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Kliethermes SA, Asif IM, Blauwet C, Christensen L, Coleman N, Lavallee ME, Moeller JL, Phillips SF, Rao A, Rizzone KH, Sund S, Tanji JL, Tuakli-Wosornu YA, Stafford CD. Focus areas and methodological characteristics of North American-based health disparity research in sports medicine: a scoping review. Br J Sports Med 2024; 58:164-171. [PMID: 38216322 PMCID: PMC10961938 DOI: 10.1136/bjsports-2023-107607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/22/2023] [Indexed: 01/14/2024]
Abstract
OBJECTIVE Health disparities are widely prevalent; however, little has been done to examine and address their causes and effects in sports and exercise medicine (SEM). We aimed to summarise the focus areas and methodology used for existing North American health disparity research in SEM and to identify gaps in the evidence base. DESIGN Scoping review. DATA SOURCES Systematic literature search of PubMed, Scopus, SPORTDiscus, CINAHL Plus with Full Text, Web of Science Core Collection and Cochrane Central Register of Controlled Trials. ELIGIBILITY CRITERIA Full-text, peer-reviewed manuscripts of primary research, conducted in North America; published in the year 2000 or after, in English; and focusing on organised sports were included. RESULTS 103 articles met inclusion criteria. Articles were classified into five focus areas: access to and participation in sports (n=45), access to SEM care (n=28), health-related outcomes in SEM (n=24), provider representation in SEM (n=5) and methodology (n=1). Race/ethnicity (n=39), socioeconomic status (n=28) and sex (n=27) were the most studied potential causes of health disparities, whereas sexual orientation (n=5), location (rural/urban/suburban, n=5), education level (n=5), body composition (n=5), gender identity (n=4) and language (n=2) were the least studied. Most articles (n=74) were cross-sectional, conducted on youth (n=55) and originated in the USA (n=90). CONCLUSION Health disparity research relevant to SEM in North America is limited. The overall volume and breadth of research required to identify patterns in a heterogeneous sports landscape, which can then be used to inform positive change, need expansion. Intentional research focused on assessing the intersectionality, causes and consequences of health disparities in SEM is necessary.
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Affiliation(s)
- Stephanie A Kliethermes
- Department of Orthopedics and Rehabilitation, University of Wisconsin-Madison, Madison, Wisconsin, USA
- The American Medical Society For Sports Medicine, Leawood, Kansas, USA
| | - Irfan M Asif
- Family and Community Medicine, The University of Alabama at Birmingham Heersink School of Medicine, Birmingham, Alabama, USA
| | - Cheri Blauwet
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation; Spaulding Hospital/Brigham and Women's Hospital, Harvard Medical School, Charlestown, Massachusetts, USA
- Kelley Adaptive Sports Research Institute, Boston, Massachusetts, USA
| | - Leslie Christensen
- Department of Library Science, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Nailah Coleman
- Pediatric Primary Care, Children's National Hospital, Washington, District of Columbia, USA
| | - Mark E Lavallee
- Department of Orthopedics, UPMC, Harrisburg, Pennsylvania, USA
| | - James L Moeller
- Orthopaedic Surgery, West Virginia University, Morgantown, West Virginia, USA
| | - Shawn F Phillips
- Department of Family and Community Medicine, Penn State Health, Mount Joy, Pennsylvania, USA
| | - Ashwin Rao
- Family Medicine, University of Washington, Seattle, Washington, USA
| | - Katherine H Rizzone
- Orthopaedics, University of Rochester Medical Center, Rochester, New York, USA
| | - Sarah Sund
- The American Medical Society For Sports Medicine, Leawood, Kansas, USA
| | - Jeffrey L Tanji
- Orthopedics, UC Davis Sports Medicine, Sacramento, California, USA
| | - Yetsa A Tuakli-Wosornu
- Chronic Disease Epidemiology, Yale University School of Public Health, New Haven, Connecticut, USA
| | - Cleo D Stafford
- Department of Orthopaedics and Rehabilitations Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
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Koontz JS, Mountjoy M, Abbott KE, Aron CM, Basile KC, Carlson CT, Chang CJ, Diamond AB, Dugan SA, Hainline B, Herring SA, Hopkins E, Joy EA, Judge JP, LaBotz M, Matuszak J, McDavis CJ, Myers RA, Nattiv A, Tanji JL, Wagner J, Roberts WO. Sexual Violence in Sport: American Medical Society for Sports Medicine Position Statement. Curr Sports Med Rep 2020; 19:232-234. [PMID: 32516194 DOI: 10.1249/jsr.0000000000000722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
The American Medical Society for Sports Medicine (AMSSM) convened a group of experts to develop a Position Statement addressing the problem of sexual violence in sport. The AMSSM Sexual Violence in Sport Task Force held a series of meetings over 7 months, beginning in July 2019. Following a literature review, the task force used an iterative process and expert consensus to finalize the position statement. The objective of this position statement is to raise awareness of this critical issue among sports medicine physicians and to declare a commitment to engage in collaborative, multidisciplinary solutions to reduce sexual violence in sport.
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Affiliation(s)
| | - Margo Mountjoy
- McMaster University Michael G. DeGroote School of Medicine, Family Medicine, Waterloo, ON, CANADA
| | - Kristin E Abbott
- Department of Family and Community Medicine, Northwestern University Health Service, Evanston, IL
| | - Cindy Miller Aron
- Department of Population Health, College of Osteopathic Medicine of the Pacific-Northwest, Lebanon, OR
| | - Kathleen C Basile
- Division of Violence Prevention, Centers for Disease Control and Prevention, Atlanta, GA
| | | | - Cindy J Chang
- Department of Orthopaedics and Family and Community Medicine, University of California San Francisco, San Francisco, CA
| | - Alex B Diamond
- Department of Orthopaedic Surgery and Pediatrics, Vanderbilt University Medical Center, Nashville, TN
| | - Sheila A Dugan
- Physical Medicine and Rehabilitation, Rush University, Chicago, IL
| | - Brian Hainline
- Sport Science Institute, National Collegiate Athletic Association, Indianapolis, IN
| | - Stanley A Herring
- Departments of Rehabilitation Medicine, Orthopaedics and Sports Medicine and Neurological Surgery, University of Washington, Seattle, WA
| | - Elliot Hopkins
- National Federation of State High School Associations, Indianapolis, IN
| | | | | | | | - Jason Matuszak
- Family Medicine, State University of New York at Buffalo, Buffalo, NY
| | | | | | - Aurelia Nattiv
- Division of Sports Medicine, Departments of Family Medicine and Orthopaedic Surgery, University of California Los Angeles, Los Angeles, CA
| | - Jeffrey L Tanji
- Orthopaedics, University of California Davis Sports Medicine, Sacramento, CA
| | - Jessica Wagner
- Sport Science Institute, National Collegiate Athletic Association, Indianapolis, IN
| | - William O Roberts
- Department of Family Medicine and Community Health, University of Minnesota, Minneapolis, MN
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Koontz JS, Mountjoy M, Abbott KE, Aron CM, Basile KC, Carlson CT, Chang CJ, Diamond AB, Dugan SA, Hainline B, Herring SA, Hopkins BE, Joy EA, Judge JP, LaBotz M, Matuszak J, McDavis CJ, Myers RA, Nattiv A, Tanji JL, Wagner J, Roberts WO. Sexual violence in sport: American Medical Society for Sports Medicine Position Statement. Br J Sports Med 2020; 55:132-134. [PMID: 32554408 DOI: 10.1136/bjsports-2020-102226] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/03/2020] [Indexed: 11/03/2022]
Abstract
The American Medical Society for Sports Medicine (AMSSM) convened a group of experts to develop a Position Statement addressing the problem of sexual violence in sport. The AMSSM Sexual Violence in Sport Task Force held a series of meetings over 7 months, beginning in July 2019. Following a literature review, the Task Force used an iterative process and expert consensus to finalise the Position Statement. The objective of this Position Statement is to raise awareness of this critical issue among sports medicine physicians and to declare a commitment to engage in collaborative, multidisciplinary solutions to reduce sexual violence in sport.
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Affiliation(s)
- Jennifer Scott Koontz
- Newton Medical Center, Newton, Kansas, USA .,Family and Community Medicine, University of Kansas School of Medicine Wichita, Wichita, Kansas, USA
| | - Margo Mountjoy
- Family Medicine, McMaster University Michael G DeGroote School of Medicine, Waterloo, Ontario, Canada.,Bureau, FINA, Lausanne, Switzerland
| | - Kristin E Abbott
- Health Service, Northwestern University, Evanston, Illinois, USA
| | - Cindy Miller Aron
- Portland State University, Portland, Oregon, USA.,Western University of Health Sciences College of Osteopathic Medicine of the Pacific, Pomona, California, USA
| | - Kathleen C Basile
- Division of Violence Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Chad T Carlson
- Sports Medicine, Stadia Sports Medicine, West Des Moines, Iowa, USA
| | | | - Alex B Diamond
- Orthopaedics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Sheila A Dugan
- Physical Medicine and Rehabilitation, Rush University Medical Center, Chicago, Illinois, USA
| | - Brian Hainline
- National Collegiate Athletic Association (NCAA), Indianapolis, Indiana, USA
| | - Stanley A Herring
- Departments of Rehabilitation Medicine, Orthopaedics and Sports Medicine and Neurological Surgery, University of Washington, Seattle, Washington, USA
| | - B Elliot Hopkins
- National Federation of State High School Associations, Indianapolis, Indiana, USA
| | - Elizabeth A Joy
- Office of Research, Intermountain Healthcare, Salt Lake City, Utah, USA
| | | | - Michele LaBotz
- InterMed, Yarmouth, Maine, USA.,Sports Medicine, InterMed, South Portland, Maine, USA
| | | | | | | | - Aurelia Nattiv
- Division of Sports Medicine, Departments of Family Medicine and Orthopaedic Surgery, University of California, Los Angeles, Los Angeles, California, USA
| | - Jeffrey L Tanji
- Orthopedics, UC Davis Sports Medicine, Sacramento, California, USA
| | - Jessica Wagner
- National Collegiate Athletic Association, Indianapolis, Indiana, USA
| | - William O Roberts
- Department of Family Medicine and Community Health, University of Minnesota, St Paul, Minnesota, USA
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Koontz JS, Mountjoy M, Abbott KE, Aron CM, Basile KC, Carlson CT, Chang CJ, Diamond AB, Dugan SA, Hainline B, Herring SA, Hopkins BE, Joy EA, Judge JP, LaBotz M, Matuszak J, McDavis CJ, Myers RA, Nattiv A, Tanji JL, Wagner J, Roberts WO. Sexual Violence in Sport: American Medical Society for Sports Medicine Position Statement. Sports Health 2020; 12:352-354. [PMID: 32510278 DOI: 10.1177/1941738120929946] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
The American Medical Society for Sports Medicine (AMSSM) convened a group of experts to develop a position statement addressing the problem of sexual violence in sport. The AMSSM Sexual Violence in Sport Task Force held a series of meetings over 7 months, beginning in July 2019. Following a literature review, the task force used an iterative process and expert consensus to finalize the position statement. The objective of this position statement is to raise awareness of this critical issue among sports medicine physicians and to declare a commitment to engage in collaborative, multidisciplinary solutions to reduce sexual violence in sport.
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Abstract
BACKGROUND Malpractice issues within the United States remain a critical factor for family physicians providing obstetric care. Although tort reform is being widely discussed, little has been written regarding the malpractice crisis from a risk management perspective. METHODS Between 1989 and 1998, a 10-year risk management study at the UC Davis Health System provided a unique collaboration between researchers, a mutual insurance carrier and family physicians practicing obstetrics. Physicians were asked to comply with standardized clinical guidelines, attend continuing medical education (CME) seminars, and submit obstetric medical records for review. Feedback analysis was provided to each physician on their records, and the insurance carrier tracked interim malpractice claims. RESULTS One hundred and ninety-four physicians participated, attending to 32,831 births. Compliance with project guidelines was 91%. Five closed obstetric cases were reported with only one settlement reported to the National Provider Data Bank. Physicians believed the project was beneficial to their practices. CONCLUSIONS Family physicians practicing obstetrics are willing to participate in a collaborative risk management program and are compliant with standardized clinical guidelines. The monetary award for successful malpractice claims was relatively low. This collaborative risk management model may offer a potential solution to the current malpractice crisis.
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Affiliation(s)
- Thomas S Nesbitt
- Outreach, TeleHealth and CME, Center for Health and Technology, University of California, Davis, 95817, USA
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Tanji JL. Medical Problems of the Athlete. Fam Med 2003. [DOI: 10.1007/978-0-387-21744-4_51] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Abstract
This article describes the benefits of exercise, including why exercise improves blood pressure control, how it may reduce the risk for cancer, and increase mental health, and how it may improve bone mineral density. The article also explores the gender-independent and gender-specific benefits of exercise for women.
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Affiliation(s)
- J L Tanji
- Department of Sports Medicine, University of California, Davis Health System, Sacramento, USA
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Affiliation(s)
- J L Tanji
- University of California Davis Medical Center, Sacramento, USA
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Batt ME, Skattum N, Chong BK, Tanji JL. Posterior element pain in a adolescent schoolgirl. Br J Sports Med 1996; 30:356-8. [PMID: 9091138 PMCID: PMC1332426 DOI: 10.1136/bjsm.30.4.356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
A case is presented of a transitional lumbosacral vertebra in a adolescent girl, presenting with low back pain. There was no evidence of a pars interarticularis defect. Careful assessment of children or adolescents presenting with low back pain is important since back pain in this age group is usually caused by organic disease.
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Affiliation(s)
- M E Batt
- Department of Family Practice, University of California, School of Medicine, Davis, Sacramento, USA
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Batt ME, Tanji JL, Skattum N. Plantar fasciitis: a prospective randomized clinical trial of the tension night splint. Clin J Sport Med 1996; 6:158-62. [PMID: 8792046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVE The objective of this study was to evaluate the efficacy of a tension night splint (TNS) as part of a treatment regimen for the management of plantar fasciitis. DESIGN The design was a randomized clinical trial. SETTING The setting was a university-based primary care sports medicine clinic in California. PATIENTS Forty patients with plantar fasciitis entered the study (age range, 20-74 years; average age, 45.7 years). Excluded from the study were patients with other concomitant ankle or foot pathology. Thirty-two patients (21 women, 11 men) completed the study with 33 treated feet. INTERVENTION The patients were randomized to one of two treatment groups. The control group (n = 17) received standard treatment of antiinflammatory medication (Ibuprofen), a Viscoheel sofspot heel cushion (Bauerfeind USA, Kennesaw, GA, U.S.A.) and a stretching program for the gastrocnemius and soleus muscles. The tension night split group (n = 16) received the same standard treatment protocol and additionally an office manufactured custom fitted posterior splint to be used at night. Those patients in the control group not responding to treatment after 8-12 weeks were crossed over to the tension night splint group. Patients were reviewed every 4 weeks for symptom assessment and compliance. MAIN OUTCOME MEASURES The main outcome measures were subjective assessment of pain (Visual analogue scale), plantar fascial tenderness, and ankle range of motion. Patients were discharged from either arm of the trial when they had resumed normal activities with minimal or no discomfort. This end point was recorded as weeks to cure. MAIN RESULTS There was no significant difference in the demographics of the two groups (p > 0.05). In the control group, 6 of 17 were cured after an average interval of 8.8 weeks. The remaining 11 of 17 control group patients were crossed over to receive a TNS in addition to control modalities. Following cross over 8 of 11 of this group were cured after an average of 13 weeks. Three of the 11 failed to significantly respond. Of the 15 patients (16 feet) originally randomly assigned to the TNS group 16 of 16 were cured with an average treatment time of 12.5 weeks. The TNS treatment protocol was a significantly more efficacious treatment regime (p < 0.05). Thus, of 33 cases of plantar fasciitis treated in this study three failed treatment. CONCLUSION When used in combination with a visco-elastic heel pad, stretching program and nonsteroidal anti-inflammatory drugs, the TNS is an effective treatment of plantar fasciitis.
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Affiliation(s)
- M E Batt
- Department of Family Practice, University of California at Davis School of Medicine, Sacramento, USA
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Abstract
In brief Plantar fasciitis, a common over use injury is characterized by heel pain that is usually more severe when the patient first arises. Frequent precipitating factors include adverse foot mechanics, training errors, and degenerative changes. Management of plantar fasciitis is a three-part process that involves treating the inflammatory lesion, correcting precipitating factors, and instituting a graduated rehabilitation program. Use of the tension night splint has shown promising results.
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Batt ME, Chir MB, Skattum N, Chong BK, Tanji JL. POSTERIOR ELEMENT PAIN IN AN ADOLESCENT SCHOOL GIRL. Med Sci Sports Exerc 1995. [DOI: 10.1249/00005768-199505001-01088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Tanji JL, Batt ME. Management of Hypertension. PHYSICIAN SPORTSMED 1995; 23:47-55. [PMID: 29272150 DOI: 10.1080/00913847.1995.11947747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
In brief Current recommendations for brief managing mild to very severe high blood pressure need to be adapted for the special concerns of physically active patients. First-line treatment involves dietary changes, smoking cessation, and aerobic exercise. The next step is to add drug therapy, and diuretics and beta-blockers are the initial drugs of choice because of their proven long-term efficacy. Diuretics may, however, produce hypokalemia or dehydration, and beta- blockers may cause hyperkalemia, reduce exercise capacity, or increase perceived exertion. Other antihypertensive agents may be preferable in specific situations.
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Tanji JL, Arevalo JA, Paliescheskey M, Lee L, Alcalde O. Prevalence rate of hypertension among recent Southeast Asian refugees to northern California. J Am Board Fam Pract 1994; 7:105-9. [PMID: 8184700] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
BACKGROUND Little is known regarding the prevalence rate of hypertension among recent Southeast Asian refugees to the United States. METHODS In this randomized, prospective study, four northern California counties with large Southeast Asian refugee populations were screened for the prevalence rates of hypertension and borderline hypertension. A population density method based upon 1988 census data was used to screen a representative sample of subjects from each county. Criteria for hypertension came from the Joint National Committee on Detection, Evaluation, and Treatment of High Blood Pressure. RESULTS In all, 964 subjects were screened. We found a prevalence rate of 4.8 percent for hypertension and 10.9 percent for borderline hypertension. CONCLUSIONS The relatively low prevalence rates of this disease can be explained by the youth of this refugee population, mean age 37.6 +/- 0.36 years, as the presence of hypertension increases with chronological age.
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Affiliation(s)
- J L Tanji
- Department of Family Practice, University of California, Davis
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Tanji JL. Medical Problems of the Athlete. Fam Med 1994. [DOI: 10.1007/978-1-4757-4005-9_49] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Barrett JR, Tanji JL, Drake C, Fuller D, Kawasaki RI, Fenton RM. High- versus low-top shoes for the prevention of ankle sprains in basketball players. A prospective randomized study. Am J Sports Med 1993; 21:582-5. [PMID: 8368420 DOI: 10.1177/036354659302100416] [Citation(s) in RCA: 101] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Using a prospective, randomized experimental design, 622 college intramural basketball players were stratified by a previous history of ankle sprains to wear a new pair of either high-top, high-top with inflatable air chambers, or low-top basketball shoes during all games for a complete season. Subjects were asked to complete a history questionnaire and were given a complete ankle examination. They were allowed to wear these shoes only during basketball competition. Followed over the course of a 2-month intramural season, 15 ankle injuries occurred during 39,302 minutes of player-time: 7 in high-top shoes, 4 in low-top shoes, and 4 in high-top shoes with inflatable air chambers. The injury rates (injuries per player-minute) were 4.80 x 10(-4) in high-top shoes, 4.06 x 10(-4) in low-top shoes, and 2.69 x 10(-4) in high-top shoes with inflatable air chambers. There was no significant difference among these 3 groups, leading to the conclusion that there is no strong relationship between shoe type and ankle sprains.
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Affiliation(s)
- J R Barrett
- Department of Family Medicine, University of Oklahoma, Oklahoma City 73104
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Nesbitt TS, Kahn NB, Tanji JL, Scherger JE. Factors influencing family physicians to continue providing obstetric care. West J Med 1992; 157:44-7. [PMID: 1413742 PMCID: PMC1021904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
To determine the reasons some family physicians continue to practice obstetrics when most of their colleagues do not, we surveyed family physicians in 26 counties of northern California whose practices include obstetrics and those who have recently discontinued it. In all, 70% of family physicians practicing obstetrics cited enjoying it as a reason for continuing this practice. Over a third of family physicians practicing obstetrics thought that obstetric practice was a responsibility to the community. Only 1 in 6 reported obstetrics to be important in terms of financial implications. Despite this, family physicians practicing obstetrics had a mean gross income derived from obstetric practice of $30,000 above the cost of their total malpractice premium. In contrast, a comparison group of family physicians who had recently discontinued obstetrics cited malpractice insurance costs most frequently as the reason for discontinuing it. Nearly 40% of these physicians indicated that they would be willing to return to obstetrics if circumstances were to change substantially. The most frequently cited change necessary for these physicians to return to obstetrics was a reduction in malpractice insurance rates.
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Affiliation(s)
- T S Nesbitt
- Department of Family Practice, University of California, Davis, School of Medicine, Sacramento 95817
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Nesbitt TS, Arevalo JA, Tanji JL, Morgan WA, Aved B. Will family physicians really return to obstetrics if malpractice insurance premiums decline? J Am Board Fam Pract 1992; 5:413-8. [PMID: 1496898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND The loss of family physicians as obstetrics providers during the last decade has had a significant impact on access to obstetric services, especially for rural populations. The expense of malpractice premiums has been cited often as a reason for physicians' discontinuation of this service. METHODS Seventy-six family physicians in northern California who recently discontinued obstetrics were surveyed regarding their decisions related to obstetric practice. Those physicians who indicated that a decrease in malpractice premiums would allow them to consider resuming obstetrics were resurveyed by telephone the following year. This telephone survey occurred following a 25 percent decrease in malpractice premiums for obstetrics by the major malpractice insurance carrier for family physicians practicing obstetrics in the study area. RESULTS Twenty-nine of the 76 physicians in the original survey who had recently discontinued obstetrics stated they would consider resuming if conditions changed. Twenty-six (90 percent) of these physicians indicated that malpractice premiums needed to change for them to consider resuming obstetrics. Following the reduction in premiums, none of these physicians reported plans to resume obstetrics or even a likelihood that they would be resuming obstetrics. CONCLUSION This study found that family physicians who discontinued obstetrics and cited malpractice premiums as a barrier to resuming obstetrics are unlikely to resume when rates decline. This finding suggests that other issues might be equally or more important in this decision.
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Affiliation(s)
- T S Nesbitt
- Department of Family Practice, University of California, Davis
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Tanji JL. Exercise and the hypertensive athlete. Clin Sports Med 1992; 11:291-302. [PMID: 1591786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Exercise helps to manage high blood pressure in most circumstances and should be encouraged in both hypertensive athletes and active individuals with this disease. Many physiologic mechanisms have been proposed that explain this benefit. Presently, it appears from both human and animal studies that exercise of moderate intensity may be optimal for control of high blood pressure. Exercise testing for the future prediction of hypertension is an intriguing concept, but more data needs to be gathered before screening can be recommended.
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Affiliation(s)
- J L Tanji
- Department of Family Practice, University of California, Davis, Sacramento
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Nesbitt TS, Tanji JL, Scherger JE, Kahn NB. Obstetric care, Medicaid, and family physicians. How policy changes affect physicians' attitudes. West J Med 1991; 155:653-7. [PMID: 1812644 PMCID: PMC1003126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Recent expansion of Medicaid eligibility for pregnant women and increased reimbursement to physicians who provide perinatal services were designed to improve access to care. Family physicians provide a relatively high proportion of care to pregnant women on Medicaid, especially in rural areas. We surveyed all family physicians who provide obstetric services in 26 northern California counties regarding these changes and perceived barriers to providing obstetric care to women on Medicaid. Of surveyed physicians who limited the number of their Medicaid obstetric patients, 58% stated that recent Medicaid policy changes had increased their willingness to accept new Medicaid obstetric patients. Despite these policy changes, administrative issues and poor reimbursement were cited as the two most notable barriers to providing obstetric care to women on Medicaid. Fear of being sued by Medicaid patients is still seen as a barrier by physicians who have recently discontinued practicing obstetrics and by those who continue to care for a large number of Medicaid obstetric patients.
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Affiliation(s)
- T S Nesbitt
- Department of Family Practice, University of California, Davis, School of Medicine, Sacramento 95817
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Abstract
Resting blood pressures were measured in 467 adolescents during preparticipation physical examinations for high school sports. Fifty-seven of the athletes (12.2%) had significantly elevated blood pressures. Forty-three (79.6%) of 54 subjects demonstrated significantly and persistently elevated blood pressures at 1-year follow-up. A family history of hypertension was positively associated with elevated blood pressures in 46 (80.7%) of 57 subjects compared with controls (23/410 [5.6%]). Consistent with previous studies, subjects with elevated blood pressures had a greater body weight (94.5 +/- 25.7 kg) compared with normotensive subjects (75.2 +/- 14.0 kg). Subjects with elevated blood pressures engaged in heavy resistance weight training (three times a week or more) more often (41/57 [71.9%]) than normotensive subjects (65/410 [15.8%]). These data support the idea that blood pressures measured during routine preparticipation physical examinations for high school sports are a useful tool in screening for elevated blood pressure in adolescents.
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Affiliation(s)
- J L Tanji
- Department of Family Practice, University of California, Davis Medical Center, Sacramento 95817
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Tanji JL, Lew EY, Wong GY, Treguboff C, Ward JA, Amsterdam EA. Dietary calcium supplementation as a treatment for mild hypertension. J Am Board Fam Pract 1991; 4:145-50. [PMID: 2053453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
The blood pressure responses of 19 mildly hypertensive (diastolic blood pressure 90-104 mmHg) individuals to treatment with either 1200 mg of elemental calcium supplementation or placebo were assessed weekly in a 6-month randomized, double-blind, placebo-controlled crossover study. Both groups showed a decrease in blood pressure (calcium treated: 6 +/- 12 mmHg systolic, 7 +/- 7 mmHg diastolic; and placebo controlled: 9 +/- 14 mmHg systolic, 9 +/- 8 mmHg diastolic). Differences between the two groups were not significant (P greater than 0.1). There were no adverse effects to either treatment. This study does not support the hypothesis that dietary calcium supplementation is more effective than placebo in reducing blood pressure in mildly hypertensive individuals.
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Affiliation(s)
- J L Tanji
- Department of Family Practice, University of California, Davis Medical Center, Sacramento 95817
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Tanji JL. The preparticipation physical examination for sports. Am Fam Physician 1990; 42:397-402. [PMID: 2200248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Up to 25 million children and adolescents in the United States participate in some type of organized sports activity each year. Most of these young athletes receive an annual preparticipation physical examination. The purpose of the examination is to identify any conditions that might interfere with the athlete's ability to participate in a given sport. The criteria for disqualification are different for each sport.
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Abstract
In brief When exercise alone does not NMM control hypertension, a medical ISMS regimen can be used in conjunction with exercise or other nonpharmacologic interventions. Diuretics, beta blockers, calcium antagonists, and angiotensin-converting enzyme (ACE) inhibitors are widely used to treat hypertension. ACE inhibitors and calcium antagonists are good choices for exercising patients because they do not limit exercise performance and have few side effects. The author gives guidelines for changing the regimen from exercise alone to exercise and medication, and for stepping down from medical therapy.
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Abstract
In brief Exercise can be an effective form of therapy for hypertension, recent research has shown. This article reviews the possible mechanisms by which exercise lowers blood pressure and gives physicians the necessary information to counsel hypertensive patients who want to start an exercise program. Some researchers are exploring the use of exercise testing to predict the onset of hypertension.
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Abstract
Liability issues have caused large numbers of obstetrical providers, particularly family and general practitioners, to discontinue offering perinatal care in rural areas. Losses of even small numbers of rural obstetrical providers can severely limit access to care for large geographic areas. A lack of access to local obstetrical care can result in less than adequate prenatal care and in potential delays in the diagnosis and care of acute perinatal complications. Women who live in these underserved rural communities suffer increased adverse birth outcomes, leading to significantly higher medical costs. Proposed solutions to the problem include risk management programs associated with reduced liability premiums; increased Medicaid reimbursement for obstetrical care; health department subsidies to offset insurance premiums for rural obstetrical care; and programs in predoctoral and residency training designed to identify, assess and address the health care needs of rural areas. Although some measure of success has resulted from these efforts, more systematic and comprehensive policy changes are needed to meet the challenge of this crisis.
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Tanji JL, Champlin JJ, Wong GY, Lew EY, Brown TC, Amsterdam EA. Blood pressure recovery curves after submaximal exercise. A predictor of hypertension at ten-year follow-up. Am J Hypertens 1989; 2:135-8. [PMID: 2920095 DOI: 10.1093/ajh/2.3.135] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
The purpose of this study is to examine the usefulness of blood pressure recovery curves after submaximal exercise in apparently normotensive young adults as an early predictor for hypertension. Twenty-six college age males in 1977, with normal blood pressures at rest, were given the Harvard Step Test and postexercise blood pressures were recorded. Criteria were set that differentiated a hypertensive from a normotensive response to exercise. In 1987, these individuals were contacted regarding their blood pressure status. Nine out of ten subjects who demonstrated a hypertensive response to exercise in 1977, now have been given the diagnosis of hypertension. Eleven out of twelve subjects who demonstrated a normotensive response to exercise in 1977, now are still considered to be normotensive. A proposed hypothesis is that during the course of this disease, exercise can unmask hypertension in subjects who have the potential for developing hypertension but currently have a normal resting blood pressure.
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Affiliation(s)
- J L Tanji
- Department of Family Practice, University of California, Davis Medical Center, Sacramento 95817
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Abstract
In brief: Primary care sports medicine is a rapidly growing field of interest; however, there are relatively few training programs in this field. The author describes the development of a one-month training program at the University of California, Davis, Medical Center. The education strategies used in the program include clinical teaching (50%), on-the- field education (20%), experiential learning (20%), and didactic instruction (10%). The most innovative part of the program is the experiential learning component, through which students learn basic sports medicine skills by actively participating in sports, exercises, strength training, and a fitness program.
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