A cross-sectional study of anxiety and depression caseness in female competitive figure skaters in Sweden.

Objectives: Little is known about figure skaters' mental health. This study aimed to describe anxiety and depression caseness (defined as a screening condition qualifying for psychiatric examination) in competitive figure skaters and analyse factors associated with such caseness. Methods: A cross-sectional study was performed in April 2019 among all competitive figure skaters in the south-eastern region of Sweden (N=400). The primary outcomes were anxiety caseness, measured using the short-form Spielberger State-Trait Anxiety Inventory and depression caseness, measured using the WHO-5 index. Multivariable logistic regression models were employed to determine the association between anxiety caseness and explanatory factors. Results: In total, 36% (n=142) of the invited skaters participated. Only females (n=137), mean age 12.9 (SD 3.0) years) were selected for analysis. Of the participating skaters, 47% displayed anxiety caseness and 10% depression caseness. Overweight body image perception (OR 5.9; 95% CI 2.0 to 17.6; p=0.001) and older age (OR 1.2; 95% CI 1.1 to 1.4; p=0.005) were associated with anxiety caseness. Skaters reporting no caseness were younger than those reporting only anxiety caseness (mean age difference -1.9 years; 95% CI -3.1 to -0.7; p=0.001) or anxiety and depression caseness (OR -3.5 years; 95% CI -5.6 to -1.5 years; p<0.001). Conclusion: Anxiety caseness was associated with overweight body image perception and older age in female competitive figure skaters. Older skaters reported generally worse mental health. More research on the mental health of figure skaters is warranted, considering comorbidity and focusing on those needing further assessment and support.

Universal prevention through a digital health platform reduces injury incidence in youth athletics (track and field): a cluster randomised controlled trial.

OBJECTIVES: To examine whether universal prevention via a digital health platform can reduce the injury incidence in athletics athletes aged 12-15 years and if club size had an influence on the effect of the intervention. METHODS: This was a cluster randomised trial where young athletics athletes were randomised through their club following stratification by club size into intervention (11 clubs; 56 athletes) and control (10 clubs; 79 athletes) groups. The primary endpoint was time from baseline to the first self-reported injury. Intervention group parents and coaches were given access to a website with health information adapted to adolescent athletes and were encouraged to log in and explore its content during 16 weeks. The control group continued training as normal. Training exposure and injury data were self-reported by youths/parents every second week, that is, eight times. The primary endpoint data were analysed using the log-rank test. Cox proportional hazards regression was used to analyse the second study aim with intervention status and club size included in the explanatory models. RESULTS: The proportion of completed training reports was 85% (n=382) in the intervention group and 86% (n=545) in the control group. The injury incidence was significantly lower (HR=0.62; χ2=3.865; p=0.049) in the intervention group. The median time to first injury was 16 weeks in the intervention group and 8 weeks in the control group. An interaction effect between the intervention and stratification factor was observed with a difference in injury risk between athletes in the large clubs in the intervention group versus their peers in the control group (HR 0.491 (95% CI 0.242 to 0.998); p=0.049). CONCLUSIONS: A protective effect against injury through universal access to health information adapted for adolescent athletes was observed in youth athletics athletes. The efficacy of the intervention was stronger in large clubs. TRIAL REGISTRATION NUMBER: NCT03459313.

Effectiveness of the BNT162b2 mRNA Vaccine Compared with Hybrid Immunity in Populations Prioritized and Non-Prioritized for COVID-19 Vaccination in 2021-2022: A Naturalistic Case-Control Study in Sweden.

The term hybrid immunity is used to denote the immunological status of vaccinated individuals with a history of natural infection. Reports of new SARS-CoV-2 variants of concern motivate continuous rethought and renewal of COVID-19 vaccination programs. We used a naturalistic case-control study design to compare the effectiveness of the BNT162b2 mRNA vaccine to hybrid immunity 180 days post-vaccination in prioritized and non-prioritized populations vaccinated before 31 July 2021 in three Swedish counties (total population 1,760,000). Subjects with a positive SARS-CoV-2 test recorded within 6 months before vaccination (n = 36,247; 6%) were matched to vaccinated-only controls. In the prioritized population exposed to the SARS-CoV-2 Alpha and Delta variants post-vaccination, the odds ratio (OR) for breakthrough infection was 2.2 (95% CI, 1.6−2.8; p < 0.001) in the vaccinated-only group compared with the hybrid immunity group, while in the later vaccinated non-prioritized population, the OR decreased from 4.3 (95% CI, 2.2−8.6; p < 0.001) during circulation of the Delta variant to 1.9 (95% CI, 1.7−2.1; p < 0.001) with the introduction of the Omicron variant (B.1.617.2). We conclude that hybrid immunity provides gains in protection, but that the benefits are smaller for risk groups and with circulation of the Omicron variant and its sublineages.

Computational models predicting the early development of the COVID-19 pandemic in Sweden: systematic review, data synthesis, and secondary validation of accuracy.

Computational models for predicting the early course of the COVID-19 pandemic played a central role in policy-making at regional and national levels. We performed a systematic review, data synthesis, and secondary validation of studies that reported on prediction models addressing the early stages of the COVID-19 pandemic in Sweden. A literature search in January 2021 based on the search triangle model identified 1672 peer-reviewed articles, preprints and reports. After applying inclusion criteria 52 studies remained out of which 12 passed a Risk of Bias Opinion Tool. When comparing model predictions with actual outcomes only 4 studies exhibited an acceptable forecast (mean absolute percentage error, MAPE < 20%). Models that predicted disease incidence could not be assessed due to the lack of reliable data during 2020. Drawing conclusions about the accuracy of the models with acceptable methodological quality was challenging because some models were published before the time period for the prediction, while other models were published during the prediction period or even afterwards. We conclude that the forecasting models involving Sweden developed during the early stages of the COVID-19 pandemic in 2020 had limited accuracy. The knowledge attained in this study can be used to improve the preparedness for coming pandemics.

Nowcasting (Short-Term Forecasting) of COVID-19 Hospitalizations Using Syndromic Healthcare Data, Sweden, 2020.

We report on local nowcasting (short-term forecasting) of coronavirus disease (COVID-19) hospitalizations based on syndromic (symptom) data recorded in regular healthcare routines in Östergötland County (population ≈465,000), Sweden, early in the pandemic, when broad laboratory testing was unavailable. Daily nowcasts were supplied to the local healthcare management based on analyses of the time lag between telenursing calls with the chief complaints (cough by adult or fever by adult) and COVID-19 hospitalization. The complaint cough by adult showed satisfactory performance (Pearson correlation coefficient r>0.80; mean absolute percentage error <20%) in nowcasting the incidence of daily COVID-19 hospitalizations 14 days in advance until the incidence decreased to <1.5/100,000 population, whereas the corresponding performance for fever by adult was unsatisfactory. Our results support local nowcasting of hospitalizations on the basis of symptom data recorded in routine healthcare during the initial stage of a pandemic.

Predicting regional COVID-19 hospital admissions in Sweden using mobility data.

The transmission of COVID-19 is dependent on social mixing, the basic rate of which varies with sociodemographic, cultural, and geographic factors. Alterations in social mixing and subsequent changes in transmission dynamics eventually affect hospital admissions. We employ these observations to model and predict regional hospital admissions in Sweden during the COVID-19 pandemic. We use an SEIR-model for each region in Sweden in which the social mixing is assumed to depend on mobility data from public transport utilisation and locations for mobile phone usage. The results show that the model could capture the timing of the first and beginning of the second wave of the pandemic 3 weeks in advance without any additional assumptions about seasonality. Further, we show that for two major regions of Sweden, models with public transport data outperform models using mobile phone usage. We conclude that a model based on routinely collected mobility data makes it possible to predict future hospital admissions for COVID-19 3 weeks in advance.

Determinants of Sports Injury in Young Female Swedish Competitive Figure Skaters.

Introduction: Although figure skating attracts several hundred thousand participants worldwide, there is little knowledge about physical health and sports injuries among young skaters. The present study aimed to describe the health status of a geographically defined Swedish population of licensed competitive figure skaters and to examine injury determinants. Methods: All licensed competitive skaters in the southeastern region of Sweden were in April 2019 invited to participate in a cross-sectional study using an online questionnaire. Multiple binary logistic regression was used for the examination of injury determinants. The primary outcome measure was the 1-year prevalence of a severe sports injury episode (time loss >21 days). The secondary outcome measure was the point prevalence of an ongoing injury. The determinants analyzed were age, skating level, relative energy deficiency indicators, and training habits. Results: In total, 142 (36%) skaters participated, 137 (96%) girls [mean (SD) age: 12.9 (SD 3.0) years]. Participating boys (n = 5) were excluded from further analysis. The 1-year prevalence of a severe sports injury episode was 31%. The most common injury locations for these injuries were the knee (25%), ankle (20%), and hip/groin (15%). In the multiple model, having sustained a severe injury episode was associated with older age (OR 1.2, 95% CI 1.1-1.4; p = 0.002) and an increased number of skipped meals per week (OR 1.1, 95% CI 1.0-1.3; p = 0.014). The point prevalence of an ongoing injury episode was 19%. The most common locations were the knee (24%), ankle (24%), and foot (24%). Having an ongoing injury episode was associated with older age (OR 1.4, 95% CI 1.2-1.7; p < 0.001) and an increased number of skipped meals per week (OR 1.1, 95% CI 1.0-1.3; p = 0.049). Conclusion: One-third of young female Swedish competitive figure skaters had sustained a severe injury episode during the past year, and a fifth reported an ongoing episode. Older age and an increased number of skipped meals per week were associated with a sports injury episode. Long-term monotonous physical loads with increasing intensity and insufficient energy intake appear to predispose for injury in young female figure skaters. Further examination of injury determinants among competitive figure skaters is highly warranted.

Injury rates decreased in men's professional football: an 18-year prospective cohort study of almost 12 000 injuries sustained during 1.8 million hours of play.

BACKGROUND: The UEFA Elite Club Injury Study is the largest and longest running injury surveillance programme in football. OBJECTIVE: To analyse the 18-season time trends in injury rates among male professional football players. METHODS: 3302 players comprising 49 teams (19 countries) were followed from 2000-2001 through 2018-2019. Team medical staff recorded individual player exposure and time-loss injuries. RESULTS: A total of 11 820 time-loss injuries were recorded during 1 784 281 hours of exposure. Injury incidence fell gradually during the 18-year study period, 3% per season for both training injuries (95% CI 1% to 4% decrease, p=0.002) and match injuries (95% CI 2% to 3% decrease, p<0.001). Ligament injury incidence decreased 5% per season during training (95% CI 3% to 7% decrease, p<0.001) and 4% per season during match play (95% CI 3% to 6% decrease, p<0.001), while the rate of muscle injuries remained constant. The incidence of reinjuries decreased by 5% per season during both training (95% CI 2% to 8% decrease, p=0.001) and matches (95% CI 3% to 7% decrease, p<0.001). Squad availability increased by 0.7% per season for training sessions (95% CI 0.5% to 0.8% increase, p<0.001) and 0.2% per season for matches (95% CI 0.1% to 0.3% increase, p=0.001). CONCLUSIONS: Over 18 years: (1) injury incidence decreased in training and matches, (2) reinjury rates decreased, and (3) player availability for training and match play increased.

Assessing parents, youth athletes and coaches subjective health literacy: A cross-sectional study.

OBJECTIVES: The aim was to describe levels of subjective Health Literacy (HL), and to examine possible differences in prevalence proportions between sexes, age groups and level of educations among youth athletes and their mentors (coaches, parents/caregivers) in Swedish Athletics. DESIGN: Cross-sectional. METHODS: Data on subjective HL were collected using the Swedish Communicative and Critical Health Literacy (S-CCHL) instrument for mentors and for youth the School-Aged Children (HLSAC) instrument. Questions assessing mentors' literacy on sports injury and return to play were also included. RESULTS: The surveys were completed by 159 (91%) mentors and 143 youth athletes (87%). The level of S-CCHL was sufficient in 53% of the mentors. Of youth athletes, 28% reported a high level of HL and the item with least perceived high HL (21%) was critical thinking. Ninety-four percent of the mentors believed that it is quite possible to prevent injuries in athletics and 53% perceived having a very good knowledge about how to prevent injuries. Forty-six percent of the mentors perceived having a very good knowledge of return to sport criteria. CONCLUSIONS: The level of health literacy was low with about half of the mentors and one out of three youth athletes having adequate HL levels. Only half of the mentors stated having a good knowledge of various injury prevention strategies. To reduce health consequences in youth sport and enable talent development more work is needed to understand the facilitators and barriers for the uptake of various health promotion and injury prevention strategies.

Clinical effectiveness of the electrodermal orienting reactivity test for evaluating relapse and recurrence risk in patients hospitalized for depression.

BACKGROUND: Recurrence is a problem for many patients who have episodes of depression. In experimental settings, hyporeactivity in the Electrodermal Orienting Reactivity (EDOR) test has been observed to be more frequent in these patients. The aim of this study was to investigate the clinical value of this test with regard to a prognosis of episode recurrence in patients hospitalized for depression. METHODS: The study was performed using a cohort design at a specialized psychiatric clinic in Warsaw, Poland. The primary endpoint measure was relapse or recurrence of depression. Data on electrodermal reactivity measured by the EDOR test, clinical status, and psychiatric history were collected at the clinic. Relapse and recurrence data were collected by clinical interviews 1 year after the EDOR test. The predictive (adjusting for confounders) and comparative (relative to other predictors) performance of electrodermal hyporeactivity was assessed using simple and multiple binary logistic regression. RESULTS: The patient sample included 97 patients aged between 20 and 81 years (mean, 51.2 years). Twenty patients (20.6%) were hyporeactive in the EDOR test. The group of hyporeactive patients did not differ significantly from the reactive group with regard to background factors or clinical status on admission. Forty-seven patients (51.6%) had at least one depressive episode during the follow-up period. In the analysis including potential confounders, the likelihood of relapse or recurrence of depression was nearly five times higher among the hyporeactive patients than the reactive patients (odds ratio [OR], 4.7; 95% confidence interval (CI), 1.3-16.2; p = 0.015). In the comparative analysis, only hyporeactivity was found to be associated with recurring episodes (OR, 3.3; 95% CI, 1.1-10.2; p = 0.036). CONCLUSIONS: Electrodermal hyporeactivity was associated with a higher risk of relapse or recurrence after discharge among patients hospitalized for depression. This finding warrants further clinical investigations that cover different types of depression and account for causal mechanisms. TRIAL REGISTRATION: The study design was registered in the German Clinical Trials Register ( DRKS00010082 ).

Suicidal thoughts (ideation) among elite athletics (track and field) athletes: associations with sports participation, psychological resourcefulness and having been a victim of sexual and/or physical abuse.

OBJECTIVE: To examine associations between suicidal ideation and sexual and physical abuse among active and recently retired elite athletics (track and field) athletes. METHODS: The study population consisted of all athletes (n=402) selected for a Swedish Athletics team between 2011 and 2017. Data on suicidal ideation, suicidal events (estimated through the 1 year non-sports injury prevalence), lifetime abuse experiences, sociodemographics, sense of coherence and coping strategies were collected using a cross-sectional survey. The data were analysed using binary logistic regression with suicidal ideation and non-sports injury as outcomes. RESULTS: 192 athletes (47.8%) returned data. The prevalence of suicidal ideation was 15.6% (men 17.4%; women 14.2%) and the non-sports injury prevalence was 8.0% (men 11.6%; women 5.7%). Among women, suicidal ideation was associated with having been sexually abused (OR 5.94, 95% CI 1.42 to 24.90; p=0.015) and lower sense of coherence (OR 0.90, 95% CI 0.85 to 0.96; p=0.001) (Nagelkerke R2=0.33). Among men, suicidal ideation was only associated with use of behavioural disengagement for coping (OR 1.51, 95% CI 1.18 to 1.95; p=0.001) (R2 =0.25). Among women, non-sports injury prevalence was associated with having been sexually abused (OR 8.61, 95% CI 1.34 to 55.1; p=0.023) and participating in an endurance event (OR 7.37, 95% CI 1.11 to 48.9; p=0.039 (R2 =0.23), while among men, having immigrant parents (OR 5.67, 95% CI 1.31 to 24.5; p=0.020) (R2 =0.11) was associated with injury outside sports. CONCLUSIONS: About one out of six international athletics athletes reported having experienced suicidal ideation. World Athletics and National Olympic Committees need to include suicide prevention in their athlete protection programmes.

Nowcasting (Short-Term Forecasting) of Influenza Epidemics in Local Settings, Sweden, 2008-2019.

The timing of influenza case incidence during epidemics can differ between regions within nations and states. We conducted a prospective 10-year evaluation (January 2008-February 2019) of a local influenza nowcasting (short-term forecasting) method in 3 urban counties in Sweden with independent public health administrations by using routine health information system data. Detection-of-epidemic-start (detection), peak timing, and peak intensity were nowcasted. Detection displayed satisfactory performance in 2 of the 3 counties for all nonpandemic influenza seasons and in 6 of 9 seasons for the third county. Peak-timing prediction showed satisfactory performance from the influenza season 2011-12 onward. Peak-intensity prediction also was satisfactory for influenza seasons in 2 of the counties but poor in 1 county. Local influenza nowcasting was satisfactory for seasonal influenza in 2 of 3 counties. The less satisfactory performance in 1 of the study counties might be attributable to population mixing with a neighboring metropolitan area.

Smartphone-Based Maternal Education for the Complementary Feeding of Undernourished Children Under 3 Years of Age in Food-Secure Communities: Randomised Controlled Trial in Urmia, Iran.

The mothers' nutritional literacy is an important determinant of child malnourishment. We assessed the effect of a smartphone-based maternal nutritional education programme for the complementary feeding of undernourished children under 3 years of age in a food-secure middle-income community. The study used a randomised controlled trial design with one intervention arm and one control arm (n = 110; 1:1 ratio) and was performed at one well-child clinic in Urmia, Iran. An educational smartphone application was delivered to the intervention group for a 6-month period while the control group received treatment-as-usual (TAU) with regular check-ups of the child's development at the well-child centre and the provision of standard nutritional information. The primary outcome measure was change in the indicator of acute undernourishment (i.e., wasting) which is the weight-for-height z-score (WHZ). Children in the smartphone group showed greater wasting status improvement (WHZ +0.65 (95% Confidence Interval (CI) ± 0.16)) than children in the TAU group (WHZ +0.31 (95% CI ± 0.21); p = 0.011) and greater reduction (89.6% vs. 51.5%; p = 0.016) of wasting caseness (i.e., WHZ < -2; yes/no). We conclude that smartphone-based maternal nutritional education in complementary feeding is more effective than TAU for reducing undernourishment among children under 3 years of age in food-secure communities.

Are Elite Soccer Teams' Preseason Training Sessions Associated With Fewer In-Season Injuries? A 15-Year Analysis From the Union of European Football Associations (UEFA) Elite Club Injury Study.

BACKGROUND: Preseason training develops players' physical capacities and prepares them for the demands of the competitive season. In rugby, Australian football, and American football, preseason training may protect elite players against in-season injury. However, no study has evaluated this relationship at the team level in elite soccer. PURPOSE/HYPOTHESIS: The aim of this study was to investigate whether the number of preseason training sessions completed by elite soccer teams was associated with team injury rates and player availability during the competitive season. It was hypothesized that elite soccer teams who participate in more preseason training will sustain fewer injuries during the competitive season. STUDY DESIGN: Descriptive epidemiology study. METHODS: We used the Union of European Football Associations (UEFA) injury dataset to analyze 44 teams for up to 15 seasons (total, 244 team-seasons). Separate linear regression models examined the association between the number of team preseason training sessions and 5 in-season injury measures. Injury-related problems per team were quantified by totals of the following: (1) injury burden, (2) severe injury incidence, (3) training attendance, (4) match availability, and (5) injury incidence. RESULTS: Teams averaged 30 preseason training sessions (range, 10-51). A greater number of preseason training sessions was associated with less injury load during the competitive season in 4 out of 5 injury-related measures. Our linear regression models revealed that for every 10 additional preseason training sessions that the team performed, the in-season injury burden was 22 layoff days lower per 1000 hours (P = .002), the severe injury incidence was 0.18 severe injuries lower per 1000 hours (P = .015), the training attendance was 1.4 percentage points greater (P = .014), and the match availability was 1.0 percentage points greater (P = .042). As model fits were relatively low (adjusted R2 = 1.3%-3.2%), several factors that contribute to in-season injury outcomes were unaccounted for. CONCLUSION: Teams that performed a greater number of preseason training sessions had "healthier" in-season periods. Many other factors also contribute to in-season injury rates. Understanding the benefit of preseason training on in-season injury patterns may inform sport teams' planning and preparation.

Time before return to play for the most common injuries in professional football: a 16-year follow-up of the UEFA Elite Club Injury Study.

OBJECTIVES: The objective was to describe the typical duration of absence following the most common injury diagnoses in professional football. METHODS: Injuries were registered by medical staff members of football clubs participating in the Union of European Football Association Elite Club Injury Study. Duration of absence due to an injury was defined by the number of days that passed between the date of the injury occurrence and the date when the medical team allowed the player to return to full participation. In total, 22 942 injuries registered during 494 team-seasons were included in the study. RESULTS: The 31 most common injury diagnoses constituted a total of 78 % of all reported injuries. Most of these injuries were either mild (leading to a median absence of 7 days or less, 6440 cases = 42%) or moderate (median absence: 7-28 days, 56% = 8518 cases) while only few (2% = 311 cases) were severe (median absence of >28 days). The mean duration of absence from training and competition was significantly different (p < 0.05) between index injuries and re-injuries for six diagnoses (Achilles tendon pain, calf muscle injury, groin adductor pain, hamstring muscle injuries and quadriceps muscle injury) with longer absence following re-injuries for all six diagnoses CONCLUSIONS: The majority of all time loss due to injuries in professional football stems from injuries with an individual absence of up to 4 weeks. This article can provide guidelines for expected time away from training and competition for the most common injury types as well as for its realistic range.

Health complaints and heat stress prevention strategies during taper as predictors of peaked athletic performance at the 2015 World Athletics Championship in hot conditions.

OBJECTIVES: To investigate whether self-reported health complaints and choice of heat stress prevention strategies during the taper predicted peaking at an athletics championship in hot conditions. DESIGN: Cohort study. METHODS: Data on health and heat stress prevention were collected before the 2015 World Athletics Championship in Beijing, China. Peaking was defined using the athlete's pre-competition ranking and final competition rank. Baseline and endpoint data were fitted into multiple logic regression models. RESULTS: Two hundred forty-five (29%) of 841 eligible athletes participated. Both sprint/power (Odds ratio (OR) 0.33 (95% Confidence interval (CI) 0.11 to 0.94), P=0.038) and endurance/combined events (OR 0.38 (95% CI 0.14 to 1.00), P=0.049) athletes having sustained concern-causing health complaints during the taper were less likely to peak. Endurance/combined events athletes who chose pre-cooling to mitigate heat stress were less likely to peak (OR 0.35 (95% CI 0.15 to 0.80), P=0.013), while sprint/power athletes reporting a sudden-onset injury complaint during the taper displayed increased peaking (OR 4.47 (95% CI 1.28 to 15.59), P=0.019). CONCLUSIONS: Health complaints that caused the athlete concern during the taper were predictive of failure to peak at a major athletics competition. Sprint/power athletes who experienced an acute injury symptom during the taper appeared to benefit from rest. Pre-cooling strategies seem to require further validation during real-world endurance/combined events. It appears that athletics athletes' self-reported health should be monitored during the taper, concerns addressed, and heat stress prevention strategies individually tested before championships in hot conditions.

Perceptions of Overuse Injury Among Swedish Ultramarathon and Marathon Runners: Cross-Sectional Study Based on the Illness Perception Questionnaire Revised (IPQ-R).

BACKGROUND: Long-distance runners' understandings of overuse injuries are not well known which decreases the possibilities for prevention. The common sense model (CSM) outlines that runners' perceptions of a health problem can be described using the categories identity, consequence, timeline, personal control, and cause. The aim of this study was to use the CSM to investigate perceptions of overuse injury among long-distance runners with different exercise loads. METHODS: The study used a cross-sectional design. An adapted version of the illness perception questionnaire revised (IPQ-R) derived from the CSM was used to investigate Swedish ultramarathon and marathon runners' perceptions of overuse injuries. Cluster analysis was employed for categorizing runners into high and low exercise load categories. A Principal Component Analysis was thereafter used to group variables describing injury causes. Multiple logistic regression methods were finally applied using high exercise load as endpoint variable and CSM items representing perceptions of injury identity, consequence, timeline, personal control, and causes as explanatory variables. RESULTS: Complete data sets were collected from 165/443 (37.2%) runners. The symptoms most commonly associated with overuse injury were pain (80.1% of the runners), stiff muscles (54.1%), and stiff joints (42.0%). Overuse injury was perceived to be characterized by the possibility of personal control (stated by 78.7% of the runners), treatability (70.4%), and that the injury context was comprehensible (69.3%). The main injury causes highlighted were runner biomechanics (stated by 78.3%), the runner's personality (72.4%), and running surface biomechanics (70.0%). Among men, a belief in that personality contributes to overuse injury increased the likelihood of belonging to the high exercise load category [Odds ratio (OR) 2.10 (95% Confidence interval (95% CI) 1.38-3.19); P = 0.001], while beliefs in that running biomechanics [OR 0.56 (95% CI 0.37-0.85); P = 0.006) and mileage (OR 0.72 (95% CI 0.54-0.96); P = 0.026] causes injury decreased the likelihood. In women, a strong perception that overuse injuries can be controlled by medical interventions decreased the likelihood of high exercise load [OR 0.68 (95% CI 0.52-0.89); P = 0.005]. CONCLUSION: This study indicates that recognition among long-distance runners of the association between own decisions in overuse injury causation is accentuated by increased exercise loads.