Greater subchondral vBMD at the tibia is observed between 1 and 5 years of anterior cruciate ligament injury.

OBJECTIVES: This study aimed to determine if differences exist in tibial subchondral bone and muscle imbalances between individuals with and without an Anterior Cruciate Ligament (ACL) repair within the past 1 to 5 years (median 3 years). METHODS: Fifteen individuals (ages 18-23 years) that had a unilateral ACL repair with no contralateral knee injuries and 15 age- and sex-matched controls (no prior knee injuries) were recruited to participate. Subchondral bone was measured using peripheral quantitative computed tomography (pQCT) distal to the tibial plateau. Muscle force, power, and force efficiency were measured using single leg jumps performed on a force platform. RESULTS: Within subject analysis showed a greater subchondral vBMD in the injured versus uninjured legs of cases (278±11 mg/cm3 and 258±6 mg/cm3, respectively, mean±SD, p=0.01). Subchondral vBMD was greater on the injured leg of cases than controls (267±8 mg/cm3 and 237±8 mg/cm3, respectively, marginal mean±SE, p=0.01). No differences were observed between cases and controls for muscle force, power, or force efficiency. CONCLUSIONS: Greater subchondral bone mineral density was observed in participants between 1- and 5-years post-op. Given the results of this study and the known long-term effects of ACL injuries, future research must continue to focus on the prevention of these injuries.

Improving officer-soldier communication through active listening skills training with Army ROTC cadets.

Military leaders are tasked with communicating effectively with their subordinates. Active listening skills are vital to this communication; however, an investigation of active listening skills in the military is lacking. Sixty-four Army ROTC cadets participated in a quasi-experimental study to determine the effectiveness of an active listening skills curriculum on developmental counseling. Self-report ratings suggested a positive treatment effect with the cadets in the experimental group from pretest to posttest on the sensing and processing subscales on the Active Empathic Listening Scale (AELS), and both self-report and observer ratings demonstrated a positive treatment effect on the Counseling Skills Scale (CSS) when compared to the control group. The study provides initial evidence on the impact of implementing an active listening skills curriculum on leadership development within developmental counseling in the military.

Neuromuscular performance changes throughout the menstrual cycle in physically active females.

OBJECTIVES: To determine changes in neuromuscular performance throughout the menstrual cycle in females aged 18-25. METHODS: Fifty physically active college females (25 on oral contraceptives (OC)) were recruited to participate. Data collection visits coincided with early-follicular (Fp), ovulatory (Op), and the mid-luteal (Lp) phases. Isokinetic peak torque at the knee (IPT) was measured at 60°/sec, 180°/sec, and 300°/sec. Grip force was measured using a handheld dynamometer. Plasma estradiol and progesterone confirmed menstrual cycle and serum relaxin was screened as a potential covariate. RESULTS: Grip strength was lower during Fp (30.1±0.7kg) than during Op (31.5±0.7 kg, p=0.003) and Lp (32.6±0.7 kg, p<0.001). IPT at 60°/sec was lower during Fp (83±14 nM) than during the Op (86±15 nM, p=0.02). IPTs at 180°/sec and 300°/sec were lower during Fp than Op and Lp (180°:54±10 vs. 58±10 and 61±11 nM [both, p<0.001]; 300°: 43±9 vs. 46±9 and 47±9 nM [both<0.001]. The OC group-by-phase interaction was not significant for any of the outcomes. CONCLUSIONS: Results indicate that muscular performance is diminished during Fp and the lack of group-by-phase interaction indicates that this effect is not hormone-related. These data indicate that females may be at a greater risk of injury due to decreased strength during Fp than other phases of their cycle.

Sports Participation in High School and College Leads to High Bone Density and Greater Rates of Bone Loss in Young Men: Results from a Population-Based Study.

Estimated lifetime risk of an osteoporotic fracture in men over the age of 50 years is substantial and lifestyle factors such as physical activity may explain variation in bone mass and bone loss associated with aging. Men (n = 253) aged 20-66 years were followed for 7.5 years and factors that influence changes in means and rates of change in bone mass, density, and size using dual-energy X-ray absorptiometry (DXA) and peripheral quantitative computed tomography (pQCT) were investigated; in particular, seasons of sports participation during high school and college. Men with greater sports participation had higher total hip bone mineral content (BMC) (48.4 ± 0.9 and 48.6 ± 0.9 g for 7-12 and 13+ seasons vs. 45.6 ± 0.8 and 45.4 ± 0.7 g for 0 and 1-6 seasons, respectively p < 0.05) and areal bone mineral density (aBMD) (1.082 ± 0.015 and 1.087 ± 0.015 g/cm2 for 7-12 and 13+ seasons vs. 1.011 ± 0.015 and 1.029 ± 0.013 g/cm2 for 0 and 1-6 seasons, respectively p < 0.05) than men who participated in less sport-seasons. However, men with higher sports participation also had greater rates of bone loss in their mid-twenties at the hip (BMC - 0.8 and - 1.2% and aBMD - 0.8 and - 0.9% for 7-12 and 13+ seasons of sport participation, respectively) compared to those with 0 seasons of sport participation (BMC - 0.6% and aBMD - 0.6%) (all p < 0.05). Similar results were observed for femoral neck aBMD. Men with 7+ seasons of sport participation had higher cross-sectional area at the 20% distal radius site than those with no sports participation (all p < 0.05). These findings support significant effects of high school and/or college sports participation on bone mass and geometry in men throughout adulthood.

Longitudinal Growth and pQCT Measures in Hutterite Children and Grandchildren Are Associated With Prevalence of Hip or Knee Replacement Resulting From Osteoarthritis in Parents and Grandparents.

BACKGROUND: Osteoarthritis (OA) is one of the leading causes of disability in the world. Several genes are associated with the development of OA, and previous studies have shown adult children of individuals with OA have higher areal bone mineral density (BMD). Because childhood is an important period of growth and bone development, and body composition is known to be associated with BMD, we speculated that there may be differences in growth and bone measures among young children with a genetic predisposition to OA. QUESTIONS/PURPOSES: (1) Do differences exist at baseline in anthropometric and peripheral quantitative CT (pQCT) measurements between children and grandchildren of individuals with OA and controls? (2) Do children and grandchildren of individuals with OA accrue bone longitudinally at a different rate than controls? METHODS: Longitudinal anthropometric (height, weight) and bone (cortical and trabecular volumetric BMD and cross-sectional area) measurements by pQCT were obtained at baseline and 18 and 36 months on children (n = 178) and grandchildren (n = 230) of 23 individuals with hip or knee arthroplasty resulting from OA and 23 sex-matched controls (16 females each). Grandchildren (age, 8-30 years) were further categorized as growing (premenarcheal or male < 14 years, n = 99) or mature (≥ 2 years postmenarchal or males ≥ 18 years, n = 96). The remaining 35 grandchildren could not be categorized and were excluded. RESULTS: Mature granddaughters and grandsons of individuals with OA had greater trabecular volumetric BMD than controls (236 ± 24 and 222 ± 26 mg/cm, respectively, for granddaughters, difference of 14 [95% confidence interval {CI}, 1-28] mg/cm, p = 0.041 and 270 ± 22 and 248 ± 30 mg/cm, respectively, for grandsons, difference of 22 [95% CI, 1-42] mg/cm, p = 0.040). Greater trabecular volumetric BMD was observed in daughters of individuals with OA compared with daughters of controls (228 ± 28 and 212 ± 33 mg/cm, respectively, difference of 18 [95% CI, 3-30] mg/cm, respectively [p = 0.021]). Growing granddaughters and grandsons of controls had greater decreases in cortical volumetric BMD than grandchildren of individuals with OA (time-by-group [TG] based on mixed model [± standard error] -9.7 ± 4.3 versus -0.8 ± 4.4 mg/cm/year, respectively, for granddaughters, difference of 9.0 [95% CI, 2.4-15.5] mg/cm/year, p = 0.007 and -6.8 ± 3.3 versus 4.5 ± 3.4 mg/cm/year, respectively, for grandsons, difference of 11.3 [95% CI, 4.3-18.3] mg/cm/year, p = 0.002). Cortical volumetric BMD was maintained in sons of individuals with OA, but decreased in sons of controls (-0.0 ± 1.5 versus -4.3 ± 1.0 mg/cm/year, respectively, difference of 4.3 [95% CI, 0.7-7.8] mg/cm/year, p = 0.019 [TG]). There was a greater apparent decrease in cross-sectional area among daughters of individuals with OA than in controls (-4.6 ± 0.9 versus -1.7 ± 0.9 mm/year, respectively, difference of -2.9 [95% CI, -5.3 to -0.6] mm/year, p = 0.015 [TG]). CONCLUSIONS: Several anthropometric and bone differences exist between children and grandchildren of individuals with OA and controls. If these differences are confirmed in additional studies, it would be important to identify the mechanism so that preventive measures could be developed and implemented to slow or reduce OA development. CLINICAL RELEVANCE: Differences in growth and bone development may lead to increased loads on cartilage that may predispose offspring to the development of OA. If these differences are confirmed in additional studies, it would be important to identify the mechanism so that preventive measures could be developed and implemented to slow or reduce OA development.

Do Sex Differences Exist in Rates of Falls and Fractures in Hutterite, Rural, and Nonrural Populations, Aged 20 to 66 Years?

BACKGROUND: Falls and fractures are a major public health concern with an economic impact of more than USD 19 billion per year. Extensive research into the risk of falls and fractures in elderly populations has been performed; however, little is known about fall or fracture risk in younger populations. Additionally, sex- and population-specific (rural versus nonrural) fall and fracture risk may be important in identifying groups most at risk in an effort to develop preventive measures. QUESTIONS/PURPOSES: The purpose of this study was to determine whether sex and population (rural versus nonrural) differences exist in fall and fracture rates. METHODS: Data from 1256 (538 men) participants of the South Dakota Rural Bone Health Study, a population-based cohort study, including those living a rural lifestyle (n=349 non-Hutterites and 572 Hutterites) and a nonrural lifestyle (n=335), were used to address our a priori hypotheses. Health histories, physical activity recall, anthropometric measurements, and dual-energy xray absorptiometry measurements of body composition were obtained longitudinally from participants every 18 months for 7.5 years. Falls and fractures were self-reported and fractures were confirmed through medical record review. Incidence rates were calculated as the number of falls or fractures per 1000 person-years and generalized estimating equations determined the association of sex and population group with fall and fractures rates while accounting for the repeated longitudinal measurements on the same person. All models adjusted for age group, percent time in moderate and vigorous physical activity, lean and fat mass, grip strength, and previous diagnosis of osteoarthritis. RESULTS: Males aged 39 years and younger had a 135% greater fall risk than females in the same age category (p=0.03), but there was no differences between males and females 40 years of age or older (p=0.26; age-by-sex interaction, p=0.05). No sex differences were observed for fracture risk. After controlling for covariates, rural and nonrural individuals fell at higher rates than Hutterites (84% and 50%, respectively, p<0.001). Additionally, rural individuals fractured at a 72% greater rate than Hutterites after controlling for covariates (p=0.03). CONCLUSIONS: Sex differences in fall risk among younger individuals along with population differences in fall and fracture rates suggest that sex and lifestyle factors may have an impact on fall and fracture risk. Future studies focusing on sex- and population-specific risk factors are necessary to develop prevention strategies tailored to specific populations. LEVEL OF EVIDENCE: Level III, prospective study.

Changes in Body Composition in Division I Football Players Over a Competitive Season and Recovery in Off-Season.

This study investigated changes in body composition over 1 competitive football season in D-I collegiate football players (N = 53; by position, 21 linemen vs. 32 nonline; or by seniority, 30 upperclassmen vs. 23 underclassmen) and additional changes by the following spring season (N = 46; 20 linemen vs. 26 nonline; 27 upperclassmen vs. 19 underclassmen). Body composition by dual-energy x-ray absorptiometry (DXA) was completed pre- and post-season and the following spring. For the team as a whole, player weight decreased 1.3 kg (1.2%) and lean mass decreased 1.4 kg (1.6%) over the season. Absolute fat mass showed no change; however, percent body fat showed a 0.5% increase. There was an interaction between player position and seniority for changes in lean mass (p < 0.01). In nonline positions upperclassmen lost more lean mass than underclassmen, whereas in line positions underclassmen lost more lean mass than upperclassmen. Spring measures indicate that weight did not increase during the off-season, but improvement in body composition was noted. Lean mass increased by 2.2 kg (2.6%), whereas absolute fat mass decreased by 1.4 kg (6.7%). Although weight and lean mass losses during the competitive season were recovered in the off-season, changes in collegiate football programs that include nutrition counseling, dietary recommendations, monitoring of weight, and skin-fold testing as an estimate of body fat change would be beneficial to players. Strength and conditioning coaches and staff need to consider strategies to incorporate these practices into their programs.

Estimation of length or height in infants and young children using ulnar and lower leg length with dual-energy X-ray absorptiometry validation.

AIM: We compared the accuracy and reproducibility of using ulnar and lower leg length measurements to predict length and height in infants and children aged 0 to 6 years. METHOD: Length/height and ulnar and lower leg length were measured in 352 healthy preterm and term-born children (167 males, 185 females) (Mean age= 2.6±1.6 years). Ulna length was measured as the distance between the proximal olecranon process and the distal styloid process of the ulna. Tibia length was measured as the distance from the proximal aspect of the medial condyle and the most distal aspect of the medial malleolus of the tibia using a segmometer. Length measurements were taken using an infant length board in children less than 24 months of age, whereas a portable stadiometer was used to measure height in older children. Equations were developed using ulnar and lower leg length and age. Intra- and inter-examiner variability (n=167) was calculated, and dual-energy X-ray absorptiometry scans (n=126) were used to determine accuracy of limb lengths. RESULTS: Ulnar and lower leg length explained over 95% of the variability in length/height in term infants and children, but less in preterm infants (R(2) =0.80-0.87). In preterm infants, the limits of agreement (LOA) for males were -2.44 to 2.44cm and -2.88 to 2.88cm for the ulna and lower leg respectively, whereas the LOA for females were -1.90 to 1.90cm and -1.87 to 1.87cm respectively. In older children, the LOA for males were -5.53 to 4.48cm and -5.59 to 4.62cm for the ulna and lower leg respectively, whereas the LOA for females were -5.57 to 5.01cm and -6.02 to 5.02cm respectively. Intra- and inter-examiner variability was low for all measurements in both sexes and age groups. INTERPRETATION: Length and height measurements using infant length board or stadiometer are reproducible. Because of the wide limits of agreement, estimation of length and height in children using ulnar and lower leg length is not an acceptable alternative to traditional methods.

Odd-impact loading results in increased cortical area and moments of inertia in collegiate athletes.

PURPOSE: The purpose of this study was to investigate tibial changes in volumetric bone mineral density and geometry that take place in athletes from pre- to post-season. METHODS: Female college athletes (n = 36) and ten controls recruited from the student population were included in the study. Participants had their left tibia scanned by pQCT at 4, 20, and 66 % of the overall length from the distal end before and after their competitive seasons. Subjects were divided into four groups: non-athlete (controls, n = 10), moderate-impact (cross-country runners, n = 13), high-impact (volleyball and basketball, n = 11), and odd-impact (soccer, n = 12). RESULTS: Anterior-posterior and medial-lateral diameter increased at the 4 % site in control subjects. In the moderate-impact group, medial-lateral moment of inertia (MOI) increased by 1.2 ± 1.8 (mean ± SD) percent at the 20 % site. In high-impact group, anterior-posterior MOI increased by 1.6 ± 2.0 percent at the 66 % site. In odd-impact group, cortical area (1.4 ± 2.3 %) and cortical thickness (1.8 ± 2.8 %) increased at the 20 % site increased, as did the polar MOI (1.8 ± 2.2 %) at the 66 % site. CONCLUSIONS: Load-specific changes resulting in improved measures of bone strength take place in athletes during a competitive season. These changes may result in improved resistance to fractures and stress fractures.

Middle Age and Older Adults: Their Nutrition and Physical Activity Needs and How Best to Address Them.

This cross-sectional study assessed the nutrition and physical activity (PA) needs, practices, and programming preferences of adults ages 40+ years from seven states (n = 1,250). Respondents were mostly educated, White, food-secure, adults ages 60+ years. Many were married, suburban-residing, and interested in health programming. By self-report most respondents were "at nutritional risk" (59.3%), in "somewhat good health" (32.3%), and sedentary (49.2%). One-third reported PA intention in the next two months. Desired programs were less than four weeks and under 4 h weekly. Respondents preferred to attend self-directed online lessons (41.2%). Program format preference varied by age (P < 0.05). More respondents aged 40-49 years and 70+ years reported a preference for online group sessions compared to those aged 50 to 69 years. Respondents ages 60 to 69 years reported the highest preference for interactive apps. More older respondents (60 years and older) preferred asynchronous online lessons compared to the younger respondents (age 59 years and younger). There were significant program participation interest differences by age, race, and location (P< 0.05). These results revealed a need and preference for self-directed, online health programming for middle-aged and older adults.

The Relationship of Physical Activity and Dietary Quality and Diabetes Prevalence in US Adults: Findings from NHANES 2011-2018.

This study aimed to examine the relationship of physical activity and/or dietary quality and diabetes prevalence in the general population and within specific age groups. It was a cross-sectional study using 2011−2018 National Health and Nutrition Examination Survey and the US Department of Agriculture's Food Patterns Equivalents data (n = 15,674). Physical activity was measured by Global Physical Activity questionnaire; dietary quality was analyzed using the Healthy Eating Index 2015; diabetes prevalence was determined by reported diagnosis and glycohemoglobin or fasting glucose. Data were analyzed using multiple logistic regression adjusted for demographic variables and weight status. Results revealed that although no statistically significant or non-substantial relationships were observed between dietary quality or physical activity and diabetes prevalence, respondents who did not meet physical activity recommendations regardless of dietary quality had a higher odds of diabetes prevalence than those who met physical activity recommendations and had a higher dietary quality (p < 0.05). In conclusion, meeting physical activity recommendations is an important protective factor for diabetes especially in combination with a higher quality diet. A healthy lifestyle appears to have the greater impact on diabetes prevention in middle-aged men and women.

A cross-sectional assessment of food practices, physical activity levels, and stress levels in middle age and older adults' during the COVID-19 pandemic.

Aim: This cross-sectional study examined how the COVID-19 pandemic impacted the food practices, physical activity (PA) levels, and stress levels of aging adults ages 40 years and older from seven states. It also explored to what extent the COVID-19 outcomes were affected by the social determinants of health (SDH). Subject and methods: Respondents (n = 1250) completed an online survey. Descriptive statistics were used to analyze the sociodemographic attributes and COVID-19 responses while the multiple llinear regression (MLR) test evaluated to what extent the SDH variables measured were associated with the reported COVID-19 impacts food practices, PA levels, and stress levels. Results: Respondents were mostly White (75.9%), married (58.7%), age 60 years and older (61.8%), with a high school education or higher (97.4%). Most of the respondents (85.8%) live in areas that respondents perceived as supportive of health and well-being opportunities for older adults. Nearly one-half of the respondents reported maintaining their pre-pandemic grocery shopping/food buying frequency (44.7%) and PA levels (48.1%). However, 48.6% reported being "somewhat or very stressed" due to the pandemic. Findings revealed that the COVID-19 impacts on food-buying, PA levels, and stress levels were significantly influenced by age, gender, race, education, location, community, nutritional risk, quality of life, food security, and income (p < 0.05). Conclusion: These findings provide valuable information as we continue to confront the impact the COVID-19 pandemic has had on the health and well-being of aging adults. We can use this information to inform future public health programming interventions and opportunities.

Healthcare Professionals' Views and Perspectives towards Aging.

Improving care for the older population is a growing clinical need in the United States. Ageism and other attitudes of healthcare professionals can negatively impact care for older adults. This study investigated healthcare professionals' (N = 140) views towards aging and characterized a confluence of factors influencing ageism perspectives in healthcare workers using path analysis models. These models proposed relationships between aging anxiety, expectations regarding aging, age, ageism, and knowledge. Aging anxiety had a less critical role in the final model than hypothesized and influenced ageism in healthcare workers through its negative effect (ß = -0.27) on expectations regarding aging. In contrast, aging knowledge (ß = -0.23), age (ß = -0.27), and expectations regarding aging (ß = -0.48) directly and inversely influenced ageism. Increased knowledge about the aging process could lower ageism amongst healthcare professionals and improve care for older adults. The results put forth in this study help to characterize and understand healthcare workers' complex views towards the aging population they often encounter. Moreover, these results highlight the need and utility of leveraging practitioner education for combating ageism in the clinical setting.

Test-Retest Reliability of the King-Devick Test in an Adolescent Population.

CONTEXT: The King-Devick (KD) test is a screening tool designed to assess cognitive visual impairments, namely saccadic rhythm, postconcussion. Test-retest reliability of the KD in a healthy adolescent population has not yet been established. OBJECTIVE: To investigate the overall test-retest reliability of the KD among a sample of healthy adolescents. Additionally, we sought to determine if sex and age influenced reliability. DESIGN: Cross-sectional study. SETTING: Secondary school. PATIENTS OR OTHER PARTICIPANTS: Sixty-eight healthy adolescents, 41 boys (age = 15.4 ± 1.9 years) and 27 girls (age = 15.4 ± 1.9 years). MAIN OUTCOME MEASURE(S): Participants completed the KD (version 1) at 3 testing sessions (days 1, 30, and 45) following standard instructions. We recorded total time to complete the reading of 3 cards for each participant during each testing session. Two-way random-effects intraclass correlation coefficients (ICCs) using single measurements repeated over time and repeatability coefficients were calculated. Linear mixed models were used to determine whether differences existed at each testing time and to examine whether changes that took place among visits were different by sex or age. RESULTS: Adolescents who completed the KD demonstrated acceptable reliability (ICC = 0.81; 95% confidence interval = 0.73, 0.87); however, the repeatability coefficient was large (±8.76 seconds). The sample demonstrated improvements between visits 1 and 2 (mean ± standard error = 4.3 ± 0.5 seconds, P < .001) and between visits 2 and 3 (2.4 ± 0.5 seconds, P < .001) for a total improvement of 6.9 seconds over 3 tests. No significant visit-by-sex or visit-by-age interactions were observed. CONCLUSIONS: Despite the ICC being clinically acceptable, providers using the KD test for serial assessment of concussion in adolescents should be cautious in interpreting the results due to a large learning effect. Incorporating multiple measures can ensure accurate detection of sport concussion.

High Prevalence of Vitamin D Insufficiency in Farming and Nonfarming Populations in South Dakota: Associations With Parathyroid Hormone, Body Fat, and Bone Density.

The purpose of this study was to investigate the role of lifestyle (farming vs nonfarming), age, season, and percent body fat on serum 25-hydroxyvitamin D (25-OHD) and parathyroid hormone (PTH). Serum 25-OHD concentrations were lower in winter than in summer and in older than in younger individuals. Dietary intake of vitamin D was associated with greater serum 25-OHD concentrations. A significant inverse relationship between PTH and 25-OHD was observed in older but not younger individuals. Trabecular volumetric bone mineral density was inversely associated with serum PTH, but not 25-OHD concentrations. Modern farm practices do not necessitate excessive sunlight exposure and that may help explain the lack of differences between farming and nonfarming populations.

A longitudinal pilot study of depressive symptoms in concussed and injured/nonconcussed National Collegiate Athletic Association Division I student-athletes.

CONTEXT: Depression, which affects millions of Americans each year, among them collegiate student-athletes, can be caused by a wide range of circumstances, including sport-related injuries. OBJECTIVE: To longitudinally examine the extent to which National Collegiate Athletic Association Division I student-athletes demonstrated postinjury depressive symptoms. DESIGN: Descriptive epidemiologic study. SETTING: National Collegiate Athletic Association Division I collegiate athletics. PATIENTS OR OTHER PARTICIPANTS: Concussed, injured/nonconcussed, and healthy Division I collegiate student-athletes (aged 18-22 years) competing in men's basketball, football, and wrestling and women's basketball, soccer, and volleyball. MAIN OUTCOME MEASURE(S): Participants completed the Center for Epidemiologic Studies Depression Scale at baseline and at 1 week, 1 month, and 3 months postinjury. We measured differences in depressive scores among concussed, injured/nonconcussed, and healthy participants. Longitudinal changes in postconcussion depressive symptoms were also examined. RESULTS: No differences in baseline depressive symptoms among subgroups were noted. After an increase between baseline and 1 week (4.3, 95% confidence interval [CI] = 0.41, 8.16, P = .02), depressive symptoms in the concussion group decreased between 1 week and 1 month (-2.7, 95% CI = -4.96, -0.47, P = .01) and between 1 week and 3 months (-4.0, 95% CI = -6.50, -1.49, P = .004). The injured/nonconcussed group showed differences between baseline and 1 week (4.6, 95% CI = 1.08, 8.17, P = .009) and between baseline and 1 month (3.2, 95% CI = -0.05, 6.30, P = .03). No significant differences were present in depressive symptoms between concussed participants and injured/nonconcussed participants at any of the postinjury time points. CONCLUSIONS: Depression may present as a postinjury sequela in Division I collegiate athletes. Athletes who sustain a concussion or other injury resulting in time lost from practice or competition need to be observed carefully for signs and symptoms that may indicate depression. Tools such as the Center for Epidemiologic Studies Depression Scale can be valuable in helping clinicians to recognize and manage depressive symptoms in these individuals.

Rural vs. non-rural differences and longitudinal bone changes by DXA and pQCT in men aged 20-66 years: A population-based study.

The purpose of this research was to determine whether there were differences in estimated means and rates of change in BMC, bone area, BMD and measures of bone geometry among men (n=544) from three distinct populations (Hutterite [rural], rural non-Hutterite, non-rural), and whether activity levels or calcium intake explain these population differences. Men were enrolled in the South Dakota Rural Bone Health Study and followed for 7.5 years to estimate means and rates of change in bone mass, density, size and geometry. Femoral neck (FN) and spine measurements were obtained every 18 months by DXA and distal radius (4% and 20%) measurements by pQCT. Activity measurements and calcium intake were obtained quarterly for the first 3 years and at 54, 72, and 90 months. Rural men had greater percent time in moderate plus vigorous activity (mean ± SD: 22 ± 10 vs. 15 ± 8%, p<0.001) and greater lean mass (69 ± 9 vs. 66 ± 10 kg, p=0.05) than non-rural men. Both rural populations (Hutterite and rural men) had larger femoral neck (FN) bone area and greater 20% radius cross-sectional area than non-rural men ([least square means ± SE] FN area: 5.90 ± 0.02 and 5.86 ± 0.02 vs. 5.76 ± 0.03 cm(2), p<0.001 and p=0.03 respectively and cross-sectional area: 171.0 ±1.3 and 165.5 ± 1.5 vs. 150.3 ± 1.6mm(2), both p<0.001). Despite lower cortical vBMD in Hutterite and rural men compared to non-rural men (1182 ± 2 and 1187 ± 2 vs. 1192 ± 2 mm(2), p<0.001 and p=0.06 respectively), bone strength (pSSI) was greater (429 ± 5 and 422 ± 5 vs. 376 ± 6 mm(3), both p<0.001). The rates of change in femoral neck BMC and aBMD and trabecular vBMD also differed by rural lifestyle, with greater losses among non-rural men in their 20s and 60s compared to both Hutterite and rural populations (time-by-age-by-group interactions, both p<0.01). Physical activity was not found to be a potential mediator of population differences. Baseline calcium intake was associated with FN aBMD (p=0.04), and increases in calcium intake were associated with spine BMC (p=0.04) and inversely associated with cortical area (p=0.02). There was some evidence for mediation by either baseline calcium intake or changes in calcium intake over the study period, but the influence on population differences were negligible. We speculate that rural-non-rural differences in bone occur earlier in life or are a result of factors that have not yet been identified.

Greater Polar Moment of Inertia at the Tibia in Athletes Who Develop Stress Fractures.

BACKGROUND: Several previous investigations have determined potential risk factors for stress fractures in athletes and military personnel. PURPOSE: To determine factors associated with the development of stress fractures in female athletes. STUDY DESIGN: Case-control study; Level of evidence, 3. METHODS: A total of 88 female athletes (cross-country, n = 29; soccer, n = 15; swimming, n = 9; track and field, n = 14; volleyball, n = 12; and basketball, n = 9) aged 18 to 24 years were recruited to participate in a longitudinal bone study and had their left distal tibia at the 4%, 20%, and 66% sites scanned by peripheral quantitative computed tomography (pQCT). Patients included 23 athletes who developed stress fractures during the following year (cases). Whole body, hip, and spine scans were obtained using dual-energy x-ray absorptiometry (DXA). Analysis of covariance was used to determine differences in bone parameters between cases and controls after adjusting for height, lower leg length, lean mass, fat mass, and sport. RESULTS: No differences were observed between cases and controls in any of the DXA measurements. Cases had significantly greater unadjusted trabecular bone mineral content (BMC), greater polar moment of inertia (PMI) at the 20% site, and greater cortical BMC at the 66% site; however, after adjusting for covariates, the differences became nonsignificant. When analyses were repeated using all individuals who had ever had a stress fracture as cases (n = 31) and after controlling for covariates, periosteal circumference was greater in the cases than the controls (71.1 ± 0.7 vs 69.4 ± 0.5 mm, respectively; P = .04). CONCLUSION: A history of stress fractures is associated with larger bones. These findings are important because larger bones were previously reported to be protective against fractures and stress fractures, but study findings indicate that may not always be true. One explanation could be that individuals who sustain stress fractures have greater loading that results in greater periosteal circumference but also results in the development of stress fractures.

Resistant starch type 4-enriched diet lowered blood cholesterols and improved body composition in a double blind controlled cross-over intervention.

A metabolic health crisis is evident as cardiovascular diseases (CVD) remain the leading cause of mortality in the United States. Effects of resistant starch type 4 (RS4), a prebiotic fiber, in comprehensive management of metabolic syndrome (MetS) remain unknown. This study examined the effects of a blinded exchange of RS4-enriched flour (30% v/v) with regular/control flour (CF) diet on multiple MetS comorbidities. In a double blind (participants-investigators), placebo-controlled, cluster cross-over intervention (n = 86, age≥18, 2-12 week interventions, 2-week washout) in the United States, individuals were classified as having MetS (With-MetS) or not (No-MetS) following International Diabetes Federation (IDF)-criteria. RS4 consumption compared with CF resulted in 7.2% (p = 0.002) lower mean total cholesterol, 5.5% (p = 0.04) lower non-HDL, and a 12.8% (p < 0.001) lower HDL cholesterol in the With-MetS group. No-MetS individuals had a 2.6% (p = 0.02) smaller waist circumference and 1.5% (p = 0.03) lower percent body fat following RS4 intervention compared to CF. A small but significant 1% increase in fat-free mass was observed in all participants combined (p = 0.02). No significant effect of RS4 was observed for glycemic variables and blood pressures. RS4 consumption improved dyslipidemia and body composition. Incorporation of RS4 in routine diets could offer an effective strategy for public cardio-metabolic health promotion.