Knowledge gaps of medical and pharmacy students with respect to performance enhancing drugs in sport: a pilot study.

BACKGROUND: Central to the work of medical and pharmacy practitioners is the provision of pharmaceutical support for patients, who may also be competitive athletes. This study aimed to assess the knowledge gaps of medical and pharmacy students at the University of Malta regarding World Anti-Doping Code and the Prohibited List. METHODS: All medical and pharmacy students studying at the University of Malta were invited to participate in an online questionnaire devised by the research team. This questionnaire assessed knowledge regarding the prohibited status of 19 substances, as well as knowledge regarding therapeutic use exemptions. The questionnaire was prepiloted with local experts in the sports doping field to test face validity, and then tested for content clarity and easy of use by 20 medical and pharmacy students. Total scores were used to compare medical student vs. pharmacy student and athlete vs. non-athlete using the Mann-Whitney U Test. RESULTS: A total of 242 students answered the questionnaire, 58% of which were female. 86% of respondents were medical students. From of the cohort of respondents, 22% identified themselves as athletes as per definition provided in the questionnaire. A number of substances, such as diuretics, morphine, cocaine and ecstasy, were incorrectly classified by the majority of participants. Paracetamol, caffeine, vitamins, NSAIDs, and antihistamines were mostly correctly classified. Pharmacy students had better knowledge when compared to medical students (U value =2734.5, P value =0.034). Student athletes did not have more knowledge than non-athletes (U value =4810.5, P value =0.659). CONCLUSIONS: Medical and Pharmacy students have significant knowledge gaps when it comes to performance enhancing drugs in sport. Sports pharmacy should be included as part of the undergraduate curriculum for both medicine and pharmacy, but especially for medical students who will be future prescribers.

Negative Poisson's ratios in tendons: An unexpected mechanical response.

Tendons are visco-elastic structures that connect bones to muscles and perform the basic function of force transfer to and from the skeleton. They are essential for positioning as well as energy storing when involved in more abrupt movements such as jumping. Unfortunately, they are also prone to damage, and when injuries occur, they may have dilapidating consequences. For instance, there is consensus that injuries of tendons such as Achilles tendinopathies, which are common in athletes, are difficult to treat. Here we show, through in vivo and ex vivo tests, that healthy tendons are highly anisotropic and behave in a very unconventional manner when stretched, and exhibit a negative Poisson's ratio (auxeticity) in some planes when stretched up to 2% along their length, i.e. within their normal range of motion. Furthermore, since the Poisson's ratio is highly dependent on the material's microstructure, which may be lost if tendons are damaged or diseased, this property may provide a suitable diagnostic tool to assess tendon health. STATEMENT OF SIGNIFICANCE: We report that human tendons including the Achilles tendons exhibits the very unusual mechanical property of a negative Poisson's ratio (auxetic) meaning that they get fatter rather than thinner when stretched. This report is backed by in vivo and ex vivo experiments we performed which clearly confirm auxeticity in this living material for strains which correspond to those experienced during most normal everyday activities. We also show that this property is not limited to the human Achilles tendon, as it was also found in tendons taken from sheep and pigs. This new information about tendons can form the scientific basis for a test for tendon health as well as enable the design of better tendon prosthesis which could replace damaged tendons.