The benefits of exercise for women.

This article describes the benefits of exercise, including why exercise improves blood pressure control, how it may reduce the risk for cancer, and increase mental health, and how it may improve bone mineral density. The article also explores the gender-independent and gender-specific benefits of exercise for women.

Posterior element pain in a adolescent schoolgirl.

A case is presented of a transitional lumbosacral vertebra in a adolescent girl, presenting with low back pain. There was no evidence of a pars interarticularis defect. Careful assessment of children or adolescents presenting with low back pain is important since back pain in this age group is usually caused by organic disease.

Plantar fasciitis: a prospective randomized clinical trial of the tension night splint.

OBJECTIVE: The objective of this study was to evaluate the efficacy of a tension night splint (TNS) as part of a treatment regimen for the management of plantar fasciitis. DESIGN: The design was a randomized clinical trial. SETTING: The setting was a university-based primary care sports medicine clinic in California. PATIENTS: Forty patients with plantar fasciitis entered the study (age range, 20-74 years; average age, 45.7 years). Excluded from the study were patients with other concomitant ankle or foot pathology. Thirty-two patients (21 women, 11 men) completed the study with 33 treated feet. INTERVENTION: The patients were randomized to one of two treatment groups. The control group (n = 17) received standard treatment of antiinflammatory medication (Ibuprofen), a Viscoheel sofspot heel cushion (Bauerfeind USA, Kennesaw, GA, U.S.A.) and a stretching program for the gastrocnemius and soleus muscles. The tension night split group (n = 16) received the same standard treatment protocol and additionally an office manufactured custom fitted posterior splint to be used at night. Those patients in the control group not responding to treatment after 8-12 weeks were crossed over to the tension night splint group. Patients were reviewed every 4 weeks for symptom assessment and compliance. MAIN OUTCOME MEASURES: The main outcome measures were subjective assessment of pain (Visual analogue scale), plantar fascial tenderness, and ankle range of motion. Patients were discharged from either arm of the trial when they had resumed normal activities with minimal or no discomfort. This end point was recorded as weeks to cure. MAIN RESULTS: There was no significant difference in the demographics of the two groups (p > 0.05). In the control group, 6 of 17 were cured after an average interval of 8.8 weeks. The remaining 11 of 17 control group patients were crossed over to receive a TNS in addition to control modalities. Following cross over 8 of 11 of this group were cured after an average of 13 weeks. Three of the 11 failed to significantly respond. Of the 15 patients (16 feet) originally randomly assigned to the TNS group 16 of 16 were cured with an average treatment time of 12.5 weeks. The TNS treatment protocol was a significantly more efficacious treatment regime (p < 0.05). Thus, of 33 cases of plantar fasciitis treated in this study three failed treatment. CONCLUSION: When used in combination with a visco-elastic heel pad, stretching program and nonsteroidal anti-inflammatory drugs, the TNS is an effective treatment of plantar fasciitis.

Prevalence rate of hypertension among recent Southeast Asian refugees to northern California.

BACKGROUND: Little is known regarding the prevalence rate of hypertension among recent Southeast Asian refugees to the United States. METHODS: In this randomized, prospective study, four northern California counties with large Southeast Asian refugee populations were screened for the prevalence rates of hypertension and borderline hypertension. A population density method based upon 1988 census data was used to screen a representative sample of subjects from each county. Criteria for hypertension came from the Joint National Committee on Detection, Evaluation, and Treatment of High Blood Pressure. RESULTS: In all, 964 subjects were screened. We found a prevalence rate of 4.8 percent for hypertension and 10.9 percent for borderline hypertension. CONCLUSIONS: The relatively low prevalence rates of this disease can be explained by the youth of this refugee population, mean age 37.6 +/- 0.36 years, as the presence of hypertension increases with chronological age.

High- versus low-top shoes for the prevention of ankle sprains in basketball players. A prospective randomized study.

Using a prospective, randomized experimental design, 622 college intramural basketball players were stratified by a previous history of ankle sprains to wear a new pair of either high-top, high-top with inflatable air chambers, or low-top basketball shoes during all games for a complete season. Subjects were asked to complete a history questionnaire and were given a complete ankle examination. They were allowed to wear these shoes only during basketball competition. Followed over the course of a 2-month intramural season, 15 ankle injuries occurred during 39,302 minutes of player-time: 7 in high-top shoes, 4 in low-top shoes, and 4 in high-top shoes with inflatable air chambers. The injury rates (injuries per player-minute) were 4.80 x 10(-4) in high-top shoes, 4.06 x 10(-4) in low-top shoes, and 2.69 x 10(-4) in high-top shoes with inflatable air chambers. There was no significant difference among these 3 groups, leading to the conclusion that there is no strong relationship between shoe type and ankle sprains.

Will family physicians really return to obstetrics if malpractice insurance premiums decline?

BACKGROUND: The loss of family physicians as obstetrics providers during the last decade has had a significant impact on access to obstetric services, especially for rural populations. The expense of malpractice premiums has been cited often as a reason for physicians' discontinuation of this service. METHODS: Seventy-six family physicians in northern California who recently discontinued obstetrics were surveyed regarding their decisions related to obstetric practice. Those physicians who indicated that a decrease in malpractice premiums would allow them to consider resuming obstetrics were resurveyed by telephone the following year. This telephone survey occurred following a 25 percent decrease in malpractice premiums for obstetrics by the major malpractice insurance carrier for family physicians practicing obstetrics in the study area. RESULTS: Twenty-nine of the 76 physicians in the original survey who had recently discontinued obstetrics stated they would consider resuming if conditions changed. Twenty-six (90 percent) of these physicians indicated that malpractice premiums needed to change for them to consider resuming obstetrics. Following the reduction in premiums, none of these physicians reported plans to resume obstetrics or even a likelihood that they would be resuming obstetrics. CONCLUSION: This study found that family physicians who discontinued obstetrics and cited malpractice premiums as a barrier to resuming obstetrics are unlikely to resume when rates decline. This finding suggests that other issues might be equally or more important in this decision.

Factors influencing family physicians to continue providing obstetric care.

To determine the reasons some family physicians continue to practice obstetrics when most of their colleagues do not, we surveyed family physicians in 26 counties of northern California whose practices include obstetrics and those who have recently discontinued it. In all, 70% of family physicians practicing obstetrics cited enjoying it as a reason for continuing this practice. Over a third of family physicians practicing obstetrics thought that obstetric practice was a responsibility to the community. Only 1 in 6 reported obstetrics to be important in terms of financial implications. Despite this, family physicians practicing obstetrics had a mean gross income derived from obstetric practice of $30,000 above the cost of their total malpractice premium. In contrast, a comparison group of family physicians who had recently discontinued obstetrics cited malpractice insurance costs most frequently as the reason for discontinuing it. Nearly 40% of these physicians indicated that they would be willing to return to obstetrics if circumstances were to change substantially. The most frequently cited change necessary for these physicians to return to obstetrics was a reduction in malpractice insurance rates.

Exercise and the hypertensive athlete.

Exercise helps to manage high blood pressure in most circumstances and should be encouraged in both hypertensive athletes and active individuals with this disease. Many physiologic mechanisms have been proposed that explain this benefit. Presently, it appears from both human and animal studies that exercise of moderate intensity may be optimal for control of high blood pressure. Exercise testing for the future prediction of hypertension is an intriguing concept, but more data needs to be gathered before screening can be recommended.

Obstetric care, Medicaid, and family physicians. How policy changes affect physicians' attitudes.

Recent expansion of Medicaid eligibility for pregnant women and increased reimbursement to physicians who provide perinatal services were designed to improve access to care. Family physicians provide a relatively high proportion of care to pregnant women on Medicaid, especially in rural areas. We surveyed all family physicians who provide obstetric services in 26 northern California counties regarding these changes and perceived barriers to providing obstetric care to women on Medicaid. Of surveyed physicians who limited the number of their Medicaid obstetric patients, 58% stated that recent Medicaid policy changes had increased their willingness to accept new Medicaid obstetric patients. Despite these policy changes, administrative issues and poor reimbursement were cited as the two most notable barriers to providing obstetric care to women on Medicaid. Fear of being sued by Medicaid patients is still seen as a barrier by physicians who have recently discontinued practicing obstetrics and by those who continue to care for a large number of Medicaid obstetric patients.

Tracking of elevated blood pressure values in adolescent athletes at 1-year follow-up.

Resting blood pressures were measured in 467 adolescents during preparticipation physical examinations for high school sports. Fifty-seven of the athletes (12.2%) had significantly elevated blood pressures. Forty-three (79.6%) of 54 subjects demonstrated significantly and persistently elevated blood pressures at 1-year follow-up. A family history of hypertension was positively associated with elevated blood pressures in 46 (80.7%) of 57 subjects compared with controls (23/410 [5.6%]). Consistent with previous studies, subjects with elevated blood pressures had a greater body weight (94.5 +/- 25.7 kg) compared with normotensive subjects (75.2 +/- 14.0 kg). Subjects with elevated blood pressures engaged in heavy resistance weight training (three times a week or more) more often (41/57 [71.9%]) than normotensive subjects (65/410 [15.8%]). These data support the idea that blood pressures measured during routine preparticipation physical examinations for high school sports are a useful tool in screening for elevated blood pressure in adolescents.

Dietary calcium supplementation as a treatment for mild hypertension.

The blood pressure responses of 19 mildly hypertensive (diastolic blood pressure 90-104 mmHg) individuals to treatment with either 1200 mg of elemental calcium supplementation or placebo were assessed weekly in a 6-month randomized, double-blind, placebo-controlled crossover study. Both groups showed a decrease in blood pressure (calcium treated: 6 +/- 12 mmHg systolic, 7 +/- 7 mmHg diastolic; and placebo controlled: 9 +/- 14 mmHg systolic, 9 +/- 8 mmHg diastolic). Differences between the two groups were not significant (P greater than 0.1). There were no adverse effects to either treatment. This study does not support the hypothesis that dietary calcium supplementation is more effective than placebo in reducing blood pressure in mildly hypertensive individuals.

The preparticipation physical examination for sports.

Up to 25 million children and adolescents in the United States participate in some type of organized sports activity each year. Most of these young athletes receive an annual preparticipation physical examination. The purpose of the examination is to identify any conditions that might interfere with the athlete's ability to participate in a given sport. The criteria for disqualification are different for each sport.

Hypertension.

In brief When exercise alone does not NMM control hypertension, a medical ISMS regimen can be used in conjunction with exercise or other nonpharmacologic interventions. Diuretics, beta blockers, calcium antagonists, and angiotensin-converting enzyme (ACE) inhibitors are widely used to treat hypertension. ACE inhibitors and calcium antagonists are good choices for exercising patients because they do not limit exercise performance and have few side effects. The author gives guidelines for changing the regimen from exercise alone to exercise and medication, and for stepping down from medical therapy.

Hypertension.

In brief Exercise can be an effective form of therapy for hypertension, recent research has shown. This article reviews the possible mechanisms by which exercise lowers blood pressure and gives physicians the necessary information to counsel hypertensive patients who want to start an exercise program. Some researchers are exploring the use of exercise testing to predict the onset of hypertension.

The impact of obstetrical liability on access to perinatal care in the rural United States.

Liability issues have caused large numbers of obstetrical providers, particularly family and general practitioners, to discontinue offering perinatal care in rural areas. Losses of even small numbers of rural obstetrical providers can severely limit access to care for large geographic areas. A lack of access to local obstetrical care can result in less than adequate prenatal care and in potential delays in the diagnosis and care of acute perinatal complications. Women who live in these underserved rural communities suffer increased adverse birth outcomes, leading to significantly higher medical costs. Proposed solutions to the problem include risk management programs associated with reduced liability premiums; increased Medicaid reimbursement for obstetrical care; health department subsidies to offset insurance premiums for rural obstetrical care; and programs in predoctoral and residency training designed to identify, assess and address the health care needs of rural areas. Although some measure of success has resulted from these efforts, more systematic and comprehensive policy changes are needed to meet the challenge of this crisis.

Blood pressure recovery curves after submaximal exercise. A predictor of hypertension at ten-year follow-up.

The purpose of this study is to examine the usefulness of blood pressure recovery curves after submaximal exercise in apparently normotensive young adults as an early predictor for hypertension. Twenty-six college age males in 1977, with normal blood pressures at rest, were given the Harvard Step Test and postexercise blood pressures were recorded. Criteria were set that differentiated a hypertensive from a normotensive response to exercise. In 1987, these individuals were contacted regarding their blood pressure status. Nine out of ten subjects who demonstrated a hypertensive response to exercise in 1977, now have been given the diagnosis of hypertension. Eleven out of twelve subjects who demonstrated a normotensive response to exercise in 1977, now are still considered to be normotensive. A proposed hypothesis is that during the course of this disease, exercise can unmask hypertension in subjects who have the potential for developing hypertension but currently have a normal resting blood pressure.

Hands-On Sports Medicine Training for Residents.

In brief: Primary care sports medicine is a rapidly growing field of interest; however, there are relatively few training programs in this field. The author describes the development of a one-month training program at the University of California, Davis, Medical Center. The education strategies used in the program include clinical teaching (50%), on-the- field education (20%), experiential learning (20%), and didactic instruction (10%). The most innovative part of the program is the experiential learning component, through which students learn basic sports medicine skills by actively participating in sports, exercises, strength training, and a fitness program.