Effect of Anterior Cruciate Ligament Injury of the Knee on Bone Mineral Density of the Spine and Affected Lower Extremity: A Prospective One-Year Follow-Up Study

The objective of this 1-year prospective follow-up study was to assess, with dual-energy X-ray absorptiometry (DXA), the effect of an anterior cruciate ligament (ACL) injury of the knee on areal bone mineral density (BMD) of the injured extremity and lumbar spine in two separate patient groups: 21 surgically treated patients (group A) and 12 conservatively treated patients (group B). Clinical and functional status of the patients and BMD of the spine (L2–L4), dominant distal radius, femoral neck, trochanter area of the femur, distal femur, patella, proximal tibia, and calcaneus of both lower extremities were determined at the time of the injury and after 4, 8, and 12 months. A surgically treated, complete ACL rupture (group A) resulted in considerable and statistically significant bone loss to the affected knee (distal femur 21%, patella 17%, proximal tibia 14%; P < 0.001 in each), whereas the other sites were clearly less affected. Patients with a conservatively treated, complete or partial ACL injury (group B) had only a small but statistically significant bone loss at the patella (−3%; P= 0.005) and proximal tibia (−2%; P= 0.022) of the injured knee, and the other sites remained unchanged. The obvious differences between the groups A and B in the severity of the injury itself (complete or partial tear), its treatment (surgical or conservative), and subsequent rehabilitation (longer nonweight-bearing times in group A) explain these different BMD results, and the forthcoming years will show whether the considerable posttraumatic osteoporosis in the affected knee of group A patients will finally recover, and if so, to what extent. Received: 16 June 1998 / Accepted: 6 October 1998     

Information sources used by women in Finland who use hormonal contraceptives

Objective The aim of this study was to examine information sources used by women who use hormonal contraceptives (HCs), and how information source affected women’s attitudes and perceptions in 2001 and 2007. Setting The questionnaires were distributed from university pharmacies in 12 large cities across Finland. Method The data were collected with two questionnaire surveys among women who used hormonal contraceptives in 2001 and 2007. In the 2001 survey the response rate was 53% (n = 264) and in the 2007 survey 55% (n = 436). Results The number of respondents who considered professional information sources the most important information sources was markedly bigger in 2007 than in 2001 (P = 0.005). The most common source of information concerning the benefits of hormonal contraceptives was a physician (2001: 43%, 2007: 53%). The most common source of information concerning the risks of hormonal contraceptives was friends and relatives (43%) in 2001 and physician in 2007 (35%). Only a few percent of the respondents considered a pharmacy the most important information source both the 2001 and 2007 surveys. Conclusion The importance of health care professionals as sources of information concerning hormonal contraceptives has increased. However, role of pharmacists as information source was surprisingly small. Women who use hormonal contraceptives need more information from professional sources to alleviate possible fears associated with use.     

Isokinetic muscle performance after surgery of the lateral ligaments of the ankle.

In this study, we assessed the isokinetic strength and power profile of 138 patients with a surgically treated lateral ligament injury of an ankle. In addition, the outcome predicting factors were analyzed. The measurements were done 6.2+/-0.8 years after the surgery using the Cybex II isokinetic dynamometer. The general strength status of the patients was good, the isokinetic testing showing no or only moderate (always < or = 18%) average strength deficits in the peak torque values of dorsiflexor and plantar flexor muscles of the injured ankle. Of the outcome predicting variables, only the age of the patient in the group with surgery for chronic ankle instability correlated significantly with the isokinetic peak torque deficits: the older the subject, the greater the peak torque deficit in the injured ankle (r(s) = -0.388 with p = 0.015) in ankle dorsiflexion at the speed of 60 degrees/s. In conclusion, patients having surgery for ankle ligament insufficiency, either in acute or chronic phase of the injury, seem to recover well showing no remarkable deficiencies in the isokinetic ankle muscle strengths several years after the repair.     

Relationship between unemployment and health among health care professionals: health selection or health effect?

OBJECTIVE: The aim of this longitudinal study was to examine (a) the causal effect of unemployment 1990-1997 on health 1998-2001 (in-patient periods) and (b) the selection effect of health 1996-1999 on unemployment 2000-2002. We examined the effects of different diagnoses, namely, all causes, circulatory diseases, diseases of the digestive system, musculoskeletal diseases, and mental disorders. METHODS: The data from the Central Register of Health Care Professionals of persons born 1945-1970 were linked to data from employment statistics and Finnish Hospital Discharge Register including 78,195 women and 12,455 men aged 31 to 56 in 2001. The associations were analyzed with logistic regression analyses and expressed as odds ratios (OR) and their 95% confidence intervals (CI). RESULTS: After adjustments, existence of unemployment periods was associated with lower odds for in-patient periods due to musculoskeletal diseases for both women (OR=0.82, 95% CI=0.76-0.89) and men (OR=0.74, 95% CI=0.60-0.89). Unemployment periods were more likely among women (OR=1.65, 95% CI=1.33-2.04) and men (OR=2.54, 95% CI=1.44-4.48) having had in-patient periods due to mental diseases and among women also due to diseases of the digestive system (OR=1.17, 95% CI=1.04-1.31). CONCLUSION: The present study found evidence for selection to unemployment according to mental diseases and diseases of the digestive system among health care professionals. In addition, our results show that unemployment periods may protect health care workers from musculoskeletal diseases.     

Impact of patient information booklet on treatment decision – a randomized trial among women with heavy menstruation

Objective  Does a patient information booklet influence treatment for menorrhagia? Design  Randomized trial and a pre‐trial prospective cohort study. Setting  Gynaecology outpatient clinics in 14 Finnish hospitals. Participants  A total of 363 (randomized trial) plus 206 (cohort study) patients with menorrhagia. Intervention  An information booklet about menorrhagia and treatment options, mailed before the first visit to the outpatient clinic. Main outcome measures  Distribution of treatment modalities, knowledge about treatment options, satisfaction with communication with personnel and anxiety. Results  Treatment decision within 3 months was made more often in the intervention group than in the control group (96% and 89% respectively, P = 0.02). Oral medication was more frequently chosen, and newly introduced treatments (minor surgery, hormonal intrauterine system) were less frequently used in the intervention group (at 3‐month follow‐up 21% and 29%, respectively). The differences persisted at the 12‐month follow‐up. In the pre‐trial group, new treatment methods were less frequently chosen and used than in the control group. Additional information did not increase the number of surgical procedures used, improve knowledge, or influence satisfaction or anxiety. Conclusion  Additional information led to an increase in specific treatment decisions and changed the distribution of used treatments without increasing the number of surgical procedures. The study suggests that well‐informed women adopting an active role may counteract physicians’ emphasis on newly introduced treatments.     

Sociodemographic differences in myocardial infarction risk perceptions among people with coronary heart disease

This study examines sociodemographic differences in myocardial infarction (MI) risk perceptions among people with coronary heart disease (CHD) (N = 3130). Two variables for comparative risk perceptions were computed: (1) own risk compared to that of an average person; and (2) own risk compared to that of an average person with CHD. Comparative optimism in MI risk perceptions was common, particularly among men and those with higher education. CHD severity and psychosocial resources mediated these sociodemographic differences. These results suggest challenges for secondary prevention in CHD, particularly regarding psychosocial interventions for communicating risk information and supporting lifestyle adjustments.     

Effects of training, immobilization and remobilization on tendons

Since a tendon is a living tissue, it is not a surprise that tendon shows the capacity to adapt its structure and mechanical properties to the functional demands of the entire muscle-tendon unit. However, compared with muscle, the experimental knowledge of the effects of strength or endurance-type training on tendon tissue is scarce and clinical human experiments are completely lacking (1). Research should, however, be able to improve the true understanding of the biomechanical, functional, morphological and biochemical changes that occur in tendons due to training and physical activity, since understanding of the basic physiology of a tissue is the key to understanding its pathological processes (1,2). Compared with muscle tissue, the metabolic turnover of tendon tissue is many times slower due to poorer vascularity and circulation (1, 3). The adaptive responses of tendons to training are therefore also slower than those in muscles, but they may finally be considerable if the time frame is long enough (3, 4).