A Preseason Checklist for Predicting Elbow Injury in Little League Baseball Players.

BACKGROUND: Despite pitch count limits, the incidence of Little League elbow is increasing. A risk-evaluation tool capable of predicting which players are predisposed to throwing injury could potentially prevent injuries. PURPOSE: To investigate the effectiveness of a risk factor checklist for predicting elbow injury in Little League baseball players during 1 season. The hypothesis was that a preseason risk-evaluation checklist could predict which players were predisposed to elbow injury. STUDY DESIGN: Case-control study; Level of evidence, 3. METHODS: A preseason risk-evaluation checklist was distributed to Little League baseball teams in Japan. Six months later, a follow-up questionnaire was mailed to determine injuries sustained during the season. Logistic regression analysis was performed, assigning presence or absence of elbow injury during the season as the dependent variable, and an injury risk score (IRS) was developed based on the statistically significant variables. Receiver operating characteristic (ROC) curve analysis was conducted to determine the predictive validity of the checklist and the optimal cutoff IRS. RESULTS: Data from 389 Little League players were analyzed. Among them, 53 players experienced an elbow injury requiring medical treatment during the season. Six checklist items associated with a medical history of throwing injury, pitch volume, and arm fatigue were found to be significant. Responses to the items could predict the players who were susceptible to injury during the season, with a two-thirds cutoff value for a 6-item checklist (area under the curve, 0.810; sensitivity, 0.717; specificity, 0.771). CONCLUSION: Results from a 6-item preseason checklist can predict which Little League players are to sustain an elbow injury by the end of the season. CLINICAL RELEVANCE: The ability to predict which Little League baseball players are predisposed to elbow injury allows parents and coaches to initiate preventive measures in those players prior to and during the baseball season, which could lead to fewer elbow injuries.

Arterial Stiffness Predicts Cognitive Decline in Japanese Community-dwelling Elderly Subjects: A One-year Follow-up Study.

AIM: The purpose of this study was to determine whether arterial stiffness can be used to predict one-year changes in the cognitive function in Japanese community-dwelling elderly subjects. METHODS: A total of 103 Japanese community-dwelling elderly patients joined this study. Information regarding the age, height, weight, gender and past medical history of each participant was obtained. Additionally, arterial stiffness was determined according to the cardio-ankle vascular index (CAVI), and the cognitive function was assessed with the Mini-Mental State Examination (MMSE). One year later, we performed the MMSE in the same subjects. After dividing the cohort according to the 80th percentile of the CAVI (normal and arterial stiffness [AS] groups), we examined whether the degree of cognitive decline, as determined using the pre- and post-MMSE, was significantly different based on the severity of arterial stiffness, adjusted for age, BMI, gender and the pre-MMSE scores. RESULTS: Of the 103 subjects who participated in the pre-data collection, 74 (38 men and 36 women, 73.4±4.0 years) joined the post-data collection. We found a significant difference in the change in the post-MMSE scores between the normal and AS groups (pre-MMSE: normal group [27.4±2.1] and AS group [26.9±2.4] and post-MMSE: normal group [27.2±2.1] and AS group [25.5±2.3], F=5.95, p=0.02). For each domain of the MMSE, the changes in MMSE-attention-and-calculation (F=5.11, p=0.03) and MMSE-language (F=4.32, p=0.04) were significantly different according to an ANCOVA. CONCLUSIONS: We found that arterial stiffness predicts cognitive decline in Japanese community-dwelling elderly subjects regardless of the initial level of the global cognitive function. This finding indicates the potential use of the degree of arterial stiffness as an indicator for preventing or delaying the onset of dementia in the elderly.

Factors associating with shuttle walking test results in community-dwelling elderly people.

BACKGROUND: The shuttle walking test (SWT) is a simple, widely used method for assessing endurance performance in the elderly. Despite widespread community use, its associated factors are unclear. AIMS: We aim to identify previously undefined SWT association factors in community-dwelling elderly people. METHODS: Herein, 149 healthy elderly Japanese subjects performed the SWT, and were assessed for height, weight, smoking history, 10-m walk time, Timed Up and Go (TUG) scores, handgrip strength, skeletal mass index (SMI), forced vital capacity (FVC), forced expiratory volume in 1 s (FEV1), cardio-ankle vascular index, and ankle brachial index. We divided men and women into higher and lower SWT score groups, compared between-group parameters, and performed stepwise multivariate logistic regression analysis to identify factors independently associated with SWT scores. RESULTS: Age, BMI, 10-m walk time, TUG score, SMI, FVC (L; %-predicted), and FEV1 (L; %-predicted) were significantly different between SWT score groups for men, while in women, significant differences were observed in age, TUG score, handgrip strength, FVC (L; %-predicted), and FEV1 (L; %-predicted) (p < 0.05). In the multivariate logistic regression model, 10-m walk time, and FEV1 showed significant associations with SWT results in men; among women, age was the only significantly associated factor (p < 0.05). CONCLUSIONS: Results indicate that better lung function and shorter walk time independently associate with SWT results in community-dwelling men; in women, age is the only association. Our findings may offer insight when considering the focus of community exercise programs among the elderly.

The physiological characteristics of community-dwelling elderly Japanese with airflow limitation: a cross-sectional study.

BACKGROUND AND AIMS: The aim of this study was to investigate the physiological characteristics of community-dwelling elderly subjects, aged ≥65 years, with airflow limitation in the Japanese community. METHODS: Subjects were recruited through local press advertisement, and 180 individuals were enrolled. Data on age, body mass index (BMI), gender, smoking history, and past medical history were obtained, as were pulmonary function parameters, skeletal muscle mass index, and physical activity. RESULTS: The final study population comprised 161 participants from whom we obtained valid spirometry results. The mean age of this population was 73.4 ± 4.4 years, and 78 participants (48.4 %) were men. The prevalence of airflow limitation was 29.2 % (n = 47). Subjects with airflow limitation were significantly older (P = 0.01) and had poorer pulmonary function (P < 0.01), lower BMI (P < 0.01), and lower skeletal muscle mass index (P = 0.03) than healthy elderly subjects. Furthermore, skeletal muscle mass index was significantly correlated with the percentage of predicted forced vital capacity (r = 0.45, P < 0.05) and forced expiratory volume in 1 s (r = 0.50, P < 0.05) only in men with airflow limitation. CONCLUSIONS: We found that the skeletal muscle mass index was significantly reduced in community-dwelling elderly with airflow limitation, and the skeletal muscle mass index was correlated with pulmonary function only in men with airflow limitation.

Arterial stiffness is associated with low skeletal muscle mass in Japanese community-dwelling older adults.

AIM: To examine whether arterial stiffness, measured by the cardio-ankle vascular index (CAVI), is associated with skeletal muscle mass index (SMI) in Japanese community-dwelling older adults. METHODS: Data were collected from 175 participants through questionnaires and specific tests; the data included demographic, lifestyle and health characteristics, body mass index (BMI), and body composition features determined by the bioelectrical impedance analysis, ankle-brachial index, the Mini-Nutritional Assessment, handgrip strength (GS), walking speed and shuttle walking tests (SW), and arterial stiffness determined by the CAVI. Absolute SMI was dichotomized according to the first quintile, which determined low (n = 35) and normal (n = 140) SMI. RESULTS: Participants with low SMI were older (P = 0.01), had more polypharmacy (P = 0.01), a lower BMI (P < 0.001), and fat mass index (P = 0.02), and had a greater risk of malnutrition (P < 0.001) than the normal group. Additionally, they showed poorer physical performance (GS and SW, P = 0.007 and 0.01, respectively) than the normal group. Furthermore, CAVI was associated with SMI even after adjustments (OR 1.82, 95% CI 1.14-2.90, P = 0.01). CONCLUSIONS: Our data showed that arterial stiffness is associated with low SMI in community-dwelling older adults, even when adjusting by multiple factors, showing a close interaction of vascular aging and muscle mass decline.

Arterial stiffness determined according to the cardio-ankle vascular index(CAVI) is associated with mild cognitive decline in community-dwelling elderly subjects.

AIMS: The purpose of this study was to determine the cross-sectional relationship between the cognitive function and cardio-ankle vascular index(CAVI) in Japanese community-dwelling elderly subjects. METHODS: A total of 179 Japanese community-dwelling elderly subjects were recruited for this study. The age, height, weight, gender and past medical history(cardiovascular disease, hypertension, diabetes mellitus, hyperlipidemia) of each participant was recorded. In addition, the degree of arterial stiffness was determined according to the CAVI, while the cognitive function was assessed using the Mini-Mental State Examination(MMSE). After dividing the cohort into two groups according to the MMSE score(≤26, ＞26), we used a multiple regression analysis to assign the level of the cognitive function as a dependent variable. RESULTS: The data were statistically analyzed for the 174 participants(84 men and 90 women) who completed the data collection process without omissions. A multivariate logistic regression analysis showed that a higher weight(Odds Ratio [OR]: 1.05, 95% Confidence Interval [95% CI]: 1.00- 1.11, p=0.03), male gender(OR: 3.13, 95% CI: 1.05-9.34, p=0.04) and lower CAVI(OR: 0.68, 95% CI: 0.48-0.96, p=0.03) were significantly correlated with a higher MMSE score. We also found significant correlations between the MMSE and weight(OR: 1.11, 95% CI: 1.03-1.19, p=0.01) and CAVI(OR: 0.57, 95% CI: 0.33-0.98, p=0.04) in elderly men only using a gender-specific analysis. CONCLUSIONS: We found that the elderly subjects with a high CAVI exhibited a worse cognitive function even after adjusting for age, height, weight and gender. This finding therefore indicates the usefulness of the CAVI in the early detection of dementia.

Cognitive decline predicts long-term care insurance requirement certification in community-dwelling older Japanese adults: a prospective cohort study.

AIM: The purpose of this prospective cohort study is to examine whether cognitive decline is an independent predictor of new long-term care insurance (LTCI) requirement certifications in Japan. METHODS: A total of 5,765 community-dwelling older Japanese adults who, at baseline, were independent in terms of their activities of daily living participated in this study and were followed up for 18 months. The outcome measure was the number of new LTCI requirement certifications during the 18-month period of the study. We collected demographic information through questionnaires and assessed cognitive skills with the Cognitive Performance Scale (CPS). The participants were divided into 3 groups according to CPS scores (0, 1, and 2 or greater). RESULTS: During the 18-month period, 399 subjects (6.9%) became newly certified for LTCI services. In a multivariate Cox proportional hazards model, older participants with a CPS score of 1 (adjusted HR: 1.39, 95% CI: 1.08-1.77) and 2 or greater (adjusted HR: 2.27, 95% CI: 1.74-2.96) were significantly more likely to receive an LTCI certification compared to those with a CPS score of 0. CONCLUSIONS: Cognitive decline is an independent predictor of new LTCI requirement certifications and the severity of cognitive decline in elderly adults is positively associated with receiving an LTCI requirement certification in Japan.

Prevalence of sarcopenia in community-dwelling Japanese older adults.

BACKGROUND: Sarcopenia, the age-dependent loss of skeletal muscle mass, is highly prevalent among older adults in many countries; however, the prevalence of sarcopenia in healthy Japanese community-dwelling older adults is not well characterized. OBJECTIVE: The aim of this study was to evaluate the prevalence of sarcopenia and to examine the association of sarcopenia with falls and fear of falling in community-dwelling Japanese older adults. DESIGN: This is a cross-sectional study. SETTING AND SUBJECTS: Healthy men (568) and women (1314) aged 65 to 89 years participated in this research. MEASUREMENTS: For all participants, 3 measurements were taken: skeletal muscle mass measurement using bioelectrical impedance, 10 m at a usual walking speed, and handgrip strength. Sarcopenia was defined as the presence of both poor muscle function (low physical performance or low muscle strength) and low muscle mass. RESULTS: The prevalence of sarcopenia, determined using the European Working Group on Sarcopenia in Older People-suggested algorithm, in men and women aged 65 to 89 years was 21.8% and 22.1%, respectively. The prevalence of sarcopenia increased age-dependently, especially in those older than 75 years in both genders. In the young old, the prevalence of sarcopenia was higher in women than in men; however, in those older than 85 years, the prevalence of sarcopenia was lower in women than in men (P < .05). In addition, fall incidents and fear of falling were more prevalent in sarcopenic older adults than in nonsarcopenic older adults (P < .05). CONCLUSIONS: These results suggest that sarcopenia is highly prevalent in community-dwelling Japanese older adults and is related to falls and fear of falling.

Chronic kidney disease (CKD) is an independent risk factor for long-term care insurance (LTCI) need certification among older Japanese adults: a two-year prospective cohort study.

CKD is associated with impairments in health status, physical function, and frailty. The aim of the current prospective cohort study was to determine whether CKD predicted new LTCI need certification among community-dwelling older Japanese adults. This was a prospective cohort study. We analyzed the cohort data from a prospective study, The Japan Multicenter Aging Cohort for Care Prevention (J-MACC). We followed 8063 elderly adults for 2 years, and we analyzed the relationship between CKD and LTCI need. The outcome studied was new certification for LTCI service need during a 2-year period. We measured serum creatinine (the estimated glomerular filtration rate; eGFR), serum albumin, frailty checklist scores, and body mass index. During the 2-year follow-up, 536 subjects (6.6%) were newly certified as needing LTCI services. We stratified the cohort according to eGFR quartile and performed multivariate analyses using an eGFR value of 71.4-83.6 ml/min/1.73 m(2) as a reference. We found that subjects with eGFR values <60.0 ml/min/1.73 m(2) had a significantly elevated risk of LTCI service need (adjusted hazard ratio: 1.44 [95% CI 1.12-1.86]). Our results indicate that CKD is independently associated with new LTCI service need certification and is an important marker of frailty in older adults.

Efficacy of an Exercise Game Based on Kinect in Improving Physical Performances of Fall Risk Factors in Community-Dwelling Older Adults.

OBJECTIVE: The purpose of this study was to demonstrate whether a 12-week program of training with dual-task Tai Chi (DTTC), which is a new concept game we developed using Kinect (Microsoft, Redmond, WA), would be effective in improving physical functions of fall risk factors. MATERIALS AND METHODS: This study examined balance, muscle strength, locomotive ability, and dual-task ability in community-dwelling older adults (75.4±6.3 years) before and after 12 weeks of DTTC training (training group [TG]; n=32) or standardized training (control group [CG]; n=41). Primary end points were based on the difference in physical functions between the TG and the CG. RESULTS: Significant differences were observed between the two groups with significant group×time interaction for the following physical function measures: timed up-and-go (TUG) (P<0.01), one-leg standing (OLS) (P<0.05), and 5 chair stand (5-CS) (P<0.05). There were no significant differences among the other measures: 10-m walking time under standard conditions, manual-task conditions, and cognitive-task conditions, 10-m maximal walking time, and Functional Reach test scores. Thus, the scores of TUG, OLS, and 5-CS in the TG improved significantly with DTTC training compared with the CG. CONCLUSIONS: The results suggest that the DTTC training is effective in improving balance ability and mobility, which are risk factors for falls.

A survey examining the correlations between Japanese little league baseball coaches' knowledge of and compliance with pitch count recommendations and player elbow pain.

BACKGROUND: With the incidence of Little League elbow increasing, pitch limit recommendations for preventing throwing injuries have been developed in both the United States and Japan. However, levels of knowledge of and compliance with these recommendations among coaches of young baseball teams in Japan remain unknown. The relationship between these levels and elbow pain among players has not been adequately studied. HYPOTHESIS: Knowledge of and compliance with these recommendations is similar in the United States and Japan. Greater knowledge and higher levels of compliance have a significant correlation with reduced elbow pain in Little League baseball players. STUDY DESIGN: Cross-sectional study. METHODS: Coaches of youth baseball teams in Kyoto, Japan, completed a questionnaire assessing knowledge of and compliance with recommendations. Team variables and coach-related factors concerning elbow pain among young baseball players were surveyed, and the questionnaire investigated demographic data and elbow pain history in the previous 12 months. RESULTS: In total, 123 baseball coaches and 654 baseball players aged 6 to 12 years participated in this study; data were analyzed for 113 coaches and 339 players. Among coaches, 39.8% had accurate knowledge of the recommendations (similar to the US data) and 28.3% complied with them (lower than the US data). There was no correlation between elbow pain and knowledge of and compliance with the recommendations, but coaches' opinions on the number of games were indicated as a significant risk factor for elbow pain; the more coaches considered the number of games played, the fewer the number of players who experienced elbow pain. CONCLUSION: The level of knowledge of recommendations in Japan was similar to that in the United States, but compliance levels were far lower. There was no correlation between elbow pain and knowledge and compliance. CLINICAL RELEVANCE: The Little League elbow problem should be addressed at global and national levels.