Is Time Spent Outside the Family Home a Risk Factor for Lead Exposure in Pre-School Children Living in Broken Hill?

Broken Hill is amongst a group of communities internationally that are at greater risk from lead due to active or historical lead industries. Current evidence suggests there is no safe level of lead for young children. This paper describes places outside the family home where young Broken Hill children spend time and considers the potential for this to contribute to lead risk. We interviewed 65 families of children 3 years old or younger and detailed the top five places children spent time at outside the family home. Exposure to private residences outside the family home was recorded for most (88%) young children. Nearly two thirds stayed there five or more hours per week. Most children went there on a weekly basis over many months (median, 12 months), increasing the likelihood of exposure to lead hazards. Further investigation of the lead hazard and risk behaviour of children at these residences would assist in developing guidelines for remediation of the lead hazard for all private residences in Broken Hill. This approach to elucidating the potential sources and pathways of lead and other heavy metal exposures for young children may have merit in other settings where comprehensive zonal remediation is not feasible or may not be warranted.

Combining the Copenhagen Adduction Exercise and Nordic Hamstring Exercise Improves Dynamic Balance Among Male Athletes: A Randomized Controlled Trial.

BACKGROUND: Copenhagen adduction exercise (CAE) and Nordic hamstring exercise (NHE) reduce the incidence of groin and hamstring injuries. Efficient dynamic balance can improve motor performance and reduce the risk of injuries in athletes. However, the effects of these exercises on dynamic balance have not been investigated. HYPOTHESIS: CAE and NHE, as well as a combination of both exercises, would improve dynamic balance among amateur male athletes. STUDY DESIGN: Randomized controlled trial. LEVEL OF EVIDENCE: Level 1. METHODS: A total of 200 male athletes aged 21.9 ± 2.4 years were included in the study and randomly assigned to 4 groups: CAE group (n = 50), NHE group (n = 50), CAE and NHE group (n = 50), and a control group (n = 50). A total of 177 male athletes completed the study. The primary outcome measure was the limit of stability (LoS), which was measured using the Biodex Stability System to assess the performance of the dynamic balance. The LoS of the athletes' performance was measured pre- and postintervention after 6 weeks. RESULTS: The LoS significantly improved in all treatment groups, including CAE (44.5% ± 5.3%), NHE (43.2% ± 5.3%), and CAE + NHE (48.4% ± 5.1%) groups when compared with the control group (28.3% ± 4.8%) after 6 weeks (all Ps < 0.01). The improvement of LoS was significantly greater in the CAE + NHE group compared with other groups (CAE, NHE, and control groups). CONCLUSION: There was a significant increase in dynamic balance performance postintervention among male athletes. CAE and NHE may improve injury prevention programs. CLINICAL RELEVANCE: The results of this study provide evidence for athlete trainers and coaches to consider including the CAE and NHE as components of injury prevention programs to improve balance capacity and performance in athletes. Such improvements in balance may prevent injury risk and decrease absenteeism and injury-related financial burdens.

Design, Development, and Evaluation of an Injury Surveillance App for Cricket: Protocol and Qualitative Study.

BACKGROUND: Injury surveillance and workload monitoring are important aspects of professional sports, including cricket. However, at the community level, there is a dearth of accessible and intelligent surveillance tools. Mobile apps are an accessible tool for monitoring cricket-related injuries at all levels. OBJECTIVE: The objective of this paper is to share the novel methods associated with the development of the free TeamDoc app and provide evidence from an evaluation of the user experience and perception of the app regarding its functionality, utility, and design. METHODS: TeamDoc mobile app for Android and Apple smartphones was developed using 3 languages: C++, Qt Modeling Language, and JavaScript. For the server-side connectivity, Hypertext Preprocessor (PHP) was used as it is a commonly used cross-platform language. PHP includes components that interact with popular database management systems, allowing for secure interaction with databases on a server level. The app was evaluated by administrating a modified user version of the Mobile App Rating Scale (uMARS; maximum score: 5). RESULTS: TeamDoc is the first complementary, standalone mobile app that records cricket injuries through a smartphone. It can also record cricketing workloads, which is a known risk factor for injury. The app can be used without the need for supplementary computer devices for synchronization. The uMARS scores showed user satisfaction (overall mean score 3.6 [SD 0.5]), which demonstrates its acceptability by cricketers. CONCLUSIONS: Electronic injury surveillance systems have been shown to improve data collection during competitive sports. Therefore, TeamDoc may assist in improving injury reporting and may also act as a monitoring system for coaching staff to adjust individual training workloads. The methods described in this paper provide a template for researchers to develop similar apps for other sports.

Cluster randomised control trial for cricket injury prevention programme (CIPP): a protocol paper.

BACKGROUND: Injury prevention programmes (IPPs) are effective in reducing injuries among adolescent team sports. However, there is no validated cricket-specific IPP despite the high incidence of musculoskeletal injuries among amateur cricketers. OBJECTIVES: To evaluate whether a cricket injury prevention programme (CIPP) as a pretraining warm-up or post-training cool-down can reduce injury rates in amateur cricket players. METHODS: CIPP is a cluster randomised controlled trial which includes 36 male amateur club teams having cricket players aged 14-40 years to be randomly assigned to three study arms: warm-up, cool-down and control (n=12 teams, 136 players in each arm). The intervention groups will perform 15 min CIPP either as a pretraining warm-up or a post-training cool-down. OUTCOME MEASURES: The primary outcome measure will be injury incidence per 1000 player hours and the secondary outcome measures will be whether IPP as a warm-up is better than IPP as a cool-down, and the adherence to the intervention. TRIAL REGISTRATION NUMBER: ACTRN 1261700047039.

Comparison of Antiretroviral Therapy Adherence Among HIV-Infected Older Adults with Younger Adults in Africa: Systematic Review and Meta-analysis.

As access to antiretroviral treatment in low- and middle-income countries improves, the number of older adults (aged ≥ 50 years) living with HIV is increasing. This study compares the adherence to antiretroviral treatment among older adults to that of younger adults living in Africa. We searched PubMed, Medline, Cochrane CENTRAL, CINAHL, Google Scholar and EMBASE for keywords (HIV, ART, compliance, adherence, age, Africa) on publications from 1st Jan 2000 to 1st March 2016. Eligible studies were pooled for meta-analysis using a random-effects model, with the odds ratio as the primary outcome. Twenty studies were included, among them were five randomised trials and five cohort studies. Overall, we pooled data for 148,819 individuals in two groups (older and younger adults) and found no significant difference in adherence between them [odds ratio (OR) 1.01; 95% CI 0.94-1.09]. Subgroup analyses of studies using medication possession ratio and clinician counts to measure adherence revealed higher proportions of older adults were adherent to medication regimens compared with younger adults (OR 1.06; 95% CI 1.02-1.11). Antiretroviral treatment adherence levels among older and younger adults in Africa are comparable. Further research is required to identify specific barriers to adherence in the aging HIV affected population in Africa which will help in development of interventions to improve their clinical outcomes and quality of life.

Drug Compliance and Its Associated Factors Among Hypertensive Patients in Pakistan: A Cross-sectional Study.

The drug compliance and its associated factors were investigated among hypertensive patients attending the outpatient department of National Institute of Cardiovascular Disease (NICVD), Karachi, from September 2014 to March 2015. Data were collected retrospectively from 300 hypertensive patients taken treatment for >1 year. Half of the patients (51%) were >55 years of age with the predominance of males (52.70%). Most respondents (47%) had had ischemic heart disease (IHD), 30% had diabetes, 47% had both IHD and diabetes, while only a small number of subjects (18%) reporting no comorbidity. Most respondents (82%) reported that they took medicine regularly. Drug compliance was found significantly higher in males (55.70%) as compared with females (44.30%) (P = .025). Similarly, drug compliance was found significantly higher in patients who monitored their blood pressure (BP) regularly (59.30%) as compared with the patients who did not monitor their BP regularly (40.70%) (P = .001). Most respondents (46.30%) with hypertension (HTN) duration ≤5 years had significantly higher drug compliance as compared with the patients with HTN duration of 6 to 10 years and ≥11 years, that is, 33.30% and 20.30%, respectively (P = .018). In conclusion, the rate of drug adherence is not up to the mark in hypertensive patients, with high compliance reported in only half of the respondents.

WITHDRAWN: Drug compliance and its associated factors among hypertensive patients in Pakistan: A cross-sectional study.

Ahead of Print article withdrawn by publisher.

Cricket Injury Epidemiology in the Twenty-First Century: What is the Burden?

BACKGROUND: At the turn of the century, a new format of cricket [Twenty20 (T20)] was introduced that has led to more matches being played. Since then, it has been debated whether T20 cricket has increased the risk of overuse injuries. OBJECTIVES: The primary aim of this study was to meta-analyse the cricket injury rates in the twenty-first century. The secondary aims were to explore the risk factors and mechanisms of injury by analysing correlates such as age, format, era of play, country, player type, etc., and to conduct a qualitative analysis of the published studies. METHODS: Several databases were searched using keywords "cricket" and "injur*" and 24 papers reporting cricket injuries fitted the inclusion criteria. Fifteen papers included data on exposure time and were used to calculate injury rates to perform sub-group analysis. RESULTS: Pooled data on 12,511 players revealed 7627 injuries, and the 1.12 million hours of cricket play from 15 studies reporting exposure time showed an injury rate of 53.16 (95% confidence interval 51.84-54.52) per 10,000 h of play. There were no statistically significant differences in injury rates based on age, format, era of play, country, player type and injury definitions. Bowling biomechanics and workload were identified as the major risk factors for bowling injuries. CONCLUSIONS: This review shows that injury rates in junior and amateur cricket are higher than the injury rates of comparable cohorts playing other popular non-contact or quasi-contact team sports. There is not enough evidence to conclude that T20 cricket has increased injury rates.

Injury rate and patterns of Sydney grade cricketers: a prospective study of injuries in 408 cricketers.

BACKGROUND: The grade cricket competition, also known as premier cricket, supplies players to the state and national teams in Australia. The players involved are generally high-performing amateur (subelite) club cricketers. However, to date, there is no study on the injury epidemiology of Australian grade cricket. AIM: To conduct injury surveillance across all teams playing Sydney Grade Cricket (SGC) competition during the 2015-2016 season. METHODS: A cohort study was conducted to track injuries in 408 male cricketers in 20 teams playing SGC competition. Players were tracked through the MyCricket website's scorebook every week. Cricket New South Wales physiotherapists were alerted if there were changes to the playing XI from the last game. If any changes were made due to injury, then an injury incident was registered. RESULTS: During the course of the season, a total of 86 injuries were registered from 65 players, resulting in a loss of 385 weeks of play. The overall injury incidence rate was 35.54 injuries/10 000 playing hours with an average weekly injury prevalence of 4.06%. Lower back injuries (20%) were the most common injuries followed by foot (14%), hand (13.75%), knee (7.5%) and calf (7.5%). Linear regression analysis showed that the likelihood of injury increased as the mean age of the teams increased (R=0.5, p<0.05). CONCLUSION: The injury rate in SGC is lower than that reported at elite level. However, the high rate of lower back injuries (20%) highlights an area of concern in this cohort. High workloads or inadequate physical conditioning may contribute to such injuries. This study sets the foundation for understanding injury epidemiology in grade cricket and examines the links between injury and performance, these results may assist coaches and administrators to develop and implement cricket-specific injury prevention programmes.

Adding a post-training FIFA 11+ exercise program to the pre-training FIFA 11+ injury prevention program reduces injury rates among male amateur soccer players: a cluster-randomised trial.

QUESTION: Does adding a post-training Fédération Internationale de Football Association (FIFA) 11+ exercise program to the pre-training FIFA 11+ injury prevention program reduce injury rates among male amateur soccer players? DESIGN: Cluster-randomised, controlled trial with concealed allocation. PARTICIPANTS: Twenty-one teams of male amateur soccer players aged 14 to 35 years were randomly assigned to the experimental group (n=10 teams, 160 players) or the control group (n=11 teams, 184 players). INTERVENTION: Both groups performed pre-training FIFA 11+ exercises for 20minutes. The experimental group also performed post-training FIFA 11+ exercises for 10minutes. OUTCOME MEASURES: The primary outcomes measures were incidence of overall injury, incidence of initial and recurrent injury, and injury severity. The secondary outcome measure was compliance to the experimental intervention (pre and post FIFA 11+ program) and the control intervention (pre FIFA 11+ program). RESULTS: During one season, 26 injuries (team mean=0.081 injuries/1000 exposure hours, SD=0.064) were reported in the experimental group, and 82 injuries were reported in the control group (team mean=0.324 injuries/1000hours, SD=0.084). Generalised Estimating Equations were applied with an intention-to-treat analysis. The pre and post FIFA 11+ program reduced the total number of injuries (χ2 (1)=11.549, p=0.001) and the incidence of initial injury (χ2 (2)=8.987, p=0.003) significantly more than the pre FIFA 11+ program alone. However, the odds of suffering a recurrent injury were not different between the two groups (χ2 (1)=2.350, p=0.125). Moreover, the severity level of injuries was not dependent upon whether or not the pre and post FIFA 11+ program was implemented (χ2 (1)=0.016, p=0.898). CONCLUSION: Implementation of the FIFA 11+ program pre-training and post-training reduced overall injury rates in male amateur soccer players more than the pre FIFA 11+ program alone. TRIAL REGISTRATION: ACTRN12615001206516. [Al Attar WSA, Soomro N, Pappas E, Sinclair PJ, Sanders RH (2017) Adding a post-training FIFA 11+ exercise program to the pre-training FIFA 11+ injury prevention program reduces injury rates among male amateur soccer players: a cluster-randomised trial. Journal of Physiotherapy 63: 235-242].

Effect of Injury Prevention Programs that Include the Nordic Hamstring Exercise on Hamstring Injury Rates in Soccer Players: A Systematic Review and Meta-Analysis.

BACKGROUND: Hamstring injuries are among the most common non-contact injuries in sports. The Nordic hamstring (NH) exercise has been shown to decrease risk by increasing eccentric hamstring strength. OBJECTIVE: The purpose of this systematic review and meta-analysis was to investigate the effectiveness of the injury prevention programs that included the NH exercise on reducing hamstring injury rates while factoring in athlete workload. METHODS: Two researchers independently searched for eligible studies using the following databases: the Cochrane Central Register of Controlled Trials via OvidSP, AMED (Allied and Complementary Medicine) via OvidSP, EMBASE, PubMed, MEDLINE, SPORTDiscus, Web of Science, CINAHL and AusSportMed, from inception to December 2015. The keyword domains used during the search were Nordic, hamstring, injury prevention programs, sports and variations of these keywords. The initial search resulted in 3242 articles which were filtered to five articles that met the inclusion criteria. The main inclusion criteria were randomized controlled trials or interventional studies on use of an injury prevention program that included the NH exercise while the primary outcome was hamstring injury rate. Extracted data were subjected to meta-analysis using a random effects model. RESULTS: The pooled results based on total injuries per 1000 h of exposure showed that programs that included the NH exercise had a statistically significant reduction in hamstring injury risk ratio [IRR] of 0.490 (95 % confidence interval [CI] 0.291-0.827, p = 0.008). Teams using injury prevention programs that included the NH exercise reduced hamstring injury rates up to 51 % in the long term compared with the teams that did not use any injury prevention measures. CONCLUSIONS: This systematic review and meta-analysis demonstrates that injury prevention programs that include NH exercises decrease the risk of hamstring injuries among soccer players. A protocol was registered in the International Prospective Register of Systematic Reviews, PROSPERO (CRD42015019912).

Olympic weightlifting training improves vertical jump height in sportspeople: a systematic review with meta-analysis.

PURPOSE: This systematic review was conducted to evaluate the effect of Olympic weightlifting (OW) on vertical jump (VJ) height compared to a control condition, traditional resistance training and plyometric training. METHODS: Five electronic databases were searched using terms related to OW and VJ. Studies needed to include at least one OW exercise, an intervention lasting ≥6 weeks; a comparison group of control, traditional resistance training or plyometric training; and to have measured VJ height. The methodological quality of studies was assessed using the Downs and Black Checklist. Random and fixed effects meta-analyses were performed to pool the results of the included studies and generate a weighted mean effect size (ES). RESULTS: Six studies (seven articles) were included in the meta-analyses and described a total of 232 participants (175 athletes and 57 physical education students) with resistance training experience, aged 19.5±2.2 years. Three studies compared OW versus control; four studies compared OW versus traditional resistance training; and three studies compared OW versus plyometric training. Meta-analyses indicated OW improved VJ height by 7.7% (95% CI 3.4 to 5.4 cm) compared to control (ES=0.62, p=0.03) and by 5.1% (95% CI 2.2 to 3.0 cm) compared to traditional resistance training (ES=0.64 p=0.00004). Change in VJ height was not different for OW versus plyometric training. CONCLUSIONS: OW is an effective training method to improve VJ height. The similar effects observed for OW and plyometric training on VJ height suggests that either of these methods would be beneficial when devising training programmes to improve VJ height.

The Efficacy of Injury Prevention Programs in Adolescent Team Sports: A Meta-analysis.

BACKGROUND: Intensive sport participation in childhood and adolescence is an established cause of acute and overuse injury. Interventions and programs designed to prevent such injuries are important in reducing individual and societal costs associated with treatment and recovery. Likewise, they help to maintain the accrual of positive outcomes from participation, such as cardiovascular health and skill development. To date, several studies have individually tested the effectiveness of injury prevention programs (IPPs). PURPOSE: To determine the overall efficacy of structured multifaceted IPPs containing a combination of warm-up, neuromuscular strength, or proprioception training, targeting injury reduction rates according to risk exposure time in adolescent team sport contexts. STUDY DESIGN: Systematic review and meta-analysis. METHODS: With established inclusion criteria, studies were searched in the following databases: Cochrane Central Register of Controlled Trials, MEDLINE, SPORTDiscus, Web of Science, EMBASE, CINAHL, and AusSportMed. The keyword search terms (including derivations) included the following: adolescents, sports, athletic injuries, prevention/warm-up programs. Eligible studies were then pooled for meta-analysis with an invariance random-effects model, with injury rate ratio (IRR) as the primary outcome. Heterogeneity among studies and publication bias were tested, and subgroup analysis examined heterogeneity sources. RESULTS: Across 10 studies, including 9 randomized controlled trials, a pooled overall point estimate yielded an IRR of 0.60 (95% CI = 0.48-0.75; a 40% reduction) while accounting for hours of risk exposure. Publication bias assessment suggested an 8% reduction in the estimate (IRR = 0.68, 95% CI = 0.54-0.84), and the prediction interval intimated that any study estimate could still fall between 0.33 and 1.48. Subgroup analyses identified no significant moderators, although possible influences may have been masked because of data constraints. CONCLUSION: Compared with normative practices or control, IPPs significantly reduced IRRs in adolescent team sport contexts. The underlying explanations for IPP efficacy remain to be accurately identified, although they potentially relate to IPP content and improvements in muscular strength, proprioceptive balance, and flexibility. CLINICAL RELEVANCE: Clinical practitioners (eg, orthopaedics, physical therapists) and sports practitioners (eg, strength and conditioners, coaches) can respectively recommend and implement IPPs similar to those examined to help reduce injury rates in adolescent team sports contexts.

How Effective are F-MARC Injury Prevention Programs for Soccer Players? A Systematic Review and Meta-Analysis.

BACKGROUND: The FIFA Medical and Research Centre (F-MARC) has designed a comprehensive warm-up program targeting muscular strength, body kinaesthetic awareness, and neuromuscular control during static and dynamic movements to decrease injury risk for soccer players. Prior studies have investigated the effectiveness of the F-MARC programs, but have not consistently reported a statistically significant reduction in injury and reduction in time loss due to injury from utilizing the program. OBJECTIVE: The purpose of this study was to conduct a systematic review and meta-analysis of randomized controlled trials and interventional studies that evaluated the efficacy of the F-MARC injury prevention programs in soccer. METHODS: Two independent researchers searched the relevant article databases. The keyword domains used during the search were 'F-MARC', 'FIFA 11+', 'the 11+', 'injury prevention programs', 'soccer', and variations of these keywords. The initial search resulted in 4299 articles which were filtered to nine articles that met the inclusion criteria. Main inclusion criteria were randomized controlled trials or interventional studies, use of F-MARC injury prevention programs, and the primary outcome measuring overall and lower extremity injuries. Extracted data were entered and analyzed using Comprehensive Meta-Analysis software, version 2 (CMA.V2). RESULTS: The pooled results based on total injuries per 1000 h of exposure showed that F-MARC injury prevention programs had a statistically significant reduction in the overall injury risk ratio of 0.771 (95% CI 0.647-0.918, p = 0.003) and the lower extremity injury risk ratio of 0.762 (95% CI 0.621-0.935, p = 0.009). Moreover, FIFA '11+' had a statistically significant reduction in the overall injury risk ratio to 0.654 (95% CI 0.537-0.798, p < 0.001) and the lower extremity injury risk ratio of 0.612 (95% CI 0.475-0.788, p < 0.001). However, FIFA '11' did not reach significance for the lower extremity and overall injury reduction. It can be suggested that teams involved in the FIFA '11+' warm-up program will reduce injury rates by between 20 and 50% in the long term compared with the teams that do not engage in F-MARC programs. CONCLUSIONS: This systematic review and meta-analysis indicated that use of F-MARC injury prevention programs, particularly the '11+' program, decreases the risk of injuries among soccer players. These data also support the case for the development and introduction of sport-specific programs.

Train High Eat Low for Osteoarthritis study (THE LO study): protocol for a randomized controlled trial.

INTRODUCTION: Osteoarthritis (OA) is one of the most prevalent chronic conditions among older adults, with the medial tibio-femoral joint being most frequently affected. The knee adduction moment is recognized as a surrogate measure of the medial tibio-femoral compartment joint load and therefore represents a valid intervention target. This article provides the rationale and methodology for THE LO study (Train High, Eat Low for Osteoarthritis), which is a randomized controlled trial that is investigating the effects of a unique, targeted lifestyle intervention in overweight/obese adults with symptomatic medial knee OA. RESEARCH QUESTION: Compared to a control group given only lifestyle advice, do the effects of the following interventions result in significant reductions in the knee adduction moment: (1) gait retraining; and (2) combined intervention (which involves a combination of three interventions: (a) gait retraining, (b) high-intensity progressive resistance training, and (c) high-protein/low-glycaemic-index energy-restricted diet)? It is hypothesized that the combined intervention group will be superior to the isolated interventions of the high-protein/low-glycaemic-index diet group and the progressive resistance training group. Finally, it is hypothesized that the combined intervention will result in a greater range of improvements in secondary outcomes, including: muscle strength, functional status, body composition, metabolic profile, and psychological wellbeing, compared to any of the isolated interventions or control group. DESIGN: Single-blinded, randomized controlled trial adhering to the CONSORT guidelines on conduct and reporting of non-pharmacological clinical trials. PARTICIPANTS: One hundred and twenty-five community-dwelling people are being recruited. Inclusion criteria include: medial knee OA, low physical activity levels, no current resistance training, body mass index ≥ 25kg/m(2) and age ≥ 40 years. INTERVENTION AND CONTROL: The participants are stratified by sex and body mass index, and randomized into one of five groups: (1) gait retraining; (2) progressive resistance training; (3) high-protein/low-glycaemic-index energy-restricted diet (25 to 30% of energy from protein, 45% of energy from carbohydrates, < 30% of energy from fat, and glycaemic index diet value < 50); (4) a combination of these three active interventions; or (5) a lifestyle-advice control group. All participants receive weekly telephone checks for health status, adverse events and optimisation of compliance. MEASUREMENTS: Outcomes are measured at baseline, 6 and 12 months. The primary outcome is the peak knee adduction moment during the early stance phase of gait. The secondary outcome measures are both structural (radiological), with longitudinal reduction in medial minimal joint space width at 12 months, and clinical, including: change in body mass index; joint pain, stiffness and function; body composition; muscle strength; physical performance/mobility; nutritional intake; habitual physical activity and sedentary behaviour; sleep quality; psychological wellbeing and quality of life. DISCUSSION: THE LO study will provide the first direct comparison of the long-term benefits of gait retraining, progressive resistance training and a high-protein/low-glycaemic-index energy-restricted diet, separately and in combination, on joint load, radiographic progression, symptoms, and associated co-morbidities in overweight/obese adults with OA of the knee.