Body Image,Anthropometric Measures,and Eating-Disorder Prevalence in Auxiliary Unit Members

Context:

Medical professionals have recognized eating disorders and related problems in competitive athletes. Auxiliary members (color guard, dance, majorettes) experience the same appearance-related pressures observed in sports commonly associated with eating disorders.

Objective:

To estimate eating-disorder prevalence based on associated eating-disorder characteristics and behaviors in female auxiliary members and to compare perceived and ideal body images and anthropometric measurements between at-risk and not–at-risk participants for eating-disorder characteristics and behaviors.

Design:

Cross-sectional design.

Setting:

Three universities in the southeastern United States.

Patients or Other Participants:

Participants (n  =  101, mean age  =  19.2 ± 1.2 years) represented 3 auxiliary units, including color guard (n  =  35), dance line (n  =  47), and majorettes (n  =  19).

Main Outcome Measure(s):

Participants self-reported menstrual history, height, and weight. Anthropometric measurements included height, weight, body fat percentage, and waist and hip circumferences. We screened for eating-disorder risk behavior with the Eating Attitudes Test (EAT)-26 and for body dissatisfaction with the Figural Stimuli Survey.

Results:

Based on the EAT-26, we estimated eating-disorder prevalence among members to measure 29.7% (95% confidence interval  =  20.8%, 38.6%). The EAT-26 results revealed that 21% of participants used purgatives and 14% vomited to control weight or shape. The at-risk group had higher scores on the EAT-26 total (P ≤ .01) and on the dieting (P ≤ .01), oral control (P  =  .02), and bulimia (P  =  .01) subscales. Hip circumference (P  =  .01), self-reported weight (P  =  .03), measured weight (P  =  .04), difference between measured and preferred weights (P  =  .02), and calculated target weight (P  =  .02) were different between the at-risk and not–at-risk groups.

Conclusions:

Collegiate auxiliary unit members may have an unacceptable prevalence of eating disorders. Our results validate concerns that auxiliary members may exhibit an unacceptable eating-disorder risk, highlighting the need to examine and address unhealthy weight-management behaviors independent of eating-disorder status.     

Lacrosse Equipment and Cervical Spinal Cord Space During Immobilization: Preliminary Analysis

Context:

Removal of the lacrosse helmet to achieve airway access has been discouraged based only on research in which cervical alignment was examined. No researchers have examined the effect of lacrosse equipment on the cervical space available for the spinal cord (SAC).

Objective:

To determine the effect of lacrosse equipment on the cervical SAC and cervical-thoracic angle (CTA) in the immobilized athlete.

Design:

Observational study.

Setting:

Outpatient imaging center.

Patients or Other Participants:

Ten volunteer lacrosse athletes (age  =  20.7 ± 1.87 years, height  =  180.3 ± 8.3 cm, mass  =  91 ± 12.8 kg) with no history of cervical spine injury or disease and no contraindications to magnetic resonance imaging (MRI).

Intervention(s):

The lacrosse players were positioned supine on a spine board for all test conditions. An MRI scan was completed for each condition.

Main Outcome Measure(s):

The independent variables were condition (no equipment, shoulder pads only [SP], and full gear that included helmet and shoulder pads [FG]), and cervical spine level (C3–C7). The dependent variables were the SAC and CTA. The MRI scans were evaluated midsagittally. The average of 3 measures was used as the criterion variable. The SAC data were analyzed using a 3 × 5 analysis of variance (ANOVA) with repeated measures. The CTA data were analyzed with a 1-way repeated-measures ANOVA.

Results:

We found no equipment × level interaction effect (F_3.7,72  =  1.34, P  =  .279) or equipment main effect (F_2,18  =  1.20, P  =  .325) for the SAC (no equipment  =  5.04 ± 1.44 mm, SP  =  4.69 ± 1.36 mm, FG  =  4.62 ± 1.38 mm). The CTA was greater (ie, more extension; critical P  =  .0167) during the SP (32.64° ± 3.9°) condition than during the no-equipment (25.34° ± 2.3°; t₉  =  7.67, P  =  .001) or FG (26.81° ± 5.1°; t₉  =  4.80, P  =  .001) condition.

Conclusions:

Immobilizing healthy lacrosse athletes with shoulder pads and no helmets affected cervical spine alignment but did not affect SAC. Further research is needed to determine and identify appropriate care of the lacrosse athlete with a spine injury.     

Identifying Relationships Among Lower Extremity Alignment Characteristics

Context:

The relationship between lower extremity alignment and lower extremity injury risk remains poorly understood, perhaps because most authors have examined only individual or a select group of alignment variables. Examining the relationships among alignment variables may allow us to more accurately describe lower extremity posture and clarify the relationship between lower extremity alignment and injury risk in future studies.

Objective:

To measure lower extremity alignment variables and examine whether relationships could be identified among these variables.

Design:

Observational study.

Setting:

Laboratory.

Patients or Other Participants:

Two hundred eighteen (102 males: age  =  23.1 ± 3.2 years, height  =  177.3 ± 8.4 cm, mass  =  80.8 ± 13.0 kg; 116 females: age  =  21.8 ± 2.7 years, height  =  163.5 ± 7.4 cm, mass  =  63.4 ± 12.4 kg) healthy, college-aged participants.

Main Outcome Measure(s):

We measured pelvic angle, femoral anteversion, quadriceps angle, tibiofemoral angle, genu recurvatum, and tibial torsion to the nearest degree and navicular drop to the nearest millimeter on the right and left lower extremities. Separate principal components factor analyses were performed for each sex and side (left, right).

Results:

A distinct lower extremity factor was identified, with relationships observed among increased pelvic angle, increased quadriceps angle, and increased tibiofemoral angle. A second distinct lower extremity factor was identified, with relationships observed among increased supine genu recurvatum, decreased tibial torsion, and increased navicular drop. Femoral anteversion loaded as an independent third factor. These distinct lower extremity alignment factors were consistent across side and sex.

Conclusions:

Factor analysis identified 3 distinct lower extremity alignment factors that describe the potential interactions among lower extremity alignment variables. Future authors should examine how these collective alignment variables, both independently and in combination, influence dynamic knee function and risk for lower extremity injuries.     

Elbow Joint Position Sense After Neuromuscular Training With Handheld Vibration

Context:

Clinicians use neuromuscular control exercises to enhance joint position sense (JPS); however, because standardizing such exercises is difficult, validations of their use are limited.

Objective:

To evaluate the acute effects of a neuromuscular training exercise with a handheld vibrating dumbbell on elbow JPS acuity.

Design:

Crossover study.

Setting:

University athletic training research laboratory.

Patients or Other Participants:

Thirty-one healthy, college-aged volunteers (16 men, 15 women, age  =  23 ± 3 years, height  =  173 ± 8 cm, mass  =  76 ± 14 kg).

Intervention(s):

We measured and trained elbow JPS using an electromagnetic tracking device that provided auditory and visual biofeedback. For JPS testing, participants held a dumbbell and actively identified the target elbow flexion angle (90°) using the software-generated biofeedback, followed by 3 repositioning trials without feedback. Each neuromuscular training protocol included 3 exercises during which participants held a 2.55-kg dumbbell vibrating at 15, 5, or 0 Hz and used software-generated biofeedback to locate and maintain the target elbow flexion angle for 15 seconds.

Main Outcome Measure(s):

We calculated absolute (accuracy) and variable (variability) errors using the differences between target and reproduced angles.

Results:

Training protocols using 15-Hz vibration enhanced accuracy and decreased variability of elbow JPS (P ≤ .005), whereas 5-Hz vibration did not affect accuracy (F_1,61  =  2.625, P  =  .100) but did decrease variability (F_1,61  =  7.250, P  =  .009). The control condition and 0-Hz training protocol had no effect on accuracy or variability (P ≥ .200).

Conclusions:

Our results suggest these neuromuscular control exercises, which included low-magnitude, low-frequency handheld vibration, may enhance elbow JPS. Future researchers should examine vibration of various durations and frequencies, should include injured participants and functional multijoint and multiplanar measures, and should examine long-term effects of training protocols on JPS and injury.     

Internal Rotation and Scapular Position Differences: A Comparison of Collegiate and High School Baseball Players

Context:

Conditions such as labral and rotator cuff injuries have been linked with decreases in glenohumeral internal-rotation and increases in external-rotation motion. Also, decreased glenohumeral internal rotation is strongly associated with scapular dyskinesis.

Objective:

To compare healthy collegiate and high school baseball players'' glenohumeral joint range of motion and scapular position.

Design:

Cross-sectional study.

Setting:

Institutional research laboratory.

Patients or Other Participants:

Thirty-one male National Collegiate Athletic Association Division I collegiate (age  =  20.23 ± 1.17 years, height  =  186.24 ± 5.73 cm, mass  =  92.01 ± 7.68 kg) and 21 male high school baseball players (age  =  16.57 ± 0.76 years, height  =  180.58 ± 6.01 cm, mass  =  79.09 ± 11.51 kg).

Main Outcome Measure(s):

Glenohumeral internal and external rotation and scapular upward rotation were measured with a digital inclinometer. Scapular protraction was measured with a vernier caliper. All variables except scapular upward rotation were calculated as the difference between the dominant and nondominant sides.

Results:

Collegiate baseball players had more glenohumeral internal-rotation deficit (4.80°, P  =  .028) and total motion deficit (5.73°, P  =  .009) and less glenohumeral external-rotation gain (3.00°, P  =  .028) than high school players. Collegiate baseball players had less scapular upward rotation than high school players at the 90° (4.12°, P  =  .015, versus 3.00°, P  =  .025) and 120° (4.00°, P  =  .007, versus 3.40°, P  =  .005) positions. The scapular protraction difference was greater in collegiate baseball players than in high school players in the hands-on-hips and 90° positions (0.77 cm, P  =  .021, and 1.4 cm, P  =  .001).

Conclusions:

When comparing high school with collegiate baseball players, these data suggest that glenohumeral internal-rotation deficit and scapular position change as the level of competition increases.     

Alterations in Knee Kinematics and Dynamic Stability Associated With Chronic Ankle Instability

Context:

Chronic ankle instability (CAI) has been previously and separately associated with deficits in dynamic stability and proximal joint neuromuscular alterations, but how the 2 factors relate is unclear.

Objective:

To examine the contributions of lower extremity kinematics during an assessment of dynamic stability in participants with CAI.

Design:

Repeated-measures case-control design.

Setting:

Research laboratory.

Patients or Other Participants:

Thirty-eight volunteers were categorized into groups of those with unilateral CAI (10 men, 9 women; age  =  20.3 ± 2.9 years, height  =  1.77 ± 0.1 m, mass  =  76.19 ± 13.19 kg) and those without (10 men, 9 women; age  =  23.1 ± 3.9 years, height  =  1.72 ± 0.1 m, mass  =  72.67 ± 16.0 kg).

Intervention(s):

Participants performed 10 jump landings on each limb with a rest period between test limbs.

Main Outcome Measure(s):

Ankle plantar flexion, knee flexion, and hip flexion were captured with an electromagnetic tracking device at the point of ground impact. Ground reaction force data were used to calculate time to stabilization in the anteroposterior and mediolateral planes.

Results:

For the anteroposterior plane, we found a group-by-side interaction (P  =  .003), with the injured side of the CAI group demonstrating reduced dynamic stability. For knee flexion, a group main effect (P  =  .008) showed that the CAI group landed with less knee flexion than the control group.

Conclusions:

Diminished dynamic stability and decreased knee flexion angle at initial contact were apparent in the CAI group and may play a role in contributing to CAI. This altered kinematic pattern may influence preventive and therapeutic interventions for those with CAI.     

Knee Joint Kinematics and Kinetics During a Lateral False-Step Maneuver

Context:

Cutting maneuvers have been implicated as a mechanism of noncontact anterior cruciate ligament (ACL) injuries in collegiate female basketball players.

Objective:

To investigate knee kinematics and kinetics during running when the width of a single step, relative to the path of travel, was manipulated, a lateral false-step maneuver.

Design:

Crossover design.

Setting:

University biomechanics laboratory.

Patients or Other Participants:

Thirteen female collegiate basketball athletes (age  =  19.7 ± 1.1 years, height  =  172.3 ± 8.3 cm, mass  =  71.8 ± 8.7 kg).

Intervention(s):

Three conditions: normal straight-ahead running, lateral false step of width 20% of body height, and lateral false step of width 35% of body height.

Main Outcome Measure(s):

Peak angles and internal moments for knee flexion, extension, abduction, adduction, internal rotation, and external rotation.

Results:

Differences were noted among conditions in peak knee angles (flexion [P < .01], extension [P  =  .02], abduction [P < .01], and internal rotation [P < .01]) and peak internal knee moments (abduction [P < .01], adduction [P < .01], and internal rotation [P  =  .03]). The lateral false step of width 35% of body height was associated with larger peak flexion, abduction, and internal rotation angles and larger peak abduction, adduction, and internal rotation moments than normal running. Peak flexion and internal rotation angles were also larger for the lateral false step of width 20% of body height than for normal running, whereas peak extension angle was smaller. Peak internal rotation angle increased progressively with increasing step width.

Conclusions:

Performing a lateral false-step maneuver resulted in changes in knee kinematics and kinetics compared with normal running. The differences observed for lateral false steps were consistent with proposed mechanisms of ACL loading, suggesting that lateral false steps represent a hitherto neglected mechanism of noncontact ACL injury.     

Muscle Activation and Movement Patterns During Prone Hip Extension Exercise in Women

Context:

The consistency of muscle activation order during prone hip extension has been debated.

Objective:

To investigate whether women use a consistent and distinguishable muscle activation order when extending the hip while prone and to explore the effects of verbal cues on muscle activation and movement.

Design:

Single-session, repeated-measures design.

Setting:

University laboratory.

Patients or Other Participants:

Eleven healthy women (age  =  27.7 ± 6.2 years [range, 22–37 years]).

Intervention(s):

We tested the participants under 3 conditions: no cues, cues to contract the gluteal muscles, and cues to contract the hamstrings muscles.

Main Outcome Measure(s):

We measured hip and knee angle and electromyographic data from the gluteus maximus, medial hamstrings, and lateral hamstrings while participants performed prone hip extension from 30° of hip flexion to neutral.

Results:

When not given cues, participants used the consistent and distinguishable muscle activation order of medial hamstrings, followed by lateral hamstrings, then gluteus maximus (195.5 ± 74.9, 100.2 ± 70.3, and 11.5 ± 81.9 milliseconds preceding start of movement, respectively). Compared with the no-cues condition, the gluteal-cues condition resulted in nearly simultaneous onset of medial hamstrings, lateral hamstrings, and gluteus maximus (131.3 ± 84.0, 38.8 ± 96.9, and 45.1 ± 93.4 milliseconds, respectively) (P > .059); decreased activation of the medial hamstrings (P < .03) and lateral hamstrings (P < .024) around the initiation of movement; increased activation of gluteus maximus throughout the movement (P < .001); and decreased knee flexion (P  =  .002). Compared with the no-cues condition, the hamstrings-cues condition resulted in decreased activation of the medial hamstrings just after the initiation of movement (P  =  .028) and throughout the movement (P  =  .034) and resulted in decreased knee flexion (P  =  .003).

Conclusions:

Our results support the contention that the muscle activation order during prone hip extension is consistent in healthy women and demonstrates that muscle timing and activation amplitude and movement can be modified with verbal cues. This information is important for clinicians using prone hip extension as either an evaluation tool or a rehabilitation exercise.     

Glenohumeral Rotation and Scapular Position Adaptations After a Single High School Female Sports Season

Context:

Anterior instability and impingement are common in overhead athletes and have been associated with decreases in internal rotation (IR) and increases in external rotation (ER) motion. However, the chronology and the effect of different female sports on these conditions have yet to be determined.

Objective:

To measure glenohumeral IR and ER rotation, total range of motion, and scapular position in female overhead athletes over a single competitive season.

Design:

Multiple group pretest-posttest study.

Setting:

High school.

Patients or Other Participants:

Thirty-six female overhead athletes (age  =  15.29 ± 1.18 years, height  =  164.16 ± 7.14 cm, mass  =  58.24 ± 9.54 kg) with no history of shoulder or elbow surgery participating in high school swimming, volleyball, or tennis.

Intervention(s):

Participants were measured for all dependent variables at preseason and postseason.

Main Outcome Measure(s):

Participants were measured for glenohumeral IR and ER with the scapula stabilized. Total glenohumeral range of motion was calculated as the sum of IR and ER. Scapular upward rotation was measured at 0°, 60°, 90°, and 120° of glenohumeral abduction in the scapular plane, and scapular protraction was measured at 0°, 45° (hands on hips), and 90° of glenohumeral abduction.

Results:

Internal rotation decreased from preseason to postseason (P  =  .012). Swimmers had less IR than both volleyball and tennis players (P  =  .001). External rotation also decreased in the swimmers (P  =  .001). Overall, preseason to postseason total motion decreased for athletes participating in swimming (P  =  .001) and tennis (P  =  .019). For all participants, preseason to postseason scapular protraction at 45° glenohumeral abduction decreased (P  =  .007).

Conclusions:

Female overhead athletes demonstrated decreases in IR after only one competitive season. Clinically, our results indicate that overhead athletes should be monitored for motion changes throughout their competitive seasons.     

Lack of reliable clinical predictors to identify obstructive sleep apnea in patients with hypertrophic cardiomyopathy

OBJECTIVE:

Obstructive sleep apnea is common among patients with hypertrophic cardiomyopathy and may contribute to poor cardiovascular outcomes. However, obstructive sleep apnea is largely unrecognized in this population. We sought to identify the clinical predictors of obstructive sleep apnea among patients with hypertrophic cardiomyopathy.

METHODS:

Consecutive patients with hypertrophic cardiomyopathy were recruited from a tertiary University Hospital and were evaluated using validated sleep questionnaires (Berlin and Epworth) and overnight portable monitoring. Ninety patients (males, 51%; age, 46±15 years; body mass index, 26.6±4.9 kg/m²) were included, and obstructive sleep apnea (respiratory disturbance index ≥15 events/h) was present in 37 patients (41%).

RESULTS:

Compared with the patients without obstructive sleep apnea, patients with obstructive sleep apnea were older and had higher body mass index, larger waist circumference, larger neck circumference, and higher prevalence of atrial fibrillation. Excessive daytime sleepiness (Epworth scale) was low and similar in the patients with and without obstructive sleep apnea, respectively. The only predictors of obstructive sleep apnea (using a logistic regression analysis) were age ≥45 years (odds ratio [OR], 4.46; 95% confidence interval [CI 95%], 1.47–13.54; p = 0.008) and the presence of atrial fibrillation [OR, 5.37; CI 95%, 1.43–20.12; p = 0.013].

CONCLUSION:

Consistent clinical predictors of obstructive sleep apnea are lacking for patients with hypertrophic cardiomyopathy, which suggests that objective sleep evaluations should be considered in this population, particularly among elderly patients with atrial fibrillation.     

Ankle Bracing and the Neuromuscular Factors Influencing Joint Stiffness

Context:

Health care professionals commonly prescribe external stabilization to decrease the incidence and severity of ankle sprains. The mechanism for this decrease is not clearly understood. Examining the effects of ankle bracing on biomechanical stability and influencing factors may provide important information regarding the neuromuscular effects of bracing.

Objective:

To study the effects of 2 different ankle braces on the neuromuscular factors influencing ankle stiffness.

Design:

Mixed-model repeated-measures design.

Setting:

Research laboratory.

Patients or Other Participants:

Twenty-eight physically active participants composing 2 groups: 14 with unilateral functional ankle instability (age  =  26.19 ± 6.46 years, height  =  166.07 ± 12.90 cm, mass  =  69.90 ± 13.46 kg) and 14 with bilaterally stable ankles (age  =  23.76 ± 5.82 years, height  =  174.00 ± 11.67 cm, mass  =  68.60 ± 13.12 kg).

Intervention(s):

Participants were fitted with surface electromyography electrodes over the peroneus longus, peroneus brevis, tibialis anterior, and soleus muscles. Each participant received transient motion oscillations to his or her ankle on a custom-built medial-lateral swaying cradle in each of 3 conditions: no ankle brace (NB), lace-up brace (LU), and semirigid brace (SR).

Main Outcome Measure(s):

Ankle stiffness as measured by the cradle and preactivation levels (percentage of maximal voluntary isometric contraction) of the 4 test muscles.

Results:

Stiffness levels increased across brace conditions (NB  =  24.79 ± 6.59 Nm/rad, LU  =  28.29 ± 7.05 Nm/rad, SR  =  33.22 ± 8.78 Nm/rad; F_2,52  =  66.185, P < .001). No differences were found between groups for rotational stiffness (stable  =  27.36 ± 6.17 Nm/rad, unstable  =  30.18 ± 8.21 Nm/rad; F_1,26  =  1.084, P  =  .307). Preactivation levels did not change for any of the tested muscles with the application of an ankle brace (F_2,52  =  1.326, P  =  .275).

Conclusions:

The increase in ankle rotational stiffness with the addition of an ankle brace and the lack of any demonstrable neuromuscular changes suggested ankle braces passively contributed to the stability of the system.     

Aural Canal,Esophageal, and Rectal Temperatures During Exertional Heat Stress and the Subsequent Recovery Period

Context:

The measurement of body temperature is crucial for the initial diagnosis of exertional heat injury and for monitoring purposes during a subsequent treatment strategy. However, little information is available about how different measurements of body temperature respond during and after exertional heat stress.

Objective:

To present the temporal responses of aural canal (T_ac), esophageal (T_es), and rectal (T_re) temperatures during 2 different scenarios (S1, S2) involving exertional heat stress and a subsequent recovery period.

Design:

Randomized controlled trial.

Setting:

University research laboratory.

Patients or Other Participants:

Twenty-four healthy volunteers, with 12 (5 men, 7 women) participating in S1 and 12 (7 men, 5 women) participating in S2.

Intervention(s):

The participants exercised in the heat (42°C, 30% relative humidity) until they reached a 39.5°C cut-off criterion, which was determined by T_re in S1 and by T_es in S2. As such, participants attained different levels of hyperthermia (as determined by T_re) at the end of exercise. Participants in S1 were subsequently immersed in cold water (2°C) until T_re reached 37.5°C, and participants in S2 recovered in a temperate environment (30°C, 30% relative humidity) for 60 minutes.

Main Outcome Measure(s):

We measured T_ac, T_es, and T_re throughout both scenarios.

Results:

The T_es (S1  =  40.19 ± 0.41°C, S2  =  39.50 ± 0.02°C) was higher at the end of exercise compared with both T_ac (S1  =  39.74 ± 0.42°C, S2  =  38.89 ± 0.32°C) and T_re (S1  =  39.41 ± 0.04°C, S2  =  38.74 ± 0.28°C) (for both comparisons in each scenario, P < .001). Conversely, T_es (S1  =  36.26 ± 0.74°C, S2  =  37.36 ± 0.34°C) and T_ac (S1  =  36.48 ± 1.07°C, S2  =  36.97 ± 0.38°C) were lower compared with T_re (S1  =  37.54 ± 0.04°C, S2  =  37.78 ± 0.31°C) at the end of both scenarios (for both comparisons in each scenario, P < .001).

Conclusions:

We found that T_ac, T_es, and T_re presented different temporal responses during and after both scenarios of exertional heat stress and a subsequent recovery period. Although these results may not have direct practical implications in the field monitoring and treatment of individuals with exertional heat injury, they do quantify the extent to which these body temperature measurements differ in such scenarios.     

Fluid Consumption and Sweating in National Football League and Collegiate Football Players With Different Access to Fluids During Practice

Context:

Considerable controversy regarding fluid replacement during exercise currently exists.

Objective:

To compare fluid turnover between National Football League (NFL) players who have constant fluid access and collegiate football players who replace fluids during water breaks in practices.

Design:

Observational study.

Setting:

Respective preseason training camps of 1 National Collegiate Athletic Association Division II (DII) football team and 1 NFL football team. Both morning and afternoon practices for DII players were 2.25 hours in length, and NFL players practiced for 2.25 hours in the morning and 1 hour in the afternoon. Environmental conditions did not differ.

Patients or Other Participants:

Eight NFL players (4 linemen, 4 backs) and 8 physically matched DII players (4 linemen, 4 backs) participated.

Intervention(s):

All players drank fluids only from their predetermined individual containers. The NFL players could consume both water and sports drinks, and the DII players could only consume water.

Main Outcome Measure(s):

We measured fluid consumption, sweat rate, total sweat loss, and percentage of sweat loss replaced. Sweat rate was calculated as change in mass adjusted for fluids consumed and urine produced.

Results:

Mean sweat rate was not different between NFL (2.1 ± 0.25 L/h) and DII (1.8 ± 0.15 L/h) players (F_1,12  =  2, P  =  .18) but was different between linemen (2.3 ± 0.2 L/h) and backs (1.6 ± 0.2 L/h) (t₁₄  =  3.14, P  =  .007). We found no differences between NFL and DII players in terms of percentage of weight loss (t₇  =  −0.03, P  =  .98) or rate of fluid consumption (t₇  =  −0.76, P  =  .47). Daily sweat loss was greater in DII (8.0 ± 2.0 L) than in NFL (6.4 ± 2.1 L) players (t₇  =  −3, P  =  .02), and fluid consumed was also greater in DII (5.0 ± 1.5 L) than in NFL (4.0 ± 1.1 L) players (t₇  =  −2.8, P  =  .026). We found a correlation between sweat loss and fluids consumed (r  =  0.79, P < .001).

Conclusions:

During preseason practices, the DII players drinking water at water breaks replaced the same volume of fluid (66% of weight lost) as NFL players with constant access to both water and sports drinks.     

The Relationships Among Sagittal-Plane Lower Extremity Moments: Implications for Landing Strategy in Anterior Cruciate Ligament Injury Prevention

Context:

Excessive quadriceps contraction with insufficient hamstrings muscle cocontraction has been shown to be a possible contributing factor for noncontact anterior cruciate ligament (ACL) injuries. Assessing the relationships among lower extremity internal moments may provide some insight into avoiding muscle contraction patterns that increase ACL injury risk.

Objective:

To examine the relationships of knee-extensor moment with ankle plantar-flexor and hip-extensor moments and to examine the relationship between knee moment and center of pressure as a measure of neuromuscular response to center-of-mass position.

Design:

Cross-sectional study.

Setting:

Applied Neuromechanics Research Laboratory.

Patients or Other Participants:

Eighteen healthy, recreationally active women (age  =  22.3 ± 2.8 years, height  =  162.5 ± 8.1 cm, mass  =  57.8 ± 9.3 kg).

Intervention(s):

Participants performed a single-leg landing from a 45-cm box onto a force plate. Kinetic and kinematic data were collected.

Main Outcome Measure(s):

Pearson product moment correlation coefficients were calculated among the net peak knee-extensor moment (KEMpk), sagittal-plane ankle (AM) and hip (HM) net internal moments, and anterior-posterior center of pressure relative to foot center of mass at KEMpk (COP).

Results:

Lower KEMpk related to both greater AM (r  =  −0.942, P < .001) and HM (r  =  −0.657, P  =  .003). We also found that more anterior displacement of COP was related to greater AM (r  =  −0.750, P < .001) and lower KEMpk (r  =  0.618, P  =  .006).

Conclusions:

Our results suggest that participants who lean the whole body forward during landing may produce more plantar-flexor moment and less knee-extensor moment, possibly increasing hip-extensor moment and decreasing knee-extensor moment production. These results suggest that leaning forward may be a technique to decrease quadriceps contraction demand while increasing hamstrings cocontraction demand during a single-leg landing.     

Comparison of depression,anxiety and long-term quality of health in patients with a history of either primary closure or Limberg flap reconstruction for pilonidal sinus

OBJECTİVE:

Pilonidal sinus is characterized by high operative morbidity mainly due to wound problems. We aimed to compare the quality of health, comfort and psychological status in patients who underwent surgery for pilonidal sinus.

METHODS:

A total of 205 pilonidal sinus patients operated on with either primary closure or Limberg flap reconstruction were compared in terms of depression, anxiety, and long-term quality of health by using Short Form 36, Beck Depression Inventory, and Beck Anxiety Inventory scales.

RESULTS:

There were 107 patients in the primary closure group with a mean follow-up of 29.6±7.7 months and 98 patients in the Limberg flap group with a mean follow-up of 34.1±7.3 months. In the SF-36 analysis, the mental health and bodily pain scores (59±6 and 56±11 in the primary closure group and 62±8 and 61±10 in the Limberg flap group) were significantly higher in the Limberg flap group (p = 0.014 and p = 0.002, respectively). The mean Beck Depression Inventory (19±6.13 vs. 16±4.90 p<0.001) and Beck Anxiety Inventory (19±6.27 vs. 16±4.90 p<0.001) scores were lower in the Limberg flap group.

CONCLUSION:

Limberg flap reconstruction produced better quality of health scores according to the SF 36, especially in terms of mental health and bodily pain. There was a higher tendency towards anxiety and depression in the primary closure group.     

The impact of glucocorticoids and anti-cd20 therapy on cervical human papillomavirus infection risk in women with systemic lupus erythematosus

OBJECTIVE:

To identify the prevalence and factors associated with cervical human papillomavirus infection in women with systemic lupus erythematosus

METHODS:

This cross-sectional study collected traditional and systemic lupus erythematosus-related disease risk factors, including conventional and biologic therapies. A gynecological evaluation and cervical cytology screen were performed. Human papillomavirus detection and genotyping were undertaken by PCR and linear array assay.

RESULTS:

A total of 148 patients were included, with a mean age and disease duration of 42.5±11.8 years and 9.7±5.3 years, respectively. The prevalence of squamous intraepithelial lesions was 6.8%. The prevalence of human papillomavirus infection was 29%, with human papillomavirus subtype 59 being the most frequent. Patients with human papillomavirus were younger than those without the infection (38.2±11.2 vs. 44.2±11.5 years, respectively; p = 0.05), and patients with the virus had higher daily prednisone doses (12.8±6.8 vs. 9.7±6.7 mg, respectively; p = 0.01) and cumulative glucocorticoid doses (14.2±9.8 vs. 9.7±7.3 g, respectively; p = 0.005) compared with patients without. Patients with human papillomavirus infection more frequently received rituximab than those without (20.9% vs. 8.5%, respectively; p = 0.03). In the multivariate analysis, only the cumulative glucocorticoid dose was associated with human papillomavirus infection.

CONCLUSIONS:

The cumulative glucocorticoid dose may increase the risk of human papillomavirus infection. Although rituximab administration was more frequent in patients with human papillomavirus infection, no association was found. Screening for human papillomavirus infection is recommended in women with systemic lupus erythematosus.     

Decreased levels of alpha-1-acid glycoprotein are related to the mortality of septic patients in the emergency department

OBJECTIVE:

To determine the validity of alpha-1-acid glycoprotein as a novel biomarker for mortality in patients with severe sepsis.

METHODS:

We prospectively included patients with severe sepsis or septic shock at the emergency department at a single tertiary referral teaching hospital. All of the patients were enrolled within the first 24 hours of emergency department admission, and clinical data and blood samples were obtained. As the primary outcome, we investigated the association of serum levels of alpha-1-acid glycoprotein and 96-hour mortality with logistic regression analysis and generalized estimating equations adjusted for age, sex, shock status and Acute Physiology and Chronic Health Evaluation II score.

RESULTS:

Patients with septic shock had lower alpha-1-acid glycoprotein levels at the time of emergency department admission compared to patients without shock (respectively, 149.1±42.7 vs. 189.8±68.6; p = 0.005). Similarly, non-survivors in the first 96 hours were also characterized by lower levels of alpha-1-acid glycoprotein at the time of emergency department admission compared to survivors (respectively, 132.18±50.2 vs. 179.8±61.4; p = 0.01). In an adjusted analysis, alpha-1-acid glycoprotein levels ≤120 mg/dL were significantly associated with 96-hour mortality (odds ratio = 14.37; 95% confidence interval = 1.58 to 130.21).

CONCLUSION:

Septic shock patients exhibited lower circulating alpha-1-acid glycoprotein levels than patients without shock. Alpha-1-acid glycoprotein levels were independently associated with 96-hour mortality in individuals with severe sepsis.     

The American Football Uniform: Uncompensable Heat Stress and Hyperthermic Exhaustion

Context:

In hot environments, the American football uniform predisposes athletes to exertional heat exhaustion or exercise-induced hyperthermia at the threshold for heat stroke (rectal temperature [T_re] > 39°C).

Objective:

To evaluate the differential effects of 2 American football uniform configurations on exercise, thermal, cardiovascular, hematologic, and perceptual responses in a hot, humid environment.

Design:

Randomized controlled trial.

Setting:

Human Performance Laboratory.

Patients or Other Participants:

Ten men with more than 3 years of competitive experience as football linemen (age  =  23.8 ± 4.3 years, height  =  183.9 ± 6.3 cm, mass  =  117.41 ± 12.59 kg, body fat  =  30.1% ± 5.5%).

Intervention(s):

Participants completed 3 controlled exercise protocols consisting of repetitive box lifting (lifting, carrying, and depositing a 20.4-kg box at a rate of 10 lifts per minute for 10 minutes), seated recovery (10 minutes), and up to 60 minutes of treadmill walking. They wore one of the following: a partial uniform (PART) that included the National Football League (NFL) uniform without a helmet and shoulder pads; a full uniform (FULL) that included the full NFL uniform; or control clothing (CON) that included socks, sneakers, and shorts. Exercise, meals, and hydration status were controlled.

Main Outcome Measure(s):

We assessed sweat rate, T_re, heart rate, blood pressure, treadmill exercise time, perceptual measurements, plasma volume, plasma lactate, plasma glucose, plasma osmolality, body mass, and fat mass.

Results:

During 19 of 30 experiments, participants halted exercise as a result of volitional exhaustion. Mean sweat rate, T_re, heart rate, and treadmill exercise time during the CON condition were different from those measures during the PART (P range, .04–.001; d range, 0.42–0.92) and FULL (P range, .04–.003; d range, 1.04–1.17) conditions; no differences were detected for perceptual measurements, plasma volume, plasma lactate, plasma glucose, or plasma osmolality. Exhaustion occurred during the FULL and PART conditions at the same T_re (39.2°C). Systolic and diastolic blood pressures (n  =  9) indicated that hypotension developed throughout exercise (all treatments). Compared with the PART condition, the FULL condition resulted in a faster rate of T_re increase (P < .001, d  =  0.79), decreased treadmill exercise time (P  =  .005, d  =  0.48), and fewer completed exercise bouts. Interestingly, T_re increase was correlated with lean body mass during the FULL condition (R²  =  0.71, P  =  .005), and treadmill exercise time was correlated with total fat mass during the CON (R²  =  0.90, P < .001) and PART (R²  =  0.69, P  =  .005) conditions.

Conclusions:

The FULL and PART conditions resulted in greater physiologic strain than the CON condition. These findings indicated that critical internal temperature and hypotension were concurrent with exhaustion during uncompensable (FULL) or nearly uncompensable (PART) heat stress and that anthropomorphic characteristics influenced heat storage and exercise time to exhaustion.     

Crack/cocaine users show more family problems than other substance users

OBJECTIVES:

To evaluate family problems among crack/cocaine users compared with alcohol and other substance users.

METHODS:

A cross-sectional multi-center study selected 741 current adult substance users from outpatient and inpatient Brazilian specialized clinics. Subjects were evaluated with the sixth version of the Addiction Severity Index, and 293 crack users were compared with 126 cocaine snorters and 322 alcohol and other drug users.

RESULTS:

Cocaine users showed more family problems when compared with other drug users, with no significant difference between routes of administration. These problems included arguing (crack 66.5%, powder cocaine 63.3%, other drugs 50.3%, p = 0.004), having trouble getting along with partners (61.5%×64.6%×48.7%, p = 0.013), and the need for additional childcare services in order to attend treatment (13.3%×10.3%×5.1%, p = 0.002). Additionally, the majority of crack/cocaine users had spent time with relatives in the last month (84.6%×86.5%×76.6%, p = 0.011).

CONCLUSIONS:

Brazilian treatment programs should enhance family treatment strategies, and childcare services need to be included.