We cannot help but note the correlation between the results of this study
of female athletes,
and the study conducted on male long distance runners in Denmark [1].
We propose that sunshine might be the common factor driving the observed bone loss in these
two,
apparent...
We cannot help but note the correlation between the results of this study
of female athletes,
and the study conducted on male long distance runners in Denmark [1].
We propose that sunshine might be the common factor driving the observed bone loss in these
two,
apparently disparate, sets of
athletes.
The secosteroid hormone 1,25-dihydroxyvitamin-D (1,25-D) is a
potent stimulator of osteoclast activity [2], and
excessive levels of 1,25-D have a direct effect on
BMD [3].
1,25-D is manufactured by skin keratinocytes upon exposure to
sunlight [4].
Sunscreens have no measurable effect on the
amount of 1,25-D produced by solar exposure [5].
Endurance runners are clearly exposed to unusual amounts of direct sunlight during
both practice and competition, and we believe that excessive concentrations of 1,25-D could
well have been an unconfounded variable in this study.
We would urge
measurement of the level of this hormone during
any future study of BMD in outdoor athletes.
References
(1) Hetland ML, Haarbo J, Christiansen C. Low bone mass and high bone
turnover in male long distance runners. J Clin Endocrinol Metab 1993 Sep;77(3):770-5. Pubmed Abstract
(2) Manolagas SC. Birth and Death of Bone Cells. Basic Regulatory
Mechanisms and Implications for the Pathogenesis and Treatment of
Osteoporosis. Endocr Rev 2000 Apr 01;21(2): 115-137. Publisher Full
Text.
(3) Adams JS, Lee G. Gains in Bone Mineral Density with Resolution of
Vitamin D Intoxication. Ann Intern Med 1997 Aug 1;127(3):203-6. Publisher Full
Text
(4) Marshall TG, Marshall FE. New Treatments Emerge as Sarcoidosis
Yields Up
its Secrets.Clinmed 2003 Jan 27;2003010001 Full Text
(5) Marks R, Foley PA, Jolley D, Knight KR, Harrison J, Thompson SC. The
effect of regular sunscreen use on vitamin D levels in an Australian
population. Results of a randomized controlled trial. Arch Dermatol 1995
Apr; 131(4): 415-21. PubMed Abstract
The helmets worn in ice hockey - what is their specification and
composition?
They look like canoeing-type and very thin plastic, if so, it
is no wonder head injuries continue. The players need padded helmets more
like motorcycle crash helmets to withstand the knocks with a layer of
polystyrene or other shock absorbing material.
I enjoyed reviewing for this journal very much and can only hope that more journals will use a similar electronic system.
Having waited over 16
weeks to hear from a different journal, I think that the electronic system provides an
excellent service to the authors.
Waddington et al.[1] have highlighted an important issue in the context of
sport injury management. However, this article, like many others,
provides erroneous information and percpetions of 'qualified
physiotherapists'. In the UK a physiotherapist must be State Registered
(CPSM at present) to work in the NHS. A physothrapist does not need to be
'chartered' - i.e. a Member of the Chartered Socie...
Waddington et al.[1] have highlighted an important issue in the context of
sport injury management. However, this article, like many others,
provides erroneous information and percpetions of 'qualified
physiotherapists'. In the UK a physiotherapist must be State Registered
(CPSM at present) to work in the NHS. A physothrapist does not need to be
'chartered' - i.e. a Member of the Chartered Society of Physiotherapy. To
get state registration requires proof of adequate level and type of
eduction, whether here or abroad.
In the context of sports therapy, we now have up and coming
designated Sports Therapists, who are registered with their own Society.
These therapists are educated in the HE sector, emerge with Hons Degrees
and an excellent training in sports injury management &
rehabilitation. Hoepfully they will soon achieve full state registration
also.
Pat Turner
Reference
(1) Hay C. Club doctors and physiotherapists. Br J Sports Med 2001;35:207.
I read with interest the report of atrial fibrillation and syncope in a body builder taking anabolic steroids and bromocriptine.[1] Drs Manoharan, Campbell and O'Brien present an interesting and perceptive report of bromocriptine misuse. Several additional points can be made regarding this case. While the authors noted the effect of the fasting state on bromocriptine kinetics,[2] in addition bromocriptine an...
I read with interest the report of atrial fibrillation and syncope in a body builder taking anabolic steroids and bromocriptine.[1] Drs Manoharan, Campbell and O'Brien present an interesting and perceptive report of bromocriptine misuse. Several additional points can be made regarding this case. While the authors noted the effect of the fasting state on bromocriptine kinetics,[2] in addition bromocriptine and methandienone share the same metabolizing enzyme, cytochrome P450 3A4.[3,4] Bromocriptine clearance has been shown to decrease with the coadministration of other drugs involving cytochrome P450 3A4 such as the macrolide antibiotics.[5]
Investigators recognised the dissociation between bromocriptine blood levels and therapeutic effects since the 1970s.[6] Over 20 years later, the clinical observations were finally explained by the work of Valente and colleagues[7] which demonstrated that hydroxylated bromocriptine metabolites are effective in reducing prolactin in the rat. Prior to this research, the specific receptor activity of bromocriptine metabolites was not characterised. In addition, possible cardiovascular effects of hydroxylated bromocriptine metabolites have not been fully investigated.
Finally, the authors note that bromocriptine had been studied in obese subjects in which weight loss and improved glucose tolerance were reported.[8] As a result of the observation of improved glycemic control after bromocriptine administration, clinical trials of bromocriptine in the treatment of Type 2 diabetes were conducted in the United States. The results of these trials were presented to the Food and Drug Administration at which time a relative risk of myocardial infarction of 2.9 after bromocriptine treatment was found.[9]
References
(1) Manoharan G, Campbell NPS, O'Brien C.J. Syncopal episodes in a young amateur body builder. Br J Sports Med 2002;36:67-8.
(2) Drewe J, Mazer N, Abisch E, et al. Differential effect of food on kinetics of bromocriptine in a modified release capsule and a conventional formulation. Eur J Clin Pharmacol 1988;35:535-41.
(3) Wynalda M, Wienkers L. Assessment of potential interactions between dopamine receptor agonists and various human cytochrome P450 enzymes using a simple in vitro inhibition screen. Drug Metab Dispos 1997;25:1211-4.
(4) Rendic S, Nolteernsting E, Schanzer W. Metabolism of anabolic steroids by recombinant human cytochrome P450 enzymes. Gas chromatographic-mass spectrometric determination of metabolites. J Chromatogr B Biomed Sci Appl 1999;735(1):73-83.
(5) Periti P, Mazzei T, Mini E, Novelli A. Pharmacokinetic drug interactions of macrolides. Clin Pharmacokinet 1992;23:106-31.
(6) Jenner P, Marsden CD, Reavill C. Evidence for metabolite involvement in bromocriptine-induced circling behavior. Br J Pharmacol 1979;66(1):103P-4P.
(7) Valente D, Delaforge M, Urien S, et al. Metabolite involvement in bromocriptine-induced prolactin inhibition in rats. J Pharmacol Exp Ther 1997;282:1418-24.
(8) Cincotta AH, Meier AH. Bromocriptine (Ergoset) reduces body weight and improves glucose tolerance in obese subjects. Diabetes Care 1996;19:667-70.
(9) Food and Drug Administration. Endocrinologic and Metabolic Drugs Advisory Committee. 70th Meeting. Bethesda,MD: Food and Drug Administration, May 14, 1998:Meeting Transcript, page 135.
In their recent article 'Intensive training in elite young female
athletes,' Baxter-Jones and Maffulli reviewed 18 manuscripts and concluded
'training does not appear to affect growth and maturation .'[1] We have
two concerns about this conclusion. First, we agree that analyses of cross
-sectional and cohort data in this population are confounded by sampling
bias; gymnasts who are successful at an elite leve...
In their recent article 'Intensive training in elite young female
athletes,' Baxter-Jones and Maffulli reviewed 18 manuscripts and concluded
'training does not appear to affect growth and maturation .'[1] We have
two concerns about this conclusion. First, we agree that analyses of cross
-sectional and cohort data in this population are confounded by sampling
bias; gymnasts who are successful at an elite level are likely to be self-
selected by their small stature and delayed maturation. Frequently,
however, data from cross-sectional and cohort studies are averaged. This
'group' approach provides little information about individual growth
patterns. Thus, in Baxter-Jones and Maffuli's review, and the literature
at large, an important basic question has been overlooked; that is, is
there any evidence that growth and/or maturation are adversely affected in
some athletes and if so, what is the frequency of this condition?
Second, in contrast to their findings, our analysis of over 35
clinical reports, cross-sectional and historical and prospective cohort
studies indicates that elite level gymnasts may be at risk for adverse
effects on growth [2]. We reported that the increased magnitude of the
delay in skeletal maturation with training in adolescent female gymnasts,
coupled with the occurrence of catch-up growth during periods of reduced
training or retirement, provides evidence that growth and maturation may
be affected in some instances [2,3]. Furthermore, in contrast to the
interpretation Baxter-Jones and Maffulli made of our data, we did report
an association between reduced growth and years of gymnastic training, and
that the deficits were greater at the axial than appendicular skeleton
[3].
We are in agreement with Baxter-Jones and Maffulli that a cause-
effect relationship between gymnastics training and inadequate growth of
females has not been demonstrated; there have been no randomized
controlled trials. However, this does not mean there is 'no evidence for
inadequate growth among female gymnasts.' If clinicians are coerced by
group means and ignore variability about the mean, then gymnasts who are
at increased risk of reduced growth may be overlooked. We recommend that
the growth of all young elite female gymnasts should be monitored
regularly. Any gymnast who falls behind in growth i.e. across two major
percentiles of the growth chart, should undergo a complete evaluation for
underlying pathology, even when height is not below the fifth percentile.
This may be normal short stature, but the clinical criterion warrants
assessment.
References
(1) Baxter-Jones ADG, Maffulli N, Intensive training in elite young
female athletes Br J Sports Med. 2002;36:13-15
(2) Caine D, Lewis R, O'Connor P, Howe W, Bass S. Does gymnastics training
inhibit growth of females? Clin J Sport Med 2001;11:260-70.
(3) Bass S, Bradney M, Pearce G, et al. Short stature and delayed puberty
in gymnasts: Influence of selection bias on leg length and the duration
of training on trunk length. J Pediatrics 2000;136(2):149-55.
Lavis et al [1] seek to explain the poor results obtained by
candidates undertaking the Bath University diploma in sports and exercise
medicine as a failure of the candidate to take the subject seriously. They
expect the standard to be comparable to “that required of a candidate
completing the same task on an ATLS, PHTLS or ALS course.”
A candidate undertaking any of the above courses, or a...
Lavis et al [1] seek to explain the poor results obtained by
candidates undertaking the Bath University diploma in sports and exercise
medicine as a failure of the candidate to take the subject seriously. They
expect the standard to be comparable to “that required of a candidate
completing the same task on an ATLS, PHTLS or ALS course.”
A candidate undertaking any of the above courses, or any of the
British equivalents run by the British Association for Immediate Care
(BASICS) such as the Pre-Hospital Emergency Care certificate, will have
completed a 3–5 day course. The courses are intensive learning
experiences comprising of lectures, skill stations, trauma moulage,
cardiac care scenarios and continual assessment.
By comparison, my experience of the Bath Diploma Course is that its
teaching relies of a small section in one of the modules, less than half a
day of practical teaching tacked on to one of its clinical weekends and
then for the students to direct themselves.
For a subject that quite rightly results in outright failure for the
candidate if they fail to demonstrate competency, resuscitation skills
attract very little attention from the course. This may be sending the
wrong message to candidates and better results from the examination of
resuscitation skills may be obtained if the course included more intensive
instruction on the topic.
[1] Lavis M, Rose J, Jenkinson T. Sports doctors resuscitation skills
under examination: do they take it seriously? Br J Sports Med 2001; 35;
128-30
I congratulate you for researching the importance of appropriate soccer
ball size. Your article on distal radial fractures was cited in The New
York Times shortly after being published, shedding light on a potentially
preventible injury in soccer. It seems possible that if children just
played with junior-sized balls, fewer would get hurt by distal radial
fractures.
I would like to add some...
I congratulate you for researching the importance of appropriate soccer
ball size. Your article on distal radial fractures was cited in The New
York Times shortly after being published, shedding light on a potentially
preventible injury in soccer. It seems possible that if children just
played with junior-sized balls, fewer would get hurt by distal radial
fractures.
I would like to add some comment for further research in this area. In
order to truly establish ball size as a causative factor, one must know
the baseline, overall usage of adult vs. junior-size balls. This can be
done by surveying the field play to get a rough estimate of the division
into adult and junior usage. I think, for this study, it was assumed that
usage was about even: fifty percent of the study population played with a
junior-sized ball and fifty with adult. However, it is possible to
imagine that more players used the bigger (adult) ball, since the
"recommendations are not in universal use." If this occurred, the
chances were much higher for observing in the clinic injuries resulting
from adult-size balls. It is comparable to finding in a study that "90%
of accidents happen within 10 kilometers of home." This is bound to
happen by chance alone. I am more convinced by results from a test of
significance when this qualification measure is taken into account.
I cannot resist the temptation to join the debate on sports doctors’
resuscitation skills [1,2]. The study by Thompson et al [3] suggested that there
is a perceived need amongst Sports specialists for first aid skills. However
I received no response to my letter concerning this, [4] which indirectly posed
the question, ‘should doctors who attend aquatic sports be able to deal with
a suspected cervical...
I cannot resist the temptation to join the debate on sports doctors’
resuscitation skills [1,2]. The study by Thompson et al [3] suggested that there
is a perceived need amongst Sports specialists for first aid skills. However
I received no response to my letter concerning this, [4] which indirectly posed
the question, ‘should doctors who attend aquatic sports be able to deal with
a suspected cervical spine fracture and recover the casualty?’ Obviously, that
is the task of a lifeguard in the same way that first aid at non-aquatic events
is the task for a first-aider but perhaps doctors should be competent first-aiders
and/or lifeguards. This was never in the medical school curriculum and perhaps
that should change. At least first-aid training is part of sports medicine courses
but I would like to suggest that lifeguarding should also be included. I would
also suggest that all doctors at aquatic events should hold the NPLQ, NBLQ or
at least bronze medallion and bronze cross of the RLSS or overseas equivalent.
Should any sports medicine course want advice on this they should contact the
RLSS at River House, High St., Broom, Alcester, Warwickshire, B50 4HN (http://www.lifesavers.org.uk/). I would
be happy to help out but would make 2 stipulations; everyone on the course should
feel obliged to join the RLSS and they should sponsor me for my next fund-raising
event for the RNLI!
Paul Schur
References
(1) Lavis M, Rose J, Jenkinson T. Sports doctors’ resuscitation skills under
examination: do they take it seriously? Br J Sports Med 2001;35: 128-130.
(2) Bottomley MB. Sorts doctors’ resuscitation skills under examination-additional
facts. Br J Sports Med 2001;35: 283.
(3) Thompson B, McNally O, Neill SO et al. What is a sports medicine specialist?
A pilot study. Br J Sports Med 2000;34: 243-4.
(4) Schur P. What is a sports medicine specialist? Br J Sports Med 2000;34: 474.
I would like to thank Dr Shrier for his letter and make a couple of
comments in reply.
First, I would like to emphasise the point I was making in my
original letter. When discussing an ill-defined procedure, as exemplified
by 'stretching', it is important to be precise about what is being done to
what, when and for how long for comparisons to be made or for valid debate
to proceed.
I would like to thank Dr Shrier for his letter and make a couple of
comments in reply.
First, I would like to emphasise the point I was making in my
original letter. When discussing an ill-defined procedure, as exemplified
by 'stretching', it is important to be precise about what is being done to
what, when and for how long for comparisons to be made or for valid debate
to proceed.
Second, I agree that further studies need to be done but care must be
taken with exact definitions. I have heard it suggested that, in the
context of slalom kayaking, both over stretching and under stretching
might be contributory factors in shoulder injury. In a complex
biomechanical system, both statements may be equally true depending on
what one is considering in the kinetic chain.
Dear Editor
We cannot help but note the correlation between the results of this study of female athletes, and the study conducted on male long distance runners in Denmark [1]. We propose that sunshine might be the common factor driving the observed bone loss in these two, apparent...
Dear Editor
The helmets worn in ice hockey - what is their specification and composition? They look like canoeing-type and very thin plastic, if so, it is no wonder head injuries continue. The players need padded helmets more like motorcycle crash helmets to withstand the knocks with a layer of polystyrene or other shock absorbing material.
Dear Editor
I enjoyed reviewing for this journal very much and can only hope that more journals will use a similar electronic system.
Having waited over 16 weeks to hear from a different journal, I think that the electronic system provides an excellent service to the authors.
Dear Editor
Waddington et al.[1] have highlighted an important issue in the context of sport injury management. However, this article, like many others, provides erroneous information and percpetions of 'qualified physiotherapists'. In the UK a physiotherapist must be State Registered (CPSM at present) to work in the NHS. A physothrapist does not need to be 'chartered' - i.e. a Member of the Chartered Socie...
Dear Editor
I read with interest the report of atrial fibrillation and syncope in a body builder taking anabolic steroids and bromocriptine.[1] Drs Manoharan, Campbell and O'Brien present an interesting and perceptive report of bromocriptine misuse. Several additional points can be made regarding this case. While the authors noted the effect of the fasting state on bromocriptine kinetics,[2] in addition bromocriptine an...
In their recent article 'Intensive training in elite young female athletes,' Baxter-Jones and Maffulli reviewed 18 manuscripts and concluded 'training does not appear to affect growth and maturation .'[1] We have two concerns about this conclusion. First, we agree that analyses of cross -sectional and cohort data in this population are confounded by sampling bias; gymnasts who are successful at an elite leve...
Dear Editor
Lavis et al [1] seek to explain the poor results obtained by candidates undertaking the Bath University diploma in sports and exercise medicine as a failure of the candidate to take the subject seriously. They expect the standard to be comparable to “that required of a candidate completing the same task on an ATLS, PHTLS or ALS course.”
A candidate undertaking any of the above courses, or a...
Dear Editor
I congratulate you for researching the importance of appropriate soccer ball size. Your article on distal radial fractures was cited in The New York Times shortly after being published, shedding light on a potentially preventible injury in soccer. It seems possible that if children just played with junior-sized balls, fewer would get hurt by distal radial fractures. I would like to add some...
I cannot resist the temptation to join the debate on sports doctors’ resuscitation skills [1,2]. The study by Thompson et al [3] suggested that there is a perceived need amongst Sports specialists for first aid skills. However I received no response to my letter concerning this, [4] which indirectly posed the question, ‘should doctors who attend aquatic sports be able to deal with a suspected cervical...
Editor,
I would like to thank Dr Shrier for his letter and make a couple of comments in reply.
First, I would like to emphasise the point I was making in my original letter. When discussing an ill-defined procedure, as exemplified by 'stretching', it is important to be precise about what is being done to what, when and for how long for comparisons to be made or for valid debate to proceed.
S...
Pages