Evaluation of protective equipment for prevention of injuries in rugby union

BACKGROUND: Rugby union has a high rate of injury. The increased use of protective equipment may help mitigate these injuries. This study investigated the injury prevention effectiveness of the protective equipment used in rugby union. METHODS: A cohort of 304 rugby players in Dunedin, New Zealand was followed weekly during the 1993 club season to assess protective equipment use, participation in rugby, and injury outcomes. Generalized Poisson regression was used to model the rate of injury while adjusting for covariates such as level of competition, playing position, and injury history. RESULTS: The use of mouthguards appeared to lower the risk of orofacial injury [rate ratio (RR) = 0.56, 95% confidence interval (CI): 0.07-4.63], and padded headgear tended to prevent damage to the scalp and ears (RR = 0.59, 95% CI: 0.19-1.86). Support sleeves tended to reduce the risk of sprains and strains (RR = 0.58, 95% CI: 0.26-1.27). The risk of concussion was not lessened by the use of padded headgear (RR = 1.13, 95% CI: 0.40-3.16) or mouthguards (RR = 1.62, 95% CI: 0.51-5.11). There was no evidence of protective effects for any other equipment item (taping, shinguards, and grease). CONCLUSIONS: The protective equipment used in rugby union has limited effectiveness in preventing injuries. The results are supportive, however, of a role for mouthguards and padded headgear in preventing orofacial and scalp injuries, respectively, and for support sleeves in preventing sprains and strains.     

Injury risk in men's Canada West University football

Injury and participation information was collected over 5 years (1993-1997) on varsity men's football players in the Canada West Universities Athletic Association. The locations of acute time-loss injuries or neurologic injures were coded as head and neck, upper extremity (shoulder to hand), or lower extremity (hip to foot). Poisson regression-based generalized estimating equations were used to estimate rate ratios and 95% confidence intervals. Injury rates were higher during games as compared with practice periods (for the head and neck, rate ratio (RR) = 9.75 (95% confidence interval (CI): 7.50, 12.67); for upper extremities, RR = 5.76 (95% CI: 4.46, 7.45); and for lower extremities, RR = 7.06 (95% CI: 6.03, 8.25)). In dry-field game situations, head and neck injury rates were 1.59 times higher on artificial turf than on natural grass (95% CI: 1.04, 2.42). Lower extremity game injury rates were higher on artificial turf than on natural grass under both dry (RR = 1.83, 95% CI: 1.35, 2.48) and wet (RR = 2.31, 95% CI: 1.18, 4.52) field conditions. Injury rates increased with every additional year of participation. Past injury increased the rate of subsequent injury. The effect of an artificial field surface may be related to infrequent use. Risk factors for injury included participation in a game, playing on artificial turf, being a veteran player, and having a past injury.     

Evaluating Tackling Rugby Injury: the pilot phase for monitoring injury

OBJECTIVE: To assess the suitability of two previously unused data sources for monitoring rugby injury throughout New Zealand. METHOD: Interviews were conducted with respondents sampled from players registered with the Rugby Football Unions (RFUs) and players claiming for rugby injuries from the Accident Rehabilitation and Compensation Insurance Corporation (ACC) in Auckland and Dunedin. RESULTS: Of the 500 RFU players sampled, 63% were interviewed and of these 39 (12%) had been injured playing rugby union. Of the 456 ACC claimants sampled, 66% were interviewed and 265 (88%) had been injured playing rugby union. CONCLUSION: Identifying injured players through ACC claims was more efficient, both procedurally and because a smaller sample size was required to detect changes in incidence. IMPLICATIONS: With no routine surveillance of sports injury being undertaken, recording sporting codes in national injury surveillance systems would assist the monitoring of sports injury.     

Sports injury experiences from the Western Australian Sports Injury Cohort Study

OBJECTIVE: The Western Australian Sports Injury Study is the first prospective cohort study of sports injuries sustained during community-level sports participation in Australia. METHODS: The players were nonprofessional/non-elite participants of hockey, Australian football, basketball and netball from metropolitan Perth. Players completed a baseline questionnaire relating to their sports injury history, training practices, protective equipment use, demographic profile, general health and lifestyle factors. Sports participation and injury experiences were monitored by monthly telephone surveys over two consecutive five-month winter sporting seasons during 1997 and 1998. RESULTS: Of the 1,512 players recruited into the initial cohort, 966 (i.e. 64%) responded to at least 700% of the callback surveys over the two-year follow-up. Across all sports, the injury incidence rate was 16.1 injuries/ 1,000 exposure hours (both games and training). Injury rates were highest in Australian football and lowest in netball. Lower limb injuries were twice as common as those to the upper limb (67% vs. 31%). Three-quarters of injured players sought treatment from a health care practitioner. CONCLUSIONS AND IMPLICATIONS: This is the first longitudinal study of injuries to community-based sports participants in Australia. Compared with elite sports participants, the risk of injury is relatively low. The results provide valuable direction for the design and conduct of further aetiological studies.     

Use of discretionary protective equipment and rate of lower extremity injury in high school athletes

Use of protective equipment is an important sports injury prevention strategy, yet use of protective equipment by high school athletes has seldom been studied. The authors analyzed data from a 3-year (1996-1999), stratified, two-stage cluster sample of athletes from 12 organized sports in 100 North Carolina high schools (n = 19,728 athlete-seasons). Information on each athlete's use of protective equipment and prior injury was collected during the preseason. Prospective information on injuries and weekly participation in games and practices was collected during the playing season. Use of lower extremity discretionary protective equipment tended to decrease the overall rate of lower extremity injury (rate ratio (RR) = 0.91, 95% confidence interval (CI): 0.72, 1.15). However, this slight protective effect was entirely due to kneepad use (for knee injury, RR = 0.44, 95% CI: 0.27, 0.74). Knee brace use and ankle brace use were associated with increased rates of knee injury (RR = 1.61, 95% CI: 1.08, 2.41) and ankle injury (RR = 1.74, 95% CI: 1.11, 2.72), respectively. This could be due to slippage of the brace during use, increased fatigue due to the energy cost of wearing a brace, or bias in the study. Further investigation into the effects of brace use is warranted.     

A prospective study of injury incidence among North Carolina high school athletes

Sports-related injuries are an issue of concern in high school sports athletes. A prospective cohort study of injury risk factors was conducted from 1996 to 1999 among varsity high school athletes in 12 sports in 100 North Carolina high schools. Data were collected by trained school personnel. Unadjusted and adjusted incidence rates and rate ratios were estimated using Poisson regression models. The overall rate of injury was 2.08 per 1,000 athlete-exposures (95% confidence interval (CI): 1.79, 2.41). At 3.54 per 1,000 athlete-exposures (95% CI: 2.87, 4.37), football had the highest rate of injury of all sports. The adjusted rate ratio for athletes with a history of injury, compared with those without a prior injury, was 1.94 (95% CI: 1.69, 2.22). The injury rate rose with each year of playing experience (rate ratio=1.06, 95% CI: 1.01, 1.12). In a subanalysis restricted to gender-comparable sports, boys had a higher rate of injury than did girls (rate ratio=1.33, 95% CI: 0.99, 1.79). All other factors did not appear to be independent predictors of the injury rate. The influence of prior injury suggests that proper rehabilitation and primary prevention of the initial injury are important strategies for injury control.     

Risk factors for injury among veterinarians.

Work-related injuries among veterinarians are a major problem, but little is known of the specific risk factors involved. The purpose of this nested case-control study, conducted from a comprehensive population-based study of practicing Minnesota veterinarians, was to identify risk factors for job-related injuries. We questioned cases (N = 193) on exposures occurring in the month before their injury, and we questioned controls (N = 495) on exposures occurring in a randomly selected month. We used logistic regression to model the dependence of veterinary work-related injury on each exposure of interest and associated confounders. We observed increased rates for prior injuries (RR = 1.7, 95% CI = 1.1-2.6), participation in sports (RR = 1.7, 95% CI = 1.05-2.6), no sharps boxes present (RR = 1.8, 95% CI = 1.01-3.2), current smoking (RR = 4.1, 95% CI = 1.8-9.1), and 6 or fewer hours of sleep (RR = 1.8, 95% CI = 1.0-3.3). We identified a dose response for lifting patients, as follows: lifting 41-75 lb (RR = 3.1, 95% CI = 1.6-5.9), lifting 76-100 lb (RR = 3.2, 95% CI = 1.6-5.9), and lifting more than 100 lb (RR = 6.1, 95% CI = 2.5-15.0). Decreased rates were observed for participation in aerobic activities (RR = 0.6, 95% CI = 0.4-0.99), perception of lower risk (RR = 0.4, 95% CI = 0.2-0.9), and experience (RR = 0.6, 95% CI = 0.4-0.9).     

Injury mortality rates in Native and non-Native children: a population-based study

OBJECTIVES: To examine injury mortality rates in Native and non-Native children in the province of Alberta, Canada, over a 10-year period, temporal trends in injury mortality rates (Native vs. non-Native), as well as relative risks of injury mortality (Native vs. non-Native) by injury mechanism and intent, were calculated. METHODS: An observational, population-based study design was used. Mortality data were obtained from provincial vital statistics, with injury deaths identified using external injury codes (E-codes). The relative risk (RR) of injury mortality (Native vs. non-Native) along with 95% confidence intervals (CIs) were calculated. Stratified analyses and Poisson regression modeling were used to calculate adjusted relative risk. RESULTS: Injury mortality rates declined over the study period, with no difference in the rate of decline between Native and non-Native children. The adjusted relative risk for all-cause injury death (Native vs. non-Native) was 4.6 (95% CI 4.1 to 5.2). The adjusted relative risks (Native vs. non-Native) by injury intent categories were: unintentional injuries, 4.0 (95% CI 3.5 to 4.6); suicide, 6.6 (95% CI 5.2 to 8.5); and homicide, 5.1 (95% CI 3.0 to 8.5). Injury mortality rates were consistently higher for Native children across all injury mechanism categories. The largest relative risks (Native vs. non-Native) were pedestrian injury (RR = 17.0), accidental poisoning (RR = 15.4), homicide by piercing objects (RR = 15.4), and suicide by hanging (RR = 13.5). CONCLUSION: The burden of injury mortality is significantly greater in Native children compared with non-Native children. Therefore, injury prevention strategies that target both intentional and unintentional injuries are needed.     

Trends in emergency department reported head and neck injuries among skiers and snowboarders

BACKGROUND: Reports from the U.S. suggest increases in the proportion and rate of head and neck injuries in skiers and snowboarders. It is important to determine if the same is true in Canada. METHODS: Skiers and snowboarders (< 18 years) presenting to 16 selected emergency departments from 1991 to 1999 were assigned one body region of injury in the following order: i) brain and spine-spinal cord, ii) head and neck, iii) face, iv) other body region (i.e., controls). Crude and adjusted (age, gender, helmet use and hospital admission) odds ratios indicating the proportion of head, brain, face, and neck injury relative to controls by calendar year were estimated. Injury rates were examined for 12 to 17 year olds over the last 4 years of the study. RESULTS: Compared with 1997-1999, there was a lower proportion of skier head injuries from 1991-93 (adjusted odds ratio (AOR) = 0.16; 95% Confidence Interval (CI) = 0.09-0.30) and from 1995-97 (AOR = 0.71; 95% CI = 0.49-1.04). The proportion of skier brain injuries was lower from 1993-95 (AOR = 0.69; 95% CI = 0.44-1.07) and from 1995-97 (AOR = 0.56; 95% CI: 0.35-0.91). In snowboarders, however, compared with 1997-99, there was evidence that although the proportion of head injuries was lower from 1991-93 (AOR = 0.19; 95% CI = 0.05-0.80), the opposite was true for facial injuries. For 12 to 17 year olds, skier brain and snowboarder head and neck injury rates increased from 1995-99. CONCLUSIONS: The results suggest that head and brain injuries in skiers and head and neck injuries in snowboarders may be increasing, particularly in adolescents.     

Single-vehicle and Multi-vehicle Accidents Involving Motorcycles in a Small City in China: Characteristics and Injury Patterns

IntroductionThere is a gap that involves examining differences between patients in single-vehicle (SV) versus multi-vehicle (MV) accidents involving motorcycles in Shantou, China, regarding the injury patterns and mortality the patients sustained. This study aims to address this gap and provide a basis and reference for motorcycle injury prevention.MethodMedical record data was collected between October 2002 and June 2012 on all motorcycle injury patients admitted to a hospital in the city of Shantou of the east Guangdong province in China. Comparative analysis was conducted between patients in SV accidents and patients in MV accidents regarding demographic and clinic characteristics, mortality, and injury patterns.ResultsApproximately 48% (n = 1977) of patients were involved in SV accidents and 52% (n = 2119) were involved in MV accidents. The average age was 34 years. Collision of a motorcycle with a heavy vehicle/bus (4%) was associated with a 34 times greater risk of death (RR: 34.32; 95% CI: 17.43–67.57). Compared to patients involved in MV accidents, those involved in SV accidents were more likely to sustain a skull fracture (RR: 1.47; 95% CI: 1.22–1.77), an open head wound (RR: 1.46; 95% CI: 1.23–1.74), an intracranial injury (RR: 1.39; 95% CI: 1.26–1.53), a superficial head injury (RR: 1.37; 95% CI: 1.01–1.86), an injury to an organ (RR: 2.01; 95% CI: 1.24–3.26), and a crushing injury (RR: 1.98; 95% CI: 1.06–3.70) to the thorax or abdomen. However, they were less likely to sustain a spinal fracture (RR: 0.58; 95% CI: 0.39–0.85), a pelvic fracture (RR: 0.22; 95% CI: 0.11–0.46), an upper extremity fracture (RR: 0.75; 95% CI: 0.59–0.96), or injuries to their lower extremities, except for a dislocation, sprain, or injury to a joint or ligament (RR: 0.82; 95% CI: 0.49–1.36).ConclusionThe relative risk of death is higher for patients involved in multi-vehicle accidents than patients in single-vehicle accidents, especially when a collision involves mass vehicle(s). Injury to the head dominated motorcycle injuries. Single-vehicle accidents have a higher correlation with head injury or internal injuries to the thorax or abdomen. Multi-vehicle accidents are more correlated with extremity injuries, especially to the lower extremities or external trauma to the thorax or abdomen.     

Health and safety implications of injury in professional rugby league football

BACKGROUND: Professional sport is characterized by high injury rates but is also covered by health and safety legislation. AIM: To examine the incidence of injury in professional rugby league as defined by the Reporting of Diseases and Dangerous Occurrences Regulations 1995 (RIDDOR 95). METHODS: All injuries received during playing and training to both first-team and 'academy' (<19 years old) players during two playing seasons at one professional club were recorded. The length of time a player was unable to take part in full training and playing was used as a measure of severity. Injuries were classified into minor injuries (0-3 days), over 3 day injuries or major injuries, in which the final two categories corresponded with RIDDOR 95. RESULTS: Thirty-two per cent (95% confidence interval=26-39%) of all injuries received satisfied the RIDDOR 95 criteria. The overall injury rate was 8.5 per 1000 h (7.2-9.9) for the first team and 4.1 per 1000 h (3.2-5.4) for the academy team. During match play the first-team injury rate was 157.7 per 1000 h (133.5-185.1) and 67.7 (51-81.1) for the academy team. Training injury rates were lower, at 0.5 per 1000 h (0.2-1.0) and 0.3 per 1000 h (0.1-0.8), respectively. CONCLUSION: The injury rate for professional rugby league is much higher than reported in other high-risk occupations such as mining and quarrying. The large differences in injury rates between first and academy teams have implications for young players likely to progress to first-team status.     

Severe injury among Hispanic and non-Hispanic white children in Washington state

OBJECTIVES: The authors' anecdotal experience at a regional Level I trauma center was that Hispanic children were overrepresented among burn patients, particularly among children with burns due to scalding from hot food. This study describes injury incidence and severity among Hispanic and non-Hispanic white infants, children, and adolescents with serious traumatic injuries in Washington State. METHODS: Data from the Washington State Trauma Registry for 1995-1997 were used to identify injured individuals aged < or = 19 years. Ratios of overall and mechanism-specific injury incidence rates for Hispanic children relative to non-Hispanic white children were calculated using denominator estimates derived from U.S. Census Bureau population data. Hispanic children and non-Hispanic white children were also compared on several measures of severity of injury. RESULTS: In 1995-1997, serious traumatic injuries were reported to the Registry for 231 Hispanic children aged < or = 19 years (rate: 54 per 100,000 person-years) and for 2,123 non-Hispanic white children (56 per 100,000 person-years), yielding an overall rate ratio (RR) of 1.0 (95% confidence interval [CI] 0.8, 1.1). Motor vehicle crashes and falls accounted for one-third to one-half of the injuries for each group. Infants, children, and adolescents identified as Hispanic had higher rates of injuries related to hot objects (i.e., burns) (RR=2.3; 95% CI 1.3, 4.1), guns (RR=2.2; 95% CI 1.5 to 3.3), and being cut or pierced (RR=3.5; 95% CI 2.2 to 5.5). The Hispanic group had a lower injury rate for motor vehicle accidents (RR=0.7; 95% CI 0.5, 0.9). Mortality rates were similar (RR=1.1; 95% CI 0.7, 1.7). The mean length of hospital stay was 5.5 days for the Hispanic group and 8.8 days for the non-Hispanic white group (difference=3.3 days; 95% CI -0.7, 7.4). CONCLUSIONS: The study found little difference between Hispanic and non-Hispanic white infants, children, and adolescents in the burden of traumatic pediatric injury. However, burns, guns, drowning, and being pierced/cut appeared to be particularly important mechanisms of injury for Hispanic children. More specific investigations targeted toward these injury types are needed to identify the underlying preventable risk factors involved.     

Increased risk of agricultural injury among African-American farm workers from Alabama and Mississippi

Research on the epidemiology of agriculture-related injuries has largely ignored African-Americans and farm workers. This cohort study is the first to estimate injury rates and to evaluate prospectively risk factors for agriculture-related injuries and compare them among African-American and Caucasian farmers and African-American farm workers. A total of 1,246 subjects (685 Caucasian owners, 321 African-American owners, and 240 African-American workers) from Alabama and Mississippi were selected from Agricultural Statistics Services databases and other sources and were enrolled between January 1994 and June 1996. Baseline data included detailed demographic, farm and farming, and behavioral information. From January 1994 to April 1998, subjects were contacted biannually to ascertain the occurrence of an agriculture-related injury. Injury rates were 2.9 times (95% confidence interval (CI): 2.0, 4.3) higher for African-American farm workers compared with Caucasian and African-American owners. Part-time farming (relative risk (RR) = 2.0, 95% CI: 1.3, 2.5), prior agricultural injury (RR = 1.5, 95% CI: 1.0, 2.1), and farm machinery in fair/poor condition (RR = 1.8, 95% CI: 1.2, 2.7) were also independently associated with injury rates. The results demonstrate the increased frequency of agricultural injury among farm workers and identify a number of possible ways of reducing them.     

Multiclonal outbreak of methicillin-resistant Staphylococcus aureus infections on a collegiate football team

An outbreak of methicillin-resistant Staphylococcus aureus (MRSA) skin and soft tissue infections (SSTIs) occurred in a college football team in August 2006. Of 109 players on the team roster, 88 (81%) were interviewed during a cohort investigation. Twenty-five cases were identified, six of which were culture-confirmed. Available culture isolates were typed by pulsed-field gel electrophoresis (PFGE), which identified two different MRSA strains associated with the outbreak. Playing positions with the most physical contact (offensive linemen, defensive linemen, and tight ends) had the greatest risk of infection [risk ratio (RR) 5.1, 95% confidence interval (CI) 2.3-11.5. Other risk factors included recent skin trauma (RR 1.9, 95% CI 0.95-3.7), use of therapeutic hydrocollator packs (RR 2.5, 95% CI 1.1-5.7), and miscellaneous training equipment use (RR 2.1, 95% CI 1.1-4.1). The outbreak was successfully controlled through team education and implementation of improved infection-control practices and hygiene policies.     

Seasonal variations in injury rates during US Army Basic Combat Training

OBJECTIVES: Previous literature suggests that injury rates during physical activity may be higher in the summer than in the fall or winter, possibly due to the greater amount or intensity of physical activity in the summer. This study examined seasonal differences in injury incidence during US Army Basic Combat Training, where physical activity was similar at all times of the year. METHODS: Four independent groups of subjects (total n = 1543 men and 1025 women) were investigated, two training in the summer and two training in the fall. Injury data were obtained from a retrospective review of the subjects' medical records at the conclusion of the 8 week training program. RESULTS: For men, the corrected relative risk of suffering an injury or a time loss injury in the summer was, respectively, 2.0 [95% confidence interval (CI) = 1.7-2.4] and 2.5 (95% CI = 1.9-3.0) times higher than in the fall. For women, the corrected relative risk of suffering an injury or time-loss injury in the summer was, respectively, 1.4 (95% CI = 1.3-1.6) and 1.7 (95% CI = 1.5-2.0) times higher than in the fall. These risks were essentially unchanged after adjustment for subject physical characteristics (age, stature, body mass, body mass index) and physical fitness (push-ups, sit-ups and 2 mile run), indicating that the summer season was an injury risk factor independent of these variables. Linear correlations (r-values) between maximal daily temperature and injury incidence ranged from 0.92 to 0.97, indicating a strong relationship between these two variables. CONCLUSIONS: These data suggest that injury incidence among physically active individuals is higher in the summer than in the fall and that environmental temperature may provide a partial explanation for this finding.     

Cancer Incidence in Kentucky, Pennsylvania, and West Virginia: Disparities in Appalachia

CONTEXT: Composed of all or a portion of 13 states, Appalachia is a heterogeneous, economically disadvantaged region of the eastern United States. While mortality from cancer in Appalachia has previously been reported to be elevated, rates of cancer incidence in Appalachia remain unreported. PURPOSE: To estimate Appalachian cancer incidence by stage and site and to determine if incidence was greater than that in the United States. METHODS: Using 1994--1998 data from the central registries of Kentucky, Pennsylvania, and West Virginia, age-adjusted incidence rates were calculated for the rural and nonrural regions of Appalachia. These state rates were compared to rates from the Surveillance, Epidemiology, and End Results (SEER) program for the same years by calculating the adjusted rate ratio (RR) and a 95% confidence interval (CI). FINDINGS: Both the entire and rural Appalachian regions had an adjusted incidence rate for all cancer sites similar to the SEER rate (RR = 1.00 [95% CI, 1.00-1.01] and RR = 0.99 [95% CI, 0.99-1.00], respectively). However, incidence of cancer of the lung/ bronchus, colon, rectum, and cervix in Appalachia was significantly elevated (RR = 1.22 [95% CI, 1.20-1.23], 1.13 [95% CI, 1.11-1.14], 1.19 [95% CI, 1.16-1.22], and 1.12 [95% CI, 1.07-1.17], respectively). Incidence of cancer of the lung/bronchus and cervix in rural Appalachia was even more elevated (RR = 1.34 [95% CI, 1.31-1.36] and 1.29 [95% CI, 1.21-1.38], respectively). Incidence of unstaged disease for all cancer sites in Appalachia (RR = 1.06 [95% CI, 1.05-1.08]), particularly rural Appalachia (RR = 1.28 [95%CI, 1.25-1.301), was elevated. CONCLUSIONS: Cancer incidence in Appalachia was not found to be elevated. However, incidence of cancer of the lung/bronchus, colon, rectum, and cervix was elevated in Appalachia. The rates of unstaged cancer of every examined site were elevated in rural Appalachia, suggesting a lack of access to cancer health care.     

Gender differences in adolescent injury characteristics: a population-based study of hospital A&E data

OBJECTIVES: To investigate patterns of adolescent home/leisure injury serious enough to require hospital attendance. STUDY DESIGN: Population-based analysis of data collected by the Home and Leisure Accident Surveillance System (HASS/LASS). METHODS: Study subjects were 0-17 year old residents of Airdrie and Coatbridge, Lanarkshire, Scotland, who attended Monklands Hospital Accident and Emergency (A&E) Department with a home/leisure injury during calendar years 1996-1999. Male to female relative risk ratios (M:F RRRs) for A&E attendance, fracture and hospital admission, stratified into sports and non-sports injuries, were calculated. Sports injuries were further analysed by specific sports and by whether the sports activity was organized or informal. Data were analysed in age groups corresponding to children's stage of schooling. RESULTS: The M:F RRR for non-sports A&E attendances remained constant throughout childhood (1.35, 95% CI 1.30-1.39 in 0-17 year olds), whilst that for sports attendances increased sharply with age (2.50, 95% CI 0.89-7.02 in 0-4 year olds, increasing to 8.11, 95% CI 6.27-10.51 in 16-17 year olds). Of sports injury attendances, 50.3% were football-related. Football was overwhelmingly the main cause of boys' sports injury in both the organized and informal sports injury categories. When football injuries were excluded from the analysis, the widening teenage gender gap in injury risk disappeared. There was no significant gender difference in teenagers' rates of A&E attendance for injuries sustained during compulsory school physical education (PE), suggesting a dose-response relationship between sports participation and injury risk. CONCLUSIONS: This study found significant gender inequalities in adolescent injury risk, which were largely attributable to boys' football injuries. Focusing prevention efforts on making football safer would, then, be a sensible strategy for reducing the overall burden of adolescent injury and for reducing sex inequalities in injury risk; however further research is needed to understand how the risks differ between organized and informal football. These findings are also interesting because of what they suggest about teenage girls' lack of participation in sport and habitual physical activity. This is clearly of public health concern because of the links between physical inactivity and a range of health problems.     

Cervical spinal cord injury in rugby union and rugby league: are incidence rates declining in NSW?

OBJECTIVES: To estimate trends in incidence rates of rugby code-related severe cervical spinal cord injuries in New South Wales (NSW) from 1986 to 2003. To evaluate the Australian Spinal Cord Injury Register (ASCIR) for injury surveillance by comparison with two published studies. METHODS: Data were cases of complete and incomplete tetraplegia in rugby union and rugby league admitted to the two spinal units in NSW. Trends in incidence rates were estimated using Poisson regression modelling. RESULTS: There was a small, non-significant decline from 1986 to 2003 in the incidence rate of tetraplegia in rugby union (9.8 vs. 6.1 per 100,000 player-years; p = 0.378) and rugby league (2.3 vs. 1.6 per 100,000 player-years; p = 0.564). The most common causes of injury were scrums for rugby union (35%) and tackles for rugby league (78%). This did not change over time (rugby union, p = 0.118; rugby league, p = 0.288). The ASCIR identified more cases of tetraplegia than insurance claims data and at least 75% of the cases ascertained by medical record review. CONCLUSIONS: There remains an urgent need to further improve safety in rugby union and rugby league. Scrummage in union and tackles in league remain the leading causes of tetraplegia. Rates of tetraplegia were significantly higher and more variable in rugby union than in rugby league. IMPLICATIONS: The ASCIR is a useful tool to monitor trends in spinal cord injury incidence in both rugby codes. Its potential value is constrained by the lack of accurate estimates of player numbers.     

太原市社区老年人轻度认知功能障碍向阿尔茨海默病转归三年随访研究

目的 探讨太原市社区轻度认知功能障碍(MCI)老年人向阿尔茨海默病(AD)的转归率,并分析影响因素.方法 从太原市9个社区6152名≥65岁老年人中筛查出600例MCI,实际随访557例,从认知正常(NC)中选择557名与MCI相匹配的老年人进行配对,对MCI组和NC组进行3年随访研究.采用自制问卷面对面调查MCI组的一般人口学资料、生活行为方式、慢性病史、主观感受等,采用16PF调查MCI的人格特征,静脉血采样进行实验室遗传基因学分析,对NC组老年人进行电话访问以得到疾病结局和发病时间.用SPSS 13.0软件进行数据录入及分析,统计学方法采用log-rank检验和Cox回归.结果 MCI组老年人向AD的平均年转归率为6.53%人年.NC组老年人向AD的平均年转归率为1.24%人年,MCI组发生AD的危险性是NC组的5.27倍(95%CI:3.01～9.82).Cox回归分析结果显示,高龄(RR=3.14,95%CI:2.98～7.46)、患高血压(RR=3.28,95%CI:3.02～8.48)、高血脂(RR=2.22,95%CI:1.29～3.82)、糖尿病(RR=4.87,95%CI:2.56～9.25)、较少运动(RR=2.02,95%CI:1.29～3.14)、焦虑(RR=4.46,95%CI:3.07～8.14)、害怕(RR=4.08,95%CI:3.52～5.25)、非乐群型(RR=1.89,95%CI:1.13～3.16)、焦虑人格(RR=5.07,95%CI:2.56～10.04)、性格内向(RR=2.05,95%CI:1.33～3.15)、携带ApoE4(RR=1.73,95%CI:1.15～2.63)是MCI转归为AD的危险因素,文化程度高(RR=0.29,95%CI:0.07～0.43)、脑力劳动(RR=0.14,95%CI:0.05～0.32)、常读书看报(RR=0.30,95%CI:0.15～0.58)、常参加活动(RR=0.41,95%CI:0.23～0.75)是MCI转归为AD的保护因素.结论 患有MCI的老年人更易发展为AD,应长期监测.

Abstract：

Objective To explore the incidence rate of people with mild cognitive impairment (MCI) which transferred to Alzheimer's disease (AD) and to study the related influencing factors. Methods 600 MCI aged people were experienced screening test which was conducted by WHO-BCA, MMSE and DCR. A three-year follow-up study was conducted to get the information on the aged people with MCI. Data related to demography, behavior, chronic diseases and perception of the elderly with MCI were collected through face to face interview. Characteristics of the elderly with MCI aged people were tested by 16PF. The content of Apoe was tested by PCR.People with NC were investigated by telephone to get the progression and the time to AD.Methodologies on statistics were log-rank test and Cox proportional hazards regression model.Results The incidence rate of MCI to AD was 6.53% person-years. The incidence rate of the normal people to AD was 1.24% person-years. The hazard of MCI to AD was 5.27 times (95%CI: 3.01-9.82)of the normal people to AD. The result of Cox proportional hazards regression model displayed that: older age (RR=3.14, 95% CI: 2.98-7.46) , hypertension (RR=3.28, 95% CI: 3.02-8.48) ,hyperlipermia (RR = 2.22,95%CI: 1.29-3.82), diabetes (RR=4.87,95%CI: 2.56-9.25), lack of sports (RR=2.02, 95%CI: 1.29-3.14), anxiety (RR=4.46, 95%CI: 3.07-8.14), dread fulness (RR=4.08,95% CI: 3.52-5.25), loneliness (RR= 1.89,95% CI: 1.13-3.16), characteristics of anxiety (RR= 5.07,95%CI: 2.56-10.04, introvert characteristics (RR=2.05,95%CI: 1.33-3.15) and ApoE4 (RR= 1.73,95% CI: 1.15-2.63) were the risk factors of MCI to AD. Higher education (RR=0.29, 95% CI:0.07-0.43), intellectual work(RR=0.14,95%CI: 0.05-0.32), often reading books(RR=0.30,95%CI:0.15-0.58), often taking part in recreational activities (RR=0.41,95%CI: 0.23-0.75) seemed to be the protective of MCI to AD. Conclusion The rate of the elderly with MCI that developing to AD was high, suggesting further study on the cognitive situation among the MCI aged people should be carried out.     

Influence of social inequality, social unrest and extreme poverty on tuberculosis morbidity in the City of Barcelona

BACKGROUND: The main purpose of this study was to analyse inequalities between tuberculosis/intravenous drug user and tuberculosis/not intravenous drug user among the different neighbourhoods of Barcelona and the relationship to socioeconomic indicators and social/material deprivation indicators throughout the 1990-1995 period. METHODS: An ecological study which included all cases of tuberculosis among residents of Barcelona, the analysis unit being the neighbourhood. Intravenous drug users within the 15-49 age range and non-intravenous drug users over age 14 were included. The mean annual incidence rate standardized by age was used. The social indicators considered were the inner city areas, unemployment, less than primary education, overcrowding, social unrest and extreme poverty. In the bivariate analysis, the relationship between tuberculosis incidence and the social indicators was studied by means of the Spearman correlation coefficient, and the multivariate analysis by means of the Poisson regression. RESULTS: The incidence rates were higher in the inner city neighbourhoods, followed by the newer outlying working class neighbourhoods in both groups studied, and in other older outlying districts for the non-users of intravenous drugs. Among the intravenous drug user group, the variables related to a greater risk of tuberculosis were: man (RR = 7.42, confidence interval at 95% ICI95%-: 6.16-8.93), age (RR = 61.51, CI95%: 34.64-109.20), unemployment (RR = 1.68, CI95%: 1.51-1.88), social unrest (RR = 1.29, CI 95%: 1.04-1.58), overcrowding (RR = 1.36, CI 95%: 1.19-1.55) and inner city areas (RR = 1.92, CI 95% 1.48-2.50). Among the male non-users of intravenous drugs, no interaction between unemployment and age was found. Neighbourhoods with extreme poverty and inner city neighbourhoods showed a higher risk of tuberculosis (RR = 1.11, CI 95% 1.08-1.135 and RR = 1.80, CI95%: 1.51-2.14). Among the female non-users of intravenous drugs, a relationship was found in those of lesser age (RR = 1.29, CI 95%: 1.05-1.57), unemployment (RR = 1.18, CI 95%: 1.09-1.26), extreme poverty (RR = 1.95, CI 95%: 1.56-2.45) and inner city areas (RR = 1.72, CI 95%: 1.35-2.19). CONCLUSION: Inequalities in tuberculosis are related to different social indicators such as unemployment and inner city areas. A difference exists between the two groups studied. Tuberculosis is related with social unrest and overcrowding among intravenous drug users and with extreme poverty among non-users of intravenous drugs.