Lester B. Mayers

Self-reported symptoms and exercise-induced asthma in the elite athlete.

PURPOSE The purpose of this study was to compare self-reported symptoms for exercise-induced asthma (EIA) to postexercise challenge pulmonary function test results in elite athletes. METHODS Elite athletes (N = 158; 83 men and 75 women; age: 22 +/- 4.4 yr) performed pre- and post-exercise spirometry and were grouped according to postexercise pulmonary function decrements (PFT-positive, PFT-borderline, and PFT-normal for EIA). Before the sport/environment specific exercise challenge, subjects completed an EIA symptoms-specific questionnaire. RESULTS Resting FEV1 values were above predicted values (114--121%) and not different between groups. Twenty-six percent of the study population demonstrated >10% postexercise drop in FEV1 and 29% reported two or more symptoms. However, the proportion of PFT-positive and PFT-normal athletes reporting two or more symptoms was not different (39% vs. 41%). Postrace cough was the most reported symptom, reported significantly more frequently for PFT-positive athletes (P < 0.05). Sensitivity/specificity analysis demonstrated a lack of effectiveness of self-reported symptoms to identify PFT-positive or exclude PFT-normal athletes. Postexercise lower limit reference ranges (MN-2SDs) were determined from normal athletes for FEV1, FEF25--75% and PEF to be -7%, -12.5%, and -18%, respectively. CONCLUSION Although questionnaires provide reasonable estimates of EIA prevalence among elite cold-weather athletes, the use of self-reported symptoms for EIA diagnosis in this population will likely yield high frequencies of both false positive and false negative results. Diagnosis should include spirometry using an exercise/environment specific challenge in combination with the athletes history of asthma symptoms.

Prevalence of body art (body piercing and tattooing) in university undergraduates and incidence of medical complications.

OBJECTIVES To survey the prevalence of body art (body piercing and tattooing) in university undergraduate students and to determine the incidence of medical complications from these procedures. SUBJECTS AND METHODS Between February and May 2001, students were offered the opportunity to complete an anonymous, voluntary survey at the beginning of class or organizational meetings. The survey instrument requested information concerning body piercing and tattooing (current or removed) by body site, age, sex, height, weight, body mass index, undergraduate class, athletic status, and the occurrence of medical complications. RESULTS Four hundred fifty-four (94.4%) of 481 students completed the survey (14.7% of total campus enrollment). The prevalence of body piercing was 51%, and that of tattooing was 23%. The chi2 analysis showed female students were more likely to be pierced than males (P=.002); there was no significant difference in the prevalence of tattooing by sex. Male athletes were more likely to be tattooed than male nonathletes (P=.02). No relationships were shown between piercing/tattooing and age or measures of body somatotype. The incidence of medical complications of piercing was 17%, and these complications included bleeding, tissue trauma, and bacterial infections. Pierced navels were particularly prone to infection. There were no reported medical complications from tattooing. Eighteen percent of piercings (58/315) and 4% of tattoos (6/149) had been removed. CONCLUSIONS Body art is prevalent among undergraduate university students, and there is a significant incidence of medical complications among students with piercing. Male athletes were significantly more likely to be tattooed than male nonathletes.

Exercise-induced asthma screening of elite athletes: field versus laboratory exercise challenge.

PURPOSE The purpose of this study was to compare a laboratory based exercise challenge (LBC) to a field based exercise challenge (FBC) for pulmonary function test (PFT) exercise-induced asthma (EIA) screening of elite athletes. METHODS Twenty-three elite cold weather athletes (14 men, 9 women) PFT positive for EIA (FBC screened) served as subjects. Twenty-three gender and sport matched controls (nonasthmatics) were randomly selected to establish PFT reference values for normal elite athletes. Before FBC, athletes completed a medical history questionnaire for EIA symptoms. FBC evaluations consisted of baseline spirometry, actual or simulated competition, and 5, 10, and 15 min postexercise spirometry. PFT positive athletes were evaluated in the laboratory using an exercise challenge simulating race intensity (ambient conditions: 21 degrees C, 60% relative humidity). PFT procedures were identical to FBC. RESULTS 91% of PFT positive and 48% of PFT normal athletes reported at least one symptom of EIA, with postrace cough most frequent. Baseline spirometry was the same for PFT positives and normal controls. Lower limit reference range (MN - 2 SD) of FEV1 for controls suggests that postexercise decrements of greater than approximately -7% indicate abnormal airway response in this population. Exercise time duration did not effect bronchial reactivity; 78% of FBC PFT positives were PFT normal post-LBC. CONCLUSION Self-reported symptoms by elite athletes are not reliable in identifying EIA. Reference range criterion for FEV1 decrement in the elite athlete postexercise contrasts current recommended guidelines. Moreover, a large number of false negatives may occur in this population if EIA screening is performed with inadequate exercise and environmental stress.

Body Art (Body Piercing and Tattooing) among Undergraduate University Students: “Then and Now”

PURPOSE To survey the prevalence of body art and incidence of medical complications among university students comparing results in 2001 and 2006. METHODS Students reported body piercings and tattoos and occurrence of medical complications. RESULTS Prevalence of body piercing was 51% and tattooing 22%. Piercing medical complication incidence was 19%. No tattooing medical complications occurred. CONCLUSIONS Body art is prevalent among undergraduate university students, with prevalence essentially unchanged during two consecutive 5-year samples. Medical complications occur frequently among those with piercings.

Clinical utility of ImPACT assessment for postconcussion return-to-play counseling: psychometric issues.

Computerized neuropsychological testing is commonly utilized in the management of sport-related concussion. In particular, the Immediate Postconcussion Assessment and Cognitive Testing 2.0 program (ImPACT) is widely used to assess the cognitive functioning of athletes before and after a concussion. We review the evidence for the clinical utility of this program in terms of validity, reliability, and use in return-to-play decisions. We conclude that the empirical evidence does not support the use of ImPACT testing for determining the time of postconcussion return to play.

A guide to treating ironman triathletes at the finish line.

IN BRIEF: The unique physiologic characteristics of an ironman triathlete present challenges to physicians covering ultraendurance events. Cardiovascular emergencies at the finish line are rare. Occult blood in postrace tirine is common but rarely of clinical significance. Medical volunteers must distinguish between signs of dehydration, heatstroke, hyponatremia, and postural hypotension and offer appropriate treatment. Recumbent positioning and oral hydration often suffice to stabilize a conscious collapsed athlete, but serious abnormalities require swift evacuation to a hospital.

Working memory capacity among collegiate student athletes: Effects of sport-related head contacts, concussions, and working memory demands

Objective: To measure working memory capacity among a cohort of collegiate athletes and to compare results between athletes competing in head-contact-prone sports with those not subject to repeated head contacts. A secondary objective was to determine the effect of sport-related concussion on working memory capacity. Design: Ambidirectional cohort study. Setting: Athletics department at an American university. Participants: Student athletes competing in various sports. Interventions: None. Main outcome measurement: Automated operation span test scores. Results: Working memory capacity is not impaired in student athletes who participate in head-contact-prone sports or in student athletes with a history of diagnosed concussion, even those who are multiconcussed. Our results suggest that athletes competing in sports that impose significant working memory loading score higher on the automated operation span test than do other athletes. Conclusions: Further research is required to determine the value of measuring working memory capacity in acutely concussed, symptomatic athletes.

Acute Transverse Patellar Fracture Associated with Weightlifting Case Report and Literature Review

Today, athletes train at ever higher levels of intensity and duration. Weightlifting is a key component of the training regimen in many sports, especially football. Risk factors for injury during weight training include errors in technique, skeletal immaturity, and anabolic steroid abuse. Although serious injuries are uncommon and fractures are a rare occurrence, the repetitive stress applied to bone during weightlifting maneuvers creates the potential for fatigue stress fracture. We provide a case report of a patellar stress fracture suggesting this sequence of events.

Outcomes of sport-related concussion among college athletes.

The author collected and analyzed data for all student-athletes diagnosed with concussion between 1998 and 2011. Outcome measurements were post-concussion symptom duration, time interval until return-to-play, and clinical outcomes self-reported by athletes and by athletes parent/guardian 1 year post-injury. A total of 98 concussions occurred in 95 student athletes among a cohort averaging 350 athletes competing yearly. Athletes were managed according to expert-consensus guidelines. Forty-one (43%) of the athletes had experienced a previously-diagnosed concussion (range: 1-3). Eight athletes (10.4%), retired from their sport for concussion-related issues. Six athletes (6.3%) with completed follow-up experienced memory and/or concentration impairment(s) lasting more than 1 year.

Authors’ reply to “Response to Mayers and Redick: ‘Clinical utility of ImPACT assessment for postconcussion return-to-play counseling: Psychometric issues’”

We appreciate the opportunity afforded by the Editor of the Journal to reply to the comments by Schatz, Kontos, and Elbin (2012, pp. 428–434 of this issue, hereafter abbreviated as SKE) about our analysis of the concussion assessment program Immediate Postconcussion Assessment and Cognitive Testing 2.0 (ImPACTTM). We consider them to be significant contributors to the study of concussion and have carefully considered their critique. We believe that the basic issue separating our position and that of ImPACT’s advocates is illustrated by the following quotations: From the ImPACT Applications, Inc. website: “The best way to prevent difficulties with concussion is proper management of the injury using the ImPACT concussion management program. [. . .] ImPACT’s approach to managing concussion has been found to be reliable, valid and extremely sensitive in determining when an athlete has recovered sufficiently from a concussion [. . .] This information can be used to help determine recovery from injury and safe return to participation and overall clinical management issues” (Impact Applications, Inc., 2012a, pp. 2, 4, emphasis added).