Sportmedizin in Deutschland

Sports medicine covers many different aspects, ranging from clinical specialties, such as internal medicine, orthopedics or pediatrics to physiology and sports sciences. The requirements for sports medicine evolve mainly from exercise physiology (elite, leisure and health oriented physical activity), orthopedics and traumatology as well as from preventive and rehabilitative issues. In the new German curriculum, sports medicine is defined as a subspecialty. Historically, sports medicine in Germany has a federal structure with a governing body (Deutsche Gesellschaft für Sportmedizin und Prävention). Due to these facts, University Departments of Sports Medicine (which vary greatly in size and performance) are either attached to Medical or non-Medical Faculties, such as Sports Sciences. In medical schools, sports medicine can be selected as an elective subject. However, the main part of teaching sports medicine is covered by Sports Science Faculties. In an international context, the strength of German sports medicine is its clinical orientation and close cooperation with the sport itself, especially high-performance sports. In the future, like in the Anglo- American countries, sports medicine in Germany will play a major role in health prevention and rehabilitation.

Tetrahydrogestrinone: the discovery of a designer steroid

The use of steroids and other pharmaceuticals to gain a competitive edge in athletics has been present in the sports world for a long time. Over the past several years, scientific advances in the detection of sports doping agents and improved collaboration between sports organizations have enhanced the monitoring of fair athletic play. Many have suspected the illegal development of designer steroids by rogue scientists to avoid detection by the standard sports doping drug screen. In 2003, the Olympic Analytical Laboratory at the University of California, Los Angeles discovered the first designer steroid, tetrahydrogestrinone (THG), by using liquid chromatography with tandem mass spectrometry. Over the past year, the THG story continues to shock the sports world with its potential to discredit or terminate several high-profile athletic careers. While confirming the existence of designer steroids is credit to the sports antidoping movement, antidoping agencies will need to continue to invest in research and depend on honest athletic participants to maintain fairness and safety in sports.

Publication rates of abstracts presented at Biennial Meetings of the International Society of Arthroscopy, Knee Surgery and Orthopaedic Sports Medicine

A study was carried out to determine the fate of abstracts presented at the Biennial Meetings of the International Society of Arthroscopy, Knee Surgery and Sports Medicine. All abstracts presented at the 1997 and 1999 Biennial Meetings of the International Society of Arthroscopy, Knee Surgery and Sports Medicine were entered into a database. A Medline search was performed in November 2003 for each abstract to determine whether a full publication resulted from the abstract. The rate of publication and the journals in which they were published were determined. The overall rate of publication from the 1997 and 1999 meetings were 34.6 and 39.3%, respectively. The most common journals for subsequent publication were Arthroscopy: The Journal of Arthroscopic and Related Surgery, American Journal of Sports Medicine, and Knee Surgery, Sports Traumatology, Arthroscopy. Research presented in abstract form at scientific meetings provides an early look at ongoing research projects. These abstracts are not subjected to the full peer-review process required of publications in journals. Many of the abstracts presented at the Biennial Meetings of the International Society of Arthroscopy, Knee Surgery and Sports Medicine did not result in a full journal publication. While it is not possible to determine the reason for abstracts failing to lead to journal publications, it is possible that some of these projects did not meet the scientific scrutiny of the peer-review process required for full publication.

[Three year action plan to renew Hygiene and Public Health Services (SISP) of Local Health Units of Veneto region. Methods and contents]

The Council of the Veneto Region entrusted the Regional Direction for Prevention and the Department for Prevention of ULSS 7 (Local Health and Social Unit) by means of the Regional Resolution 3045/2001, the strategic coordination and development of a three year Plan concerning the Hygiene and Public Health (SISP) Services in Veneto. The Plan aims to renew working methods, areas of activities and the organization of the SISP Services. The activities were divided in the following four categories from LEA (Essential levels of Assistance) and from the regional price list: 1) innovative activities to be put into practice; 2) new activities to be developed; 3) activities to be standardized; 4) obsolete activities to be deleted. The Plan identified the following five macroareas: 1. Epidemiology and prophylaxis of communicable diseases; 2. Prevention of non communicable diseases: 3. Urban and Environmental Hygiene; 4. Forensic and necroscopic Medicine; 5. Health safeguard in sports activities, with twenty specific technical schemes regarding the main areas of Hygiene and Public Health Services and three cross cutting schemes regarding: 1. the relationship with the user; 2. the SISP System; 3. training. The Plan also identified leaders and members of task forces that are in charge of developing the schemes. The 23 schemes of the Plan were approved by means of the Regional Resolution 3015/2003 and are now being implemented. The coordination of the activities of the Plan is carried out by a special Service.

Management of the Critically Injured Athlete: Packaging of Head and Cervical Spine Injuries

Emergency medical personnel must take extreme caution when evaluating and treating an athlete with a suspected head or spine injury. While head and neck injuries may continue to be life threatening, the proper management of these injuries may prevent further injury from occurring.

American College of Sports Medicine position stand. Exercise and hypertension

Hypertension (HTN), one of the most common medical disorders, is associated with an increased incidence of all-cause and cardiovascular disease (CVD) mortality. Lifestyle modifications are advocated for the prevention, treatment, and control of HTN, with exercise being an integral component. Exercise programs that primarily involve endurance activities prevent the development of HTN and lower blood pressure (BP) in adults with normal BP and those with HTN. The BP lowering effects of exercise are most pronounced in people with HTN who engage in endurance exercise with BP decreasing approximately 5-7 mm HG after an isolated exercise session (acute) or following exercise training (chronic). Moreover, BP is reduced for up to 22 h after an endurance exercise bout (e.g.postexercise hypotension), with greatest decreases among those with highest baseline BP. The proposed mechanisms for the BP lowering effects of exercise include neurohumoral, vascular, and structural adaptations. Decreases in catecholamines and total peripheral resistance, improved insulin sensitivity, and alterations in vasodilators and vasoconstrictors are some of the postulated explanations for the antihypertensive effects of exercise. Emerging data suggest genetic links to the BP reductions associated with acute and chronic exercise. Nonetheless, definitive conclusions regarding the mechanisms for the BP reductions following endurance exercise cannot be made at this time. Individuals with controlled HTN and no CVD or renal complications may participated in an exercise program or competitive athletics, but should be evaluated, treated and monitored closely. Preliminary peak or symptom-limited exercise testing may be warranted, especially for men over 45 and women over 55 yr planning a vigorous exercise program (i.e. > or = 60% VO2R, oxygen uptake reserve). In the interim, while formal evaluation and management are taking place, it is reasonable for the majority of patients to begin moderate intensity exercise (40-<60% VO2R) such as walking. When pharmacological therapy is indicated in physically active people it should be, ideally: a) lower BP at rest and during exertion; b) decrease total peripheral resistance; and, c) not adversely affect exercise capacity. For these reasons, angiotensin converting enzyme (ACE) inhibitors (or angiotensin II receptor blockers in case of ACE inhibitor intolerance) and calcium channel blockers are currently the drugs of choice for recreational exercisers and athletes who have HTN. Exercise remains a cornerstone therapy for the primary prevention, treatment, and control of HTN. The optimal training frequency, intensity, time, and type (FITT) need to be better defined to optimize the BP lowering capacities of exercise, particularly in children, women, older adults, and certain ethnic groups. based upon the current evidence, the following exercise prescription is recommended for those with high BP: Frequency: on most, preferably all, days of the week. Intensity: moderate-intensity (40-<60% VO2R). Time: > or = 30 min of continuous or accumulated physical activity per day. Type: primarily endurance physical activity supplemented by resistance exercise.

Spinal injuries in rugby union, 1970–2003: lessons and responsibilities

There was an increase in the frequency of rugby union spinal injuries worldwide during the 1970s and early 1980s. The United Kingdom and Australia have since had some success in reducing this increase in spinal injuries. These changes were the result of actions by rugby union authorities in response to recommendations by medical advisors; legal action by injured players has also played a part. The frequency of spinal injuries has not decreased in New Zealand (up to 2000) and South Africa (up to 1997). Rugby union authorities' responsibilities should include establishing and maintaining national and international spinal injury registers to forge closer working relationships with medical researchers. Such registers would provide up-to-date information for enhancing and developing preventive measures. There has been no specific publicly available record of the incidence of rugby union spinal injuries in Australia since 1996, so it is uncertain whether the safety measures introduced so far have had a lasting impact.

Medical care at the VIIth International Amateur Athletics Federation World Championships in Athletics ‘Sevilla ‘99’

INTRODUCTION

The World Athletics Championships are considered to be the third most important sporting event on the planet. Before the celebration of their seventh meeting in Seville, Spain, the need for medical care, as in the Olympic Games, was supposed to be low and of minimal complexity. It was nevertheless judged necessary to install strategically located assistance points, and to evaluate the results of this intervention. METHODOLOGY AND DESIGN: Following the planning phase carried out by a multidisciplinary commission of health, set up by the Organizer Committee, which prepared protocols, that were elaborated by five working groups, the operation developed during the World Championships in Athletics is described. Five clinics and several first aid stations were set up in the stadium and its surroundings, in hotels, warm-up and training tracks, the high-speed train station and the airport, as well as strategic points in the city.

RESULTS

There were 1338 medical consultations, and 35 patients (2.6%) were transferred to hospitals. 21 codes of the International Classification of Disease constituted 50.4% of the case mix. Injuries, which accounted for 36.1% of all medical visits, were more common among athletes (48.9%) than among other groups. Injuries accounted for 30.5% of all other groups combined. Spectators and other groups accounted for most (86.8 and 63.1%, respectively) of the 276 visits concerning contusions and 165 visits for heat-related illness. The overall physician treatment rate was 19.3% for athletes and 4.5/10 000 for spectators.

CONCLUSION

The preparation of a potent pre-hospital service, strategically located and dedicated to the event, was able to solve the problems that occurred. Nevertheless, a hospital alert and a coordination centre are also necessary. These data should be useful in planning medical resources for future mass sporting events.

Physical Activity and Cardiovascular Disease Prevention in Women: How Much Is Good Enough?

Epidemiologic data suggest that 30 min x d(-1) of brisk walking can reduce cardiovascular disease incidence in women and men. In a sedentary society, public health initiatives that promote moderate increases in physical activity may represent the optimal balance between efficacy, feasibility, and safety to achieve the desired cardioprotective effect.

Fluid replacement during marathon running

During endurance exercise, about 75% of the energy produced from metabolism is in the form of heat, which cannot accumulate. The remaining 25% of energy available can be used for movement. As running pace increases, the rate of heat production increases. Also, the larger one's body mass, the greater the heat production at a particular pace. Sweat evaporation provides the primary cooling mechanism for the body, and for this reason athletes are encouraged to drink fluids to ensure continued fluid availability for evaporation and circulatory flow to the tissues. Elite level runners could be in danger of heat illness if they race too quickly in hot/humid conditions and may collapse at the end of their event. Most marathon races are scheduled at cooler times of the year or day, however, so that heat loss to the environment is adequate. Typically, this postrace collapse is due simply to postural hypotension from decreased skeletal muscle massage of the venous return circulation to the heart on stopping. Elite athletes manage adequate hydration by ingesting about 200-800 mL/hour, and such collapse is rare. Athletes "back in the pack" are moving at a much slower pace, however, with heat accumulation unlikely and drinking much easier to manage. They are often urged to drink "as much as tolerable," ostensibly to prevent dehydration from their hours out on the race course. Excessive drinking among these participants can lead to hyponatremia severe enough to cause fatalities. A more reasonable approach is to urge these participants not to drink as much as possible but to drink ad libitum (according to the dictates of thirst) no more than 400-800 mL/hour.

Extreme sports: injuries and medical coverage

Extreme sports (including in-line skating, snowboarding, mountain bicycling, extreme skiing, rock climbing, indoor tackle football, kickboxing, skateboarding, and ultra-endurance racing) are growing in popularity. Often these sports are designed to expose athletes to greater thrills and risks than are found in traditional sporting activities. Despite this increased risk of injury, athletes competing in these sports often have little or no formal medical coverage. This article reviews what is known about this emerging area of sports medicine to assist physicians in preparing for medical coverage of these athletes and their competitions.

Sports dentistry and dental traumatology

Sports dentistry had its origins in the 1980s. More recently, the Academy for Sports Dentistry joined forces with the International Association of Dental Traumatology in cosponsoring the World Congress on Sports Dentistry and Dental Traumatology. It is the intent of the present paper to introduce readers to the arena of sports dentistry, suggest future areas for collaborative research, and stimulate authors to submit high quality, scientifically based manuscripts on sports dentistry to Dental Traumatology.

Arthroscopic proficiency: a survey of orthopaedic sports medicine fellowship directors and orthopaedic surgery department chairs

PURPOSE

The goal of this study was to evaluate the opinion of sports medicine fellowship directors and orthopaedic surgery department chairpersons on how many repetitions the average resident needs to become proficient in several common arthroscopic procedures.

TYPE OF STUDY

A cross-sectional study.

METHODS

A questionnaire was mailed to all fellowship directors on a list maintained by the American Academy of Orthopaedic Surgeons and to all department chairpersons on a list maintained by the American Medical Association. Respondents were asked to estimate the number of operations needed for a trainee to reach minimal proficiency (able to perform procedure skin-to-skin with supervision) and proficiency (capable of performing procedure without supervision) for 5 common arthroscopic procedures: diagnostic knee scope, partial medial meniscectomy, anterior cruciate ligament (ACL) reconstruction, diagnostic shoulder scope, and subacromial decompression.

RESULTS

A total of 164 of 230 (71%) people responded to the questionnaire. Department chairpersons who did not perform arthroscopy consistently estimated two thirds the number of operations that department chairpersons who did perform arthroscopy and nearly half the number of operations estimated by fellowship directors. Chairpersons who did perform arthroscopy had responses more similar to fellowship directors than to department heads who did not perform arthroscopy.

CONCLUSIONS

These results indicate that, in the opinion of physicians involved in the education of residents and fellows, it may take a substantial number of repetitions to become proficient in arthroscopy. Physicians who perform little or no arthroscopy themselves may underestimate its difficulty. Interestingly, there was substantial variability in the number of repetitions estimated to achieve proficiency in all procedures. The results of this study may be helpful in designing arthroscopic training programs for orthopaedic residents or sports medicine fellows; however, the wide variability in opinions may indicate difficulty in reaching a consensus.