Vigorous Sports Research Articles

Mobile self-management guide for young men with mild hemophilia in cases of minor injuries

Hemophilia is a group of inherited disorders where a defect or absence of a clotting factor protein limits the ability of the blood to clot following injury. The most common form is Hemophilia A; it is classified as severe, moderate or mild. Those with severe and moderate Hemophilia are likely to experience bleeding into joints and muscles following minor injury and are advised to limit participation in rough activities. Those with milder disorders usually experience bleeds only after significant injury, and may participate in vigorous sports with few consequences. As a result, they sometimes ‘forget’ that they have Hemophilia, and are slow to recognize injuries which may require treatment. In our ongoing project, we designed a mobile app which is a self-assessment guide for young men with mild hemophilia. The mobile application guides the user in assessing suspected bleeds, applying appropriate first aid, and locating the nearest hemophilia treatment center. In this paper, we detail the architectural design of the mobile app (“HIRT?”). We proposed a three-layered distributed system architecture comprised of the mobile devices, a cloud-oriented proxy and a database server where user feedback is stored for further analysis. The proxy framework is designed to address the challenges of network latency in mobile environments since the primary means of communication is over wireless media. Preliminary evaluation of the proposed system shows high performance boost in terms of the minimization of latency. Furthermore, the usability test shows that the application is convenient to use by both mobile techies and non-techies.

Arthroscopically assisted fixation of the lesser trochanter fracture: a case series.

Avulsion fractures of the lesser trochanter in adolescents are uncommon. This injury is a result of a sudden forceful contraction of the iliopsoas tendon. It usually occurs during vigorous sport activity. Historically, these injuries were treated non-operatively, with guarded results, including weak hip flexor strength and non-union, hindering return to competitive sport. We report a series of three arthroscopically assisted fracture fixations performed by the senior author, using cannulated screw fixation in two cases and an anchor in one case. Mobilization was commenced immediately following surgery, allowing weight bearing as tolerated using crutches for 4 weeks, thereafter unaided walking was allowed. Patients were assessed at 2 weeks, 6 weeks, 3 months and 1-year post-operatively. Radiographs were utilized to confirm full union. All three patients were able to mobilize unaided by 4 weeks post-operatively and two of the three patients returned to competitive sport at 3 months. Near—anatomical union was achieved in all cases. No complications were noted during surgery and the peri-operative period in our series. The utilization of arthroscopic reduction and fixation of avulsion of the lesser trochanter results in good fixation and allows a faster recovery with a return to sports activity, and therefore, we suggest it as a viable treatment option for such injuries.

Participation in some sports, not running, increases risk of knee and hip osteoarthritis

The rates of reduction of hip replacement (an end-stage treatment of hip OA) were 35.1%, 50.4%, and 38.5%, respectively. These data, combined with the body mass index (BMI) data of the runners, suggest that running reduced OA and hip replacement risk partially due to the lower BMI associated with runners. Furthermore, the study showed that increased running speed, distance, or years of running did not increase OA risk, but seemed to increase risk of hip replacement. The results also demonstrated that running presents no increased risk for OA compared to walking. The author argued that running may decrease OA more than walking due to the larger percentage of runners (89.5%) who exceeded 1.8 MET-h/day compared to walkers (52.8%). However, the study did not report jointspecific OA in the runners. This prospective cohort study has a large sample size, exceeding the number of surveyed runners 10 times compared to the number of runners surveyed in all previous cross-sectional running studies combined. 3 OA risks associated with participation in other vigorous sports are not clearly evidenced and consistent in the literature. A recent systematic review and meta-analysis on the effects of sport activities on OA predictions (hip, knee, and ankle) provide some new insight. 4 The review, which initially identified 1294 studies and included 43 qualified studies according to a pre-defined set of criteria, included studies that had a large variation in the number of participants (16e8000) and duration of the study period (30 monthse40 years). Regarding the relationship between OA and sport activity, 12 papers met the inclusion criteria, including two retrospective cohort studies, two case series studies, seven caseecontrol studies, and one cross-sectional study. Either radiographic or magnetic resonance imaging was used to define OA in most of the studies; questionnaire, physician diagnosis, and selfreported pain and disability were also used in some of the studies. It was reported that participation in team sports was a risk factor for knee OA onset prior to 45 years of age. 5 One study identified participation in soccer as a risk factor for knee OA 6 while another study did not identify it as a risk factor. 7 Females had an increased risk of developing knee OA compared to males when participating in gymnastics or Kung Fu. 8 A caseecontrol study showed that an increased risk of developing knee OA was associated with participation in soccer, ice hockey, and tennis, but not in track and field, skiing, and orienteering. 9 However, after adjustment for knee

Validating a Lifestyle Physical Activity Measure for People With Serious Mental Illness

Purpose: To evaluate the measurement structure of the Physical Activity Scale for Individuals With Physical Disabilities (PASIPD) as an assessment tool of lifestyle physical activities for people with severe mental illness.Method: A quantitative descriptive research design using factor analysis was employed. A sample of 72 individuals with severe mental illness was used to examine the factorial structure of the PASIPD, which contains 12 items and 5 factors.Results: Principal components analysis results indicate that the 5-factor structure of the PASIPD can be replicated with people with severe mental illness, which include light/moderate recreation and physical activity, housework, vigorous sport and recreation, lawn and garden work, and occupation.Conclusions: The results underscore the importance of increasing lifestyle physical activity levels among this population, which requires increased attention in the development of measurement tools and interventions for these activities.

Anterior Choroidal Artery Territory Stroke in Young Patient

Introduction: Stroke incidence in young patients is about 10 cases in 100.000, according to several European studies. In this age group arterial dissection is one of the main pathological mechanisms involved. The internal carotid’s artery (ICA) main supraclinoid branch is the anterior choroidal artery (AChA). The occurrence of infarction in its territory due to internal carotid dissection is considered to be a rare event and may have different clinical presentations due to anatomical variability. Clinical case: A 31-year-old male patient, without any known cardiovascular risk factors or chronic medication, presented with acute onset of stabbing right sided headache while practicing football. Visual disturbances and hemiparesis with hypesthesia of his left arm were also mentioned. On admission left homonymous hemianopsia, left hemiparesis and left extensor plantar reflex were present. Brain magnetic resonance showed hyperintensity of T2 and FLAIR signals and restricted diffusion pattern suggested acute/subacute infarctions in the thalamic and subcapsular area, corpus callosum, splenium and subcortical parietal right region. Magnetic resonance angiography (MRA) of the brain showed reduction of the right ICA’s caliber, mainly of its supraclinoid segment in which a marked irregular stenosis was visualized, suggestive of arterial dissection. This stenotic segment included the origin of the AChA and of the posterior communicating cerebral artery with an exchange in their territories. Lumbar puncture results were normal as were analytical investigations which included CBC, sedimentation rate, syphilis serology and immunologic and prothrombotic screen. There were no phenotype characteristics suggestive of connective tissue disease. Conclusion: Trauma seems to be the most probable lesion mechanism for the occurrence of intracranial carotid’s dissection in this particular case, as the patient was practicing vigorous sports at time of onset. In view of great anatomic variability and multiple anatomical sites supplied by the AChA its occlusion will induce a wide range of clinical manifestations.

The Hunt of King Frederik II of Denmark: Structures and Rituals

The court hunt provided relaxation and vigorous sport in the open air, but it could also be a powerful engine of economic growth. King Frederik II of Denmark and Norway demonstrated this when he reorganized his entire domain to serve the needs of a particular kind of royal hunt. But what was the Great Hunt (storjagt, Hauptjagen) at a northern court of the late sixteenth century? When did this form of hunting make the transition from a fiercely dangerous field sport into a safe and secure public ritual of domination over nature? That question remains elusive.

Sports Safety With Implantable Cardioverter-Defibrillators

Sports Safety With Implantable Cardioverter-Defibrillators

Safety of Sports for Athletes With Implantable Cardioverter-Defibrillators

Background— The risks of sports participation for implantable cardioverter-defibrillator (ICD) patients are unknown. Methods and Results— Athletes with ICDs (age, 10–60 years) participating in organized (n=328) or high-risk (n=44) sports were recruited. Sports-related and clinical data were obtained by phone interview and medical records. Follow-up occurred every 6 months. ICD shock data and clinical outcomes were adjudicated by 2 electrophysiologists. Median age was 33 years (89 subjects <20 years of age); 33% were female. Sixty were competitive athletes (varsity/junior varsity/traveling team). A pre-ICD history of ventricular arrhythmia was present in 42%. Running, basketball, and soccer were the most common sports. Over a median 31-month (interquartile range, 21–46 months) follow-up, there were no occurrences of either primary end point—death or resuscitated arrest or arrhythmia- or shock-related injury—during sports. There were 49 shocks in 37 participants (10% of study population) during competition/practice, 39 shocks in 29 participants (8%) during other physical activity, and 33 shocks in 24 participants (6%) at rest. In 8 ventricular arrhythmia episodes (device defined), multiple shocks were received: 1 at rest, 4 during competition/practice, and 3 during other physical activity. Ultimately, the ICD terminated all episodes. Freedom from lead malfunction was 97% at 5 years (from implantation) and 90% at 10 years. Conclusions— Many athletes with ICDs can engage in vigorous and competitive sports without physical injury or failure to terminate the arrhythmia despite the occurrence of both inappropriate and appropriate shocks. These data provide a basis for more informed physician and patient decision making in terms of sports participation for athletes with ICDs.

Is Protecting the Healing Ligament Beneficial After Immobilization in External Rotation for an Initial Shoulder Dislocation?

Background: Immobilization in external rotation is one of the treatment options for an initial dislocation of the shoulder. However, it remains unclear how long it takes for a Bankart lesion to heal. Hypothesis: Protection of a healing Bankart lesion from stretching would promote the healing process and decrease the recurrence rate after an initial dislocation of the shoulder. Study Design: Randomized controlled trial; Level of evidence, 2. Methods: This was a multicenter, prospective randomized study. Between January 2005 and August 2009, 109 patients (71 male and 38 female; mean age, 30 years) with an initial traumatic dislocation of the shoulder were enrolled. After 3 weeks of immobilization in external rotation, a shoulder motion restriction band designed to avoid stretching the anteroinferior shoulder capsule was used for 0 weeks (36 patients), 3 weeks (37 patients), or 6 weeks (36 patients). After using the band, patients were allowed to use their shoulders freely, but they were advised to avoid vigorous sport activities for at least 3 months after the injury. Any recurrent dislocation and return to sports were assessed at 2-year follow-up. Results: Of 109 patients, 90 were followed up for 2 years. The compliance rates were 60% to 72% among the groups (P = .54). The recurrence rate of dislocation was 28% in the 0-week group, 33% in the 3-week group, and 32% in the 6-week group (P = .88) according to the intention-to-treat analysis, and they were a respective 24%, 28%, and 27% according to the per-protocol analysis (P = .95). Based on the sport activity level, the recurrence rates for patients involved in contact sports (7/15, 47%) and those involved in noncontact sports (19/51, 37%) were significantly higher than for those not involved in sport activities (2/24, 8.3%) (P = .0076). Among the 3 groups, there were no significant differences in the recurrence rates. There was no significant difference in the rate of return to sports (P = .39). Conclusion: No difference in the recurrence rate was seen with the use of a shoulder motion restriction band after 3 weeks of immobilization in external rotation after an initial dislocation of the shoulder.

Participation in vigorous sports, not moderate sports, is positively associated with cardiorespiratory fitness among adolescent girls.

There is controversy regarding whether moderately-intense sports can improve physical fitness, which declines throughout adolescence among girls. The objective was to estimate the association between moderate and vigorous sports participation and cardiorespiratory fitness in a racially diverse sample of adolescent girls. Cardiorespiratory fitness was measured using a modified physical work capacity test in 1029 eighth-grade girls participating in the Trial of Activity for Adolescent Girls. Girls reported sports in which they participated in the last year on an organized activity questionnaire. Using general linear mixed models, the study regressed absolute and relative fitness on the number of vigorous and moderate sports in which girls participated, race/ethnicity, age, treatment group, fat mass, fat-free mass, and an interaction between race and fat-free mass. The number of vigorous sports in which girls participated was positively associated with absolute fitness (β = 10.20, P = .04) and relative fitness (β = 0.17, P = .04). Associations were reduced, but not eliminated, after controlling for MET-weighted MVPA. Participation in moderate sports was not associated with either fitness measure. Vigorous sports participation is positively associated with cardiorespiratory fitness. Future longitudinal research should analyze whether promoting vigorous sports at an early age can prevent age-related declines in cardiorespiratory fitness among adolescent girls.

The Military Extremity Trauma Amputation/Limb Salvage (METALS) Study

The study was performed to examine the hypothesis that functional outcomes following major lower-extremity trauma sustained in the military would be similar between patients treated with amputation and those who underwent limb salvage. This is a retrospective cohort study of 324 service members deployed to Afghanistan or Iraq who sustained a lower-limb injury requiring either amputation or limb salvage involving revascularization, bone graft/bone transport, local/free flap coverage, repair of a major nerve injury, or a complete compartment injury/compartment syndrome. The Short Musculoskeletal Function Assessment (SMFA) questionnaire was used to measure overall function. Standard instruments were used to measure depression (the Center for Epidemiologic Studies Depression Scale), posttraumatic stress disorder (PTSD Checklist-military version), chronic pain (Chronic Pain Grade Scale), and engagement in sports and leisure activities (Paffenbarger Physical Activity Questionnaire). The outcomes of amputation and salvage were compared by using regression analysis with adjustment for age, time until the interview, military rank, upper-limb and bilateral injuries, social support, and intensity of combat experiences. Overall response rates were modest (59.2%) and significantly different between those who underwent amputation (64.5%) and those treated with limb salvage (55.4%) (p = 0.02). In all SMFA domains except arm/hand function, the patients scored significantly worse than population norms. Also, 38.3% screened positive for depressive symptoms and 17.9%, for posttraumatic stress disorder (PTSD). One-third (34.0%) were not working, on active duty, or in school. After adjustment for covariates, participants with an amputation had better scores in all SMFA domains compared with those whose limbs had been salvaged (p < 0.01). They also had a lower likelihood of PTSD and a higher likelihood of being engaged in vigorous sports. There were no significant differences between the groups with regard to the percentage of patients with depressive symptoms, pain interfering with daily activities (pain interference), or work/school status. Major lower-limb trauma sustained in the military results in significant disability. Service members who undergo amputation appear to have better functional outcomes than those who undergo limb salvage. Caution is needed in interpreting these results as there was a potential for selection bias.

Overweight and Obesity, and Associated Factors among High School Students in Gondar Town, North West Ethiopia

Introduction: Overweight and obesity are defined as abnormal or excessive fat accumulation in the body that may affect health. The prevalence of overweight and obesity in children is increasing worldwide, and currently 1 child in 10 is overweight or obese. Overweight and obesity are now considered as very important risk factors for many chronic diseases which exploit high cost of medical care. Objective: To assess the prevalence of overweight and obesity, and associated factors among high school students in Gondar town. Methodology: Institution based cross-sectional study was conducted from April 12/2012 to April 30/2012 in Gondar town administration. A total of 800 students were included in the study. Multistage sampling strategy was applied to enroll students. Both bivariate and multivariate logistic regression analysis was done to identify associated factors. Result: The overall prevalence of overweight and obesity in this study was 5.4% and 0.5% respectively. The prevalence of overweight among the adolescents studying in private schools was 10.1% and was higher than those studying in government schools (4%). Overweight was 4.47 times higher among girls [Adjusted Odds Ratio (AOR) =4.47; 95% CI: 1.79, 11.13], and 2.53 times higher among Students of private school [AOR =2.53, 95% CI: 1.33, 4.64]. Consuming sweet food item was significantly associated with overweight. However, moderate or vigorous sport activity for at least 10 minutes continuously was only marginally significant. Conclusion and recommendation: This study revealed that Overweight and obesity are emerging in Gondar. School type, sex and consuming sweet food item were among the predictors that were significantly associated with overweight. Hence decreasing consumption of sweet food items and doing physical activity could reduce risk of overweight.

Ischemia-modified Albumin Levels In Professional Male Soccer Players Before And After Training

Objectives: The ischemia-modified albumin (IMA) test is a promising indicator of myocardial ischemia in the early diagnosis of the acute coronary syndrome (ACS). Recent studies examining alterations in IMA levels caused by myocardial ischemia that develops during exercise have shown contradictory results. There has been an increase in severe exercise-related cardiac events in football. We therefore, assessed IMA levels before and after exercise in professional soccer players in order to examine the effect of the exercise on IMA levels. Methods: Blood was collected from professional soccer players before and after exercise. IMA levels were measured by using spectrophotometric methods, and the albumin levels were measured in an autoanalyzer. Results: The average pre- and post exercise IMA levels of 16 soccer players were found to be 0.438±0.071 and 0.386±0.069, respectively. The pre- and post exercise albumin levels of the same group were 4.08±0.20 g/dL and 4.21±0.19 g/dL, respectively. There was a strong negative correlation between post exercise IMA and albumin levels, which was statistically significant (r = -0.535. p = 0.033).Conclusion: IMA levels should be examined not only in noncardiac pathologies, but also in specific serum albumin concentrations and in individuals practicing vigorous sport activities

Growth Plate Alteration Precedes Cam-type Deformity in Elite Basketball Players

Vigorous sporting activity during the growth years is associated with an increased risk of having a cam-type deformity develop. The underlying cause of this osseous deformity is unclear. One may speculate whether this is caused by reactive bone apposition in the region of the anterosuperior head-neck junction or whether sports activity alters the shape of and growth in the growth plate. If the latter is true, then one would expect athletes to show an abnormal shape of the capital growth plate (specifically, the epiphyseal extension) before and/or after physeal closure. We therefore raised three questions: (1) Do adolescent basketball players show abnormal epiphyseal extension? (2) Does the epiphyseal extension differ before and after physeal closure? (3) Is abnormal epiphyseal extension associated with high alpha angles? We performed a case-control comparative analysis of young (age range, 9-22 years) male elite basketball athletes with age-matched nonathletes, substratified by whether they had open or closed physes. We measured epiphyseal extension on radial-sequence MRI cuts throughout the cranial hemisphere from 9 o'clock (posterior) to 3 o'clock (anterior). Epiphyseal extension was correlated to alpha angle measurements at the same points. Epiphyseal extension was increased in all positions in the athletes compared with the control group. On average, athletes showed epiphyseal extension of 0.67 to 0.83 versus 0.53 to 0.71 in control subjects. In the control group epiphyseal extension was increased at all measurement points in hips after physeal closure compared with before physeal closure. In contrast, the subgroup of athletes with a closed growth plate only had increased epiphyseal extension at the 3 o'clock position compared with the athletes with an open [corrected] growth plate (0.64-0.70). We observed a correlation between an alpha angle greater than 55° and greater epiphyseal extension in the anterosuperior femoral head quadrant: the corresponding Spearman r values were 0.387 (all hips) and 0.285 (alpha angle>55°) for the aggregate anterosuperior quadrant. These findings suggest that a cam-type abnormality in athletes is a consequence of an alteration of the growth plate rather than reactive bone formation. High-level sports activity during growth may be a new and distinct risk factor for a cam-type deformity.

Effects of habitual kendo practice on uric acid excretion

Introduction: Previous studies have suggested that intense training may produce increased uric acid which potentially induces hyperuricemia followed by gout. Kendo, one of the martial arts, has been known as a vigorous sport. However, there is limited comprehensive research into uric acid associated with hydration status during habitual practice of collegiate kendo players. The purpose of this study was to determine the potential to induce hyperuricemia during three consecutive days of kendo practice.

Collision Sports and Risk of Bleeding in Children With Hemophilia

IN THIS ISSUE OF JAMA, BRODERICK AND COLLEAGUES 1 report results of their study of the association of vigorous sports with bleeding rate in 104 children and adolescents with moderate or severe hemophilia. Most participants were receiving prophylactic infusions of replacement clotting factor, which has been established as the standard of care for children and adolescents with hemophilia. Activities were scored as category 1, 2, or 3, depending on the expected trauma related to frequency and severity of collisions associated with the activity; category 2 and 3 activities can be referred to as collision sports. The study results indicate that the risk of bleeding events requiring acute factor replacement was increased following collision sports, with an odds ratio of 2.7 for category 2 activities (such as basketball or baseball) and 3.7 for category 3 activities (such as wrestling or US football). However, because exposure time to the higher-risk activities was a small percentage of total life hours and because the annual rate of bleeding was low, the absolute increase in risk was low. Additional statistical modeling, in which factor level was inferred from infusion schedule and known recovery and half-life, revealed that each 1% increase in plasma factor activity was associated with a 2% lower bleeding risk, thus suggesting therapeutic strategies that might further reduce the bleeding risk associated with collision sports. The study was strengthened by a novel and robust prospective case-crossover design. Data were acquired for each bleeding event from the 24-hour period preceding the event, as well as the 2 preceding 24-hour periods that served as control time periods during which exposure to sports and factor infusions were compared. To evaluate the accuracy of activity estimates during the control periods, participants were also asked to report their physical activity during randomly chosen times without bleeding events, along with the 2 preceding 24-hour intervals. This accuracy check found activity levels that were comparable with the control periods. The study by Broderick et al expands previous data on injury and bleeding rates related to sports participation in children with severe hemophilia. A study of school-aged children by Ross et al comparing 299 high-impact-sports seasons in 27 children and 46 low-impact-sports seasons in 10 children (92% using clotting factor prophylaxis) found a very low rate and no between-group differences for joint hemorrhage, injuries, or new target joint development related to high-impact sports. Similar bleeding outcomes were found in a study by Tiktinsky et al of 44 children with hemophilia not using prophylaxis. Both studies suggested that bleeding events related to sports in children with severe hemophilia represent a small proportion of total bleeding episodes. Evidence that participation in collision sports does not worsen the outcome of severe hemophilia may seem counterintuitive and inconsistent with conventional wisdom. However, the study by Broderick et al suggests that a factor level below a critical threshold is a more important determinant of bleeding risk than modest exposure to vigorous activities. All children need to feel part of their peer group. The label of a rare disorder, requirements for frequent intravenous infusions, and exclusion from sports intensify a painful sense of being different for children with hemophilia. Hemophilia almost exclusively affects males and peer participation of boys in many societies is centered around competitive sports. Participation in a popular sport can be important to reduce the sense of isolation experienced by many boys with hemophilia. Participation in desired but possibly higher-risk sports may be a strong motivator for positive health-promoting activities such as self-infusion of prophylactic factor replacement, year-round conduct of strengthening exercises, and increased body awareness with early bleed recognition. In the study by Ross et al, all participants, with their parents, underwent counseling regarding the risks and benefits of the sports in question as well as techniques to minimize risks and maximize health benefits. In addition, prophylaxis regimens were carefully reviewed and optimized. The analyses by Broderick et al suggest that higher factor level at the time of collision was preventive for tempo-

Does long-lasting sports practice increase the risk of atrial fibrillation in healthy middle-aged men? Weak suggestions, no objective evidence

Some authors have suggested that sports activity can increase the risk of atrial fibrillation in healthy middle-aged men. Therefore, sport activity, although it prevents coronary artery disease, might be the cause of a potentially dangerous arrhythmia. To verify this assumption, we critically analyzed the current literature including original articles, reviews and meta-analyses. All published articles showed several limitations. The data provided by published studies support the following conclusions: the incidence of atrial fibrillation in sporting middle-aged men is rare (<0.5% per year); a possible facilitating effect on atrial fibrillation is limited to vigorous endurance exercise, not to less vigorous sports; there are no convincing data to demonstrate that sport itself may be the cause of atrial fibrillation in healthy middle-aged men; and a facilitating effect of long-lasting sport cannot be excluded in middle-aged individuals with cardiovascular disorders. Nevertheless, the beneficial effects of exercise should offset this supposed risk, which, albeit increased, remains low.

Cardiovascular Assessment for Risk of Sudden Cardiac Death in Athletes

Cardiovascular Assessment for Risk of Sudden Cardiac Death in Athletes

Evaluation and Management of Arrhythmia in the Athletic Patient

Athletes may present with palpitations, syncope, or arrest resulting in the diagnosis of arrhythmia, or screening may result in diagnosis of conditions with predisposition to arrhythmia. This chapter focuses on 3 common arrhythmic conditions in athletes—atrial fibrillation, premature ventricular contractions (PVCs), and the athlete with an implanted device.(1) Atrial fibrillation: most studies show that atrial fibrillation is more common in competitive athletes, particularly those participating in long-term endurance sports. Postulated mechanisms include morphologic changes such as atrial dilatation, autonomic changes such as increased vagal tone, or inflammatory changes due to sports participation. Treatment options include long-term antiarrhythmic agents, “pill in the pocket” medications, or radiofrequency ablation, a highly successful procedure in athletes.(2) Premature ventricular contractions: data conflict on whether the incidence of PVCs is increased in highly trained individuals. Very frequent PVCs in athletes, however, can be a manifestation of underlying heart disease, and athletes presenting with PVCs should undergo evaluation. In the absence of underlying heart disease, PVCs do not carry a poor prognosis, and US guidelines do not recommend restriction from sports.(3) Implanted devices: the safety of sports for the athlete with an implanted device is unknown, and current guidelines recommend against participation in vigorous competitive sports, based on postulated risks including failure to defibrillate and risk of injury. Many athletes with defibrillators and pacemakers do participate in sports. Ongoing research will better delineate the risks of sports for the athlete with an implanted device.

Age at menarche and menstrual cycle pattern among school adolescent girls in Central India.

Background:The onset of menstruation is part of the maturation process. However, variability in menstrual cycle characteristics and menstrual disorders are common. The purpose of this study was to determine the age at menarche and patterns of menstruation among school adolescent girls and explore its variation across socio-economic and demographic factors.Methodology:This is a cross-sectional descriptive study carried out on 1100 school adolescent girls in district Wardha, Central India. Data were collected using a self-administered structured questionnaire on menstruation. Data was entered and analyzed by using Epi Info 6.04 software package. Chi- square value was used for testing statistical significance.Results:Mean ages of menarche were 13.51 + 1.04 years and 13.67 + 0.8 years for urban and rural areas respectively. Abnormal cycle length was common and affected 30.48%. The majority 56.15 experienced dysmenorrhoea and 56.16 percent had premenstrual syndrome. Self medication was practiced by 7.13% of the adolescent girls. The most common premenstrual symptom was headache 26.74%. Absenteeism from the school 13.9% was the effect of menstruation related problems on their daily routine. Dysmenorrhea and premenstrual symptoms were perceived as most distressing symptoms leading to school absenteeism. Majority of the girls 75.58% had discussed menstrual problems with someone, most commonly with their mothers 38.15%. There was a general lack of information about menstrual issues especially with regards to cycle length, duration of menses and age at menarche. Girls from families of high socio-economic class have significantly lower mean menarcheal age in both urban and rural area. The mean age of menarche was significantly higher in girls involved in vigorous sporting activity in urban area compared to their non-sporting counterparts.Conclusion:Age at menarche was delayed. The menstrual disorders among female adolescents are common. A school health education on menstrual problems targeting adolescent girls and their parents and routine screening for menstrual problems by healthcare providers can help to prevent the absenteeism in the school.