Recurrent childhood wheezing and exercise induced asthma in later life.

AIM: Exercise induced asthma (EIA) common in endurance and other athletes limits physical activity. Although a correlation between recurrent childhood bronchitis and the development of asthma has been reported, its relation to EIA in adult athletes has not been assessed. The study evaluates the EIA risk after recurrent childhood wheezing (RCW) and its aggravating influence on the known risk factors outdoor and professional sports. METHODS: To evaluate the effect of RCW on EIA, 570 multiple choice questionnaires were evaluated, assessing the history of RCW and the EIA occurrence. The latter was defined either according to physician-derived diagnosis, by typical symptoms or by decrease of the 1-second forced expiratory volume after a 6-minute running test. Contingency tables and a logistic regression model were worked out to describe referring parameters of EIA incidence. RESULTS: Almost one quarter of the athletes with RCW were attributed positive for EIA. Contingency calculations revealed a 2.6 times higher chance of symptoms of EIA after RCW which further increased in outdoor sports on a professional level. The duration of sports participation, cold environment and self-limiting of symptoms are predicting factors of a higher risk of EIA, being responsible for 53% of the prevalence variance. CONCLUSION: The results point towards a facilitating effect of recurrent affections of the respiratory tract in young age in addition to generally accepted factors of EIA in adults. For safe sports participation, the athlete, as well as involved caregivers (parents, coach) should have an adequate knowledge of EIA and prevention/intervention strategies like warming up or the use of inhalers.

Implementation of structured physical activity in the pediatric stem cell transplantation.

The peripheral blood stem cell transplantation (PBSCT) represents a specific, but stressful therapy for hemato-oncological diseases. While for adults, data suggest positive eff ects for a supportive sport therapy, this question is not evaluated sufficiently for children. The objective of this study was to examine the integration of sports activity into pediatric PBSCT and to indicate attainable results. This 2-step case-control-study included 23 children and adolescents from the PBSCT: During the isolation phase 13 patients trained 3 times per week on a cycle ergometer and passed a course with different sports equipment. Apart from recording physiologic adaptations, quality of live was inquired in a pre-post design using questionnaires. Guided interviews according to necessity and requirements for sports activity at the PBSCT unit completed the evaluation and were used for the intervention as well as for the control group (n = 10) without sports therapy. On the ergometer, patients trained average 25 min with 0.6 watt / kg. In the majority, a loss of muscular power could be avoided. Quality of life and fatigue symptoms improved by trend. Interview analysis showed general acceptance of physical activity during PBSCT. After initial skepticism due to the additional burden, our implementation study showed the feasibility of supportive sports therapy in PBSCT. Quality and flexibility of the equipment should be higher than normal and different physical and psychological conditions of the patients should be anticipated and integrated into the training program.

The importance of accurate microorganism identification in microbial challenge tests of membrane filters--part I.

Microbial challenge testing is a common procedure to determine the retention efficiency, performance, and validity of a sterilizing-grade filter. The ASTM 838-05 standard describes a bacteria challenge test procedure based on Brevundimonas diminuta (ATCC 19146), routinely used to verify a 0.2 µm rated sterilizing-grade filter. Process validation procedures most often also utilize B. diminuta (ATCC 19146), but instead of the standard procedures and fluids, process, and product parameters are employed to determine whether these parameters influence the retentivity of the filter or changes to the challenge organism, which might result in the penetration of the filter. In certain instances, the native bioburden within the drug manufacturing process is used to perform such process validation challenge tests. Filter penetrations can happen and cause concern; therefore, it is essential to identify the organism species with accuracy to avoid unnecessary confusion. This paper and its follow-up will describe such imprecision and the resulting misconceptions. It will clarify past determinations and put perspective on the findings. LAY ABSTRACT: Sterilizing-grade filters are used to remove microorganisms from biopharmaceutical solutions. To determine the retention performance of such filters, bacteria challenge tests are utilized, often with a standard challenge organism (Brevundimonas diminuta), in instances with native bioburden. The accuracy of the microorganism identification is of importance to avoid flawed results and misinterpretation of the filter's performance.

[Health prevention for children and adolescents in competitive sports]. / Leistungssport und Gesundheitsvorsorge bei Kindern und Jugendlichen.

The promotion of sport talents in Germany is federally standardised. Apart from the training and management support, annual sports-medical investigations with standardised procedures are mandatory for athletes' health and safety. For the first time, this study evaluates the prevalence ratio of medical findings in Hessian top athletes. The data of all athletes presenting in one of the 27 licenced examination centres in Hesse during the period of investigation were evaluated for age, sex and sports discipline as well as medical findings and a trinomial classification of the sports-related health status. The completeness of this collection in the relevant period from November 2006 to October 2007 was assured by cross-checking the application charts of all related sports associations. Data of 1620 (m: 904, 14.8 +/- 2.5 years; w: 716, 14.3 +/- 2.6 years) of all 1713 athletes presenting during the evaluation period were used for analysis. Medical findings (e. g., resulting in follow-up evaluation or further consultations) were seen in 83.5 % of all athletes. A small group (3.6 %) was temporarily, and one single athlete was completely exempted from sports participation. These results underline (additionally to the preventive capability of sports-medical investigations) the need for an annual medical consultation of juvenile athletes. Further investigations should be extended to other districts and classes and might evaluate the direct and indirect costs of diseases.

[Sports medical aspects in cardiac risk stratification--heart rate variability and exercise capacity]. / Sportmedizinische Aspekte kardialer Risikostratifizierung: Herzfrequenzvariabilität und physische Leistungsfähigkeit.

The present study investigates the association of the predicted CHD-risk (PROCAM) with the individual endurance capacity and heart rate variability (HRV) in a population-based sample of sedentary elderly. After stratification, in 57 men (48.1+/-9.5 yrs.) with an overall PROCAM-risk <10% (28.7+/-10.9 points) and 22 men (54.5+/-7.7 yrs.) with a coronary 10-year risk > or =10% (50.8+/-5.6 points) cycle ergometries and short-term HRV analysis of time (RRMEAN, SDNN, RMSSD) and frequency domain parameters (LF, HF, TP, LF/HF) were conducted. Additionally the autonomic stress index (SI) was calculated. Nonparametric tests were used for statistical correlation analysis (Spearman rho) and group comparisons (Mann-Whitney). For endurance capacity [W/kg] (r=-0.469, p<0.001), SDNN (r=-0.302, p<0.05), RMSSD (r= -0.311, p<0.05), LF (r=-0.325, p<0.05), HF (r= -0.311, p<0.05) and TP (r= -0.307, p<0.05) negative monotone correlations with the coronary score-risk were determined. Significant positive correlations were calculated for SI (r=0.476, p<0.001). Except for RRMEAN and LF/HF significant group differences (p<0.05) were computed for SDNN (30.0+/-20.0 vs 20.0+/-10.0 ms), RMSSD (22.2+/-18.3 vs 18.0+/-8.7 ms), LF (90.9+/-241.5 vs 41.35+/-81.1 ms(2)), HF (43.0+/-105.1 vs 18.0+/-27.0 ms(2)) and TP (189.0+/-457.1 vs 100.0+/-157.6 ms(2)). Significant differences (p<0.01) were evaluated for exercise capacity (2.4+/-0.5 vs 1.8+/-0.3 W/kg) and SI (90+/-183 vs 322+/-291). The results underline the predictive value of HRV analysis in risk stratification and outline the interrelation of a decreased exercise capacity and autonomic function with a raised individual 10-year cardiac risk. As an independent parameter of the vegetative regulatory state the stress index may contribute to an increased practical relevance of short-time HRV analysis.