Cheerleading accounts for more than half of ‘catastrophic’ injuries to female athletes

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Lenny BernsteinMisFits columnistCheerleading accounts for more than half of ‘catastrophic’ injuries to female athletes

Bigstock - More than 70 perecent of direct catastrophic injuries in women’s college sports between 1982 and 2009 happened in cheerleading.

By Lenny Bernstein, E-mail the writer

Quick, name the sport that causes the largest number of catastrophic injuries among girls and young women. No, it’s not soccer, lacrosse, gymnastics, basketball or even flag football.

It’s cheerleading, also known as “competitive cheer” or “acrobatics and tumbling,” as the University of Maryland called the activity before killing it as a varsity sport during budget cuts last year.

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Actually, my initial question was a bit of a trick, because some states don’t recognize cheerleading as a sport, and neither does the NCAA, a major problem unto itself, some believe. Without the oversight of government and big-time sports, some of the people running cheer squads and competitions aren’t held to the same safety, training and coaching standards applied to other sports, even rough ones such as football — though cheerleading does make considerable effort to police itself.

With or without government regulation, cheerleading poses by far the greatest risk of catastrophic injury to young female participants of any sport. According to a 2012 report and policy statement by the American Academy of Pediatrics, cheerleading “accounted for 65 percent of all direct catastrophic injuries to girl athletes at the high school level and 70.8 percent at the college level” between 1982 and 2009.

The overall number is small — 110 closed-head injuries, skull fractures and cervical spine injuries that resulted in “permanent brain injury, paralysis or death” over that period — and the number of participants in cheerleading is large, an estimated 3.6 million nationwide, the academy found. (A number of other girls suffered cardiac problems and heat stroke.) But the disproportionate number of severe injuries in this one activity is striking.

So as our sons head back to the gridiron this fall, and we head back to the stands to watch them, it might be worth taking a glance at what’s happening with the daughters who have traditionally urged us both on. We’ve begun a national debate about the concussion risks in youth football — President Obama said last season he was unsure he’d let his son play if he had one — but there doesn’t appear to be a corresponding discussion about our daughters. At least not one I’ve heard about.

In part this is because the non-catastrophic injury rate in cheerleading is quite low. But it’s also because some people don’t know that cheer has left the sidelines in the past two decades to become a sport of tumbling, flying through the air and building tall human pyramids.

“I don’t know that the general impression has evolved as fast as the sport has,” said Cynthia LaBella, lead author of the Academy of Pediatrics paper and an associate professor of pediatrics at Northwestern University’s Feinberg School of Medicine. “It takes time for these things to register.

“These girls — and boys — are at risk for injury,” she added. “This should be considered a sport, and these folks should be treated as athletes, not as entertainers.” Boys make up about 4 percent of cheerleaders.

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Targeting An Untapped Female Sexual Dysfunction Drug Market

(Editors' Note: This article discusses micro-cap stocks. Please be aware of the risks associated with these stocks.)

The pharmaceutical industry remains extremely interested in female sexual dysfunction, primarily due to the enormous revenues that could be generated from this untapped US market.

From our last note on FSD (link):

Female Sexual Dysfunction (FSD) is often overshadowed by the more prominent erectile dysfunction market. While companies like Pfizer (NYSE: PFE) recruit the likes of Bob Dole and other prominent celebrities to help push Viagra, the attention on FSD has been lacking to say the least. This obscures an analysis of a National Health and Social Life Survey performed six years before initial FDA approval of Viagra which estimated that 43% of women suffer from symptoms of FSD. This and other studies imply that there is indeed a vast and significant unmet need for FSD treatments that needs to be addressed to improve the wellbeing of millions of women. In addition to this, there is a huge and untapped therapeutic market that offers a multi-billion opportunity (mimicking the size and scope of the Viagra/Cialis market) for drug developers and their investors.

Although generic competition has arrived, we can say that the Viagra/Cialis market is at least $2 B in size. $3-4 B may be more appropriate, heavily depending on the pricing of any mainstream FSD therapies that could be approved in the United States.

For now testosterone treatment for FDS can be available off-label, but progress towards an FDA-approved FSD testosterone product has been weak:

Recall the transdermal testosterone patch Intrinsa, was not successful at obtaining FDA approval after successful clinical development. Intrinsa did not have efficacy problems, although the FDA was very against its approval due to abuse potential and other safety concerns.

Also recall the testosterone product called Libigel, which was being developed by BioSante Pharmaceuticals (its ticker was "BPAX") until the product failed to achieve statistically significant improvements in Phase III trials. The results of this trial were quite upsetting and controversial for most investors, largely part due to the surprisingly positive performance in the placebo arm. Note that this, plus multiple investor lawsuits, eventually led to Biosante's merger with generic manufacturer ANI Pharmaceuticals (ANIP).

Testosterone products are approved in other countries for FSD, although it seems that non-hormonal therapy may be the first to officially hit the United States. Current non-hormonal drug developers targeting FSD are also "under-the-radar" for the time being, making them interesting considerations for special situation and value investors.

Osphena - Shionogi

Osphena (Ospemifene) is a selective estrogen receptor modulator (SERM) drug developed by Japanese pharmaceutical company Shionogi & Co (SGIOF) that was approved earlier this year, although it is specifically used for women who experience pain during sex (dyspareunia). This is an effect of vaginal dryness, which is frequent in menopausal women who have lower estrogen levels. Osphena helps to rebuild the actual thickness of the vaginal wall without direct use of estrogen, which is novel.

Although it is efficacious, Osphena has some major drawbacks with regards to its safety and use. Uncommon and possible side effects of the drug include stroke, blood clots, and endometrial cancer (cancer of the uterus). Common side effects include hot flashes, discharge, muscle spams, and increased sweating. While this therapy may replace standard estrogen therapy, it is dangerous. In addition, it is far from an equivalent to "female Viagra".

Flibanserin - Sprout

The original attempt at female Viagra was with Flibanserin by Boehringer Ingelheim. The drug failed from an efficacy standpoint, and is now controlled by a very new private entity called Sprout Pharmaceuticals (an offshoot of Slate Pharmaceuticals). The company has already submitted an NDA, and expects a response before the end of 2013.

Bremelanotide - Palatin

Palatin (PTN) recently completed end-of-phase II meetings with the FDA, and has reached preliminary agreement on key aspects of the Phase III pivotal trial. This includes the FSD patient population, the primary and key secondary efficacy endpoints, design, dosing, and safety monitoring. Since the FDA has been hard on efficacy data presented for the FSD indication, it's encouraging to hear their close involvement with the design of bremelanotide's pivotal trial.

Phase II data and discussion from a previous note (link):

The Company is testing bremelanotide, a peptide melanocortin receptor agonist, in patients with FSD. Bremalanotide works via activation of melanocortin receptors in the central nervous system, and is intended for on-demand use approximately an hour prior to anticipated sexual activity. In the first quarter of 2013, Palatin released top-line data for their Phase IIb, at-home clinical trial in patients with female sexual dysfunction.

The trial hit on the primary and key secondary endpoints, a major success, demonstrating a good safety profile for bremalanotide and statistically significant increases in the number of Satisfying Sexual Events (SSE) versus placebo. The most common adverse reactions with incidence over 5% among bremalanotide users at any dose included nausea, flushing, and headache. The FDA approved a Phase III trial design with bremalanotide, and the Company could start the trial as early as Q4 2013.

The drug's safety and tolerability has been adequate up to this point, and should be adequate for approval after the trial. This is because the cardiovascular risk concerns will be studied closely through patient blood pressure monitoring.

The FDA is expected to finalize the design of the trial before the end of the year. Patient screening is also expected to start before the end of the year. Official estimates for interim data aren't available, although the conclusion of the enrollment process should give us a lot more to work with. Investor attention is expected to increase significantly as we approach potential data releases for the pivotal trials, since they will be major catalysts for shares of PTN.

Femprox - Apricus

Femprox is a Prostaglandin Ei (alprostadil) cream being developed by Apricus Biosciences (APRI) that passed its first Phase III trial and has yet to start its pivotal Phase III trial. The first Phase III trial consisted of over 400 patients in China, and application of the cream was not performed in the clinic. Primary and secondary efficacy endpoints were achieved with statistical significance. A foreign trial may mean these data may be deemed less reliable when the FDA performs its review. This may put more weight on the pivotal trial, which investors are eagerly anticipating.

Notes on Biotech Risk:

Investors should realize that unprofitable biotechnology companies in the development stage experience particularly high volatility, are speculative, and do hold significant risk for loss of wealth. Investors believe that the company's valuation will increase more over time than the rate at which the company will burn cash, which is why the high risks are taken.

Disclosure: I have no positions in any stocks mentioned, and no plans to initiate any positions within the next 72 hours. I wrote this article myself, and it expresses my own opinions. I am not receiving compensation for it. I have no business relationship with any company whose stock is mentioned in this article. (More...)

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Ovarian reserve affects early menopause after cancer treatment and young, female cancer survivors' quality of life long after treatment

Main Category: Ovarian Cancer
Also Included In: Fertility
Article Date: 14 Aug 2013 - 1:00 PDT Current ratings for:
Ovarian reserve affects early menopause after cancer treatment and young, female cancer survivors' quality of life long after treatment

A new study led by a University of Colorado Cancer Center member recently published in the journal reveals that in young, female cancer survivors, quality of life is significantly impaired long after treatment. The study compared 59 cancer survivors to 66 healthy controls and found that, as expected, cancer survivors showed higher stress and anxiety than the general population. Of note, survivors reported particular stress around the issues of sexual problems, physical pain and fatigue. The study also measured hormone levels reflecting woman's number of eggs, and showed that among young, female cancer survivors, those with reassuring fertility status were likely to report higher quality of life once treatment ends.

"What it came down to was a woman's opinion of her own fertility status after cancer treatment," says Laxmi Kondapalli, MD, MSCE, director of the CU Cancer Center Oncofertility Program.

See, there was one intervening step between normal ovarian reserve and quality of life: the regularity of a woman's menstrual cycle after undergoing chemotherapy and/or radiation treatment for cancer. All women lose a certain number of eggs during these treatments, but those with higher baseline reserve are more likely to withstand the treatment with their overall fertility unaffected. Women with lower ovarian reserve at baseline are more likely to have impaired fertility after treatment.

"But it wasn't the lab and ultrasound markers of ovarian reserve alone that affected quality of life," Kondapalli says. "It was a woman's opinion of her fertility status based on her menstrual cycle that had the most impact on quality of life."

Following cancer treatment, many women think that if they maintain regular menstrual cycles, their fertility is preserved, and that if their menstrual cycles become irregular, then they are likely infertile due to treatment.

"This isn't necessarily the case, because we are finding that menstrual cyclicity is a poor predictor of fertility status in these young, female cancer survivors," Kondapalli says. "Survivors may be falsely reassured if they resume normal periods, or they may be unnecessarily stressed if they don't get regular periods after cancer treatment."

According to Kondapalli, women with high ovarian reserve are less likely to experience symptoms of early menopause after cancer treatment. And it is these symptoms that go on to influence young patients' quality of life.

"I think what our study demonstrates is that clearly there are many components that impact a survivor's quality of life after cancer treatment. Although objective markers of ovarian reserve play an important role, a woman's perception of her own fertility status was more influential in her overall quality of life," Kondapalli says.

Understanding the different factors involved with quality of life in this population may help identify ways to manage late effects of treatment and improve comprehensive survivorship care.

Article adapted by Medical News Today from original press release. Click 'references' tab above for source.
Visit our ovarian cancer section for the latest news on this subject.

Supported by NIH T32 HD007440 and NIH 5K12HD001271-12

Quality of life in female cancer survivors: is it related to ovarian reserve?

Laxmi A. Kondapalli, Katherine E. Dillon, Mary D. Sammel… in Quality of Life Research (2013)

University of Colorado Denver

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Female deaths much less likely to be reported to coroner in England and Wales, UK

Main Category: Women's Health / Gynecology
Article Date: 30 Jul 2013 - 0:00 PDT Current ratings for:
Female deaths much less likely to be reported to coroner in England and Wales, UK

Doctors in England and Wales are much less likely to report a woman's death to a coroner than they are a man's, reveals research published online in the Journal of Clinical Pathology.

Furthermore, women's deaths are less likely to proceed to an inquest, and those that do are less likely to result in a verdict of "unnatural" death than men's, with some coroners particularly likely to favour a verdict according to the sex of the deceased, the research shows.

The authors analysed figures from the Ministry of Justice on the numbers and proportions of deaths reported to all 98 coroners, in each of the 114 jurisdictions in England and Wales, between 2001 and 2010.

These figures were then set in the context of official national statistics on the number of deaths registered in England and Wales over the same period.

Doctors are not obliged to report a death to a coroner, and the legal duty to hold an inquest resides with the coroner, usually prompted by a death in unnatural or violent circumstances, or when the death is sudden, of unknown cause, or happens in prison.

The analysis of the figures showed that coroner reporting rates varied widely across England and Wales.

Plymouth and South West Devon topped the league table, with 87% of registered deaths reported to the coroner between 2001 and 2010, while Stamford in Lincolnshire came bottom, with only 12% of deaths reported to the coroner.

There were no obvious explanations to account for such wide differences, which remained stable throughout the decade, suggesting that local demographics or medico-legal practice had a part to play, say the authors.

Similarly, coroners varied widely in their use of verdicts, which again remained consistent over time, the analysis showed. This is likely to reflect the personal decision making style of the coroner rather than any local patterns in deaths, say the authors.

But when they looked at reporting rates according to the sex of the dead person, a striking gender divide emerged.

While jurisdictions with high reporting rates for men also had high reporting rates for women, and vice versa, male deaths were 26% more likely to be reported to the coroner than female deaths.

Higher reporting rates for men were common across all jurisdictions in England and Wales, and in some areas male deaths were 48% more likely to be reported.

Not only were female deaths less likely to be reported, but they were also less likely to proceed to an inquest.

Female deaths were half as likely to proceed to an inquest as men's, with just 8% going to this stage compared with 16% of all male deaths. And even when female deaths did get an inquest, they were more likely to be given a verdict of natural causes than men (28% compared with 22%).

Among verdicts of unnatural deaths, men were overrepresented in occupational diseases and suicide while women were overrepresented in narrative verdicts - where cause of death is given in the form of a narrative rather than as a single "short form" definition - and accidents, implying that sex of the deceased influences the verdict, say the authors.

Furthermore, some coroners were "gendered," in their approach to inquest verdicts, and more likely to favour a particular verdict when dealing with a death, according to the gender of the deceased.

The government is currently reforming the death certification process in a bid to strengthen arrangements and improve the quality and accuracy of causes of death, but there are some concerns that the move will prompt a fall in deaths reported to the coroner from the present national average of 46% to around 35%, say the authors.

Article adapted by Medical News Today from original press release. Click 'references' tab above for source.
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