Improve the health of the people of Wisconsin by supporting and strengthening physicians' ability to practice high-quality patient care in a changing environment.

Volume 106, Issue 6 (September 2007)

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John J. Frey, III, MD
Treating the Health of Wisconsin Athletes
(full text PDF)

In This Issue

Original Research

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
Athletic Amenorrhea and Endothelial Dysfunction
(full text PDF)

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.

Sharon L. Busey, MD; Casey G. Batten, MD; Craig C. Young, MD; Dawn S. Bragg, PhD
A Survey of Inner City Youth and Their Parents about Participation in Sports
(full text PDF)

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.

Matthew J. Landis, MS; Paul P. Peppard, PhD; Patrick L. Remington, MD, MPH
Characteristics of School-Sanctioned Sports: Participation and Attrition in Wisconsin Public High Schools
(full text PDF)

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.

Tanya D. Jagodzinski, MD; Michael F. Fleming, MD, MPH
Correlates of Postpartum Alcohol Use
(full text PDF)

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.

Charles W. Schauberger, MD, MS; Ken W. Merkitch, MD; Ann M. Prell, RN
Acute Cystitis in Women: Experience with a Telephone-Based Algorithm
(full text PDF)

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.

Review Articles

Emily B. Porter, MD; Craig C. Young, MD; Mark W. Niedfeldt, MD; Laura M. Gottschlich, DO
Sport-Specific Injuries and Medical Problems of Figure Skaters
(full text PDF)

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.

Benton Ng, MD; Kathleen R. Maginot, MD
Sudden Cardiac Death in Young Athletes: Trying to Find the Needle in the Haystack
(full text PDF)

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.

Your Practice

Mark I. Boebel, CPA/ABV, CVA
Family Limited Partnerships preserve wealth
(full text PDF)

Jay Gold, MD, MPH, JD
Physicians should make use of ‘Welcome to Medicare’ visit
(full text PDF)

Your Profession

Ruth Heitz, JD, Wisconsin Medical Society General Counsel
A Case for Advance Directives
(full text PDF)

From the Office of General Counsel . . .

Robert N. Golden, MD
Tackling obesity from many angles
(full text PDF)