Extrinsic Risk Factors Research Articles

EPIDEMIOLOGY OF INJURIES AND ASSOCIATED RISK FACTORS IN ATHLETES PARTICIPATING IN 2022 AEROBIC GYMNASTICS WORLD CHAMPIONSHIPD CHAMPIONSHIP ATHLETES

Exercise is described as a preventive and therapeutic strategy against various diseases. However, competitive sports practice is associated with an increased risk of injuries, particularly with specialization and more intense training at younger ages. Given the importance of surveillance and epidemiological studies to protect athletes’ health, our study aimed to describe the prevalence of injuries among athletes at the 2022 Aerobic Gymnastics World Championship (WCH) and to understand the intrinsic and extrinsic risk factors that may contribute to these injuries. Athletes participating in WCH 2022 were invited to complete a retrospective injury questionnaire covering the past 12 months of their training schedule. Descriptive statistic data were used to analyze all variables in the study. Seventy-three percent of athletes reported sustaining injuries, with an average of 1.6 ± 1.5 injuries occurring one to three times in the past year. The most common injuries were muscle injuries, joint sprains, stress fractures, and contusions, with the lower limbs being the most affected, followed by the upper body and trunk. Regarding injury risk factors, a significant number of athletes reported experiencing psychological stress (p=0.043) and concerns about individual protection equipment (p=0.042). Given that the type of injury and affected body region seem to be related to sports-specific movements, the impact absorption of the floor and footwear should be studied further. Additionally, injury prevention measures should include coping strategies to manage stress effectively.

Assessment of treatment effect heterogeneity for multiregional randomized clinical trials

Multiregional clinical trials (MRCTs) have become increasingly common in recent years. Detecting underlying regional heterogeneity is a critical issue for these trials. Existing methods for assessing treatment effect heterogeneity across regions have ignored the incomparability of baseline extrinsic risk factors of the randomized patients from different regions. In this paper, a calibration weighting method is proposed to calibrate the distribution of these extrinsic risk factors between multiple regions. We establish the consistency and the asymptotic normality of the calibration weighting estimator. Simulation studies confirm the finite sample properties of the proposed estimator as well as its superior performance over naive methods and the inverse probability weighting method. The proposed method is illustrated using a randomized clinical trial of adjuvant chemotherapy for resected non-small-cell lung cancer.

12391 When Pressure Drops, Consequences Rise: A Case Of Pituitary Apoplexy And Watershed Infarcts

Abstract Disclosure: D. Moreno Watashi: None. H.R. Alkaissi: None. M.B. Sharma: None. Introduction: Pituitary apoplexy (PA) results from sudden hemorrhaging and infarction of the pituitary gland, typically within a pituitary adenoma. The primary symptom is a sudden, severe headache, often followed by acute endocrine dysfunction, ophthalmoplegia and visual or neurological disturbances. Case Description: A 68-year-old male with a past medical history of hypertension presented to the emergency department with acute chest and upper back pain, beginning one day prior. No history of smoking, alcohol intake or drug use. Blood pressure (BP) on arrival was 180/95 mmHg. Initial labs revealed mild electrolyte abnormalities. Troponins were normal, but ECG showed diffuse T wave inversion and ST depression. CT angiography revealed a type B aortic dissection. He was managed in the critical care unit with continuous esmolol intravenous (IV) infusion and planned for endovascular repair. During his stay, he became disoriented and hypotensive. MRI from the brain incidentally discovered a pituitary macroadenoma measuring 2.9x2.2x3cm and recent infarcts, with a distribution concerning for hypoperfusion. Fundoscopy concerning for optic chiasm compression. Labs indicated secondary hypothyroidism and hypogonadism (TSH 0.3 uUI/ml, free T4 0.88 ng/dL, total testosterone 56.3 ng/dL). Neurosurgical intervention was deferred until after aortic repair. Endovascular aortic repair was performed with episodes of hypotension. Post-procedure, the patient developed fever (39.5°C) and worsening mental status. Head CT revealed an increased suprasellar extension of the pituitary macroadenoma and vasogenic edema, consistent with hemorrhage of the lesion. He was started on stress doses of hydrocortisone, levothyroxine 125mcg and managed conservatively due to a high surgical risk. Discussion: PA's extrinsic risk factors include angiographic procedures, endocrinological dynamic tests, anticoagulation therapy, exogenous estrogen administration, orthopedic and cardiac surgeries (due to BP fluctuations). The intrinsic risk factors are non-functioning adenomas, macroadenomas and suprasellar extension. Treatment is focused on immediate correction of endocrine derangements and relieving local compression. Stress dosage of corticosteroids should be administered IV as soon as the diagnosis is confirmed to prevent life-threatening corticotropic deficiency. Neurosurgical decompression via a transsphenoidal approach is the definitive therapy to relieve local compression with severe visual loss, obtundation or rapidly progressive course. The potential outcomes are based on the extent of hemorrhage, necrosis, and edema. PA should be treated as a medical emergency in the setting of hemodynamic changes from acute corticotropic deficiency and irreversible neurological damage from acute intracranial compression. The risk factors for PA should be known to assist in early diagnosis. Presentation: 6/1/2024

Babesia bigemina and Theileria annulata infections in cattle: molecular detection, phylogenetic analysis, and assessment of risk factors.

Babesia bigemina and Theileria annulata are tick-borne protozoans that cause piroplasmosis in cattle, resulting in huge damages to the livestock industry. The prevalence of these infections depends on various intrinsic and extrinsic risk factors. In Pakistan, there is no information regarding the molecular characterization of Babesia bigemina and the risk factors associated with piroplasmosis. This study aimed to molecularly characterize Babesia spp. and Theileria spp. infecting various cattle breeds in Khyber Pakhtunkhwa, Pakistan, and to shed light on risk factors associated with these infections. Altogether, 219 blood samples were collected from various symptomatic cattle breeds, including Holstein Friesian (65.3%; 143/219), Jersey (21.5%; 47/219) and Sahiwal (13.2%; 29/219). Isolated genomic DNA from these blood samples was used in PCR for the amplification of the 18S rRNA fragment of apicomplexan parasites. Obtained 18S rDNA sequences from cattle hosts showed 99.5% identity with B. bigemina, or 100% with T. annulata. Having an overall infection rate of 61.6% (135/219), the highest infection rate was recorded for T. annulata (43.8%; 95/219), followed by B. bigemina (18.3%; 40/219). Phylogenetic analysis of 18S rDNA sequences revealed that B. bigemina clustered with corresponding species reported from Bolivia, and South Africa, while T. annulata grouped with same species from Italy, India, and Turkey. Among the different risk factors, the breed, season, and tick infestation were found to have a significant (P < 0.05) association with the piroplasmid infections. The information obtained in this study can be employed for effective surveillance and control of babesiosis and theileriosis in Pakistan. In addition to confirming our previous molecular detection of T. annulata in cattle, this study provides the first molecular surveillance and phylogenetic position of B. bigemina and associated risk factors in the study region.

Primary Anterior Cruciate Ligament Injury: Extrinsic and Intrinsic Risk Factors.

Anterior cruciate ligament (ACL) injuries continue to increase in incidence despite extensive research into prevention strategies. Many extrinsic and intrinsic risk factors for sustaining ACL injuries have been identified and continue to be investigated. Extrinsic risk factors for ACL injury relate to the athlete's environment, such as the shoe-surface interaction, weather conditions, and sport played. Intrinsic risk factors relate to the athlete's sex, hormones, knee anatomy, landing and pivoting biomechanics, and neuromuscular control. Recent research has highlighted the role of the bony morphology of the proximal tibia and distal femur on primary ACL injury risk, as well as the risk for ACL graft failure. Sex differences in bony and ligamentous morphology of the knee, neuromuscular control, and hormonal factors, such as serum relaxin levels and variations within the menstrual cycle, have been correlated with a higher risk of noncontact primary ACL injuries in female athletes compared with male athletes.

Exploring Older Adults' Perceptions of Stair Hazards and an m-health Fall Prevention App: A Focus Group Study

Older adults are disproportionately susceptible to hospitalizations and fatalities due to stair-related falls. While many intrinsic risk factors, such as mobility and vision, may increase the likelihood of falls on stairs, features of the stairs that increase the risk of falls are understudied. This study aimed to capture older adults’ perspectives of stair falls, as well as introduce the Safer Steps app and explore its feasibility in this population. This m-health technology was designed to gather data on stair-related falls and identify hazardous stair features (e.g., the absence of handrails, uneven steps). Capturing older adults’ perspectives of the role of the built environment in stair-related falls is crucial for fostering the adoption and use of the Safer Steps app in this demographic. Fifteen older adults (&lt;em&gt;M&lt;/em&gt; = 73 years, SD = 5.29) participated in focus groups discussing falls, stair-related falls, technology use and the design concept of the Safer Steps app. Reflexive thematic analysis revealed that participants expressed fear of falling and cited intrinsic risk factors, such as age, medications, and footwear, alongside extrinsic risk factors related to the built environment, to be major causes of stair-related falls. They highlighted the significance of the built environment in fall prevention, particularly surface conditions, step dimensions, and handrails. Most participants were familiar with apps and endorsed the Safer Steps app design to mitigate stair-related fall risk. Findings indicate older adults' willingness to engage in strategies which reduce stair fall risk, such as modifying their behaviour by using handrails and changing footwear, viewing the Safer Steps app as a practical tool for identifying built environment hazards.

ACL Injury Etiology in Its Context: A Systems Thinking, Group Model Building Approach.

Background/Objectives: Given the complex nature of Anterior Cruciate Ligament (ACL) injury, it is important to analyze its etiology with suitable approaches in order to formulate intervention strategies for effective prevention. The present study employs system thinking techniques to develop a Causal Loop Diagram (CLD) Model for investigating the risk factors for ACL Injury (CLD-ACLI), through a Group Model Building approach. Methods: A two-stage procedure was applied involving a comprehensive literature review followed by several systems thinking group-modeling co-creation workshops with stakeholders. Results: Based on input from experts and stakeholders, combined with the latest scientific findings, the derived CLD-ACLI model revealed a series of interesting complex nonlinear interrelationships causal loops between the likelihood of ACL injury and the number of risk factors. Particularly, the interaction among institutional, psychological, neurocognitive, neuromuscular, malalignment factors, and trauma history seem to affect neuromuscular control, which subsequently may alter the biomechanics of landing, predisposing the ACL to injury. Further, according to the proposed CLD-ACLI model, the risk for injury may increase further if specific environmental and anatomical factors affect the shear forces imposed on the ACL. Conclusions: The proposed CLD-ACLI model constitutes a rigorous useful conceptual presentation agreed upon among experts on the dynamic interactions among potential intrinsic and extrinsic risk factors for ACL injury. The presented causal loop model constitutes a vital step for developing a validated quantitative system dynamics simulation model for evaluating ACL injury-prevention strategies prior to implementation.

Identification of House Dust Mite and the Risk Factor of Cronic Itch in Elderly

Introduction: Senile pruritus etiology is uncertain. However, well as intrinsic factors, one of the extrinsic risk factors causing pruritus is house dust mites (HDM) as. Aim of this study was to analyze the association between house dust mite density and the pruritus level among elderly residents. Methods: This is an observational study with cross-sectional design. The 34 elderly who met the criteria were included in this study. The pruritus level was obtained using questionnaire as to duration, degree, direction, disability, distribution (5D) itch scale based on NRS (numerical rating scale) categories divided into 4 categories (no, low, moderate, and severe itch). House dust mite density was checked using flotation method and the results categorized into low, moderate, and high density. The dust sample was checked for the species by microscope. The preventive activity to prevent the pruritus were also analyzed. The relationship between itch scale, preventive activity with HDM density was analyzed using STATA 17. Results and Discussion: A total of 34 elderly was included. Elderly were dominated with women (67.6%), moderate itch scale (38.2%) and moderate HDM density (58.8%). Most of the correlation between itch scale based NRS and preventive activity with HDM density p-value was not significant. But the elderly’s’ habit to clean the mattress was significantly correlated with HDM density (p=0.00). The Dermatophagoides sp were the dominant mites found in elderly’s’ room. Conclusion: Itch scale in elderly were not related with HDM density, but correlated with the habit to clean the mattress.

Imaging of sports injuries in adolescents.

Musculoskeletal injuries in adolescents tend to occur in particular locations and have distinct characteristics, as they affect an immature skeleton. Increased engagement in sports, extended training and competition periods, and early specialization in specific sports, among other factors, have contributed significantly to the rise in musculoskeletal sports injuries in adolescents. Furthermore, females show a particularly pronounced increase in sports participation, where anatomical and hormonal factors play crucial roles in the development and increased frequency of sports-related injuries. Consequently, there is a growing demand for diagnostic imaging techniques. Musculoskeletal and pediatric radiologists require a comprehensive understanding of intrinsic and extrinsic risk factors and the successive stages of skeletal development that can influence the specific characteristics of sports injuries in adolescents. These aspects are crucial for the diagnostic, prognostic, and therapeutic management of these injuries and for mitigating chronic conditions that could compromise future sports participation. This review analyzes the primary musculoskeletal injuries in adolescent athletes and highlights the pivotal role of different imaging methods in their diagnosis and management.

Overhead and Wheelchair Sport-related injuries in Para Athletes: Interplay between disability and sport specific factors.

With the increasing opportunities for people with disabilities to engage in competitive Para sports, it becomes imperative to understand the injury consequences that may impact both sports participation and daily life activities. This narrative review aims to examine the intrinsic and extrinsic risk factors inherent in overhead and wheelchair summer Para sports, while also exploring prospective avenues for implementing prevention strategies. By understanding the injury epidemiology in this cohort of Para athletes, this review aims to explore the intricate interplay between the athletes' underlying disability with sport-specific factors, such as how wheelchair use might amplify injury susceptibility. Specifically, we highlight the impact of impairment, daily activity, and workload or discipline-induced overuse on injury occurrence, as well as how surveillance methods can be tailored to this population. In this regard, we propose practical injury surveillance methods that encompass a sensitive injury definition, severity assessment, incidence rate calculation, and the recording of adaptive equipment (e.g., type of wheelchair) and workload monitoring. It is worth noting that studies of prospective injury surveillance systems coupled with workload monitoring within a dedicated Para sport web-based platform are scarce. To establish a comprehensive understanding of Para athlete health, the monitoring framework should incorporate regular athlete follow-ups and facilitate knowledge transfer.

A Model for Causality of Pitching-related Overuse Injuries in Women's Fastpitch Softball.

Fastpitch softball is a popular women's sport, and athletes, particularly pitchers, are at high risk for overuse injury. Softball-related injury rates are low; however, the prevalence of overuse injuries is high. Injuries at the high school and collegiate levels occur early in the season, and approximately 50% of shoulder and elbow injuries in softball are attributable to overuse. Survey research showed 77% of high school pitchers pitch with pain, and 73% of collegiate pitchers reported an overuse injury in the previous season. Modifiable and non-modifiable intrinsic and extrinsic risk factors contribute to injury risk in a model that can be used in history taking, clinical examination, and management of softball-related injuries. In this manuscript, we present a scoping review of fastpitch softball injury research by competitive levels from 1990 to present. We also introduce a model for overuse injury causality in this athlete population. With this information, clinicians will be able to identify risk factors related to injury in softball pitchers. More research is needed to make evidence-based recommendations for injury prevention in this athlete population.

ASSESSMENT OF THE RISK FOR FALLS IN THIRD-AGE PERSONS

Introduction: Falls in the elderly population are one of the main geriatric syndromes and a clear indicator of the fragility of the elderly population. Falls are a leading cause of death and injury in the elderly, resulting in disability and immobility requiring ongoing medical care and high treatment costs. Difficulties in performing daily life activities increase with age due to decline in physical and cognitive functioning. Research objectives: To assess the ability to perform daily life activities, to analyze the risks of falling in elderly people. Methods: 100 people over the age of 65 participated in the research. The research instruments were a questionnaire for the assessment of daily life activities - Barthel Scale / Index (BI) and a questionnaire on screening assessments for the evaluation of falls. Results: The Barthel index shows that the majority of respondents perform daily life activities without problems. Intrinsic factors prove that the median score was 12 with an interquartile range of 7 to 15, which represents the risk of falls in people of the third age. Extrinsic risk factors for falls in people of the third age indicate a median of 4 with an interquartile range of 2 to 5, which represents the risk for falls in older people. The most influential risk factors for falling in our survey are difficulty walking upstairs, incorrect or insufficient use of orthopedic aids, feeling of instability when standing up for the first time, complaining of weakness or reduced sensation in one or the other leg, feeling of low self-confidence, instability when walking and fear from falling. Conclusion: Analyzing the risk factors for a fall, we obtained the result that there is an evident risk for a fall. Based on the estimated risk of falling, the most influential risk factors that affect the performance of daily life activities of elderly people were singled out.

Critical Shoulder Angle in Patients With Cuff Tears.

The pathogenesis of rotator cuff tears (RCTs) is multifactorial. Critical shoulder angle (CSA), which represents the lateral extension of the acromion over the cuff, has been proposed as an extrinsic risk factor. The aim of the present systematic review and meta-analysis was to analyze the available literature regarding the correlation between RCT and CSA. A review was carried out in accordance with the "Preferred Reporting Items for Systematic reviews and Meta-Analyses" guidelines on July 17, 2023, using the following databases: PubMed, Ovid, and Cochrane Reviews. The following keywords were used: "critical shoulder angle," "rotator cuff tears," and "rotator cuff lesions." The methodological quality of the studies was assessed with the MINORS SCORE. Twenty-eight studies were included. The average CSA among the 2110 patients with full-thickness RCT was 36.7 degrees, whereas the same value among the 2972 controls was 33.1 degrees. The average CSA in the 348 patients with partial-thickness RCT was 34.6 degrees, whereas it was 38.1 degrees in the 132 patients with massive RCT. The average MINORS score was 15.6. CSA values were significantly higher in patients with RCT compared with the asymptomatic population. In addition, it appears that CSA values increase with the severity of rotator cuff involvement.

Osteonecrosis of Humeral Head after Arthroscopic Capsular Release for Postoperative Shoulder Joint Stiffness: A Case Report

An arthroscopic capsular release (ACR) is used for persistent shoulder stiffness after an index surgery. No cases of post-ACR humeral head osteonecrosis have been reported to date. A 56-year-old male patient underwent open reduction and internal fixation using a hook plate for acromioclavicular joint dislocation. Despite hardware removal, the patient presented with unresolved shoulder pain and range-of-motion (ROM) limitations. He had a history of hypertension, chronic hepatitis B infection, and alcohol consumption. His preoperative ROM was 90° for active forward flexion, 90° for abduction, 40° for external rotation, and at a sacral level for internal rotation. His preoperative functional status was a visual analog scale (VAS) score of 4, an American Shoulder and Elbow Surgeons (ASES) score of 51, and a Constant–Murley (CMS) score of 48 through normal radiography and magnetic resonance imaging. A standard ACR was performed with a 360° release of the joint capsule via electrocautery ablation. Six months post-ACR, his ROM (forward flexion: 135°; abduction: 135°; external rotation: 70°; internal rotation: T10 vertebra) and functional outcomes (VAS 2; ASES 79; CMS 75) were significantly improved, without an interval change in radiographic assessment. However, 15 months post-operation, the patient experienced a recurrence of shoulder pain and subsequently underwent triamcinolone injections in both the 15th and 21st postoperative months. Radiography revealed humeral head osteonecrosis. Patients with intrinsic or extrinsic risk factors related to humeral head circulation disturbance should be monitored for humeral head osteonecrosis post-ACR.

Does Prophylactic Stretching Reduce the Occurrence of Exercise-Associated Muscle Cramping? A Critically Appraised Topic.

Exercise-associated muscle cramps (EAMC) are sudden, painful, and involuntary contractions of skeletal muscles during or after physical activity. The best treatment for EAMC is gentle static stretching until abatement. Stretching is theorized to relieve EAMC by normalizing alpha motor neuron control, specifically by increasing Golgi tendon organ activity, and physically separating contractile proteins. However, it is unclear if stretching or flexibility training prevents EAMC via the same mechanisms. Despite this, many clinicians believe prophylactic stretching prevents EAMC occurrence. Do athletes who experience EAMC during athletic activities perform less prophylactic stretching or flexibility training than athletes who do not develop EAMC during competitions? In 3 cohort studies and 1 case-control study, greater preevent muscle flexibility, stretching, or flexibility training (ie,duration, frequency) was not predictive of who developed EAMC during competition. In one study, athletes who developed EAMC actually stretched more often and 9 times longer (9.8 [23.8]min/wk) than noncrampers (1.1 [2.5]min/wk). There is minimal evidence that the frequency or duration of prophylactic stretching or flexibility training predicts which athletes developed EAMC during competition. To more effectively prevent EAMC, clinicians should identify athletes' unique intrinsic and extrinsic risk factors and target those risk factors with interventions. Minimal evidence from 3 prospective cohort studies and 1 case-control study (mostly level 3 studies) that suggests prophylactic stretching or flexibility training can predict which athletes develop EAMC during athletic competitions.

New Insights into the Link Between Melanoma and Obesity.

The significant increase in the incidence of obesity represents a global health crisis. Obesity is actually a multi-organ disease affecting the entire organism; hence, skin is no exception. As the functional alterations in the adipose tissue are contributing factors to many diseases, including cancer, recently, the link between the development of melanoma skin cancer and obesity gains increased attention. Besides several other factors, the increase of adipose stromal/stem cells (ASCs) impacts cancer progression. Moreover, increased production of cytokines and growth factors done by ASCs induces tumorigenesis and metastasis. The chronic inflammatory state that is sustained by this metabolic imbalance favors skin malignancies, melanoma included. Cutaneous melanoma, as an aggressive skin cancer, has both intrinsic and extrinsic risk factors where sun exposure and lifestyles are the main environmental factors inducing this skin cancer. With the advent of recent targeted and immune-based therapies in melanoma, the link between obesity and the efficacy of these therapies in melanoma remains controversial. A recent molecular relationship between the melanocortin pathway appending to both melanin synthesis and obesity was established. The biology of adipokines, molecules secreted by the adipose tissue, is linked to inflammation, and their molecular pathways can be involved in angiogenesis, migration, invasion, and proliferation of melanoma cells. In melanoma cells, among the most noticeable metabolic reprogramming characteristics is an increased rate of lipid synthesis. Lipid mediators impact classical oncogenic pathways, affecting melanoma progression. The chapter will tackle also the practical implications for melanoma prevention and treatment, namely, how metabolic manipulation can be exploited to overcome immunosuppression and support immune checkpoint blockade efficacy.

Falls and Alzheimer Disease.

Falls are the leading cause of injury, disability, and injury-related mortality in the older adult population. Older adults with Alzheimer disease (AD) are over twice as likely to experience a fall compared to cognitively normal older adults. Intrinsic and extrinsic fall risk factors may influence falls during symptomatic AD; intrinsic factors include changes in cognition and impaired functional mobility, and extrinsic factors include polypharmacy and environmental fall hazards. Despite many known fall risk factors, the high prevalence of falls, and the presence of effective fall prevention interventions for older adults without cognitive impairment, effective fall prevention interventions for older adults with AD to date are limited and inconclusive. Falls may precede AD-related cognitive impairment during the preclinical phase of AD, though a narrow understanding of fall risk factors and fall prevention interventions for older adults with preclinical AD limits clinical treatment of falls among cognitively normal older adults with preclinical AD. This mini review explores fall risk factors in symptomatic AD, evidence for effective fall prevention interventions in symptomatic AD, and preclinical AD as an avenue for future falls research, including recommendations for future research directions to improve our understanding of falls and fall risk during preclinical AD. Early detection and tailored interventions to address these functional changes are needed to reduce the risk of falls for those at risk for developing AD. Concerted efforts should be dedicated to understanding falls to inform precision fall prevention strategies for this population.

A population study on factors associated with unintentional falls among Iranian older adults

IntroductionFalls among older adults are a significant cause of disability, injury, and death worldwide. The high incidence of falls in older adults, combined with the increased susceptibility to injury of the older adult population, leads to severe global health issues. Further studies are needed to comprehensively evaluate the typical personal and environmental risk factors of falls in the Iranian elderly population. Future preventive strategies and intervention programs will be based on these findings. The study determined the risk factors associated with unintentional falls among a representative sample of older adults living in Tehran, the capital city of Iran.MethodsThe study design was cross-sectional. The target population was men/women aged 65 years and over from the general population living in 22 different districts of Tehran who were selected by stratified random sampling. The researchers gathered the data using validated questionnaires and observations. The informed consent was obtained from all participants before starting the interview. Multivariate logistic regression analysis examined the association between falls occurring during the past 12 months with demographics/ socioeconomics and fall-related predictor factors.ResultsThe risk of falls was higher in women (47.0%) and those aged ≥ 75 years (44.1%). Older adults who were married had their fall risk reduced by 36.4% compared with other types of marital status. Older adults who were illiterate (48.1%), housewives (47.0%), and always had concerns about living expenses (53.9%) tended significantly to have a higher risk of falls. Moreover, participants who live with their family were less likely to fall than those who live alone (36.5% vs. 40.4%). Persons with safe homes were less likely to experience falls than persons with unsafe homes (30.9% vs. 41.4%). The logistic regression analysis showed that the female gender, being worried about living expenses, home safety, functional behavior, and function factors, were independently associated with the risk of falls during the past 12 months.ConclusionsOur findings revealed that a wide range of intrinsic and extrinsic risk factors contributed to injurious falls; based on the literature, some are preventable. The present data may be helpful as a starting point and guide future efforts for health providers and policymakers to allocate additional resources and develop proper falls prevention or intervention programs at the community level.

An inpatient fall risk assessment tool: Application of machine learning models on intrinsic and extrinsic risk factors

BackgroundThis study aimed to identify the most impactful set of intrinsic and extrinsic fall risk factors and develop a data-driven inpatient fall risk assessment tool (FRAT). MethodsThe dataset used for the study comprised in-hospital fall records from 2012 to 2017. Four machine learning (ML) algorithms, Support Vector Machine (SVM), Random Forest (RF), Gradient Boosting (Gboost), and Deep Neural Network (DNN) were utilized to predict the inpatient fall risk level. To enhance the performance of the prediction models, two approaches were implemented, including (1) feature selection to identify the optimal feature set and (2) the development of three distinct shift-wise models. Furthermore, the optimal feature sets in the shift-wise models were extracted. ResultsAccording to the results, DNN outperformed other methods by reaching an accuracy, sensitivity, specificity, and AUC of 0.71, 0.8, 0.6, and 0.7, respectively, considering the full set of features. The performance of the models was further improved (by 3-5 %) by conducting a feature selection process for all models. Specifically, the DNN model achieved an accuracy of 0.74 while considering the optimal set of predictors. Moreover, the shift-wise RF models demonstrated higher accuracies (by 4-10 %) compared to the same model using a full feature set. ConclusionsThis study's outcome confirms ML models' compelling capability in developing an inpatient FRAT while considering intrinsic and extrinsic factors. The insight from such models could form a foundation to (1) monitor the inpatients’ fall risk, (2) identify the major factors involved in inpatient falls, and (3) create subject-specific self-care plans.

Orthopedic sports injuries: advanced imaging modalities, return-to-play criteria, and injury prevention

Orthopaedic sports injuries encompass a wide range of musculoskeletal conditions resulting from the physical demands of athletic activities. These injuries can vary from acute, such as sprains and fractures, to chronic overuse syndromes like tendinopathies. Prevalent due to the global enthusiasm for sports, they affect bones, muscles, tendons, ligaments, and joints. The etiology of these injuries is multifactorial, stemming from biomechanical stressors, training methods, genetics, and environmental conditions. Advanced imaging modalities like magnetic resonance imaging and Computed tomography have revolutionized the assessment and diagnosis of these injuries, aiding in treatment decisions and return-to-play criteria. Injury prevention is paramount and involves understanding intrinsic (athlete-related) and extrinsic (environmental) risk factors. Strategies include pre-participation screening, strength and conditioning programs, biomechanical analysis, neuromuscular training, proper equipment use, rule changes, education, and creating a safety-conscious culture. Effective prevention reduces the burden of these injuries. Treatment strategies range from conservative approaches to surgery, depending on the type and severity of the injury. Emerging trends in sports medicine, including biologic therapies and telemedicine, offer promising avenues for improved diagnosis and recovery. The holistic approach to orthopaedic sports injuries encompasses prevention, diagnosis, and treatment, ensuring athletes' well-being and longevity in their chosen sports.