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Disco fever: epidemic meningococcal disease in northeastern Argentina associated with disco patronage.

Neisseria meningitidis is a leading cause of adult meningitis worldwide. From 5 to 14 August 1996, 8 cases of meningococcal disease occurred in Corrientes city (population 306,000) in northeastern Argentina. Those infected ranged in age from 15 to 45 years (median, 18.5). To determine risk factors for infection, a case-control study was done. Infecting isolates were serogrouped and underwent phenotyping by multilocus enzyme electrophoresis (MLEE) and pulsed-field gel electrophoresis (PFGE). Those infected were significantly more likely than those not infected to have had exposure to passive or active cigarette smoke or to have attended a particular disco. Isolates available from 6 case-patients were all serogroup C; all had identical MLEE and PFGE patterns. These data suggest that dance clubs or discos may be a focus of transmission of N. meningitidis among young people.

Adolescent↗

Action observation and acquired motor skills: an FMRI study with expert dancers.

When we observe someone performing an action, do our brains simulate making that action? Acquired motor skills offer a unique way to test this question, since people differ widely in the actions they have learned to perform. We used functional magnetic resonance imaging to study differences in brain activity between watching an action that one has learned to do and an action that one has not, in order to assess whether the brain processes of action observation are modulated by the expertise and motor repertoire of the observer. Experts in classical ballet, experts in capoeira and inexpert control subjects viewed videos of ballet or capoeira actions. Comparing the brain activity when dancers watched their own dance style versus the other style therefore reveals the influence of motor expertise on action observation. We found greater bilateral activations in premotor cortex and intraparietal sulcus, right superior parietal lobe and left posterior superior temporal sulcus when expert dancers viewed movements that they had been trained to perform compared to movements they had not. Our results show that this 'mirror system' integrates observed actions of others with an individual's personal motor repertoire, and suggest that the human brain understands actions by motor simulation.

Adolescent↗

Medical and rehabilitation issues in classical ballet.

Classical ballet is a demanding professional occupation, with participants who are often underserved in terms of accurate diagnosis and appropriate comprehensive medical care. The view that follows is designed to be as global and insightful as published to date. Specific rehabilitation considerations, dance mechanics, idiosyncratic differential diagnosis, and personality and equipment issues are discussed, and a rational view of dogma is presented.

Athletic Injuries↗

Creativity and spirituality in nursing: implementing art in healing.

Creative modalities offer nurses a new perspective on how to care for patients. The link between creativity and healing is well documented. In response to this, many hospitals have instituted programs that include arts and creativity. Because of their unique bonds with patients, nurses play a crucial role in bringing creative arts into patient care. Several recommendations are given for implementing specific art media (eg, music, drawing, dance, writing) in the clinical setting.

Adaptation, Psychological↗

Amenorrhea in ballet dancers in the Netherlands.

The prevalence of amenorrhea was studied among 113 professional and student ballet dancers in the Netherlands (mean age 23.3 yr, SD 4.8). Sixty-one dancers not on oral contraceptives were included in the subsequent analyses. Six cases (prevalence 9.8 percent, 95 percent confidence interval: 2.4-17.2) with secondary amenorrhea (< or = 4 cycles per year; previous menstruation > or = 3 months prior to the study; menarche > or = 1 yr prior to the study) were found. Two dancers had primary amenorrhea (no menarche at the age of > or = 16). There was a negative correlation between the age of menarche and the number of menstrual cycles during the 12 months preceding the study (r = -0.46, P = 0.001). Body composition (four-compartment model), amount of dancing (recorded), resting energy expenditure (ventilated hood), dietary intake (recorded), and indices of eating disorders (Eating Disorders Inventory, EDI) were studied in 15 of the dancers, 5 amenorrheic and 10 eumenorrheic. No significant differences were found between the amenorrheic and eumenorrheic dancers. An explanation for the lower prevalence of amenorrhea in ballet dancers in the Netherlands, compared with U.S. dancers, was not obvious. Relatively low EDI scores (25.8, SD 14.5) in a subsample of 24 dancers could indicate less rigid emphasis on leanness and dieting.

Adult↗

Injury rates from walking, gardening, weightlifting, outdoor bicycling, and aerobics.

PURPOSE: The objective of this survey was to estimate the frequency of injuries associated with five commonly performed moderately intense activities: walking for exercise, gardening and yard work, weightlifting, aerobic dance, and outdoor bicycling. METHODS: National estimates were derived from weighted responses of over 5,000 individuals contacted between April 28 and September 18, 1994, via random-digit dialing of U.S. residential telephone numbers. Self-reported participation in these five activities in the late spring and summer of 1994 was common, ranging from an estimated 14.5 +/- 1.2% of the population for aerobics (nearly 30 million people) to 73.0 +/- 1.5% for walking (about 138 million people). RESULTS: Among participants, the activity-specific 30-d prevalence of injury ranged from 0.9 +- 0.5% for outdoor bicycle riding to 2.4 +- 1.3% for weightlifting. The estimated number in the 30 d of people injured in the 30 d before their interview ranged from 330,000 for outdoor bicycle riding to 2.1 million for gardening or yard work. Incidence rates for injury causing reduced participation in activity were 1.1 +/- 0.5x100 participantsx30 d for walking, 1.1 +/- 0.4 for gardening, and 3.3 +/- 1.9 for weightlifting. During walking and gardening, men and women were equally likely to be injured, but younger people (18-44 yr) were more likely to be injured than older people (45 + yr). Injury rates were low, yet large numbers of people were injured because participation rates were high. Most injuries were minor, but injuries may reduce participation in these otherwise beneficial activities. CONCLUSIONS: Additional studies to confirm the magnitude of the problem, to identify modifiable risk factors, and to recommend methods to reduce the frequency of such injuries are needed.

Adolescent↗

Body composition in dancers: the bioelectrical impedance method.

PURPOSE: The aim of this study was to generate and validate a prediction equation for estimating the body composition in dancers using the bioelectrical impedance analysis (BIA) as a method of assessment. METHODS: The fat-free mass (FFM) of 42 young female professional dance students was estimated by four different methods: dual x-ray absorptiometry (DXA), BIA, simple anthropometry, and skinfold thickness; DXA was used as a criterion method. RESULTS: The dancers' FFM was 42.6 kg (SD: 3.3) and, on the average, body fat represented the 19.4% (SD: 4.3) of their body weight. Two dancer-specific BIA equations for the prediction of FFM (E(BIA)) were developed by multiple regression analysis using weight, height, resistance index, and triceps as predictor variables (E(BIA) and E(BIA-TRICEPS)). The validity of these equations as well as of those previously reported was assessed in two randomly selected subgroups of the initial study group, as described by the Bland-Altman analysis. The bias and the limits of agreement of the equations developed in the present study were lower than those resulting from the application of the previously used equations of Segal et al. and Hergenroeder et al. It was also found that, when validated against DXA, skinfolds measurements did not accurately predict body fatness in this group of young females. CONCLUSION: The new equations allow for an accurate routine assessment of body composition in young female dancers by using the method of BIA. Further studies are needed for the cross-validation of the equations in various groups of dancers.

Absorptiometry, Photon↗

Eccentric and concentric knee extensor muscle performance in professional ballet dancers.

Ballet dancers are exposed to great eccentric loading of the lower extremities due to a high frequency of repetitive jumps and leaps. The purpose of this study was to evaluate eccentric (ECC) and concentric (CON) knee extensor muscle endurance and strength in professional ballet dancers (six men and 11 women) in relation to moderately active control subjects (17 men and 18 women). A Biodex dynamometer was used for isokinetic torque measurements. The ECC endurance (total work per kilogram) was on average 31% greater in professional ballet dancers compared to control subjects, while the corresponding average difference for CON endurance was 7%. A greater ECC CON total work ratio was observed for ballet dancers (mean ballet, 2.07; mean control, 1.74). The ECC and CON strengths (peak torque per kilogram) were greater in professional ballet dancers compared to controls (27 and 22%). No intraindividual torque difference between left and right limbs was found. Men showed significantly greater strength (peak torque per kilogram) and endurance (total work per kilogram) compared to women, similar in both groups. No differences in the ECC/CON relationship between genders were observed. In essence, our results favor the hypothesis that repetitive loading of the lower extremities in ballet dance leads to a higher standard of ECC knee extensor endurance.

Adult↗

Anterior tibial stress fracture treated with intramedullary nailing: a case report.

This article describes the use of intramedullary rodding as a treatment for an anterior tibial stress fracture in a patient with high functional demands: a professional ballet dancer. In our patient, a year of conservative treatment and later tibial drilling was unsuccessful. After sustaining a complete fracture at the site of the stress fracture, he was treated with intramedullary rodding and was able to dance 21 weeks after surgery. The fracture went on to complete healing. The role of prophylactic intramedullary nailing in this difficult fracture is discussed.

Adult↗

Hip and ankle range of motion in elite classical ballet dancers and controls.

OBJECTIVE: To report range of motion at the hip and ankle in male and female ballet dancers compared with controls. DESIGN: Cross-sectional cohort study with convenience control sample. SETTING: National classical ballet school in Australia. PARTICIPANTS: Thirty-three female and 30 male full-time ballet students of mean (SD) age 16.9 (0.8) and 18.0 (1.4) years, respectively. Controls were 31 female and 16 male nondancing, normally active university students of average ages 18.8 +/- 0.6 and 18.8 +/- 0.9 years, respectively. MAIN OUTCOME MEASURES: Degrees of range of motion of left and right sides for the following four movements: standing plié in parallel-passive ankle dorsiflexion (DF), standing turnout in the balletic first position-lower limb external rotation (LLER), supine hip external rotation (ER), supine hip internal rotation (IR). Two additional ranges of motion were calculated. External rotation below the hip joint (BHER) was derived by subtracting hip ER from LLER, and total supine hip rotation (Hip IR + ER) was derived by summing hip ER and hip IR. MAIN RESULTS: On both left and right sides, dancers had greater LLER (p < 0.0001) and hip ER (p < 0.0001) but lesser hip IR than the controls (p < 0.0001). Female but not male dancers had greater total supine hip rotation (hip ER+IR) than controls (p < 0.05). There was no difference in either BHER or ankle DF between dancers and controls. Within dancers, females had greater range in both left and right hip IR, LLER, and hip IR + ER. There was no difference in hip ER. Regression analysis revealed that LLER related to hip ER in both males and females. CONCLUSIONS: Elite classical dance students had greater hip external rotation (both ER and LLER) and less hip internal rotation than controls but similar BHER and ankle DF. Since ER below the hip joint and ankle DF do not differ between dancers and controls, despite repeated training of these movements in ballet, there may be anatomical (bony/ligamentous) limitations to these movements.

Ankle Joint↗

Premature osteoarthrosis in professional dancers.

OBJECTIVE: The purpose of this study was to determine whether arthrosis begins at an unusually early age in professional dancers; if there is an association between hypermobility and osteoarthrosis in dancers; and if osteoarthrosis is a contributing factor to retirement from a professional career in this population. DESIGN: Dance and injury history; physical examinations of back, lower extremities, and ligamentous laxity; and radiographs of lower extremity joints were performed in retired dancers. The dancers' radiographs were compared to those of age-matched nondancers. The radiologist was blinded to the origin of the radiographs. PARTICIPANTS: Fourteen retired dancers aged 27 to 46 years who had performed professionally for a minimum of 10 years were included in the study. Thirty-six age-matched nondancers with injuries or pain in various lower extremity joints were used as controls. MAIN OUTCOME MEASURES: This study measured radiographic findings of osteoarthrosis, including sclerosis, joint space narrowing, osteophytes, and subchondral cysts; hypermobility (after Klemp) as manifested by > 3 of 5 tests being positive; and the dancers' reasons for retirement. RESULTS: Changes of arthrosis were found in 34 of 56 joints in 14 dancers and in 3 of 36 joints in 36 nondancers. Hip calcifications were found in 10 hips in 7 dancers and in 1 nondancer's hip. None of the participants in this study was hypermobile or had retired because of arthrosis. CONCLUSIONS: The prevalence of arthrosis in knees, ankles, and first metatarsophalangeal joints in young dancers was increased when compared to that of nondancers in the same age group. Arthrosis does not necessarily cause retirement from a performance career.

Adult↗

Spontaneous pneumomediastinum and myocarditis following Ecstasy use: a case report.

Ecstasy is a very popular and widely used party drug with known complications such as agitation, hyperpyrexia, rhabdomyolysis or renal failure. A 16-year-old boy was admitted to our Emergency Department with a spontaneous pneumomediastinum (SPM) after Ecstasy ingestion, complicated by myocarditis. To our knowledge this is the first case described with the combination of Ecstasy ingestion, SPM and myocarditis. Although SPM is well known in inhalation drug users who try to enhance alveolar resorption with repeated valsalva manoeuvres, it is rather rare after the ingestion of party drugs. The probable causative event is the prolonged and excessive dancing in this party drug culture. The course is usually benign, with spontaneous resorption. Emergency physicians should be aware of the risk, especially if a drug user presents with neck emphysema, difficulty in swallowing, and precordial crepitations or thoracic pain. Ecstasy, similarly to cocaine, can induce cardiac symptoms.

Adolescent↗

Comparisons of motivation, health behaviors, and functional status among elders in residential homes in Korea.

This study compared the changes in health behaviors, motivation, and functional status between motivation enhancement exercise-program participants and program dropouts over 6 months. A total of 73 older adults living in residential homes participated in the study. Face-to-face interviews were conducted at pretest and then at 10 weeks and 6 months in the program. The participants exercised using traditional Korean dance movements for 50 min, 4 times per week, for 6 months. The subjects were classified as participants or dropouts by using a cutoff attendance rate of 80%. Repeated ANOVA revealed the following results over 6 months: 1 The motivation to perform health behaviors, especially for perceived benefits, improved significantly for the participants than for the dropouts. 2 Significant differences in the performance of overall health behaviors and exercise-related behaviors were found between the participants and the dropouts. 3 The sickness impact profile (SIP) of the participants improved significantly, compared with the dropouts. Significant group differences were found for total SIP, physical dimensions, and enjoyment of recreation and pastimes. In conclusion, the study found that the 6-month motivation enhancement program was effective in motivating older adults to perform health behaviors and to improve their functional status.

Activities of Daily Living↗

Responses to music and movement in the development of children with Down's syndrome.

Physical responses to rhythmic stimuli and music, of different degrees of complexity were registered from 25 children with Down's syndrome and 25 other mentally handicapped children. Required performances were taught and then recorded on video-tape, after which they were assessed by experienced teacher/judges. Whilst there were no overall significant differences between the groups, important differences were detected between the children in different schools with attendant implications for differential treatment. Apart from an overall and general assessment of performance, analysis was made of demographic variables, for example, sex, intelligence, age and social development. It is concluded that specific teaching approaches can significantly effect the development of children with Down's syndrome in such creative aspects of the curriculum as music, movement and dance.

Adolescent↗

Body weight, exercise and menstrual status among ballet dancers in training.

A prospective study of the menstrual pattern and weight changes was made in the first year of training of 29 new female entrants to a professional ballet school. Seventy-nine per cent of the student girls had menstrual disturbances at entry: primary amenorrhoea, four; secondary amenorrhoea, 11; irregular menses, eight. The incidence of secondary amenorrhoea increase substantially by the end of the year (20), but was not associated with any significant change in body weight. Only three students menstruated regularly during the year. Menstrual regularity improved during periods of injury and long vacation and it appears that deterioration of the menstrual pattern during dancing periods was related to strenuous physical exercise rather than to any change in body weight.

Adolescent↗

Reported eating behavior and attitudes improvement after a nutrition intervention program in a group of young female dancers.

The aim of the study was to evaluate the effectiveness of an intervention program that combined nutrition education and prevention of disordered eating in a group of female professional dance students. Thirty-two dancers, aged 19-25 years, took part in the program. Evaluation was done by a series of questionnaires that participants were asked to complete on 3 occasions. Assessments of body composition and dietary intake were also performed. Significant improvements in nutrition knowledge as well as a decrease in abnormal eating behavior and dietary restraint were observed at post intervention. At 6-month follow-up, the positive effects were maintained and further benefits were recorded; only nutrition knowledge showed a minor decline. Participants who were at higher risk for adopting abnormal eating behavior benefited the most from the program. These findings encourage the implementation of intervention programs in groups of young women that experience particular pressures for controlling body weight.

Adult↗

Bone mineral density in young active females: the case of dancers.

The aim of the study was to evaluate the combined effect of several environmental factors on bone mineral density (BMD) in a group of highly active young women. Body composition, total body and regional (arms, legs and trunk) BMD, dietary intake, menstrual status, training habits, and eating attitudes were assessed in 37 professional dance students, aged 18 to 26 years. Dancers had higher BMD values compared to age- and weight-matched reference population (mean total body BMD: 1.185 g/cm2, 9% higher than reference values). No differences were detected between currently eumenorrheic and noneumenorrheic dancers; subjects who encountered menstrual problems during adolescence had significantly lower BMD values compared to counterparts who did not. Regarding dietary intake, dancers in the highest quartile of calcium intake (1323 +/-113 mg/d) exhibited significantly higher total BMD values than subjects in the other 3 quartiles (p =.04). A moderate inverse relationship was found between protein intake and total BMD, after controlling for energy and calcium intake (r = - 0.37). Fat-free soft mass was the only significant predictor of total BMD, explaining 20% of the variance. High levels of calcium intake were associated with high total BMD values. These results confirm the beneficial role of long-term and intensive physical activity on BMD and further suggest that dancers are not at a greater risk compared to the general population for developing osteoporosis, despite their menstrual and eating problems.

Absorptiometry, Photon↗

Effects of weight bearing and non-weight bearing exercises on bone properties using calcaneal quantitative ultrasound.

OBJECTIVE: This study was designed to investigate bone properties using heel quantitative ultrasound (QUS) in young adults participating in various sports. METHODS: A cross sectional study was performed on Chinese male students (n = 55), aged 18-22 years. Subjects with previous fractures or suffering from any diseases known to affect bone metabolism or taking any medication with such an effect, were not included. The subjects were categorised according to their main sporting activities, including soccer (n = 15) (a high impact, weight bearing exercise), dancing (n = 10) (a low impact, weight bearing exercise), and swimming (n = 15) (non-weight bearing exercise). A sedentary group acted as controls (n = 15). A reproducibility study of the velocity of sound (VOS) and the broadband ultrasound attenuation (BUA) measurement was performed and analysed using the intraclass correlation coefficient (ICC). RESULTS: There was good intra-investigator and inter-investigator agreement (ICC > or = 0.8; p < 0.05) in the measurement of BUA and VOS. No significant differences in BUA and VOS (p > 0.05) were found between the dominant and non-dominant heel. Soccer players (137 +/- 4.3 dB/MHz; 1575 +/- 56 m/s; 544.1 +/- 48.4) and dancers (134.6 +/- 3.7 dB/MHz; 1538 +/- 46 m/s; 503.0 +/- 37.0) had significantly higher BUA, VOS, and stiffness index (SI) scores (p < 0.05), respectively, than swimmers (124.1 +/- 5.1 dB/MHz; 1495 +/- 42 m/s; 423.3 +/- 46.9) and the sedentary control group (119.9 +/- 6.1 dB/MHz; 1452 +/- 41 m/s; 369.9 +/- 46.4). A trend of a significant linear increase with the weight bearing and high impact exercise was revealed in all QUS parameters (p < 0.05). CONCLUSION: This cross sectional study indicated that regular participation in weight bearing exercise in young people might be beneficial for accruing peak bone mass and optimising bone structure.

Adolescent↗