bluuebunny/crossref_metadata_2025 huggingface dataset:
Changes in haematological parameters and iron metabolism associated with a 1600 kilometre ultramarathon.
Authors: Fallon K E , Sivyer G , Sivyer K , Dare A
Published: December 2008

OBJECTIVE: To investigate haematological variations and iron related changes in the serum of participants in a 1600 kilometre ultramarathon run. PARTICIPANTS: Seven male and two female participants in a 1600 km foot race. METHODS: Blood samples were obtained from the participants before, after four and 11 days of running, and at the end of the event. Samples were analysed by standard methods for haemoglobin, packed cell volume, total red cell count, mean red cell volume, mean red cell haemoglobin, total white cell count and differential, platelets, reticulocytes, iron, ferritin, total iron binding capacity, percentage transferrin saturation, haptoglobin, and bilirubin and corrected for changes in plasma volume. RESULTS: The following variables decreased during the event (p < 0.05): haemoglobin, packed cell volume, mean red cell volume, percentage lymphocytes, percentage monocytes, serum iron, total iron binding capacity, and percentage transferrin saturation. Increases (p < 0.05) were found in plasma volume, total red cell count (day 4 only), total white cell count, percentage and absolute numbers of neutrophils and reticulocytes, absolute numbers of lymphocytes and monocytes (day 4 only), absolute numbers of eosinophils (day 11 and race end), absolute numbers of basophils (race end only), platelets, ferritin, haptoglobin, and bilirubin (day 4 only). CONCLUSION: Ultramarathon running is associated with a wide range of changes in haematological parameters, many of which are related to the normal acute phase response to injury. These should not be confused with indicators of disease.
Factors influencing tackle injuries in rugby union football.
Authors: Garraway W M , Lee A J , Macleod D A , Telfer J W , Deary I J , Murray G D
Published: December 2008

OBJECTIVES: To assess the influence of selected aspects of lifestyle, personality, and other player related factors on injuries in the tackle. To describe the detailed circumstances in which these tackles occurred. METHODS: A prospective case-control study was undertaken in which the tackling and tackled players ("the cases") involved in a tackle injury were each matched with "control" players who held the same respective playing positions in the opposing teams. A total of 964 rugby matches involving 71 senior clubs drawn from all districts of the Scottish Rugby Union (SRU) were observed by nominated linkmen who administered self report questionnaires to the players identified as cases and controls. Information on lifestyle habits, match preparation, training, and coaching experience was obtained. A validated battery of psychological tests assessed players' trait anger and responses to anger and hostility. The circumstances of the tackles in which injury occurred were recorded by experienced SRU coaching staff in interviews with involved players after the match. RESULTS: A total of 71 tackle injury episodes with correct matching of cases and controls were studied. The following player related factors did not contribute significantly to tackle injuries: alcohol consumption before the match, feeling "below par" through minor illness, the extent of match preparation, previous coaching, or practising tackling. Injured and non-injured players in the tackle did not differ in their disposition toward, or expression of, anger or hostility. Some 85% of tackling players who were injured were three quarters, and 52% of injuries occurred when the tackle came in behind the tackled player or within his peripheral vision. Either the tackling or tackled player was sprinting or running in all of these injury episodes. One third of injuries occurred in differential speed tackles--that is, when one player was travelling much faster than the other at impact. The player with the lower momentum was injured in 80% of these cases. Forceful or crunching tackles resulting in injury mostly occurred head on or within the tackled player's side vision. CONCLUSIONS: Attention should be focused on high speed tackles going in behind the tackled player's line of vision. Comparative information on the circumstances of the vast majority of tackles in which no injury occurs is required before any changes are considered to reduce injuries in the tackle.
Reduction of exercise-induced asthma in children by short, repeated warm ups.
Authors: de Bisschop C , Guenard H , Desnot P , Vergeret J
Published: December 2008

AIM: To study the effect of a warm up schedule on exercise-induced asthma in asthmatic children to enable them to engage in asthmogenic activities. METHOD: In the first study, peak flows during and after three short, repeated warm up schedules (SRWU 1, 2, and 3), identical in form but differing in intensity, were compared in 16 asthmatic children. In the second study the efficiency of the best of these SRWU schedules was tested on 30 young asthmatic children. Children performed on different days a 7 minute run alone (EX1) or the same run after an SRWU (EX2). RESULTS: The second study showed that for most children (24/30) the fall in peak flow after EX2 was less than that after EX1. The percentage fall in peak flow after EX2 was significantly correlated with the percentage change in peak flow induced by SRWU2 (r = 0.68). The children were divided into three subgroups according to the change in peak flow after SRWU2: (G1: increase in peak flow; G2: < 15% fall in peak flow; G3: > 15% fall in peak flow). Only the children in the G3 subgroup did not show any gain in peak flow after EX2 compared with EX1. CONCLUSION: The alteration in peak flow at the end of the SRWU period was a good predictor of the occurrence of bronchoconstriction after EX2. An SRWU reduced the decrease in peak flow for most of the children (24/30) in this series, thus reducing subsequent post-exercise deep bronchoconstriction.
Incidence and causes of tenosynovitis of the wrist extensors in long distance paddle canoeists.
Authors: du Toit P , Sole G , Bowerbank P , Noakes T D
Published: December 2008

OBJECTIVES: To investigate the incidence and causes of acute tenosynovitis of the forearm of long distance canoeists. METHOD: A systematic sample of canoeists competing in four canoe marathons were interviewed. The interview included questions about the presence and severity of pain in the forearm and average training distances. Features of the paddles and canoes were determined. RESULTS: An average of 23% of the competitors in each race developed this condition. The incidence was significantly higher in the dominant than the nondominant hand but was unrelated to the type of canoe and the angle of the paddle blades. Canoeists who covered more than 100 km a week for eight weeks preceding the race had a significantly lower incidence of tenosynovitis than those who trained less. Environmental conditions during racing, including fast flowing water, high winds, and choppy waters, and the paddling techniques, especially hyperextension of the wrist during the pushing phase of the stroke, were both related to the incidence of tenosynovitis. CONCLUSION: Tenosynovitis is a common injury in long distance canoeists. The study suggests that development of tenosynovitis is not related to the equipment used, but is probably caused by difficult paddling conditions, in particular uneven surface conditions, which may cause an altered paddling style. However, a number of factors can affect canoeing style. Level of fitness and the ability to balance even a less stable canoe, thereby maintaining optimum paddling style without repeated eccentric loading of the forearm tendons to limit hyperextension of the wrist, would seem to be important.
Injuries caused by falling soccer goalposts in Denmark.
Authors: Blønd L , Hansen L B
Published: December 2008

OBJECTIVE: A falling soccer goalpost is associated with the potential risk of serious injury that can sometimes even be fatal. The aim of the study was to analyse the extent of the problem in Denmark and focus on the mechanism of injury and prevention. METHODS: Data were analysed for the period 1989-1997 from the European Home and Leisure Accident Surveillance System, which is an electronic register of the injuries seen in the casualty departments of the hospitals of five selected cities in Denmark representing 14% of the Danish population; in addition, fatal accidents in the whole of Denmark since 1981 were examined. Forty two injured persons were interviewed about the circumstances of the accident. Attempts were made to estimate the proportion of goalposts secured by counterweight in the five different regions, compared with the proportion secured with ground stakes and those that were unsecured, by analysing data from the largest producers of goalposts in Denmark. RESULTS: In the period 1981-1988, two fatal accidents were recorded. In the period 1989-1997, 117 people were injured by a falling goalpost; six of the injuries required hospitalisation. Some 88% of the injured were under the age of 15. In a telephone interview with 42 of the injured, 50% stated that the goalpost fell because someone was hanging on the crossbar. Comparing the five different regions with respect to the proportion of goalposts secured by counterweight and the number of accidents, the following relation was found. Areas in which a high percentage of the goalposts were secured by a counterweight correlated inversely with a high number of accidents (r = -0.9; p = 0.04). CONCLUSION: Soccer is a widely played sport and it is important to be aware that accidents caused by falling goalposts can occur and that they presumably can be prevented by proper use of goalposts, by using secure goalposts, and by securing old goalposts with a counterweight.
Velocity associated characteristics of force production in college weight lifters.
Authors: Kanehisa H , Fukunaga T
Published: December 2008

OBJECTIVE: To determine velocity specific isokinetic forces and cross sectional areas of reciprocal muscle groups in Olympic weight lifters. METHODS: The cross sectional area of the flexor or extensor muscles of the elbow or knee joint was determined by a B-mode ultrasonic apparatus in 34 college weight lifters and 31 untrained male subjects matched for age. Maximum voluntary force produced in the flexion and extension of the elbow and knee joints was measured on an isokinetic dynamometer at 60, 180, and 300 degrees/s. RESULTS: The average cross sectional area was 31-65% higher, and the force was 19-62% higher in weight lifters than in the untrained subjects. The ratio of force to cross sectional area was the same in both groups. The weight lifters showed a lower velocity associated decline in force than untrained subjects in the elbow and knee flexors but not in the extensors. CONCLUSIONS: These results indicate that for muscle contractions with velocities between 60 degrees/s and 300 degrees/s the difference in isokinetic force between weight lifters and untrained subjects can be primarily attributed to the difference in the muscle cross sectional area. However, the lower velocity associated decline in force implies that weight lifters may have a higher force per cross sectional area than untrained subjects at velocities above 300 degrees/s.
Effect on nasal resistance of an external nasal splint and isotonic exercise.
Authors: Wilde A D , Ell S R
Published: December 2008

OBJECTIVES: The now commonplace wearing of external nasal splints by sportsmen and athletes has never been scientifically evaluated. The present study looks into the effect of isotonic exercise on nasal resistance, and examines whether this effect is altered by the wearing of an external nasal splint. METHODS: Twenty subjects not suffering from rhinitis were tested. Nasal resistance measurements were recorded using an anterior rhinomanometer before and after isotonic exercise with and without an external nasal splint. Pulse and blood pressure were measured before and after exercise. RESULTS: Significant changes were observed in pulse (p < 0.001) and both systolic (p < 0.002) and diastolic (p < 0.001) blood pressure in response to exercise. Significant differences were seen in nasal resistance when the splint was applied (p < 0.001) and after exercise (p < 0.003). No significant difference was observed after exercise when the splint was worn (p = 0.167). CONCLUSIONS: External nasal splints decrease nasal resistance at rest but are of little value during isotonic exercise.
Safe relief of rest pain that eases with activity in achillodynia by intrabursal or peritendinous steroid injection: the rupture rate was not increased by these steroid injections.
Authors: Read M T
Published: December 2008

A history of morning and rest pain that eases with activity was found to improve after anti-inflammatory injections around the paratenon or within the Achilles bursae. The reduction in pain morbidity was significant, and the peritendinous steroid injections did not increase the rupture rate.
Abdominal injuries and sport.
Authors: Ryan J M
Published: December 2008

Serious abdominal injuries resulting from sport are rare. The potential for misdiagnosis is significant and the consequences may be serious. Patients with abdominal pain should be taken very seriously and investigated with appropriate diagnostic equipment. Sporting bodies have a responsibility to address safety within a particular sport and to change the rules where necessary as injury patterns are identified.
Analysis of the aerobic-anaerobic transition in elite cyclists during incremental exercise with the use of electromyography.
Authors: Lucía A , Sánchez O , Carvajal A , Chicharro J L
Published: December 2008

OBJECTIVES: To investigate the validity and reliability of surface electromyography (EMG) as a new non-invasive determinant of the metabolic response to incremental exercise in elite cyclists. The relation between EMG activity and other more conventional methods for analysing the aerobic-anaerobic transition such as blood lactate measurements (lactate threshold (LT) and onset of blood lactate accumulation (OBLA)) and ventilatory parameters (ventilatory thresholds 1 and 2 (VT1 and VT2)) was studied. METHODS: Twenty eight elite road cyclists (age 24 (4) years; VO2MAX 69.9 (6.4) ml/kg/min; values mean (SD)) were selected as subjects. Each of them performed a ramp protocol (starting at 0 W, with increases of 5 W every 12 seconds) on a cycle ergometer (validity study). In addition, 15 of them performed the same test twice (reliability study). During the tests, data on gas exchange and blood lactate levels were collected to determine VT1, VT2, LT, and OBLA. The root mean squares of EMG signals (rms-EMG) were recorded from both the vastus lateralis and the rectus femoris at each intensity using surface electrodes. RESULTS: A two threshold response was detected in the rms-EMG recordings from both muscles in 90% of subjects, with two breakpoints, EMGT1 and EMGT2, at around 60-70% and 80-90% of VO2MAX respectively. The results of the reliability study showed no significant differences (p > 0.05) between mean values of EMGT1 and EMGT2 obtained in both tests. Furthermore, no significant differences (p > 0.05) existed between mean values of EMGT1, in the vastus lateralis and rectus femoris, and VT1 and LT (62.8 (14.5) and 69.0 (6.2) and 64.6 (6.4) and 68.7 (8.2)% of VO2MAX respectively), or between mean values of EMGT2, in the vastus lateralis and rectus femoris, and VT2 and OBLA (86.9 (9.0) and 88.0 (6.2) and 84.6 (6.5) and 87.7 (6.4)% of VO2MAX respectively). CONCLUSION: rms-EMG may be a useful complementary non-invasive method for analysing the aerobic-anaerobic transition (ventilatory and lactate thresholds) in elite cyclists.
Injuries to riders in the cross country phase of eventing: the importance of protective equipment.
Authors: Whitlock M R
Published: December 2008

OBJECTIVES: To determine the distribution of injuries in the eventing discipline of equestrian sports and the effectiveness of the protective equipment worn. METHODS: Data on all injuries sustained in the cross country phase over fixed obstacles were collected from 54 days of competition from 1992 to 1997. This involved 16,940 rides. RESULTS: Data on a total of 193 injuries were collected, which included two deaths. This represents an injury rate of 1.1%. Head and facial injuries represented the largest group (31%), with one third of these requiring treatment in hospital. All riders were wearing protective helmets and body protectors. CONCLUSIONS: Eventing is one of the most dangerous equestrian sports. Improved protective equipment, which is mandatory for 1999, should reduce the severity of these injuries.
Development of a Scottish physical activity questionnaire: a tool for use in physical activity interventions.
Authors: Lowther M , Mutrie N , Loughlan C , McFarlane C
Published: December 2008

OBJECTIVES: Three studies were undertaken to establish the reliability and validity of the Scottish physical activity questionnaire (SPAQ), developed to aid seven day recall of leisure and occupational physical activity. METHODS: To establish reliability, SPAQs (n = 34) were completed on a Monday and the following Wednesday. Thus each questionnaire measured four identical days. To establish concurrent validity, 94 participants completed a SPAQ and an adapted stage of exercise behaviour change questionnaire. Responses to SPAQ were then analysed by stage of exercise behaviour change. In a further study of criterion validity, 30 volunteers wore a Caltrac motion sensor for four consecutive days, after which they completed a SPAQ. RESULTS: In the first study, total physical activity had a coefficient of repeatability (R) of 53 minutes. Occupational physical activity showed a similar variance (R = 54.6 minutes) but leisure physical activity was more reliable (R = 29.3 minutes). The main variation in occupational physical activity was found to be walking (R = 39.8 minutes). In study 2, a one way analysis of variance showed the expected relation between physical activity and stage of exercise behaviour change, confirming the concurrent validity of SPAQ with the stage of exercise behaviour change model. In study 3, several erroneous recordings affected both SPAQ and the Caltrac results (kcal). After relevant corrections had been made, the correlation between the two measurement devices was 0.52 (p < 0.05). CONCLUSIONS: SPAQ has been shown to be reliable and to hold strong concurrent validity and limited criterion validity. The main limitation in SPAQ appears to be the measurement of occupational walking. It is therefore recommended that further work be conducted to refine the measurement of this physical activity component. It is evident nonetheless that SPAQ can be used with confidence to measure outcomes in physical activity interventions when account is taken of its limitations.
Eccentric/concentric ratios at selected velocities for the invertor and evertor muscles of the chronically unstable ankle.
Authors: Hartsell H D , Spaulding S J
Published: December 2008

OBJECTIVE: The use of muscle balancing by the clinician to determine return to activity or discharge of a patient is not a well understood measure. Because of the lack of information on the poorly understood concept of eccentric/concentric (E/C) ratios at the ankle, the purpose was to determine the E/C ratios for the invertor and evertor muscles at various velocities in healthy and chronically unstable ankles. METHODS: Ten subjects with healthy ankles and 14 with chronically unstable ankles performed five maximal effort reciprocal eccentric/contraction contractions on an isokinetic dynamometer at four velocities (60, 120, 180, and 240 degrees/s) and for each physiological movement of inversion and eversion. Data were analysed using a two way mixed model analysis of variance with repeated measures, with Tukey's test used for post hoc analysis. RESULTS: Although the chronically unstable ankle was significantly weaker (p < 0.05) eccentrically and concentrically for inversion and eversion, the main effect of the E/C ratios for the ankle was not significant for either joint motion. The main effect of velocity was significant (p < 0.05) for each joint motion, but no significant interaction effects were observed. As velocity increased, the E/C ratio increased, except at 180 and 240 degrees/s for either ankle group. CONCLUSIONS: Chronic ankle instability and muscle weakness co-exist. Adequate E/C ratios in the chronically unstable ankle may exist in the absence of normal strength values.
A rare fracture-dislocation of the hip in a gymnast and review of the literature.
Authors: Mitchell J C , Giannoudis P V , Millner P A , Smith R M
Published: December 2008

Posterior fracture-dislocation of the hip is an uncommon injury in athletics and leisure activities. It is more commonly seen in high energy motor vehicle accidents and occasionally in high energy sporting activities. A rare case is reported of posterior fracture-dislocation of the hip joint that occurred in a young athlete during gymnastics. This unusual mechanism of injury illustrates the great forces sustained by the hip joint of gymnasts. Early reduction and operative treatment led to a congruent and stable hip joint. After rehabilitation, she returned to light sporting activities after six months.
Electrocardiographic changes in 1000 highly trained junior elite athletes.
Authors: Sharma S , Whyte G , Elliott P , Padula M , Kaushal R , Mahon N , McKenna W J
Published: December 2008

OBJECTIVES: To evaluate the spectrum of electrocardiographic (ECG) changes in 1000 junior (18 or under) elite athletes. METHODS: A total of 1000 (73% male) junior elite athletes (mean (SD) age 15.7 (1.4) years (range 14-18); mean (SD) body surface area 1.73 (0.17) m2 (range 1.09-2.25)) and 300 non-athletic controls matched for gender, age, and body surface area had a 12 lead ECG examination. RESULTS: Athletes had a significantly higher prevalence of sinus bradycardia (80% v 19%; p<0.0001) and sinus arrhythmia (52% v 9%; p<0.0001) than non-athletes. The PR interval, QRS, and QT duration were more prolonged in athletes than non-athletes (153 (20) v 140 (18) milliseconds (p<0.0001), 92 (12) v 89 (7) milliseconds (p<0.0001), and 391 (27) v 379 (29) milliseconds (p = 0.002) respectively). The Sokolow voltage criterion for left ventricular hypertrophy (LVH) and the Romhilt-Estes points score for LVH was more common in athletes (45% v 23% (p<0.0001) and 10% v 0% (p<0.0001) respectively), as were criteria for left and right atrial enlargement (14% v 1.2% and 16% v 2% respectively). None of the athletes with voltage criteria for LVH had left axis deviation, ST segment depression, deep T wave inversion, or pathological Q waves. ST segment elevation was more common in athletes than non-athletes (43% v 24%; p<0.0001). Minor T wave inversion (less than -0.2 mV) in V2 and V3 was present in 4% of athletes and non-athletes. Minor T wave inversion elsewhere was absent in non-athletes and present in 0.4% of athletes. CONCLUSIONS: ECG changes in junior elite athletes are not dissimilar to those in senior athletes. Isolated Sokolow voltage criterion for LVH is common; however, associated abnormalities that indicate pathological hypertrophy are absent. Minor T wave inversions in leads other than V2 and V3 may be present in athletes and non-athletes less than 16 but should be an indication for further investigation in older athletes.
Sledging related spinal injuries and fracture patterns: a report on five cases.
Authors: Basu S , Makwana N K , Khazim R
Published: December 2008

The cases are reported of five patients who presented to The Queens Medical Centre, Nottingham after a sledging accident. All five patients presented consecutively during the first weekend in 1997 having sustained the accident in the same public park. The mechanism and subsequent fracture type is described for each. These injuries are preventable, and increasing public awareness of the risk of sledging in public places may reduce the incidence.
Is there a role for exercise in the prevention of osteoporotic fractures?
Authors: Rutherford O M
Published: December 2008

OBJECTIVES: To examine whether there is a role for exercise in improving bone mineral density (BMD), particularly in postmenopausal women. The effects of different types of exercise are examined together with their effects at selected skeletal sites. The role of activity in reducing falls and hip fractures will also be considered as well as the potentially negative effects of excessive exercise. METHODS: A literature search over the past 20 years was conducted and landmark papers selected. RESULTS: Certain types of exercise have been found to exert moderate benefits on BMD of the wrist, spine, and hip. Most studies do not detect a difference between the effects of endurance activities and strength training for BMD of the spine. It has been more difficult to isolate the optimal type of activity for effecting an osteogenic response at the hip, but recent evidence suggests that high impact work such as stepping and jumping may be effective at this site. The combination of hormone replacement therapy and exercise would appear to be more effective than either intervention on its own. Certain types of exercises have additional benefits, such as muscle strengthening, which could reduce the incidence of falls. Excessive exercise can lead to menstrual disturbances in female athletes and this in turn can cause bone loss, particularly from the spine. CONCLUSIONS: Exercise across the life span should be encouraged in order to maximise peak bone mass, reduce age related bone loss, and maintain muscle strength and balance. Although the effects of exercise on BMD later in life are small, epidemiological evidence suggests that being active can nearly halve the incidence of hip fractures in the older population. This effect is most probably multifactorial through the positive effects on bone, muscle strength, balance, and joint flexibility. Younger women should be aware of the dangers to the skeleton of menstrual disorders.
Heart dimensions may influence the occurrence of the heart rate deflection point in highly trained cyclists.
Authors: Lucía A , Carvajal A , Boraita A , Serratosa L , Hoyos J , Chicharro J L
Published: December 2008

OBJECTIVES: To determine whether the heart rate (HR) response to exercise in 21 highly trained cyclists (mean (SD) age 25 (3) years) was related to their heart dimensions. METHODS: Before performing an incremental exercise test involving a ramp protocol with workload increases of 25 W/min, each subject underwent echocardiographic evaluation of the following variables: left ventricular end diastolic internal diameter (LVIDd), left ventricular posterior wall thickness at end diastole (LVPWTd), interventricular septal wall thickness at end diastole (IVSTd), left ventricular mass index (LVMI), left atrial dimension (LAD), longitudinal left atrial (LLAD) and right atrial (LRAD) dimensions, and the ratio of early to late (E/A) diastolic flow velocity. RESULTS: The HR response showed a deflection point (HRd) at about 85% VO2MAX in 66.7% of subjects (D group; n = 14) and was linear in 33.3% (NoD group; n = 7). Several echocardiographic variables (LVMI, LAD, LLAD, LRAD) indicative of heart dimensions were similar in each group. However, mean LPWTd (p<0.01) and IVSTd (p<0.05) values were significantly higher in the D group. Finally, no significant difference between groups was found with respect to the E/A. CONCLUSIONS: The HR response is curvilinear during incremental exercise in a considerable number of highly trained endurance athletes-that is, top level cyclists. The departure of HR increase from linearity may predominantly occur in athletes with thicker heart walls.
Effect of changing the saddle angle on the incidence of low back pain in recreational bicyclists.
Authors: Salai M , Brosh T , Blankstein A , Oran A , Chechik A
Published: December 2008

OBJECTIVE: According to the literature, 30-70% of cyclists suffer from cervical, dorsal, or lumbar back pain. This study was conducted to evaluate one of the possible causes of low back pain and to suggest a solution by appropriate adjustments to the bicycle. METHODS: Serial fluoroscopic studies were performed while cyclists sat on different types of bicycle (sports, mountain, and city). Pelvic/spine angles were measured at different seat angles, and the related force vectors analysed. RESULTS: There was a tendency towards hyperextension of the pelvic/spine angle which resulted in an increase in tensile forces at the promontorium. These forces can easily be reduced by appropriate adjustment of the seat angle--that is, by creating an anterior inclining angle. The findings of the biomechanical analysis were then applied to a group of cyclists who were members of a cycling club and who complained of low back pain. After appropriate adjustment of the saddle angle, most of the cyclists (>70%) reported major improvement in the incidence and magnitude of their back pain. CONCLUSIONS: The incidence and magnitude of back pain in cyclists can be reduced by appropriate adjustment of the angle of the saddle. It is important that these findings be conveyed to cyclists, bicycle salesmen, trainers, and members of the general public who engage in cycling, in order to decrease the prevalence of back pain.
Upright posture and maximal exercise increase platelet aggregability and prostacyclin production in healthy male subjects.
Authors: Feng D L , Murillo J , Jadhav P , McKenna C , Gebara O C , Lipinska I , Muller J E , Tofler G H
Published: December 2008

BACKGROUND: It is well accepted that heavy physical exertion can trigger the onset of myocardial infarction, but the mechanism is uncertain. As platelet and endothelial function play an important role in thrombotic events, platelet and prostacyclin responses to maximal treadmill exercise were studied. METHODS/RESULTS: The study subjects were 40 healthy men, mean (SEM) age 29 (5) years. Platelet aggregation was measured on a four channel aggregometer. Plasma 6-keto-prostaglandin F1alpha was analysed using an enzyme immunoassay technique. Upright posture and exercise produced an increase in platelet aggregability, as indicated by a fall in the threshold concentration of adrenaline (epinephrine) from 7.6 (1.5) microM at rest to 4.3 (1.0) microM after exercise (p = 0.002). The collagen lag time became significantly shorter with exercise (from 79.1 (3.1) seconds at rest to 71.9 (2.6) seconds after exercise, p = 0.003). Exercise was also associated with a 55% increase in plasma 6-keto-prostaglandin F1alpha (from 38.1 (75%CI 29.0 to 46.5) pg/ml at rest to 59.2 (47.3 to 66.8) pg/ml after exercise, p<0.001). CONCLUSIONS: In healthy male subjects, upright posture and maximal exercise increased platelet aggregability but this increase was counteracted by an increase in prostacyclin production. In patients with endothelial dysfunction, a reduced prostacyclin response to exercise may promote a transient prothrombotic imbalance that may trigger cardiovascular disease onset.
Sport medicine and the ethics of boxing.
Authors: Leclerc S , Herrera C D
Published: December 2008

In the light of medical evidence of the health risks associated with boxing, a watchful agnostic position among sport physicians is no longer justifiable. The normal activity in a boxing match places the athletes at risk of head injury, some of which may be difficult to detect and impossible to repair. This suggests that sport physicians and others expert in the prevention and diagnosis of such injuries should take a public stand against boxing, as other medical associations have. Although there is a need for continuing research into the health risks, doctors can in the interim take steps to increase public awareness of these risks. Sport physicians in particular can make a strong public statement by also ending their professional involvement with boxing. This need not be interpreted as paternalism; doctors are qualified neither to make laws nor to restrict private behaviour. Sport physicians are, however, well equipped to advise those who do make laws and those who choose to engage in boxing. In the end, because this stance against boxing will probably reduce the number of brain injuries in certain athletes, autonomy will be preserved, rather than restricted.
Community based intervention on adolescent risk taking: using research for community action
Authors: Coggan Carolyn , Disley Barbara , Patterson Pam
Published: December 2008

Objectives—To use research on adolescent risk taking behaviour as an impetus for a community to develop locally based injury prevention strategies.

Design—Case study, based on a community action model and formative evaluation. This involved: a community profile on adolescent risk taking behaviour; interviews with service providers; dissemination of research findings to local policy makers; development and implementation of a community action plan to address adolescent risk taking; and assessment of its impact.

Setting—A rural town with a population of 10 195 situated in the North Island of New Zealand.

Subjects—School aged adolescents and the safety policies and practices of community organisations involved with adolescents.

Results—Risk taking behaviours identified by the community profile included: drink-driving, substance abuse, carrying of weapons with intent to harm, and suicidal ideation. Community members identified that risk taking behaviour associated with alcohol in relation to: (1) violence (self directed and assault) and (2) road related injuries should be the focus of their activities. The strategies identified focused on advocacy, education, legal/regulatory change, and environmental modification. Evaluation conducted six months after intervention identified increased community awareness of the adverse effects of adolescent risk taking and some changes in policies and practice related to adolescent safety.

Conclusions—Providing a community with local information that has high relevance for its members may act as a stimulus for the development of injury prevention initiatives. While this case study illustrated that a comprehensive approach focusing on adolescent risk taking behaviour, rather than on isolated injury problems, may be an appropriate way to highlight escalating adolescent injury rates, it also demonstrates the limitations of a short time frame for a community development project.
Safe Child Penarth: experience with a Safe Community strategy for preventing injuries to children
Authors: Kemp Alison , Gibbs Nigel , Vafidis Gail , Sibert Jo
Published: December 2008

Objectives—To evaluate the process of establishing a Safe Community project for children.

Design—A descriptive study.

Setting—Penarth, a town (population 20 430) Vale of Glamorgan, South Wales.

Subjects—3943 children and their families in Penarth.

Main outcome measures—Whether the 12 criteria for a Safe Community project (World Health Organisation) were met. Implementation of the safety agenda set by the community.

Results—Safe Child Penarth met 10 of the 12 criteria for the Safe Community network. All the items on the agenda were introduced in the initial two years of the project. There were difficulties, however, achieving sustained community ownership of the project.

Conclusions—The Safe Community concept stimulated work to improve child safety in Penarth. Community safety initiatives should involve all local agencies to identify the problems and work with the community to set and meet the safety agenda. Partnership with the local authority is valuable to improve the safety of the environment. The experience generated from Safe Child Penarth has been used to develop a county wide, all age community safety project.
Epidemiology of bicycle injury, head injury, and helmet use among children in British Columbia: a five year descriptive study
Authors: Linn S , Smith D , Sheps S
Published: December 2008

Objectives and methods—Data on 1462 injured bicyclists aged 1–19, obtained over a period of five years from the British Columbia Children's Hospital as part of a national emergency room based program in Canada, were analyzed to describe the epidemiology of injuries, helmet use, and the occurrence of head injuries before the enactment of a new mandatory helmet law. The odds ratio (OR) and 95% confidence interval (CI) were calculated for non-users compared with helmet users.

Results—Bicycle injuries comprised 4% of all injuries seen in the five year study period. The proportion of admissions was 12.7% among bicyclists, significantly higher than the 7.9% admissions of all 35 323 non-bicyclist children who were seen during the study period (OR = 1.96, CI = 1.44 to 1.99). Boys were injured more often than girls. The proportion of admissions for boys was 13.8% compared with 10.2% among girls (OR = 1.41, CI = 0.97 to 2.05). More than 70% of injured bicyclists reported no helmet use. The proportion of admissions of injured bicyclists who did not use helmets was always higher than the proportion of admissions of those who used helmets (OR = 2.23, CI = 1.39 to 3.62). Head and face injuries occurred more often among those who did not use helmets (OR = 1.55, CI= 1.18 to 2.04 ). However, there was no excess of minor head injuries among non-users (OR = 1.10, CI = 0.60 to 2.06). Of the 62 concussions, 57 occurred to non-helmet users (OR = 4.04, CI = 1.55 to 11.47). Most injuries occurred in the upper (46.4%) or lower extremities (32.4%). Dental injuries occurred slightly more often among helmet users compared with non-users but this excess was not statistically significant (OR = 1.29, CI = 0.76 to 2.20).

Conclusion—The data indicate the need to control injuries by using helmets. A decrease in the number of head injuries and their severity is expected when bicycle helmet use becomes law in British Columbia.
Impact of a theory based intervention to increase bicycle helmet use in low income children
Authors: Hendrickson Sherry Garrett , Becker Heather
Published: December 2008

Objective—While community interventions to increase bicycle helmet use have increased markedly, few of these studies are theoretically based. The purpose of this study was to determine relationships among PRECEDE model predictors and self reported helmet use among 407 fourth graders from nine low income, non-urban schools.

Setting—Low income schools, with high minority populations in eight non-metropolitan Central Texas counties were chosen.

Methods—Schools were randomly assigned in a repeated measures design to either classroom only, parent-child, or control groups. School nurses were educated by the researchers to present a head injury prevention program in all but the experimental schools. Researchers made contact by phone with the parents of children in the parent-child group.

Results and conclusions—Participation in either of the educational interventions, followed by belief that helmets protect your head (a predisposing factor), and participation in the parent intervention condition, added significant unique variance to the prediction of helmet use after helmet ownership is accounted. These four variables, taken together, account for 72% of the variance in predicting bicycle helmet use.
Drowning surveillance: how well do E codes identify submersion fatalities
Authors: Smith Gordon S , Langley John D
Published: December 2008

Objectives—The aim was to determine in New Zealand: (1) to what degree the International Classification of Diseases Supplementary Classification (ICD) external cause (E) codes for drowning identify all deaths involving drowning; (2) how the other drowning deaths are distributed across E codes; and (3) whether the proportion of drownings not identified by traditional ICD E codes has changed over time.

Methods—Mortality files for the period 1977–92, which were coded in the range E800-E999 (external causes of injury and poisoning), were searched electronically using the keyword “drown”.

Results—2718 cases that involved drowning were identified. This represents a 17.7% increase in the number of cases one would identify using ICD drowning E codes alone. The majority (65%) of the 408 drownings not coded as such were coded as motor vehicle traffic crashes. The number of drownings that were not identified by ICD E codes remained relatively constant over time, although the number of deaths E coded as drowning declined significantly in recent years.

Conclusion—Standard ICD E codes for drowning do not identify all drowning related deaths, which may make comparisons of injury rates between countries difficult, especially for injuries such as drownings and burns that can be both nature of injury and external cause codes. Multiple cause coding and the inclusion of free text narratives are an important tool to improve the value of a country's vital statistics for injury prevention, and facilitate comparisons with other countries.
Reported incidence of injuries caused by street glass among urban children in Philadelphia: Table 1
Authors: Makary Martin A
Published: December 2008

Objectives—First, to assess the incidence and cause of lacerations sustained by urban children from walking outdoors as well as to identify possible means of prevention. Second, to identify the type of health care sought after injury and to measure the extent of glass litter on the streets.

Setting—Children (18 years of age or younger) in the Ludlow community of Philadelphia.

Methods—A retrospective analysis of lacerations sustained while walking outdoors. A personal survey was conducted with 241 children on a door to door basis. Glass litter was measured by visual inspection of individual streets.

Results—Of 241 children, 83 (34%) had been cut at least once while walking outdoors. Of the 83, 62 were not wearing footwear at the time of injury. The majority of lacerations (86%) were caused by broken glass. Thirty nine of the 83 children received professional medical care for the laceration. Broken glass was estimated to be present on 30% of the outdoor walking area.

Conclusions—Broken glass is a significant health problem on littered urban streets. Preventive measures such as street cleaning, footwear education, and glass recycling incentives are needed to address this public health hazard.
Observed child restraint use in automobiles
Authors: Williams Allan F
Published: December 2008

Visual observations were made on restraint use in occupants of 5050 automobiles containing at least one passenger less than 10 years of age, and short interviews were conducted with the drivers. Ninety three per cent of passengers less than 10 years old were not restrained. Eighty nine per cent of passengers 10 or older and 78% of the drivers were not restrained. Sixteen per cent of child motor vehicle restraint devices observed were not used, and 73% of those in use were not used correctly. Use of such devices declined sharply after age one. Although child passengers were more likely to be restrained if the driver was restrained, more than 75% of the children were not restrained when the driver was, even if the driver was the child's parent.
An observational study of protective equipment use among in-line skaters: Table 1
Authors: Warda Lynne , Harlos Sande , Klassen Terry P , Moffatt Michael E K , Buchan Norma , Koop Virginia L
Published: December 2008

Objectives—To describe the patterns of protective equipment use by in-line skaters in Winnipeg, Manitoba and nearby rural communities.

Methods—In-line skaters were observed for three months in 1996 at 190 urban and 30 rural sites selected using a formal sampling scheme. Age, gender, protective equipment use, skating companions, correct helmet use, and use of headphones were recorded.

Results—Altogether 123 in-line skaters were observed at 61 sites, including one rural site. No skaters were observed at the remaining sites. There were 37 adults and 86 children; 56% were male. Helmet use was 12.2% (95% confidence interval (CI ) = 6.4% to 18.0%), wrist guard use was 16.3% (95% CI = 9.7% to 22.8%), knee pad use was 9.8% (95% CI = 5.2% to 16.4%), and elbow pad use was 7.3% (95% CI = 3.4% to 13.4%). Children were more likely to wear a helmet than teens 12–19 years of age (relative risk (RR) = 30, 95% CI = 4.01 to 225). Adults were more likely to wear wrist guards than children (RR = 4.32, 95% CI = 1.87 to 9.94). No gender differences were found. Incorrect helmet use was documented in four skaters; three skaters were wearing headphones.

Conclusions—Low rates of protective equipment use were documented in our region, significantly lower than those reported in the literature. Barriers to equipment use are not known, and should be examined by further study. In-line skating safety programs should be developed, promoted, and evaluated. Teens should be targeted for future preventive efforts.
Are life vests worn? A multiregional observational study of personal flotation device use in small boats: Table 1
Authors: Quan Linda , Bennett Elizabeth , Cummings Peter , Trusty Michaela N , Treser Charles D
Published: December 2008

Objective—Although life vest use is thought to prevent drowning, their use by boaters has not been described. This study sought to determine the use of personal flotation devices (PFDs) in small boats.

Methods—Boaters were observed between April and June 1995 in Washington and Oregon and classified by their age, gender, PFD use, and boat type.

Results—Among 4181 boaters, 25% wore a PFD. Use was highest in <5 year olds (91%) and lowest in those over 14 years (13%). Those in kayaks were most likely (78%) and those in motor boats (19%) were least likely to wear a PFD. Females were more likely to wear a PFD than males (relative prevalence 1.5, 95% confidence interval 1.3 to 1.6). When a child less than 15 years was in a boat with an adult, PFD use was 65% if no adult wore a PFD and 95% if at least one accompanying adult wore a PFD (p=0.001).

Conclusions—Generally, PFD use by boaters was low in the Northwestern US. Efforts to increase PFD use should target adolescents, adults and specific boating populations, especially those in motor boats.
Some observations on waterslide injuries: Figure 1
Authors: Ball David J
Published: December 2008

Study objective—To investigate the causes of a series of interperson collisions on a waterslide resulting in serious injury, and to assess adequacy of control systems and legal liability.

Method—Site investigation of operating characteristics including a traffic light controlled system, organisational safety culture, and user behaviour.

Results—Despite a battery of safety features including closed circuit TV, citizen's band radios, a traffic light controlled system, part time supervision, and warning notices, the system was found to be inherently “unsafe” as operated. It placed a small but significant percentage of users in a hazardous situation whereby consecutive riders could collide with each other while in the flumeeven when conforming with all instructions. The realised risk might have been even higher were not staff and users adopting their own precautionary measures.

Conclusions—The risk to waterslide users, even the majority observing the safety rules, was questionably high, and facility operators were vulnerable to a court ruling that they had failed in their duty of care. It is suggested that waterslide operators elsewhere, who are wholly or partially reliant on traffic light controlled systems, should carefully scrutinise the safety of their operating systems. Members of the public who use these facilities would, in any event, be well advised to remain vigilant whatever the perceived adequacy of the safety system in operation.
Measures of injury severity in childhood: a critical overview
Authors: Beattie T F , Currie C E , Williams J M , Wright P
Published: December 2008

Many different methods for assessing injury severity have appeared in the literature. This paper discusses the commonly used measures, many of which are subjective and depend on clinical practice or sociological factors. Even if apparently objective measures are used their appropriateness for use in children is questionable. Particular problems occur with scoring or categorising events such as poisoning, choking, and near drowning. Researchers need to reach a consensus on injury severity reporting to ensure comparability between studies and programs for injury prevention.