Quantifying Hitting Load in Racket Sports: A Scoping Review of Key Technologies

PURPOSE

This scoping review aims to identify the primary racket and arm-mounted technologies based on inertial measurement units that enable the quantification of hitting load in racket sports.

METHODS

A comprehensive search of several databases (PubMed, SPORTDiscus, Web of Science, and IEEE Xplore) and Google search engines was conducted following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) extension for scoping reviews guidelines. Included records primarily focused on monitoring hitting load in racket sports using commercialized racket or arm-mounted inertial sensors through noncompetitive and competitive racket-sports players.

RESULTS

A total of 484 records were identified, and 19 finally met the inclusion criteria. The largest number of systems found were compatible with tennis (n = 11), followed by badminton (n = 4), table tennis (n = 2), padel (n = 1), and squash (n = 1). Four sensor locations were identified: grip-attached (n = 8), grip-embedded (n = 6), wrist (n = 3), and dampener sensors (n = 2). Among the tennis sensors, only 4 out of the 11 (36.4%) demonstrated excellent reliability (>.85) in monitoring the number of shots hit either during analytic drills or during simulated matches. None of the other racket-sports sensors have undergone successful, reliable validation for hitting-volume quantification.

CONCLUSIONS

Despite recent advancements in this field, the quantification of hitting volume in racket sports remains a challenge, with only a limited number of tennis devices demonstrating reliable results. Thus, further progress in technology and research is essential to develop comprehensive solutions that adequately address these specific requirements.

Analysis of injuries during the 2019 Rink Hockey World Championship

OBJECTIVES

The purpose of this study is to describe the incidence and characteristics of injuries at the 2019 Rink Hockey World Championship.

METHODS

A cross-sectional study was performed among rink hockey athletes from three National Teams (Argentina, Portugal, and Spain). All injuries were reported by the medical staff of each National Team during the preparation period and the competition in the 2019 World Championship (Barcelona, Spain). Injury rate was calculated as the number of injuries per 1000 hours of player-hours of exposure.

RESULTS

A total of 91 players (n = 61, 67% male; and n = 30, 33% female) participated in the study: 31 Senior Male (34%), 30 Senior Female (33%), and 30 Under-19 Male (33%). A total of 54 games were played by 9 teams from 3 countries, comprising of 4562 and 4380 hours of total athletic game and training exposure recorded, respectively. Fifty-one injuries (20 injuries with time-loss and 31 medical attention -injuries with no time-loss) were reported. The overall injury incidence rate was 11.2/1000 hours (95% CI, 8.5-14.7). The injury incidence during games (27.5; 95% CI, 11.6-65.2) was higher than the injury incidence during training sessions (3.4; 95% CI, 2-5.7). The incidence rate for game for the entire study period was 8.19 times higher (95% CI, 2.61-21.36) than that for training. The global injury burden was 45.4 days/1000 hours for a total exposure time. Acute was the most frequently documented onset and the non-contact was the most common mechanism. The most frequently reported injuries were head contusion (n = 5, 25%), followed by thigh injuries (n = 3, 15%).

CONCLUSIONS

The injury incidence reported in a Rink Hockey international competition was 11.2/1000 hours. The risk of injury was higher during games than during training. Prevention strategies for injuries in these kinds of championships may be worth discussing. The craniofacial injuries were the most frequently reported.

Assessing the impact of the COVID-19 lockdown on the energy consumption of university buildings

Exceptional pandemic lockdown measures enabled singular experiments such as analysing the energy consumption of vacant buildings. This paper assesses the impact of the COVID-19 lockdown on the energy use of academic buildings. For this purpose, weather-adjusted energy use was compared before and during the lockdown, including different levels of lockdown restrictions. Results obtained for the 83 academic buildings of Universitat Politècnica de Catalunya - Barcelona Tech (UPC) reveal that the avoided energy consumption amounted to over 4.3 GWh during the post-pandemic year. However, the results indicate that academic buildings were still using approximately 46.9% of their typical energy consumption during strict lockdown. This revelation emphasizes the high environmental burden of buildings, regardless of whether they are occupied.

Use of GPS to measure external load and estimate the incidence of muscle injuries in men's football: A novel descriptive study

Measurement of external load in players provides objective information to optimise the weekly balance between training and recovery to improve performance and prevent injuries. Our aim was to evaluate the incidence of sports-related muscle injuries of the lower limb in relation to external load, measured by global positioning system (GPS), in football players. A descriptive study was carried out. Data were collected from 71 professional male football players (30 professionals and 41 youth players) from an elite football club competing in the Spanish and European League in the 2017-2018 season. As external load variables, we measured High Metabolic Load Distance (HMLD), High Speed Running (HSR), Player Load (PL), and Total Distance (TD) through GPS. Injury rate (IR) was calculated both in relation to such GPS load metrics and to load exposure time. We considered categories (youth and professional), playing positions (centre back, full back, midfielder, and forward), and training day with respect to match-day (-4MD, -3MD, -2MD, -1MD, MD, +1MD, +2MD). The GPS load metrics HMLD, HSR, PL, and TD showed very similar patterns across categories and positions, but varied according to training session or MD. The highest loads were observed on MD and three days prior to the match (-3MD). Similarly, the overall IR, both calculated per load exposure time and per GPS load metrics, was highest on MD and -3MD. Again, no differences were observed between youth and professional players. Midfielders demonstrated the highest IR in all metrics, followed by the forwards. In conclusion, this study suggests that external load and incidence of muscle injuries are directly proportional. Therefore, the measurement of more external load variables other than load exposure time, such as the GPS metrics HMLD, HSR, PL, and TD may help to describe the pattern and magnitude of injuries. Future studies based on ours may help to further improve the understanding of the incidence of muscle injuries on the basis of external loads measurements in different football teams.

Impacts of ambient temperature and seasonal changes on sports injuries in Madrid, Spain: a time-series regression analysis

Objectives

Recreational physical activity is an integral part of our society, and the injuries caused by sports activities are a concern for public health. We studied the effect of outdoor ambient temperature on hospital emergency department visits caused by sports injuries in Madrid, Spain, and accounted for its seasonal changes.

Methods

We used a time-series design. Data was analysed with quasi-Poisson regression models. We calculated the proportion of emergency visits attributable to seasonal changes before and after adjusting for daily ambient temperature. We modelled the association between emergency visits and temperature using distributed lag non-linear models.

Results

The proportion of emergency visits attributable to seasonal changes was 24.1% and decreased to 7.6% after adjusting for temperature. We found a high risk of emergency visits associated with cold and hot temperatures, whereas the risk was higher for heat.

Conclusion

Sports and recreational physical activity injuries are not rare events; therefore, appropriate healthcare decisions should consider the impact of outdoor ambient temperature and seasonal changes.

The use of recovery strategies by Spanish first division soccer teams: a cross-sectional survey

OBJECTIVES

different active and passive post-exercise recovery techniques such as massage, foam rolling, stretching or ice baths among others, are used by elite athletes to promote effective physiological, physical, and mental restoration. However, limited research is available investigating the use of recovery strategies in professional soccer. As such, we aimed to explore and describe the use of strategies by professional teams throughout the season, describing competitive and preparatory phases.

METHODS

the present study collected data from all professional Spanish soccer teams who played in 'LaLiga' (The Spanish first division), during the season 2018-2019 (n = 20) and the ones promoted for the season 2019-2020 (n = 3). A six-section online survey was responded once.

RESULTS

teams used different recovery protocols and combinations, although natural and physical strategies such as sleep/nap, food/fluid replacement, cold/ice bath/shower/immersion, and massage were always present. However, there is no agreement in the protocols and timings employed. Three physical strategies showed a higher presence in the recovery protocols after competition: cold/ice bath/shower/immersion, massage and foam rolling; always used by seventeen teams (74%), sixteen (70%) and thirteen (57%) respectively. The design and supervision of recovery are multidisciplinary tasks in 87% of the teams. Our findings also demonstrate that although there is a body of scientific evidence on recovery, a gap between theory and practice exists with 13% of the teams acknowledging that insufficient logistics and economic resources limit the use of some strategies, and two teams (9%) not periodizing or individualizing recovery.

CONCLUSION

the investigation provided insight into the current use of recovery strategies by 'LaLiga' teams, highlighting that all clubs used them to one extent or another, but also that significant variability responding to individualized perceptions exists. Moreover, this study provides relevant contextual information that may be useful for professional soccer staff concerning the use of recovery strategies.

P–174 Globulin-rich protein supplements improve blastulation efficiency in culture and promote implantation in vitro

Study question

Can globulin-rich compared to albumin (HSA) supplements improve blastulation and support embryo development towards post implantation?

Summary answer

Yes, globulin supplements with clinical-grade quality increase blastulation efficiency by 20% (50% in older mothers) and support the transition of embryos towards post-implantation development.

What is known already

During embryonic development at the morula stage there is a metabolic transition towards glycolysis as demand from outsourced energy increases. Therefore as cleavage proceeds, the demand for nutrients in the embryo increases accordingly.

With few exceptions, HSA from human plasma or recombinant origin has been the main an only protein supplement used in almost all IVF-procedures. Globulin rich supplements are available but their use is not widespread and little is known about their efficiency in post-implantation development.

Study design, size, duration

We have cultured more than 600 mouse embryos in continuous media containing a protein supplement#1 (PS#1), from 1-cell up to blastocyst stage. At blastocyst stage embryos were replaced into fresh media containing protein supplement#2 (PS#2). The embryos were allowed to hatch naturally and then transferred into a proprietary matrix for further development and implantation for an additional 48h. Participants/materials, setting, methods: The blastulation rate, measured for HSA-supplemented embryo cohort was compared with embryos cultured in PS#1. Hatching efficiency was reported for embryos cultured in transfer media including PS#2. Once embedded in the matrix, advanced label-free imaging techniques and custom algorithms to measure matrix implantation strength were used. Key molecular markers (i.e. OCT4, CDX2) for correct post-implantation lineage patterning were documented by conventional 3D confocal immunofluorescence imaging.

Main results and the role of chance

Embryos supplemented with PS#1 reached blastocyst with overall 21% higher efficiency than embryos supplemented by HSA. When separated by age cohorts, embryos obtained from older females (ex-colony breeders, >14 weeks old) reached blastocyst stage with 55% higher efficiency than the same type of embryos cultured in the presence of HSA. Embryos obtained from females at optimal reproductive age reached blastocyst stage 10% more efficiently under PS#1 supplementation than with HSA. Hatching efficiency was 45% higher for embryos cultured with PS#2 than embryos supplemented with HSA. For every variable tested (e.g.% of arrested or degenerated embryos) or condition implemented (e.g. mouse basal media, human basal media from different brands, etc.) PS#1 and PS#2 outperformed, without exception, the supplementation with HSA.

When embedded in the implantation matrix, the embryos cultured with PS#1 (cleavage) and transferred to PS#2 at blastocyst stage showed a remarkable implantation ability as measured by trophoblast outgrowth and matrix deformations. The embryos in PS#2 medium exerted stronger force into the matrix and also survived longer times than the embryos in HSA. PS#2 supported the transition of blastocyst towards post-implantation stages of development showing the correct lineage patterning of embryonic and extraembryonic molecular markers, including Oct4, CDx2, EOMES or GATA4.

Limitations, reasons for caution

This is a study based on an animal model. These observations need to be confirmed by ongoing experiments with human embryos.

Wider implications of the findings: This work constitutes a proof-of-concept for the use of globulin-rich supplements as higher performance substitute of albumin in the culture of IVF embryos, both as (i) a standard protein source for culture media and (ii) as a supplement for transfer media to capacitate the embryo for implantation.

Trial registration number

Not applicable

Skin manifestations of COVID-19 in children: Part 2

The current COVID-19 pandemic is caused by the SARS-CoV-2 coronavirus. The initial recognized symptoms were respiratory, sometimes culminating in severe respiratory distress requiring ventilation, and causing death in a percentage of those infected. As time has passed, other symptoms have been recognized. The initial reports of cutaneous manifestations were from Italian dermatologists, probably because Italy was the first European country to be heavily affected by the pandemic. The overall clinical presentation, course and outcome of SARS-CoV-2 infection in children differ from those in adults, as do the cutaneous manifestations of childhood. In this review, we summarize the current knowledge on the cutaneous manifestations of COVID-19 in children after thorough and critical review of articles published in the literature and from the personal experience of a large panel of paediatric dermatologists in Europe. In Part 1, we discussed one of the first and most widespread cutaneous manifestations of COVID-19, chilblain-like lesions. In this part of the review, we describe other manifestations, including erythema multiforme, urticaria and Kawasaki disease-like inflammatory multisystemic syndrome. In Part 3, we discuss the histological findings of COVID-19 manifestations, and the testing and management of infected children for both COVID-19 and any other pre-existing conditions.

Groin problems from pre- to in-season: a prospective study on 386 male Spanish footballers

This study investigated the weekly prevalence of groin problems over a 3-week football pre-season, compared to a 39-week competitive in-season. We registered time-loss groin injuries, and self-reported weekly groin-pain in 17 amateur male football teams (386 players). The average weekly prevalence of groin problems (prevalence ratio (PR)) was 1.8 times higher (95% CI 1.6 to 2.0) during pre-season (21%) compared to in-season (12%). We found a higher weekly prevalence (PR 1.8; 95% CI 1.6 to 2.1) of groin problems without time loss, during the pre-season (19%) compared to the in-season (10%), but no significant difference in the weekly prevalence of groin problems with time loss (PR 1.5; 95% CI 1.0 to 2.4). Attention should be given to optimal load progression, and early implementation of preventive measures during the football pre-season to reduce the prevalence of groin problems in both pre- and in-season.

Skin manifestations of COVID-19 in children: Part 3

The current COVID‐19 pandemic is caused by the SARS‐CoV‐2 coronavirus. The initial recognized symptoms were respiratory, sometimes culminating in severe respiratory distress requiring ventilation, and causing death in a percentage of those infected. As time has passed, other symptoms have been recognized. The initial reports of cutaneous manifestations were from Italian dermatologists, probably because Italy was the first European country to be heavily affected by the pandemic. The overall clinical presentation, course and outcome of SARS‐CoV‐2 infection in children differ from those in adults as do the cutaneous manifestations of childhood. In this review, we summarize the current knowledge on the cutaneous manifestations of COVID‐19 in children after thorough and critical review of articles published in the literature and from the personal experience of a large panel of paediatric dermatologists in Europe. In Part 1, we discuss one of the first and most widespread cutaneous manifestations of COVID‐19, chilblain‐like lesions, and in Part 2 we expanded to other manifestations, including erythema multiforme, urticaria and Kawasaki disease‐like inflammatory multisystemic syndrome. In this part of the review, we discuss the histological findings of COVID‐19 manifestations, and the testing and management of infected children for both COVID‐19 and any other pre‐existing conditions.

Click here for the corresponding questions to this CME article.

Skin manifestations of COVID-19 in children: Part 1

The current COVID‐19 pandemic is caused by the SARS‐CoV‐2 coronavirus. The initial recognized symptoms were respiratory, sometimes culminating in severe respiratory distress requiring ventilation, and causing death in a percentage of those infected. As time has passed, other symptoms have been recognized. The initial reports of cutaneous manifestations were from Italian dermatologists, probably because Italy was the first European country to be heavily affected by the pandemic. The overall clinical presentation, course and outcome of SARS‐CoV‐2 infection in children differ from those in adults as do the cutaneous manifestations of childhood. In this review, we summarize the current knowledge on the cutaneous manifestations of COVID‐19 in children after thorough and critical review of articles published in the literature and from the personal experience of a large panel of paediatric dermatologists in Europe. In Part 1, we discuss one of the first and most widespread cutaneous manifestation of COVID‐19, chilblain‐like lesions. In Part 2, we review other manifestations, including erythema multiforme, urticaria and Kawasaki disease‐like inflammatory multisystemic syndrome, while in Part 3, we discuss the histological findings of COVID‐19 manifestations, and the testing and management of infected children, for both COVID‐19 and any other pre‐existing conditions.

Click here for the corresponding questions to this CME article.

Higher training workloads do not correspond to the best performances of elite basketball players

The aim of this study was to identify the correspondence between the workload demands in training sessions and the game performance from elite basketball players, according to their specific positions. Data were collected from a professional men's basketball team competing in the Spanish Professional League and Euroleague. Players' activity during the training sessions was measured using WIMU PRO® and the game statistics were used as a measure of game performance. Cluster analysis allowed to classify the training workload and the game performance, whereas correspondence analysis allowed to explore their relationship. In essence, there was no correspondence from the higher workloads with the best performances, on the contrary, the small forwards' best performances corresponded to lower training workouts. Despite their importance, the external measures of load need to be complemented with additional (and valid) measures that can be translated to game performance.

Performance changes during the off-season period in football players - Effects of age and previous hamstring injury

The aims of this study were to investigate changes in selected performance measures during an off-season period, their association, and the potential role of age and previous hamstring injury in semi-professional and amateur football players. Seventy-four male players (age: 25 ± 4 years, stature: 178.0 ± 6.6 cm, body mass: 74.9 ± 8.1 kg) were assessed at the beginning and end of the off-season summer-period for sprint, change-of-direction performance and eccentric hamstring strength. Small to medium increases in sprint times were observed at 5 (d = 0.26, p = 0.057), 10 (d = 0.42, p < 0.001) and 30 m (d = 0.64, p < 0.001). Small (d = -0.23, p = 0.033) improvements were observed for COD performance, and no changes in eccentric hamstring strength (d = 0.10, p = 0.317). The changes in the outcomes were not affected by age (p = 0.449 to 0.928) or previous hamstring injury (p = 0.109 to 0.995). The impaired sprint performance was not related to changes in eccentric hamstring strength (r = -0.21 to 0.03, p = 0.213 to 0.856), instead, changes in COD performance were associated with changes in eccentric hamstring strength (r = -0.42, p = 0.008).

Differences in Physical Demands between Game Quarters and Playing Positions on Professional Basketball Players during Official Competition

The purpose of this study was to compare physical demands between game quarters and specific playing positions during official basketball competition. Thirteen professional male basketball players from the Spanish 2nd Division were monitored across all 17 regular-season home games. Physical demands were analyzed using a local positioning system (WIMU PRO™, Realtrack Systems S.L., Almería, Spain) and included peak velocity, total distance covered, high-speed running (>18 km·h-1), player load, jumps (>3G), impacts (>8G) and high-intensity accelerations (≥2 m·s-2) and decelerations (≤-2 m·s-2). A linear mixed model was used to test statistical significance (p < 0.05) between independent variables. Furthermore, standardized Cohen's effect size (ES) and respective 90% confidence intervals were also calculated. There was an overall decrease in all variables between the first and fourth quarter during competition. Specifically, total distance covered (p < 0.001; ES = -1.31) and player load (p < 0.001; ES = -1.27) showed large effects between the first and last period. Regarding differences between positions, guards presented significant increased values compared to centers (p = 0.04; ES = 0.51), whereas centers achieved significant larger results and moderate effects in comparison to guards in peak velocity (p = 0.01; ES = 0.88) and jumps (p = 0.04; ES = 0.86). In conclusion, physical demands vary between game quarters and playing positions during official competition and these differences should be considered when designing training drills to optimize game performance.

Incidence of Tendinopathy in Team Sports in a Multidisciplinary Sports Club Over 8 Seasons

Tendinopathy is a critical medical condition that often hinders level of participation for professional and young athletes in many sports. The purpose of the study was to describe the incidence and severity of tendinopathy in a multi-sport club with professional and youth teams. We performed a retrospective epidemiological study. Incidence of tendinopathy in players (n = 3839; 8-38 years, professional and youth) was reviewed over 8 seasons (2008-2016) in 5 team sports: football, basketball, handball, roller hockey, and futsal. Team physicians diagnosed and classified tendinopathies according to anatomical location, sport types, playing category, sex, playing surface, lost training time, and severity (time to return to play). Injuries were coded using OSICS-10, and incidence of tendinopathies were calculated as the number of injuries per 100 players per season. The total relative frequency of tendinopathy (versus total injuries) was 22% (843/3839) over 8 seasons from 360 in youth and 483 in professional teams. The incidence of injury was the highest in professional basketball [69.9, 95%CI: (58.0-81.4)] followed by professional roller hockey [64.4, 95%CI: (47.3-85.6)], and professional futsal [36.2, 95%CI: (27.3-47.1)]. The most incidences commonly affected tendons were the patellar [11.7, 95%CI: (10.0-13.5)] and Achilles [10.3, 95%CI: (8.5-12.5)]. Tendinopathies represent a significant number of injuries in team sports and are more common in professional than youth teams, especially basketball and roller hockey. Additional studies are needed to understand associated time-loss and impact on performance, and to develop prevention strategies for high risk sports.

Ankle Sprain Versus Muscle Strain Injury in Professional Men's Basketball: A 9-Year Prospective Follow-up Study

Background:

Ankle sprain is the most common injury in basketball players. However, in our routine clinical evaluation, we observe a high frequency of muscle injury. Currently, no reliable information is available regarding the magnitude of these types of injury.

Purpose:

To describe the type and rate of muscle injuries in male basketball players and discuss clinical management and prevention strategies.

Study Design:

Descriptive epidemiology study.

Methods:

A total of 59 professional male basketball players were evaluated over 9 seasons (2007-2015). All injuries during the study period were registered through use of a validated electronic medical record system.

Results:

We analyzed 463 injuries, of which 207 resulted in time loss and 256 required medical attention, for a total exposure time of 42,678 hours for the 59 players involved in the study. Muscle strains and ankle sprains accounted for 21.2% (n = 98) and 11.9% (n = 55) of all injuries, respectively. The global incidence rate was 10.8 injuries per 1000 player-hours (95% CI, 9.9-11.9). The global injury burden was 53.9 days lost due to injuries per 1000 hours for a total exposure time. The incidence rate of muscle strains (2.3; 95% CI, 1.9-2.8) was higher than that of ankle sprains (1.3; 95% CI, 1-1.7). The incidence rate for muscle injuries for the entire study period was 1.8 times higher (95% CI, 1.28-2.49) than that for ankle sprains.

Conclusion:

In this study, muscle injuries were more commonly observed compared with ankle sprains. Prevention strategies for muscle injuries may be worth discussing.

Does the economic recession influence the incidence of pertussis in a cosmopolitan European city?

Background

In the last few years, pertussis has re-emerged worldwide. The aim of this article is to study how the incidence of the disease has evolved in Barcelona city over a 16-year period, and determine which factors are associated with the evolution of the disease. We discuss the causes of the observed changes considering different possibilities such as vaccination coverage, vaccine effectiveness, increased surveillance or the effect of the current economic recession.

Methods

We performed a cross-sectional, observational, population-based descriptive study using data for the 2000–2015 period from the notifiable diseases register maintained by Barcelona Public Health Agency. We used Poisson regression to compute adjusted odds ratios (aOR) and their corresponding 95% confidence intervals (CI).

Results

A total of 1791 cases were registered. The incidence of the disease increased throughout the city from 2011 onwards. While children under 1 year of age had the highest-incidence and were the most at risk (aOR = 27.18, CI:23.51–31.44), we found that the age of affected children was higher in the last years. Incidence proportion (PRR) was lower among foreign-born children than native children (PRR = 0.43 CI:0.32–0.58). In the whole-cell vaccine period (2000–2004), the percentage of cases under 1 year of age who received the vaccine was lower than in 2005–2015 when the acellular vaccine was used (p = 0.01), suggesting a lower efficacy of the acellular vaccine. However, vaccination coverage in children under 6 years remained high (~ 90%), and there were no significant year-to-year variations (p = 0.757). Moreover, there did not appear to be any significant restrictions in medical care. According to the index of disposable household income (DHI), pertussis incidence increased from 2011 onwards in all neighbourhoods and remained higher in those with lower DHI.

Conclusions

The noteworthy increase in pertussis incidence does not seem to be due to the economic recession, but to other factors here described.

Sports Biostatistician: a critical member of all sports science and medicine teams for injury prevention

Sports science and medicine need specialists to solve the challenges that arise with injury data. In the sports injury field, it is important to be able to optimise injury data to quantify injury occurrences, understand their aetiology and most importantly, prevent them. One of these specialty professions is that of Sports Biostatistician. The aim of this paper is to describe the emergent field of Sports Biostatistics and its relevance to injury prevention. A number of important issues regarding this profession and the science of sports injury prevention are highlighted. There is a clear need for more multidisciplinary teams that incorporate biostatistics, epidemiology and public health in the sports injury area.

Low External Workloads Are Related to Higher Injury Risk in Professional Male Basketball Games

The primary purpose of this study was to identify potential risk factors for sports injuries in professional basketball. An observational retrospective cohort study involving a male professional basketball team, using game tracking data was conducted during three consecutive seasons. Thirty-three professional basketball players took part in this study. A total of 29 time-loss injuries were recorded during regular season games, accounting for 244 total missed games with a mean of 16.26 ± 15.21 per player and season. The tracking data included the following variables: minutes played, physiological load, physiological intensity, mechanical load, mechanical intensity, distance covered, walking maximal speed, maximal speed, sprinting maximal speed, maximal speed, average offensive speed, average defensive speed, level one acceleration, level two acceleration, level three acceleration, level four acceleration, level one deceleration, level two deceleration, level three deceleration, level four deceleration, player efficiency rating and usage percentage. The influence of demographic characteristics, tracking data and performance factors on the risk of injury was investigated using multivariate analysis with their incidence rate ratios (IRRs). Athletes with less or equal than 3 decelerations per game (IRR, 4.36; 95% CI, 1.78-10.6) and those running less or equal than 1.3 miles per game (lower workload) (IRR, 6.42 ; 95% CI, 2.52-16.3) had a higher risk of injury during games (p < 0.01 in both cases). Therefore, unloaded players have a higher risk of injury. Adequate management of training loads might be a relevant factor to reduce the likelihood of injury according to individual profiles.

Retrospective study of clinical and lesion characteristics of patients undergoing surgical treatment for Pulmonary Tuberculosis in Georgia

Objectives

Our aim was to retrospectively compare clinical data and characteristics of removed lesions of the cohort of patients undergoing therapeutical surgery for their tuberculosis.

Design and methods

Demographic and epidemiological details, clinical data, data on the surgery performed, macroscopic characteristics of the TB lesions removed, and outcome were recorded retrospectively from the 137 patients who underwent therapeutical surgery for their TB in Tbilisi, Georgia during 2014 and 2015.

Results

Men represented 70% of the included patients, presented more comorbidities and underwent operation earlier in terms of days between diagnostic and surgery. Women underwent operation at younger ages, and in MDR/XDR-TB cases, showed higher percentages of sputum conversion at >2 months and of fresh necrosis in the surgical specimens, suggesting a worse evolution. Half of cases were MDR/XDR-TB cases. In spite of being considered microbiologically cured according to WHO, a non despricable percentage of cases showed viable bacilli in the surgical specimen. Even if no causality could be statistically demonstrated, differences could be encountered according to gender and drug susceptibility of the responsible strains.

Conclusions

According to our results, host factors such as gender, type of necrosis found in the lesions, size of lesions and presence of viable bacilli in the surgical specimen, should be included in future studies on therapeutical surgery of TB. As most of studies are done in MDR/XDR-TB, more data on DS-TB operated cases are needed. Our results also highlight that, in spite of achieving the microbiologically cured status, sterilization might not occur, and thus new biomarkers and new methods to evaluate the healing process of TB patients are urgently needed and radiological assays should be taken into account.

Game-Related Performance Factors in four European Men's Professional Volleyball Championships

The present study was designed to assess the relevance of game-related performance factors as outcome predictors in high-level volleyball. To carry out the analysis, the official box scores of 399 matches played by 47 different teams in four different European male professional volleyball leagues (Italy, Poland, Germany and Turkey) during the 2013-14 regular season were analyzed. A logistic mixed model was performed to determine the effects of different variables in matches’ outcomes. According to the multivariate analysis the following factors were significantly associated with winning matches: the number of scorers (OR = 1.32; CI: 1.09 – 1.59), service errors (OR = 0.91; CI: 0.87 – 0.95), service points (OR = 1.25; CI: 1.15 -1.36), reception errors (OR = 0.79; CI: 0.74 – 0.84), the percentage of positive receptions (OR = 1.02; CI: 1.00 -1.04) and blocked balls (OR = 1.17; CI: 1.11 – 1.26). Team category 2 (OR = 0.39; CI: 0.24 – 0.63) and team category 3 (OR = 0.15; CI: 0.09 – 0.25) were significantly associated with losing matches. These findings can contribute to a better understanding of performance indicators in professional volleyball, helping coaches and decision makers to better determine the importance of particular game factors.

Factors associated with diabetes mellitus among adults with tuberculosis in a large European city, 2000-2013

BACKGROUND

Diabetes mellitus (DM) can contribute to the development of tuberculosis (TB).

OBJECTIVE

To analyse the prevalence of DM and its associated factors among adults with TB in a large city in an industrialised country.

METHODS

This is a population-based study in adults diagnosed with TB between 2000 and 2013 in Barcelona. We studied potentially associated sociodemographic and clinical/epidemiological factors. Logistic regression was used to calculate odds ratios (ORs) and their 95% confidence intervals (CIs).

RESULTS

Of 5849 TB patients, 349 (5.9%) had DM. The annual prevalence of DM ranged from 4.0% to 7.2%. Factors associated with DM were being Spanish-born (OR 1.46, 95%CI 1.11-1.96), age ⩾40 years (OR 6.08, 95%CI 4.36-8.66), cavitary patterns on chest X-ray (OR 1.42, 95%CI 1.08-1.86), experiencing more side effects due to anti-tuberculosis treatment (OR 1.86, 95%CI 1.28-2.64) and hospitalisation at the time of diagnosis (OR 1.8, 95%CI 1.40-2.31). Human immunodeficiency virus infection was associated with a lower probability of DM in both subjects with a history of injection drug use (OR 0.27, 95%CI 0.10-0.57) and those without (OR 0.04, 95%CI 0.002-0.19).

CONCLUSIONS

DM prevalence among adults with TB in Barcelona is low and remained stable over the 14-year study period. However, TB patients with DM were potentially more infectious and their clinical management was more complicated.

Factors associated with smoking among tuberculosis patients in Spain

BACKGROUND

To determine the prevalence of smoking and analyze associated factors in a cohort of patients diagnosed with tuberculosis (TB) in Spain between 2006 and 2013.

METHODS

Multicenter, cross-sectional, descriptive, observational study using a national database of TB patients, using logistic regression to calculate odds ratios (OR) and confidence intervals (CI).

RESULTS

We analyzed 5,846 cases (62 % men, mean age 39 years, 33 % foreigners). 23.4 % were alcohol abuser, 1.3 % were injected drug users (IDU), 4.6 % were co-infected with HIV, and 7.5 % had a history of TB treatment. 6.6 % and 0.8 % showed resistance to one and multiple drugs, respectively. The predominant clinical presentation was pulmonary (71 %) with a cavitary radiological pattern in 32.8 % of cases. 82 % of cases were confirmed microbiologically, and 54 % were smear-positive microscopy. 2,300 (39.3 %) patients were smokers. The following factors were associated with smoking: male sex (OR = 2.26;CI:1.97;2.60), Spanish origin (OR = 2.79;CI:2.40-3.24), alcoholism (OR = 2.85;CI:2.46;3.31), IDU (OR = 2.78;CI:1.48;5.52), homelessness (OR = 1.99;CI:1.14-3.57), pulmonary TB (OR = 1.61;CI:1.16;2.24), cavitary radiological pattern (OR = 1.99;CI:1.43;2.79) and a smear-positive microscopy at the time of diagnosis (OR = 1.39;CI:1.14;1.17).

CONCLUSIONS

The prevalence of smoking among TB patients is high. Smokers with TB have a distinct sociodemographic, clinical, radiological and microbiological profile to non-smokers.

Factors Associated with Fatality during the Intensive Phase of Anti-Tuberculosis Treatment

OBJECTIVE

To determine the case-fatality rate (CFR) at the end of the intensive phase of tuberculosis (TB) treatment, and factors associated with fatality.

METHODS

TB patients diagnosed between 2006 and 2013 were followed-up during treatment. We computed the CFR at the end of the intensive phase of TB treatment, and the incidence of death per 100 person-days (pd) of follow-up. We performed survival analysis using the Kaplan-Meier method and Cox regression, and calculate hazard ratios (HR) and 95% confidence intervals (CI).

RESULTS

A total of 5,182 patients were included, of whom 180 (3.5%) died; 87 of these deaths (48.3%) occurred during the intensive phase of treatment, with a CFR of 1.7%. The incidence of death was 0.028/100 pd. The following factors were associated with death during the intensive phase: being >50 years (HR = 36.9;CI:4.8-283.4); being retired (HR = 2.4;CI:1.1-5.1); having visited the emergency department (HR = 3.1;CI:1.2-7.7); HIV infection (HR = 3.4;CI:1.6-7.2); initial standard treatment with 3 drugs (HR = 2.0;CI:1.2-3.3) or non-standard treatments (HR = 2.68;CI:1.36-5.25); comprehension difficulties (HR = 2.8;CI:1.3-6.1); and smear-positive sputum (HR = 2.3-CI:1.0-4.8).

CONCLUSION

There is a non-negligible CFR during the intensive phase of TB, whose reduction should be prioritised. The CFR could be a useful indicator for evaluating TB programs.

Tuberculosis Costs in Spain and Related Factors

OBJECTIVE

To analyze the direct and indirect costs of diagnosis and management of tuberculosis (TB) and associated factors.

PATIENTS AND METHODS

Prospective study of patients diagnosed with TB between September 2014 and September 2015. We calculated direct (hospital stays, visits, diagnostic tests, and treatment) and indirect (sick leave and loss of productivity, contact tracing, and rehabilitation) costs. The following cost-related variables were compared: age, gender, country of origin, hospital stays, diagnostic testing, sensitivity testing, treatment, resistance, directed observed therapy (DOT), and days of sick leave. Proportions were compared using the chi-squared test and significant variables were included in a logistic regression analysis to calculate odds ratio (OR) and corresponding 95% confidence intervals.

RESULTS

319 patients were included with a mean age of 56.72±20.79 years. The average cost was €10,262.62±14,961.66, which increased significantly when associated with hospital admission, polymerase chain reaction, sputum smears and cultures, sensitvity testing, chest computed tomography, pleural biopsy, drug treatment longer than nine months, DOT and sick leave. In the multivariate analysis, hospitalization (OR=96.8; CI 29-472), sensitivity testing (OR=4.34; CI 1.71-12.1), chest CT (OR= 2.25; CI 1.08-4.77), DOT (OR=20.76; CI 4.11-148) and sick leave (OR=26,9; CI 8,51-122) showed an independent association with cost.

CONCLUSION

Tuberculosis gives rise to significant health spending. In order to reduce these costs, more control of transmission, and fewer hospital admissions would be required.

Do Basketball Players Have a High Risk of Pulmonary Embolism? A Scoping Review

PURPOSE

Pulmonary embolism (PE) is a serious preventable disease that requires urgent care. In recent years, there have been several reports in the media about basketball players experiencing PE. The aim of the present study was to assess whether there is a need for in-depth studies to determine whether basketball players constitute a group particularly at risk of PE and to describe some hypotheses to be investigated.

METHODS

We reviewed original articles about PE among professional and amateur basketball players in the scientific literature (PubMed) and the Internet (Google search) for the seasons 2010-2011 to 2014-2015, both of which were included. We used search strategies that included some combination of PE-related terms. Rates of PE were calculated and were compared with those obtained from other studies.

RESULTS

Of the 15 cases detected, the majority were men (66.7%), mean ages being 28.8 yr among males and 20.4 yr among females. We focused on six cases which, were detected among National Basketball Association and Asociación de Clubes de Baloncesto basketball players, resulting in an average incidence of 1.27 and 2.06 cases per 1000 players per year in the National Basketball Association and Asociación de Clubes de Baloncesto, respectively. This incidence is much higher than that observed in general population studies for the same age group.

CONCLUSIONS

Basketball players seem to have a higher risk of PE than their peers from the general population. More studies are needed to confirm these findings and identify factors predisposing them to PE to contribute to its prevention.

Factors associated with unreported tuberculosis cases in Spanish hospitals

BACKGROUND

Under-reporting of tuberculosis (TB) cases complicates disease control, hinders contact tracing and alters the accuracy of epidemiological data, including disease burden. The objective of the present study is to evaluate the proportion of unreported TB cases in Spanish healthcare facilities and to identify the associated factors.

METHODS

A multi-center retrospective study design was employed. The study included TB cases diagnosed in 16 facilities during 2011-2012. These cases were compared to those reported to the corresponding public health departments. Demographic, microbiological and clinical data were analyzed to determine the factors associated with unreported cases. Associated factors were analyzed on a bivariate level using the x(2) test and on a multivariate level using a logistic regression. Odds ratios (OR) and 95 % confidence intervals (CI) were calculated.

RESULTS

Of the 592 TB cases included in the study, 85 (14.4 %) were not reported. The percentage of unreported cases per healthcare center ranged from 0-45.2 %. The following variables were associated to under-reporting at a multivariate level: smear-negative TB (OR = 1.87; CI:1.07-3.28), extrapulmonary disease (OR = 2.07; CI:1.05-4.09) and retired patients (OR = 3.04; CI:1.29-7.18). A nurse case manager was present in all of the centers with 100 % reporting. The percentage of reported cases among the smear-positive cases was 9.4 % and 19.4 % (p = 0.001) among the rest of the study population. Smear-positive TB was no associated to under-reporting.

CONCLUSIONS

It is important that TB Control Programs encourage thorough case reporting to improve disease control, contact tracing and accuracy of epidemiological data. The help from a TB nurse case manager could improve the rate of under-reporting.

[Tuberculosis and immigration in Spain: scoping review]

BACKGROUND

Immigration is a fairly recent phenomenon in Spain and there are still few scientific publications on tuberculosis (TB) and immigration. Therefore, the aim of this study is to describe the differential characteristics of TB in the immigrant population with respect to natives in Spain.

METHODS

Literature review of original articles written in Spanish or English and published 1998-2012 about TB among immigrant population. The articles with the key words "Tuberculosis", "immigrants" and "Spain" were included. Literature search was performed in Medline and MEDES.

RESULTS

A total of 72,087 articles on TB were detected worldwide, 6% of them dealt with the immigration issue. Regarding Spain we found 2,917 articles representing 4% of the papers published worldwide, and in 219 (7.5%) immigration was considered. Of the 219 articles, 48% were published in Spanish journals and the 52% remaining in Anglo-Saxon journals. 93.5% of immigrants with TB were younger than 51, whereas this percentage was 64.9% in natives. Drug resistance can be seen in 7.8% of the immigrant population but in only 3.8% of natives. It was also detected that the unavailability of a health card could be a problem.

CONCLUSION

Immigrants with TB were characterized by being younger and having more drug resistance and coming mostly from Latin America, Eastern Europe, Africa and Asia. It was also detected that the unavailability of a health card could be a problem.

An anatomical and histological study of the structures surrounding the proximal attachment of the hamstring muscles

INTRODUCTION

The proximal attachment of hamstring muscles has a very high incidence of injuries due to a wide number of factors and its morphology may be one of the underlying factors as scientific literature points out. The connective tissue component of the attachment of hamstring muscles is not well known. For this reason the aim of this study is to describe the anatomy and histology surrounding the proximal attachment of the hamstring muscles (PAHM) and its direct anatomic relations.

METHODS

Forty-eight cryopreserved lower limbs have sequentially been studied by means of dissection, anatomical sections and histology.

RESULTS

All specimens studied presented an annular connective tissue structure that resembles a retinaculum, which covers and adapts to the attachment of hamstring muscles on the ischial tuberosity.

CONCLUSION

The results show how this retinaculum is continuous with the long head of biceps femoris muscle, however there is a layer of loose connective tissue between the retinaculum and the semitendinosus muscle. Furthermore, this structure receives expansions of the anterior epimysium of the gluteus maximus muscle (GIM).

Methodological quality and reporting of generalized linear mixed models in clinical medicine (2000-2012): a systematic review

BACKGROUND

Modeling count and binary data collected in hierarchical designs have increased the use of Generalized Linear Mixed Models (GLMMs) in medicine. This article presents a systematic review of the application and quality of results and information reported from GLMMs in the field of clinical medicine.

METHODS

A search using the Web of Science database was performed for published original articles in medical journals from 2000 to 2012. The search strategy included the topic "generalized linear mixed models","hierarchical generalized linear models", "multilevel generalized linear model" and as a research domain we refined by science technology. Papers reporting methodological considerations without application, and those that were not involved in clinical medicine or written in English were excluded.

RESULTS

A total of 443 articles were detected, with an increase over time in the number of articles. In total, 108 articles fit the inclusion criteria. Of these, 54.6% were declared to be longitudinal studies, whereas 58.3% and 26.9% were defined as repeated measurements and multilevel design, respectively. Twenty-two articles belonged to environmental and occupational public health, 10 articles to clinical neurology, 8 to oncology, and 7 to infectious diseases and pediatrics. The distribution of the response variable was reported in 88% of the articles, predominantly Binomial (n = 64) or Poisson (n = 22). Most of the useful information about GLMMs was not reported in most cases. Variance estimates of random effects were described in only 8 articles (9.2%). The model validation, the method of covariate selection and the method of goodness of fit were only reported in 8.0%, 36.8% and 14.9% of the articles, respectively.

CONCLUSIONS

During recent years, the use of GLMMs in medical literature has increased to take into account the correlation of data when modeling qualitative data or counts. According to the current recommendations, the quality of reporting has room for improvement regarding the characteristics of the analysis, estimation method, validation, and selection of the model.

Resistance to first-line antituberculosis drugs in Spain, 2010-2011. RETUBES Study

INTRODUCTION

The magnitude of current resistance to antituberculosis drugs in Spain is unknown. The objective of this study is to describe resistance to first-line antituberculosis drugs and determine the associated factors.

METHODS

Prospective multicenter study of adult tuberculosis patients with positive Mycobacterium tuberculosis culture and antibiogram including first-line drugs in 32 hospitals and one out-patient center of the Spanish Health System between 2010 and 2011.

RESULTS

A total of 519 patients, 342 Spanish nationals and 177 (34.1%) foreigners were studied. Drug resistance was found in 48 (9.2%), of which 35 (6.7%) were isoniazid-resistant. There were 10 (1.9%) multiresistant cases and no strain was extremely resistant. Initial isoniazid resistance was detected in 28 of the 487 (5.7%) antituberulosis-naïve patients, most of whom were foreigners (P<.01). Acquired resistance was seen in 7 (22.6%) previously treated cases. Multiresistance was initial in 6 cases (1.2%) and acquired in another 4 (12.9%). Factors associated with initial isoniazid resistance were immigrant status and group cohabitation OR=2.3; 95%CI: .98-5.67 and OR=2.2; 95%CI: 1.05-7.07 respectively). The factor associated with acquired resistance to isoniazid was age below 50 years (P=.03).

CONCLUSIONS

The rate of initial isoniazid resistance is greater than estimated, probably due to the increase in immigration during recent years, suggesting that systematic national monitoring is required. Immigrants and those who cohabit in groups have a higher risk of isoniazid resistance.

Monitoring changes in anti-tuberculosis treatment: associated factors determined at the time of diagnosis

OBJECTIVES

To determine predictive factors for changes in standard anti-tuberculosis chemotherapy at the time of diagnosis.

METHODS

A prospective study was performed among tuberculosis (TB) patients treated at specialised centres during 2008-2009. Treatment outcome was monitored per standard guidelines. Treatment was considered successful if the patient was cured or completed treatment. Factors associated with treatment modification were analysed at the bivariate and multivariate levels using logistic regression.

RESULTS

A total of 427 patients were included in the study. The initial standard treatment regimen was retained for 249 patients (58.3%), extended to 9 months for 36 (8.4%) and changed for 142 (33.3%). Factors associated with a change of regimen at the multivariate level were female sex, age ≥ 50 years, human immunodeficiency virus infection, comorbidities, alcoholism, hospitalisation and culture-positive sputum. Drug resistance and toxicity were analysed independently. Treatment outcome was successful in 97.2% of cases without a regimen change and in 87.3% of those with a changed regimen (P < 0.001).

CONCLUSION

Factors associated with changes in the initial anti-tuberculosis regimen should be considered for rigorous follow-up. Results obtained through individualised treatment provided by specialists were good despite the complexity of the cases treated.

Successful management of multidrug-resistant tuberculosis under programme conditions in the Dominican Republic

SETTING

The Dominican Republic is a high-incidence area for multidrug-resistant tuberculosis (MDR-TB; 6.6% of initial cases). Standardised treatment regimens for MDR-TB may be a potential solution.

OBJECTIVE

To present the effectiveness of standard regimens under routine national conditions.

DESIGN

We reviewed all MDR-TB patients treated under routine conditions from 29 August 2006 to 30 June 2010, showing interim and final outcomes. Patients were treated with regimens that were standardised or individualised based on previously received second-line anti-tuberculosis drugs.

RESULTS

Population description and culture conversion data are reported for the 289 MDR-TB patients. The median patient age was 31 years. Most had failed first-line treatment (72.6%). Culture negativity was obtained within 4 months (median 2 months) in 78.6%. Among the 150 patients treated between 2006 and 2008, 74% had favourable results on standardised and 66% on individualised regimens (P = 0.211). The efficacy of the standardised and individualised regimens was respectively 92.8% and 81% (P = 0.056). The relapse rate was approximately 1%. A median of five drug side effects occurred per patient. More than 2 months to culture conversion and bilateral cavitation on chest X-ray were found to be unfavourable outcome risk factors.

CONCLUSIONS

Standardised MDR-TB regimens may be effective at the national level, even in resource-poor settings.

Tuberculosis recurrence after completion treatment in a European city: reinfection or relapse?

BACKGROUND

Tuberculosis (TB) recurrence can be due to reinfection or relapse. The contribution of each to TB incidence and the factors associated with recurrence are not well known. Effectiveness of TB control programs is assessed in part by recurrence rates. The aim of this study was to establish the recurrence rate of TB in Barcelona, the associated risk factors and the role of reinfection.

METHODS

A population-based retrospective longitudinal study was performed in Barcelona, Spain. TB patients with positive culture results who completed treatment between Jan 1(st), 2003 and Dec 31(st), 2006 were followed-up until December 31st, 2009 by the TB Control Program. The incidence rate of recurrence was calculated per person-year of follow-up (py). Kaplan-Meier and Cox regression methods were used for the survival analysis by calculating the hazard ratio (HR) with 95% confidence intervals (CI).

RESULTS

Of the 1,823 TB cases identified, 971 fulfilled the inclusion criteria and 13 (1.3%) had recurrent TB. The recurrence rate was 341 cases per 100,000 py, 13 times higher than the TB incidence of the general population. Likelihood of TB recurrence at the 1st, 3rd and 5th year of follow-up was 0.1%, 1.4% and 1.6%, respectively. Factors associated with recurrence were HIV infection (HR: 4.7, CI: 1.4-15.7), living in the inner city district (HR: 3.9, CI: 1.3-11.8) and history of TB treatment (HR: 5.2, CI: 1.7-16.2). Genotyping results of recurrent cases were available for 6 patients (3 reinfections and 3 relapses).

CONCLUSION

The rate of TB recurrence in Barcelona is low and most episodes occur within the first three years. Patients at higher risk of recurrence are co-infected with HIV, living in neighborhoods with high TB incidence or with a history of TB treatment. When available, genotyping results help determine whether the recurrence is due to reinfection or relapse.

Recurrences in tuberculosis in a cohort of human immunodeficiency virus-infected patients: the influence of highly active antiretroviral therapy

BACKGROUND

Little is known about recurrent tuberculosis (TB) among HIV-infected patients and the influence of highly active antiretroviral therapy (HAART).

METHODS

A population-based retrospective longitudinal study was conducted on all HIV-infected TB patients in Barcelona (Spain) notified in 1987-2003, and followed up until 2005. TB recurrence and HAART influence were analysed according to calendar period.

RESULTS

Patients with no-treatment and those in pre-HAART had more risk of TB recurrence (RR: 2.3; CI: 1-5.8 and RR: 4.8; CI: 2-12).

CONCLUSIONS

HAART decreases probability of TB recurrence and should be extended to all cases.

A predictive scoring instrument for tuberculosis lost to follow-up outcome

BACKGROUND

Adherence to tuberculosis (TB) treatment is troublesome, due to long therapy duration, quick therapeutic response which allows the patient to disregard about the rest of their treatment and the lack of motivation on behalf of the patient for improved. The objective of this study was to develop and validate a scoring system to predict the probability of lost to follow-up outcome in TB patients as a way to identify patients suitable for directly observed treatments (DOT) and other interventions to improve adherence.

METHODS

Two prospective cohorts, were used to develop and validate a logistic regression model. A scoring system was constructed, based on the coefficients of factors associated with a lost to follow-up outcome. The probability of lost to follow-up outcome associated with each score was calculated. Predictions in both cohorts were tested using receiver operating characteristic curves (ROC).

RESULTS

The best model to predict lost to follow-up outcome included the following characteristics: immigration (1 point value), living alone (1 point) or in an institution (2 points), previous anti-TB treatment (2 points), poor patient understanding (2 points), intravenous drugs use (IDU) (4 points) or unknown IDU status (1 point). Scores of 0, 1, 2, 3, 4 and 5 points were associated with a lost to follow-up probability of 2,2% 5,4% 9,9%, 16,4%, 15%, and 28%, respectively. The ROC curve for the validation group demonstrated a good fit (AUC: 0,67 [95% CI; 0,65-0,70]).

CONCLUSION

This model has a good capacity to predict a lost to follow-up outcome. Its use could help TB Programs to determine which patients are good candidates for DOT and other strategies to improve TB treatment adherence.