Dissecting the doctor-dancer relationship: health care decision making among American collegiate dancers.

OBJECTIVE: To examine perceptual influences on dancers' health care-seeking decisions and whether dancers' beliefs correlate with actual use of provider services when they are injured. Secondary aims were to understand how dancers may select physicians and what they consider to be the most important features of the medical consultation. DESIGN: Prospective cohort study. SETTING: University and conservatory dance departments. PARTICIPANTS: Forty American collegiate dancers. ASSESSMENT OF RISK FACTORS: Before the start of the dance semester, all participants completed a retrospective survey that included baseline demographic data, dance experience, a dance-related injury (DRI) inventory, previous health care exposures, and perceptions regarding health care treatment providers. Data regarding new DRIs and health care exposures were then prospectively collected every 2 weeks for 6 months. MAIN OUTCOME MEASUREMENTS: A DRI was defined as any neuromusculoskeletal condition sustained as the result of dancing activity that caused a dancer to stop or modify his or her dancing for more than 3 consecutive days. RESULTS: Dancers perceived dance teachers to be first-line treatment providers (47.5%), followed by physical therapists (PTs; 30%). Physicians were ranked third (12.5%) and only marginally higher than a dance colleague (10%). The dancers expressed a strong preference for nonsurgical rather than surgical physicians (87.5% versus 5.0%), and among physicians, the majority of dancers preferred subspecialists (60%), namely nonsurgical sports medicine doctors and physiatrists. During the 6-month prospective data-collection period, 25 dancers (69.4%) sustained 55 unique injuries, with 22 dancers (88%) and 34 injuries (61.8%) undergoing evaluation. Only 17.7% of injuries were evaluated by a physician. Dancers showed greater incongruity between their preinjury perceptions and postinjury use of physicians than they did with PTs (P = .0002). CONCLUSIONS: Although dancers did not perceive physicians to be first-line treatment providers for DRIs, these perceptions about physicians were poorly correlated with use. Instead, injured dancers' health care-seeking behaviors were more likely related to relatively decreased barriers to other nonphysician providers, as well as pre-existing referral pathways to PTs.

Exercise in the older adult: from the sedentary elderly to the masters athlete.

The diverse exercise goals of the aging population present several challenges to physicians. Whereas some Masters athletes aim to set personal time records, sedentary elderly persons may look to exercise to help maintain independence and combat functional decline. This review article examines the common cardiovascular and neuromuscular physiological changes associated with aging and how regular exercise is used to improve physiological parameters and functional abilities. Exercise precautions specific to the elderly population are discussed. Exercise recommendations for persons with osteoarthritis and after joint arthroplasty also are presented.

Expression pattern of zebrafish tcf7 suggests unexplored domains of Wnt/beta-catenin activity.

Tcf/Lef transcription factors play an important role in mediating canonical Wnt signaling. When bound by beta-catenin, Tcf/Lef proteins either activate or de-repress gene transcription. In zebrafish, four members have been identified: Lef1, Tcf3, Tcf3b, and Tcf4. Here, we report the cloning and expression of the tcf7 gene. Forms of Tcf7 expressed in the embryo contain two highly conserved regions: an N-terminal beta-catenin binding domain and a C-terminal HMG domain. Tcf7 lacks a putative Groucho corepressor binding site, suggesting that, like Lef1, it functions as a transcriptional activator. We isolated three C-terminal splice variants of tcf7 corresponding to human B, C, and D isoforms. tcf7 expression overlaps with lef1 expression maternally, in the tail bud, fin buds, and paraxial mesoderm, and we expect that the two genes function redundantly in those areas. tcf7 is also expressed in nonoverlapping areas such as the prechordal mesoderm, dorsal retina, and median fin fold, suggesting unique functions.