Clinical Briefs



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Am Fam Physician. 1998 Mar 15;57(6):1433-1436.

Statement on Weight Loss in Wrestlers

Because rapid weight reduction remains popular among amateur wrestlers and has significant health consequences, the American College of Sports Medicine (ACSM) has released a position statement on weight loss in wrestlers. In addition to recommending that coaches and wrestlers be educated about the adverse consequences of prolonged fasting and dehydration on physical performance and health, the ACSM recommends that males 16 years of age and younger with a total body fat value below 7 percent or those over age 16 with body fat below 5 percent obtain medical clearance before being allowed to compete. Female wrestlers need minimal body fat of 12 to 14 percent. ACSM also discourages the use of rubber suits, steam rooms, hot boxes, saunas, laxatives and diuretics for weight reduction.

The minimal caloric intake for wrestlers of high school and college age ranges from 1,700 to 2,500 kcal per day. Rigorous training may increase the caloric need by an additional 1,000 calories per day. ACSM notes that physicians should discourage wrestlers from consuming less than their minimal daily needs. Combined with exercise, a minimal caloric intake will allow for gradual weight loss. Wrestlers should be encouraged to meet their caloric need from a balanced diet high in carbohydrates, low in fat and with adequate protein determined on the basis of recommended dietary allowance (RDA) guidelines and levels of physical activity.

ACSM encourages cooperative efforts between coaches, exercise scientists, physicians, dietitians and athletes to use research and education to determine the best medically sound system for selecting weight class.

The complete position stand can be obtained by calling the ACSM at 317-637-9200 or writing the American College of Sports Medicine, 401 W. Michigan St., Indianapolis, IN 46202-3233.

Publication on Preventing Allergic Reactions to Natural Rubber Latex in the Workplace

The National Institute for Occupational Safety and Health (NIOSH) has issued a revised publication of recommendations to help workers exposed to latex gloves and other products containing natural rubber latex prevent allergic reactions. Some of the steps that workers with ongoing exposure to natural rubber latex should take include the following:

  • Powder-free gloves with reduced protein content must be used.

  • When wearing latex gloves, oil-based hand creams or lotions (which cause glove deterioration) should not be used unless they have been shown to reduce latex-related problems and maintain glove barrier protection.

  • Learn to recognize the symptoms of latex allergy: skin rashes; hives; flushing; itching; nasal, eye or sinus symptoms; asthma, and shock.

  • If symptoms develop, direct contact with latex gloves and products should be avoided until a physician can be seen.

Copies of this and other NIOSH documents are available from Publications Dissemination, EIA, NIOSH, 4676 Columbia Pkwy., Cincinnati, OH 45226; telephone: 800-35-NIOSH; fax: 513-533-8573; E-mail: pub-staft@niosdt1.em.cdc.gov.

Youth Drinking: Risk Factors and Consequences

The National Institute on Alcohol Abuse and Alcoholism (NIAAA) has published a report that discusses the risk factors and consequences of youth drinking (Alcohol Alert, No. 37). The report states that some youth who drink may later abuse alcohol and may develop alcoholism. The progression of drinking from use to abuse to dependence is associated with biologic and psychosocial factors. Research suggests that distinct criteria may be needed to diagnose alcoholism among youth.

Risk factors for adolescent alcohol use, abuse and dependence that are discussed in the report include genetic risk factors, biologic markers, childhood behavior, psychiatric disorders and suicidal behavior. The report also discusses psychosocial risk factors, consequences of adolescent alcohol use and prevention of adolescent alcohol use.

To obtain a free copy of “Youth Drinking: Risk Factors and Consequences,” or to add your name to the mailing list to receive future Alcohol Alert bulletins, write the NIAAA, attention: Alcohol Alert, Publications Distribution Center, P.O. Box 10686, Rockville, MD 20849-0686. Full text of the report is also available on the NIAAA's Web site at http://www.niaaa.nih.gov.

Sibutramine for the Treatment of Obesity

Sibutramine (Meridia) has been approved by the U.S. Food and Drug Administration (FDA) for the management of obesity, including weight loss and maintenance of weight loss, when used in conjunction with a reduced-calorie diet. It is indicated for obese persons with an initial body mass index of 30 or more, or 27 or more in the presence of other risk factors such as hypertension or diabetes.

Sibutramine is a neurotransmitter reuptake inhibitor that merely enhances the body's normal function. It works by affecting natural chemicals in the brain that are involved in regulating appetite.

In clinical trials, persons who received sibutramine while on a reduced-calorie diet showed a significant weight loss during the first six months of treatment, and significant weight loss was maintained for one year. In one trial that included 485 patients, 56 percent of subjects who stayed on the drug for 12 months achieved a 5 percent weight loss and 30 percent achieved a 10 percent weight reduction while taking a 10-mg dose. Of the subjects who received the 15-mg dose, 65 percent achieved a 5 percent weight loss and 39 percent achieved a 10 percent weight loss.

The most common side effects associated with sibutramine include dry mouth, headache, constipation and insomnia. Small, mean increases in blood pressure and heart rate were also reported in the trials. The FDA recommends that patients taking sibutramine be monitored with regular blood pressure measurements. Persons with uncontrolled high blood pressure should not take sibutramine. According to the FDA, no cases of pulmonary hypertension have been reported in persons in clinical trials receiving sibutramine.

Raloxifene for the Prevention of Osteoporosis

The U.S. Food and Drug Administration (FDA) has approved raloxifene (Evista) for the prevention of osteoporosis in postmenopausal women. Raloxifene is one of a new class of drugs called selective estrogen receptor modulators (SERMs) that are being studied for their ability to mimic the effect of estrogen in some tissues.

The FDA reviewed data from 50 studies in 20 countries to establish the safety and efficacy of raloxifene. More than 12,000 women have participated in the clinical program to date. A total of 1,764 postmenopausal women participated in three pivotal Phase 3 osteoporosis prevention studies for 24 months. Women taking 400 mg to 600 mg of calcium and 60 mg of raloxifene daily had a greater increase in bone density, compared with women taking only the calcium supplementation. There was no evidence of an increased risk of breast cancer or endometrial cancer in women who received raloxifene up to two and one-half years.

Commonly reported side effects included hot flushes and leg cramps. A rare but serious side effect associated with taking raloxifene was an increased risk of venous thromboembolic events. Women with a history of venous thrombosis should not use raloxifene. It is also contraindicated in pregnant women.

Cancer Facts and Figures

The American Cancer Society (ACS) has released its annual publication on cancer trends in the United States. “Cancer Facts & Figures 1998”includes the latest statistics on cancer incidence, mortality rates and survival rates, as well as information on specific cancers, cancer prevention and research.

Lung cancer remains the number one cause of cancer deaths in the United States, with 160,100 deaths predicted for 1998, accounting for 28 percent of all cancer deaths. The incidence rate of lung cancer is declining in men, from a high of 87 cases per 100,000 men in 1984 to 74 cases per 100,000 men in 1994. Since 1987, more women have died each year of lung cancer than breast cancer, which, for over 40 years, was the major cause of cancer death in women. Recently, the rate of increase among women has begun to slow. A special section on prostate cancer is included in the ACS report and provides in-depth information on incidence and mortality, survival, risk factors, disease control strategies and treatment.

Between 1991 and 1995, the national cancer death rate fell 2.6 percent. According to the ACS, researchers attribute the reduction to prevention activities, early detection of cancer and improvements in medical treatment. The report notes that most of the decline can be attributed to decreases in mortality from cancers of the lung, colon/rectum and prostate in men, and breast, colon/rectum and gynecologic cancers in women.

A companion piece titled “Cancer Risk Report: Prevention and Control 1997” is also available. This report presents data from the nation and the states on tobacco control, nutrition, physical activity and cancer screening. The percentage of adults in the United States who report no leisure-time physical activity (30.9 percent in 1994) has remained twice as high as the goal for the year 2000 (15 percent) despite efforts to promote physical activity.

The two reports “Cancer Facts and Figures 1998” and “Cancer Risk Report: Prevention and Control, 1997” are available on the ACS Web site at http://www.cancer.org. Copies of the reports may also be obtained by calling 800-ACS-2345.

Increase in Mammograms in Women Over Age 40

Recently revised guidelines from the American Cancer Society recommend annual mammography for women 40 years of age and older. The National Cancer Institute recommends screening mammograms every one to two years for women 40 years of age or older if they are at average risk of breast cancer. To estimate the state-specific percentages of women age 40 years or older who reported receiving a mammogram during the preceding two years, the Centers for Disease Control and Prevention evaluated data from the Behavioral Risk Factor Surveillance System (BRFSS). The report appears in Morbidity and Mortality Weekly Report (MMWR 1997;46:937-41).

The findings indicate that from 1989 to 1995, the percentage of women 40 years of age or over who reported having had a mammogram during the preceding two years increased in the 39 states that reported data to the BRFSS. The median age-adjusted percentage was 53.5 percent in 1989 and 69.5 percent in 1995.

The report concludes that because regular breast cancer screening can reduce the annual rate of breast cancer deaths in the United States, initiatives to encourage women to receive an initial screening for breast cancer are important and should emphasize rescreening.

1998 Primary Care Achievement Awards

Nominations are being accepted for the 1998 Primary Care Achievement Awards, a program of the Pew Health Professions Commission. Awards may be given to one individual and one organization or program in recognition of excellence in advancing primary care in the United States in each of the following categories: education, patient care and research.

Eligible individuals must demonstrate training in primary care competencies. This includes physicians in family medicine, general internal medicine and general pediatrics; physician assistants in primary care and primary care nurse practitioners. However, nominees from the full range of health professions will be considered if their achievements are in the area of primary care. For organization and institution nominees, a commitment to primary care must be evidenced in their mission and priorities.

The deadline for nomination is May 15, 1998. For more information or a nomination form, call Samantha Lekus at 415-476-8181. Nomination forms are on the Web site: http://www.futurehealth.ucsf.edu.



Copyright © 1998 by the American Academy of Family Physicians.
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