Predictive Validity of Multifactorial Injury Risk Models and Associated Clinical Measures in the U.S. Population.

Background: Popular movement-based injury risk screens were shown to lack predictive precision, leading to interest in multifactorial models. Furthermore, there is a lack of research regarding injury risk assessment for those currently or planning to be recreationally active. This study aims to provide injury risk insights by analyzing multifactorial injury risk models and associated clinical measures in the U.S. population. Methods: Data related to injury, inflammatory markers, physical functioning, body composition, physical activity, and other variables from 21,033 respondents were extracted from NHANES. Odds ratios for self-reported injury were calculated for single predictors and risk models. Case-control and principal component analyses (PCA) were conducted to elucidate confounders and identify risk factor clusters, respectively. Receiver operating characteristic analysis was used to test the precision of a risk factor cluster to identify pain points and functional difficulties. Results: Sociodemographic, individual, and lifestyle factors were strongly associated with higher odds of injury. Increases in fibrinogen and C-reactive protein were significantly associated with all risk groups. Membership to the high-risk group (age over 40, obesity, no muscle-strengthening activities, sedentary lifestyle, and low back pain) predicted at least one functional difficulty with 67.4% sensitivity and 87.2% specificity. In the injury group, bone turnover markers were higher, yet confounded by age, and there was a significantly higher prevalence of self-reported osteoporosis compared to the control. In males, low testosterone was associated with injury, and high estradiol was associated with pain and functional difficulties. In females, high follicle-stimulating hormone was associated with functional difficulties. PCA revealed four high-risk profiles, with markers and activities showing distinct loadings. Conclusions: A comprehensive approach to injury risk assessment should consider the nexus of aging, lifestyle, and chronic disease to enhance tailored injury prevention strategies, fostering safe and effective physical activity participation and reducing the burden of musculoskeletal disorders.

Prognostic Power of Foot Mobility in Identifying the Risk of Musculoskeletal Injuries: A Cross-Sectional Study of Male Volleyball Players at Different Competitive Levels.

(1) Background: The arch structure and mobility of the foot are considered injury risk factors in volleyball. However, there are limited studies presenting differences in injury prevalence and the risk of lower limb injuries in relation to the competitive level in male volleyball. Therefore, the main aim of the current study was to evaluate foot mobility (through navicular drop test) as an injury risk factor in volleyball players from different competitive levels. (2) Methods: The reliability and usefulness of navicular drop testing were initially assessed in test-retest procedures (based on a sample of eight participants and 16 feet measurements), with primary analyses conducted using foot measurements of the twelve top-level volleyball players (24 feet) and eighteen academic-level volleyball players (36 feet). The modified navicular drop test was conducted, and the feet were classified based on arch height, and injury prevalence was retrospectively assessed with a previously validated questionnaire. Chi-squared tests, receiver operating curves, and logistic regression were used as statistical methods. The navicular drop test was verified as a reliable tool by intraclass correlation coefficient (ICC) (3.1) analysis. (3) Results: There were no significant differences in injury prevalence between academic- and top-level volleyball players, though there was a significant relationship between pronated foot and injury risk independent of competitive level. Generally, for both groups, thresholds above 10 mm of the navicular drop were predictors of lower limb injuries. The risk of injury if the foot was pronated ranged from 70% (academic level) to over 90% (top-level players). However, no statistically significant effect of competitive level on the chance of injury was observed. (4) Conclusions: Our study found a high prevalence of foot injuries independently of competitive level. There was a relationship between pronation of the foot and the risk of injury. However, the risk of lower limb injury was higher in pronated top-level players. Also, a navicular drop greater than 10 mm was an excellent predictor of injuries at both competitive levels.

Multivariate Analysis of Risk Factors for Injury and Surgical Interventions in Ankle and Knee Injuries in NBA Athletes.

Objective: Lower extremity ankle and knee injuries occur at a high rate in the National Basketball Association (NBA) often requiring surgical intervention. This study aimed to identify surgical rates and risk factors for surgical intervention using multivariate analysis in ankle and knee injuries in NBA player. Methods: Player demographics, performance metrics, advanced statistics, and injury characteristics were recorded using publicly available data. To standardize injury events over multiple years, injury events per 1000 athlete exposure events (AE, one player participating in one game) were calculated. Descriptive analysis and multivariate logistic regression were completed to find associations with surgical intervention in ankle and knee injuries. Results: A total of 1153 ankle and knee injuries were included in the analysis with 73 (6.33%) lower extremity injuries treated with surgery. Knee injuries had a higher incidence of surgical intervention (0.23 AE) than ankle injuries (0.04 AE). The most frequent surgical knee injury was meniscus tear treated with meniscus repair (0.05 AE) and the most frequent ankle surgery was surgical debridement (0.01 AE) Multivariate logistic regression indicated lower extremity injuries that required surgery were associated with more minutes per game played (odds ratio [OR] 1.13; p = 0.02), a greater usage rate (OR 1.02 p < 0.001), the center position (OR 1.64; 95% [CI] 1.2-2.24; p = 0.002) and lower player efficiency rating (OR 0.96; 95% p < 0.001). Conclusion: Knee surgery was significantly more frequent than ankle surgery despite similar injury rates per 1000 exposures. The center position had the greatest risk for lower extremity injury followed by minutes played while a higher player efficiency rating was protective against surgical intervention. Developing strategies to address these factors will help in the management and prevention of lower extremity injuries requiring surgical intervention.

Factors associated with residential fire-related hospitalisations and deaths: A 10-year population-based study.

This study aims to identify residential fire risk factors and their health outcomes in terms of hospital admissions from burns and smoke inhalation together with related readmissions, length of hospital stay (LOS), costs of hospitalisation and mortality within 30 days of the fire incidence. Residential fire-related hospitalisations from 2005 to 2014 in New South Wales, Australia were identified using linked data. Univariate and multivariable Poisson regression analyses were performed to determine factors associated with residential fires on hospital admission and loss of life. During the study period, 1862 individuals were hospitalised due to residential fires. In terms of prolonged LOS, high hospitalisation cost or mortality, fire incidents' that damaged both contents and structures of the property; were ignited by smokers' materials and/or due to mental or physical impairment of the residents had more adverse outcomes. Individuals aged 65 and over with comorbidities and/or acquired severe injuries from the fire incident were at a higher risk of long-term hospitalisation and death. This study provides information to response agencies in communicating fire safety messages and intervention programs to target vulnerable population. In addition, it also supplies indicators on hospital usage and LOS following residential fires to health administrators.

Pediatric and Adolescent Knee Injuries: Risk Factors and Preventive Strategies.

It is estimated that approximately 2.5 million sports-related knee injuries occur in the pediatric population annually in the United States. Thus, identifying appropriate screening tools and injury prevention strategies is imperative. To develop successful injury prevention strategies, risk factor identification is the first step. There are two types of risk factors: non-modifiable (age, gender, injury history, and anatomical alignment) and modifiable risk factors (biomechanical and neuromuscular control, training loads, and body mass index). These risk factors can be addressed by three types of preventive interventions: primary, secondary, and tertiary. To translate study evidence to clinical practices and routine trainings, awareness of injury prevention and health promotion needs to be further strengthened.

Injury Rates, Patterns, Mechanisms, and Risk Factors Among Competitive Youth Climbers in the United States.

INTRODUCTION: Competitive rock climbing is a fast-growing sport. Despite comprehensive reviews on adult climbing-related injuries, few pediatric-specific reviews exist, and studies exclusively on competitive youth climbers are needed. Objectives of this study include 1) estimating the injury rate (IR); 2) describing injury patterns and mechanisms; and 3) identifying injury risk factors in competitive youth climbers. METHODS: The study design was cross-sectional. Competitive youth climbers were included. Participants completed an anonymous questionnaire to document climbing injuries over the preceding 12 mo. Demographic data and data regarding injuries were collected. The IR was calculated. Analyses were performed to assess association between injury and multiple variables. Multivariate logistic regression was completed for significant variables to control for exposure time. RESULTS: The IR was 2.7 injuries per 1000 climbing hours. Hand/Finger injuries were most frequent; chronic overuse was the most common etiology. Injury severity was low overall. Risk factors significantly associated with climbing injury were climbing discipline (bouldering > sport/lead climbing), return to climbing while still in pain, finger taping, higher number of hours climbed per session and per year, climbing at higher bouldering difficulties, and unsupervised climbing. CONCLUSIONS: The IR in competitive youth climbers was found to be lower than previously reported but higher than suggested by adult studies or those that exclude chronic injuries. Findings are consistent with types, severity, and mechanisms reported in other studies. Modifiable risk factors, especially return to climbing while still injured, warrant further prospective investigation.

Sport Science Lab® Screening Protocol: The association between physical fitness Parameters and injury among elite rugby players.

CONTEXT AND OBJECTIVES: The Sport Science Lab® (SSL®) screening protocol includes novel methods of assessing flexibility, strength, plyometric ability and rugby specific fitness. The objective of this study was to investigate the association between these tests and injury among professional rugby players. DESIGN: Prospective cohort study. SETTING: Fitness facilities of participating teams. PARTICIPANTS: Thirty-nine injury-free, elite, adult (>18 years), male rugby players. MAIN OUTCOME MEASURES: The test battery consisted of eleven flexibility-, nine strength- and six plyometric tests and a rugby specific fitness test (RSFT). Injuries were recorded weekly during the 2019 rugby season. Associations between test results and injuries were analysed utilising suitable tests of association i.e., sensitivity, specificity, false positive rate, false negative rate, positive predictive value and negative predictive value and odds ratios (OR) (with confidence intervals (CI)). Bivariate correlations and logistic regression were performed to assess the relationship of the predictor variables to the outcome. RESULTS: Players who achieved the set standard for the RSFT (OR = 3.17; 95% CI = 0.79-12.75), triple horizontal broad jump (OR = 2.40; 95% CI = 0.86-19.61) and lateral depth jumps (OR = 2.40-3.44; 95% CI = 0.53-18.84) were two to three times less likely to sustain an injury during the season. CONCLUSION: Players with superior rugby specific fitness and cyclic linear- and lateral plyometric ability, may have a decreased risk of sustaining injuries.

The interrater and intrarater reliability of the flexibility and strength tests included in the Sport Science Lab® screening protocol amongst professional rugby players.

BACKGROUND: Considering the injury incidence rate (IR) associated with elite-level rugby, measures to reduce players' injury risk are important. Establishing scientifically sound, pre-season musculoskeletal screening protocols forms part of injury prevention strategies. OBJECTIVE: To determine the interrater and intrarater reliability of the flexibility and strength tests included in the Sport Science Lab® (SSL) screening protocol. METHODS: We determine the interrater and intrarater reliability of 11 flexibility and nine strength tests. Twenty-four injury-free, elite, adult (> 18 years), male rugby players were screened by two raters on two occasions. To establish intrarater and interrater reliability, Gwet's AC1, AC2 and intraclass correlation coefficients (ICC) were used for the analysis of binary, ordinal and continuous variables, respectively. Statistical significance was set at 95%. RESULTS: Flexibility tests which require lineal measurement had at least substantial interrater (ICC = 0.70-0.96) and intrarater reliability (ICC = 0.89-0.97). Most of the flexibility tests with binary outcomes attained almost perfect interrater and intrarater reliability (Gwet's AC1 = 0.8-0.97). All strength tests attained at least substantial interrater (Gwet's AC2 = 0.73-0.96) and intrarater (Gwet's AC2 = 0.67-0.97) reliability. CONCLUSION: The level of interrater and intrarater reliability of most of the flexibility and strength tests investigated supports their use to quantify various aspects of neuromusculoskeletal qualities and possible intrinsic risk factors amongst elite rugby players. CLINICAL IMPLICATIONS: Establishing the reliability of tests, is one step to support the inclusion thereof in official screening protocols. Results of our study, verify the reliability of the simple, clinically friendly strength and flexibility tests included and therefore support their use as preparticipation screening tools for rugby players. Further investigation as to the association thereof to athletes' injury risk and performance is warranted.

Functional Movement Screen Detected Asymmetry & Normative Values Among College-Aged Students.

BACKGROUND: The Functional Movement Screen (FMS™) is a popular test used by sports medicine professionals to identify dysfunctional movement patterns by analyzing mobility and stability during prescribed movements. Although the FMS™ has been a popular topic of research in recent years, normative data and asymmetries in college-aged students have not been established through research. PURPOSE: The objective was to determine normative FMS™ scores, report frequency counts for FMS™ asymmetries, and determine if the number of sports seasons and number of different sports an individual participated in during high school varied between university students that showed FMS™ identified asymmetries. STUDY DESIGN: Cross-sectional Study. METHODS: One hundred university students completed the FMS™ and an associated survey to determine which sport(s) and for how many seasons they participated in each sport(s) during high school. Total FMS™ scores were assessed as well as identifying the presence of an asymmetry during a FMS™ screen. An asymmetry within the FMS™ was defined as achieving an unequal score on any of the screens that assessed right versus left movements of the body. DATA ANALYSIS: Data analysis included descriptive statistics, Pearson correlation was utilized to investigate the relationship between number of sports played and number of sport seasons. Shapiro Wilk test for normality, and Mann Whitney U test was employed to investigate group differences in number of sports played. All analyses were conducted using SPSS software. RESULTS: Statistically significant correlations (r = .286, r2 = .08, p < 0.01) were found for both number of sport seasons and number of sports with FMS™ total score. In addition, participants without FMS™-detected asymmetries played significantly more seasons and more sports than their peers that presented asymmetries (U = 946.5, z = -1.98, p = 0.047). Finish with the actual p-value in parenthesis. CONCLUSION: Participating in multiple sports and multiple sport seasons during high school was associated with higher FMS™ total scores. Results suggest that participating in multiple sports and multiple sport seasons was associated with fewer asymmetries, which may decrease subsequent injury risk. LEVEL OF EVIDENCE: 3b.

Systematic review of screening tools for common soccer injuries and their risk factors.

BACKGROUND: Several screening tools are available for use in a clinical setting to predict injury. However, there is a lack of evidence regarding the accuracy of these tools to predict soccer-specific injuries. OBJECTIVES: The purpose of this systematic literature review was to determine the psychometric properties or accuracy of screening tools for common soccer injuries. METHODS: A systematic review of diagnostic test accuracy was undertaken based on the Joanna Briggs Institute (JBI) procedure for conducting systematic reviews. Databases such as SPORT Discus, Cinahl, Medline, Science Direct, PubMed and grey literature were searched in order to access suitable studies. RESULTS: A total of 10 studies were included for the analysis - three were analysed quantitatively whilst the remaining seven were analysed qualitatively. The screening tools were of high reliability, sensitivity and specificity (calculated as intraclass correlation coefficient [ICC] (0.68 95% confidence interval [CI]: 0.52-0.84 and 0.64 95% CI: 0.61-0.66, respectively). CONCLUSION: The screening tools assessed for the prediction of common soccer injuries that emerged from this systematic review include the Functional Movement Screening (FMS™), the Landing Error Scoring System (LESS), the Tuck Jump Assessment, the Soccer Injury Movement Screening (SIMS) and the conventional hamstrings to quadriceps ratio; all with good evidence of predicting common soccer injuries. These tools were of high sensitivity and specificity thus reliable for soccer screening. CLINICAL IMPLICATIONS: The validity of these tools is acceptable and therefore the authors recommend that these tools be included in an injury prevention programme for soccer players.

Ski boot canting adjustments affect kinematic, kinetic, and postural control measures associated with fall and injury risk.

OBJECTIVES: The aim of this study was to investigate if and to what extent small lateral wedges inserted under the ski boot, known as canting, could impact knee kinematics/kinetics, balance, and neuromuscular activity in recreational alpine skiers in the laboratory setting. DESIGN: Experimental, crossover study with repeated-measures analysis METHODS: Thirty-eight recreational skiers completed a single-leg postural balance test while wearing standardized ski boots in their unmodified state (control), and with medial and lateral canting wedges applied. Kinematics, kinetics, postural control measures, and neuromuscular activity of the lower extremity were assessed using optical motion capture, instrumented force plates, and electromyography. RESULTS: Canting modifications had significant impact on lower extremity kinematics and kinetics: canting wedges on the medial side of the foot significantly decreased knee valgus moments, hip internal rotation, and hip adduction. Medial canting also improved some postural control measures associated with balance quality, and reduced activation levels of the Vastus Lateralis, Biceps Femoris, and Tibialis Anterior. CONCLUSIONS: In the laboratory setting, canting appears to be an appropriate option for improving balance in alpine skiers. Medial canting can alter skier kinematics and kinetics in ways which are consistent with mechanisms of ACL injury. Canting may also result in reduced neuromuscular effort. These changes in movement have potential to prevent lower limb injuries in alpine skiers. The findings of this study motivate future research to predict individual responses to canting treatment in a study setting more closely resembling the sports environment.

Epidemiological and clinical characteristics of 70 cases of coronavirus disease and concomitant hepatitis B virus infection: A multicentre descriptive study.

The interaction between existing chronic liver diseases caused by hepatitis B virus (HBV) infection and COVID-19 has not been studied. We analysed 70 COVID-19 cases combined with HBV infection (CHI) to determine the epidemiological, clinical characteristics, treatment and outcome. We investigated clinical presentation, imaging and laboratory parameters of COVID-19 patients of seven hospitals from Jan 20 to March 20, 2020. Multivariate analysis was used to analyse risk factors for progression of patients with COVID-19 combined with HBV infection. Compared with COVID-19 without HBV infection (WHI) group, patients with dual infection had a higher proportion of severe/critically ill disease (32.86% vs. 15.27%, P = .000), higher levels of alanine aminotransferase (ALT), aspartate transaminase (AST) and activated partial thromboplastin (APTT) [50(28-69)vs 21(14-30), P = .000; 40(25-54) vs 23(18-30), P = .000; 34.0(27.2-38.7) vs 37.2(31.1-41.4), P = .031]. The utilization rates of Arbidol and immunoglobulin were significantly higher than those in the co-infected group [48.57% vs. 35.64%, P < .05; 21.43% vs. 8.18%, P < .001], while the utilization rate of chloroquine phosphate was lower (1.43% vs 14.00%, P < .05) in the co-infected patients group. Age and c-reactive protein (CRP) level were independent risk factors for recovery of patients with COVID-19 combined with HBV infection. The original characteristics of COVID-19 cases combined with HBV infection were higher rate of liver injury, coagulation disorders, severe/critical tendency and increased susceptibility. The elderly and patients with higher level of CRP were more likely to experience a severe outcome of COVID-19.

The epidemiology of wrist and hand injury in two hospitals in Jerusalem: substantial differences between population subgroups.

BACKGROUND: Wrist and hand injuries are common and constitute a major economic burden. General injury prevention programs have failed to demonstrate a decrease in injury rates. We hypothesized that there are differences in injury patterns in culturally diverse subpopulations of a metropolitan area treated within the same medical system, which may partly explain the difficulties associated with injury prevention. METHODS: We conducted a survey of patients admitted to emergency departments of two hospitals in Jerusalem for wrist and hand injuries during a 3 month period. Patients were asked to complete a questionnaire regarding demographic data, injury type and mechanism. Injury type and mechanism were then compared for age, gender, level of education and degree of religiosity. RESULTS: The questionnaire was completed by 799 patients (response rate 62%; 75% male; average age 27). Thirty-one percent reported they were injured at work, 33% at home and 36% during leisure activities. Data analysis showed that several subpopulations were found to be at risk as compared to their corresponding groups and relative proportion in the overall population of the city. These included contusions after falls in non-ultra-Orthodox Jewish women aged 65 years and over, crush injuries in ultra-Orthodox Jews under the age of 10 (53% vs. 14% for non ultra-Orthodox Jews, respectively) and Muslim teens. Muslims were injured more, especially at work, in comparison to their relative proportion in the population as a whole. CONCLUSION: Different subpopulations at risk and different injury patterns of wrist and hand injuries were found in this culturally heterogeneous population. Awareness of these differences may be the first step when designing specific injury prevention programs in a culturally diverse population. A combined effort of community leaders and government agencies is needed to deal with the specific populations at risk, although legislation may be needed to limit some of the risks such as teens and specific work related hazards and exposures.

External loads associated with anterior cruciate ligament injuries increase the correlation between tibial slope and ligament strain during in vitro simulations of in vivo landings.

BACKGROUND: The aim of the present study was to evaluate the relationship between tibial slope angle and ligament strain during in vitro landing simulations that induce ACL failure through the application of variable external loading at the knee. The hypothesis tested was that steeper posterior tibial slope angle would be associated with higher ACL strain during a simulated landing task across all external loading conditions. METHODS: Kinetics previously derived from an in vivo cohort performing drop landings were reproduced on 45 cadaveric knees via the mechanical impact simulator. MRIs were taken of each specimen and used to calculate medial compartment posterior tibial slope, lateral compartment posterior tibial slope, and coronal plane tibial slope. Linear regression analyses were performed between these angles and ACL strain to determine whether tibial slope was a predictive factor for ACL strain. FINDINGS: Medial and lateral posterior tibial slope were predictive factors for ACL strain during some landings with higher combined loads. Medial posterior slope was more predictive of ACL strain in most landings for male specimens, while lateral posterior and coronal slope were more predictive in female specimens, but primarily when high abduction moments were applied. INTERPRETATION: Tibial slope has the potential to influence ACL strain during landing, especially when large abduction moments are present at the knee. Deleterious external loads to the ACL increase the correlation between tibial slope and ACL strain, which indicates that tibial slope angles are an additive factor for athletes apt to generate large out-of-plane knee moments during landing tasks.

Epidemiological characteristics and risk factors of nonfatal injury among middle school students in Zhejiang Province / 预防医学

Objective@#To understand the epidemiological characteristics of nonfatal injury and its influencing factors among middle school students in Zhejiang Province,and to provide evidence for prevention and control of nonfatal injury of adolescents. @*Methods@#Using multi-stage stratified cluster sampling method,24 157 middle school students from 442 schools in 30 counties（cities,districts）of Zhejiang Province were selected to investigate socio-demographic characteristics,the occurrence of nonfatal injury and injury-related behaviors from April to May of 2017. Logistic regression model was used to analyze influencing factors for nonfatal injury among middle school students.@*Results@#The incidence of nonfatal injuries in 23 462 secondary school students in the past 12 months was 20.86%. The incidence of nonfatal injury was 24.15% in boys,which was higher than 17.33% in girls（P<0.05）. The incidence of nonfatal injury was 20.17% in urban students and 21.19% in rural students,and the difference between them was not statistically significant（P>0.05）. The incidence of nonfatal injury was 22.17% in junior high school students,19.42% in senior high school students and 19.51% in vocational high school students,and there was statistically significant difference between them（P<0.05）. The results of the multivariate logistic regression analysis showed that boys（girls：OR=0.805,95%CI：0.728-0.890）,poor academic performance（OR=1.149,95%CI：1.018-1.298）,smoking（OR=1.260,95%CI：1.083-1.466）,drinking（OR=1.410,95%CI：1.279-1.553）,more physical activity（OR：1.244- 1.527,95%CI：1.098-1.767）,loneliness（OR：1.336-1.500,95%CI：1.219-1.682）,sadness（OR=1.308,95%CI：1.186-1.441）,absenteeism（OR=1.390,95%CI：1.182-1.634）,running away from home（OR=1.242,95%CI：1.076- 1.435）,fighting（OR=1.771,95%CI：1.594-1.967）and being bullied（OR=2.071,95%CI：1.869-2.294）were risk factors for nonfatal injury in middle school students.@*Conclusion@#The incidence of nonfatal injuries among secondary school students was 20.86%. Male students were the high risk group. The incidence of nonfatal injury was related to gender,smoking,drinking,negative emotions and violence.

Rate of Upper Extremity Injury in High School Baseball Pitchers Who Played Catcher as a Secondary Position.

CONTEXT: Many high school pitchers play another position after they have finished pitching for the day or on their rest days from pitching. Because of the cumulative demands on the arm, pitchers who also play catcher may have a greater risk of developing a throwing-related shoulder or elbow injury. OBJECTIVE: To compare the rate of throwing-related upper extremity injuries between high school baseball pitchers who also played catcher as a secondary position and those who did not play catcher. DESIGN: Prospective cohort study. SETTING: Field laboratory. PATIENTS OR OTHER PARTICIPANTS: A total of 384 male high school baseball pitchers were recruited from 51 high school teams. Pitchers who reported their secondary position as catcher were classified into the pitcher/catcher group and those who did not report playing catcher as a secondary position were classified into the other group. MAIN OUTCOME MEASURE(S): Participants completed a demographic questionnaire preseason and then athlete participation and injury status were tracked during the subsequent season. Athlete-exposures were monitored and the shoulder and elbow injury proportion rates were calculated. RESULTS: Athlete-exposures did not differ between groups ( P = .488). The pitcher/catcher group's risk of shoulder or elbow injury was 2.9 times greater than that of the other pitchers (15% versus 5%; injury proportion rate = 2.9; 95% confidence interval = 1.03, 8.12). CONCLUSIONS: Pitchers who reported also playing catcher were at a greater risk of sustaining a throwing-related shoulder or elbow injury than the other pitchers. These findings suggest that pitchers should consider not playing catcher as their secondary position in order to allow adequate time for recovery and to decrease their overall throwing load. Serial physical examinations of pitchers/catchers during the season may be useful in determining if their physical characteristics are changing during the season because of the cumulative throwing load.

Analysis of Landing Error Scoring System during Drop Vertical Jump on Anterior Cruciate Ligament Injury Risk Factors in Elite Fencers / 대한스포츠의학회지

PURPOSE: The aim of this study was to identify the differences of gender and detail items by using landing error scores during drop vertical jumping that can be used in the field for elite fencers and to use them as basic data for prevention of injury. METHODS: The subjects were 42 elite fencers. Independent sample t-test was used to compare the landing error scoring system (LESS) score between the groups. In order to compensate for errors that may occur in multiple comparisons, they are corrected through the Bonferroni collection. The significant differences between the groups were evaluated using Cohen effect difference, and one-way analysis of variance was performed for differences in epee, fleuret, and sabre. RESULTS: The comparison of landing error scores between male and female fencer groups showed that the knee valgus angle at initial contact, lateral trunk flexion angle at initial contact, stance width-narrow, foot position-toe out, symmetric initial foot contact, in the total score of LESS items, female fencer group was higher and statistically significant difference was found. CONCLUSION: In the case of fencing players, there is no significant difference in the LESS scores according to the items. However, when comparing gender, female fencers have higher LESS scores than male fencers; female fencers should be more careful in preventing injuries.

Long-Term Athletic Development in Youth Alpine Ski Racing: The Effect of Physical Fitness, Ski Racing Technique, Anthropometrics and Biological Maturity Status on Injuries.

Alpine ski racing is known to be a sport with a high risk of injuries. Because most studies have focused mainly on top-level athletes and on traumatic injuries, limited research exists about injury risk factors among youth ski racers. The aim of this study was to determine the intrinsic risk factors (anthropometrics, biological maturity, physical fitness, racing technique) for injury among youth alpine ski racers. Study participants were 81 youth ski racers attending a ski boarding school (50 males, 31 females; 9-14 years). A prospective longitudinal cohort design was used to monitor sports-related risk factors over two seasons and traumatic (TI) and overuse injuries (OI). At the beginning of the study, anthropometric characteristics (body height, body weight, sitting height, body mass index); biological maturity [status age at peak height velocity (APHV)]; physical performance parameters related to jump coordination, maximal leg and core strength, explosive and reactive strength, balance and endurance; and ski racing technique were assessed. Z score transformations normalized the age groups. Multivariate binary logistic regression (dependent variable: injury yes/no) and multivariate linear regression analyses (dependent variable: injury severity in total days of absence from training) were calculated. T-tests and multivariate analyses of variance were used to reveal differences between injured and non-injured athletes and between injury severity groups. The level of significance was set to p < 0.05. Relatively low rates of injuries were reported for both traumatic (0.63 TI/athlete) and overuse injuries (0.21 OI/athlete). Athletes with higher body weight, body height, and sitting height; lower APHV values; better core flexion strength; smaller core flexion:extension strength ratio; shorter drop jump contact time; and higher drop jump reactive strength index were at a lower injury risk or more vulnerable for fewer days of absence from training. However, significant differences between injured and non-injured athletes were only observed with respect to the drop jump reactive strength index. Regular documentation of anthropometric characteristics, biological maturity and physical fitness parameters is crucial to help to prevent injury in youth ski racing. The present findings suggest that neuromuscular training should be incorporated into the training regimen of youth ski racers to prevent injuries.

Injury risk factors to farm and ranch operators in the Central United States.

BACKGROUND: This study focused on risk factors for serious injuries in farm and ranch operators in the central United States. METHODS: The Central States Center for Agricultural Safety and Health, in collaboration with the National Agricultural Statistics Service, sent mail surveys to 6953, 6912, and 6912 farms/ranches in 2011-2013, respectively, covering seven Midwestern states. RESULTS: The average survey response rate was 35%. The average annual incidence rate (injuries/100 workers) was 6.91 for all injuries and 2.40 for serious injuries. Univariate analyses determined several demographic and farm production-related risk factors for serious injury. Adjusted analysis showed a greater risk of serious injury for operators of age 45-54 years (vs. 65 and higher), those who worked 75-99% of their time (vs. less time), and those who operated larger land areas (vs. smaller). CONCLUSION: The identified risk factors should be considered when targeting injury prevention programs.

Concussion Mechanisms and Activities in Youth, High School, and College Football.

Our purpose was to determine concussion mechanism and activity differences among three cohorts of football players: youth, high school, and college. Participants in this prospective cohort study were youth (ages 5-14 years, 118 teams, 310 team-seasons), high school (96 teams, 184 team-seasons), and college (34 teams, 71 team-seasons) football players. Athletic trainers collected athlete-exposure (AE) and concussion data during the 2012-2014 seasons. Injury mechanism referred to the object that made contact with the concussed player, resulting in the concussion. Injury activity referred to the type of football-specific activity that the player was involved in when the concussion was sustained. Injury proportion ratios (IPR) compared distributions of concussion mechanisms and activities among age levels. A total of 1429 concussions were reported over 1,981,284 AE across all levels (Rate: 0.72/1000AE). Overall, most concussions were caused by player contact (84.7%). During games, a greater proportion of youth football concussions (14.7%) were caused by surface contact than high school (7.3%, IPR = 2.02; 95% confidence interval [CI]: 1.10-3.72) and college (7.1%, IPR = 2.07, 95% CI: 1.02-4.23) football. Compared with college football concussions (90.2%), a smaller proportion of youth (80.0%, IPR = 0.89, 95% CI: 0.79-0.99) and high school (83.2%, IPR = 0.92, 95% CI: 0.86-0.99) football concussions were caused by player contact. A greater proportion of game youth football concussions (42.1%) occurred while an individual was being tackled than occurred in high school (23.2%, IPR = 1.81, 95% CI: 1.34-2.45) and college (23.0%, IPR = 1.83, 95% CI: 1.29-2.62) football. Findings were similar during practices. Compared with college football game concussions (15.8%), a smaller proportion of youth (6.3%, IPR = 0.40, 95% CI: 0.17-0.93) and high school (9.5%, IPR = 0.60, 95% CI: 0.38-0.95) football game concussions occurred while an individual was being blocked. Concussion mechanism and activity differences should be considered when developing concussion prevention and sport-safety methods specific to different age levels, in order to maximize effectiveness.