The Currie Cup Premiership Competition Injury Surveillance Report 2014 - 2018

The Currie Cup Premiership Competition Injury Surveillance Report 2014 - 2018

The South African Rugby Union Youth Weeks Injury Surveillance Report 2018

The South African Rugby Union Youth Weeks Injury Surveillance Report 2018

The health burden of preventable disease in Australia: a systematic review

OBJECTIVE

A systematic review was conducted to determine the health burden of preventable disease in Australia.

METHODS

The PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) statement guidelines were followed to identify, screen and describe the protocols used in the systematic review.

RESULTS

Eleven studies were included in the review. Data on the health burden associated with lifestyle-related risk factors were extracted by disease with outcomes reported in attributable number and proportion of deaths, years of life lost, years lived with disability and disability-adjusted life years (DALYs). Around one-third of DALYs was attributed to all modifiable risk factors. The range of estimates of DALYs attributable to each prioritised risk factor was: combined dietary risk factors, 7.2% to 9.7%; tobacco, 7.9% to 9.0%; alcohol, 5.1% to 12.2%; high body mass, 5.5% to 8.3%; and physical inactivity, 1.2% to 5.5%.

CONCLUSIONS

Although the methods used to estimate preventable health burden varied greatly between studies, all found that a substantial amount of death and disability was attributable to lifestyle-related risk factors. Implications for public health: There is a large health burden in Australia caused by modifiable risk factors and further action is warranted to address this burden.

Head injuries - let's face the facts

Head injuries - let's face the facts

Aerobic physical activity and salivary cortisol levels among women with a history of breast cancer

BACKGROUND

Physical activity (PA) helps reduce cancer-related symptoms and improves overall functioning for women with and without a history of breast cancer (BC). Few researchers have examined the associations between PA and physiological stress measures. The aim of this study was to determine whether aerobic PA was associated with diurnal and reactive cortisol patterns, and whether these associations differed for women with and without a history of BC.

METHODS

Participants were 25 women with a history of BC and 23 women without a history of BC who self-reported aerobic PA frequency. To assess diurnal cortisol patterns, participants provided five saliva samples collected on two consecutive days at the following times: upon awakening, 30 min after waking, 12 PM, 4 PM, and 9 PM. To measure reactive cortisol patterns, participants provided seven saliva samples collected before, during, and after doing the Trier Social Stress Test.

RESULTS

Cortisol patterns differed statistically based on women's cancer history, whereby women without a history of BC had significantly higher overall cortisol reactivity to an acute stressor, and a marginally significant (p = .05) cancer experience by aerobic PA interaction was observed when analyzing diurnal cortisol data.

CONCLUSIONS

Findings suggest that PA may not have the same effect on women with and without a history of BC.

Concomitant association of giant cell arteritis and malignancy: a multicenter retrospective case-control study

INTRODUCTION

Some studies suggest that there is an increased risk of malignancies in giant cell arteritis (GCA). We aimed to describe the clinical characteristics and outcomes of GCA patients with concomitant malignancy and compare them to a GCA control group.

METHOD

Patients with a diagnosis of GCA and malignancy and with a maximal delay of 12 months between both diagnoses were retrospectively included in this study and compared to a control group of age-matched (3:1) patients from a multicenter cohort of GCA patients.

RESULTS

Forty-nine observations were collected (median age 76 years). Malignancies comprised 33 (67%) solid neoplasms and 16 (33%) clonal hematologic disorders. No over-representation of a particular type of malignancy was observed. Diagnosis of GCA and malignancy was synchronous in 7 (14%) patients, while malignancy succeeded GCA in 29 (59%) patients. Malignancy was fortuitously diagnosed based on abnormalities observed in laboratory tests in 26 patients, based on imaging in 14 patients, and based on symptoms or clinical examination in the nine remaining patients. Two patients had a concomitant relapse of both conditions. When compared to the control group, patients with concomitant GCA and malignancy were more frequently male (p < 0.001), with an altered general state (p < 0.001), and polymyalgia rheumatica (p < 0.01).

CONCLUSIONS

This study does not indicate an over-representation of any particular type of malignancy in GCA patients. Initial follow-up dictated by vasculitis may have led to an early identification of malignancy. Nevertheless, GCA male patients with an altered general state and polymyalgia rheumatica might more frequently show concomitant malignancies.

The South African Rugby Union: SA Rugby Injury and Illness Surveillance and Prevention Project (SARIISPP): Youth Week, Injury Surveillance Report, 2018

The South African Rugby Union Youth Weeks Injury Surveillance Report 2018

[Contraception for women after 40: CNGOF Contraception Guidelines]

INTRODUCTION

Choosing contraception for women over 40 can be sometimes difficult but it is crucial since fertility and pregnancy's risks still exist. It requires a thorough evaluation of the situation, in order to identify any vascular and metabolic risk factors, along with the uterine and mammary benign pathologies already diagnosed.

OBJECTIVE

The objective of this review was to elaborate some guidelines for clinical practice regarding contraception's prescription for women over 40.

METHODS

A systematic review of the French and English existing literature was conducted. Pubmed and the Cochrane library were used to identify studies about contraception for perimenopausal women. International guidelines published by scientific societies were also reviewed (RCOG, FSRH, ESHRE, ACOG, WHO, HAS).

RESULTS

No contraceptive methods are contraindicated on the sole basis of age alone. However, because age is a risk factor for vascular and metabolic diseases, combined hormonal contraception and DMPA should not be prescribed at first intention. Copper IUD and progestin-only contraceptives (pill, implant, intrauterine device) should primarily be considered, since they offer good efficacy with lower risks.

CONCLUSIONS

Contraception for women over 40 should not be put aside. Long acting reversible contraception and progestin-only pill have to be prescribed as first-ine. Contraception is no longer needed for women over 50 who use non-hormonal contraception, after a 12 month-amenorrhea. Patients treated with combined hormonal contraception must stop using it over 50. Measuring hormonal levels while using hormonal contraception is not recommended. An hormonal-contraception-free interval must be considered, while using barrier contraception method. If an ovarian activity persists, a non-hormonal contraception or progestin-only contraception (except for DMPA) should be (re-)established.

[Contraception: CNGOF Guidelines for Clinical Practice (Short Version)]

The French College of Obstetrics and Gynecology (CNGOF) releases its first global recommendations for clinical practice in contraception, to provide physicians with an updated synthesis of available data as a basis for their practice. The French Health Authority (HAS) methodology was used. Twelve practical issues were selected by the organizing committee and the task force members. The available literature was screened until December 2017, and allowed the release of evidence-based, graded recommendations. This synthesis is issued from 12 developed texts, previously reviewed by experts and physicians from public and private practices, with an experience in the contraceptive field. Male and female sterilization, as well as the use of hormonal treatments without contraceptive label were excluded from the field of this analysis. Specific practical recommendations on the management of contraception prescription, patient information including efficacy, risks, and benefits of the different contraception methods, follow up, intrauterine contraception, emergency contraception, local and natural methods, contraception in teenagers and after 40, contraception in vascular high-risk situations, and in case of cancer risk are provided. The short/mid-term future of contraception mostly relies on improving the use of currently available methods. This includes reinforced information for users and increased access to contraception for women, whatever the social and clinical context. That is the goal of these recommendations.

The Currie Cup Premiership Competition Injury Surveillance Report 2014 - 2017

The content of the report is based on data collected by the SA Rugby Injury and Illness Surveillance and Prevention Project (SARIISPP) steering group.

Understanding longer-term disability outcomes for Māori and non-Māori after hospitalisation for injury: results from a longitudinal cohort study

OBJECTIVES

The objectives are to (1) describe disability outcomes at 24 months after injury and (2) identify factors contributing to disability outcomes at 24 months after injury, for Māori and non-Māori who have been hospitalised for injury.

STUDY DESIGN

This is a prospective cohort study.

METHODS

Prospective Outcomes of Injury Study participants were injured New Zealanders aged 18-64 years and recruited from New Zealand's no-fault injury insurer, the Accident Compensation Corporation's entitlement claims register. Data about a number of pre-injury, injury-related and early post-injury characteristics were collected from interviews held at 3 and 24 months after injury. Disability was measured using the World Health Organization Disability Assessment Schedule (WHODAS). Modified Poisson regression modelling was used to estimate relative risks (RRs) of disability for Māori and non-Māori who were hospitalised for injury.

RESULTS

Analyses were restricted to 375 Māori and 1824 non-Māori participants for whom complete data were available. Of these, 105 (28%) Māori and 446 (24%) non-Māori were hospitalised for their injury. Of these hospitalised groups, 26% of Māori and 10% of non-Māori were experiencing disability (WHODAS ≥10) at 24 months after injury. Māori who were hospitalised for injury and who were not working for pay before their injury (RR = 2.7; 95% confidence interval [CI] 1.4-4.9), who were experiencing disability before their injury (RR = 3.1; 95% CI 1.6-5.8) or who reported trouble accessing healthcare services for their injury (RR = 2.6; 95% CI 1.3-5.2) were independently at increased risk of disability 24 months after injury. Non-Māori who were hospitalised for injury and who had inadequate household income before injury (RR = 2.4; 95% CI 1.4-4.1), less than the secondary school qualifications (RR = 2.0; 95% CI 1.1-3.8), were not working for pay before injury (RR = 2.8; 95% CI 1.5-5.1), were experiencing disability before their injury (RR = 3.0; 95% CI 1.7-5.2), had ≥2 chronic conditions (RR = 3.5; 95% CI 2.0-6.4) or had body mass index ≥30 kg/m²/undisclosed (RR = 2.4; 95% CI 1.3-4.4) were at increased risk of disability 24 months after injury.

CONCLUSIONS

Variables predicting disability 24 months after injury for Māori, also predict disability 24 months after injury for non-Māori, with one notable exception-trouble accessing healthcare services. Our findings show that having access to healthcare services for injury plays an important role after injury and must be focussed on to ensure that the burden of poor injury-related outcomes and injury-related inequities are reduced and ultimately eliminated.

Modelle für eine zukunftsfähige psychiatrische Versorgung

Die Psychiatrische Versorgungslandschaft steht vor großen Herausforderungen: einerseits steigt die Inanspruchnahme psychiatrisch-psychotherapeutischer Leistungen, andererseits wird auf diesem Hintergrund eine teilweise schon reale und zum Teil noch erwartete Ressour-cenverknappung deutlich. Seit Jahren gibt es Bestrebungen, die Ausgabensteigerung zu begrenzen. Ebenfalls seit Jahren zeigt sich ein Mangel an qualifizierten Mitarbeitern, der in der Berufsgruppe der Ärzte vielfach schon spürbar ist, in der Pflege für die nahe Zukunft prognostiziert wird. Hinzu kommt der vielbeschriebene demografische Wandel, der neben einer Zunahme von älteren Nutzern auch mit einer Zunahme an alternden Helfern einhergehen wird. Aufbauend auf diesen Herausforderungen beschreibt der Beitrag die Aspekte, die für ein zukunftsfähiges psychiatrisches Versorgungssystem aus Sicht der Autoren zu bedenken sind und wendet sich dann bestehenden Versorgungsmodellen zu, die als Antwortversuche auf diese Fragestellungen verstanden werden können. Zum Abschluss werden die sich daraus entwickelnden Zukunftsperspektiven umrissen und ein Ausblick auf eine gesundheitsfördernde psychiatrische Versorgungslandschaft gegeben.

Social gradient in caries experience of Belgian adults 2010

OBJECTIVE

This study aims to explore the caries experience of the Belgian population in relation to social indicators.

BASIC RESEARCH DESIGN

Data collection (2009-2010) consisted of an oral health questionnaire and examination during a home visit.

PARTICIPANTS

Representative sample of the Belgian population (⟩5 years old). Only the economically active population was included for final analyses.

MAIN OUTCOME MEASURES

ANOVA and multivariable regression analyses were used to reveal associations between social indicators, oral hygiene, untreated decay, DMFT and edentulousness.

RESULTS

2742 participants completed the questionnaire, of whom 2563 were examined clinically. Most (53%) were female and mean age was 43.3 years (95% CI= 41.2-45.4). In the total population, 11.1 % were caries-free (DMFT = 0) and mean DMFT was 10.8 (95% CI = 10.0-11.5). In the analysed subsample, higher educated participants had lower DMFT scores than those with low or no educational qualifications (p = 0.003). Employment status was associated with the presence of untreated tooth decay, especially in the youngest age group (p = 0.015), and with edentulousness (p = 0.02), with a higher risk among unemployed women of being completely edentulous (OR = 5.32; 95% CI = 1.75-16.12). Untreated tooth decay was related to frequency of tooth brushing and plaque index (p ⟨ 0.002 and ⟨ 0.001 respectively).

CONCLUSIONS

Caries experience in Belgium, expressed as mean DMFT and proportion of untreated tooth decay, is more associated with level of education and employment status than with family income, which is still the main criterion for larger government allowances for healthcare in Belgium.

Bleeding complications and antithrombotic treatment in 264 pregnancies in antiphospholipid syndrome

Purpose The purpose of this study was to evaluate the safety of antithrombotic treatments prescribed during pregnancy in patients with antiphospholipid syndrome (APS). Methods This international, multicenter study included two cohorts of patients: a retrospective French cohort and a prospective US cohort (PROMISSE study). Inclusion criteria were (1) APS (Sydney criteria), (2) live pregnancy at 12 weeks of gestation (WG) with (3) follow-up data until six weeks post-partum. According to APS standard of care, patients were treated with aspirin and/or low-molecular weight heparin (LMWH) at prophylactic (pure obstetric APS) or therapeutic doses (history of thrombosis). Major bleeding was defined as abnormal blood loss during the pregnancy and/or post-partum period requiring intervention for hemostasis or transfusion, or during the peripartum period greater than 500 mL and/or requiring surgery or transfusion. Other bleeding events were classified as minor. Results Two hundred and sixty-four pregnancies (87 prospectively collected) in 204 patients were included (46% with history of thrombosis, 23% with associated systemic lupus). During pregnancy, treatment included LMWH ( n = 253; 96%) or low-dose aspirin ( n = 223; 84%), and 215 (81%) patients received both therapies. The live birth rate was 89% and 82% in the retrospective and prospective cohorts, respectively. Adverse pregnancy outcomes occurred in 28% of the retrospective cohort and in 40% of the prospective cohort. No maternal death was observed in either cohort. A combined total of 45 hemorrhagic events (25%) occurred in the retrospective cohort, but major bleeding was reported in only six pregnancies (3%). Neither heparin nor aspirin alone nor combined therapy increased the risk of hemorrhage. We also did not observe an increased rate of bleeding in the case of a short interval between last LMWH (less than 24 hours) or aspirin (less than five days) doses and delivery. Only emergency Caesarean section was significantly associated with an increased risk of bleeding (odds ratio (OR) 5.03 (1.41-17.96); p=.016). In the prospective cohort, only one minor bleeding event was reported (vaginal bleeding). Conclusion Our findings support the safety of antithrombotic therapy with aspirin and/or LMWH during pregnancy in high-risk women with APS, and highlight the need for better treatments to improve pregnancy outcomes in APS. PROMISSE Study ClinicalTrials.gov identifier: NCT00198068.

Negative effects in psychotherapy: commentary and recommendations for future research and clinical practice

BACKGROUND

Psychotherapy can alleviate mental distress and improve quality of life, but little is known about its potential negative effects and how to determine their frequency.

AIMS

To present a commentary on the current understanding and future research directions of negative effects in psychotherapy.

METHOD

An anonymous survey was distributed to a select group of researchers, using an analytical framework known as strengths, weaknesses, opportunities and threats.

RESULTS

The researchers perceive an increased awareness of negative effects in psychotherapy in recent years, but also discuss some of the unresolved issues in relation to their definition, assessment and reporting. Qualitative methods and naturalistic designs are regarded as important to pursue, although a number of obstacles to using such methods are identified.

CONCLUSION

Negative effects of psychotherapy are multifaceted, warranting careful considerations in order for them to be monitored and reported in research settings and routine care.

DECLARATION OF INTEREST

None.

The what and how of video analysis research in rugby union: a critical review

BACKGROUND

Video analysis is a common tool used in rugby union research to describe match performance. Studies using video analysis range from broad statistical studies of commercial databases to in-depth case-studies of specific match events. The range of types of studies using video analysis in rugby union, and how different studies apply the methodology, can make it difficult to compare the results of studies and translate the findings to a real-world setting. In attempt to consolidate the information on video analysis in rugby, a critical review of the literature was performed.

MAIN BODY

Ninety-two studies were identified. The studies were categorised based on the outcome of the study and the type of research question, sub-categorised as 'what' and 'how' studies. Each study was reviewed using a number of questions related to the application of video analysis in research. There was a large range in the sample sizes of the studies reviewed, with some of the studies being under-powered. Concerns were raised of the generalisability of some of the samples. One hundred percent of 'how' studies included at least one contextual variables in their analyses, with 86% of 'how' studies including two or more contextual variables. These findings show that the majority of studies describing how events occur in matches attempted to provide context to their findings. The majority of studies (93%) provided practical applications for their findings.

CONCLUSION

The review raised concerns about the usefulness of the some of the findings to coaches and practitioners. To facilitate the transfer and adoption of research findings into practice, the authors recommend that the results of 'what' studies inform the research questions of 'how' studies, and the findings of 'how' studies provide the practical applications for coaches and practitioners.

11th Biennial International Congress of the South African Sports Medicine Association

.

Changes to the Journal - adapt or perish?

.

Bilateral Optic Neuropathy Associated with the Crest Variant of Scleroderma

We report a case of bilateral optic neuropathy associated with the CREST syndrome, a variant of scleroderma. Immunosuppressive therapy achieved significant improvement of the visual symptoms for two years. The pathophysiological mechanisms underlying this unique association remain unclear.

The transition of the South African Journal of Sports Medicine

.