Thomas Küpper

The negative impact of attention-deficit/hyperactivity disorder on occupational health in adults and adolescents

PurposeTo review the negative effects of attention-deficit/hyperactivity disorder (ADHD) in adolescence and adulthood on work productivity and occupational health.MethodsA review of the MEDLINE database was carried out to identify direct and indirect effects of ADHD on work, employment and occupational health.ResultsADHD is associated with higher levels of unemployment versus controls. Adults with ADHD who are employed experience workplace impairment and reduced productivity, as well as behavioural issues such as irritability and low frustration tolerance. Adults with ADHD are also at increased risk of accidents, trauma and workplace injuries, particularly traffic accidents. Indirect effects of ADHD on occupational health include reduced educational achievement and increased rates of substance abuse and criminality. Overall, ADHD in adults has a substantial economic impact as a result of absenteeism and lost productivity. Psychoeducation, combined with stimulant medications if necessary, is recommended as first-line treatment for adults with ADHD. Limited data available suggest that stimulant treatment can improve work productivity and efficacy, and reduce the risks associated with driving, although further studies are necessary.ConclusionsADHD can affect the ability to gain and maintain employment and to work safely and productively. As ADHD is a treatable condition, patients, employers and physicians have a role to play in ensuring optimal occupational health.

Evaluation of Injury and Fatality Risk in Rock and Ice Climbing

Rock and ice climbing are widely considered to be ‘high-risk’ sporting activities that are associated with a high incidence of severe injury and even death, compared with more mainstream sports. However, objective scientific data to support this perception are questionable. Accordingly, >400 sport-specific injury studies were analysed and compared by quantifying the injury incidence and objectively grading the injury severity (using the National Advisory Committee for Aeronautics score) per 1000 hours of sporting participation. Fatalities were also analysed. The analysis revealed that fatalities occurred in all sports, but it was not always clear whether the sport itself or pre-existing health conditions contributed or caused the deaths. Bouldering (ropeless climbing to low heights), sport climbing (mostly bolt protected lead climbing with little objective danger) and indoor climbing (climbing indoors on artificial rock structures), showed a small injury rate, minor injury severity and few fatalities. As more objective/external dangers exist for alpine and ice climbing, the injury rate, injury severity and fatality were all higher. Overall, climbing sports had a lower injury incidence and severity score than many popular sports, including basketball, sailing or soccer; indoor climbing ranked the lowest in terms of injuries of all sports assessed. Nevertheless, a fatality risk remains, especially in alpine and ice climbing. In the absence of a standard definition for a ‘high-risk’ sport, categorizing climbing as a high-risk sport was found to be either subjective or dependent on the definition used. In conclusion, this analysis showed that retrospective data on sport-specific injuries and fatalities are not reported in a standardized manner. To improve preventative injury measures for climbing sports, it is recommended that a standardized, robust and comprehensive sport-specific scoring model should be developed to report and fully evaluate the injury risk, severity of injuries and fatality risk in climbing sports.

The UIAA Medical Commission injury classification for mountaineering and climbing sports.

OBJECTIVE Variations in definitions, scores, and methodologies have created differences in the results and conclusions obtained from studies on mountaineering and climbing sports injuries and illnesses; this has made interstudy comparisons difficult or impossible. To develop a common, simple, and sport-specific scoring system to classify injuries and illnesses in mountaineering and climbing studies; such retrospective scoring would facilitate the analysis and surveillance of their frequencies, severity and fatalities, and outcomes of any treatment. METHODS The UIAA (The International Mountaineering and Climbing Federation) makes recommendations, sets policy, and advocates on behalf of the climbing and mountaineering community internationally through its various commissions. Using a nominal group consensus model approach, a working group was formed during the UIAA Medical Commissions meeting in Adršpach - Zdoňov, in the Czech Republic, 2008. This group critically examined climbing and other relevant literature for various methodological approaches in measuring injury incident rates and severity, including data sources, and produced a working document that was later edited and ratified by all members of the UIAA Medical Commission. RESULTS Definitions of injury location, injury classification, and fatality risk are proposed. Case fatality, time-related injury risk, and a standardized metric climbing difficulty scale are also defined. CONCLUSIONS The medical commission of the UIAA recommends the use of the described criteria and scores for future research in mountaineering and climbing sports in order to enable robust and comprehensive interstudy comparisons and epidemiological analysis.

Low‐Dose Theophylline Reduces Symptoms of Acute Mountain Sickness

OBJECTIVE Headache, nausea, and sleeplessness at altitude [acute mountain sickness (AMS)] are major health problems for several million mountain recreationists who ascend to high altitudes each year. We aimed to test the efficacy of low-dose, slow-release theophylline for the prevention of AMS in a placebo-controlled, double-blind, randomized trial. METHODS Twenty healthy male volunteers (mean age 34.7 y) were randomized (random allocation) to receive either 300 mg theophylline daily or placebo 5 days prior, during ascent, and during a stay at 4,559 m altitude. AMS symptoms were collected using the Lake Louise Score on each day during ascent and at high altitude. A 12-channel sleep recorder recorded sleep and breathing parameters during the first night at 4,559 m. Theophylline serum levels were drawn prior to the sleep study. RESULTS Seventeen completed the entire study. Theophylline (n = 9) compared to placebo (n = 8) significantly reduced AMS symptoms at 4,559 m (Lake Louise Score: 1.5 +/- 0.5 vs placebo 2.3 +/- 2.37; p < 0.001), events of periodic breathing (34.3/h vs placebo 74.2/h; p < 0.05), and oxygen desaturations (62.3/h vs placebo 121.6/h; p < 0.01). No significant differences in sleep efficiency or sleep structure were present in the two groups. No adverse drug effects were reported. CONCLUSIONS Low-dose, slow-release theophylline reduces symptoms of AMS in association with alleviation of events of periodic breathing and oxygen desaturations.

Feet injuries in rock climbers

While injuries of the upper extremity are widely discussed in rock climbers, reports about the lower extremity are rare. Nevertheless almost 50 percent of acute injuries involve the leg and feet. Acute injuries are either caused by ground falls or rock hit trauma during a fall. Most frequently strains, contusions and fractures of the calcaneus and talus. More rare injuries, as e.g., osteochondral lesions of the talus demand a highly specialized care and case presentations with combined iliac crest graft and matrix associated autologous chondrocyte transplantation are given in this review. The chronic use of tight climbing shoes leads to overstrain injuries also. As the tight fit of the shoes changes the biomechanics of the foot an increased stress load is applied to the fore-foot. Thus chronic conditions as subungual hematoma, callosity and pain resolve. Also a high incidence of hallux valgus and hallux rigidus is described.

The actual role of sodium cromoglycate in the treatment of asthma—a critical review

IntroductionDespite international consensus and clearly written guidelines urging wider use of corticosteroids or combinations of inhaled short- and long-acting β-agonists (SABA and LABA) and corticosteroids in persistent asthma, prescribing patterns and compliance rates fall far short of recommendations.ObjectivesThe failure to use steroids more aggressively is due, in part, to their side effects, even with inhaled forms of the drug. There is a role for expanded use of sodium cromolyn in asthma. Its potent anti-inflammatory effects, lack of side effects, and acceptable dosing and method of delivery, as well as its special role in exercise-induced asthma, make it a very suitable choice in the initial therapy for control of asthma.ConclusionCompared to SABA and LABA, cromoglycates alone are unsuspicious of being used to enhance physical performance.

Preacclimatization in hypoxic chambers for high altitude sojourns

IntroductionSince hypoxic chambers are more and more available, they are used for preacclimatization to prepare for sojourns at high altitude. Since there are different protocols and the data differ, there is no general consensus about the standard how to perform preacclimatization by simulated altitude. The paper reviews the different types of exposure and focuses on the target groups which may benefit from preacclimatization.DiscussionSince data about intermittent hypoxia for some hours per day to reduce the incidence of acute mountain sickness differ, it is suggested to perform preacclimatization by sleeping some nights at a simulated altitude which follows the altitude profile of the “gold standard” for high altitude acclimatization.

Work in Hypoxic Conditions-Consensus Statement of the Medical Commission of the Union Internationale des Associations d'Alpinisme (UIAA MedCom)

OBJECTIVES The Commission gives recommendations on how to provide health and safety for employees in different kinds of low oxygen atmospheres. So far, no recommendations exist that take into account the several factors we have outlined in this report. METHODS The health and safety recommendations of several countries were analysed for their strength and deficiencies. The scientific literature was checked (Medline, etc.) and evaluated for relevance of the topic. Typical situations of work in hypoxia were defined and their specific risks described. Specific recommendations are provided for any of these situations. RESULTS We defined four main groups with some subgroups (main risk in brackets): short exposure (pressure change), limited exposure (acute altitude disease), expatriates (chronic altitude disease), and high-altitude populations (re-entry pulmonary oedema). For healthy unacclimatized persons, an acute but limited exposure down to 13% O(2) does not cause a health risk. Employees should be advised to leave hypoxic areas for any break, if possible. Detailed advice is given for any other situation and pre-existing diseases. CONCLUSIONS If the specific risk of the respective type of hypoxia is taken into account, a pragmatic approach to provide health and safety for employees is possible. In contrast to other occupational exposures, a repeated exposure as often as possible is of benefit as it causes partial acclimatization. The consensus statement was approved by written consent in lieu of a meeting in July 2009.

Genetic analysis of Rhipicephalus sanguineus sensu lato ticks parasites of dogs in Africa north of the Sahara based on mitochondrial DNA sequences

The aim of this work was to determine the evolutionary relationship among tick populations of Rhipicephalus sanguineus sensu lato distributed in Africa north of the Sahara and different lineages of R. sanguineus s.l. distributed in different regions of Sub-Saharan Africa, America and Europe through the analysis of DNA sequences of two mitochondrial genes. One hundred and thirty six 16S rRNA gene sequences and twenty-seven 12S rRNA gene sequences of R. sanguineus s.l. were analyzed. Phylogenetic analyses were performed including different lineages of R. sanguineus s.l. from America, Europe and Africa, and species belonging to the R. sanguineus group as Rhipicephalus camicasi, Rhipicephalus guilhoni, Rhipicephalus sulcatus, Rhipicephalus rossicus, Rhipicephalus pusillus, Rhipicephalus turanicus and Rhipicephalus leporis. At least two different lineages of R. sanguineus s.l. are living in sympatry in Africa north of the Sahara. One of these mitochondrial lineages belongs to the same evolutionary entity that R. sanguineus s.l. from tropical areas of America, R. sanguineus s.l. from Sub-Saharan Africa, R. camicasi and R. guilhoni. The other mitochondrial lineage of R. sanguineus s.l. present in Africa north of the Sahara is phylogenetically associated to R. sanguineus s.l. ticks from southeastern Europe (Romania, Turkey and Greece). Both evolutionary entities are clearly different to the evolutionary entity formed by R. sanguineus s.l. from western Europe and temperate areas of America. Thus, the name R. sanguineus s.s. cannot be assigned to any of the two evolutionary entities present in Africa north of the Sahara. The taxonomic status of these taxa will remain unresolved until new lines of evidence become available to complement the current results based on mitochondrial DNA.

Coracoid Impingement Syndrome Due to Intensive Rock Climbing Training

Overuse and acute injuries to the upper body are common in rock climbing. Such injuries primarily affect the fingers; but shoulder problems are increasingly common, especially among more experienced and older climbers who climb at a high ability level. Such shoulder problems are often due to subacromial impingement, shoulder dislocations with bankart lesions, hyperlaxity, SLAP lesions or irritations of the long biceps tendon. In contrast to these known conditions, we describe a case of an ambitious female rock climber who trained intensively and developed a coracoid impingement caused by hypertrophied subscapularis tendon and muscle following sport-specific training. Diagnosis was made through clinical evaluation and confirmed by magnetic resonance tomography. Coracoid impingement syndrome is a less common cause of shoulder pain and occurs when the subscapularis tendon impinges between the coracoid and the lesser tuberosity of the humerus. The patient was treated successfully with a conservative therapy and returned to full activity within 6 weeks.