Contraception, female cycle disorders and injuries in Swiss female elite athletes-a cross sectional study.

Aim: The national Olympic committee of Switzerland has conducted an online survey among female elite athletes with a focus on cycle disorders, contraception, and injuries in 2021. Methods: A total of 1,092 female elite athletes from 107 different sports were asked to answer the questionnaire. A descriptive analysis was carried out to determine location parameters and create frequency tables. Results: The questionnaire was completed by 408 athletes (37.4%) from 92 different sports. 43.4% participated in a lean sport. 57.1% reported no injuries, 32.6% one injury, and 10.2% two or more injuries per year. A considerable proportion reported being affected by primary amenorrhoea (10.8%). Primary amenorrhoea occurred significantly more often in female athletes with a BMI lower than 21.7 kg/m2 (15.2%) than in athletes with a BMI above 21.7 kg/m2 (7.4%, p = 0.021). Considering contraception, 25.8% of female athletes were currently using an oral contraceptive pill. The proportion of female athletes not using contraception at all or using non-hormonal contraceptive methods was high at 54.4%. In lean sports, significantly more athletes used no or non-hormonal contraceptives (p < 0.05). Conclusion: Among top Swiss female athletes, a considerable proportion used non-hormonal or no contraceptives. This trend was more evident in lean sports. Delayed menarche and cycle irregularities were common among female athletes, especially among athletes with high training volumes as well as a BMI below 21.7 kg/m2. This orienting survey underlines the importance of specialized gynecological care for elite female athletes.

Diagnostic delay in moderately/poorly differentiated breast cancer types.

BACKGROUND: Diagnostic delay of breast cancer related to the false-negative assessment of the healthcare provider leads to tumor progression and might worsen the outcome. Previous studies found some factors associated with provider-related diagnostic delay; however, tumor biology has tended not to be considered. The aim of our study was to find differences in diagnostic delay of poorly differentiated breast cancer types. METHODS: Data of 970 patients with newly diagnosed moderately/poorly differentiated (G2/3) breast cancer at the age ≥40 years was retrospectively analyzed regarding breast cancer type, diagnostic delay and its consequence, clinical factors and physician's assessment. Multivariate analysis was used to evaluate associated factors with diagnostic delay. RESULTS: We observed a diagnostic delay in 3.8% (n = 37) of all patients. Mean delay time was 128 days, and clinically relevant tumor growth was observed in 43.2% of these cases. Delay was significantly higher in the group of triple-negative breast cancer (9.9% versus 2.7, 5.3 and 1.8% in hormonal receptor (HR)+/human epidermal growth factor receptor 2 (HER2)-, HR-/Her2+ and HR+/Her2+, respectively; P value <0.001). Age, breast density and reason for presentation were not correlated to diagnostic delay. CONCLUSION: Patients with triple-negative breast cancer are at higher risk of receiving a false-negative assessment and experiencing a diagnostic delay. Our results emphasize the importance of a detailed consideration of clinical risk factors and provider training and suggest a broad indication for a core needle biopsy.

Columbia University Master of Public Health Core Curriculum: Implementation, Student Experience, and Learning Outcomes, 2013-2018.

OBJECTIVES: Public health education must respond to 21st-century public health challenges in an ever-evolving landscape. We describe implementation and educational outcomes of the Columbia University Master of Public Health (MPH) Core (hereinafter, Core) curriculum since its inception. METHODS: This retrospective evaluation combined 6 years (2013-2018) of student survey data collected from students (N = 1902) on the structure and delivery of the Core curriculum to quantify implementation, student experience, and learning outcomes, both during study (Core Evaluation Survey [CES]) and after graduation (Graduate Exit Survey [GES]). We used χ2 tests and analysis of variance to compare outcomes across years, and we used McNemar tests to compare differences in outcomes from the same students at different time points. RESULTS: Of 1902 respondents to the CES, 1795 (94.4%) completed the Core curriculum. During the study period, 81.7% of students were able to integrate concepts across Core curriculum modules with ease; postgraduation, a similar proportion of respondents were able to apply Core curriculum content to departmental and certificate coursework and applied field experiences. On-time graduation rates were high (range, 85%-93%). CONCLUSIONS: The high percentage of students who reported their ability to integrate concepts and who completed the Core during the study period likely reflected changes to teaching team structures, training, attention to inclusion and equity, and collaboration to implement active learning strategies. The Core curriculum meets its intended goals by providing critical learning abilities to support ongoing interdisciplinary work.

Changes in Sex Difference in Time-Limited Ultra-Cycling Races from 6 Hours to 24 Hours.

Background and objective: Existing research shows that the sex differences in distance-limited ultra-cycling races decreased with both increasing race distance and increasing age. It is unknown, however, whether the sex differences in time-limited ultra-cycling races will equally decrease with increasing race distance and age. This study aimed to examine the sex differences regarding performance for time-limited ultra-cycling races (6, 12, and 24 h). Methods: Data were obtained from the online database of the Ultra-Cycling Marathon Association (UMCA) of time-limited ultra-cycling races (6, 12, and 24 h) from the years 1983-2019. A total of 18,241 race results were analyzed to compare cycling speed between men and women by calendar year, age group (<29; 30-39; 40-49; 50-59; 60-69; >70 years), and race duration. Results: The participation of both men (85.1%) and women (14.9%) increased between 1983 and 2019. The age of peak performance was between 40 and 59 years for men and between 30 and 59 years for women. Between 2000 and 2019, more men (63.1% of male participants and 52.2% of female participants) competed in 24 h races. In the 24 h races, the sex difference decreased significantly in all age groups. Men cycled 9.6% faster than women in the 12 h races and 4% faster in the 24 h races. Both women and men improved their performance significantly across the decades. Between 2000 and 2019, the improvement in the 24 h races were 15.6% for men and 21.9% for women. Conclusion: The sex differences in cycling speed decreased between men and women with increasing duration of ultra-cycling races and with increasing age. Women showed a greater performance improvement than men in the last 20 years. The average cycling speed of men and women started to converge in the 24 h races.

Cognitive health after menopause: Does menopausal hormone therapy affect it?

Dementia is a pandemic chronic non-communicable disease. 10 in 100 women above age 65 will be diagnosed with dementia, primarily Alzheimer's disease (AD). Apart from age and hereditary risk factors, there are multiple acquired risk and protective factors. So far, Menopausal Hormone Therapy (MHT) is not recommended as preventive measure. A systematic literature search on MHT and dementia risk and MHT and cognitive performance in demented women, respectively, was performed. Two recent meta-analyses identified 18 and 16 studies analyzing the impact of MHT on dementia/AD risk. Our systematic literature search identified eight additional original articles. The majority of studies found a risk reducing impact of MHT by 11-33%. However, results may vary depending on MHT type, age at initiation and study design. For example, the Women's Health Initiative Memory Study (WHIMS) reported an approximately 2-fold increased risk of dementia/Alzheimer's disease if MHT comprising conjugated equine estrogens and medroxyprogesterone acetate was initiated in predominantly comorbid postmenopausal women above age 65. In general, MHT displays a beneficial effect on several dementia risk factors and also augments some protective factors. Accordingly, clinicians can be reassured that MHT can be safely prescribed in the context of cognition in women free of dementia. However, MHT is not indicated for cognitive improvement in demented women. International scientific guidelines on MHT and dementia should consider incorporating most recent data.

Can the Performance Gap between Women and Men be Reduced in Ultra-Cycling?

This study examined a large dataset of ultra-cycling race results to investigate the sex difference in ultra-cycling performance (100 to 500 miles) according to age and race distance. Data from the time period 1996-2018 were obtained from online available database of the ultra-cycling marathon association (UMCA), including distance-limited ultra-cycling races (100, 200, 400, and 500 miles). A total of 12,716 race results were analyzed to compare the performance between men and women by calendar year, age group (18-34, 35-44, 45-59, and 60+ years), and race distance. Men were faster than women in 100 and 200 mile races, but no sex differences were identified for the 400 and 500 mile races. The performance ratio (average cycling speedmen/average cycling speedwomen) was smaller in the 200 mile races compared to the 100 mile races and remained stable in the 400 and 500 mile races. In all race distances, the difference in average cycling speed between women and men decreased with increasing age. The gender gap in performance was closed in several distance-limited ultra-cycling races, such as the 400 and 500 mile races.

Changes in single skinfold thickness in 100 km ultramarathoners.

BACKGROUND: Changes in single skinfold thickness and body fat have been investigated in ultraswimmers and ultracyclists, but not in ultrarunners. The present study investigated the changes in single skinfold thickness during a 100 km ultramarathon. METHODS: Firstly, we investigated associations between prerace preparation and prerace body composition and, secondly, changes in single skinfold thickness during a 100 km ultramarathon in 219 male ultramarathoners. Changes in fat mass and skeletal muscle were estimated using anthropometric methods. RESULTS: Kilometers run weekly prerace and running speed during training were negatively associated with all skinfold thicknesses (P < 0.05) except for the front thigh skinfold. During the race, skinfold thickness at the pectoral (-0.1%), suprailiac (-1.8%), and calf (-0.8%) sites decreased (P < 0.05). The subjects lost 1.9 ± 1.4 kg of body mass (P < 0.001), 0.7 ± 1.0 kg of estimated skeletal muscle mass (P < 0.001), and 0.2 ± 1.3 kg of estimated fat mass (P < 0.05). The decrease in body mass was positively related to the decrease in both estimated skeletal muscle mass (r = 0.21, P = 0.0017) and estimated fat mass (r = 0.41, P < 0.0001). CONCLUSION: Firstly, prerace fat mass and prerace skinfold thickness were associated with both volume and speed in running training. Secondly, during the ultramarathon, skinfold thickness decreased at the pectoral, suprailiac, and calf sites, but not at the thigh site. Percent decreases in skinfold thickness for ultrarunners was lower than the percent decreases in skinfold thickness reported for ultraswimmers and ultracyclists.