Use of prescription drugs in athletes.

Although athletes are young and generally healthy, they use a variety of non-doping classified medicines to treat injuries, cure illnesses and obtain a competitive edge. Athletes and sports medicine physicians try to optimize the treatment of symptoms related to extreme training during an elite athlete's active career. According to several studies, the use of antiasthmatic medication is more frequent among elite athletes than in the general population. The type of training and the kind of sport influence the prevalence of asthma. Asthma is most common among those competing in endurance events, such as cycling, swimming, cross-country skiing and long-distance running. Recent studies show that athletes use also NSAIDs and oral antibacterials more commonly than age-matched controls, especially athletes competing in speed and power sports. Inappropriately high doses and concomitant use of several different NSAIDs has been observed. All medicines have adverse effects that may have deleterious effects on elite athletes' performance. Thus, any unnecessary medication use should be minimized in elite athletes. Inhaled beta(2)-agonists may cause tachycardia and muscle tremor, which are especially harmful in events requiring accuracy and a steady hand. In experimental animal models of acute injury, especially selective cyclo-oxygenase-2 inhibitors have been shown to be detrimental to tissue-level repair. They have been shown to impair mechanical strength return following acute injury to bone, ligament and tendon. This may have clinical implications for future injury susceptibility. However, it should be noted that the current animal studies have limited translation to the clinical setting. Adverse effects related to the CNS and gastrointestinal adverse reactions are commonly reported in connection with NSAID use also in elite athletes. In addition to the potential for adverse effects, recent studies have shown that NSAID use may negatively regulate muscle growth by inhibiting protein synthesis. Physicians and pharmacists taking care of athletes' medication need to be aware of the medicines that an athlete is taking and how those medicines interact with performance, exercise, environment and other medicines. Sport associations should repeatedly monitor not only the use of banned substances, but also the trends of use of legal medicines in athletes. Not only physicians and pharmacists, but also athletes and coaches should be better educated with respect to potential benefits and risks, and how each agent may affect an athlete's performance. The attitudes and beliefs leading to ample use of legal medicines in athletes is an interesting area of future research.

Sexual activity and satisfaction in men with traumatic spinal cord lesion.

OBJECTIVE: To estimate sexual activity and sexual satisfaction in men with spinal cord lesion. DESIGN: Cross-sectional study. SUBJECTS: All adult citizens in Helsinki with traumatic spinal cord lesion were identified. The final study group comprised 92 male subjects, corresponding to a participation rate of 79%. METHODS: A structured questionnaire was sent to all subjects and they were invited for a clinical visit. Clinical examination was based on the manual of the American Spinal Injury Association (ASIA). Examinations were performed on all subjects by the same experienced physician and physiotherapist. RESULTS: In total, 86% of the subjects experienced sexual desire and 68% had been sexually active during the last 12 months. A total of 65% of subjects reported experiencing orgasm since the injury, but most subjects rated it as weaker than before the injury. There were no statistically significant differences between the ASIA Impairment Scale groups. Men with paraplegia reported a more satisfactory sex life (p = 0.05) than those with tetraplegia. CONCLUSION: This study confirms the earlier findings that the ability to reach orgasm is deficient in men with spinal cord lesion. The completeness of the lesion had no effect. The more severe locomotory disability might adversely affect the sex life of persons with tetraplegia compared with those with paraplegia.

Applicability of the ICF checklist to traumatically brain-injured patients in post-acute rehabilitation settings.

OBJECTIVE: To evaluate the applicability of the International Classification of Functioning, Disability and Health (ICF) checklist in post-acute traumatically brain-injured patients in rehabilitation settings. DESIGN: A cross-sectional study based on the written documents of an interdisciplinary rehabilitation team. SUBJECTS: A sample of 55 patients with traumatic brain injury. METHODS: Two raters extracted information from the patients' medical documents using the ICF checklist. The most common ICF categories were identified and the agreement between the raters was evaluated. RESULTS: Of the 123 checklist categories, 30 reached a prevalence of 30% or more in the ratings of both raters, and 18 further categories reached a prevalence of 30% or more in the ratings of either one rater. Seventy-five categories (61%) did not reach the cut-off point and were thus considered irrelevant. Fourteen ICF categories not included in the checklist were also considered important. Extracting the data from pre-existing documents seems to be reliable: in 86% of the most relevant categories the difference between the raters in the qualifier values was at most 1. CONCLUSION: A checklist is a practical tool in clinical work. However, the current ICF checklist seems not to be adequate in characterizing patients with post-acute traumatic brain injury. Developing an ICF core set for these patients might prove useful.

Traumatic brain injury is under-diagnosed in patients with spinal cord injury.

OBJECTIVE: To investigate the occurrence and severity of traumatic brain injury in patients with traumatic spinal cord injury. DESIGN: Cross-sectional study with prospective neurological, neuropsychological and neuroradiological examinations and retrospective medical record review. PATIENTS: Thirty-one consecutive, traumatic spinal cord injury patients on their first post-acute rehabilitation period in a national rehabilitation centre. METHODS: The American Congress of Rehabilitation Medicine diagnostic criteria for mild traumatic brain injury were applied. Assessments were performed with neurological and neuropsychological examinations and magnetic resonance imaging 1.5T. RESULTS: Twenty-three of the 31 patients with spinal cord injury (74%) met the diagnostic criteria for traumatic brain injury. Nineteen patients had sustained a loss of consciousness or post-traumatic amnesia. Four patients had a focal neurological finding and 21 had neuropsychological findings apparently due to traumatic brain injury. Trauma-related magnetic resonance imaging abnormalities were detected in 10 patients. Traumatic brain injury was classified as moderate or severe in 17 patients and mild in 6 patients. CONCLUSION: The results suggest a high frequency of traumatic brain injury in patients with traumatic spinal cord injury, and stress a special diagnostic issue to be considered in this patient group.

EEG and MEG brain-computer interface for tetraplegic patients.

We characterized features of magnetoencephalographic (MEG) and electroencephalographic (EEG) signals generated in the sensorimotor cortex of three tetraplegics attempting index finger movements. Single MEG and EEG trials were classified offline into two classes using two different classifiers, a batch trained classifier and a dynamic classifier. Classification accuracies obtained with dynamic classifier were better, at 75%, 89%, and 91% in different subjects, when features were in the 0.5-3.0-Hz frequency band. Classification accuracies of EEG and MEG did not differ.

Work participation among persons with traumatic spinal cord injury and meningomyelocele1.

OBJECTIVE: To study injury-related and individual factors as predictors of work participation in persons with traumatic and congenital spinal cord injury. DESIGN: Cross-sectional questionnaire study. SUBJECTS: One hundred and eighty-two persons with traumatic spinal cord injury treated in the Spinal Injuries Unit in Sahlgrenska University Hospital, Göteborg, Sweden, and 48 persons with meningomyelocele admitted to the Young Adult Teams in Göteborg, Borås and Skövde, Sweden. METHODS: A structured questionnaire was sent by post. Main outcome variable was participation in work. Logistic regression modelling was used to study the associations between the potential predictors and work participation. RESULTS: Employment rates were 47% in the traumatic spinal cord injury group and 38% in the meningomyelocele group. The presence of other somatic or mental disorder, and neuropathic pain decreased work participation among the men with traumatic spinal cord injury. Among persons with meningomyelocele, better ambulatory status and higher educational level increased work participation. In all groups higher independence in daily activities increased the probability of work participation. According to multivariable modelling carried out for the men with traumatic spinal cord injury, age over 55 years and the presence of mental disorder decreased work participation. CONCLUSION: Our data show that work participation is affected by individual and injury-related factors. Of the latter, many can be affected by rehabilitation.

Motor performance in physically well-recovered men with traumatic brain injury.

OBJECTIVE: The primary aim of this study was to compare the motor performance of physically well-recovered men with traumatic brain injury with that of healthy men. DESIGN: Cross-sectional study in a national rehabilitation centre. METHODS: Static and dynamic balance, agility and rhythm co-ordination of men with traumatic brain injury (n=34) and healthy controls (n=36) were assessed. Between-group differences in dynamic balance and agility were analysed by analysis of covariance and differences in static balance and rhythm co-ordination by logistic regression analysis. Cut-off points for clinical screening were determined by receiver operating characteristics analyses. RESULTS: Men with traumatic brain injury had impaired balance and agility compared with healthy men and in a rhythm co-ordination test they had difficulties in starting and sustaining simultaneous rhythmical movements of hands and feet. In receiver operating characteristics analyses a running figure-of-eight test (agility), tandem walking forwards (dynamic balance) and rhythm co-ordination test with fast tempo were found the most sensitive and specific for distinguishing between men with traumatic brain injury and the healthy men. CONCLUSIONS: The impairments in motor performance of physically well-recovered patients with traumatic brain injury were obvious. The results of this study extend the knowledge of problems in motor performance among patients with traumatic brain injury and provide further information for clinical rehabilitation.

Allergic rhinitis and pharmacological management in elite athletes.

INTRODUCTION: Only a few studies have examined the occurrence of atopy and clinically apparent allergic disease and their pharmacological management in elite athletes. The aim of the study was to assess the frequency of allergic rhinitis and the use of antiallergic medication within the subgroups of elite athletes as compared with a representative sample of young adults of the same age. METHODS: A cross-sectional survey was carried out in 2002. All the athletes (N = 494) financially supported by the National Olympic Committee comprised the study group. Of them, 446 (90.3%) filled in a structured questionnaire concerning asthma and allergies, the use of medication, characteristics of sport activities, and smoking habits. A representative sample of Finnish young adults (N = 1504) served as controls. RESULTS: The endurance athletes reported physician-diagnosed allergic rhinitis more often (36.1%) than other athletes (23.4%) or control subjects (20.2%). The use of antiallergic medication was reported by 33.3, 15.7, and 15.6% of those, respectively. Among both athletes and controls, females reported the use of antiallergic medication more often than males. Only half of those athletes reporting allergic rhinitis had used antiallergic medication during the past year. After adjusting for age and sex, OR (95% CI) for allergic rhinitis and the use of antiallergic medication were 2.24 (1.48-3.39) and 2.79 (1.82-4.28), respectively, in endurance athletes as compared with the controls. CONCLUSIONS: Endurance athletes have physician-diagnosed allergic rhinitis, and they use antiallergic medication more often than athletes in other events or control subjects. Only half of those athletes reporting allergic rhinitis take antiallergic medication. More attention needs to be paid to the optimal management of allergic rhinitis, especially in highly trained endurance athletes.

Health-related quality of life in persons with traumatic spinal cord lesion in Helsinki.

OBJECTIVE: To estimate the health-related quality of life (HRQoL) of persons with spinal cord lesion. DESIGN: The study design was cross-sectional. SUBJECTS: All adult citizens in Helsinki with traumatic spinal cord lesion were identified. The final study group comprised 117 subjects, corresponding to a participation rate of 77%. METHODS: HRQoL was assessed by a generic 15-dimensional self-administered instrument (15D). Clinical examination was based on the manual of the American Spinal Injury Association. Examinations were performed on all subjects by the same experienced physician and physiotherapist. RESULTS: The average 15D score of the study group was significantly lower (p<0.001) than that measured in the age-matched general population sample. Subjects with spinal cord lesion had significantly more problems due to the neurological lesion but also on the dimensions of sleeping, discomfort and symptoms and vitality. In regression analysis of the study group the only variable explaining HRQoL was the neurological level of the lesion. Spinal cord lesion caused more depression and distress in persons with motor incomplete lesion than those with motor complete lesion. CONCLUSION: Persons with spinal cord lesion had lower HRQoL than the population in general. The results indicate that spinal cord lesion may cause problems in the areas of sleeping, discomfort and symptoms or vitality, in particular. More attention should be paid to finding ways of improving the situation of persons with motor incomplete lesion, especially in terms of psychological function.

Prolactin and cortisol responses to the experience of low back pain.

Demographic, clinical and psychological characteristics of 92 patients with low back pain were correlated with prolactin and cortisol levels in cerebrospinal fluid (CSF). Somatization and depression scores correlated statistically significantly with the CSF serum ratio of prolactin both in men and in the total group. An increased CSF/serum ratio of cortisol was slightly associated with somatization scores in the total group. Multiple stepwise regression, furthermore, revealed that somatization, anxiety and one of the pain indices contributed to the variance in the CSF prolactin level, which was mostly dependent on the respective serum level. Sex and electromyographic findings (EMG) accounted for 12 and 7%, respectively, of the variance in the afternoon cortisol levels. Women reported more somatization and depression feelings than did men. Most of the data support our earlier assumption that male and female pain patients have different coping mechanisms. In spite of the common underlying endocrine responses to distress in men and women, gender differences in psychological response appear to modify endocrine responses to the experience of low back pain.

Neurotransmission and the experience of low back pain; no association between CSF monoamine metabolites and pain.

We have investigated the possible associations between the demographic, clinical and psychological characteristics of 80 patients with low back pain and the CSF levels of 5-hydroxyindoleacetic acid (5-HIAA), homovanillic acid (HVA) and 3-methoxy-4-hydroxyphenylglycol (MHPG), the principal central nervous system metabolites of serotonin, dopamine and noradrenaline, and of tryptophan, the amino acid precursor of serotonin. Neither the clinical measures nor the psychological characteristics were significantly correlated with the CSF neurochemistry. Therefore the hypothesis about an intimate relationship between monoaminergic neurotransmission and the experience of chronic low back pain was not confirmed. Among the other factors studied, body height contributed most to the variance in both 5-HIAA and HVA concentrations; the levels of MHPG increased with age.

Neuropeptide converting enzyme activities in CSF of low back pain patients.

The activity levels of a dynorphin converting enzyme (DCE), a substance P endopeptidase (SPE) and a substance P alpha-amidating enzyme (SP-GLYE) were measured in the cerebrospinal fluid (CSF) of 90 patients with chronic low back pain, sciatica and neurological signs of rhizopathy. The DCE activity was significantly higher in men than in women. Age was related to the DCE activity independent of sex, i.e., older patients had higher enzyme activity. The activities of two substance P converting enzymes were not related to sex or age. Self-reported pain experience and affective covariates (anxiety, depression, hostility, somatization) of pain, and myelography data were not found to be related to the enzyme activity levels once adjustment had been made for sex and age. The activity levels of the enzymes measured here had no predictive value for the long-term outcome of rehabilitation and therapy at the 5-year follow-up of the patients. The sex difference in DCE activity provides further evidence in favor of the role of gender in the psychoendocrine coping with pain distress.

Asthma medication in Finnish olympic athletes: no signs of inhaled beta2-agonist overuse.

INTRODUCTION: Occurrence of asthma has been reported to be frequent in endurance athletes and especially high in winter sport athletes. Recently, the International Olympic Committee has restricted the use of inhaled beta2-agonists and requires documentation for their use. However, epidemiologic data comparing the use of antiasthmatic medication in different sport events are mostly missing. METHODS: A cross-sectional questionnaire survey was carried out in 2002. All the athletes (N = 494) financially supported by National Olympic Committee comprised the study group. Of them, 446 (90.3%) filled in a structured questionnaire concerning asthma and allergies, use of medication, characteristics of sport activities, and smoking habits. A representative sample of Finnish young adults (N = 1 504) served as controls. RESULTS: Physician-diagnosed asthma was more common in athletes as compared with controls (13.9% vs 8.4%). Use of any asthma medication was reported by 9.6% of the athletes and by 4.2% of the controls. No difference was observed in the frequency of asthma medication used by winter or summer sport athletes (10.0% vs 9.4%). Inhaled beta2-agonists were used by 7.4% and 3.0% of the athletes and controls, respectively. After adjusting for age, sex, and smoking, odds ratio with 95% confidence interval for use of any asthma medication was 0.69 (0.17-2.92) for motor skills demanding events, 1.87 (0.85-4.11) for speed and power sports, 3.00 (1.68-5.37) for team sports, and 4.16 (2.22-7.78) for endurance events as compared with controls. None of the athletes used antiasthmatic medication without physician diagnosis. CONCLUSIONS: The frequency of antiasthmatic medication is clearly lower than the occurrence of physician-diagnosed asthma in Finnish Olympic athletes. No evidence of overuse of inhaled beta2-agonists is found.

Functional independence in persons with spinal cord injury in Helsinki.

OBJECTIVE: To estimate the functional independence of persons with spinal cord injury according to the Functional Independence Measure motor items. DESIGN: The study design was cross-sectional. SUBJECTS: All adult citizens of Helsinki with traumatic spinal cord injury were identified. The final study group consisted of 121/152 subjects (80%). METHODS: Functional Independence Measure assessments and American Spinal Cord Association examinations were performed on all subjects by the same experienced group including a physician and a physiotherapist. RESULTS: The most assistance-craving items were climbing stairs and bladder management. There were no significant differences between the genders. Subjects with tetraplegia needed significantly more assistance in all motor items except walking/wheelchair locomotion, where there was no significant difference. Subjects with tetraplegia in American Spinal Injury Association Impairment Scale D had higher Functional Independence Measure scores, more functional independence, than subjects in American Spinal Injury Association Impairment Scale A-C, the difference being significant. CONCLUSION: Because of new information, the results of this study may provide better possibilities for planning and coordinating rehabilitation measures and social services.

Does good trunk extensor performance protect against back-related work disability?

In this cohort study, dynamic trunk extensor performance was studied as a predictor of permanent work disability due to back disorders. As part of the comprehensive Mini-Finland Health Survey in 1978-80, the back muscle performance of 535 persons (267 men, 268 women) was measured using standardized repetitive arch-up and sit-up tests. At baseline, the participants were between 30 and 64 years of age. Retirements were followed for 12 years on average. During the follow-up, 56 subjects developed permanent work disability; 15 of these cases were back-related. Good dynamic trunk extensor performance was predictive of a decreased incidence of work disability due to chronic back disorders but not work disability due to other diseases. The risk of back-related work disability in the three highest quartiles in relation to the lowest quartile of dynamic trunk extension capacity was 0.28 (95% confidence interval, 0.09-0.94). Our study suggests that good dynamic trunk extension performance may protect against back-related permanent work disability.

Relationship between cognitive and motor performance in physically well-recovered men with traumatic brain injury.

OBJECTIVE: To explore the relationship between cognitive and motor performance in physically well-recovered men with traumatic brain injury. DESIGN: Cross-sectional explorative study in a national neurorehabilitation centre. SUBJECTS: Men with post-acute traumatic brain injury (n = 34; aged 19-55 years) who had recovered well physically. METHODS: Cognitive performance (attention, information processing, cognitive flexibility, motor regulation, praxis of the upper limbs) and motor performance (postural balance, agility, rhythm-co-ordination) were assessed. Partial rank correlation coefficients and analyses of covariance were used to assess the associations between these tests. RESULTS: Associations were found between the time taken in both Trail Making tests and performance time in the agility test (r = 0.57). The score on the Digit Symbol test correlated with time in the agility test (r = -0.52). Patients with normal performance in verbal fluency performed the tests of dynamic balance and agility 26% more quickly than those with abnormal performance. Moreover, patients with normal performance in the reproduction of rhythmic structures were 20% faster in the dynamic balance test. Motor functions of the hands associated with all the motor-performance test results. CONCLUSION: Measures of information processing, attention and executive functioning may be associated with motor performance. Apart from the theoretical relevance, the finding of an association between cognitive and motor performance may have clinical relevance with regard to rehabilitation.

Traumatic brain injury in Finland 1991-2005: a nationwide register study of hospitalized and fatal TBI.

PRIMARY OBJECTIVE: To examine the epidemiology of traumatic brain injury (TBI) in Finland in 1991-2005. RESEARCH DESIGN: Nationwide population based data of hospitalized and fatal TBI collected from the national registers of Finland. The incidence, age and gender distribution, aetiology, external causes, cursory outcome and mortality are presented. METHODS AND PROCEDURES: The data were collected from the National Hospital Discharge Register of Finland and from the official cause-of-death register of Statistics Finland. MAIN OUTCOME AND RESULTS: The average incidence of hospitalized TBI was 101/100,000 population and the mortality rate 18.1/100,000. The incidence increased by 59.4% in the patients aged 70 years or older while the incidence decreased by 2.4% in the younger age groups. The mortality rate decreased in men. The most common external causes were falls. The oldest patients needed 6.8-times longer stay in the hospital than the youngest. After discharge 54% of the patients needed at least occasional care. CONCLUSIONS: TBI prevention should be focused to the main groups at risk. The need for further care, rehabilitation and increasing the awareness of TBI is obvious.

EEG-based brain-computer interface for tetraplegics.

Movement-disabled persons typically require a long practice time to learn how to use a brain-computer interface (BCI). Our aim was to develop a BCI which tetraplegic subjects could control only in 30 minutes. Six such subjects (level of injury C4-C5) operated a 6-channel EEG BCI. The task was to move a circle from the centre of the computer screen to its right or left side by attempting visually triggered right- or left-hand movements. During the training periods, the classifier was adapted to the user's EEG activity after each movement attempt in a supervised manner. Feedback of the performance was given immediately after starting the BCI use. Within the time limit, three subjects learned to control the BCI. We believe that fast initial learning is an important factor that increases motivation and willingness to use BCIs. We have previously tested a similar single-trial classification approach in healthy subjects. Our new results show that methods developed and tested with healthy subjects do not necessarily work as well as with motor-disabled patients. Therefore, it is important to use motor-disabled persons as subjects in BCI development.

Control of the lumbar neutral zone decreases low back pain and improves self-evaluated work ability: a 12-month randomized controlled study.

STUDY DESIGN: A randomized controlled study with 12 months intervention. OBJECTIVE: To study the effectiveness of a training intervention with emphases on the control of lumbar neutral zone (NZ) and behavior modeling as secondary prevention of low back pain (LBP) and disability. SUMMARY OF BACKGROUND DATA: Improving the control of lumbar NZ and enhancing muscle activation patterns ensuring spinal stability have been proposed as means for secondary prevention of LBP and disability. In addition, cognitive behavior interventions have been shown to lower the risk of recurrence of LBP and long-term disability. METHODS: Middle-aged working men with recent LBP but without severe disability were randomly allocated to either a training (TG, n = 52) or control group (CG, n = 54). The aim was to exercise twice a week for 12 months, once guided and once independently. The outcome measures were the changes in intensity of LBP, disability, self-evaluated future work ability, and neuromuscular fitness. RESULTS: The intensity of LBP decreased significantly more (39%) in the TG than in CG at 12 months. The proportion of subjects with negative expectations about their future work ability decreased in both groups at 6 and 12 months; however, the proportion was significantly bigger in TG compared with CG (P = 0.028). There effects on disability indexes and fitness were not statistically significant. CONCLUSIONS: Controlling lumbar NZ is a specific form of exercise and daily self-care with potential for prevention of recurrent nonspecific LBP and disability among middle aged working men.