Most Americans may not be looking at Chicago's ban on handguns through a health and medical prism. But the American Public Health Assn. is.

With the challenge to the law now before the U.S. Supreme Court, the association has weighed in, coming down strongly on the side of ...

(Do you have to ask?)

Here's an excerpt from the organization's statement about its recent friend-of-the-court brief:

"APHA has long supported comprehensive measures to reduce and prevent premature injury and death from handguns, including limiting access to handguns, creating a national database to facilitate research on handgun-related fatalities and developing community- and school-based programs targeting the prevention of handgun injuries, suicides, homicides and assaults."

And here's a previous L.A. Times story on the case that explains how this 2nd Amendment and public-health issue can affect a community near you. It begins:

"The Supreme Court's decision Wednesday to hear a 2nd Amendment challenge to Chicago's handgun ban could open the door to similar lawsuits in cities and states across the nation."

For a related editorial, also from the L.A. Times, click here. And, if you're so inclined, some explainers of "friend-of-the-court brief" and docket information on McDonald vs. Chicago.

-- Tami Dennis

Photo: The Los Angeles Police Department displays some of the handguns turned in last year in exchange for supermarket gift cards.

Credit: Brian Vander Brug / Los Angeles Times

Here's a really stupid idea: ear candles, fabric tubes soaked in beeswax or paraffin, inserted in the ear, and set on fire. The candles are being marketed as treatments for a variety of conditions, including ear wax buildup, sinus infections, hearing loss, headaches, colds, flu and sore throats. Astonishingly, some companies are even claiming the devices are appropriate for use on chldren.

Some ear candles are even offered as products that purify blood, strengthen the brain or even cure cancer.

The Food and Drug Administration and its Canadian counterpart, Health Canada, are saying, Wait a minute!  The agencies are issuing import alerts about the products, warning the manufacturers, issuing injunctions and seizing shipments.

First of all, the FDA believes there is "no valid scientific evidence for any medical benefit" from their use, said Dr. Eric Mann of the agency's Division of Ophthalmic, Neurological, and Ear, Nose and Throat Devices.

Secondly, they are very hazardous. Among injuries that have been reported burns to the face, ear canal, eardrum and middle ear; injury to the ear from dripping wax; ears plugged by candle wax; bleeding; and puncture of the eardrum. Fires have also been reported. Moreover, people who use them often delay seeking treatment for their original illnesses. The two agencies believe that injuries caused by the devices are underreported.

The devices could be particularly hazardous for children, officials said, because they are likely to squirm, which increases the likelihood of injuries from fire, dripping wax and punctures.

-- Thomas H. Maugh II

An ear candle being burned, an indication of their size, and part of a box label showing a candle in use on an adult in a sitting position. Credit: FDA

The terms concussion and mild traumatic brain injury pretty much mean the same thing. But which term a parent hears from the doctor makes a big difference in the seriousness with which the injury is treated, a new study finds.

Injured kids whose parents hear the word "concussion" spend less time in the hospital, go back to school and other activities earlier, and run greater risks to their cognitive health than do kids whose parents are told their child has sustained a "brain injury."

The study, published today in the journal Pediatrics, tracked 268 kids admitted to a hospital in Ontario, Canada after a head trauma. Doctors there gave a third of them a diagnosis of "concussion," while the rest got some variant of traumatic brain injury -- sometimes shortened to TBI. In the days following their injuries, those with a diagnosis of concussion were 1 1/2 times as likely to be discharged from the hospital as those with a "mild TBI" diagnosis -- even though there was significant overlap between the two groups in terms of the severity of their head injuries. There was a 2 1/2 times greater likelihood that the kids diagnosed with "concussion" would go back to school early as well.

"Our study suggests that if a child is given a diagnosis of a concussion, the family is less likely to consider it an actual injury to the brain," said the study's lead author, Carol DeMatteo, an occupational therapist and childhood disability researcher at McMaster University, in a news release accompanying the article. "These children may be sent back to school or allowed to return to activity sooner, and maybe sooner than they should. This puts them at greater risk for a second injury, poor school performance, and wondering what is wrong with them."

Physicians' alertness to a concussion's potentially lingering effects -- including hearing loss, dizziness, memory problems, headaches, depression -- is growing, the result of the U.S. military's burgeoning experience with personnel in Iraq and Afghanistan who are showing signs of brain trauma. As described in a recent article in The Times, the challenge of caring for troops with brain injuries sustained in battle has brought new money and attention to the study of brain injury and its aftermath.

The world of professional sports, which has had years of experience with concussions, has much to contribute to the effort. But organizations such as the National Football League have shown reluctance to acknowledge what is increasingly clear to medical researchers: that patients with repeated concussions, especially those who go back to strenuous activity before their brain has healed, run a high risk of negative effects long after sustaining a bump to the head.

-- Melissa Healy 

Injecting plasma into the Achilles tendon is not helpful in reducing pain or increasing mobility, according to a study published today in the Journal of the American Medical Assn.

Injection of platelet-rich plasma for chronic Achilles tendinopathy is increasingly popular. The injury is an overuse disorder that often affects athletes but also inactive middle-aged people. The platelet-rich plasma injection is thought to release growth factors that assist in tissue repair. The study, by researchers in the Netherlands, was a randomized, blinded clinical trial that assigned 54 patients with the disorder to either exercise with the plasma injection or exercise with a saline injection (the placebo treatment). The participants were given questionnaires to gauge pain and activity levels at weeks six, 12 and 24 of treatment. But participants in both groups improved significantly after 24 weeks. There was no additional benefit from receiving the plasma injection.

The treatment should not be recommended, said the authors of the study.

"The reason why both treatment groups show clinical progress in our study, but also in other studies on platelet-rich plasma, is likely due to the fact that exercises were performed," they wrote.

- Shari Roan

Photo credit: Ricardo DeAratanha  /  Los Angeles Times

Parents eyeballing public playground hazards may first look to the infamous monkey bars, perilously high above the earth.

They have reason to fear. “You see monkey bar injuries and monkey bar injuries and monkey bar injuries,” pediatric orthopedic surgeon Andrew W. Howard said of his line of work.

What they may not look at is the ground itself. In a study published today in PLoS Medicine, Howard and his fellow researchers documented the playground injuries at 37 elementary schools in Toronto. They found that children who fell from a height onto a wood chip surface were nearly five times more likely to sustain an arm fracture than children who fell onto granite sand.

Both surfaces meet school safety standards, Howard said, but what gives granite sand the edge is each surface’s sliding friction. When a person falls, the surgeon pointed out, the hand usually hits the ground before the body does, which could force the arm to bend beyond the load it can carry. But granite sand allows the hand to slide a little bit, saving the arm from a nasty break.

The study took advantage of a playground safety overhaul that the Toronto School District Board was going through at the time – so no other surfaces, such as those made from recycled rubber, were examined.

But of the 5,900 fracture-related hospitalizations that happen as a result of a playground fall in the United States, the study observes, 3,900 to 4,700 could be prevented if they had occurred on granite sand surfaces.

Time to level all the playgrounds in America?

“I don’t think we need to call the gravel trucks tomorrow,” Howard said in an interview. “But in a gradual enlightened way we should be using sand under playground whenever possible as the falling surface.”

If you feel like seeing if your child’s playground is up to standard, here’s a safety checklist courtesy of the Consumer Product Safety Commission.

-- Amina Khan

It goes by many names: "black out," "space monkey," "fainting game." Participants – teenagers, mostly, it seems – play it by cutting off oxygen to the brain. They use belts, neckties, other types of binding – or a friend's helping hands – to induce a "natural high." 

Yet, say authors of a paper published in the January issue of Pediatrics, of the 163 Ohio physicians who responded to a survey, only 111 (68.1%) said they had heard of the game – mostly through popular media sources. Of those who knew about it, only 7.6% reported having a patient who they suspected was
 playing the choking game.

That’s a seriously low level of awareness, says Nancy E. Bass, one of the authors of the paper. "The choking game may not be as prevalent as other [risky behaviors] like drugs, but the issue is it can result in death," Bass said, adding, "It’s becoming more prevalent ... if you have an asphyxia related death, it's difficult to know whether it's unintentional."

The Centers for Disease Control and Prevention surveyed media reports and counted 82 deaths between 1995 and 2007 that were likely the result of the choking game. It's an indication that physicians simply may not be trained to recognize the warning signs, from strange bruises to bloodshot eyes.

Bass said she hopes the paper will encourage physicians – particularly those in pediatric practice and emergency room training – to include the choking game in their general-advice discussions with teenagers, which includes such topics as smoking, balanced diets, school performance and alcohol use.

For a personal account, here's Sandy Banks' 2005 story of a family dealing with the aftermath of a likely choking game-related death. Here's a CDC fact sheet on the choking game and its warning signs.

-- Amina Khan

Cheerleading can be a demanding sport, with its increasingly complex lifts, throws and gymnastics tricks. But it is not without risks, as this L.A. Times story on cheerleading injuries reports. The Journal of Athletic Training recently published studies on cheerleading that examined those risks and resulting injuries.

One study looked at the epidemiology of fall-related injuries in U.S. cheerleading and found that over the course of a year, 79 fall-related injuries were reported among 412 cheer teams taking part in offical practices, competitions or events. The vast majority of those injuries -- 85% -- took place during practice, and 51% of the injuries occured among high schoolers. In 89% of the incidents, cheerleaders were trying to do a stunt or pyramid.

The most common injuries were strains and sprains, and most falls were from 1 foot to 11 feet above the ground. Only 6% of injuries were concussions or closed head injuries. No deaths were reported in the study, but risk of serious injury increased with fall height, with less-cushioned floors, or both.

Another study examined the surfaces on which cheerleaders practice and how they relate to potential head injuries. Researchers observed indoor gyms as well as outdoor locations. According to the study, higher grass and wetter soil provided more absorption, and the more absorption, the greater the critical height for grass surfaces. Critical height of a surface material is, according to the authors, "the approximation of the fall height below which a life-threatening head impact injury would not be expected to occur."

Only spring floors and landing mats 4 inches thick resting on foam floors had critical heights greater than 10.5 feet, which would have enough impact absorption for level 2 stunts, which include some tumbling moves and tosses.

Another epidemiological study examined overall injuries via type of cheerleading team and events over a year among 412 cheerleading teams. Over that year, 567 injuries were reported, with 83% happening during practice, 52% occuring during a stunt attempt, and 24% taking place while a cheerleader was basing or spotting one or more people. College-level cheerleaders were more apt to have a concussion, and all-star cheerleaders were more likely to suffer a fracture or dislocation than cheerleaders on other teams.

Researchers on all three studies were from the Research Institute at Nationwide Children's Hospital and the Ohio State University College of Medicine, both in Columbus.

-- Jeannine Stein

Photo credit: Carmen Jaspersen / EPA

Bicycle riding is increasingly popular, thanks to more environmentally conscious people, a desire to be fit, and wanting to save money on gas. The downside, however, is that cyclists may be suffering more injuries.

That's the conclusion of researchers who looked at accident rates and severity from 1996 to 2006. Among 329 bicycle accident cases admitted to the Rocky Mountain Regional Trauma Center at Denver Health Medical Center, the length of stay increased substantially over those years. In addition, an increase was seen in chest injuries (up 15%), and abdominal injuries tripled over the last five years of the study. About one-third of 118 patients had head injuries.

In a Reuters story, lead researcher Dr. Jeffry Kashuk from the University of Colorado, Denver, said, "Although the public is very enthusiastic about bicycle use as a means of transportation, we think that infrastructure has lagged behind in the U.S. The government is pushing bike days, and rebates for bike use. Communities are putting in bicycle kiosks." He added that only limited data exist showing there are bikeways to support an increase in bike use.

The findings from the study were presented at the American College of Surgeons' 95th annual Clinical Congress being held this week in Chicago.

-- Jeannine Stein

Photo credit: Irfan Khan / Los Angeles Times

Pity the awareness raiser who has little to use but a calendar date that rolls around once every year. But try they must. And so in the last five days alone, we've been told:

- "This week, the NFL and the American Urological Association Foundation (AUAF) launched on a campaign for men called “Know Your Stats” in honor of September’s Prostate Cancer Awareness Month." 

- "We hope to coordinate an interview for Suicide Prevention Month (September)."

- "Sept 20-26 is National Rehabilitation Week, and (Julia) Keller’s new young adult novel -- based on her personal and professional experiences, and written from the point of view of a young teenage girl -- tells the story of a family coping with the return of a severely injured soldier father."

- "Following is some detailed information which you may find interesting for a story in support of World Vegetarian Day and Vegetarian Awareness Month throughout the month of October." 

- "With National Breast Cancer Month coming up in October, we thought information on a new breast cancer radiation technique with proven life-saving benefits would be of interest." (This was just one of the breast-cancer-awareness suggestions received this week.)

- "The celebration, Batter Up! A Home Run for Recovery Month was part of National Alcohol and Drug Addiction Recovery Month celebrated annually in September."

- "The webinar, which comes on the final day of National ADHD Public Awareness Month, will report on published research on the effects of the Transcendental Meditation technique for improving academic achievement and executive brain function while reducing learning disorders, anxiety, depression, metabolic syndrome, diabetes, and heart disease."

We give in. Coming soon: A special Health section issue with no news or trends or context, just efforts to make you aware. (Kind of like this blog post.) 

Until that carefully unspecific time, allow me to recommend the list of 2009 National Health Observances. It's one-stop shopping for those who need to know which diseases, conditions and issues warrant awareness today, this week, this month.

After I make it through my inbox, I'll really have to figure out whose idea that was.

-- Tami Dennis

Photo: Even the NFL is on the game.

Credit: Matthew Emmons / US Presswire

When it comes to ACL injuries, size may matter.

The anterior cruciate ligament is the bane of many exercisers and athletes. Found behind the kneecap, it's responsible for keeping the knee stable and is the most often injured knee ligament. Athletes are especially vulnerable because the ACL can tear or fray during moves such as jumping, pivoting or stopping quickly. Women are especially at risk.

A recent study found that injured ACLs are also often smaller ACLs. Researchers from Ohio State University performed magnetic resonance imaging scans on the non-injured knee of 27 people who had suffered a previous non-contact ACL injury. They compared them to a 27-person matched control group to see if there was a difference in the size of the ligament between the two groups.

Among the previously injured study participants, 16 had smaller ACLs than the control group. The average ACL volume of the injured participants was 1,921 cubic millimeters, while the non-injured group had an average ACL volume of 2,151 cubic millimeters.

A larger ACL could equal a stronger ACL, according to Ajit Chaudhari, assistant professor of orthopedics at Ohio State and lead author of the study, the results of which appeared recently in the American Journal of Sports Medicine. "If you have a weaker ACL, it's more likely to tear if all other factors are equal," he said in a news release. "If being larger in size means the ACL has more fibers, then that would make it stronger. If the individual building blocks are of similar strength, then it comes down to how much total tissue there is."

The researchers caution that this doesn't mean that having a smaller ACL will always trigger an injury. And they don't recommend having knees screened via MRIs to see if they may be at risk. But they do think there may be potential in finding out how the ACL can be strengthened, made larger, or both, while a child is still developing.

-- Jeannine Stein

Photo: Antti Aimo Koivisto / Associated Press