photo: Aflo/Corbis

Judo is a martial art that a person can master no matter what his or her size.

Success in judo (which evolved from jujitsu and is sometimes known as the gentle way) can be achieved through speed and skill rather than strength. Judo will be on a global stage at this summer’s Olympics. Learn more at www.usjudo.org or  www.london2012.com/judo.

This post originally appeared as the Go page in the February 2012 issue of Current Health Teens, available now.

1. Select one of our categories on the right-hand page of the blog, under “GET UP AND GO!” and see what interests you.

photo: IStock

2. Take a hike!

3. Go outside and play football! Or just toss a ball around.

4. Go take a brisk walk and bring a camera to photograph your journey.

5. Set a fitness goal for six months from today. Write down the steps to achieving it and get started on the first one.

6. Gather some friends for a rousing game of boogalah

7. … or kemari

8. … or Hooverball, a sport named after a President!

9. Go bowling with some friends.

10. Find a place to play near you, and go there.

11. Play a game that was made by Native Americans, such as hoop-and-pole. (Or lacrosse!)

photo: Aflo/Corbis

12. Did you see our 99th post? It was about judo, a martial art that people of all sizes delight in.

13. Kickball, hopscotch, Simon Says … ancient-fashioned playground games are still fun.

14. Perhaps you’ll get an thought from these ways to take advantage of winter.

15. Go to the batting cage and hit some baseballs or softballs.

16. Go to the driving range and hit some golf balls.

17. Go for a walk, a jog, or a run.

18. New to running? Check out these tips for getting started.

19. Grab a pool noodle and make up an active game to play with it.

20. Print out the pledge to Get Up and Go, fill it out, and place it somewhere that motivates you to exercise.

21. Then print out our weekly Activity Log. You can fill it in with your exercise every day for a week—then print out another one, and keep going!

22. Go for a bike ride.

23. Can’t ride a bike? Learn how!

24. Learn about synchronized swimming.

25. Pick up a wicket and try cricket!

Photo: C.S. Manish

26. Try one of these ways to exercise with friends.

27. Get in the swing with golf.

28. Meet The Workout Kid.

29. Curious about Korfball? You may already have all the equipment you need.

30. Just hang out.

31. Play an active video game, such as Dance Dance Revolution, Dance Central, or Wii Sports Plus.

32. Do you normally get exercise using a treadmill or other machine that plugs into the wall? Go green by finding an electricity-free way to work out.

33. Choose one of these “outdoor sports for one.”

34. Like movies? Check out the art of film dance.

Photo: IStock

35. Shoot some hoops!

36. Or use a basketball to play one of these games.

37. Two words: Scavenger hunt!

38. Surf the Web. (No, really: you can watch how-to videos about surfing and learn some key moves from the comfort of your home.)

39. Try this “boot camp”-style routine.

40. Try a sport from Ireland, such as Gaelic football.

41. Or learn about the Irish sports hurling or camogie. People call them “the fastest field team sports” around.

42. Ready for the 2012 Summer Olympics? One well loved sport is beach volleyball.

43. Get Up and Go with people you know.

44. Organize a hoop jam.

45. Go fishing. It can be active as well as relaxing.

46. Stop whatever you are doing and get everyone in your house (or classroom) to exercise for five minutes.

47. “Go Your Body!”

48. Add some exercise to your chores.

49. What is the wildest sport you can possibly imagine? Is it this?

50. Go swimming!

51. (Or diving or kayaking or sailing).

52. Earth Day is in April, but you can help the Earth while you get moving any day of the year.

53. Make like it’s spring year-round by trying these thoughts we offered in March 2011.

54. Or pretend it’s summer.

55. See whether there is a Play Day near you. If not, figure out what you’d need to do to start one!

Yosemite National Park. Photo by Richard E. Ellis, www.spinics.net/Yosemite, via Wikimedia Commons

56. Visit a national park.

57. Reckon differently about getting active. Be creative.

58. PLAY BALL! (Baseball or softball, that is.)

59. Set up an indoor circuit training area.

60. Learn about track and field events.

61. Make yourself a Get Up and Go Tote.

62. Work on your flexibility.

63. Design the perfect playground. Find out whether any play places near you fit the bill.

64. Find out what a burpee is.

65. Start a walking club.

66. Go for a ride on a pogo stick!

67. Take the stairs.

68. Find some examples of cardiovascular exercise and try one of them.

69. Rollerskate! (Or try jamskating.)

Photo: Hannibal Hanschke/AFP/Getty Images

70. Got snow? Go out and play in it.

71. No snow? Grab a flying disc and play a game of Ultimate Frisbee.

72. Add a stability ball to your workout.

73. Place on a pedometer and take a walk.

74. Or try Nordic walking (also known as ski walking).

75. Go for yoga.

76. If you’ve read this far, you must be a very motivated person. Here are more hints for you.

77. Find a dance class near you and sign up for it.

78. Jump rope!

79. The sport of curling got a lot of attention during the 2010 Olympics. Not sure what it is? Learn more about it.

Photo: AP Images

80. Grab a broom and play Quidditch, featured in the Harry Potter books.

81. Is there a game or sport played in a book you like? Go and play it.

82. Pick a board game you like and make up new rules that get players moving. (For instance, have players do something after each turn – jumping jacks are an simple one.)

83. Play a game of bocce.

84. Make an obstacle course and give it a run-through.

85. Read about cross-training and choose some ways to do it.

86. Make plans to go somewhere—the library, the store, a friend’s house – and walk, run, bike, or skate there.

87. Juggling + running = joggling.

88. Learn what functional fitness is and try a new way to play musical chairs or tag.

89. Turn on your radio and dance.

90. Learn to ride a skateboard. (Already know how? Go outside and ride!)

91. Hula hoop! You can do this by yourself or have a contest with someone else. See who can keep hooping the longest.

92. Design a game or sport that you might play on another planet or the moon. Then go play it!

93. Turn off your TV and play.

94. Look into orienteering.

95. Take a walk around a historic site near you.

96. Exercise with your family.

Photo courtesy of Hunter Lussi

97. Beach paddleball!

98. Try letterboxing, which is a combination of hiking and treasure hunting.

99. Learn what a triathlon is and how to get started.

100. Still not sure what type of exercise is right for you? Take our “What’s Your Exercise Personality?” quiz!

You read all the way to the end! Fantastic job. Now choose one of the thoughts above and Get Up and Go!

Reuters: Health News

(CNN) — A school system in upstate New York, where more than a dozen female high school students are suffering from uncontrolled verbal outbursts and twitching, said it has hired a company to review environmental testing within the school and community.

The development comes as famed activist Erin Brockovich and other environmentalists are looking into whether a chemical that spilled in a 1970 train derailment about four miles from the school has anything to do with the girls’ mysterious behavior. One of Brockovich’s associates walked the grounds of Le Roy Senior High School on Saturday and traveled to the derailment site.

The Le Roy Central School District said it wanted “sound advice” from professionals on the situation, “void of self-interest.”

“Our community has suddenly found itself at the center of national attention due to the students who have been exhibiting neurological symptoms,” Superintendent Kim M. Cox said in a statement released Friday. “This has led to much speculation, conjecture and misinformation in the national media and consequently within our community.”

Cox said the school district is working with local, state and federal health and environmental agencies.

A statement posted earlier on the school’s website said, in part, “The medical and environmental investigations have not uncovered any evidence that would link the neurological symptoms to anything in the environment or of an infectious nature.”

The school district posted air quality and mold reports on its website. “Water was also ruled out because the school is serviced by public water,” it said.

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The mother of one affected girl said she doesn’t reckon enough testing has been done.

Health officials say the girls’ symptoms are consistent with “conversion disorder.”

Brockovich told HLN’s “Dr. Drew” on Friday night that she will try to corroborate a note she said one of the affected family members received about the derailment.

“The contaminated rock, fill and soil was used to build the new school,” Brockovich said of the note.

According to the U.S. Environmental Protection Agency, one ton of cyanide crystals spilled onto the ground in the December 6, 1970, derailment.

About 30,000 gallons of trichloroethene (TCE), a potentially harmful contaminant, also were released from two ruptured tank cars, the agency said.

“I have read and been involved in cases that we have had that TCE can be associated with neurological disorders,” Brockovich told HLN.

The first significant cleanup and remediation did not start for 20 years, she said, adding she was worried about the chemical getting into bedrock and groundwater supplies. The TCE may have reached the school grounds, she said.

The EPA’s Superfund website provides a progress report of the cleanup done in the area over the past 20 years.

“Drinking wells in the area were found to have TCE contamination,” the EPA said. “Sampling of private wells between 1990 and 1994 detected TCE in approximately 50 wells located east or southeast of the site.”

The EPA installed water-treatment systems at 37 locations where TCE levels were high. The New York State Department of Environmental Conservation used soil vapor extraction and bedrock vapor extraction to address the source of the contamination.

“A water-line extension was selected to provide a safe, potable water supply to all affected residents and businesses,” the EPA said.

Robert Bowcock, an environmental water specialist associated with Brockovich, went to the derailment site Saturday and took water samples to test for contaminants. He also took water samples from wells at private residences. An HLN producer saw several dozen drums in a fenced-off area at the derailment site, but it was not clear what they may contain. One was rusted and had dirt-like material inside.

Brockovich gained fame after the 2000 movie bearing her name and starring Julia Roberts in the title role. It told the tale of how she, as a file clerk at a law firm, established that a toxic chemical from a compressor station leaked into the groundwater of a nearby California town, according to a biography posted on Brockovich’s website.

Medical experts, meanwhile, continue to investigate the girls’ symptoms, which in some cases, include stuttering.

Dr. Jennifer McVige, a pediatric neurologist at the DENT Neurologic Institute who is treating many of the students affected, said, “Conversion disorder is a physical manifestation of physiological symptoms where there is traditionally some kind of stress or multiple stressors that provoke a physical reaction within the body.”

McVige said the symptoms are real. “This is unconscious. It is not done purposefully.”

Thera Sanchez, a senior on the honor roll at the school, said she has been fighting this affliction since October. She said after waking up from a nap, “I got upset, I couldn’t stop stuttering.”

During an interview with CNN’s Jason Carroll, Thera’s symptoms were apparent: She was twitching uncontrollably, flailing her left arm and jerking her head to one side. Thera said she also faints and has seizures. The seizures are a result of her pre-existing epilepsy disorder, which had been under control for years.

“I don’t reckon that all physical aspects of this have been exhausted; not enough testing has been done,” Thera’s mother, Melissa Phillips, said.

She also disagreed with McVige’s assertion that the girls are improving, saying, “Nothing is getting better, you know, the girls are still getting worse. They have excellent days and terrible days.”

McVige is not sure why so many girls at the same school are suffering all at once. “I do know that traditionally when they’ve (doctors) looked back at different events that occurred in a similar nature, a majority of the time it is girls.”

According to the Mayo Clinic, females are much more likely to get conversion disorder and it is more common in adolescents or young adults.

McVige said she used the “diagnosis of exclusion” to determine what happened to the girls, which means using the process of elimination. She ruled out a laundry list of factors to reach her diagnosis, including infections, drug use, food allergies and vaccine reactions, specifically Gardasil.

The New York State Health Department agreed with McVige’s diagnosis after speaking with several doctors who evaluated the students.

“There are many causes of tic-like symptoms. Stress can often worsen them,” said spokesman Jeffrey Hammond. “The doctors all agree that the symptoms these girls are experiencing are real.”

HLN’s Liz Flynn reported from Le Roy, New York. CNN’s Laura Dolan, Maggie Schneider and Jason Carroll also contributed to this report.

View the original article here

(CNN) — Joe Palese took his first yoga class in the 1990s, right as the practice started gaining in popularity in the United States.

“They didn’t even have any yoga mats,” he said, recalling the New York sports club that offered the class.

It wasn’t until Palese started taking classes at yoga studios that he realized a lot of the previous sessions were “watered down” versions of yoga.

The loose interpretation wasn’t bothersome; yoga by definition is a diverse practice with more than a dozen different styles. But as Palese remembers, some of the poses the inexperienced teachers were demonstrating were simply not right.

“The instructors were cool people, and they’d play excellent music, but students didn’t know they were being taught poorly,” said Palese, who became a yoga instructor himself 14 years ago.

And, according to author and New York Times science writer William J. Broad, some of the common yoga poses can cause serious injuries like nerve hurt, torn cartilage, and strokes, among others.

An article adapted from Broad’s upcoming book on yoga featured in the New York Times Sunday Magazine earlier this month with the title “How Yoga Can Wreck Your Body,” sparked a lively debate within the yoga community about how to keep practitioners safe.

In the article, Broad noted that yoga is a “free-for-all” with “no hierarchy of officials or organization to ensure purity and adhere to agreed-upon sets of facts and poses, rules and procedures, outcomes and benefits.”

Broad is right — there isn’t a government oversight committee dedicated to yoga practice. And that’s because many practitioners prefer it that way.

“Yoga comes from India. Things are not uniform by tradition,” said Gyandev McCord, who has taught yoga for 25 years.

In an effort to provide a common ground for the diverse practice of yoga, a group of seasoned yoga practitioners — “yogis” — came together in 1999 to form the Yoga Alliance, a nonprofit organization whose sole purpose is to make minimum standards for yoga teacher training.

Fearing government or insurance companies might step in and start calling the shots, the alliance set forth to self-regulate, said McCord, who is the co-founder and vice chairman of the organization.

It is for yogis, by yogis. After all, McCord said, those “who don’t know the landscape of yoga aren’t qualified” to regulate the standards for teaching.

Anyone trained by schools registered with the Yoga Alliance completes 200 or 500 hours of training, based on the following five principles: yoga techniques, including poses, breathing and meditation; general teaching methodology; anatomy and physiology; yoga philosophy and ethics; and training, practicum, and supervised teaching, in which senior instructors observe trainees to identify and right any issues.

McCord said the five principles allow for “a lot of wiggle room,” and aim to protect and promote the teacher’s individuality.

Once trained, the instructors are certified by their school and their names are listed on a registry that informs the public of teachers in their area who have completed the minimum standards for yoga instruction. Yoga Alliance-trained teachers may also use the trademarked “RYT” — registered yoga teacher — behind their name, indicating they’ve completed the required hours.

Not all members of the yoga community are on board with this approach, but.

Leslie Kaminoff, co-founder of the Breathing Project, a nonprofit that provides continuing education to yoga practitioners, disagrees with yoga regulation of any kind. He believes in a free market approach to regulations for yoga teacher training.

“Yoga is about freedom,” he said, “The market place is the ultimate quality control.”

Yoga is about freedom. The marketplace is the ultimate quality control.
Leslie Kaminoff, co-founder, The Breathing Project

Yoga instruction, he said, is about a relationship between a teacher and a student. If a teacher is trained to teach yoga on the Internet or by a DVD at home and the student is fine with it, it’s really nobody’s business.

McCord said he has no problem with that approach. “It’s not illegal to teach without training as a teacher,” he said.

But Palese is more wary. He believes that learning how to align properly is something that needs an “expert eye,” one that can’t be achieved by watching a DVD.

“Anyone can tell you what to do, it’s explaining how to do it,” he said. And that is what separates effective teachers from the rest, according to Palese.

“It’s alignment with awareness,” he said.

Palese trains teachers at a studio where he teaches in suburban Atlanta. His 200-hour training class meets one weekend a month for 10 months, a long stretch of time imperative to the teaching process.

“You need time for information to settle,” Palese said.

Since yoga instruction is far more complex than just leading students to do poses, Palese said he reserves the right to extend the training past 10 months if needed. He wants to give his new teachers whatever time they need to assimilate the information so that they can feel confident teaching others.

“It’s the integrity and the awareness that the teacher brings to class that is most vital,” Palese said.

Palese said successful teachers are committed to the safety for their students and will provide suggestions for modification, as well as props like belts, blankets and blocks to make those modifications. A willingness to adapt the practice for different audiences and environments helps too.

“I’ve taught yoga in the oddest of places,” he said. Excellent teachers “can teach yoga in an auditorium, a prison, a hospital.”

They “can transform the whole thing just by who they are.”

View the original article here

(CNN) — Helen, 50, was college educated, married, worked in middle management at a financial services company and had excellent health insurance.

She was diagnosed with early stage breast cancer in 1990. She saw doctors with some of the best reputations. After an appropriate surgery, she was given high dose chemotherapy with a bone marrow transplant.

The treatment nearly killed her several times and she was hospitalized for nearly a year.

My book, “How We Do Harm,” co-authored with Paul Goldberg describes the challenges that some ordinary Americans experience while trying to get quality health care.

In the book we show real examples, like Helen, of the irrationality of how medicine is practiced and consumed in the United States. We discuss those who do not get excellent care and those who suffer because of excessive and illogical health care. Both occur among the insured and the uninsured.

Dr. Otis Webb Brawley is the chief medical officer of the American Cancer Society.

The book also assesses the threat our health care system poses to the economy and offers suggestions on what needs to change. It was motivated by the ongoing debate about health care reform.

For more than two decades, I have studied disparities in health outcomes and the inconsistencies in how medicine is practiced. I have come to believe that much of the rhetoric for and against health care reform lacks the understanding that the issue involves human beings.

Lost in that debate is the fact that a large number of our fellow Americans are suffering and dying avoidable deaths, because of lack of quality health care.

I believe we should be both ashamed and furious about our health care system. America spends more per person on health care than any other country. Per-person costs are nearly 1.5 times higher than the second most expensive country. We simply do not get the outcomes we pay for.

Among the nations of the world, we rank 50th in life expectancy and American life expectancy is decreasing. America is 47th in infant mortality, just better than Croatia.

The therapy Helen received was expensive and commonly given to women with breast cancer in the early 1990s. During this time, numerous women sued insurance companies who did not want to pay for the therapy and nearly a dozen states passed laws saying insurance companies had to pay for it.

There was one really excellent reason why the health insurers did not want to pay for high dose chemotherapy and bone marrow transplant for breast cancer: No study had ever been done to prove it beneficial.

Even without evidence, some patients and their doctors had faith that it worked. The procedure was common because some doctors taught that the transplant was beneficial to patients. Truth be told, it was very beneficial to the doctors and hospitals offering it.

By 1999, well after Helen had recovered, three well-designed clinical trials were completed. They showed that bone marrow transplant and high dose chemotherapy, a treatment now common for nearly a decade and a half, was not better than the standard therapy and there were indications it was more harmful.

The current course is not sustainable. Medical costs will rise until the economy collapses.
Dr. Otis Brawley

This shows that even the well-insured often get substandard care. Medical gluttony, the inappropriate use and overuse of medical treatment, is not just adding unnecessary cost to health care. It can really be harmful to the individual.

Doctors deserve some blame for this mess. Appreciation of the science of medicine and the scientific method is often lacking.

It is incredible the number of health care professionals who seemingly reject the scientific method. They prescribe treatments they believe to be appropriate as opposed to therapies that are known to be appropriate based on objective scientific evidence. This form of ignorance is a root cause of much of the overuse of medical therapy.

Too often, doctors fail to distinguish what is scientifically known from what is unknown, from what is believed. This is beyond mere disagreement about interpretation of the science. There is often selective reading of the science, especially by those trained in a specialty wanting to advocate for it.

Health care providers and the public often overlook the emotional and financial conflicts of interest of health care professionals.

While I blame the medical profession, blame also rests on hospitals, drug and device manufacturers, insurance companies, lawyers, politicians, government and even with patients.

I see hospitals advocating unproven screening and treatment while advertising for business. There are patient advocacy groups often funded by hospitals and medical manufacturers, who also advocate the unproven and instill in patients that they need what may be unnecessary and can be harmful.

American medicine is huge business. It is about 18% of the U.S. economy and growing. The average cost of a health insurance policy for a family of four is $19,400 per year. The expense of our inefficient health care system is a major drain on the economy. It is a major reason why employers are hesitant to hire and a reason why many employers cannot provide health insurance to employees.

We have what could be an extraordinary health care system and some patients do get extraordinary care. But patient tales show how our system is inefficient.

The book “How We Do Harm” releases January 31.

Our system is focused on treating people after they get sick with relative inattention to promoting health and preventing disease. Such public health efforts have not received adequate support.

The triad of obesity, lack of physical activity and high caloric intake (terrible diet) is making a tsunami of chronic disease. If the system persists as is, medical costs will grow dramatically over the next several decades as the number of patients with diabetes, cardiovascular diseases, cancer and orthopedic injury dramatically grows.

The current course is not sustainable. Medical costs will rise until the economy collapses.

I know that the book will upset and rage some people, especially those who profit from medicine. I hope the book allows some reasonable people (both lay and medical professionals) to better know what we are doing to our country.

We all need to realize that some Americans are harmed by lack of treatment and others by overtreatment. The cold hard reality is America does not need to reform health care, we need to transform health care.

The American health care system is fundamentally flawed and encourages inappropriate behavior and a subtle form of corruption. There truly is a combination of greed, ignorance and apathy within health care that is a cancer on this country. There is nothing incorrect with medicine as a business, and nothing incorrect with making an honest profit.

But, in some cases, greed needs to be replaced with public interest, a concern for the national excellent.

We need a greater commitment to the practice of evidence-based medicine. Some politicians choose to scare people with words like “rationing medicine” and “death panels.” Truth be told, we all need to talk about defining the “rational use of medicine.” A widespread demand for rational use of health care can lower costs and increase the number of people getting high quality care and save lives.

Americans need to better know the science of medicine and the scientific method, be right to science and support evidence-based medicine. We need to embrace an interest in public health and adopt preventive strategies.

The most vital question we can question is, “How can we provide all Americans with excellent high quality care to include preventive care?”

Opinions expressed are those of the author and do not necessarily represent those of CNN, The American Cancer Society, or Emory University.

View the original article here

The study looked at over 2,000 UK civil servants

“Working eleven hours a day can lead to severe depression,” Metro has today reported. According to the newspaper, staff who place in 11 or more hours a day at the office are twice as likely to suffer a severe bout of depression than those working just eight.

This news is based on a study that examined the working habits of over 2,000 UK civil servants and how their working related to major depressive symptoms in the six years that followed. After accounting for other factors linked to depression, the researchers found that working 11 or more hours a week was associated with a 2.5 times increase the odds of experiencing a major depressive episode compared with their colleagues working the Civil Service’s standard seven to eight hours a day.

This research has found a link between working overtime and the risk of subsequent major depressive episodes. But, the relationship is complicated and this research cannot concretely tell whether or not overtime really causes depression. Verifying this potential link would probably require controlled studies looking at whether or not cutting back work hours proves effective at reducing people’s risk of depression.

Also, this study found strong links between financial status, seniority and a reduced risk of major depression, making the influence of working hours harder to judge. Overall, it is likely that several factors work together to cause depression and the role working hours play in this is unclear.

The study was carried out by researchers from Queen Mary’s of the University of London, University College of London, the University of Bristol, McGill University in Canada, and the Finnish Institute of Occupational Health. The research was funded by the Medical Research Council, the British Heart Foundation, the Stroke Association and the US National Institutes of Health.

The study was published in the peer-reviewed scientific journal PLoS ONE.

The study was covered appropriately in the media, although headlines that suggested working overtime certainly causes depression are not supported by the research. The Daily Mail, The Daily Telegraph and The Independent all reported, in both their headlines and main tale, that the research found an association or link between overtime and the risk of depression.

This was a prospective cohort study that examined the association between people’s number of hours worked a day and their risk of going on to experience a major depressive episode (MDE).

This research analysed data from a large well-known cohort study, called the Whitehall II study, which examined how work related to health in over 10,000 London based civil servants. This particular analysis on depression included full-time workers who were free from any psychiatric disorders and still employed at the time of the study’s follow-up period.

Prospective cohort studies have the advantage of ensuring that the exposure of interest (in this case, working hours) precedes the outcome of interest (experiencing MDE). This is one of several criteria needed to show causality. It is not, but, sufficient on its own to prove that the number of hours worked leads to or causes depression.

At the start of the study (known as the baseline) participants completed a survey that included questions on:

job characteristics: including hours worked, degree of work stress, strain and social support socio-demographic factors: including sex, age, marital states and socio-economic status health-related behaviours: including alcohol consumption and smoking status physical health: including the presence of a longstanding illness or coronary heart disease

Participants were divided into four groups based on their working hours:

those who worked seven to eight hours a day (the standard civil service day) those who worked nine hours a day (classed as one hour of overtime a day) those who worked 10 hours a day (classed as two hours of overtime a day) those who worked 11 to 12 hours a day (classed as three to four hours of overtime a day)

Approximately six years later they completed another interview that included a clinical health examination. At this interview, researchers determined whether or not participants had experienced a MDE during the previous year.

Researchers then analysed the data to assess how the odds of experiencing MDE in the two groups working the fewest and most hours. This analysis adjusted for possible confounding factors, including the baseline job characteristics, socio-demographic, health-related and physical health factors outlined above, in several separate analyses.

In all, 2,123 participants were included in the study. Those included in this study tended to be younger than those participating in the general Whitehall II cohort, and more likely to be male, married and from higher occupational grades. Participants were also more likely to experience low work strain than the Whitehall II cohort, and less likely to have a chronic disease or be a smoker.

Of the included participants:

52% worked a standard seven to eight-hour day 21% worked a nine-hour day 16% worked a 10-hour day 11% worked an 11- to 12-hour day

Employees with the longest working days were more likely to be male, married, from higher occupational grades, have more active jobs and high social support at work compared to those who worked the standard seven to eight-hour day. In addition, they tended to drink more alcohol than the recommended daily limits and to be ex-smokers.

Of the 2,123 participants, 66 experienced a major depressive episode; this is equivalent to a 3.1% rate of depression. When assessing MDE risk, and adjusting for multiple potential confounding variables, the researchers found that employees who worked 11 to 12 hours a day had 2.52 time the odds of experiencing MDE compared to those who worked the standard seven to eight hours a day (Odds ratio [OR] 2.5, 95% confidence interval [CI] 1.12 to 5.65).

Other factors that were associated with increased odds of MDE were:

sex: females were just over twice as likely to experience MDE compared to males (OR 2.08, 95% CI 1.25 to 3.46) presence of a chronic physical disease (OR 2.30, 95% CI 1.41 to 3.78) moderate alcohol consumption, compared to teetotallers (OR 2.68, 95% CI 1.05 to 6.82) lower occupational grades (grades 4-5), compared to the highest grade, which is grade 1 (grade 5: OR 4.53, 95% CI 1.47 to 13.90; grade 4: OR 3.19, 95% CI 1.02 to 9.99)

Factors that were not associated with increased odds of MDE included:

marital status smoking status high alcohol use job strain social support at work

The researchers conclude that, ‘working overtime predicted the onset of a major depressive episode in a middle-aged cohort of British civil servants’. They add that this association held after adjusting for ‘a range of socio-demographic, lifestyle and work-related factors at baseline.’

This was a large cohort study that examined the association between the number of hours worked a day and the risk of subsequent major depressive disorder. It found that, after an adjusted analysis, those who worked three to four hours of overtime a day at the start of the study had a 2.5 fold increase in the chance they would go on to experience MDE.

The size and prospective nature of this cohort study mean that we can be quite confident in the results. There are, but, several limitations to the study that should be considered before insisting that our work hours are cut back. These include:

The participants in this study were a specific subgroup of an already specific cohort group. Generalising these results to non-urban, non-civil service workers may not be appropriate. The researchers call for further research to determine whether this association can be found in non-civil service contexts. This study only included workers with no history of psychological disorders. It is unclear how work hours influence mental health in people with a history of psychological disorders. Working hours were assessed only at the start of the study. It is possible that these conditions changed in the six years between the first and second interviews. This could have distorted the results. There were a limited number of MDE cases in the cohort. This makes it impossible to determine the role specific factors play in this association. Despite news reports to the contrary, the researchers say that this study cannot offer plausible explanations of why long working hours are associated with the development of depression. The say that ‘intervention studies are needed to examine whether interventions designed to reduce working hours would alter depression risk in working populations’. The rate of depression found in this study being 3.1%. While those with longer workdays were found to have 2.5 times greater odds of MDE, this is still a low rate overall. Additionally, this rate is lower than the general population rate of depression, which the authors estimate to be approximately 5%. This study confirmed a strong link between occupational grade and depression, with higher socioeconomic status associated with a reduced risk of major depression. This had to be carefully adjusted for in the analysis. Major depressive episodes involve a specific range of depressive symptoms, but people can also experience milder forms of depression that will not meet the criteria for this diagnosis.

Overall, this research indicates that a very specific subset of civil servants were at increased risk of experiencing a major depressive episode. It is likely that several factors work together as ‘causes’ of depression and so the researchers were right to avoid saying that they had found a cause.

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CNN.com – Health

Researchers claim that autism was detected in infants

“Signs of autism can be detected in six-month-ancient babies by measuring brain activity,” the Daily Mail has reported. While the Mail was right, the research has not yet proved to be a perfect diagnostic test.

This and other related headlines are based on a study that assessed the brain activity of 104 infants aged 6-10 months as they watched an image of an adult’s face whose eyes went from looking away from them, to directly at the infant, then away again. Researchers called these eye movements ‘dynamic eye-stare shifts’. They then assessed whether differences in brain activity in response to the eye-stare shifts were related to autism developing in the same children at three years.

Children who did not develop autism showed large spikes in brain activity when they saw the ‘stare shifts’. Much smaller spikes in brain activity were detected in the infants who went on to develop autism, raising the prospect that autism could be identified earlier than is currently clinically possible.

But, this test was not 100% accurate. Some babies showing low brain activity spikes did not go on to develop autism and vice versa. As the groups overlap, there cannot be a simple and useful cut-off value to predict autism.

Developing and refining this type of test into something that can be routinely used to detect autism in infants is likely to take some time and will certainly require more research on larger groups of infants with autism and unselected healthy infants too.

The study was carried out by a collaboration of researchers from English, Canadian and Australian universities and was funded by the UK Medical Research Council. It was published in the peer-reviewed science journal Current Biology.

The media reporting of this tale was generally well balanced. Many tales included quotes from the study authors that a definitive test would take time to develop and that the current assessment is not 100% effective.

This study was a prospective longitudinal study investigating whether the brain function of infants aged 6-10 months differed in response to viewing faces that changed the direction of their stare. The researchers then looked at whether these brain function differences could predict a diagnosis of autism at three years of age.

The authors report that there are currently no reliable methods of predicting autism in infants younger than about two years of age. Current diagnosis relies on the detection of behavioural symptoms of autism that typically develop in a child’s second or third year. Behaviours associated with autism include impairments in social skills and communication, and the presence of rigid, stereotyped and repetitive behaviours.

The authors say previous research shows typical infants’ sensitivity to eye stare in the first year of life predicts a range of social and communication skills that emerge later. Detecting autism at an early age could potentially lead to ways of better supporting the child during early development, improving their wellbeing and life chances.

The researcher recruited a group of 104 infants – 54 at risk of autism because of a family history of the condition and 50 controls, with no family history of autism. The infants were followed from 6-10 months through to three years of age.

The researchers measured the 6 to 10-month-ancient infants’ response to changing images of faces. They did this by recording event-related potentials (ERPs), which are a measure of brain electrical activity in response to a thought or perception. In this study, ERPs were used to measure the perception of a face changing between looking directly at the infant and then away from them. The researchers called this ‘dynamic stare-shift stimuli’.

The researchers also tracked the eyes of the infants to examine the amount of time they spent looking at the eye region of the faces they were shown. This allowed the researchers to assess whether different responses to the eye stare were due to differences in attention to the eye region or whether brain functions were more vital.

The researchers reported that dynamic stare-shift stimuli are more likely to engage wider social brain mechanisms than static images as they mimic a real social interaction more closely. But, researchers compared their dynamic stare results with that from ‘static stare’, (images of a face whose eyes were looking at, or away from, the infant) to see how they compared to each other.

The brain activity levels of infants at risk of autism were contrasted with the controls. The researchers then looked at how the brain function differences at 6-10 months related to a later diagnosis of autism. An independent team assessed whether the infants had autism at two and three years ancient.

The brain activity of the control group showed large spikes of activity in response to eye stare changes when the face image held a stare toward, compared to away from, the infant. The brain activity spikes of infants at risk of autism were significantly smaller in response to the same stimulus.

The differences in brain activity of the control group verse at risk group were not restricted to the dynamic stare results. Similar results were seen when static images were used.

The researchers found that those who did not go on to develop autism at three years of age showed large spikes in brain activity relating to the changes in eye stare at 6-10 months. Crucially, those that did develop autism showed significantly smaller spikes in brain activity. The static image test did not predict a later diagnosis of autism.

Eye tracking information was available for 93 of the 104 infants. There was no difference in the time at-risk infants and control infants spent looking at the faces’ eyes relative to other areas of the face.

The authors conclude that ‘brain function measures can successfully differentiate groups of infants at risk [of autism] from low-risk control within the ?rst year of life’. They go on to say that ‘response to dynamic stare shifts during the first year of life distinguished the group of infants who later develop autism’.

This small study highlights a potential method of identifying children who are likely to develop autism at 6-11 months, much earlier than the current method of diagnosis. The authors suggest this could potentially pave the way for more selective targeting of early intervention efforts and procedures to these children, increasing their life chances.

While this study provides intriguing results it is vital to bear in mind some practical limitations. For instance, while the average differences between the brain function of the infants that went on to develop autism compared to those that did not were significantly different, individual values from the two groups did overlap. This means that there is probably no useful clinical cut-off value to predict autism. Similarly, the researchers do not describe how the controls were selected or report how excellent the test was at diagnosing autism, known as the ‘test sensitivity’. Reporting these key results would have helped us better assess the accuracy and importance of these findings.

Much larger studies would be needed to establish a suitable brain activity level to use to identify as child as ‘likely to develop autism’. These studies could better assess the natural variation in brain activity from a large group of infants. Similarly, it is unlikely a future autism assessment would rely on a single test, such as dynamic eye stare, but would instead use a combination of tests.

The uncertainty about what cut-off values to use, and the drawbacks of using a single predictive test, makes the development of an early identification test more complex. It may be some time before a predictive test is routinely available to identify infants likely to develop autism earlier than is currently possible.

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Talk to your GP or surgeon if you are worried about PIP implants

Women concerned about French-made PIP breast implants can find all the latest NHS information about the issue on this page.

Worries about the implants have emerged since news of a major investigation into them in France was widely covered in the media in December 2011.

It is thought that around 40,000 women in the UK have the implants, with about 95% of them having been provided privately for purely cosmetic reasons.

The French implants caused global concern after it was revealed they contained industrial silicone rather than medical-grade fillers and that they may be more prone to rupture and leakage. Initially reports also linked the implants to a rare form of cancer known as ALCL. This cancer link has been now been firmly discounted by medical experts here and in Europe.

The implants involved are called Poly Implant Prosthèse (PIP) and were made, starting in 2001, by a French company of the same name.

The marketing, distribution and use of the PIP implants was suspended in March 2010 after regulators found that the manufacturers were using silicone intended for industrial use, and not medical-grade silicone fillers. It is reported that the company used a cheap type of silicone gel intended for making mattresses.

Most breast implants need to be removed or replaced after 10-15 years.

An expert committee was set up recently to examine the specific risks associated with PIP implants. It concluded that as yet there was not enough evidence to recommend their early removal.

But, the committee said the NHS would remove and replace the implants without charge if patients that the NHS had operated on remained concerned. The government expects the private sector to follow suit.

NHS medical director Professor Sir Bruce Keogh, who led the expert review group, said: “On the basis of the information we have, we do not reckon it is necessary to recommend the routine removal of these implants.

“But we know that some women will be very concerned so we support the government’s position that the NHS will support removal of PIP implants if the patient has concerns and, with her doctor, she decides that it is right to do so.”

More than 300,000 PIP implants have been sold globally in 65 countries over the past 12 years. Europe was a major market but more than half of the implants went to South America.

In the UK, 40,000 women are thought to have the implants. Private clinics fitted 95% of these for women seeking cosmetic breast augmentation. The remaining 5% were fitted on the NHS.

The NHS provides breast implants only where there is clinical need. For example, women who have a mastectomy (breast removal surgery) as part of treatment for breast cancer are often offered implants as part of reconstructive surgery.

Women who received a PIP implant from the NHS will be contacted to let them know they have one.

If you are worried, you should book a consultation with your specialist or GP. They will offer clinical advice on the best way forward. This could include an examination using scans, such as MRI, to look for any signs that the implant may have ruptured.

The NHS will support removal and replacement of PIP implants if a woman and her doctor choose that it is the right thing to do. The secretary of state has made clear that patients’ concerns must be place first.

The following private clinics have said they will replace PIP implants free if clinically necessary: Holly House, Highgate Hospitals, Make Yourself Incredible (MYA Cosmetic Surgery), Ramsay Health Care, Spire Healthcare, BMI Healthcare, Nuffield Healthcare and HCA International. The Transform medical group has said it will remove the implants free for its patients who had them fitted since 2001 and The Hospital Group said it would offer free removal to patients it operated on from 2001-2009; both will charge for replacements.

If a private clinic that provided PIP implants no longer exists or refuses to help, then, so long as you are entitled to NHS services, the NHS will cover the cost of the removal of PIP implants if your doctor agrees there is a clinical need. This would not include the replacement of private cosmetic implants.

During December 2011 UK media had originally focused on a possible link between PIP implants and a rare type of cancer called anaplastic large cell lymphoma (ALCL). This arose after a French woman with PIP implants developed the cancer and died. But, after reviewing the evidence, the expert group conducting the review agreed that there was no link with cancer.

More recently, attention has focused on the rupture rate of the implants, and whether the unapproved gel filling of PIP implants could have a toxic effect.

The review has specifically looked at these issues, and found:

From the “patchy” data available, the review panel was not able to tell whether the rupture rate for PIPs is higher than for other types of implant. From the implants that have been tested there appears to be no risk of perilous toxic effects in the event of a rupture. The review group said it could not be certain that the manufacturer did not change the content of the implants, so could not completely rule out the possibility that some might contain toxic substances. 

A rupture is a split that occurs in the implant’s casing. A rupture can be caused if:

the implant’s shell gets weaker over time the implant is hurt during the operation there is a flaw in the implant the breast is injured

If you have any of the following signs or symptoms, you should discuss them with your GP, who will refer you to a specialist:

lumpiness of the breast lumpiness or swelling in the area around the breast change in shape of the breast deflation of the breast redness tenderness of the breast swelling of the breast pain or sensitivity

Yes, the Department of Health has set up two reviews to look at how the PiP situation occurred and the issue of regulating the cosmetic surgery industry as a whole.

The first review will be led by Lord Howe and will address a number of specific issues, including:

what information about PiP implants was available from routine systems for reporting adverse events what external concerns about PiP implants were brought to the attention of regulators, and when how these concerns and any related information were handled what information was shared between MHRA and counterpart agencies abroad  what action was taken to safeguard and advise patients whether action was sufficiently prompt and appropriate

The report is due to be submitted to the Health Secretary by the end of March 2012.

The second review will look at whether the cosmetic surgery industry needs to be regulated, and if so how this should happen. It be led by Professor Sir Bruce Keogh, the NHS Medical Director, who said:

“I am working with experts from the plastic surgery field to look at what we can do to make sure people who choose to have cosmetic surgery and other cosmetic procedures are safe.

“I will be looking at all aspects of regulation – at the regulation of implants and fillers, at whether the people who carry out cosmetic interventions have the right skills, at whether the clinics look after the care and welfare of their patients.”

The extensive report is due to be submitted by March 2013.

In France, Jean-Claude Mas, head of Poly Implant Prosthese, has been charged with causing involuntary injury. He was released on bail after being arrested on January 26.

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