Back pain and MRI changes in the thoraco-lumbar spine of top athletes in four different sports: a 15-year follow-up study

A total 71 male athletes (weight lifters, wrestlers, orienteers, and ice-hockey players) and 21 non-athletes were randomly selected, for a baseline MRI study. After 15 years all the participants at baseline were invited to take part in a follow-up examination, including a questionnaire on back pain and a follow-up MRI examination. Thirty-two athletes and all non-athletes had disc height reduction at one or several disc levels. Disc degeneration was found in more than 90% of the athletes and deterioration had occurred in 88% of the athletes, with the highest frequency in weight lifters and ice-hockey players. 78% of the athletes and 38% of the non-athletes reported previous or present history of back pain at baseline and 71 and 75%, respectively at follow-up. There was no statistically significant correlation between back pain and MRI changes. In conclusion, athletes in sports with severe or moderate demands on the back run a high risk of developing disc degeneration and other abnormalities of the spine on MRI and they report high frequency of back pain. The study confirmed our hypothesis, i.e. that most of the spinal abnormalities in athletes seem to occur during the growth spurt, since the majority of the abnormalities demonstrated at follow-up MRI after the sports career were present already at baseline. The abnormalities found at young age deteriorated to a varying degree during the 15-year follow-up, probably due to a combination of continued high load sporting activities and normal ageing. Preventive measures should be considered to avoid the development of these injuries in young athletes.     

Health of master track and field athletes: a 16-year follow-up study.

OBJECTIVE: To study different aspects of health in master athletes. DESIGN: A 16-year follow-up study. SETTING: Finland. PARTICIPANTS: All male Finnish master athletes (N=102, mean age 58.3 years) who in 1985 participated in track and field athletic World Veterans Games. Controls were men, who as young adults had been classified as completely healthy (N=777, mean age 55.0 years). MAIN OUTCOME MEASUREMENTS: Health questionnaires at baseline (in 1985) and at 10-year and 16-year follow-ups. RESULTS: During follow-up, the master athletes self-rated their health as better (P<0.001) and they coped better with leisure-time daily activities (P=0.024) than controls. The adjusted risk for shoulder region (odds ratio 2.84, P<0.03) and Achilles tendon rupture (14.87, P<0.01) after the age of 45 years was higher in the athletes than in the controls. At the 16-year follow-up, none of the athletes, but 9% of controls reported having diabetes mellitus. The adjusted odds ratio of having at least 1 metabolic syndrome disease was 0.43 (P=0.01) in the athletes compared with the controls. At follow-up among subjects without reported coronary heart disease in 1985, the age-adjusted hazard ratio (HR) in the athletes compared with the controls of death from natural-cause was 0.41 (P<0.01). CONCLUSIONS: Master athletes had a lower risk of chronic diseases than the controls. It remains to be determined how far this advantage is due to initial selection and/or incomplete adjustment for covariates. CLINICAL RELEVANCE: There seems to be no such health risks as to why those who have good training background and feel healthy should avoid participating in master athletics.     

Steroid use and long-term health risks in former athletes

This article focuses on anabolic steroid adverse effects on the cardiovascular system and mental health issues as well as the possible increase in the incidence of neoplasms in anabolic steroid users. On the basis of findings in the literature, the authors consider these three issues as the most significant concerning morbidity and mortality among anabolic steroid users. A study by P?rssinen et al. (2000) has shown an increased incidence of premature mortality among power lifters. Anabolic steroids and other concomitantly used drugs are the probable cause of this increased mortality, as power training itself does not increase health risks and all types of physical activity promote health.     

A comparison of myocardial function in former athletes and non-athletes.

Heart rate (HR), total electromechanical systole (Q-S2), left ventricular ejection time (LVET), pre-ejection period (PEP), and diastole (D) were compared in 350 former athletes and 156 non-athletes, age 27-74. The two cohorts had been equated according to habitual leisure time physical activity. Former athletes exhibited significantly longer Q-S2 and PEP at rest, and significantly lower HR and lengthened Q-S2, LVET, PEP, and D at one minute following a standard two minute step test (less than 0.05). Significantly differences were observed between athletes and non-athletes in the light and moderate activity categories. There were no significant differences between former athletes and non-athletes currently engaged in strenuous leisure time physical activity. Comparisons were made among the three levels of habitual leisure time physical activity with each group and revealed that HR was lower and Q-S2, LVET, PEP, and D were longer at rest and following exercise as the level of physical activity increased. There were more significant differences among former athletes than among non-athletes. Most of these differences were between light to moderate and light to strenuous levels of activity. The evidence suggests an advantage in myocardial function among former athletes compared to their non-athlete counterparts.     

Magnetic resonance imaging of the asymptomatic shoulder of overhead athletes: a 5-year follow-up study

BACKGROUND: Although several studies have described magnetic resonance imaging findings in shoulders of asymptomatic volunteers, no such investigation has been performed on asymptomatic dominant and nondominant shoulders of elite overhead athletes. HYPOTHESIS: Asymptomatic dominant shoulders of elite overhead athletes may have a higher incidence of magnetic resonance imaging abnormalities than either their nondominant shoulder or shoulders of asymptomatic volunteers. STUDY DESIGN: Prospective cohort study. METHODS: Detailed magnetic resonance imaging scans of asymptomatic dominant and nondominant shoulders of elite overhead athletes were obtained. Three experienced musculoskeletal radiologists interpreted each scan for multiple variables, including rotator cuff appearance. Images from a surgical control group were intermixed to assess accuracy and control for observer bias. A 5-year follow-up interview was performed to determine whether magnetic resonance imaging abnormalities found in the initial stage of the study represented truly clinical false-positive findings or symptomatic shoulders in evolution. RESULTS: Eight of 20 (40%) dominant shoulders had findings consistent with partial- or full-thickness tears of the rotator cuff as compared with none (0%) of the nondominant shoulders. Five of 20 (25%) dominant shoulders had magnetic resonance imaging evidence of Bennett's lesions compared with none (0%) of the nondominant shoulders. None of the athletes interviewed 5 years later had any subjective symptoms or had required any evaluation or treatment for shoulder-related problems during the study period. CONCLUSIONS: Magnetic resonance imaging alone should not be used as a basis for operative intervention in this patient population.     

Long-term prognosis for jumper's knee in male athletes. A prospective follow-up study

BACKGROUND: Little information is available on the long-term outcome of jumper's knee, a common problem among athletes. PURPOSE: Our aim was to determine the 15-year prognosis of jumper's knee. STUDY DESIGN: Prospective case control. METHODS: The prognosis for jumper's knee was studied using two groups: athletes with jumper's knee and nonsymptomatic control athletes. At baseline, all subjects participated in standardized clinical examinations and measurements, and 15 years later they were asked to respond to a questionnaire. RESULTS: Twenty athletes with jumper's knee and 16 athlete control subjects responded (response rate 74% and 84%, respectively). The jumper's knee group reported significantly more knee symptoms according to their Kujala score and more knee pain after repeated squatting. Fifty-three percent of the subjects in the jumper's knee group (9 of 17) reported that they had quit their sports career because of their knee problem, compared with 7% of the control athletes (1 of 14). Patellar height was associated with knee symptoms at follow-up. CONCLUSION: Jumper's knee causes mild but long-lasting symptoms after an athletic career.     

Caloric expenditure, life status, and disease in former male athletes and non-athletes

This study examined the association between aerobic, caloric exercise expenditure and life status (living vs deceased) as well as the prevalence rates of hypertension (HBP) and cardiovascular disease (CVD) in former male athletes (ATH) and non-athletes (N-ATH). The initial survey for this study was done in 1952. Follow-up surveys of respondents were done in 1960, 1968, 1976, and 1984. The present study used all subjects who responded fully to activity and health questions in 1976 and who were reported as either dead or alive (not lost to follow-up) in 1984. A total of 348 subjects (185 ATH, 163 N-ATH) were assessed and caloric expenditure groups were established by kilocalories (kcal) of aerobic exercise per week; 0 kcal (group 1), 1-399 kcal (group 2), 400-899 kcal (group 3), 900-1499 kcal (group 4), 1500-2499 kcal (group 5), and 2500+ kcal (group 6). Only activity considered to be aerobic was used in the establishment of the aerobic categories. Death rate was highest in groups 1 and 2. Subjects in group 1 tended to be the oldest. Year of birth (age) (P less than 0.001) and CVD (P less than 0.05) as reported in 1976 were significantly related to mortality between 1976 and 1984. College athletic status and 1976 exercise level were not significantly related to mortality. Prevalence of CVD and HBP was highest in groups 1 and 6, suggesting a moderate amount of aerobic activity as optimal.     

SARS治疗一线医护人员心理健康状况调查

目的研究SARS治疗一线医护人员在工作不同阶段的心理健康状况。方法采用症状自评量表(SCL90)对小汤山医院620名一线医护人员进行心理评估。结果除精神病性因子以外,该群体SCL90各因子5个时间段的得分与地方常模比较,差异均有统计学意义(P<0.05);每个因子5个时间段的得分之间的比较差异有统计学意义(P<0.05)。各因子不同时间段的得分呈动态变化,焦虑、恐怖因子得分逐步下降,躯体化、强迫、抑郁、偏执因子得分先升高后下降,人际敏感因子得分先下降后上升,敌对因子得分最后有所升高。结论SARS治疗一线医护人员的心理健康水平总体上低于地方常模,焦虑、恐怖、强迫、躯体化症状相对突出,其心理健康状况值得重视。     

Advantages of electrocardiographic monitoring in top level athletes.

We used continuous electrocardiographic monitoring according to Holter's method for a tentative evaluation of the prognostic value of the main electrocardiographic peculiarities of the "athlete's heart". Five hundred and eighty-seven Holter recordings were performed in 164 top athletes divided into three groups: dynamic, static and mixed. Selection criteria were either clinical or electrical (resting-ECG). The prognostic value of arrhythmia is variable: unworrying junctional rhythm (JR) and auriculo-ventricular blocks (AVB) that disappeared under strain, which in our study interested mostly the dynamic group. No pejorative prognostic criteria were found related to supraventricular premature beats (SVPB). Ventricular premature beats (VPB) of recent occurrence were predominantly found, in our study, in the static athletes; their occurrence was not always accounted for and their prognosis, at least as regards sports, was uncertain. Holters repeated throughout the sports season made it possible to establish a relationship between some peculiarities and the training intensiveness: auriculo-ventricular block and junction rhythm culminated during intensive periods. Unusual sinus tachycardia would be indicative of over-training.     

Homocysteine status in former top-level male athletes: possible effect of physical activity and physical fitness

The importance of elevated homocysteine (Hcy) as a risk marker for cardiovascular disease is continously under debate. Lifestyle factors may increase the total Hcy (tHcy) level of the plasma, but there are no consistent findings relating to Hcy, physical activity, and cardiorespiratory fitness. Cross-sectional measurement from an ongoing follow-up study was performed on 77 former male athletes and 33 sedentary controls (age range 35-62 years). Lifestyle parameters (current physical activity patterns, smoking, etc.), anthropometric and blood pressure data, and data about tHcy, reduced, and oxidized glutathione (GSH, GSSG, respectively) in blood, lipoproteins, and maximal oxygen consumption (VO(2max)) were collected. Our study results showed that the subgroup of physically active ex-athletes (n=52) had a significantly lower tHcy level and glutathione redox ratio (GSSG:GSH) in comparison with the subgroup of sedentary ex-athletes (n=25). tHcy level was inversely related to cardiorespiratory fitness (VO(2max)/kg). Dietary and smoking habits were not significantly associated with the tHcy level in our study group. In conclusion, the research findings indicate that both current physical activity and cardiorespiratory fitness are significantly inversely associated with an elevated homocysteine level in middle-aged former athletes.     

A study of the health status of radar workers.

The health status was examined of 322 radar workers with a history of occupational exposure in a microwave field from 5-10 years. The clinical findings were compared with a control group of 220 persons. There were no statistically significant differences in clinical and laboratory findings between exposed and control group. Only some subjective complaints were found more frequently in the exposed group than in the control. The authors' feeling is that subjective complaints in radar workers could not be ascribed only to the influence of microwaves because they could be due to other nonspecific harmful occupational factors. On the basis of the results of this work, the authors concluded that it is unlikely to expect marked harmful effects from microwaves in radar workers in normal working conditions.     

Latent profile analysis of physical activity and sedentary behavior with mortality risk: A 15-year follow-up

By exploring multiple characteristics of physical activity and sedentary behavior (SB), different physical activity profiles could be obtained, which may be beneficial for health and targeted physical activity interventions. The aim of this study was to identify distinct physical activity profiles based on accelerometer-derived activity characteristics and to determine whether these profiles are associated with all-cause mortality. Eight hundred fifty-one participants (56% women, mean age: 53 years) provided objectively assessed physical activity data using an ActiGraph accelerometer and were followed for 15 years. Physical activity profiles were determined using latent profile analyses of 14 derived activity variables, resulting in that three profiles were identified: “Low Active” (n = 147), “Average Active” (n = 397), and “High Active” (n = 307). “Low Active” was characterized by participants with low absolute, relative, and limited variation of time spent in physical activity, and high time spent in SB. “Average Active” had the most balanced movement behavior with values close to the mean for all activity variables. “High Active” was characterized by participants with high absolute, relative, and great variation of time spent in physical activity. Overall, a potentially non-linear pattern between multiple activity variables and all-cause mortality was found as “Low Active” was significantly (P < .05) positively associated with all-cause mortality, and no difference in mortality risk was found between “High Active” and “Average Active.” Our data suggest that day-to-day variation in SB is not associated with all-cause mortality. The important message is to keep the overall time spent in SB low and replace this behavior with physical activity.     

A 12-year follow-up study of malpractice claims against radiologists in Italy

PURPOSE: Malpractice claims filed against radiologists have become a relevant phenomenon in Italy and are a real risk in the radiologists' professional activity. MATERIALS AND METHODS: Insurance claims of Italian radiologists over the 1993-2004 period were anonymously assessed. A total of 990 insurance claims were classified according to cause: (1) missed diagnosis, (2) complications of the radiological procedure, (3) failure to order further radiological examinations, (4) radiation treatment, (5) slip-and-fall injuries, (6) miscellaneous causes. RESULTS: A total of 990 claims were filed during the period, with most claims being filed a considerable time after the event. As a consequence, the estimated incidence may be 44 per 1,000. In other words, 44% of Italian radiologists have received, or will receive, a summons regarding their professional activity of the past 10 years. Misdiagnosis made up the first and most important claim category. Missed abnormalities on breast radiographs accounted for the greatest percentage of cases. Missed bone abnormalities were the following most common diagnostic errors. Complications following interventional procedures accounted for 10% of all cases. A few cases resulted from the radiologist's failure to order further diagnostic examinations. Lastly, radiologists were frequently named as one of multiple defendants, together with medical (or surgical) doctors, in cases of patient death in roughly 6% of all cases. CONCLUSIONS: The risk of medical malpractice litigation for Italian radiologists is by now comparable to that for American radiologists. Strict adherence to radiological standards may be a means of reducing the risk of legal action and obviating litigation.