Focus On...Youth Violence Prevention

Recognizing & preventing youth violence: A guide for physicians & other health care professionals

Massachusetts Medical Society Committee on Youth Violence

Editor’s Note: The task force on youth violence initiated by the Wisconsin Medical Society in February of 2002 heard from physicians and other health care professionals of the need for protocols during office visits to help identify children at risk for violence. After reviewing many studies, it was clear the Massachusetts Medical Society Committee on Youth Violence had developed what the task force was looking for.



Author Affiliations: This portion of the Massachussetts Medical Society Committee on Violence’s publication Recognizing & Preventing Youth Violence: A Guide for Physicians & Other Health Care Professionals is reprinted with permission.


Corresponding Author: Please address correspondence to the Wisconsin Medical Society at 608.442.3800

Editorials

Treating the Health of Wisconsin Athletes

John J. Frey, III, MD

In This Issue

Author Affiliations: Medical Editor, Wisconsin Medical Journal

Corresponding Author: Wisconsin Medical Journal

Original Research

Athletic Amenorrhea and Endothelial Dysfunction

Anne Z. Hoch, DO; Jason W. Jurva, MD; Megan A. Staton, MD; Robert Thielke, PhD; Raymond G. Hoffmann, PhD; Nick Pajewski, BS; David D. Gutterman, MD

Objectives: To determine if menstrual status changed in amenorrheic college runners over a 2-year period and what effect this had on brachial artery flow-mediated dilation.

Participants: Eighteen athletes first studied in our laboratory 2 years prior were available for follow-up. Nine of the 10 original women with athletic amenorrhea (mean + SE, age 21.3 + 1.2 yrs), and 9 of the 11 eumenorrheics/controls (age 20.1 + 0.5 yrs) were studied 2 years after baseline measurements.

Methods: Questionnaires/personal interviews and blood draws were performed to determine menstrual status. A non-invasive ultrasound technique was used to determine brachial artery flow-mediated dilation (endothelium-dependent).

Results: Menstrual status changed in 7 of 9 original amenorrheic subjects (2 were taking hormone replacement, 2 were taking oral contraceptives, 3 had a natural menstrual period prior to testing, and 2 remained amenorrheic). Endotheliumdependent brachial artery dilation, measured as the percent change in maximal brachial artery diameter from baseline during reactive hyperemia, was improved in the original amenorrheic subjects (a 1.1% + 1.0 increase in the original study versus 5.6% + 1.1 increase in the current study, P=0.01) while in the eumenorrheic/control group there was no change (6.3% + 1.7 versus 8.0% + 1.3, P=0.42).

Conclusions: Menstrual status changed in 7 of the 9 original amenorrheic athletes, and this change was associated with an improvement in brachial artery flow-mediated dilation.



Author Affiliations: Departments of Orthopaedic Surgery/Cardiovascular Center (Hoch, Staton), Cardiovascular Center (Jurva, Gutterman), General Clinical Research Center (Thielke, Hoffman, Pajewski), Medical College of Wisconsin, Milwaukee, Wis.

Corresponding Author: Anne Z. Hoch, DO, Associate Professor, Sports Medicine Center, Women’s Sports Medicine Program, Department of Orthopaedic Surgery/Cardiovascular Center, 9200 W Wisconsin Ave, Medical College of Wisconsin, Milwaukee, Wis 53226; phone 414.805.7461; fax 414

A Survey of Inner City Youth and Their Parents about Participation in Sports

Sharon L. Busey, MD; Casey G. Batten, MD; Craig C. Young, MD; Dawn S. Bragg, PhD

Background: Several studies have explored motivating factors for sports participation for youth, but limited data is available regarding factors motivating inner-city children to participate in sports.

Methods: A consecutive sample of parents (n=100 parents) and children (n=138 children) attending a health fair in an inner-city community were surveyed regarding motivating factors for enrolling in a team sport (or enrolling their child in a team sport). Parents and children indicated the importance of 10 factors (1=not very important to 4=very important) on separate but similar written surveys.

Results: “Developing healthy habits” and “Becoming physically fit and healthy” received the highest mean rankings from both parents and children. “Helping my child gain or lose weight” received one of the lowest rankings from parents.

Conclusions: To encourage sports participation by inner-city children, health care professionals and others should emphasize identified motivational factors for children and their parents.


Author Affiliations: Departments of Pediatrics, Medical College of Wisconsin, Milwaukee, Wis (Busey); Orthopaedics and Family & Community Medicine, Medical College of Wisconsin, Milwaukee, Wis (Young); Academic Affairs, Medical College of Wisconsin, Milwaukee, Wis (Bragg); De

Corresponding Author: Sharon Busey, MD, Medical College of Wisconsin, Department of Pediatrics, Downtown Health Center, 1020 N 12th St, Milwaukee, Wis 53233; phone 414.277.8920; fax 414.277.8939; e-mail sbusey@mcw.edu

Characteristics of School-Sanctioned Sports: Participation and Attrition in Wisconsin Public High Schools

Matthew J. Landis, MS; Paul P. Peppard, PhD; Patrick L. Remington, MD, MPH

Introduction: Successful approaches are needed to decrease the burden of obesity on America’s youth. Researchers often look to the high school interscholastic sports experience as a promising area for intervention. The purpose of this paper is to examine trends in participation over the course of a 4-year educational period.

Methods: Two research questions are posed in this study: (1) how does participation in interscholastic sports change over the high school interscholastic sports experience, and (2) how do gender and school size influence these patterns? To answer these questions, a panel study is used to prospectively follow 412 Wisconsin public high schools from freshman year (2000-2001) to senior year (2003-2004). Participation prevalence (percent participation) in freshman year and risk of attrition (defined as a reduction in prevalence) from freshman to senior year are reported for sport, gender, and school size characteristics.

Results: Overall sports participation is greatest in smaller schools versus larger schools for both females (36% versus 20%) and males (38% versus 25%). Most high school sports exhibit declines in participation, including those sports with the highest prevalence of freshman participation. Compared to sports participants attending large schools, participants attending small schools have a lower risk of attrition from freshman to senior year. However, female attrition is much higher than male attrition in small schools, whereas this difference is not as apparent in large schools.

Conclusion: The results of this research suggest school size and gender play important roles in initial and sustained involvement during high school. Despite the potential immediate and long-term benefits of high school interscholastic sports participation, there is limited research that prospectively examines patterns of participation through high school. Expanding the use of this measurement approach may effectively promote physical activity as youth grow into adults.


Author Affiliations: University of Wisconsin Population Health Institute (Landis, Peppard, Remington).

Corresponding Author: Matthew Landis, UW Population Health Institute, Department of Population Health Sciences, University of Wisconsin School of Medicine and Public Health, Ste 760, 610 Walnut St, Madison, WI 53726-2397; e-mail mjlandis@wisc.edu

Correlates of Postpartum Alcohol Use

Tanya D. Jagodzinski, MD; Michael F. Fleming, MD, MPH

Objective: The purposes of this investigation are to (1) describe drinking patterns among women attending a postpartum visit, and (2) identify correlates of postpartum “at risk” drinking.

Methods: A survey was completed by 8706 women at their postpartum visit. We identified correlates of “at risk” drinking, defined as binge drinking (4 or more drinks per occasion at least once in the past month) or consuming an average of >7 drinks/wk.

Results: A total of 997 women (12%) reported “at risk” drinking. At risk drinkers were more likely than other women to have been frequent drinkers prior to pregnancy (>7 drinks/wk), scored 1 or 2 on the CAGE, smoked postpartum, and been unmarried. Black women, those over age 35, “stay-at-home mothers,” and women having breastfed were less likely to report “at risk” drinking.

Conclusion: This study supports routine alcohol screening of women attending a postpartum visit with their obstetrician.



Author Affiliations: University of Wisconsin – Madison, Madison, Wis (Jagodzinski, Fleming).

Corresponding Author: Tanya D. Jagodzinski, MD, 2870 University Ave, Suite 205, Madison, WI 53705; phone 608.263.0950; fax 608.263.5813; e-mail tjagodzinski@wisc.edu

Acute Cystitis in Women: Experience with a Telephone-Based Algorithm

Charles W. Schauberger, MD, MS; Ken W. Merkitch, MD; Ann M. Prell, RN

Objective: This paper evaluates short-term (60-day) outcomes for women with symptoms of acute cystitis evaluated and treated with a telephone-based protocol.

Methods: We used a retrospective analysis of medical records of patients evaluated and treated according to a guideline-based algorithm for symptoms of acute cystitis.

Results: The algorithm was utilized in the care of 273 women reporting symptoms of urinary tract infection (UTI), with 75.4% being treated without urinalysis or cultures. Over the next 60 days, 46 (16.8%) were seen or made phone contact for recurrent or persistent urinary tract symptoms, with 6 patients (2.2%) diagnosed with pyelonephritis. No other adverse events were identified in the 60 days after use of the protocol.

Conclusions: A telephone-based nurse evaluation and treatment algorithm can allow for successful management of the majority of women identifying symptoms of uncomplicated lower UTIs.


Author Affiliations: Department of Obstetrics and Gynecology, Gundersen Lutheran Medical Center, La Crosse, Wis (Schauberger, Merkitch, Prell).

Corresponding Author: Charles Schauberger, MD, 1900 South Ave, La Crosse, WI 54601; phone 608.775.2748; fax 608.775.6611; e-mail cwschaub@gundluth.org.

Sport-Specific Injuries and Medical Problems of Figure Skaters

Emily B. Porter, MD; Craig C. Young, MD; Mark W. Niedfeldt, MD; Laura M. Gottschlich, DO

Figure skating is becoming increasingly popular as both a recreational and competitive sport. As the number of figure skating participants increases, so will the number of active patients who present to their primary care physician with sport-related injuries and medical problems. Figure skating is a unique sport that continues to evolve and progress with participants partaking in more difficult moves and more rigorous training programs. Common problems in figure skating include acute musculo-skeletal injuries and chronic overuse injuries, which primarily occur in the foot, ankle, knee, leg, hip, and lower back. Figure skaters are also more likely to endure specific medical problems such as exercise-induced bronchospasm and eating disorders. Primary care physicians are able to contribute to their figure skating patient’s health by recognition and appropriate treatment of acute injuries and prevention of chronic injuries and other medical problems.

Author Affiliations: University of Wisconsin, Department of Family Medicine, Madison Residency Program (Porter); Medical College of Wisconsin, Milwaukee, Wis (Young, Niedfeldt, Gottschlich).

Corresponding Author: Emily B. Porter, MD, 21 S Vine St, Belleville, WI 53508; phone 608.424.3384; e-mail emily.porter@fammed.wisc.edu

Sudden Cardiac Death in Young Athletes: Trying to Find the Needle in the Haystack

Benton Ng, MD; Kathleen R. Maginot, MD

Sudden cardiac death in young athletes is an infrequent, but catastrophic event. Hypertrophic cardiomyopathy, coronary artery anomalies, and arrhythmias are common identifiable causes of sudden cardiac death. Many of these disorders can be difficult to diagnose, and athletes may be completely asymptomatic prior to their sudden death event. This article reviews causes of sudden cardiac death in young athletes and current recommendations for pre-participation screening.

Author Affiliations: University of Wisconsin School of Medicine and Public Health, Madison, Wis (Ng, Maginot)

Corresponding Author: Kathleen Maginot, MD, Department of Pediatrics, Division of Cardiology, University of Wisconsin School of Medicine and Public Health; phone 608.263.8535; fax 608.265.8065; e-mail krmaginot@wisc.edu

Your Practice

A Case for Advance Directives

Ruth Heitz, JD, Wisconsin Medical Society General Counsel

From the Office of General Counsel . . .

Author Affiliations: Wisconsin Medical Society General Counsel

Corresponding Author: Wisconsin Medical Society

Family Limited Partnerships preserve wealth

Mark I. Boebel, CPA/ABV, CVA

Corresponding Author: Please address coorespondence to Wisconsin Medical Society

MetaStar Matters

Jay Gold, MD, MPH, JD

Physicians should make use of ‘Welcome to Medicare’ visit

Author Affiliations: MetaStar

Corresponding Author: Please direct correspondence to Wisconsin Medical Society

Your Profession

Tackling obesity from many angles

Robert N. Golden, MD

Author Affiliations: Dean, University of Wisconsin School of Medicine and Public Health, Vice Chancellor for Medical Affairs, University of Wisconsin-Madison

Corresponding Author: University of Wisconsin School of Medicine and Public Health