bluuebunny/crossref_metadata_2025_split huggingface dataset:
Implementing Strength Training Strategies for Injury Prevention in Soccer: Scientific Rationale and Methodological Recommendations
Authors: Beato Marco , Maroto-Izquierdo Sergio , Turner Anthony N. , Bishop Chris 
Published: January 2021

Due to the negative effects that injuries have on performance, club finances, and long-term player health (permanent disability after a severe injury), prevention strategies are an essential part of both sports medicine and performance.Purpose:To summarize the current evidence regarding strength training for injury prevention in soccer and to inform its evidence-based implementation in research and applied settings.Conclusions:The contemporary literature suggests that strength training, proposed as traditional resistance, eccentric, and flywheel training, may be a valid method to reduce injury risk in soccer players. Training strategies involving multiple components (eg, a combination of strength, balance, plyometrics) that include strength exercises are effective at reducing noncontact injuries in female soccer players. In addition, the body of research currently published supports the use of eccentric training in sports, which offers unique physiological responses compared with other resistance exercise modalities. It seems that the Nordic hamstring exercise, in particular, is a viable option for the reduction of hamstring injuries in soccer players. Moreover, flywheel training has specific training peculiarities and advantages that are related to the combination of both concentric and eccentric contraction, which may play an important role in injury prevention. It is the authors’ opinion that strength and conditioning coaches should integrate the strength training methods proposed here in their weekly training routine to reduce the likelihood of injuries in their players; however, further research is needed to verify the advantages and disadvantages of these training methods to injury prevention using specific cohorts of soccer players.
No change in neurodevelopment at 11 years after extremely preterm birth
Authors: Marlow Neil , Ni Yanyan , Lancaster Rebecca , Suonpera Emmi , Bernardi Marialivia , Fahy Amanda , Larsen Jennifer , Trickett Jayne , Hurst John R , Morris Joan , Wolke Dieter , Johnson Samantha 
Published: January 2021

ObjectiveTo determine whether improvements in school age outcomes had occurred between two cohorts of births at 22–25 weeks of gestation to women residents in England in 1995 and 2006.DesignLongitudinal national cohort studies.SettingSchool-based or home-based assessments at 11 years of age.ParticipantsEPICure2 cohort of births at 22–26 weeks of gestation in England during 2006: a sample of 200 of 1031 survivors were evaluated; outcomes for 112 children born at 22–25 weeks of gestation were compared with those of 176 born in England during 1995 from the EPICure cohort. Classroom controls for each group acted as a reference population.Main outcome measuresStandardised measures of cognition and academic attainment were combined with parent report of other impairments to estimate overall neurodevelopmental status.ResultsAt 11 years in EPICure2, 18% had severe and 20% moderate impairments. Comparing births at 22–25 weeks in EPICure2 (n=112), 26% had severe and 21% moderate impairment compared with 18% and 32%, respectively, in EPICure. After adjustment, the OR of moderate or severe neurodevelopmental impairment in 2006 compared with 1995 was 0.76 (95% CI 0.45 to 1.31, p=0.32). IQ scores were similar in 1995 (mean 82.7, SD 18.4) and 2006 (81.4, SD 19.2), adjusted difference in mean z-scores 0.2 SD (95% CI −0.2 to 0.6), as were attainment test scores. The use of multiple imputation did not alter these findings.ConclusionImprovements in care and survival between 1995 and 2006 are not paralleled by improved cognitive or educational outcomes or a reduced rate of neurodevelopmental impairment.
Single modality radical radiotherapy is an acceptable alternative for the older patient with squamous cell carcinoma of the oesophagus
Authors: Derby Sarah , Forshaw Matthew , Lowrie Caroline , Grose Derek , Marashi Husam , McLoone Philip , Wilson Christina , McIntosh David 
Published: January 2021

BackgroundOesophageal cancer remains a common cause of cancer mortality worldwide. Increasingly, oncology centres are treating an older population and comorbidities may preclude multimodality treatment with chemoradiotherapy (CRT). We review outcomes of radical radiotherapy (RT) in an older population treating squamous cell carcinoma (SCC) oesophagus.MethodsPatients over 65 years receiving RT for SCC oesophagus between 2013 and 2016 in the West of Scotland were identified. Kaplan-Meier and Cox-regression analysis were used to compare overall survival (OS) between patients treated with radical RT and radical CRT.ResultsThere were 83 patients over 65 years treated with either RT (n=21) or CRT (n=62). There was no significant difference in median OS between CRT versus RT (26.8 months vs 28.5 months, p=0.92). All patients receiving RT completed their treatment whereas 11% of CRT patients did not complete treatment.ConclusionSurvival in this non-trial older patient group managed with CRT is comparable to that reported in previous trials. RT shows better than expected outcomes which may reflect developments in RT technique. This review supports RT as an alternative in older patients, unfit for concurrent treatment.
Examining chronic inflammatory markers on blood pressure measures in the presence of vitamin D insufficiency among indigenous cree adults: results from the cross-sectional Multi-Community Environment-and-Health Study inEeyou Istchee, Quebec, Canada
Authors: Zuk Aleksandra M , Liberda Eric N , Tsuji Leonard J S 
Published: January 2021

ObjectiveHigh blood pressure (BP) is a risk factor for cardiovascular disease. Examining the role of inflammatory mediators on BP is important since vitamin D (VD) is a modifiable risk factor, which possibly modulates inflammatory cytokines. This study simulated what are known as average ‘controlled direct effects (CDE)’ of inflammatory markers, C reactive protein (CRP), tumour necrosis factor-α (TNF-α), and interlukin-6 (IL-6) on continuous BP measures, while fixing VD, an intermediate variable to specific level.DesignCross-sectional study.SettingWe analysed data from the Multi-Community Environment-and-Health Study, 2005–2009, conducted inEeyou Istchee, Quebec, Canada.ParticipantsThis study recruited 1425 study Indigenous Cree participants from seven Cree communities. Only adults with serum VD levels, inflammatory markers and BP measures were included in this data analysis.Primary and secondary outcomes measuresInflammatory markers examined the top 25th exposure percentiles. VD ‘insufficiency’ (ie, 25-hydroxyvitamin-D levels<50 nmol/L) defined by the Institute of Medicine. CDE for each inflammatory marker in the presence and absence of population VD insufficiency simulated the average direct effect change for systolic and diastolic BP (SBP and DBP) measures. All models were adjusted for exposure-and-mediator outcome relationship.ResultsAmong 161 participants, 97 (60 %) were female. The prevalence of VD insufficiency was 32%. CDE estimates show in the presence and absence of population vitamin D insufficiency, inflammatory markers have a slightly different association on BP. TNF-α significantly and inversely associated with SBP in the presence of vitamin D insufficiency, fully adjusted model β = −13.61 (95% CI −24.42 to −2.80); however, TNF-α was not associated with SBP in the absence of vitamin D insufficiency. CRP, IL-6 were also not significantly associated with BP measures, although the magnitude of association was greater for those with elevated inflammation and VD insufficiency.ConclusionThis novel analysis shows in the presence of VD insufficiency, inflammation (particularly TNF-α) may affect SBP. Additional research is needed to elucidate these findings, and the temporal relationship between these variables.
Antiplatelet therapy in patients with myocardial infarction without obstructive coronary artery disease
Authors: Bossard Matthias , Gao Peggy , Boden William , Steg Gabriel , Tanguay Jean-Francois , Joyner Cam , Granger Christopher B , Kastrati Adnan , Faxon David , Budaj Andrzej , Pais Prem , Di Pasquale Giuseppe , Valentin Vicent , Flather Marcus , Moccetti Tiziano , Yusuf Salim , Mehta Shamir R 
Published: January 2021

ObjectiveApproximately 10% of patients with myocardial infarction (MI) have no obstructive coronary artery disease. The prognosis and role of intensified antiplatelet therapy in those patients were evaluated.MethodsWe analysed data from the Clopidogrel and Aspirin Optimal Dose Usage to Reduce Recurrent Events–Seventh Organisation to Assess Strategies in Ischaemic Symptoms trial randomising patients with ACS referred for early intervention to receive either double-dose (600 mg, day 1; 150 mg, days 2–7; then 75 mg/day) or standard-dose (300 mg, day 1; then 75 mg/day) clopidogrel. Outcomes in patients with myocardial infarction with non-obstructive coronary arteries (MINOCA) versus those with obstructive coronary artery disease (CAD) and their relation to standard-dose versus double-dose clopidogrel were evaluated. The primary outcome was cardiovascular (CV) death, MI or stroke at 30 days.ResultsWe included 23 783 patients with MI and 1599 (6.7%) with MINOCA. Patients with MINOCA were younger, presented more frequently with non-ST-segment elevation MI and had fewer comorbidities. All-cause mortality (0.6% vs 2.3%, p=0.005), CV mortality (0.6% vs 2.2%, p=0.006), repeat MI (0.5% vs 2.3%, p=0.001) and major bleeding (0.6% vs 2.4%, p<0.0001) were lower among patients with MINOCA than among those with obstructive CAD. Among patients with MINOCA, 2.1% of patients in the double-dose clopidogrel group and 0.6% in the standard-dose group experienced a primary outcome (HR 3.57, 95% CI 1.31 to 9.76), whereas in those with obstructive CAD, rates were 4.3% and 4.7%, respectively (HR 0.91, 95% CI 0.80 to 1.03; p value for interaction=0.011).ConclusionsPatients with MINOCA are at lower risk of recurrent CV events compared with patients with MI with obstructive CAD. Compared with a standard clopidogrel-based dual antiplatelet therapy (DAPT) regimen, an intensified dosing strategy appears to offer no additional benefit with a signal of possible harm. Further randomised trials evaluating the effects of potent DAPT in patients with MINOCA are warranted.Trial registration numberNCT00335452.
Structural racism, racial inequities and urban–rural differences in infant mortality in the US
Authors: Vilda Dovile , Hardeman Rachel , Dyer Lauren , Theall Katherine P , Wallace Maeve 
Published: January 2021

BackgroundWhile evidence shows considerable geographic variations in county-level racial inequities in infant mortality, the role of structural racism across urban–rural lines remains unexplored. The objective of this study was to examine the associations between county-level structural racism (racial inequity in educational attainment, median household income and jail incarceration) and infant mortality and heterogeneity between urban and rural areas.MethodsUsing linked live birth/infant death data provided by the National Center for Health Statistics, we calculated overall and race-specific 2013–2017 5-year infant mortality rates (IMRs) per 1000 live births in every county. Racially stratified and area-stratified negative binomial regression models estimated IMR ratios and 95% CIs associated with structural racism indicators, adjusting for county-level confounders. Adjusted linear regression models estimated associations between structural racism indicators and the absolute and relative racial inequity in IMR.ResultsIn urban counties, structural racism indicators were associated with 7%–8% higher black IMR, and an overall structural racism score was associated with 9% greater black IMR; however, these findings became insignificant when adjusting for the region. In white population, structural racism indicators and the overall structural racism score were associated with a 6% decrease in urban white IMR. Both absolute and relative racial inequity in IMR were exacerbated in urban counties with greater levels of structural racism.ConclusionsOur findings highlight the complex relationship between structural racism and population health across urban–rural lines and suggest its contribution to the maintenance of health inequities in urban settings.
Do differences in work disability duration by interjurisdictional claim status vary by industry and jurisdictional context?
Authors: Macpherson Robert A , Koehoorn Mieke , Neis Barbara , McLeod Christopher B 
Published: January 2021

ObjectivesTo examine whether differences in work disability duration between out-of-province and within-province workers differed by industry and jurisdictional context.MethodsWorkers’ compensation data were used to identify comparable lost time, work-related injury and musculoskeletal disorder claims accepted in six Canadian jurisdictions between 2006 and 2015. Out-of-province workers were identified as workers who filed claims in a different provincial jurisdiction to their province of residence. Coarsened exact matching was used to match out-of-province workers with within-province workers based on observable characteristics. Quantile regression models were used to estimate differences in cumulative disability days paid between out-of-province workers and within-province workers at different percentiles in the disability distribution, adjusting for confounders.ResultsCompared with within-province workers, out-of-province workers were paid more disability days even after matching and adjusting on observable characteristics. Differences between the two groups of workers were observed for short-duration, medium-duration and long-duration claims (differences of 1.57, 6.39, 21.42, 46.43 days at the 25th, 50th, 75th and 90th percentiles, respectively). Industry-specific models showed that differences were largest in construction, transportation and warehousing, and mining, quarrying and oil and gas extraction. Jurisdiction-specific models showed that differences were largest in the western provinces where out-of-province workers were concentrated in those sectors.ConclusionsOut-of-province workers are a vulnerable group with respect to risk of longer work disability duration. Workers’ compensation systems, employers and healthcare providers may need to tailor specific interventions for these types of workers, particularly those employed in resource economy-dependent regions that are far from their regions of residence.
Performance and impact of disposable and reusable respirators for healthcare workers during pandemic respiratory disease: a rapid evidence review
Authors: Burton Christopher , Coles Briana , Adisesh Anil , Smith Simon , Toomey Elaine , Chan Xin Hui S , Ross Lawrence , Greenhalgh Trisha 
Published: January 2021

ObjectivesTo synthesise evidence concerning the range of filtering respirators suitable for patient care and guide the selection and use of different respirator types.DesignComparative analysis of international standards for respirators and rapid review of their performance and impact in healthcare.Data sourcesWebsites of international standards organisations, Medline and Embase, hand-searching of references and citations.Study selectionStudies of healthcare workers (including students) using disposable or reusable respirators with a range of designs. We examined respirator performance, clinician adherence and performance, comfort and impact, and perceptions of use.ResultsWe included standards from eight authorities across Europe, North and South America, Asia and Australasia and 39 research studies. There were four main findings. First, international standards for respirators apply across workplace settings and are broadly comparable across jurisdictions. Second, effective and safe respirator use depends on proper fitting and fit testing. Third, all respirator types carry a burden to the user of discomfort and interference with communication which may limit their safe use over long periods; studies suggest that they have little impact on specific clinical skills in the short term but there is limited evidence on the impact of prolonged wearing. Finally, some clinical activities, particularly chest compressions, reduce the performance of filtering facepiece respirators.ConclusionA wide range of respirator types and models is available for use in patient care during respiratory pandemics. Careful consideration of performance and impact of respirators is needed to maximise protection of healthcare workers and minimise disruption to care.
Comparison of left ventricular rotational mechanics between term and extremely premature infants over the first week of age
Authors: Smith Aisling , Bussmann Neidin , Levy Phillip , Franklin Orla , McCallion Naomi , EL-Khuffash Afif 
Published: January 2021

ObjectiveLeft ventricle (LV) rotational mechanics is an emerging tool to characterise LV function, but warrants further evaluation in neonates. The aim of this study was to compare LV rotational mechanics between term and extremely preterm babies over the first week of age.MethodsIn this prospective study, we serially assessed LV rotational parameters in 50 term infants and compared them with a historical dataset of 50 preterm infants born <29 weeks gestation. LV basal and apical rotation, LV twist, LV twist/untwist rate and torsion were derived using two-dimensional speckle tracking echocardiography at three time points over the first week of age.ResultsThere was no change in LV twist, LV torsion, basal rotation or apical rotation in term infants over the study period (all p>0.05). LV twist and torsion were higher in preterm infants, and increased over time. In preterm infants, basal rotation evolved from anticlockwise to clockwise rotation. Apical rotation remained anticlockwise in both groups (all p>0.05). LV twist rate (LVTR) and untwist rate was higher in preterm infants and increased over the three time points (all p>0.05). There was a strong positive correlation between LV torsion and LV untwist rate (LVUTR) in the entire cohort during the third scan.ConclusionTerm infants exhibit minimal LV twist which remains unchanged over the first week of age. This is in contrast to premature infants who demonstrate increasing indices of twist, torsion, LVTR and LVUTR over the first week, likely as a compensatory mechanism for reduced LV compliance.
Sex disparities in the presentation, management and outcomes of patients with acute coronary syndrome: insights from the ACS QUIK trial
Authors: Khraishah Haitham , Alahmad Barrak , Alfaddagh Abdulhamied , Jeong Sun Young , Mathenge Njambi , Kassab Mohamad Bassam , Kolte Dhaval , Michos Erin D , Albaghdadi Mazen 
Published: January 2021

AimsOur aim was to explore sex differences and inequalities in terms of medical management and cardiovascular disease (CVD) outcomes in a low/middle-income country (LMIC), where reports are scarce.MethodsWe examined sex differences in presentation, management and clinical outcomes in 21 374 patients presenting with acute coronary syndrome (ACS) in Kerala, India enrolled in the Acute Coronary Syndrome Quality Improvement in Kerala trial. The main outcomes were the rates of in-hospital and 30-day major adverse cardiovascular events (MACEs) defined as composite of death, reinfarction, stroke and major bleeding. We fitted log Poisson multivariate random effects models to obtain the relative risks comparing women with men, and adjusted for clustering by centre and for age, CVD risk factors and cardiac presentation.ResultsA total of 5191 (24.3%) patients were women. Compared with men, women presenting with ACS were older (65±12 vs 58±12 years; p<0.001), more likely to have hypertension and diabetes. They also had longer symptom onset to hospital presentation time (median, 300 vs 238 min; p<0.001) and were less likely to receive primary percutaneous coronary intervention for ST-elevation myocardial infarction (45.9% vs 49.8% of men, p<0.001). After adjustment, women were more likely to experience in-hospital (adjusted relative risk (RR)=1.53; 95% CI 1.32 to 1.77; p<0.001) and 30-day MACE (adjusted RR=1.39; 95% CI 1.23 to 1.57, p<0.001).ConclusionWomen presenting with ACS in Kerala, India had greater burden of CVD risk factors, including hypertension and diabetes mellitus, longer delays in presentation, and were less likely to receive guideline-directed management. Women also had worse in-hospital and 30-day outcomes. Further efforts are needed to understand and reduce cardiovascular care disparities between men and women in LMICs.
Planning virtual residency interviews as a result of COVID-19: insight from residency applicants and physicians conducting interviews
Authors: Shreffler Jacob , Platt Melissa , Thé Selena , Huecker Martin 
Published: January 2021

AbstractBackgroundIn response to the COVID-19 pandemic, the 2020–2021 residency interview process will undergo significant changes. Residency programme stakeholders would benefit from knowledge on what students and physicians expect from this process.ObjectiveThe purpose of the study was to describe and contrast the perspectives of student applicants and interviewing physicians related to the residency programme virtual interview process.MethodsA survey consisting of 24 Likert statements was administered across listservs in summer 2020 to physicians (attendings and residents who interview medical students). Medical students also received an anonymous survey and were recruited via email to participate.ResultsA total of 155 individuals (104 fourth-year medical students and 51 physicians) completed a survey. Results showed students would prefer in-person interviews over virtual. Residency applicants had high agreement on the limited ability to fully assess the programme and city due to virtual interviews. Individuals with lower step 1 scores had higher agreement on preferring in-person interviews. Individuals in the lowest and highest scoring groups appear more worried about the representation of themselves as a result of virtual interviews. Furthermore, applicants feel that more weight will be placed on steps 1 and 2 scores and class ranks, and they may not be able to fully demonstrate their personality compared with interviewers.ConclusionThe result of COVID-19 has created challenges and subsequent reshuffling of medical education requiring careful preparation and planning. This study provides insight for residency programmes to better understand the applicants' expectations for the 2020–2021 residency interview and matching process.
Service reconfiguration in the department of hand surgery during the UK COVID-19 lockdown: Birmingham experience
Authors: Picardo Natasha Emma , Walker Harriet , Vanat Qureish , Nizar Bafiq , Madura Tomas , Jose Rajive 
Published: January 2021

ABSTRACTIn early 2020, the COVID-19 pandemic swept through the UK and had a major impact on healthcare services. The Birmingham hand centre, one of the largest hand trauma units in the country, underwent a dramatic service reconfiguration to enable robust and safe provision of care that would withstand the peak of the pandemic. Streamlining our service significantly reduced patient footfall and hospital admission while preventing intra-hospital viral transmission. Many of the changes implemented have been kept as permanent adjustments to our practice as this new model of care yields higher patient satisfaction and efficacy to withstand the pressures of further peaks in the pandemic.