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Weak muscles may be the cause of the painful and debilitating condition known as “runner’s knee,” new research suggests.

People who develop the condition tend to have “weaker quads and hamstrings,” study co-author Darin Padua, said in a news release. “As a result, they don’t bend their knees as much when doing tasks, such as running or jumping. That means the contact area between the kneecap and the femur is smaller, so pressure is focused and pinpointed on a smaller area.”

That, in turn, leads to runner’s knee, also known as patellofemoral pain syndrome, said Padua, an associate professor of exercise and sport science at the University of North Carolina at Chapel Hill. Runner’s knee, which affects an estimated one in four people who are physically active, can lead to osteoarthritis.

The research appears to be the first of its kind to study athletes both before and after they develop runner’s knee, Padua said.

The researchers studied nearly 1,600 midshipmen from the U.S. Naval Academy. Of those, 40 people — 24 women and 16 men — developed runner’s knee over several years.

The study authors noted that those with weaker hamstring and quadriceps muscles, a larger “navicular drop” (flattening of arches in the foot) and less flexible knees were several times more likely to develop the condition.

People who wake up during the night to urinate shouldn’t automatically blame a urological problem. Sleep apnea, a breathing-related sleep disorder, could be the cause.

A new study suggests that nighttime urination, or nocturia, is comparable to loud snoring as a marker for obstructive sleep apnea, a disorder in which soft tissue in the throat blocks the flow of air into the lungs, disrupting sleep.

Previous studies established a link between nocturia and sleep apnea, a potentially serious condition that affects about 25 percent of U.S. men and 10 percent of U.S. women, the researchers said. But they believe this is among the first to show that screening for nocturia could help doctors identify patients with apnea.

The study also suggests that a common treatment for sleep apnea — positive airway pressure (PAP) therapy — can reduce symptoms of nocturia, thereby improving sleep and preventing debilitating falls among elderly people who get out of bed at night to use the bathroom.

PAP involves wearing a pressurized air mask while sleeping.

Typically, doctors screen for apnea by assessing patients’ weight (the condition is associated with overweight/obesity) and asking if they snore heavily, notice breathing problems at night or feel tired during the day (because of interrupted sleep). But because many patients, especially those who sleep alone, are unaware that they snore, apnea often goes undiagnosed.

“When you ask people about symptoms like snoring and gasping, they tend to say, ‘No, I don’t have them’,” said study author Edward Romero, research coordinator at the Sleep & Human Health Institute in Albuquerque, N.M. “But it’s very easy for them to realize that they wake up at night to go to the bathroom.”

One of Romero’s co-authors, institute director Dr. Barry Krakow, said doctors and patients are quick to blame nocturia on diabetes, prostate enlargement and other medical conditions with which it is associated. “I see patients all the time who think they’re waking up to urinate because they have prostate trouble or a small bladder,” Krakow said. “About 80 percent of the time we discover that apnea is the cause of their problem.”

Besides nocturia and snoring, symptoms of sleep apnea include daytime drowsiness, memory problems and depression. Untreated sleep apnea can lead to high blood pressure, blood clots and heart disease.

For the study, published online recently in Sleep and Breathing, the researchers reviewed data on 1,007 adults treated at two sleep clinics in New Mexico between 2005 and 2007. Of the participants, 797 were diagnosed with sleep apnea, 777 reported snoring and 839 reported nocturia. Neither snoring nor nocturia was proof of apnea, but the two symptoms were similar in their power to predict it: snoring was reported by 82.6 percent of apnea sufferers, and 84.8 percent of apnea sufferers reported nocturia.

The authors propose further research be conducted to confirm the effectiveness of nocturia as an apnea screening tool.

Mary Umlauf, a professor at the University of Alabama Capstone College of Nursing in Tuscaloosa and a noted nocturia researcher, said the study could play an important role in dispelling “old wives’ tales” about nocturia.

“Many health-care providers and ordinary people think of nocturia as a urological or gynecological problem,” she said. “They don’t understand that sleep apnea can cause the body to produce too much urine at night.

“People who wake up to urinate shouldn’t assume that it’s my prostate, or ‘I’m just old’,” she said.

When babies are teething, they’re generally miserable from the pain, swelling and tenderness in their gums.

Here are suggestions from the Nemours Foundation to help comfort little ones who are teething:
Use a warm, wet cloth to wipe down baby’s face and remove any drool. This may help prevent a rash.
Offer baby something soothing, such as a teething ring or a wet washcloth that’s been chilled in the freezer for about 30 minutes. Be sure to wash the cloth after each use.
Treat baby to a gentle gum massage, making sure to use a clean finger.
Ask your doctor if it’s safe to give baby acetaminophen. Make sure your doctor approves a specific dose and frequency.

Never tie a teething ring to baby, especially around the neck, as it could cause strangulation.

A number of adverse effects can result if you don’t take a medication as directed.

The American Academy of Family Physicians offers this list of possibilities:
Side effects, such as dizziness or nausea.
An interaction with another drug.
An interaction with a food or beverage.
An allergic reaction.
A sensitivity that results from use of the drug, such as sensitivity to the sun.

A potentially deadly intestinal infection is on the rise outside of hospital settings, especially among the elderly, researchers warn.

The germ that causes the condition, known as Clostridium difficile, can create serious symptoms, including diarrhea and an inflammation of the colon, that can be fatal. The infection can be difficult to treat because the bacteria have become immune to some drugs.

The bacteria have been found mostly in hospitals, nursing homes and similar facilities.

“Recent reports have shown increasing incidence and severity of C. difficile infection, especially in the older population,” Dr. Darrell Pardi, a Mayo Clinic gastroenterologist and senior author of a study on the situation, said in a Mayo news release. “Our study examines why the cases are on the rise and who is getting the infection.”

The findings were presented recently at the American College of Gastroenterology annual meeting, in San Diego.

The researchers examined 385 cases of disease caused by the germ from 1991 to 2005 to see if more were being acquired in places other than a hospital.

They found that people who got sick outside of a hospital were younger — a median of 50 years old versus 72 — and had less severe cases.

“The growing incidence of C. difficile infection in both inpatient and outpatient settings could be linked to the increasing usage of antibiotics and to the possibility that C. difficile may be getting resistant to some of our newer antibiotics,” Pardi said.

Health experts have gotten better at spotting the bacteria in hospitals and nursing homes, he said, but “now doctors and patients need to be more aware that you can get this infection as an outpatient and that a case of diarrhea or abdominal cramps at home could become serious.”

The germ kills an estimated 5,000 people in the United States each year, according to the U.S. Centers for Disease Control and Prevention.

The federal government’s push to control health costs through comparative effectiveness research could threaten strides in personalized medicine, in which medicines are tailored to an individual’s genetic makeup, the chief of the National Institutes of Health said on Monday.

“There is a potential collision here,” Dr. Francis Collins, director of the National Institutes of Health said at a forum sponsored by the American Association for the Advancement of Science.

Collins, a genetics pioneer tapped by President Barack Obama in July to head the NIH, said studies that lump together large groups of people to test the effectiveness of treatment A versus treatment B run the risk of overlooking clusters of people for whom a drug might have a dramatic effect.

“That’s going to get lost in the wash by considering everybody equivalent, which we know they are not,” said Collins, who helped lead the Human Genome Project that in 2003 produced a sequence of all the DNA in people.

“The antidote to that is pretty straightforward,” said Collins, saying that studies need to include genetic information that allows researchers to find such responses.

Backers of comparative effectiveness research, who include insurers and large employers, see the government-funded studies as a way to learn which treatments work best. But Collins said the studies should be well crafted.

“We need to be mindful of the goal of comparative effectiveness research and not lose all that we have gained in understanding how individuals differ and how that could be factored into better diagnostics and preventive strategies,” Collins told the meeting, which was broadcast on the Internet.

COST-CUTTING POTENTIAL

There is already evidence that personalized medicine can help reduce health costs, Collins said, pointing to Genomic Health’s Oncotype DX, a genetic test that can predict the recurrence of breast cancer.

“This test allows those individuals at low risk for recurrence to know they are at low risk and make a decision about whether to forgo chemotherapy, with all of its adverse consequences, based on that information,” Collins said.

He said the test costs $3,500, and most women who get tested and discover they are at low risk decide to forego chemotherapy, saving an average of $2,000 per patient in additional costs from chemotherapy treatment.

“In 2009, roughly 50,000 women are going through this process, predicting we will therefore save the healthcare system $100 million this year based on the availability of this kind of personalized medical test,” Collins said.

Dr. Margaret Hamburg, commissioner of the U.S. Food and Drug Administration, told the meeting that many clinical trials are structured to determine if a drug is safe and effective in a large group of patients, but the drugs often leave out the why — why certain patients benefit while others do not.

The FDA increasingly is approving drugs with companion diagnostic tests using biomarkers — such as specific proteins or genes — that improve the odds that a new, high-cost biotechnology drug will work.

She said studies that look at the genetic profile of patients and its role in how drugs work could strengthen a drug’s application, lending more scientific certainty about why a new drug works.

“Perhaps then we could see more new drug applications in the pipeline that are more likely to succeed,” she said.

A diet high in a form of sugar found in sweetened soft drinks and junk food raises blood pressure among men, according to research likely to mean more bad news for beverage companies and restaurant chains.

One of two studies released on Wednesday provided the first evidence that fructose helps raise blood pressure. It also found that the drug allopurinol, used to treat gout, can alleviate the effect by reducing uric acid levels in the body.

The second study, which measured fructose intake in mice, suggested that people who consume junk foods and sweetened soft drinks at night could gain weight faster than those who don’t.

“These results suggest that excessive fructose intake may have a role in the worldwide epidemic of obesity and diabetes,” said Dr. Richard Johnson of the University of Colorado-Denver, who studied the link between blood pressure and men.

The findings provide the latest evidence of ties between sugar-rich diets and health problems that have prompted some experts to call for a tax on sugary soft drinks.

Fructose accounts for about half the sugar molecules in table sugar and in high-fructose corn syrup, the sweetener used in many packaged foods.

Johnson and colleagues at the Mateo Orfila Hospital in Spain studied 74 men given 200 grams of fructose per day on top of their regular diet. That amount is well above a daily intake of 50 grams to 70 grams of fructose consumed by most American adults.

Half the men were also given allopurinol.

After two weeks, the men who received only the fructose registered increases of six millimeters in systolic blood pressure — the top reading — and about three millimeters in diastolic or the bottom reading, the researchers told an American Heart Association meeting in Chicago.

REVERSIBLE EFFECT

Most of their blood pressure readings returned to normal levels after two months.

The men who did not get allopurinol also were twice as likely to develop metabolic syndrome, measured by risk factors such as too much abdominal fat, high blood pressure and poor cholesterol readings.

By contrast, those given allopurinol and fructose had significantly lower uric acid levels, and virtually no increase in systolic blood pressure or higher risk of metabolic syndrome.

For the second study, researchers in Ohio studied mice given fructose water to drink. Some had unrestricted access, while others received it during the day or at night.

“The first thing we noticed was that the mice on restricted access rushed to their drinking bottles to load up on the sweetened beverage, similar to teenagers who drink too many soft drinks,” said Mariana Morris of Wright State University in Dayton, Ohio.

The mice that drank fructose water during their regular daylight sleeping hours gained more weight and had higher stress hormone levels than the other mice.

“This model may be similar to the human condition of night time bingeing of fructose-laden foods and beverages,” Morris said.

The American Heart Association says women should eat no more than 100 calories of added processed sugar per day, or six teaspoons (25 grams), while most men should keep it to just 150 calories or nine teaspoons (37.5 grams). On average Americans consume 22 teaspoons (90 grams) or 355 calories of added sugar each day.

Sickle Cell Trait
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Did you know?
Sickle cell disease occurs more often in people from parts of the world where malaria is or was common. It is believed that people who carry the sickle cell trait are less likely to be infected with malaria.
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People who inherit one sickle cell gene and one normal gene have the sickle cell “trait.”
People with sickle cell trait usually do not have any of the symptoms of the disease. But, it is possible for a person with sickle cell trait to have complications of the disease under extreme conditions, such as:
High altitude (flying, mountain climbing, visiting cities with a high altitude)
Increased pressure (scuba diving)
Low oxygen (mountain climbing or exercising extremely hard, such as in military boot camp or when training for an athletic competition)
Dehydration (too little water in the body)

In addition, people with sickle cell trait can potentially pass the disease on to their children.

It’s important to know whether or not you have sickle cell trait. Sickle cell trait is diagnosed with a simple blood test. People at high risk for having sickle cell trait are those whose ancestors come from Africa, South or Central America, the Caribbean, Mediterranean countries, India, and Saudi Arabia.
The Cost of Sickle Cell Disease

Sickle cell disease is a major health concern. People with sickle cell disease can have lifelong disabilities. The average life expectancy is 42 years for men and 48 years for women.1 In addition, the cost to people with the disease and the health care system is high. For example, hospital stays due to complications of sickle cell disease cost an estimated at $475 million during the period 1989–1993.2
A Public Health Approach

Right now, there are no data systems to find out how many people have sickle cell disease in the United States. CDC, in partnership with the National Institutes of Health (NIH), is working to develop a pilot surveillance system to help learn more about how many people have the disease and how it affects them.

In addition, CDC is helping to educate people a bout this disease. We have a website with information about the disease and tip sheets on how to stay healthy, how to prevent infections, and when to see the doctor. We are also developing new materials to help people better understand certain drug therapies and to raise awareness among students, teachers, and others in the community.
Help Spread the Word

Every September—during National Sickle Cell Awareness Month—community organizations, families, and others join together to spread the word about sickle cell disease.

Sickle cell disease (SCD) is a common inherited blood disorder in the United States, affecting an estimated 70,000 to 100,000 Americans.

The Many Faces of Sickle Cell Disease

Sickle cell disease affects people of many racial and ethnic groups. In the United States, 1 in 500 African-American newborns has the disease. Other people affected include Hispanics, people of Mediterranean and Middle Eastern descent, and Asians. In addition, more than 2 million people carry the gene that allows them to potentially pass the disease on to their children.
About Sickle Cell Disease

In sickle cell disease, the red blood cells become hard and sticky and look like a C-shaped farm tool called a “sickle.” The sickle cells die early, which causes a constant shortage of red blood cells. Also, when these blood cells travel through small blood vessels, they get stuck and clog the blood flow. This results in repeated episodes of severe pain, organ damage, serious infections, or anemia.

People with sickle cell disease can live full lives and enjoy most of the activities that other people do. There are things that people with sickle cell disease can do to stay as healthy as possible. Here are some examples:
Get regular checkups. Regular health checkups with a primary care doctor can help prevent some serious problems.
Prevent infections. Common illnesses, like the flu, can quickly become dangerous for a child with sickle cell disease. The best defense is to take simple steps to help prevent infections. See tips to help avoid getting an infection.
Learn healthy habits. People with sickle cell disease should drink 8 to 10 glasses of water every day and eat healthy food. They also should try not to get too hot, too cold, or too tired.
Look for clinical studies. New clinical research studies are happening all the time to find better treatments, and hopefully a cure, for sickle cell disease. People who take part in these studies might have access to new medicines and treatment options.
Get support. Find a patient support group or other organization in your community that can provide information, assistance, and support.

If your immune system is weakened, you may want to rethink that daily shower.

New research suggests that ordinary showerheads are awash in germs, particularly a type that can cause lung disease in people whose immunity to illness is compromised.

The germs could be “blasted out of the showerhead and inhaled by the person showering,” said study co-author Leah M. Feazel, a researcher at the University of Colorado’s department of molecular, cellular and developmental biology.

But Feazel said showerheads shouldn’t pose a threat to most people. And while the new findings do raise questions, it’s not clear if showerheads are any more germ-friendly than other places around the house, such as faucets, counters and toilets, she said.

Feazel and her colleagues decided to look at showerheads because they seem like an ideal place for germs to grow.

The inside of a showerhead provides ideal conditions for microbial growth, Feazel said. “It is moist, warm, protected from disturbance, and frequently fed with nutrient resources in the tap water. Also, most people have noticed discoloration on their showerheads. This ’soap-scum’ is actually microbial growth.”

The researchers analyzed germs found in the film formed in 45 showerheads from nine U.S. cities. They found a variety of bacteria in showerheads, most of which don’t cause illness in people. But they also found germs called mycobacteria, which are common and can cause lung disease in people with compromised immune systems, Feazel said.

The levels of certain germs that could spell trouble were 100 times above what they were in water before it made its way to the showerhead, the researchers said.

The unique thing about showerheads is that the germs could be inhaled. People are unlikely to inhale other kinds of household germs that fit into the category known as biofilms, with the exception of those produced by humidifiers, according to the study.

The findings were published in this week’s online issue of the Proceedings of the National Academy of Sciences.

Feazel stressed that most people shouldn’t be concerned about showerheads.

“If a person is worried about the risk of lung infection from showering, they have several options,” she said. “Bathing, rather than showering, is probably best for those who are at risk. The size of the water droplets produced in bathing is too large to go deep into the lungs, whereas showering creates tiny particles that can go very deep and cause disease.”

An all-metal showerhead — not a plastic one with a metal coating — is another alternative, as is replacing a showerhead several times a year, Feazel said.

“Cleaning the inside of a showerhead is very difficult and may be only partially effective,” she explained.

George A. O’Toole, an associate professor in the department of microbiology and immunology at Dartmouth Medical School, noted that germs lurk everywhere.

“I imagine that if you looked at the kitchen sink, faucet and drain, the insinkerator, your dishwasher, the toilet, your washing machine and the hose in the yard, you might find similar pathogens,” he said.

In the case of showerheads, he said, “people with good immune systems really don’t need to worry about this. People with bad immune systems probably do, but they also need to worry about every encounter with microbes.”

People with weakened immune systems include those infected with HIV, cancer patients undergoing chemotherapy, and recent transplant recipients.