Who stays in addiction treatment groups? Anxiety and avoidant attachment styles predict treatment retention and relapse.

Attachment styles have been shown to be an important predictor of relationship quality and well-being. They have also been linked with ability to function well in groups. Insecure attachment styles are thought to be an underlying cause of addiction and represent a target for change in one-to-one therapy. How attachment styles themselves affect group therapy for addiction is understudied. The current study addresses this gap by examining the effects of attachment styles on relapse and treatment retention amongst a population of people attending addiction therapy groups. Fifty-eight individuals in such groups completed measures of attachment anxiety and avoidance. Participants were followed up 4 weeks later, and their continued treatment attendance and relapse status were recorded. In terms of treatment retention, high anxiety/high avoidant participants had the highest retention. In terms of relapse, low anxiety/high avoidant participants had the lowest rates. These results are discussed in terms of the potentially protective effects of avoidant attachment styles during group therapy and the role of anxiety attachment in the continued maintenance of both protective and risky personal relationships.

Achilles tendon adaptation in cross-country runners across a competitive season.

Ultrasound tissue characterization (UTC) is an imaging tool used to quantify tendon structural integrity. UTC has quantified Achilles tendon (AT) acute response to load in athletes; however, AT response to cumulative load over a season is unknown. The purpose of this study was to evaluate AT response across a four-month competitive season in collegiate cross-country (XC) runners. Participants (n=21; male=9, female=12; age=19.8±1.2 years; height=171.9±8.9 cm; weight=60.2±8.5 kg) were imaged using the UTC device with a 10-MHz linear-array transducer mounted in a tracking device. The device captures images at 0.2 mm intervals along the AT. UTC algorithms quantified the stability of pixel brightness over every 17 contiguous transverse images into four echo types (I-IV). A total of 168 scans (n=21, bilateral limbs) were performed monthly across the four-month season (Aug=M1, Sep=M2, Oct=M3, Nov=M4). Echo-type percentages (%) were calculated from each scan. Generalized estimating equations (GEE) linear regression models evaluated echo-type % change (ß) over the season (M1=reference). Type I increased from M1 to M4 (ß=9.10, P<.01; 95%CI: 7.01, 11.21) and Type II decreased from M1 to M3 (ß=-2.71, P=.018; 95%CI: -4.96, -0.47) and M1 to M4 (ß=-10.19, P<.01; 95%CI: -12.22, -8.17). Type III increased from M1 to M3 (ß=0.42, P=.003; 95%CI: 0.19, 0.65) and M1 to M4 (ß=0.49, P=.002; 95%CI: 0.18, 0.81), Type IV increased from M1 to M4 (ß=0.57, P<.01; 95%CI: 0.29, 0.84). A positive adaptation in AT structural integrity was observed over the XC season, with a ~10% shift from Type II to Type I UTC echo types, suggesting AT resilience to a competitive season of repetitive loading in highly trained runners.

The effects of building-related factors on classroom relative humidity among North Carolina schools participating in the 'Free to Breathe, Free to Teach' study.

UNLABELLED: Both high and low indoor relative humidity (RH) directly impact Indoor Air Quality (IAQ), an important school health concern. Prior school studies reported a high prevalence of mold, roaches, and water damage; however, few examined associations between modifiable classroom factors and RH, a quantitative indicator of dampness. We recorded RH longitudinally in 134 North Carolina classrooms (n = 9066 classroom-days) to quantify the relationships between modifiable classroom factors and average daily RH below, within, or above levels recommended to improve school IAQ (30-50% or 30-60% RH). The odds of having high RH (>60%) were 5.8 [95% Confidence Interval (CI): 2.9, 11.3] times higher in classrooms with annual compared to quarterly heating, ventilating, and air-conditioning (HVAC) system maintenance and 2.5 (95% CI: 1.5, 4.2) times higher in classrooms with HVAC economizers compared to those without economizers. Classrooms with direct-expansion split systems compared to chilled water systems had 2.7 (95% CI: 1.7, 4.4) times higher odds of low RH (<30%). When unoccupied, classrooms with thermostat setbacks had 3.7 (95% CI: 1.7, 8.3) times the odds of high RH (>60%) of those without setbacks. This research suggests actionable decision points for school design and maintenance to prevent high or low classroom RH. PRACTICAL IMPLICATIONS: This study combines longitudinal measurements of classroom relative humidity with school inspection data from several schools to describe the problem of relative humidity control in schools. Our findings on how maintenance and mechanical factors affect classroom humidity provide suggestions on building operations policies and heating, ventilating, and air-conditioning (HVAC) design considerations that may improve classroom relative humidity control.

Association between serum and urine biomarkers and lumbar spine individual radiographic features: the Johnston County Osteoarthritis Project.

OBJECTIVE: (1) To determine associations between radiographic features of lumbosacral (LS) spine disc space narrowing (DSN) and osteophytes (OST) and joint metabolism biomarkers (serum cartilage oligomeric matrix protein (COMP), hyaluronic acid (HA), collagen neoepitope (C2C), C-propeptide of type II procollagen (CP-II), urine C-terminal cross-linking telopeptide (CTX-II) and N-terminal telopeptide (NTX-I)). (2) To explore interactions with race, gender and low back symptoms. DESIGN: Cross-sectional analysis of 547 participants enrolled in the Johnston County (JoCo) Osteoarthritis Project from 2003 to 2004. Mean biomarker levels were estimated with linear regression. Proportional and partial-proportional odds models were used to estimate associations. Interactions were tested with likelihood ratio tests at a P-value < 0.10. Biomarkers were natural log (ln) transformed. RESULTS: Significant differences in mean biomarker levels were found across severity of DSN for lnHA and lnC2C and lnCTX-II across severity of both DSN and OST. Moderate-to-strong associations were found between biomarkers of type II collagen and DSN, whereas associations with OST were weak. An association between lnHA and DSN was seen in women (adjusted odds ratio [aOR] = 1.34 (95% confidence intervals (CI) 1.08, 1.65)) but no association among men (aOR = 0.90 (95% CI 0.63, 1.26)). In Caucasians there was a decreased association with NTX-I and OST (aOR = 0.67 (95% CI 0.49, 0.91)) and no association in African Americans (AAs) (aOR = 1.06 (95% CI 0.76, 1.47)). There was a positive association of lnCOMP with DSN among those with low back symptoms (aOR = 1.82 (95% CI 1.02, 3.27)), but no association in those without low back symptoms (aOR = 0.65 (95% CI 0.35, 1.20)). CONCLUSION: Joint metabolism biomarkers suggest biological differences in the pathologic process involved in DSN and OST that may be gender (HA) and ethnicity (NTX-I) specific.

Heat injury in youth sport.

Heat injury is a potentially lethal condition that is considered to be completely preventable. Fatal heat injury is relatively rare (0.20 per 100 000 player-seasons in US high school football) and there are very limited data on non-fatal incidence. Expert recommendations for prevention include gradual acclimatisation of youth athletes to hot conditions, reductions in activity in hot and humid conditions, wearing light and light-coloured clothing, careful monitoring of athletes for signs of heat injury to facilitate immediate detection, having the resources to immediately and rapidly cool affected athletes, and education of athletes, care givers, and coaches about heat injury. Although a base of observational case data, physiological information, and expert opinion exists, the science surrounding this field is devoid of health communication and health behaviour research, and there is a pressing need for analytical studies to evaluate intervention programmes and/or identify new risk factors. There is also a need for ongoing data collection on heat injury incidence and on the knowledge, attitudes and behaviours towards heat injury among youth athletes, their care givers and their coaches.

A case crossover study of triggers for hand injuries in commercial fishing.

OBJECTIVES: Previous studies estimate hand and wrist injuries are common in commercial fishing. Risk factors including working with catch, handling gear and slips or falls, have been identified from activity and injury contact reports, but no studies have examined the influence of transient risk factors, or triggers. This case crossover study design was conducted to investigate triggers for acute hand trauma in commercial fishing. METHODS: A case crossover study was nested within a previously established prospective cohort of 217 southeastern United States commercial fishermen followed from April 1999 through October 2001. Hand injury cases and controls were matched using three control selection strategies. Odds ratios (OR) and 95% confidence intervals (95% CI) were calculated to determine if transient risk factors such as glove use, engaging in more than one type of fishing, maintenance activities and other covariates of interest increased the risk of occupational traumatic hand/wrist/digit injuries. RESULTS: 21% (46/217) of fishermen reported one or more hand/wrist/digit injuries, yielding 65 eligible cases. Performing maintenance work (any vs none) (OR 3.1, 95% CI 1.8 to 5.5) and using multiple types of fishing equipment in comparison to using only one type (OR 1.9, 95% CI 0.9 to 3.8) were associated with increased risk of hand/wrist/digit injury. There was no evidence glove use was protective (any vs none) for hand/wrist/digit injury (OR 0.9, 95% CI 0.5 to 1.7). CONCLUSIONS: The case crossover design is a useful method to determine triggers of commercial fishing-related hand/wrist/digit injuries. Maintenance work was strongly associated with hand/wrist/digit injury for these fishermen.

Cost of injuries from a prospective cohort study of North Carolina high school athletes.

OBJECTIVE: To estimate the economic cost of injuries in a population of US high school varsity athletes. DESIGN AND SETTING: The North Carolina High School Athletic Injury Study, conducted from 1996 to 1999, was a prospective cohort study of injury incidence and severity. A two-stage cluster sampling technique was used to select athletic teams from 100 high schools in North Carolina. An injury cost model was used to estimate the economic cost of injury. PARTICIPANTS: Varsity athletes from 12 sports: football, girls' and boy's soccer, girls' and boys' track, girls' and boy's basketball, baseball, softball, wrestling, volleyball, and cheerleading. MAIN OUTCOME MEASURES: Descriptive data were collected at the time of injury. Three types of costs were estimated: medical, human capital (medical costs plus loss of future earnings), and comprehensive (human capital costs plus lost quality of life). RESULTS: The annual statewide estimates were $9.9 million in medical costs, $44.7 million in human capital costs, and $144.6 million in comprehensive costs. The mean medical cost was $709 per injury (95% CI $542 to $927), $2223 per injury (95% CI $1709 to $2893) in human capital costs, and $10,432 per injury (95% CI $8062 to $13,449) in comprehensive costs. Sport and competition division were significant predictors of injury costs. CONCLUSIONS: Injuries among high school athletes represent a significant economic cost to society. Further research should estimate costs in additional populations to begin to develop cost-effective sports injury prevention programs.

Deaths from violence in North Carolina, 2004: how deaths differ in females and males.

OBJECTIVE: To identify gender differences in violent deaths in terms of incidence, circumstances, and methods of death. DESIGN: Analysis of surveillance data. SETTING: North Carolina, a state of 8.6 million residents on the eastern seaboard of the US. SUBJECTS: 1674 North Carolina residents who died from violence in the state during 2004. METHODS: Information on violent deaths was collected by the North Carolina Violent Death Reporting System using data from death certificates, medical examiner reports, and law enforcement agency incidence reports. RESULTS: Suicide and homicide rates were lower for females than males. For suicides, females were more likely than males to have a diagnosis of depression (55% v 36%), a current mental health problem (66% v 42%), or a history of suicide attempts (25% v 13%). Firearms were the sole method of suicide in 65% of males and 42% of females. Poisonings were more common in female than male suicides (37% v 12%). Male and female homicide victims were most likely to die from a handgun or a sharp instrument. Fifty seven percent of female homicides involved intimate partner violence, compared with 13% of male homicides. Among female homicides involving intimate partner violence, 78% occurred in the woman's home. White females had a higher rate of suicide than African-American females, but African-American females had a higher rate of homicide than white females. CONCLUSIONS: The incidence, circumstances, and methods of fatal violence differ greatly between females and males. These differences should be taken into account in the development of violence prevention efforts.

Injury history as a risk factor for incident injury in youth soccer.

OBJECTIVES: To determine if athletes with a self reported history of previous injury have a higher incident injury rate than athletes without a self reported injury history. METHODS: A prospective cohort study of Classic League soccer players playing at the level under 12 through under 18. Injury history forms were mailed to all registering Classic League soccer players in the North Carolina Youth Soccer Association during 1997-2000 (n = 7000); 1483 (19%) returned the baseline questionnaire and were followed up for injuries. RESULTS: There were 5139 player-seasons of follow up and an estimated 171 957 athlete-exposures. More than half self reported an injury history (59.7%). Overall, the unadjusted incidence rate was 4.6 (95% confidence interval (CI) 4.3 to 4.9) incident injuries per 1000 athlete-exposures. Multivariate generalised Poisson regression modelling indicated that players with one previous injury had a twofold greater risk of incident injury (IRR = 2.6; 95% CI 2.0 to 3.3), and those with two or more previous injuries had a threefold greater risk of incident injury (IRR = 3.0; 95% CI 2.3 to 3.8) compared with athletes with no previous injuries. CONCLUSIONS: Injury history was associated with an increased injury rate. This suggests that, even in these youth soccer players, those with an injury history may be at higher risk.

Work related injuries in small scale commercial fishing.

OBJECTIVE: To describe the epidemiology of work related injury in a group of small scale, independent commercial fishers. DESIGN: Cross sectional survey (baseline instrument of a prospective cohort study). SETTING AND SUBJECTS: Commercial fishers in eastern North Carolina. RESULTS: A cohort of 219 commercial fishers was established and 215 subjects completed an injury questionnaire. The main types of fishing conducted by the cohort were finfishing (159/215) and crabbing (154/215). Of the 215 fishers, 83 reported that they had suffered an injury event in the previous 12 months, a retrospective recall incidence proportion of 38.6 per 100 workers (95% confidence interval 32.1 to 45.1). The 83 injury events resulted in 94 injuries; 47% were penetrating wounds and 24% were strains/sprains. Half of injuries were to the hand/wrist/digits and 13% were to the back. Of the penetrating wounds, 87% were to the hand/wrist/digits, 32% became infected, and 80% were caused by contact with finfish, shellfish, or other marine animal. Of the strains/sprains, 48% were to the back and 26% were to the shoulder. Seventy percent of strains/sprains were caused by moving heavy objects, mainly either while hauling in nets, pots, or lines or loading/unloading the boat. CONCLUSION: In this group of small scale, independent fishers, the most common reported injuries were penetrating wounds to the hand/wrist/digits from marine animals and strains/sprains to the back while moving heavy objects.

Helmet rental practices at United States ski areas: a national survey.

OBJECTIVES: Studies have shown that head injuries are the leading cause of death on ski slopes. Statistics on helmet rental practices at ski areas across the United States have never been reported. This study sought to determine the prevalence of United States ski areas offering helmet rental during the 2002-03 ski season. Secondarily it sought to analyze the relationships of geographic region and size of ski area with helmet rental availability and to gather information on ski helmet rental cost to the consumer. METHODS: and setting: A stratified cross sectional telephone survey of a sample of 331 United States ski area onsite rental shops during February 2003. RESULTS: Altogether 50% of ski areas offered helmet rental with significant variation in the prevalence of helmet rental among ski areas of differing regions and sizes (p<0.01). A majority of Northeastern (57%), Western (63%), and Rocky Mountain (71%) ski areas rented helmets, whereas a minority of Southern (37%) and Midwestern (23%) ski areas rented helmets. Twenty five percent of the smallest ski areas (< or =50 acres) rented helmets compared with 74% of the largest ski areas (> or =501 acres). CONCLUSIONS: United States ski area helmet rental practices vary by region of the country and ski area size. Winter sports participants interested in wearing protective headgear should be aware of the helmet rental practices at the ski area in which they plan to visit and consider helmet purchase if they visit mainly smaller ski areas or areas within the South or Midwest.

Use of protective equipment in a cohort of rugby players.

PURPOSE: To describe the level of usage of protective devices and equipment in a cohort of New Zealand rugby players. METHODS: Male and female players (N = 327) from a range of competitive grades were followed over the course of the season. Participants were interviewed weekly about their participation in rugby and use of protective equipment. The main outcome measure was percentage of all player-weeks of follow-up for which each equipment item was used. RESULTS: Mouthguards, the most commonly used equipment item, were worn for 64.9% of player-weeks. Mouthguard usage ranged from 55.0% of player-weeks in Schoolgirls grade to 72.9% of player-weeks in Senior A competition. The next most common item was taping of body joints (23.7% of player-weeks). The sites most commonly taped were the ankle, knee, and hand. Overall usage for the other protective equipment items studied (shin guards, padded headgear, head tape, support sleeves, and grease) was below 15%. In general, forwards had higher usage of protective equipment than backs, and male players had higher usage than female players. The most common self-reported reasons for using protective equipment were to prevent injury and because of a past injury. Players exhibited considerable week-to-week variation in their usage of protective equipment. CONCLUSIONS: In general, equipment usage was highest in those at greatest risk of injury, namely, forwards, male players, and the senior grades. The high voluntary use of mouthguards is encouraging and indicative of a base of player support for their role in this sport.

Homicide on the job: workplace and community determinants.

Homicide is the second leading cause of death on the job for workers in the United States. To identify workplace-level predictors of homicide risk, a case-control study of worker killings in North Carolina in 1994-1998 was conducted. Workplaces were the units of analysis: case workplaces (n = 105) were those where a worker was killed during the study period, while controls (n = 210) were a density sample of North Carolina workplaces, matched on time and industry sector. Potential risk and protective factors were assessed in telephone interviews with workplace managers. Associations were measured by the exposure odds ratio and 95% confidence interval, estimated via conditional logistic regression. Characteristics associated with notably higher risk included being at the current location for 2 years or less (odds ratio (OR) = 5.3, 95% confidence interval (CI): 2.2, 12.6), having only one worker (OR = 2.9, 95% CI: 1.2, 7.2), and having night (OR = 4.9, 95% CI: 2.7, 8.8) or Saturday (OR = 4.2, 95% CI: 1.9, 9.2) hours. Workplaces with only male employees (OR = 3.1, 95% CI: 1.5, 6.5) or with African-American or Asian employees were also more likely to experience a killing. While few of the preceding risk factors are directly modifiable through workplace interventions, it is important to identify them before developing or evaluating preventive measures.

The New Zealand rugby injury and performance project. VI. A prospective cohort study of risk factors for injury in rugby union football.

OBJECTIVES: Although the nature of rugby injury has been well documented, little is known about key risk factors. A prospective cohort study was undertaken to examine the association between potential risk factors and injury risk, measured both as an injury incidence rate and as a proportion of the playing season missed. The latter measure incorporates a measure of injury severity. METHODS: A cohort of 258 male players (mean (SD) age 20.6 (3.7) years) were followed through a full competitive season. At a preseason assessment, basic characteristics, health and lifestyle patterns, playing experience, injury experience, training patterns, and anthropometric characteristics were recorded, and then a battery of fitness tests were carried out. RESULTS: A multiple regression model identified grade and previous injury experience as risk factors for in season injury, measured as an injury incidence rate. A second model identified previous injury experience, hours of strenuous physical activity a week, playing position, cigarette smoking status, body mass index, years of rugby participation, stress, aerobic and anaerobic performance, and number of push ups as risk factors for in season injury, measured as proportion of season missed. CONCLUSIONS: The findings emphasise the importance of previous injury as a predictor of injury incidence and of missing play. They also show the importance of considering both the incidence rate and severity of injury when identifying risk factors for injury in sport.

Injuries in little league baseball from 1987 through 1996: implications for prevention.

UNLABELLED: Baseball is a very popular team sport in the United States, but there has been concern with the number of injuries and fatalities. OBJECTIVE: This study describes the incidence of injuries to Little League Baseball, Inc, players from 5 to 12 years old from 1987 through 1996. METHODS: Descriptive statistical analyses of injuries derived from Little League Baseball, Inc, insurance data from 17,221,210 player-years of follow-up in the 10-year study period. An average of 1,722,121 children participated every year. RESULTS: During the study, there were 29,038 injuries and an injury rate of 1.69 injuries per 1,000 participants per season. Ball-related injuries totaled 15,266, and batters had the greatest number of ball injuries. There were 12,306 facial and teeth injuries, mostly in defensive players. Sliding was associated with 60% of the injuries to base runners. Approximately 25% of the injuries were considered severe (fractures, dislocations, and concussions), and 13 players died. CONCLUSION: Based on the data, youth baseball appears to be a very safe sport, but there are areas where injury prevention is possible. Data and additional attention are needed concerning face mask use for players in the field, modified balls for minimizing contact injuries, education on sliding technique, and use of safety bases for runners.

Temporal patterns of injury during a rugby season.

The aim of this study was to describe temporal patterns in the frequency, nature and circumstances of injuries occurring among a cohort of 356 rugby players during a club rugby season in New Zealand. It was found that the rate of injury in games decreased significantly over time in both males and females. The reduction in injury rate over the season was more pronounced in some grades, but no differences were found when examined by gender. playing position, age, ethnicity or by health and fitness types. Trends in injury rate were consistent over the rugby season and did not appear to be the result of a bias involving under-reporting of end-of-season injuries. The types and severity of injury remained relatively constant, but the proportion of injuries occurring in back play fell significantly over the season and injuries were more likely to occur in the trunk body region as the season progressed. This study supported the hypothesis that higher rates of injury occur at the start of the rugby season and decrease over the course of the season. This reduction is consistent over time and across player types, and is not attributable either to decreasing injury severity or to increasing player fitness.

The New Zealand Rugby Injury and Performance Project: V. Epidemiology of a season of rugby injury.

OBJECTIVE: To describe the incidence, nature, and circumstances of injury experienced by a cohort of rugby union players during a full competitive club season. METHODS: A prospective cohort study followed up 356 male and female rugby players throughout the 1993 competitive club season. Players were interviewed by telephone each week to obtain information on the amount of rugby played and the injury experienced. RESULTS: Detailed information was collected for 4403 player-games and 8653 player-practices. A total of 671 injury events were reported, of which 569 were rugby related. The injury rate for games was higher than that for practices (rate ratio 8.3). At 10.9 injuries per 100 player-games, males had a higher rate of injury than females at 6.1 injuries per 100 player-games (p<0.001). Injury rates varied by position, with male locks (13.0 injuries per 100 player-games) and female inside backs (12.3 injuries per 100 player-games) having the highest rate in their respective sexes. The lower limb was the body region most often injured in games (42.5%) and practices (58.4%). Sprains/strains were the most common type of injury in games (46.7%) and practices (76.1%). In games the tackle was the phase of play in which the most injuries occurred (40%), followed by rucks (17%) and mauls (12%). Thirteen per cent of game injury events were the result of foul play. CONCLUSIONS: Rugby injury was common among the study subjects and varied according to grade and gender. Identifying the causes of injuries in the tackle, lower limb injuries, and dealing with the issue of foul play are priority areas for the prevention of rugby injury.

Adult thermal injuries in New Zealand resulting in death and hospitalization.

This paper provides an overview of thermal injury resulting in death or hospitalization in New Zealand adults, defined as age 15 years and over. For the 10-year period 1978-1987, there were 493 adult thermal injury deaths resulting in an overall rate of 2.1 per 100000 person-years (95%CI: 1.9-2.3). For the year 1988, there were 644 hospitalizations resulting in a rate of 25.1 per 100000 (95%CI: 23.2-27.1). The highest rates of death and hospitalization were observed in the elderly (65 years of age and over). Young males (15-29 years) also had a very high rate of hospitalization. Residential fire was the most common type of burn event resulting in death (44%), and smoking materials were the most common source of ignition in fatal residential fires (37%). Hot liquids were the most common source of thermal energy for the hospitalized injuries (34%). Typical scenarios involved burns from hot water expelled from automobile radiators, from hot water use in the workplace, from hot beverages, and from household hot tap-water. The epidemiology of the adult thermal injuries in New Zealand is similar to that reported in other developed countries. Opportunities and strategies for the prevention of these injuries are discussed.