The impact of 3D virtual reality radiography practice on student performance in clinical practice

IntroductionSimulation-based learning plays an integral role in preparing students for clinical practice. This study investigated the impact of immersive three-dimensional (3D) virtual reality (VR) simulation-based learning on first-year radiography students’ performance in the clinical setting.MethodsA retrospective analysis of first-year radiography clinical assessments was carried out to compare performance pre-and post-introduction of VR. The stage one cohort with no VR education was considered the control group (n = 93). The VR group (n = 98) had seven hours of practice in the immersive VR suite (Virtual Medical Coaching). Experienced clinical tutors assessed first-year students performing an extremity radiographic examination in the clinical setting. Assessment criteria were ranked on a 5-point Likert scale from poor to excellent. Mann Whitney U Tests were applied to compare performance across cohorts.ResultsStudents trained with VR performed better across 20 of the 22 assessment criteria. VR-trained students performed significantly better (more ranked as ‘very good’ or ‘excellent’) than the control group in the following criteria; positioning patients for X-rays (19% difference) (U = 3525, z = ?2.66, p < 0.05), selecting exposure factors (12% difference) (U = 3680, z = ?3.13, p < 0.05), image appraisal of patient positioning (27% difference) (U = 3448, z = ?2.9, p < 0.05) and image appraisal of image quality (18% difference) (U = 3514, z = ?2.6, p < 0.05). Their comprehension of clinical indications, equipment set up and explanation of the procedure was also significantly better (p < 0.05).ConclusionThis is the first study to investigate the translation of VR learning into radiography clinical practice. VR learning had a positive impact on the performance of first-year students in their clinical assessment, especially with respect to patient positioning, exposure parameter selection and image appraisal.Implications for practiceVR is a valuable educational tool in preparing novice radiography students for clinical practice. It is particularly useful to enhance student knowledge in the areas of patient positioning, exposure factor selection and radiographic image appraisal.     

Drug-related deaths between 2002 and 2013 with accent to methadone and benzodiazepines

AimThe aim of the study is to assess the trends of overdose and drug related fatalities in the Republic of Macedonia during the 11 years.Material and methodsCross-sectional retrospective survey and reviewed of postmortem toxicological analyses which examined fatal poisonings with illegal drugs in years 2002–2013. Information about gender, age, drug consumption, reported years were analyzed. Narcotics were confirmed with toxicological semi quantitative fluorescence polarization immunoassay (FPIA) in urine (range 250–4000 ng/ml).ResultsTotal of 165 deaths were observed. Out of them 145 (87.9%) were male. There is statistical significant differences between male and female DRD due to age (Mann–Whitney U Test = 925, Z = −2626, p = 0.0087). For p < 0.05 there is significant differences between genders due to cause of overdose (Pearson Chi-square = 9743, df = 4, p = 0.0449). DRD among male were mainly because of overdose due to heroin in 80 (51.17%) cases followed by DRD due to combination of methadone and BZD in 25 (11.72%) cases. Out of all DRD cases 50 (30.3%) are related to polydrug use. For p < 0.01 there is a significant differences between analyzed age groups due to cause of overdose (Pearson Chi-square = 33,886, df = 12, p = 0.0007).ConclusionsDeath cause analysis reveals the difficulties in determining the role of substitution drugs, as many other factors may be involved. The findings also highlight the importance of further enhancing treatment interventions for benzodiazepine misuse among patients on methadone substitution treatment.     

Can deaths in police cells be prevented? Experience from Norway and death rates in other countries

PurposeTo describe the changes in death rates and causes of deaths in Norwegian police cells during the last 2 decades. To review reports on death rates in police cells that have been published in medical journals and elsewhere, and discuss the difficulties of comparing death rates between countries.MethodsData on deaths in Norwegian police cells were collected retrospectively in 2002 and 2012 for two time periods: 1993–2001 (period 1) and 2003–2012 (period 2). Several databases were searched to find reports on deaths in police cells from as many countries as possible.ResultsThe death rates in Norwegian police cells reduced significantly from 0.83 deaths per year per million inhabitants (DYM) in period 1 to 0.22 DYM in period 2 (p < 0.05). The most common cause of death in period 1 was alcohol intoxication including intracranial bleeding in persons with high blood alcohol levels, and the number declined from 16 persons in period 1 to 1 person in period 2 (p = 0.032). The median death rate in the surveyed Western countries was 0.44 DYM (range: 0.14–1.46 DYM).ConclusionThe number of deaths in Norwegian police cells reduced by about 75% over a period of approximately 10 years. This is probably mainly due to individuals with severe alcohol intoxication no longer being placed in police cells. However, there remain large methodology difficulties in comparing deaths rates between countries.     

The relationship between positional asphyxia and increasing body mass index

Review of the files of the Pathology section of Forensic Science SA over 17 yrs (January 2003-December 2019) revealed 32 adult cases of positional asphyxia (age range 18–87 years; average 49 years – m:f ratio 3:1). Predisposing/causative conditions were accidents, N = 8, alcohol intoxication N = 7, neurological disease N = 7, drug intoxication N = 5, morbid obesity N = 2, combinations of factors N = 2, and a single homicide N = 1. There was one case with below normal weight (BMI 17.9), with 6 cases having normal weights (BMI range 18.9–24.6, average 22.3), 9 being overweight (BMI range 25.3–29.5, average 27.9), and 16 being obese (BMI range 30–66.2, average 40.9). Only 7 cases (22%) had either under/normal weight compared to 25 (78%) who were overweight/obese (p < 0.05). Increasing body mass appears to be a risk factor to be considered in all forms of positional asphyxia; BMI should, therefore, be routinely taken into account in the forensic evaluation of such cases.     

Characteristics of methadone-related fatalities in Norway

There are currently over 7000 patients enrolled in opioid maintenance treatment (OMT) programs in Norway. A rise in methadone-related deaths proportional to increasing methadone sales over the period 2000–2006 has been observed, but the causative factors for these fatalities have been elusive. In the present study, individual characteristics, methadone concentrations and additional toxicological findings were analyzed. Methadone intoxication deaths (n = 264) were divided into 3 groups according to toxicological findings in whole blood: group 1 – methadone detected alone, or together with one additional drug at low or therapeutic levels, or a low concentration of ethanol (<1 g/L) (n = 21); group 2 – multiple additional drugs/substances detected below lethal levels (n = 175); group 3 – one or more additional drugs/substances detected at lethal levels, or ethanol >3 g/L (n = 55). Methadone blood concentrations in decedents who had been enrolled in OMT were higher than for decedents not in treatment, in all groups. Blood methadone concentrations around 1 mg/L were present in fatal multi-drug intoxications in OMT patients. Results suggest that some patients may be at risk of dying when combining therapeutic concentrations of methadone with other psychoactive substances. Somatic disease was a common finding among deceased OMT patients. Concentrations in methadone users not enrolled in OMT were predominantly between 0.3 and 0.4 mg/L and were not related to the presence of other drugs. However, methadone concentrations below 0.1 mg/L may be associated with intoxication following methadone use, both alone and in combination with other drugs. Younger male users (mean age 34 years) seemed to have a higher susceptibility to methadone intoxication.     

Effects of assistive insole feedback training on immediate and multi-day partial weight bearing retention during walking: A pilot study

BackgroundAdherence to partial weight bearing (PWB) plays a crucial role in early rehabilitation and motor control. Dynamic biofeedback insole systems provide a supportive function on immediate PWB adherence, while important long-term retention effects and potential advantages to a conventional static training remain unknown.Research questionIs acoustic insole feedback training effective for the retention of prescribed PWB adherence and is there any advantage relative to static training using a conventional bathroom scale? Methods Twenty-four volunteers were randomized into two groups receiving biofeedback training (N = 12) via a mobile insole system (Loadsol®) or conventional training using a bathroom scale (N = 12). After initial PWB training (20 kg) of one randomized leg, the immediate and one-week retention effects were analysed using mean and maximum load (N) and overload rate (%). Statistical analysis was performed using a two-way repeated measures ANOVA with post-hoc pairwise comparisons (p < 0.05).ResultsA significantly (p < 0.001) improved immediate and long-term PWB adherence was found for the insole feedback group during walking. A significant (p < 0.001) reduction of the overload rate by 86% was found for the insole feedback group when compared to the conventional training group after one week. Significant (p < 0.01) reductions by 51% and 46% was also found for the mean and maximum load in the insole feedback group when compared to the conventional training group.SignificanceThe use of insole feedback systems can serve as a viable tool to become familiar with PWB and to provide optimal retention of specified loads. Therefore, such systems serve as an advantageous training intervention to maintain a prescribed PWB during locomotion.     

A structured accelerated versus control rehabilitation pathway after anterior cruciate ligament reconstruction using autologous hamstrings demonstrates earlier improvement in physical outcomes without increasing graft laxity: A randomized controlled trial

ObjectivesTo investigate whether an accelerated rehabilitation pathway could enhance strength and functional symmetry after ACLR, without affecting laxity.DesignRandomized Controlled Trial.SettingPrivate rehabilitation clinic.Participants44 patients randomized to an ‘Accelerated’ (n = 22) or ‘Control’ (n = 22) rehabilitation intervention.Main outcome measuresGraft laxity (primary outcome), isokinetic knee extensor and flexor strength, hop tests, surveys, sport participation, re-injuries and re-operations.ResultsNo knee laxity differences (p > 0.05) were observed. A significantly greater (p = 0.006) percentage of Accelerated (77.3%) versus Control (59.1%) patients were participating in Level 1 or 2 pivoting sports at 12 months. Greater limb symmetry indices were observed in the Accelerated group for knee extensor strength at 6 (p < 0.0001), 12 (p = 0.010) and 24 (p = 0.005) months, as well as the triple hop at 6 (p = 0.015) and 9 (p = 0.008) months, and the triple crossover hop at 6 (p < 0.0001) and 9 (p = 0.009) months. One ipsilateral re-tear was observed (Control group, 17 months). No differences (p˃0.05) existed in surveys apart from the Anterior Cruciate Ligament Return to Sport after Injury (ACL-RSI) score, better (p = 0.001) in the Accelerated group at 12 months.ConclusionsAccelerated rehabilitation produced earlier improvement in strength and hop LSIs, without increasing graft laxity.     

Baseline global longitudinal strain by computed tomography is associated with post transcatheter aortic valve replacement outcomes

BackgroundsSubclinical myocardial dysfunction detected by global longitudinal strain (GLS) using echocardiography is associated with poor outcomes in patients with severe aortic stenosis (AS) despite normal left ventricular ejection fraction (LVEF). Computed tomography angiography derived GLS (CTA-GLS) has recently shown to be feasible, however the prognostic value remains unclear in severe AS patients treated with transcatheter aortic valve replacement (TAVR).MethodsWe analyzed consecutive patients who underwent TAVR with pre-TAVR retrospective gated acquisition CTA study with adequate image quality covering the entire left ventricle. CTA-GLS analysis was performed using 2D CT-Cardiac Performance Analysis prototype software (TomTec GmbH). Kaplan-Meier and Cox regression analyses were performed to evaluate the association of baseline CTA-GLS with all-cause mortality and a composite outcome of all-cause death and hospitalization for heart failure after TAVR.ResultsA total of 223 patients were included (mean age 83.5 ± 6.8 years, 45.7% female, mean CTA-LVEF 50.7 ± 14.5%). During a median follow-up of 32 months, 81 all-cause deaths and 134 composite outcomes occurred. When compared to patients with normal LVEF (≥50%) and preserved CTA-GLS (≤-20.5%), patients with normal LVEF but reduced CTA-GLS (>-20.5%) had higher all-cause mortality (Chi-square 6.89, p = 0.032) and the risk of composite outcome (Chi-square 7.80, p = 0.020) which was no different than those with impaired LVEF. Reduced CTA-GLS was independently associated with all-cause mortality (HR 1.71, 95% CI 1.01–2.90, p = 0.049) and the risk of composite outcome (HR 1.51, 95% CI 1.01–2.25, p = 0.044) on multivariable Cox regression analysis.ConclusionsReduced CTA-GLS provides independent prognostic value above multiple clinical and echocardiographic characteristics.     

Exploring correlations between the breast density of the women of Papua New Guinea and breast cancer risk factors

IntroductionPapua New Guinea (PNG), has experienced an increase in breast cancer incidence correlating to the westernisation of the country. Increased breast density is known to increase breast cancer risk. This study investigates if there are any factors unique to the women of PNG that may impact breast density and breast cancer risk.MethodA survey was undertaken of 1,161 women who had undergone mammographic imaging at the Pacific International Hospital (PIH). Results were correlated with the five Tabár mammographic parenchymal patterns (TP), recorded for each woman and geographical location, parity, breast size, occupation, marital and menstrual status, smoking and alcohol consumption, hormone replacement therapy (HRT), and exercise. Statistical analysis was undertaken using chi-square test, Fisher's exact test and Odds Ratio (OR).ResultsRelationships were identified between TP and parity (p < 0.001), marital status (p < 0.001), smoking (p < 0.001), alcohol intake (p = 0.029) and HRT (p = 0.029). There was no evidence of a relationship between pattern type and geographical location (p = 0.290), breast size (p = 0.592), occupation (p = 0.724), menstruation (p = 0.866) or exercise (p = 0.290). Married women, OR = 0.4004, CI 95% (0.2873–0.5579) and those with higher parity, OR 0.5034, CI 95% (0.3693–0.6862) were half as likely to have increased breast density reducing risk.ConclusionThere was no clear relationship across almost all data. Factors associated with increased breast density in PNG included parity, marital status, smoking, alcohol, and HRT use were evidenced in this snapshot of PNG women. Breast cancer risk was shown to be reduced for married women and those with increased parity.     

Right ventricular dysfunction by computed tomography associates with outcomes in severe aortic stenosis patients undergoing transcatheter aortic valve replacement

BackgroundAlthough cardiac computed tomography angiography (CCTA) assessment of right ventricular dysfunction (RVD) is feasible, the incremental prognostic value remains uncertain in patients undergoing transcatheter aortic valve replacement (TAVR) evaluation. This study sought to determine the incremental clinical utility of RVD identification by CCTA while accounting for clinical and echocardiographic parameters.MethodsPatients who underwent multiphasic ECG-gated functional CCTA using dual-source system for routine TAVR planning were evaluated. Biphasic contrast protocol injection allowed for biventricular contrast enhancement. CCTA-based RVD was defined as right ventricular ejection fraction (RVEF) ?< ?50%. The association of CCTA-RVD with all-cause mortality and the composite outcome of death or heart failure hospitalization after TAVR was evaluated and examined for its incremental utility beyond clinical risk assessment and echocardiographic parameters.ResultsA total of 502 patients were included (median [IQR] age, 82 [77 to 87] years; 56% men) with a median follow-up of 22 [16 to 32] months. Importantly, 126 (25%) patients were identified as having RVD by CCTA that was not identified by echocardiography. CCTA-defined RVD predicted death and the composite outcome in both univariate analyses (HR for mortality, 2.15; 95% CI, 1.44–3.22; p ?< ?0.001; HR for composite outcome, 2.11; 95% CI, 1.48–3.01; p ?< ?0.001) and in multivariate models that included clinical risk factors and echocardiographic findings (HR for mortality, 1.74; 95% CI, 1.11–2.74; p ?= ?0.02; HR for composite outcome, 1.63; 95% CI, 1.09–2.44; p ?= ?0.02).ConclusionsFunctional CCTA assessment pre-TAVR correctly identified 25% of patients with RVD that was not evident on 2D echocardiography. The presence of RVD on CCTA independently associates with clinical outcomes post-TAVR.     

Injury risk is greater in physically mature versus biologically younger male soccer players from academies in different countries

ObjectivesTo investigate if maturity status was associated with injury risk in male academy soccer players.DesignProspective cohort surveillance study.SettingProfessional soccer academies.Participants501 players (aged 9–23 years) from eight academies in England, Spain, Uruguay and Brazil.Main outcome measuresPlayers were grouped by maturity offset as pre-peak height velocity (PHV), circa-PHV, post-PHV or adult. Injury prevalence proportion (IPP) and days missed were recorded for one season per player, with training/match exposure recorded in a sub-sample (n = 166).ResultsIPP for all injuries combined increased with advancing maturity, with circa-PHV (p = 0.032), post-PHV (p < 0.001) and adult (p < 0.001) higher than pre-PHV. IPP was higher in post-PHV and adult than pre-PHV for non-contact (p = 0.001 and p = 0.012), soft-tissue (both p < 0.001), non-contact soft-tissue (p < 0.001 and p = 0.005), muscle (both p < 0.001), thigh (both p < 0.001), ankle (p = 0.035 and p = 0.007) and hamstring injuries (p = 0.041 and p = 0.017). Ligament/tendon IPP was greater in adult versus pre-PHV (p = 0.002). IPP for growth-related injuries was lower in post-PHV than pre-PHV (p = 0.039). Injury incidence rates (n = 166) exhibited similar patterns to IPP in the full cohort.ConclusionsInjury patterns were similar between post-PHV and adult academy players but, crucially, relatively more of these groups suffered injuries compared to pre- and circa-PHV (except growth-related injuries).     

Aortic valve calcification as a risk factor for major complications and reduced survival after transcatheter replacement

BackgroundAortic valve calcification is supposed to be a possible cause of embolic stroke or subclinical valve thrombosis after transcatheter aortic valve replacement (TAVR). We aimed to assess the role of aortic valve calcification in the occurrence of in-hospital clinical complications and survival after TAVR.MethodsWe retrospectively analyzed preoperative contrast-enhanced multidetector computed tomography scans of patients who underwent TAVR on the native aortic valve in our center. Calcium volume was calculated for each aortic cusp, above and below the aortic annulus. Outcomes were recorded according to VARC-2 criteria.ResultsOverall, 581 patients were included in the study (SapienXT = 192; Sapien3 = 228; CoreValve/EvolutR = 45; Engager = 5; Acurate = 111). Median survival was 4.98 years (interquartile range 4.41–5.54). Logistic regression identified calcium load beneath the right coronary cusp in left ventricular outflow tract (LVOT) as significantly associated with stroke (odds ratio [OR] 1.2; 95% confidence interval [CI] 1.03–1.3; p = 0.0019) and in-hospital mortality (OR 1.1; 95% CI 1.004–1.2; p = 0.04), whereas total calcium volume of the LVOT was associated with both in-hospital and 30 day-mortality (OR 1.2; 95% CI 1.01–1.4; p = 0.03, and OR 1.2; 95% CI 1.02–1.43; p = 0.029, respectively). Cox regression identified total calcium of LVOT (hazard ratio [HR] 1.18; 95% CI 1.02–1.38; p = 0.026), male sex (HR 1.88; 95% CI 1.06–3.32; p = 0.031), baseline creatinine clearance (HR 0.96; 95% CI 0.93–0.98; p < 0.001), and baseline severe aortic regurgitation (HR 7.48; 95% CI 2.76–20.26; p < 0.001) as risk factors associated with lower survival.ConclusionLVOT calcification is associated with increased risk of peri-procedural stroke and mortality as well as shorter long-term survival.     

Practices & attitudes towards recovery in elite Asian & UK adolescent athletes

ObjectivesAssess current practice and attitudes towards recovery in adolescent athletes.DesignQuestionnaires were administered either via print or online questionnaire.ParticipantsAthletes and coaches from within Asia were surveyed (n = 112 & 53), with a comparative sample in the UK (n = 53 & 8).Main outcome measuresThe approaches and attitudes to recovery in both training and competition.ResultsAdolescent athletes perceive a variety of recovery modalities as important, though prioritise active recovery, nutrition and sleep. Attitudes towards recovery differed between athletes in Asia and the UK with respect to the perceived benefits of: sleep (96% believe in it in the UK v 69% in Asia, p < 0.01); nutrition (92 v 58%, p < 0.01); and active recovery (70 v 52%, p = 0.03). The number of recovery techniques used with Asian athletes was higher after training (p = 0.009) and competition (p < 0.01). Asian athletes rely more on ‘feel’ to justify interventions.ConclusionsThere was a major disconnect amongst athletes’ belief in particular strategies and their behaviours. The results of this study show the need for educating coaches and athletes.     

Spatiotemporal gait variables and step-to-step variability in preschool-aged children born < 30 weeks’ gestation and at term in preferred speed,dual-task paradigm,and tandem walking

BackgroundChildren born very preterm (< 32 weeks’ gestation) are at greater risk of motor impairment and executive/attentional dysfunctions than term-born children; however, little is known about how functional tasks, including walking, may be affected by very preterm birth.Research questionHow does the gait pattern of preschool-age children born < 30 weeks compare with term-born controls under a variety of walking conditions?MethodsIn this prospective cohort study, children born < 30 weeks and at term were assessed at 4.5–5 years’ corrected age, blinded to birth group. Four walking conditions were assessed using the GAITRite® system: preferred speed, cognitive dual-task, motor dual-task, and tandem walking. Gait variables analysed included speed, cadence, step length, step time, base of support (BOS), and single and double support time. Spatiotemporal variables were compared between groups using linear regression, adjusting for lower-limb length, corrected age at assessment, and number of trials.Results224 children (112 < 30 weeks and 112 term-born) were assessed. Gait variables of children born < 30 weeks did not differ from their term-born peers when walking at their preferred speed, except for higher BOS variability (mean difference [MD] = 0.19 cm, 95% confidence interval [CI] 0.10, 0.27, p < 0.001). Under the motor dual-task condition, children born < 30 weeks walked faster (MD= 3.06 cm/s, 95% CI 0.14, 5.97, p = 0.040), with a longer step length (MD= 1.10 cm, 95%CI 0.19, 2.01, p = 0.018), and a wider BOS (MD= 0.37 cm, 95%CI 0.06, 0.67, p = 0.019). In cognitive dual-task and tandem conditions, children born < 30 weeks walked with a wider BOS compared with term-born peers (MD= 0.43 cm, 95%CI 0.05, 0.81, p = 0.028; and MD= 0.30 cm, 95%CI 0.09, 0.51, p = 0.005, respectively).SignificanceThis research highlights the need to consider the walking performance of preschool-age children born < 30 weeks under challenging conditions, such as dual-task or tandem walking, when assessing gait patterns and planning interventions.     

Ethanol as a single toxin in non-traumatic deaths – A toxicology perspective

There were 285 autopsy cases in 2010 where ethanol was the only toxin. To try to ascertain the toxicity of ethanol alone, those cases where clinical details stated ‘sudden death’, ‘collapsed’, ‘brought in dead to hospital’, ‘found dead at home’, ‘fell down stairs and dead at end of stairs’, ‘sudden death in alcoholic’ and ‘brought in dead and seizures’ were extracted. There were 55 males aged from 23 to 76 years and 17 females aged from 41 to 71 years who fulfilled these criteria. Blood ethanol ranged from <50 to 556 mg/dl. The median band in males is 200–249 mg/dl and the 31% of male cases are in the 200s mg/dl range, levels conventionally considered benign. The levels found in females were spread relatively evenly across the range 150–600 mg/dl. The urine/blood ethanol ratios ranged from 0.13 to 2.02. The blood/vitreous ratios in 10 cases ranged from 0.76 to 1.24 with a median value of 1.16. Calculated blood ethanol from vitreous levels showed a negative bias when compared to the measured value but not in all cases. This limits the role of calculated values in legal cases. The threshold for lethal alcohol toxicity is indistinct and likely to be lower than conventionally acknowledged.     

Association of psychosocial traits with coronary artery calcium development and progression: The Multi-Ethnic Study of Atherosclerosis

BackgroundCoronary artery calcium (CAC) is a well-established quantifiable risk factor for cardiovascular disease (CVD). We examined the association of anger, hostility, anxiety, and depression with the development and progression of CAC.MethodsWe studied the association of these psychosocial traits with CAC among participants in the Multi-Ethnic Study of Atherosclerosis (MESA). Anger was measured using the Spielberger Trait Anger questionnaire, hostility using a modified Cook-Medley Hostility questionnaire, anxiety using the Spielberger Trait Scale, and depression using the Center for Epidemiological Studies Depression Scale (CES-D). Among the subsample of participants with CAC = 0 at the beginning of the study period, Poisson regression models were used to determine the relative risk of developing CAC>0 over the study period. In the subsample that developed CAC>0, we used linear regression models to estimate the average increase in CAC associated with a unit increase in psychosocial trait.ResultsMedian time of follow-up was 9.4 years (range 8.0–11.4 years). Cross-sectional analyses at baseline revealed no association of any of the psychosocial traits with the presence or magnitude of CAC (anger: RR 0.98, p < 0.01; hostility: RR 1.01, p = 0.25; anxiety: RR 0.99, p < 0.01; depression: RR 0.99, p < 0.01 [not statistically significant after adjustment for covariates]). No association was detected between the traits and development of CAC (anger: RR 0.99, p = 0.23; hostility: RR 1.01, p = 0.68, anxiety: RR 1.00, p = 0.49; depression: RR 1.00, p = 0.51). We also found no association between any of the traits and progression of CAC (anger: beta ?3.21, p = 0.08; hostility: beta 2.28, p = 0.43; anxiety: 3.45, p = 0.02 [not statistically significant after adjustment for covariates]; depression: beta ?1.46, p = 0.11).ConclusionsWe found no association between anger, hostility, anxiety, or depression and CAC, suggesting these personality traits are not independent risk factors for CVD.     

Deep hip external rotator muscle size in ballet dancers compared to non-dancing athletes,and associations to pain

ObjectivesTo compare the deep hip external rotator (DHER) muscle (piriformis, gemelli, quadratus femoris (QF)) cross-sectional area (CSA) in dancers and athletes and evaluate the relationship between DHER size and hip pain.Study designCross-sectional study.SettingElite ballet and sport.Participants33 professional ballet dancers and 33 age and sex-matched athletes.Main outcome measuresCSAs of piriformis, gemelli and QF on magnetic resonance imaging (MRI). Hip pain scored with the Copenhagen Hip and Groin Outcome Score (HAGOS): Hip pain was categorised as ‘yes’ if HAGOS pain score was <100, ‘no’ if HAGOS pain was = 100.ResultsEstimated marginal mean CSA of piriformis, gemelli and QF muscles was similar in athletes and dancers (p > 0.05), and CSAs were not associated with hip pain. Male and female dancers had similar sized DHER muscles. In athletes, CSA of piriformis was 55% (p = 0.02, Cohen's d(95%CI) = 0.98 (0.26,1.71)) and the gemelli were 34% (p = 0.03, Cohen's d(95%CI) = 0.98 (0.26,1.70)) larger in men than women; QF was 36% larger (p = 0.08, Cohen's d(95%CI) = 0.77 (0.06,1.48)).ConclusionAlthough ballet dancers perform in external rotation, their DHER are no larger than athletes and muscle size was not associated with hip pain.     

Motor alterations in the kinetic chain in individuals with chronic shoulder pain

BackgroundShoulder pain may be related to biomechanical dysfunctions in the kinetic chain.ObjectiveTo compare the mobility and muscular endurance of thoracolumbar spine and hip, and the neuromuscular control of the lower extremity of individuals with and without shoulder pain and to determine the discriminative capacity between groups of these variables.DesignA cross-sectional study.MethodOne hundred and two individuals with and without shoulder pain were evaluated to range of motion (ROM) of the thoracolumbar spine and hips, the muscular endurance time of the thoracolumbar spine and hips muscles, and the neuromuscular control of the lower extremity, by the Star Excursion Balance Test (SEBT).ResultsIndividuals with shoulder pain presented lower ROM and muscular endurance time in all tests evaluated (p < 0.01–p = 0.03), greater perception of pain during all ROM and muscle endurance (p < 0.01–p = 0.04) evaluations, and less neuromuscular control of the lower extremity in the compound reach (p < 0.01–p = 0.01), anterior and posteromedial (p < 0.01–p = 0.04) directions of the SEBT on both sides. The anterior reach direction of the SEBT of the contralateral limb to the shoulder pain (AUC=0.80, cut-off point=47.7%) presented excellent capacity to discriminate individuals with shoulder pain, while the other variables showed between acceptable and small capacity (AUC=0.58–0.76).ConclusionIndividuals with chronic shoulder pain presented alterations in joint mobility, muscular endurance time of the thoracolumbar spine and hips and neuromuscular control of the lower extremity. The anterior reach of the SEBT of the contralateral limb showed excellent discriminative capacity.     

History of chronic disease is a novel intrinsic risk factor associated with gradual onset injuries in recreational road cyclists: A cross-sectional study in 21,824 cyclists - SAFER XIV

ObjectivesRisk factors related to Gradual onset injuries (GOIs) in cyclists need to be identified to enable effective injury prevention strategies. We aim to determine risk factors related to GOIs in cyclists participating in mass community-based events.DesignCross-sectional study.SettingCape Town Cycle Tour.ParticipantsRace entrants (n = 35,914)Main outcome measuresCompletion of pre-race medical questionnaires. 21,824 consenting cyclists (60.8%) were studied. 617 cyclists reported GOIs. Selected risk factors associated with GOIs: demographics, training/racing history, chronic disease history, and medication use, were explored using multi-variate analyses.ResultsPrevalence ratio (PR) of GOIs was similar in males and females, but higher in older age categories [>50 yrs vs. categories: ≤30yrs (PR = 1.6); 31 to ≤40yrs (PR = 1.5); 41 to <50yrs (PR = 1.4)] (p < 0.0001). Intrinsic risk factors associated with GOIs (adjusted for gender and age) were: 1) increased weekly training/racing frequency (PR = 1.1, p = 0.0003), 2) chronic disease history [cardiovascular disease symptoms (PR = 2.3, p = 0.0026), respiratory disease (PR = 1.6, p < 0.0001), nervous system/psychiatric disease (PR = 1.5, p = 0.0082)], and 3) history of analgesic/anti-inflammatory medication (AAIM) used before/during racing (PR = 5.1, p < 0.0001).ConclusionIncreased training frequency, chronic disease and AAIM use are risk factors associated with GOIs in cyclists. A novel finding is that in recreational cyclists, chronic disease history could be considered when managing GOIs and implementing prevention programs.