Downhill skiing injuries: associated factors and prevention strategies

Abstract

Downhill skiing is a unique sport with respect to its technique and equipment. A variety of injuries have been reported, which include tears of the anterior cruciate and medial collateral ligaments of the knee, tear of the ulnar collateral ligament of the metacarpo-phalangeal joint of the thumb, ankle sprain, fracture of the lower leg, soft tissue injury of the shoulder, tear of the medial meniscus of the knee, muscle strains, and lumbar spine strain. The findings from research into factors associated with injury are often equivocal. The main findings reported include: beginner–intermediate level of skiing ability, between one and four days of skiing, between two and three hours of skiing on the day of injury, fine weather, slow speed of skiing, slopes classified as 'easy', lack of professional instruction, and failure of bindings to release prior to injury. Further research into pre-season training and pre-skiing warm-up is required. General injury prevention recommendations have been made, however, thorough injury prevention strategies are yet to be developed. Recommendations include: equipment modifications, skiing specific pre-season training and pre-skiing warm-up with attention to a wide variety of body areas, professional instruction, and current information regarding risk factors and injury prevention to be made available to appropriate health professionals and the skiing public.     

Key determinants of AIDS impact in Southern sub-Saharan Africa

To investigate why Southern sub-Saharan Africa is more severely impacted by HIV and AIDS than other parts of sub-Saharan Africa, I conducted a review of the literature that assessed viral, host and transmission (societal) factors. This narrative review evaluates: 1) viral factors, in particular the aggregation of subtype-C HIV infections in Southern sub-Saharan Africa; 2) host factors, including unique behaviour patterns, concomitant high prevalence of sexually transmitted diseases, circumcision patterns, average age at first marriage and immunogenetic determinants; and, 3) transmission and societal factors, including levels of poverty, degrees of literacy, migrations of people, extent of political corruption, and the usage of contaminated injecting needles in community settings. HIV prevalence data and published indices on wealth, fertility, and governmental corruption were correlated using statistical software. The high prevalence of HIV in Southern sub-Saharan Africa is not explained by the unusual prevalence of subtype-C HIV infection. Many host factors contribute to HIV prevalence, including frequency of genital ulcerating sexually transmitted infections, absence of circumcision (compiled odds ratios suggest a protective effect of between 40% and 60% from circumcision), and immunogenetic loci, but no factor alone explains the high prevalence of HIV in the region. Among transmission and societal factors, the wealthiest, most literate and most educated, but also the most income-disparate, nations of sub-Saharan Africa show the highest HIV prevalence. HIV prevalence is also highest within societies experiencing significant migration and conflict as well as in those with government systems experiencing a high degree of corruption. The interactions between poverty and HIV transmission are complex. Epidemiologic studies currently do not suggest a strong role for the community usage of contaminated injecting needles. Areas meriting additional study include clade type, host immunogenetic determinants, the complex interrelationship of HIV with poverty, and the community usage of contaminated injecting needles.     

School-Based Prevention Efforts Addressing the Sociocultural Risk Factors of Eating Disorders

Today's young people are surrounded by sociocultural messages that promote thinness and create high levels of body dissatisfaction. Children and adolescents consequently develop disordered eating behaviors and experience detrimental effects to their development in physical, social-emotional, and academic arenas. Given the many barriers to the effective treatment of full-blown eating disorders, there is currently a push towards administering early prevention efforts within schools. In particular, school mental health programs can work with school staff to create a supportive environment to encourage higher levels of body satisfaction, counter negative sociocultural messages, and help to prevent the development of eating disorders. This article will explore and define the relationship between sociocultural risk factors and the prevalence of eating disorders, supply a rationale for addressing eating disorders within school-based mental health programs, provide a brief review and analysis of some important prevention programs within schools, and suggest recommendations for further research and school-based program development.     

FRAX underestimates fracture risk in patients with diabetes

The study objective was to determine whether diabetes is a risk factor for incident hip or major osteoporotic fractures independent of the WHO fracture risk assessment tool (FRAX). Men and women with diabetes (n = 3518) and nondiabetics (n = 36,085) aged ≥50 years at the time of bone mineral density (BMD) testing (1990 to 2007) were identified in a large clinical database from Manitoba, Canada. FRAX probabilities were calculated, and fracture outcomes to 2008 were established via linkage with a population-based data repository. Multivariable Cox proportional hazards models were used to determine if diabetes was associated with incident hip fractures or major osteoporotic fractures after controlling for FRAX risk factors. Mean 10-year probabilities of fracture were similar between groups for major fractures (diabetic 11.1 ± 7.2 versus nondiabetic 10.9 ± 7.3, p = 0.116) and hip fractures (diabetic 2.9 ± 4.4 versus nondiabetic 2.8 ± 4.4, p = 0.400). Diabetes was a significant predictor of subsequent major osteoporotic fracture (hazard ratio [HR] = 1.61, 95% confidence interval [CI] 1.42-1.83) after controlling for age, sex, medication use, and FRAX risk factors including BMD. Similar results were seen after adjusting for FRAX probability directly (HR = 1.59, 95% CI 1.40-1.79). Diabetes was also associated with significantly higher risk for hip fractures (p < 0.001). Higher mortality from diabetes attenuated but did not eliminate the excess fracture risk. FRAX underestimated observed major osteoporotic and hip fracture risk in diabetics (adjusted for competing mortality) but demonstrated good concordance with observed fractures for nondiabetics. We conclude that diabetes confers an increased risk of fracture that is independent of FRAX derived with BMD. This suggests that diabetes might be considered for inclusion in future iterations of FRAX.     

Manual Therapy in Children

Abstract

It has been proposed that patients with low back-related leg pain can be classified according to pain mechanisms into four distinct subgroups: Central Sensitization (CS), Denervation (D), Peripheral Nerve Sensitization (PNS), and Musculoskeletal (M). The purpose of this study was to determine whether there were any differences in terms of disability and psychosocial factors between these four subgroups. Forty-five subjects with low back-related leg pain completed the Oswestry Disability Index, the Hospital Anxiety and Depression Scale, and the Fear Avoidance Beliefs Questionnaire. Subsequently, an examiner blinded to the questionnaire results classified the subjects into one of the four subgroups, according to the findings of the self-administered Leeds Assessment of Neuropathic Signs and Symptoms questionnaire and a physical examination. It was found that the PNS subgroup had significantly greater disability compared to all other subgroups and significantly greater fear avoidance beliefs about physical activity compared to the CS and D subgroups. This highlights the importance of sub-classification but also the need to take into account disability and psychosocial factors in the management of low back-related leg pain.     

Bioactive functionalized polymer of malic acid for bone repair and muscle regeneration

A bioactive poly(β-hydroxyalkanoate) derived from malic acid was prepared and tested on bone repair and muscle regeneration. This functionalized and hydrolyzable polymer was obtained after several steps, the first one being the anionic copolymerization of three malolactonic acid esters. Chemical modifications were carried out on the terpolymer to turn benzyl-protecting groups into carboxyl groups and allyl groups into sulfonate groups. The resulting polymer bore carboxylate, sulfonate, and sec-butyl pendent groups in 65/25/10 molar proportions and were aimed at interacting with heparan binding growth factors. This polymer did not present any toxic effect in cell viability of HepG₂ cells, over a large range of concentrations (0.01-0.25 mg l^-1). Its ability to improve wound healing was tested in vivo and positive results are reported. Furthermore, the bioactivity of this polymer was evaluated using the regeneration model of Extensor digitorum longus (EDL) rat muscle. The study displayed a significant increase in the muscle regeneration and maturation.     

A Case-Control Assessment of Risk Factors for Gallbladder Carcinoma

Gallbladder carcinoma is an uncommon, but highlyfatal disease. Its symptoms frequently mirror those ofgallstone disease, and in most instances, diagnosis isan incidental finding at surgery. While risk factors have been suggested for this cancer,many may in reality simply be a consequence of the olderage of the population. This study is one of the few toapproach this question by using a case-control study design comparing gallbladder carcinomapatients with a gallstone population, coupled withmultivariate analysis to determine age-independent riskfactors. Univariate analyses showed gallbladdercarcinoma patients to be older than gallstone patientsand to have many age-associated diseases. Followingmultiple regression adjustment for age, this disease wasassociated with female gender and with a previous history of gallstone symptoms. Carcinomapatients were less likely to have cholesterol gallstonesin their gallbladders at surgery. A previous history ofsmoking was a substantial risk but of borderline statistical significance. Previous studiesreport associations that may be due to the older age ofthe gallbladder carcinoma patient. Our results show thatafter adjusting for age with multivariate analysis, gallbladder cancer subjects were predominantlyfemale, more likely to report previous gallstonesymptomology, and to smoke. While gallstones were notuniversally isolated from carcinoma patients atcholecystectomy, when present, they were less frequentlyclassified as cholesterol gallstones based on visualinspection. Further cohort studies which target thesepopulations will allow us to gain a more solid consensus on the risk factors for this disease.     

老年性肺部真菌感染60例临床分析

【目的】探讨老年人肺部真菌感染的相关因素。【方法】对我们收治的60例老年性肺部真菌感染患者的资料进行回顾分析,寻找其感染菌群的病原体及可能与真菌感染相关的因素。【结果】老年性肺部真菌感染主要菌群为白色念珠茵,其发生可能与下列因素密切相关：基础疾病、抗生素的应用、低蛋白血症、糖皮质激素的应用。【结论】老年性肺部真菌感染主要茵群为白色念珠菌,基础疾病、抗生素的应用、低蛋白血症、糖皮质激素的应用可能是肺部真菌感染的相关危险因素,而中医药在治疗该病方面有独特的优势：