Important Risk Factor For Injury Research Articles

Muscle Injuries in Elite Youth Football Academy: A Six-Year Longitudinal Study on the U15 Football Team

To develop specific preventive strategies, it is necessary to investigate in detail the occurrence of injuries in young football players. This study aimed to provide details about the type, location, severity, and contact nature of muscle injuries in elite U15 Croatian football players. A total number of 130 muscle injuries occurred during the six competitive seasons, of which 88 were DOMS injuries and 42 were rupture injuries. Specifically, 87% of all muscle injuries belonged to the four major groups, with only 15 injuries to the other muscle groups: hamstrings (43), quadriceps (41), adductors (25), calves (6). The muscle injury incidence was stable during the observed period as the injury incidence rate ratio (IRR) was 1.01 (95%CI: 0.99–1.03), with 3.13 (95%CI: 3.09–3.17) muscle injuries per 1000 h of exposure in the first season and 3.06 (95%CI: 3.02–3.1) in the sixth season. A significantly higher risk for muscle injuries was discovered in the competition as the incidence for the whole observed period was 7.38 (95%CI: 7.29–7.47) compared to 2.25 (95%CI: 2.24–2.26) in the training period. Despite the relatively stable number of sustained muscle injuries, the relative proportion of muscular injuries increased over the years due to a severe decrease in the total number of injuries. Regarding the proportion of players who had sustained a muscle injury, our results suggest that approximately two out of five players can expect a muscular injury over the one-season period. Relatively high injury expectancy rates, as well as reinjury rates, require specific preventive interventions that will reduce the number and severity of new and recurred injuries. Future studies should include a wide set of predictor variables in order to establish the most important injury risk factors.

Concussion history and virtual reality metrics predict core or lower extremity injury occurrence among high school athletes.

A history of concussion is recognized as a risk factor for musculoskeletal injury, which is likely associated with physiological effects that warrant better understanding. This study aimed to assess the potential of measurements obtained from an immersive virtual reality (VR) test to identify a subtle perceptual-motor impairment that may be prospectively associated with the occurrence of a core or lower extremity sprain or strain. A cohort of 68 high school athletes (41 female soccer players and 27 male football players) provided survey responses and completed an immersive VR test several days prior to the initiation of preseason practice sessions. Measurements of eye, neck, arm, and whole-body displacements were obtained during 40 successive lunging/reaching responses to visual stimuli moving horizontally across the VR headset display. Injury occurrences were electronically documented from the initial preseason practice session to the final game of the season. A statistically significant and intrinsically credible two-factor prediction model for core or lower extremity injury occurrence included an interaction between female sex and a self-reported history of two or more concussions, along with slow response time (RT) for arm reach (OR = 4.67; 95% CI, 1.51-14.43). Follow-up analyses identified sex-specific cut points for arm reach RT associated with elevated injury risk, which were ≥1.385 s for females and ≥1.257 s for males. High school female soccer players who have sustained more than one concussion appear to be highly vulnerable to core or lower extremity sprain or strain, with the risk of injury compounded by a slow arm reach RT. Male football players as a group demonstrated significantly faster arm reach RT than that of female soccer players, but slow perceptual-motor RT for arm reach was also identified as a potentially important injury risk factor for male players. Immersive VR appears to provide precise measurements of behavioral performance characteristics that depend on brain processing efficiency. Given that the speed, accuracy, and consistency of perceptual-motor responses may be modifiable, future research should explore the potential benefits of VR training for reducing the risk of sport-related injuries.

Injury prevention strategies at the 2019 FIFA Women's World Cup display a multifactorial approach and highlight subjective wellness measurements

ObjectiveTo report the injury prevention programs utilised by top-level female footballers competing internationally. MethodsAn online survey was administered to physicians of the 24 competing national teams at the 2019 Federation Internationale de Football Association (FIFA) Women's World Cup. The survey included 4 sections regarding perceptions and practices concerning non-contact injuries: (1) risk factors, (2) screening tests and monitoring tools, (3) preventative strategies, and (4) reflection on their World Cup experience. ResultsFollowing responses from 54% of teams, the most common injuries encountered included muscle strains, ankle sprains, and anterior cruciate ligament ruptures. The study also revealed the most important injury risk factors during the FIFA 2019 World Cup. Intrinsic risk factors include accumulated fatigue, previous injury, and strength endurance. Extrinsic risk factors include reduced recovery time between matches, congested match schedule, and the number of club team matches played. The 5 most used tests for risk factors were flexibility, joint mobility, fitness, balance, and strength. Monitoring tools commonly used were subjective wellness, heart rate, minutes/matches played, and daily medical screening. Specific strategies to limit the risk of an anterior cruciate ligament injury included the FIFA 11+ program and proprioception training. ConclusionThe present study revealed multifactorial approaches to injury prevention strategies for women's national football teams at the FIFA 2019 World Cup. Challenges to injury prevention program implementation reflect time limitations, schedule uncertainties, and varying club team recommendations. Level of evidenceIV.

Effects and Causes of Detraining in Athletes Due to COVID-19: A Review.

Several aspects of systemic alterations caused by the SARS-CoV-2 virus and the resultant COVID-19 disease have been currently explored in the general population. However, very little is known about these particular aspects in sportsmen and sportswomen. We believe that the most important element to take into account is the neuromuscular aspect, due to the implications that this system entails in motion execution and coordination. In this context, deficient neuromuscular control when performing dynamic actions can be an important risk factor for injury. Therefore, data in this review refer mainly to problems derived in the short term from athletes who have suffered this pathology, taking into account that COVID-19 is a very new disease and the presented data are still not conclusive. The review addresses two key aspects: performance alteration and the return to regular professional physical activity. COVID-19 causes metabolic-respiratory, muscular, cardiac, and neurological alterations that are accompanied by a situation of stress. All of these have a clear influence on performance but at the same time in the strategy of returning to optimal conditions to train and compete again after infection. From the clinical evidence, the resumption of physical training and sports activity should be carried out progressively, both in terms of time and intensity.

A Data Mining Approach to Predict Non-Contact Injuries in Young Soccer Players

Abstract Predicting and avoiding an injury is a challenging task. By exploiting data mining techniques, this paper aims to identify existing relationships between modifiable and non-modifiable risk factors, with the final goal of predicting non-contact injuries. Twenty-three young soccer players were monitored during an entire season, with a total of fifty-seven non-contact injuries identified. Anthropometric data were collected, and the maturity offset was calculated for each player. To quantify internal training/match load and recovery status of the players, we daily employed the session-RPE method and the total quality recovery (TQR) scale. Cumulative workloads and the acute: chronic workload ratio (ACWR) were calculated. To explore the relationship between the various risk factors and the onset of non-contact injuries, we performed a classification tree analysis. The classification tree model exhibited an acceptable discrimination (AUC=0.76), after receiver operating characteristic curve (ROC) analysis. A low state of recovery, a rapid increase in the training load, cumulative workload, and maturity offset were recognized by the data mining algorithm as the most important injury risk factors.

Hand-Held Shoulder Strength Measures Correlate With Isokinetic Dynamometry in Elite Water Polo Players.

Previous authors suggest that lack of strength is an important risk factor for injuries in water polo. Hand-held dynamometers have potential as a clinical tool to measure strength, but they have not been validated in water polo players. The purpose of this study was to estimate intertrial variability and concurrent validity of hand-held dynamometer shoulder strength measurements in elite water polo players. A total of 19 male and 20 female elite water polo players performed isometric external (ER) and internal (IR) rotation strength tests against a hand-held dynamometer bilaterally in supine position with the shoulder in a 90-90 position. In addition, concentric IR and ER was captured at 90 deg/s with an isokinetic dynamometer, and torque values were determined near the 90-90 position. Spearman correlation coefficients were calculated for ER torque, IR torque, and ER/IR ratios between the devices. Two-way mixed-model intraclass correlations were used to assess intertrial variability. Correlations between the devices were strong to very strong (ρ = .65-.82, P < .01) for absolute IR and ER but low for ER/IR ratios (ρ = .29, P = .07). There was less agreement at higher torque values. Intertrial variability was low with intraclass correlation values .88 to .93, P < .05. These results show that hand-held dynamometers are adequate clinical alternatives to measure absolute shoulder strength in water polo players. Stronger players may require stronger evaluators to resist the player's push and obtain reliable results.

Current Concepts in Arm Care Exercise Programs and Injury Risk Reduction in Adolescent Baseball Players: A Clinical Review.

Awareness of important injury risk factors associated with excessive pitching volume has been highlighted in the literature, but injury rates remain high. Shoulder pain in baseball players is associated with various changes in musculoskeletal movements, which presents as measurable impairments throughout the kinetic chain. Baseball coaches and rehabilitation professionals have utilized exercise programs targeting strength and flexibility of the throwing arm to prevent injuries. The purpose of this review is to summarize the current evidence regarding the effectiveness of arm care exercise programs in reducing upper extremity injury rates in adolescent baseball players. A search of electronic databases, including CINAHL with full text, MEDLINE, and SPORTDiscus was conducted to retrieve available articles in English from the years 2010 through 2020. The search terms injury prevention, exercise, and adolescent baseball were used. Clinical review. Level 4. Improving shoulder internal rotation range of motion by stretching the posterior shoulder muscles daily was associated with a 36% risk reduction of shoulder and elbow injuries. Group-based arm care exercise programs that target multiple musculoskeletal impairments demonstrated an approximately 50% reduced risk of elbow injury. For adolescent baseball players, arm care injury prevention programs focusing on important musculoskeletal impairments are effective at reducing injury incidence rates. Multimodal injury prevention programs that improve multiple musculoskeletal impairments are more comprehensive and may result in better injury reduction than programs focusing on a singular impairment.

The Effect of Combined Training and Racing High-Speed Exercise History on Musculoskeletal Injuries in Thoroughbred Racehorses: A Systematic Review and Meta-Analysis of the Current Literature.

Simple SummaryDespite extensive international research, musculoskeletal injuries remain a key problem for the Thoroughbred racing industry, with multiple welfare and ethical consequences. High-speed exercise (HSE) history is an important risk factor for injury. However, studies report conflicting findings concerning the effect of HSE on the risk of injury. Although most injuries and fatalities occur during training rather than racing, many research studies only evaluate injuries reported on race day, which likely underrepresents the injuries acquired by these horses. This study aimed to determine the effect of combined training and racing HSE on injuries in racehorses. We performed a systematic search of the relevant literature and evaluated the effect of seven measures of HSE on injury through meta-analyses. The total career HSE distance significantly affected the odds of musculoskeletal injuries (MSI). With every 5-furlong (1 km) increase in career HSE distance, the odds of MSI increased by 2%. The average HSE distance per day also affected the odds of MSI. With every additional furlong (200 m) of average HSE per day, the odds of MSI increased by 73%. However, the strength of the available evidence is restricted by methodological limitations, which will need to be addressed in the future, to explore the level of risk and mechanisms for injury in more detail.Despite over three decades of active research, musculoskeletal injuries (MSI) remain a global problem for the Thoroughbred (TB) racing industry. High-speed exercise history (HSEH) has been identified as an important risk factor for MSI. However, the nature of this relationship remains unclear, with an apparent protective effect of HSE against injury, before it becomes potentially harmful. Many MSI cases and fatalities occur during training rather than during racing, resulting in an underestimation of injury from studies focused on race day. The objective of this study was to examine the current evidence of the effect of combined training and racing HSEH on MSI in TB flat racehorses, through a systematic review and meta-analysis. A systematic search of the relevant literature was performed using PubMed®, Scopus®, Web of Science®, and Embase® online databases and the gray literature using sites containing “.edu” or “.edu.au”. Studies included in the review had explored seven different measures of HSE, including total career HSE distance, cumulative HSE distance in the 30 and 60 days before MSI, average HSE distance per day, per event and per 30 days, and the total number of HSE events. The total cumulative career HSE distance significantly affected the odds of MSI, with every 5-furlong increase, the odds of MSI increased by 2% (OR = 1.02; 95% CI 1.01, 1.03; p = 0.004). The average HSE distance per day also affected the odds of MSI, with every additional furlong increasing the odds of MSI by 73% (OR = 1.73; 95% CI 1.29, 2.31; p < 0.001). Other measures of HSE were not found to be consistently associated with risk of MSI, but these results should be interpreted with caution. Significant methodological limitations were identified and influence the comparability of studies. Standardizing the measures of HSE in studies of MSI, and describing training conditions in more detail, would support a more thorough investigation of the relationship between HSE and MSI. An improved understanding of this relationship is critical to mitigating the impact of MSI in the Thoroughbred racehorse.

Leaving injury prevention theoretical? Ask the coach!—A survey of 1012 football coaches in Germany

High injury rates in football (soccer) suggest an urgent need for preventive approaches. Theoretical models illustrating systematic sports injury prevention procedures typically consider descriptions of injury epidemiology and etiology, but do not regard the knowledge and specific needs of important stakeholders within sport practice. This might be one reason why there is still a research-to-practice gap-reducing effectiveness of preventive approaches under real life conditions. Thus, the present study asks football coaches, as the most important decision-makers among coaching and medical staff, for their opinions about injuries and prevention. A random sample of 2000 German football coaches was drawn from the database of the German Football Federation (DFB) and invited to participate in an online survey; of these, 1012 (50.6%) were included for analysis. Participants were subdivided by age categories, coaching licenses, and performance levels of the teams they coached. Overall, lack of fitness/athletics was rated as the most important risk factor for injuries, followed by previous injuries and lack of regeneration. Coordination and core stabilization training as well as regeneration were stated as the most beneficial preventive areas. The results suggest that in general, periodization, load monitoring and reintegration of injured players must be given greater priority in future preventive approaches. Education curricula for lower-level coaching licenses should focus on basic physiology, fundamental medical and physiotherapeutic support, and on low-threshold possibilities of testing and training. To gain a more professional oriented license, coaches should qualify as decision-makers within a team of experts and be taught leadership competence and communication skills.

Internal workload and non-contact injury: a one-season study of five teams from the UEFA Elite Club Injury Study

BackgroundInternal workload (ie, from training and matches) is considered one of the most important injury risk factors for elite European football teams, however there is little published evidence to support...

Can Genetics Predict Sports Injury? The Association of the Genes GDF5, AMPD1, COL5A1 and IGF2 on Soccer Player Injury Occurrence.

Genetics plays an integral role in athletic performance and is increasingly becoming recognised as an important risk factor for injury. Ankle and knee injuries are the most common injuries sustained by soccer players. Often these injuries result in players missing training and matches, which can incur significant costs to clubs. This study aimed to identify genotypes associated with ankle and knee injuries in soccer players and how these impacted the number of matches played. 289 soccer players, including 46 professional, 98 semi-professional and 145 amateur players, were genetically tested. Ankle and knee injuries and the number of matches played were recorded during the 2014/15 season. Four genes were assessed in relation to injury. Genotypes found to be associated with injury included the TT (nucleobase) genotype of the GDF5 gene, TT and CT (nucleobase) genotypes of AMPD1 gene, TT genotype of COL5A1 and GG (nucleobase) genotype of IGF2 gene. These genes were also associated with a decrease in the number of matches played.

Prevalence and risk factor for injury in sub-Saharan Africa: a multicountry study

IntroductionInjury-related morbidity is a neglected health concern in many low-income and middle-income countries. Most injury data in Africa have been collected from hospital-based studies, and few studies have occurred across...

No Association Between Return to Play After Injury and Increased Rate of Anterior Cruciate Ligament Injury in Men's Professional Soccer.

Background:Studies have shown that previous injury, not necessarily anatomically related, is an important injury risk factor. However, it is not known whether a player runs an increased risk of anterior cruciate ligament (ACL) injury after returning to play from other injury types.Purpose:To analyze whether professional soccer players are more susceptible to ACL injury after returning to play from any previous injury.Study Design:Case-control study; Level of evidence, 3.Methods:A total of 101 elite male soccer players suffering a first-time complete ACL injury between 2001 and 2014 were included and matched according to team, age, and playing position with control players who did not have a current injury (1:1 match). For each injured player, the 90-day period prior to the ACL injury was analyzed for injuries and compared with that of control players by using odds ratios (ORs) and 95% CIs.Results:The odds of a player with an ACL injury sustaining a previous injury in the 90-day period did not differ significantly from that of controls (OR, 1.20; 95% CI, 0.66-2.17; P = .65). Testing the frequency of absence periods due to injury between the groups revealed that the odds of a player with an ACL injury having a previous period of absence due to injury did not differ compared with controls (OR, 1.14; 95% CI, 0.64-2.01; P = .77).Conclusion:Players with ACL injury did not have a greater occurrence of absence due to injury in the 3 months preceding their ACL injury compared with matched controls. This indicates that previous injury of any type does not increase the risk of suffering an ACL injury.

Utilization of Practice Session Average Inertial Load to Quantify College Football Injury Risk.

Wilkerson, GB, Gupta, A, Allen, JR, Keith, CM, and Colston, MA. Utilization of practice session average inertial load to quantify college football injury risk. J Strength Cond Res 30(9): 2369-2374, 2016-Relatively few studies have investigated the potential injury prevention value of data derived from recently developed wearable technology for measurement of body mass accelerations during the performance of sport-related activities. The available evidence has been derived from studies focused on avoidance of overtraining syndrome, which is believed to induce a chronically fatigued state that can be identified through monitoring of inertial load accumulation. Reduced variability in movement patterns is also believed to be an important injury risk factor, but no evidence currently exists to guide interpretation of data derived from inertial measurement units (IMUs) in this regard. We retrospectively analyzed archived data for a cohort of 45 National Collegiate Athletic Association Division 1-football bowl subdivision football players who wore IMUs on the upper back during practice sessions to quantify any associations between average inertial load measured during practice sessions and occurrence of musculoskeletal sprains and strains. Both the coefficient of variation for average inertial load and frequent exposure to game conditions were found to be strongly associated with injury occurrence. Having either or both of the 2 risk factors provided strong discrimination between injured and noninjured players (χ = 9.048; p = 0.004; odds ratio = 8.04; 90% CI: 2.39, 27.03). Our findings may facilitate identification of individual football players who are likely to derive the greatest benefit from training activities designed to reduce injury risk through improved adaptability to rapidly changing environmental demands.

DRINKING AND DRIVING AMONG HIGH SCHOOL STUDENTS IN BAC GIANG PROVINCE AND BINH THUAN PROVINCE

Background: Alcohol consumption and driving after drinking have become major public health problems worldwide. Time of first getting drunk is becoming earlier among young people and alcohol has become an important risk factor for injuries, especially traffic injuries among the youth. Objective: To assess the patterns of alcohol consumption and drink-driving behaviour of high school students aged from 15-18. Methods: A cross-sectional descriptive study was conducted among 2,625 high school students in 2 provinces of Bac Giang and Binh Thuan. Results: The average age of first time drinking was 14.4, the average age of first time getting drunk was 15.5. The proportion of students drinking in the past year was 25.9%, of which in Binh Thuan province was 17.6% and that in Bac Giang province was 33.2%. Among students who drank before, 80% of them reported of consuming from 1 to 2 drinks, while 8.6% reported consuming 3 or 4 drinks on a typical day when drinking. The reported rate of drink-driving among these students was 12.1%. Conclusion: Alcohol consumption and driving after drinking among high school students are alarming in Vietnam. The findings suggest an urgent need for a multi-sectorial approach to curtail drink driving among high school students in Vietnam as well as a need of developing an accessible model in the community to support young people to limit the drinking and drink-driving behavior. Key words: alcohol consumption, drink-driving, student

Young Drivers and the Risk for Drowsy Driving

In this issueofJAMAPediatrics,Martiniuketal1prospectivelyfollowed up a large cohort of 19 327 Australian new drivers aged 17 through24years.Driverswere asked todescribe their hours of sleepoverall, aswell as their typical hours of sleeponweekends.Participantswerealsoaskedaboutother important injury risk factors including alcohol anddruguse. These surveydata were linkedprospectively to licensingdataandpolice-reported crashes over the following 2 years. Crash riskwas adjusted for a number of important confounders: time in the study, prior crashes, agegroup, sex, averageweeklydrivinghours, remoteness of residence, drinking behavior (Alcohol Use Disorders Identification Test score), risky driving behaviors, self-harm, drug use, sensation seeking, and psychological distress. They found that those who said they slept fewer than 6 hours each night were at increased risk for crash compared with those who reported getting more than 6 hours of sleep (relative risk, 1.21; 95% CI, 1.04-1.41). Crashes for individuals with less sleep per night (on average and on weekends) were significantly more likely to occur in the evening hours between 8 PM and 6 AM (relative risk, 1.86; 95% CI, 1.11-3.13). Individuals who slept 6 or fewer hours each night were also more risky on nearly every measure studied: they had more prior crashes, drove more each week, and had higher reported alcohol and drug use. The authors do not describe police-reported risk factors identified at the crash, such as suspected alcohol use or contributing factors, which might have provided evidence of associated risks in this cohort. Themagnitude of the increased crash risk (1.21) was comparatively lowrelativetootherriskfactorssuchasreportedcrash risk fromalcohol (estimatedcrash relative riskof 27.4 foryoung drivers 17-20yearsofagewithbloodalcohol level>.08,andrelative risk of 4.62 for young drivers 21-24 years of age).2 However, this riskwasbasedonaveragereportedsleepandmayhave beenmuch higher for individual trips for a drowsy individual. Martiniuk et al1 found that the youngest drivers reported slightly higher average hours of sleep than the older groups in their study, which may have been owing to pressures from work. However, nearly 10% of 17-year-old participants and 17% of 20to 24-year-old subjects reported getting fewer than 6 hours of sleep per night. From the public health perspective, one important question is to examine what potentially modifiable factors may reduce crash risk from drowsy driving. Sleep habits have changed substantially over time,3 and young people experience significant health consequences and reduction in driving performance with sleep deprivation.4-6 The growth in late-night media and technology use may be further jeopardizing healthy sleep for young people.7 Parents can play a role in setting guidelines for healthy sleep, late-night screen time, and driving restrictions. Nighttime driving restrictions for novice young drivers are a standard part of the graduated driving laws. The increased nighttime crash rates described in this study provide further support for the potential benefit of nighttime driving restrictions. Other measures that make it easier to identify novice drivers, such as license-plate decals, hold promise for improving compliance with and enforcement of graduated driving laws and reducing crash risk.8 Young drivers sleeping few hours a night were also more likely to have other high-risk behaviors. They were more likely to drink regularly and use other drugs, and they scored higher on measures of risk taking and sensation seeking. In the study by Martiniuk et al, drivers reporting less sleep were more likely to have crashed in the past. The impact of other crash risk factors, such as alcohol, confers greater risk for young people than for older, more experienced drivers.2 Younger people, who have not fully integrated their driving skills, are particularly vulnerable to behaviors that impair response times and driving performance. Interventions that have been effective for reducing impaired driving remain important tools for reducing the burden of road traffic injury for all ages. Driving remains one of the riskiest activities that young people undertake.9 Seeking interventions that address these risks is a critical public health challenge.10 The longitudinal study by Martiniuk and colleagues provides impetus for seeking public health approaches to reducing drowsy driving, improving enforcement of nighttime driving restrictions for novice drivers, and further exploring the cluster of high-risk driving behaviors among young drivers.

Socioeconomic Status and Injury in a Cohort of Saskatchewan Farmers

To estimate the strength of relationships between socioeconomic status and injury in a large Canadian farm population. We conducted a prospective cohort study of 4,769 people from 2,043 farms in Saskatchewan, Canada. Participants reported socioeconomic exposures in 2007 and were followed for the occurrence of injury through 2009 (27 months). The relative hazards of time to first injury according to baseline socioeconomic status were estimated via Cox proportional hazards models. Risks for injury were not consistent with inverse socioeconomic gradients (adjusted HR 1.07; 95% CI: 0.76 to 1.51 for high vs low economic worry; adjusted HR 1.72; 95% CI: 1.23 to 2.42 for completed university education vs less than high school). Strong increases in the relative hazard for time to first injury were identified for longer work hours on the farm. Socioeconomic factors have been cited as important risk factors for injury on farms. However, our findings suggest that interventions aimed at the prevention of farm injury are better focused on operational factors that increase risk, rather than economic factors per se.

Intrinsic Risk Factors for Hamstring Injuries Among Male Soccer Players

Background: Strain injuries of the posterior thigh are common in soccer. It seems that previous injury and age are important risk factors, but the literature is limited. This study was conducted to see if we could identify intrinsic risk factors for hamstring injuries among male soccer players. Hypothesis: We hypothesized that previous hamstring injuries, reduced function scores, abnormalities on a clinical examination, high maximum sprint speed, poor hamstring strength, or low hamstring/quadriceps ratio can predict increased risk of new hamstring injuries. Study Design: Cohort study; Level of evidence, 2. Methods: A total of 508 players representing 31 amateur teams were tested during the 2004 preseason for potential risk factors for hamstring injury through a questionnaire on previous injury and function score (Hamstring Outcome Score [HaOS]), a clinical examination of the hamstring, and specific hamstring relevant tests. Generalized estimating equations were used in univariate analyses to identify candidate risk factors, and factors with a P value of <.10 were then examined in a multivariate model. Results: During the soccer season, 76 hamstring injuries, affecting 65 legs (61 players), were registered. Univariate analyses revealed previous acute hamstring injury (yes/no) (odds ratio [OR], 2.62; 95% confidence interval [CI], 1.54-4.45), HaOS function score with all subscores except “Soreness” (OR for a 10-point difference in total score, 1.29; 95% CI, 1.08-1.54), age (OR, 1.25; 95% CI, 0.96-1.63), and player position (P = .09) as candidate predictors of high injury risk. In a multivariate analysis, the most important risk factor for injuries to the hamstring was previous acute hamstring injury (yes/no) (adjusted OR, 2.19; 95% CI, 1.19-4.03; P = .01). Conclusion: In a multivariate analysis, previous acute hamstring injury was found to be a significant risk factor for new hamstring injuries. Previously injured players have more than twice as high a risk of sustaining a new hamstring injury.

Injuries to belted older children in motor vehicle crashes

Context The American Academy of Pediatrics and the National Highway Traffic Safety Administration currently recommend that, unless they are under 57 in. in height, 8–12-year-old children use seat belts and all should ride in the rear seats of vehicles. These recommendations assume that the vehicle seat belt should provide adequate protection for these older children in the event of a crash. Objectives To describe characteristics of older children in the rear seat using seat belts in crashes, to estimate their risk and body region distribution of injury, and to identify risk factors for injury. Methods A representative sample of 6680 seat belt-restrained occupants, 8–12 years of age, seated in the rear seat during crashes involving insured vehicles in 16 US states between December 1998 and December 2007. A telephone interview was conducted with the driver of each vehicle. The main outcome was the parent-reported injury defined as Abbreviated Injury Scale (AIS) 2 or greater injuries. Results The risk of injury for belted 8–12 year olds in the rear seat was 1.3%. Head injury was the most common injury (60%), followed by injuries to the face (9%), upper extremity (9%) and abdomen (9%). One out of five (21%) 8–12 year olds either did not use the shoulder portion of the vehicle seat belt or placed it incorrectly behind their back or under their arm. Bivariate analyses indicated a higher risk of injury for these children (1.8%) as compared to children using both the lap and shoulder portions of the seat belt (1.1%). However, this difference was not statistically significant when other risk factors such as crash severity and characteristics of the driver were considered. Conclusions Injuries to the head, face, abdomen and upper extremity are the most common injuries to target for improved protection among 8–12 year olds in seat belts. Driver and crash characteristics are important risk factors for injury. A recent federal motor vehicle safety standard requiring lap and shoulder belts in all rear seat positions has the potential to further decrease the risk of injury to older children using seat belts.

Alcohol and Nonlethal Injuries: A Swiss Emergency Department Study on the Risk Relationship Between Acute Alcohol Consumption and Type of Injury

Acute alcohol consumption has been reported to be an important risk factor for injury, but clear scientific evidence on issues such as injury type is not available. The present study aims to improve the knowledge of the importance of alcohol consumption as an injury determinant with regards to two dimensions of the type of injury, namely the nature and the body region involved. Risk relationships between two injury type components and acute alcohol use were estimated through multinomial and logistic regression models based on data from 7,529 patients-among whom 3,682 had injury diagnoses-gathered in a Swiss emergency department. Depending on the type of injury, between 31.1% and 48.7% of casualties report alcohol use before emergency department attendance. The multinomial regression models show that even low alcohol levels are consistently associated with nearly all natures of injury and body regions. A persistent dose-response effect between alcohol levels and risk associations was observed for almost all injury types. The results highlight the importance and consistency of the risk association between low and moderate levels of acute alcohol consumption and all types of injury. None of the body regions and natures of injury could pride on absence of association between alcohol and injury. Public health, prevention, and care implications are considered.