Baseball and softball sliding injuries: incidence and correlates during one high school league varsity season.

OBJECTIVE: To estimate injury rates associated with sliding in high school baseball and softball. DESIGN: Prospective cohort study. SETTING: Community high school athletic events. PARTICIPANTS: Ten high school varsity baseball and softball teams over 1 season. ASSESSMENT OF RISK FACTORS: All sliding attempts were recorded during each game and recorded as headfirst, feetfirst, or diveback. Base type, playing surface, and field conditions were also noted. MAIN OUTCOME MEASURES: Injury exposure rates by game exposures and sliding/diveback exposures. RESULTS: Data were collected from 153 baseball games and 166 softball games. A greater proportion of slides were associated with injury in softball than in baseball (42.0 and 4.9 per 1000 slides; P < 0.05). Headfirst slides led to more injuries than feetfirst slides in baseball (16.8 vs 0 per 1000 slides; P < 0.05) but not in softball (55 vs 35 per 1000 slides; P = 0.74). CONCLUSIONS: More powerful studies are required to determine whether efforts to prevent baseball sliding injuries at the high school level should focus on better education in sliding technique or changes in equipment. Softball players are vulnerable to injury when wearing inadequate protective sliding apparel.

Sex differences in response to citalopram: a STAR*D report.

OBJECTIVE: Controversy exists as to whether women with depression respond better to selective serotonin reuptake inhibitors (SSRIs) than men. The purpose of this report was to determine whether men and women differ in their responses to treatment with the SSRI citalopram using a large sample of real world patients from primary and psychiatric specialty care settings. METHOD: As part of the sequenced treatment alternatives to relieve depression (STAR *D) study, 2876 participants were treated with citalopram for up to 12-14 weeks. Baseline demographic and clinical characteristics and outcomes were gathered and compared between men and women. RESULTS: At baseline, women were younger, had more severe depressive symptoms and were more likely to have: early onset; previous suicide attempt(s); a family history of depression, alcohol abuse or drug abuse; atypical symptom features; and one or more of several concurrent psychiatric disorders. Despite greater baseline severity and more Axis I comorbidities, women were more likely to reach remission and response with citalopram than men. CONCLUSIONS: Women have a better response to the SSRI citalopram than men, which may be due to sex-specific biological differences particularly in serotonergic systems.

Medical school debt load of graduate anesthesiologists at a single medical school campus, 1982-2007.

Medical school debt continues to grow at an ever increasing rate. We questioned whether the debt incurred by the residents finishing their training at the University of Kansas School of Medicine-Wichita (UKSM-W) was overly burdensome. We surveyed all graduate anesthesiologists from UKSM-W. The returned questionnaires were tabulated and subjected to statistical analysis comparing two cohorts: those graduates finishing in the years 1982-1992 (earlier cohort) to those finishing in the years 1993-2007 (later cohort). There was a statistical difference in median debt load between the cohorts, $56,823 to $113,746 earlier versus later cohorts (constant dollars). The percentage of gross income required to repay the debt was the same for both cohorts. Both cohorts reported under-funding retirement plans and children's education to service debt. Few of either cohort chose practice location because of debt load.

Influences of hormone-based contraception on depressive symptoms in premenopausal women with major depression.

OBJECTIVE: Hormone-based contraceptives affect mood in healthy women or in women with premenstrual dysphoric disorder (PMDD). No study has yet examined their association with mood in women with major depressive disorder (MDD). The purpose of this study was to determine whether estrogen-progestin combination or progestin-only contraceptives are associated with depression severity, function and quality of life, or general medical or psychiatric comorbidity in women with MDD. METHODS: This analysis focused on a large population of female outpatients less than 40 years of age with non-psychotic MDD who were treated in 18 primary and 23 psychiatric care settings across the US, using data from the Sequenced Treatment Alternatives to Relieve Depression (STAR*D) study. Baseline demographic and clinical information was gathered and compared between three groups based on hormonal use: combination (estrogen-progestin)(N=232), progestin-only (N=58), and no hormone treatment (N=948). RESULTS: Caucasians were significantly more likely to use combined hormone contraception. Women on progestin-only had significantly more general medical comorbidities; greater hypersomnia, weight gain and gastrointestinal symptoms; and worse physical functioning than women in either of the other groups. Those on combined hormone contraception were significantly less depressed than those with no hormone treatment by the 16-item Quick Inventory of Depressive Symptomatology-Self-Rated. The combined hormone group also demonstrated better physical functioning and less obsessive-compulsive disorder (COCD) comorbidity than either of the other groups. CONCLUSIONS: Synthetic estrogen and progestins may influence depressive and physical symptoms in depressed women.

Intramuscular haloperidol or lorazepam and QT intervals in schizophrenia.

The objective of this study was to estimate the effects of intramuscular haloperidol and lorazepam on the QT interval in volunteers with schizophrenia. Intramuscular haloperidol and intramuscular lorazepam are standard treatments in the acute management of agitation and aggression. Although prolongation of the QT interval and sequelae, including torsade de pointes and death, have been reported for haloperidol (but not lorazepam), formal studies have been lacking. Volunteers with schizophrenia (n = 12) were administered a single intramuscular injection of 7.5 mg haloperidol or 4 mg lorazepam in a blinded, randomized, placebo-controlled crossover design. Serial EKGs and concurrent blood samples were obtained over 6 hours following each injection. Changes in the QT interval were evaluated, as were plasma drug and prolactin concentrations. Haloperidol injection increased the heart rate-corrected QT interval an average of 5.1 msec using Bazett's correction (QTb 90% confidence interval [CI]: 0.3, 9.8), 3.6 msec using Fridericia's correction (QTf 90% CI: 0.02, 7.2), and 4.2 msec using an empirically derived "baseline correction" (QT(ii) 90% CI: 0.3, 8.0). Effects of lorazepam on QT were nullified by correction for the heart rate elevation (QTb 3.8 msec, 90% CI: 0.6, 7.1; QTf 0.0 msec, 90% CI: -3.2, 3.4; QTii -2.3 msec, 90% CI: -6.6, 2.0). An association between QT prolongation and occurrence of extrapyramidal symptoms was observed. On average, intramuscular haloperidol led to minimal prolongation of the QT interval. This propensity is of theoretical concern in individuals with risk factors for torsade de pointes but seems unlikely to be a problem in the vast majority of patients.

Ovulation disturbances and mood across the menstrual cycles of healthy women.

We examined the cyclicity of negative mood relative to ovulation and ovulation disturbances in Menstrual Cycle Diary(c) data collected daily during a 1-year study of ovulation, exercise, and bone change. A validated quantitative basal temperature-based methodology was used to determine the onset of the luteal phase. 'Feeling depressed', 'feeling anxious', and 'feeling angry/frustrated' were scored on a scale of 0 (absent) to 4 (very intense). Mood scores were examined over two 15-day intervals centered on either ovulation/midpoint, or on the onset of flow. Data were available from 765 cycles of 62 healthy and initially ovulatory women with a mean age of 33.9 +/- 5.4 years. Of 739 cycles that could be classified, 532 (72%) were normally ovulatory, 185 (25%) were ovulatory with a short (<10 day) luteal phase, and 22 (3%) were anovulatory. Minor cyclic mood changes were present in both ovulatory and anovulatory menstrual cycles. In anovulatory cycles, mood tended to be more variable but less negative, with a time course that differed from that in ovulatory cycles. Mood scores did not differ based on luteal phase length or with hormone levels. Patterns and mechanisms of mood change in very symptomatic women appear to be essentially amplifications of normal experiences.

Acute worsening of chronic depression during a double-blind, randomized clinical trial of antidepressant efficacy: differences by sex and menopausal status.

OBJECTIVE: Acute worsening of depression can negatively impact the outcomes of clinical trials of antidepressants and patient compliance to treatment. We hypothesized that acute worsenings would be more frequent in premenopausal women, relative to men or postmenopausal women, and in women who had demonstrated premenstrual symptom exacerbations (PMEs) prior to treatment, relative to those who had demonstrated no PMEs. METHOD: Subjects diagnosed with DSM-III-R chronic major depressive disorder or double depression (dysthymia with concurrent major depressive episode) were randomly assigned between February 1993 and December 1994 to 12 weeks of double-blind treatment with flexibly-dosed sertraline or imipramine, with crossover to the alternate drug in the absence of response. A 6-point or more increase in the 17-item Hamilton Rating Scale for Depression relative to the (7-14 day) previous visit defined worsening. PME was assessed through daily diaries prior to treatment. RESULTS: There were 3582 evaluable visits attended by 554 subjects. Premenopausal women had a deteriorating depressive presentation at a greater proportion of their visits (8.6%) than did postmenopausal women (4.5%, p < .01) or men (5.9%, p < .01). The presence of PME at baseline was associated with more worsenings than the absence of PME (12.0% vs. 7.3%, p < .05). Results were similar whether the subject was treated with sertraline or imipramine. Nonresponse at treatment completion was more likely among subjects with worsening (p < .01). Dropouts were more likely than completers to have had an exacerbation at their terminal visit (p < .05). CONCLUSION: Acute worsening of depression was associated with reproductive variables and negatively affected clinical trial outcomes including early treatment discontinuation and nonresponse.