A conceptual model and detailed framework for stress-related,strain-related,and overuse athletic injury

A multitude of athletic injuries occur when the various tissues that make up the human body experience stresses and strains that exceed their material strength. The precise amount of stress and strain that any given tissue can withstand is determined by the mechanical properties and resultant strength of that particular tissue. These mechanical properties are directly determined by an individual’s physiology and acute regulation of these properties. A number of theoretical frameworks for athletic injury occurrence have been proposed, however, a detailed conceptual framework for injury aetiology that considers the interplay between the physiological and mechanical factors and outlines the causal pathways to tissue damage and injury is needed. This will guide injury research towards a more thorough investigation of causal mechanisms and understanding of risk factors. Further, it is important to take into account the considerable differences in loading patterns which can result in varying injury outcomes such as acute stress-related, strain-related, or overuse injury. Within this article a simplified conceptual model of athletic injury is proposed along with a detailed, evidence-informed, conceptual framework for athletic injury aetiology that focuses on stress-related, strain-related, and overuse injury.     

Help me fix: The provision of injection assistance at an unsanctioned overdose prevention site in Toronto,Canada

BackgroundThere is an acute public health crisis from opioid-related poisoning and overdose in Canada. The Moss Park Overdose Prevention Site (MP-OPS) - an unsanctioned overdose prevention site - opened in a downtown park in Toronto in August 2017, when no other supervised consumption services existed in the province. As an unsanctioned site, MP-OPS was not constrained by federal rules prohibiting assisted injection, and provided a unique opportunity to examine assisted injection within a supervised setting. Our objective was to examine the association between assisted injection and overdose, and whether any association between assisted injection and overdose differs according to gender.MethodsDrawing on data from 5657 visits to MP-OPS from October 2017 to March 2018, we used multivariable logistic regression to investigate the relationship between assisted injection and overdose. To examine the influence of gender on this relationship, we further conducted stratified analyses by gender.ResultsAmong 5657 visits to MP-OPS, 471 (8.3%) received assisted injection, of which 242 (51.4%) were received by women and 226 (48.0%) by men. Using multivariable logistic regression, assisted injection was not associated with overdose in the overall sample (adjusted odds ratio [aOR]1.58, 95% confidence interval [CI]: 0.94, 2.67). In gender-stratified models, women receiving assisted injection were more than twice as likely (aOR 2.23, 95% CI: 1.17, 4.27) to experience overdose than women who did not receive assisted injection, and no association between assisted injection and overdose was found among men.ConclusionFindings that women receiving assisted injecting are at higher odds of overdose within the supervised setting of the MP-OPS are consistent with previous literature on assisted injection in community settings. Rules banning assisted injection in supervised consumption services may be putting a group of people, particularly women and those injecting fentanyl, at higher risk of health harms by denying them access to a supervised space where prompt overdose response is available.     

Correlates of cigarette and alternative tobacco product use among young tobacco users experiencing homelessness

IntroductionMost young people experiencing homelessness smoke cigarettes, but little is known about use of alternative tobacco products (ATPs) such as e-cigarettes or other electronic nicotine delivery systems (ENDS) and little cigars/cigarillos (LCCs). This study examines past month use and correlates of cigarettes and ATP among young tobacco users experiencing homelessness.MethodsWe surveyed a probability sample of N = 469 unaccompanied homeless 13–25 year olds (mean age = 22; 71% male), who reported past month use of any type of tobacco product, from 25 service and street sites in Los Angeles County.ResultsNearly all (90%) participants reported smoking regular cigarettes, and 78% reported using at least one tobacco product other than regular cigarettes. The most commonly used of these other products was natural cigarettes (55%), followed by LCCs (43%), ENDS (34%), cigars (31%), hookah (14%), chewing tobacco (7%), and snus (5%). Multivariable models indicated that correlates of past month use differed by product, but included sociodemographic characteristics, homelessness severity, depression, exposure to other people who used the product, and product perceptions (e.g., relative access, cost, and harm compared to cigarettes).ConclusionUse of cigarettes and ATPs are both widespread among young homeless tobacco users, suggesting that efforts to reduce tobacco use in this population should have a broad focus that includes a variety of products. The effectiveness of these efforts may be enhanced by addressing their considerable exposure to other tobacco users, as well as their perceptions of certain products as being less harmful or more cost-effective options than regular cigarettes.     

Perceived mechanisms of change in therapeutic yoga targeting psychological distress

IntroductionThis study was designed to investigate yoga teachers' and yoga therapists’ perceptions of the ways yoga is applied to treat symptoms of psychological distress, and identify the defining features, main components, and mechanisms of change in therapeutic practice.MethodsA qualitative design was employed. Six yoga teachers who had specific training and experience in teaching therapeutic yoga or practicing ‘yoga therapy’ took part in one-to-one interviews during which they gave accounts of their experiences of helping people cope with psychological distress through yoga. Participants' interviews were transcribed verbatim and were analysed using an integrative inductive-deductive thematic analysis.ResultsFour key themes were identified in relation to the benefits of therapeutic yoga: Awareness, Choice, Relationships, and Tailoring.ConclusionsThe findings support previous research which suggests that individualised yoga therapy is a promising intervention, and may help to form a theoretical rationale for the future treatment of psychological distress with yoga.     

Immunizations at Wisconsin Pharmacies: Results of a statewide vaccine registry analysis and pharmacist survey

BackgroundThere is currently limited data in the United States on the proportion of immunization doses given at pharmacies outside the influenza vaccine. This study aims to obtain baseline information on the percentage of vaccine doses administered at pharmacies in Wisconsin and to understand the immunization barriers for Wisconsin pharmacists, to inform interventions to increase immunization access at pharmacies.MethodsAggregated data from the Wisconsin Immunization Registry (WIR) was obtained for all vaccines administered at pharmacies to patients over the age of six from July 2017 through June 2018. In addition, a survey on attitudes towards and barriers to vaccination was sent to 2000 Wisconsin pharmacists with 236 respondents yielding a 12% response rate.ResultsWIR data demonstrates that zoster and influenza vaccines have the highest proportion of doses administered at pharmacies (39% and 20%, respectively). Human papillomavirus (HPV) vaccines have the lowest proportion of doses at 0.2%. Pharmacy survey shows that 86% provide immunizations. Most stock influenza vaccines (84%), whereas much fewer stock HPV vaccines (21%). The greatest immunization barriers for the pharmacy respondents include billing and reimbursement challenges and competing demands for staff.ConclusionsDespite the barriers, community pharmacies have significant potential to address vaccination gaps. Physicians, patients, and legislative bodies are generally well-accepting of pharmacists as immunizers. Pharmacists, in order to be fully utilized as immunizers, must engage in active communication with patients and be willing to collaborate with physicians. Legislative policy and health insurance reimbursement reforms are also necessary to facilitate further pharmacist participation in immunization.