient alertness to learn or play,” Dr. Key says.

He suggests that kids should stay home when they experience:

*Vomiting twice or more over a 24-hour period or being unable to tolerate normal food and drink, or both.

*A temperature of 101 or higher.

*Severe coughing or difficulty breathing.

*Repeated bouts of severe diarrhea for at least a day.

*Persistent abdominal pain (more than 2 hours).

*Open sores on the mouth.

*A skin rash or red eye from an undetermined cause.

*Head lice or scabies.

*Other contagious conditions such as strep throat, chicken pox, impetigo, etc.

According to Mayo Clinic, the top four infectious illnesses that keep children home from school or daycare are colds, the “stomach flu,” pink eye and strep throat.

If your child’s illness seems to be more than just a common cold or flu, you may want to contact his or her regular health care provider to see whether the symptoms could indicate something more serious.

The single most important thing your child can do to prevent illness is to wash his or her hands thoroughly and frequently. The Centers for Disease Control and Prevention recommends that people wash their hands with soap and warm water for 15 seconds — about as long as it takes to sing the “Happy Birthday” song twice.

Why obese people may have higher rates of asthma

Posted on January 8, 2013 by Stone Hearth News

Findings suggest that therapies that increase leptin-signaling may relieve asthma in obese people

New York, NY — A new study led by Columbia University Medical Center (CUMC) researchers has found that leptin, a hormone that plays a key role in energy metabolism, fertility, and bone mass, also regulates airway diameter. The findings could explain why obese people are prone to asthma and suggest that body weight–associated asthma may be relieved with medications that inhibit signaling through the parasympathetic nervous system, which mediates leptin function. The study, conducted in mice, was published in the online edition of the journal Cell Metabolism.

“Our study started with the clinical observation that both obesity and anorexia can lead to asthma,” said Gerard Karsenty MD, PhD, professor and chair of genetics and development and professor of medicine at CUMC, and lead author of the study. “This led us to suspect that there must be a signal coming from fat cells that somehow affects the lungs —directly or indirectly.” The most likely candidate was leptin, a protein made by fat cells that circulates in the bloodstream and travels to the brain.

Extensive evidence shows that obesity can cause narrowing of the airways (bronchoconstriction). When obesity develops in people with asthma, it exacerbates the breathing disorder and hampers its treatment through mechanisms that are poorly understood. The current study was designed to elucidate the genetic and molecular bases of the relationships among obesity, airway diameter, and lung function.

Through mouse studies, the researchers showed that abnormally low or high body weight and fat mass results in bronchoconstriction and diminished lung function. Next, they showed that leptin increases airway diameter independently of, and at a lower threshold than, its regulation of appetite.

Leptin affects the airways by decreasing the activity of the parasympathetic nervous system, a branch of the autonomic nervous system not usually associated with leptin. The researchers also showed that regulation of airway diameter occurs regardless of local inflammation in the bronchi.

The researchers conducted two subsequent experiments to determine if these findings might have bearing on asthma therapy. In one, they took obese, asthmatic mice and administered a substance that increases lung inflammation. When they infused leptin in the brain of these mice for four days, “There was no effect on inflammation, but airway diameter and lung functions were normal,” said Dr. Karsenty. “This showed that, at least in the mouse, you can cure obesity-related asthma without affecting inflammation.” In the second experiment, the researchers treated obese, asthmatic mice with drugs that decrease parasympathetic tone, or rate of neuronal firing. Again, the asthma abated after several days.

“The therapeutic implication is that it may be possible to correct asthma in obese people with drugs that inhibit parasympathetic signaling—and thereby increase leptin-related brain signaling,” said Dr. Karsenty. Such drugs are already available. One is methacholine (Provocholine®, manufactured by Methapharm Inc.), which is used primarily to diagnose bronchial hyperreactivity, the hallmark of asthma. Clinical trials are needed before this or a more active and selective drug can be recommended for the treatment of body weight–associated asthma, Dr. Karsenty added.

The title of the paper is “Inhibition of leptin regulation parasympathetic signaling as a cause of extreme body weight associated asthma.” The other contributors are Emilio Arteaga-Solis, Tiffany Zee, Charles W. Emala (CUMC); and Charles Vinson, and Jürgen Wess (NIH).

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The study was supported by the John M. Driscoll, Jr., MD, Children’s Fund Scholars, the Irving Institute/Clinical Trials Office Pilot Award, and the National Institutes of Health (RO1 DK58883).

The authors declare no financial or other conflicts of interest.

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Female knees and ACL ruptures very different from men’s

Posted on January 8, 2013 by Stone Hearth News

Sports training and ACL reconstruction should focus on unique characteristics of the female knee

ROSEMONT, Ill.—Female athletes are three times more likely to suffer from anterior cruciate ligament (ACL) ruptures, one of the most common knee injuries, compared to male athletes. The ACL is one of the four main ligaments within the knee that connect the femur (upper leg bone) to the tibia (lower leg bone). Recent research highlights the unique anatomical differences in the female knee that may contribute to higher injury rates, and should be taken into consideration during reconstructive surgery and sports training, according to a review article in the January 2013 issue of the Journal of the American Academy of Orthopaedic Surgeons (JAAOS).

“As female athletes have increased their participation in sports, many studies have shown the vulnerability of female athletes to ACL ruptures,” said Karen Sutton, MD, assistant professor, Yale University Department of Orthopaedics and Rehabilitation, and lead author of the review article. “This devastating injury has a long recovery period and a slow return to sport. Thus, research has been done focusing on why women are more vulnerable to ACL injuries and how to prevent them.”

Multiple, recent research studies also have found that preseason and ongoing neuromuscular training programs as part of an overall sports training program aimed specifically at improving knee stability when jumping, landing or pivoting can significantly decrease ACL injury risk among girls and women.

Unique anatomical features of female athletes such as a larger quadriceps angle (“Q angle”)—the angle at which the femur meets the tibia—may cause a greater pull of the knee muscles during physical activity, and contribute to more ACL injuries among females.

Anatomical differences in the female knee should be taken into consideration during ACL reconstruction, said Dr. Sutton. Females are more likely than males to have a smaller, A-shaped intercondylar notch (the deep groove between the rounded ends of the femur bone), making ACL reconstruction more challenging, and possibly requiring altered surgical techniques.

“All female athletes, starting in adolescence, should learn appropriate training techniques,” said Dr. Sutton. “This includes the appropriate way to land from a jump, increasing the strength of muscles that could have a protective affect on the ACL—core, gluteal, quadriceps and hamstring muscles, as well as working on the body’s reaction to change of direction and change of speed.”

Read about how Aimee Hartwell, Christina Gordon, and Joanne Donoghue overcame their sports-related ACL rupture injuries on ANationInMotion.org.

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January 2013 Full JAAOS Table of Contents

• Correspondence: Displaced Clavicle Fractures in Adolescents
• Adjacent Segment Disease Following Cervical Spine Surgery
• Mucopolysaccharide Disorders in Orthopaedic Surgery
• Soft-tissue Management in Revision Total Shoulder Arthroplasty
• Posterior Malleolus Fractures
• Bone-Graft and Bone Graft Substitutes in Spine Surgery: Current Concepts and Controversies
• On the Horizon from the ORS: Mensenchymal Stem Cell Transplantation
• On the Horizon from the ORS: The Role of Metabolomics in Osteoarthritis Research

A Nation in Motion

More than one in four Americans have bone or joint health problems, making them the greatest cause of lost work days in the U.S. When orthopaedic surgeons restore mobility and reduce pain, they help people get back to work and to independent, productive lives. Orthopaedic surgeons provide the best value in American medicine in both human and economic terms and access to high-quality orthopaedic care keeps this “Nation in Motion.” To learn more, to read hundreds of patient stories or to submit your own story, visit anationinmotion.org.

Aerobic exercise is best bet for weight, fat loss

Aerobic, not resistance, exercise is best bet for weight, fat loss: Journal of Applied Physiology

Posted on January 2, 2013 by Stone Hearth News

BETHESDA, Md. (Jan. 2, 2012)—A new study led by North Carolina researchers has found that when it comes to weight- and fat loss, aerobic training is better than resistance training. The study is believed to the largest randomized trial to directly compare changes in body composition induced by comparable amounts of time spent doing aerobic and resistant training, or both in combination, among previously inactive overweight or obese non-diabetic adults.

The study is entitled “Effects of aerobic and/or resistance training on body mass and fat mass in overweight or obese adults.” It is published in the December 2012 edition of theJournal of Applied Physiology published by the American Physiological Society.

Methodology

A total of 234 previously sedentary overweight or obese males and females, age 18-70 years of age, were enrolled in one of three eight-month supervised protocols: aerobic training (AT), resistance training (RT), or a combination (AT/RT). Of the total, 119 participants completed the trials and had complete data for the variables of interest in the article.

Those assigned to aerobic training exercised vigorously, at about 70-85% of maximum heart rate. They exercise approximately 45 minutes three days per week throughout the study period.

Individuals assigned to resistance training also exercised three days a week, completing three sets of 8-12 reps on eight resistance machines that targeted all major muscle groups. Resistance was increased throughout the study to maintain a steady level of challenge as the participants gained strength.

Individuals who were assigned to AT/RT performed all the exercises assigned to both AT and RT groups. At the end of study each enrollee was assessed for weight, body composition, waist circumference, cardiopulmonary fitness and strength compared to their baseline.

Key Findings and Conclusions

The researchers found:

• The groups assigned to aerobic training and aerobic plus resistance training lost more weight than those that did resistance training only. In fact, those who did resistance training only actually gained weight due to an increase in lean body mass.
• Fat mass and waist circumference significantly decreased in the AT and AT/RT groups, but were not altered in RT. However, measures of lean body mass significantly increased in RT and AT/RT, but not in AT. The finding suggest that aerobic exercise is more effective in reducing these measures.
• Lean body mass increased with both RT and AT/RT, but not AT. Having the benefit to of both modes of exercise allowed AT/RT to decrease body fat percent significantly more than either AT or RT due to decreased fat mass combined with increased lean body mass.

Importance of the Findings

According to Leslie H. Willis, an exercise physiologist at Duke University Medical Center and the study’s lead author, “Given our observations, it may be time to seriously reconsider the conventional wisdom that resistance training alone can lead to weight and fat loss.”

Willis added, “If increasing muscle mass and strength is a goal, then resistance training is required. However, the majority of Americans could experience health benefits due to weight and fat loss. The best option in that case, given limited time for exercise, is to focus on aerobic training. When you lose fat, it is likely you are losing visceral fat, which is known to be associated with cardiovascular and other health benefits.”

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Research Team

In addition to Leslie Willis, the study was conducted by Cris A. Slentz, Lori A. Bateman, Lucy W. Piner, Connie W. Bales and William E. Kraus of the Duke University Medical Center; and Joseph A Hourmard and A. Tamlyn Shields of East Carolina University.

Funding

This study was conducted with funds provided by the NHLBI, National Institutes of Health (2R01-HL057354).

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