Account for high flow rate-low detrusor pressure voids in female: Contribution of VBN model.

INTRODUCTION: Nomograms using the VBN model of women micturition allowed evaluating detrusor contractility (k) and urethral obstruction (U) from pressure-flow (PFs) recordings. While the model worked for most of the patients, an intriguing result, negative U value was observed for patients with high flow-low detrusor pressure (Qp voids). To explain that condition, our hypothesis was a weak urethral resistance to dilatation or increased expansibility (URD). METHODS: The area offered to the fluid at each point of the urethra (its dilatation) is a function of the time depending difference between inside and outside pressures. In the VBN model, this function is sigmoid-like, the same for all women. For Qp voids, Qrecorded was more higher than it would be with the recorded pressure (VBN analysis). So, modeling allowed computing abnormally increased urethral wall expansibility (URD) whose consequence would be an increased flow. RESULTS: Among 222 non-neurologic women referred for investigation of various lower urinary tract symptoms, 27 (mean age 66.3±11.4 y) had Qp void: Qmax=27±6mL/s; pdet.Qmax =7.5±4.7cm H2O. Mean URD value was .36±.67. Introduction of URD in a modeled analysis of urodynamic traces led to a good fitting between recorded and computed traces for the 27 Qp. CONCLUSION: Mathematical modeling of micturition allows proposing an explanation of the unexpected observations of Qp voids. They would be due to abnormal urethral wall elasticity. Despite major challenges measurement of this elasticity would be the next step. LEVEL OF EVIDENCE: 3.

Comparison of indices allowing an evaluation of detrusor contractility in women.

AIMS: To compare 3 detrusor contractility indices, projected isovolumetric pressure (PIP-BCI), PIP1, and k from the VBN mathematical model, for women referred for evaluation of various lower urinary tract symptoms (LUTS) in relationship to age, presenting complaint and urodynamic diagnosis. METHODS: Urodynamic tracings of non-neurologic women were analyzed. Three indices of detrusor contractility were measured from the pressure-flow study. Exclusion criteria were voided volume<100mL, stage>2 prolapse, interrupted flow, abdominal straining. Age sub-groups were pre-, peri- and post-menopause. Urodynamic diagnosis included incontinence findings and detrusor activity during voiding. RESULTS: Main complaint was incontinence (354 women); 95 women (Other) had non-incontinence LUTS. PIP-BCI, PIP1 and k decreased significantly with ageing in each sub-group. PIP-BCI was significantly different between MUI and Other (P=.0259) while PIP1 was significantly higher in UUI vs. Other (P=.0161) and k in UUI vs. SUI (P=.0107), MUI (P=.0010) and Other (P=.0224). Low value of PIP-BCI for bladder outlet obstruction vs. detrusor overactivity while PIP1 and k values were high and similar for these two diagnoses and a high value of PIP-BCI for detrusor overactivity with impaired contractility close to the value for bladder outlet obstruction while PIP1 and k were low. CONCLUSION: Evaluation of detrusor contractility in women is easily obtained using indices PIP-BCI and PIP1 or using the VBN nomogram giving indice-parameter k. PIP1 and parameter k produced comparable and consistent results with the urodynamic diagnosis while PIP-BCI leads to inconsistencies. LEVEL OF EVIDENCE: 4.

Is bladder voiding efficiency useful to evaluate voiding function in women older than 65 years?

AIMS: The aims of the study were to evaluate the reproducibility of bladder voiding efficiency (BVE) between free flow (FF) and intubated flow(IF) in old women, and to search for a relationship of this index with complaint and urodynamic diagnosis. METHODS: Urodynamic tracings of non-neurologic women referred for investigation of various lower urinary tract symptoms (LUTS) were analyzed. Urodynamic study included one FF followed by one cystometry and IF. Post void residual volume (PVR) was measured using a Bladder-scan. Exclusion criteria were voided volume<100ml and prolapse of grade>2. RESULTS: One hundred and ninety women met the study criteria. The mean age was 74±6 years [65-96years]. The main complaint was urinary incontinence: stress (26), urge (53) and mixed (56). Forty-four women had various complaints without incontinence. Overall BVE IF (77.6±25.8) was significantly lower than BVE FF (90.4±15.3) (P<.0001). Age sub-groups stratification led similar results. BVE IF was significantly lower than BVE FF in women with incontinence whatever the cause. Urodynamic diagnosis was posed according to the ICS/IUGA recommendations and 2 sub-groups defined according with involvement of detrusor. BVE IF was significantly lower than BVE FF for detrusor dysfunction, except for detrusor overactivity. CONCLUSION: In this large cohort of old non-neurologic women studied urodynamically for a variety of LUTS, BVE is higher when evaluated from a FF whatever age and for complaint of urinary incontinence. In addition, a low BVE value from an IF may suggest a detrusor dysfunction. LEVEL OF EVIDENCE: 4.

Do urodynamics provide a better understanding of voiding disorders in women over 80?

AIMS: Population ageing has as consequence an increasing number of women older than 80 years with lower urinary tract symptoms (LUTS). Despite old age, urodynamic study is often performed to diagnose the cause of LUTS. Our purpose is to discuss the contribution of urodynamics to manage that population. METHODS: Urodynamic studies of 169 consecutive women older than 80 years, respectively 124 non-neurological (non-N) and 45 neurological (N), were retrospectively analysed. RESULTS: Number of co-morbidities was lower in non-N (2.5 vs. 3.1) with predominance of cardiovascular and endocrinology while musculo-skeletal, cognitive and previous pelvic surgery predominated in N. Among main complaint, incomplete retention or dysuria was more frequent in N while incontinence and frequency were predominant in non-N. More frequent urodynamic diagnosis (UD) was "normal" i.e. non contributive (25.0%) and intrinsic sphincter deficiency (ISD=21.7%) in non-N, detrusor overactivity (DO=42.2%) and detrusor underactivity (DU=38.8%) in N. In non-N, there were 94 treatment proposals based on the complaint when UD was "normal" and on UD for DO, DU and ISD. In N, treatment proposals were mainly prompted voiding or self-catheterization based on DU diagnosis. CONCLUSION: Usefulness of urodynamics to manage LUT dysfunction in women older than 80 y is greatly dependent on their neurological status. In non-neurological women this is non debatable but proposed treatment needs to take into account existing co-morbidities. In neurological women the main usefulness is to unmask DU and to propose the best management in order to avoid complete retention. LEVEL OF EVIDENCE: 4.

Usefulness of an algebraic fitting of nomograms allowing evaluation detrusor contractility in women.

AIMS: Nomograms based on Valentini-Besson-Nelson (VBN) model implying only 3 measurements (filling bladder volume, maximum flow-rate [Qmax] and detrusor pressure at Qmax) were recently developed to evaluate detrusor contractility (k) and urethral obstruction (U) in women. As their algebraic fitting leads to fast evaluations (Excel® software), our aims were applications to populations of non-neurologic women without and with bladder outlet obstruction (BOO). METHODS: The software was applied to measurements obtained during pressure flow studies. Hidden hypothesis of nomograms were no significant contribution of abdominal pressure between onset of flow and Qmax and standard nervous excitations until Qmax. Studied populations were 202 women without symptom suggestive of obstruction and 125 women with proven anatomical urethral obstruction who underwent urodynamic study. RESULTS: For non-obstructed women, a good agreement was found between the values of k and U obtained using nomograms or a complete VBN analysis of the recorded curves. Whatever the obstructive status, there was a good correlation between the value of k and U. Evolution with ageing was similar with higher values of k and U in the BOO group. Curves k(age) and U(age) gave coefficients allowing an age adjustment. The high k value in the detrusor overactive (DO) group was consistent with a similar effect to that of BOO on the detrusor. CONCLUSION: Evaluation of detrusor contractility (k) and urethral obstruction (U) can be obtained from the point of Qmax during pressure-flow study. Evolution with ageing is similar with (higher values) or without BOO. DO also induces an increased detrusor contractility. LEVEL OF EVIDENCE: 4.

False positive for ß2-transferrin in rhinorrhoea. Ocular trauma. / Un falso positivo para ß2-transferrina en rinorrea. Traumatismo ocular.

Ocular perforations require an action depending on the findings observed. Additionally, the closeness of the orbit to the nasal cavity and the anterior cranial fossa requires any collateral damage in these spaces to be ruled out. The presence of a penetrating ocular injury associated with ipsilateral rhinorrhoea in which the presence of ß2-transferrin -a highly specific and sensitive marker to identify cerebrospinal fluid- is detected, obliges to suspect and locate any possible leakage. A case is presented in which this unbound protein is detected in post-traumatic rhinorrhoea with an origin in the eyeball, making the diagnosis of a CSF leak into a false positive.

[Blood transfusion in neonatology: Study of practical aspects in 2016 in France, excluding acute bleeding or surgical care]. / Réalisation d'une transfusion sanguine en néonatologie : état des lieux des pratiques en 2016 en France ; situations aiguës ou chirurgicales exclues.

BACKGROUND: Blood transfusion is common in neonatology, especially in preterm or low birth weight infants. Recommendations were proposed by the French National Authority of Health (HAS) in 2014 and 2015 for red blood cells and platelet transfusion respectively, but an heterogeneity of practical attitudes persist. The objective of this survey is to evaluate transfusion practices in neonatal intensive care units. METHODS: Investigation of practice of neonatal transfusion was organized among 68 neonatal intensive care unit (level 3) between September 2016 and May 2017, by mailing survey focused on systematic training of nurses, patient identification, immunohematology, information and technical aspects of blood components administration. RESULTS: Twenty-three neonatal intensive care units among the 68s answered the questionnaire. One thousand five hundred sixty seven neonates were transfused and 3382 blood products were administered. The results highlight a consensual attitude concerning the procedures of patient identification, immunohematology tests and blood products administration. However, heterogeneity remains concerning information of the parents or the person with parental authority, immediate and delayed follow-up and devices used for the transfusion. However HAS guidelines (2014 and 2015) appear to be well applied by clinicians for blood products, specifications and calcul of transfused volume based on gestational age and weight.

Peri-implantitis and the prosthodontist.

Peri-implantitis has been described as progressive crestal bone loss around a dental implant. The condition is poorly understood, and is challenging to manage; it is commonly and widely attributed to issues with the implant, the implant surface, surgical technique and oral hygiene. The effect of prosthodontic stages of treatment on the postoperatively established state has not been adequately investigated. It is the authors' contention that the manner in which the implant is restored contributes significantly to prognosis and peri-implant disease experience, and that the role of prosthodontic aspects of treatment in the causation of peri-implantitis may be seriously underestimated. The prosthodontist has a clear role and responsibility in the avoidance of future peri-implant problems by ensuring that implants are restored in an entirely biologically and biomechanically sound manner. The number of implant treatments carried out year-on-year is rising apace, with more and more implants being restored in general dental practice. With the rapid emergence of lower cost dental implant systems and a broadening range of generic restorative options and components for well-established systems, there is an increasing need to consider and understand how the implant restorative process may have a negative impact upon the peri-implant tissues, and how this effect may be minimised and peri-implant health promoted and maintained by paying attention to detail throughout the entire process.

Current and Future Challenges in Group Therapy.

This article reviews changes and considers challenges in group therapy since AGPA's 50th anniversary 25 years ago. The authors acknowledge the many important changes that have occurred in research, theory, and practice in the last two and a half decades, but focus on four topics: treating trauma with cultural sensitivity; the impact of technology on groups; challenges for LGBTQ clients in group; and the future for psychodynamic groups. The authors review the literature and provide recommendations on how to address the challenges.

Live high-train low associated with increased haemoglobin mass as preparation for the 2003 World Championships in two native European world class runners.

BACKGROUND: It is unclear whether world class endurance athletes, in contrast with less well trained subjects, increase their haemoglobin mass on a regimen of living high and training low (LHTL). OBJECTIVE: To assess whether haemoglobin mass increases in world class athletes on LHTL and whether this increase is associated with peak performance at a subsequent important competition. METHODS: Two Swiss world class runners (one 5000 m and one marathon) lived for 26 days (18 hours a day) at an altitude of 2456 m and trained at 1800 m. This LHTL camp was the preparation for the World Athletic Championships taking place 27-29 days after the end of the camp. Haemoglobin mass and other haematological variables were measured before and after the LHTL camp. The performance parameter was the race times during that period. RESULTS: Haemoglobin mass increased by 3.9% and 7.6%, and erythrocyte volume by 5.8% and 6.3%. The race times, as well as the ranking at the World Championships, indicated clearly improved performance after the LHTL camp. CONCLUSIONS: The results suggest that LHTL with an adequate dose of hypoxia can increase haemoglobin mass even in world class athletes, which may translate into improved performance at important competitions at sea level.

3D printing in dentistry.

3D printing has been hailed as a disruptive technology which will change manufacturing. Used in aerospace, defence, art and design, 3D printing is becoming a subject of great interest in surgery. The technology has a particular resonance with dentistry, and with advances in 3D imaging and modelling technologies such as cone beam computed tomography and intraoral scanning, and with the relatively long history of the use of CAD CAM technologies in dentistry, it will become of increasing importance. Uses of 3D printing include the production of drill guides for dental implants, the production of physical models for prosthodontics, orthodontics and surgery, the manufacture of dental, craniomaxillofacial and orthopaedic implants, and the fabrication of copings and frameworks for implant and dental restorations. This paper reviews the types of 3D printing technologies available and their various applications in dentistry and in maxillofacial surgery.

Anthropometric and lifestyle correlates of serum lipoprotein and apolipoprotein levels among normal non-smoking men and women.

The relationship between serologic predictors of coronary risk and anthropometric as well as lifestyle characteristics was investigated in 61 men (37.5 +/- 8.5 yrs) and 33 women (40.1 +/- 9.0 yrs). All subjects were healthy non-smokers, mostly middle-class bank employees. In bivariate analysis, among both genders the ratio of waist-to-hip circumference (WHR) was the single best predictor of levels of serum LDL-cholesterol, apolipoprotein B, VLDL-cholesterol and triglycerides (positive association) as well as HDL-cholesterol and apolipoprotein A-I (inverse association). In men, body fat as estimated from bioelectrical impedance measurement was the second best predictor of lipoprotein and apoprotein concentrations, whereas in women it was the body mass index (BMI). The additional independent predictive power of WHR and body fat for the lipid profile was tested in multivariate analysis by adding WHR and body fat sequentially to regression models containing already BMI, endurance capacity, exercise, alcohol consumption and age. For example, explained variance of triglyceride distribution rose from 26.3 to 35.1% (P = 0.01 for increase) when body fat was entered into the regression equation, or inclusion of WHR into a model already containing age, the behavioral variables, BMI, and body fat increased the explained variance of LDL/HDL-cholesterol ratio from 20.9 to 27.6% (P = 0.04 for increase). In women, the same regression models were even slightly more predictive for the serum lipid profile. Endurance capacity was related to a low atherogenic risk lipid profile in bivariate analysis but lost much of its predictive power in multivariate analysis, which confirms that the effect of fitness on lipid levels is probably mediated in part by a low body fat content. It is concluded from this cross-sectional investigation that studies which focus on associations between lifestyle and serologic predictors of atherogenic risk should possibly include the WHR and a measure of body fat, since the latter two appear to be closer correlates of serum lipoprotein and apolipoprotein levels than BMI or single behavioral factors, at least among male non-smokers.

Effects of long-term, self-monitored exercise on the serum lipoprotein and apolipoprotein profile in middle-aged men.

To study the effects of long-term, self-monitored exercise on the serum lipid profile and body composition of middle-aged non-smoking males, a controlled study was conducted in 61 sedentary, middle-class Swiss men. Thirty-nine men were randomly allocated to jog 2 h/wk for 4 months on an individually prescribed, heart rate-controlled basis, whereas 22 men served as controls. Despite varying adherence to the exercise regimen, the following 4-month net changes (effect in exercise group minus effect in control group) in lipids were seen: HDL cholesterol (C) +0.12 mmol/l (95% CI 0.02, 0.22; P = 0.028), LDL-C +0.08 mmol/l (ns), VLDL-C -0.26 mmol/l (-0.45, -0.07; P = 0.009), total triglycerides (TT) -0.21 mmol/l (ns), HDL-C/total C +0.02 (0.001, 0.05; P = 0.047). The net changes in endurance capacity and resting heart rate in favour of exercisers were significant as well, whereas no significant changes in apolipoprotein levels were seen. Exploratory analyses revealed, for example, associations of the increase in total physical activity with an increase in the HDL-C/total C ratio (r = 0.46; P less than 0.001), and of the change in estimated body fat content with an opposed change in the HDL-C/total C ratio (r = -0.40; P less than 0.001), or an inverse relationship of the change in subcutaneous fat with a change in the HDL2-C level (r = -0.39; P less than 0.001). Multivariable regression analysis suggested that much of the effect of jogging on HDL-C was apparently mediated through a decrease in body fat content. A change in the waist/hip ratio was unrelated to lipoprotein changes but was related to the change of TT level (r = 0.22; P less than 0.05). This study confirms that individually prescribed, unsupervised jogging can increase HDL-C levels and improve the serum lipoprotein profile in self-selected nonsmoking males. Although the effect is modest, it may be relevant to preventive cardiology, given the evidence for a reduction in cardiovascular risk even after apparently small decreases in risk factor levels.

Jogging or walking--comparison of health effects.

The present study compared the different health effects of 6 months' endurance training at two exercise intensities. Seventy-five nonsmoking, sedentary men were randomly assigned to either a home-based, unsupervised exercise program of 4 x 30 min/wk jogging at an intensity of 75% VO2max (n = 28), or of 6 x 30 min/wk walking at an intensity of 50% VO2max (n = 28), or to an inactive control group (n = 19). Exercise adherence and injuries related to exercise training as well as changes in endurance capacity, body fat, and serum lipids were assessed. After 6 months, joggers and walkers showed a similar increase in VO2max as measured by a maximal bicycle ergometer test (2.9 +/- 4.1 ml/kg min, P < 0.01 and 2.5 +/- 5.7 ml/kg min, P < 0.5, respectively). There were no significant changes in blood lipids in either group, although results revealed a significant association between the amount of training (i.e., kilometers exercised) and the increase in high-density lipoprotein-cholesterol (HDL-C) in joggers (Pearson's r = 0.42, P < 0.05). In walkers, a significant association between the amount of exercise and the decrease in sum of skinfolds and the waist-hip ratio was observed (Pearson's r = -0.48 and -0.45, P < 0.05 for both). The adherence rate was similar for both training groups with respect to the prescribed intervention goal with an average of 90 +/- 41 min/wk (joggers) and 121 +/- 72 min/wk (walkers) spent on endurance training.(ABSTRACT TRUNCATED AT 250 WORDS)

Long-term effects of physical training on aerobic capacity: controlled study of former elite athletes.

We studied 15-yr changes in physical training, subcutaneous fat, and maximal oxygen consumption (VO2 max) in male former elite athletes (27 long-distance runners and 9 bobsledders) and in a control group of 23 normal men. In 1973, elite athletes all trained vigorously, whereas in 1988 there was a great interindividual variation in physical training. In the lowest tertile of runners' training activity in 1988 (n = 9), the rate of decline in VO2max during the 15 yr was 1.11 +/- 0.15 (SE) ml.kg-1.min-1.yr-1, or 16% per decade, whereas the most active quintile of runners (n = 5) tended to increase VO2max (NS). The remaining 13 runners showed a rate of decline in VO2max of 0.54 +/- 0.14 ml.kg-1.min-1.yr-1, or 7% per decade. The rates of decline were 0.22 +/- 0.12 and 0.56 +/- 0.10 ml.kg-1.min-1.yr-1, or 5 and 11% per decade, in bobsledders and controls, respectively. When normalized for lean body mass instead of body weight, VO2max showed a reduced variability in the rate of decline, with values ranging from 0.00 +/- 0.27 (most active runners) to 0.69 +/- 0.15 ml.kg lean body mass-1.min-1.yr-1 (least active runners). In multiple linear regression analysis, 15-yr changes in mileage, running pace, and truncal fat together explained 51% of variance in the 15-yr change of VO2max normalized for body weight in runners and 41% in all study men. In runners, change in truncal fat was dependent on changes in both mileage and running pace. In the presence of physical training and anthropometric variables in the regression equation, the 15-yr decrease in maximum heart rate was only modestly predictive of the change in VO2max.(ABSTRACT TRUNCATED AT 250 WORDS)

Relation between leisure time exercise and cardiovascular risk factors among 15-year-olds in eastern Finland.

STUDY OBJECTIVE: To examine the associations between frequency of leisure time exercise and cardiovascular risk factors in adolescents. DESIGN: Cross sectional survey carried out over a 3 month period in 1984. SETTING: All 24 schools in North Karelia province and 16 randomly selected schools in Kuopio province. PARTICIPANTS: A total of 1142 boys and girls aged 15, randomly selected from 40 schools (16 boys and 16 girls from each), participated out of a possible total sample of 1280. Main reason for non-participation was absence from school but a small number refused to participate. MEASUREMENTS AND MAIN RESULTS: The investigation comprised a medical examination, including anthropometry, a self administered questionnaire checked by interview, a parental questionnaire, and a blood sample for biochemical estimations. The main findings were: (1) Leisure time exercise was inversely related to daily smoking (Spearman's rho, boys -0.16, p less than 0.01; girls -0.13, p less than 0.01) but was not related to serum lipoproteins or blood pressure. The inverse association between exercise and smoking was independent of socioeconomic family background. (2) Body mass index and sexual maturation were associated with systolic blood pressure, and among boys they were inversely related to high density lipoprotein cholesterol. (3) The lack of linear trends between exercise and biological risk factors may be explained by the high prevalence of leisure time exercise in the sample (72% of boys and 71% of girls exercised at least 2-3 times per week, in addition to physical education classes at school). CONCLUSIONS: Among 15-year-old eastern Finnish boys and girls, leisure time exercise is favourably associated with the main behavioural cardiovascular risk factor, smoking, but not with serum total cholesterol or blood pressure.

Body fat distribution in the Finnish population: environmental determinants and predictive power for cardiovascular risk factor levels.

STUDY OBJECTIVE: The aim was to examine (1) whether health habits are associated with body fat distribution, as measured by the waist/hip girth ratio, and (2) to what extent environmental factors, including anthropometric characteristics, explain the variability in levels of cardiovascular risk factors. DESIGN: The study was a population based cross sectional survey, conducted in the spring of 1987 as a part of an international research project on cardiovascular epidemiology. SETTING: The survey was conducted in three geographical areas of eastern and south western Finland. SUBJECTS: 2526 men and 2756 women aged 25-64 years took part in the study, corresponding to a survey participation rate of 82%. MEASUREMENTS AND MAIN RESULTS: In men, waist/hip ratio showed stronger associations with exercise (Pearson's r = -0.24), resting heart rate (r = 0.10), alcohol consumption (r = 0.07), smoking (r = 0.05), and education (r = -0.23) than did body mass index. Jointly, exercise, resting heart rate, alcohol consumption, education, and age explained 18% of variance in male waist/hip ratio, but only 9% of variance in male body mass index. In women, environmental factors were more predictive for body mass index than for waist/hip ratio, with age and education being the strongest determinants. Waist/hip ratio and body mass index were approximately equally strong predictors of cardiovascular risk factor levels. The additional predictive power of waist/hip ratio over and above body mass index was tested in a hierarchical, stepwise regression. In this conservative type of analysis the increase in explained variance uniquely attributable to waist/hip ratio was 2-3% for female and 1-2% for male lipoprotein levels, and less than 0.5% for female and 0-2% for male blood pressure values. CONCLUSIONS: The distribution of abdominal obesity in Finland is significantly influenced by health habits and sociodemographic factors in both men and women. This in turn is obviously one reason for the relatively small "independent" effect of body fat distribution on cardiovascular risk factor levels.

Health effects of recreational running in women. Some epidemiological and preventive aspects.

Estimated maximum oxygen uptake of middle-aged nonelite road race entrants is around 45 to 50 ml/kg/min, which is 40 to 100% higher than values from the female general population. Endurance training, low bodyweight, and nonsmoking of runners explain part of, but not the whole, difference in aerobic capacity observed between athletes and the general population. Sedentary women can improve cardiorespiratory fitness through aerobic exercise programmes, and the women with the lowest level of initial fitness have the highest proportional improvement following training. Regularly exercising women have a significantly reduced risk of fatal and nonfatal coronary events, and low cardiorespiratory fitness is associated with an increased risk of death and nonfatal stroke. The influence of habitual running on the female blood lipid profile is not clear. Cross-sectional studies have found elevated HDL cholesterol concentrations in distance runners, but intervention studies on the effect of jogging on lipid and lipoprotein levels have provided equivocal results. A higher level of physical fitness is associated with a lower risk to subsequently develop hypertension. Experimental studies have shown that moderate intensity aerobic exercise (40 to 60% VO2max) is able to reduce blood pressure significantly in hypertensive subjects. An athletic lifestyle may be associated with a reduced risk of adult-onset diabetes mellitus (via an exercise-induced increase in insulin-sensitivity), and with a reduced risk of cancers of the reproductive system, breast, and colon. Recreational running is also correlated with better weight control. Surveys of recreational and elite distance runners show a great variability in the prevalence of secondary amenorrhoea, between 1 and 44%. Environmental factors determining the risk of amenorrhoea in runners are low body fat content, mileage, and nutritional inadequacy, with low intakes of calories, protein, and fat. Amenorrhoeic athletes in their third and fourth decade have lower vertebral bone density, which is improved after resumption of menses but does not completely reach age-specific average values. Regardless of menstrual status, the effectiveness of exercise to maintain bone mass throughout life is an important issue. Habitual exercise is associated with increased bone density of the spine both in premenopausal and postmenopausal women. Several controlled training studies suggest that postmenopausal women may at least retard their bone loss with regular aerobic exercise. Running-related injuries and complaints are common in recreational joggers, even though the reported 1-year incidence, varying between 14 and approximately 50%, depends on injury definition. Mileage and a history of previous running injury are known risk factors.(ABSTRACT TRUNCATED AT 400 WORDS)