Head-torso coordination in police officers wearing loaded tactical vests during running

BACKGROUND

The influence of load carriage in operational police officers is not well understood despite a relatively high injury rate. Assessing load related changes in head and torso coordination may provide valuable insight into plausible injury mechanisms.

RESEARCH QUESTION

Do typical police tactical vest loads alter head and torso coordination during running?

METHODS

Thirty-eight UK police officers ran at a self-selected pace (>2 ms-1) on a non-motorised treadmill in four vest load conditions (unloaded, and low, high and evenly distributed loads). Peak head and torso tilt, and peak vest displacement were compared between all four conditions. Timings between vest and torso change of direction were compared between the three loaded conditions. The coupling angle between the head and torso calculated using modified vector coding were compared between unloaded and each loaded conditions using Statistical Parametric Mapping.

RESULTS

No significant differences were found between conditions for peak head or torso tilt alone (p > 0.05). Loading equipment low on the vest led to significantly greater mediolateral vest displacements (38 mm) away from the torso than a high (34 mm) or evenly distributed (30 mm) conditions. The vest was found to change direction vertically before the torso in the anterior-posterior direction, and then influence torso motion. The loaded conditions changed the head-torso coupling from in-phase (with head-dominancy) to anti-phase (with torso dominancy) between 55% and 77% stance. Anti-phase with a relatively stationary head and the torso rotating forward likely places a greater concentric demand on the posterior neck muscles relative to unloaded running.

SIGNIFICANCE

Current tactical vest designs allow significant extra displacement of load away from the body during running, altering coordination at the head and torso.

The effect of alcohol marketing on people with, or at risk of, an alcohol problem: A rapid review

Background

Little is known about the impact of alcohol marketing on people with, or at risk of, an alcohol problem. A rapid review of primary studies was conducted with the aim of exploring the effect of alcohol marketing in this population.

Methods

People with, or at risk of an alcohol problem were defined as people with an alcohol use disorder, in recovery from an alcohol use disorder, and hazardous and harmful drinkers. Searches for relevant literature were conducted through Medline, EMBASE and PsychINFO; reference list scanning and citation tracking of included studies; and grey literature searching of relevant websites. A narrative synthesis of included studies was undertaken.

Results

The review included 11 studies, which focused on participants recovering from an alcohol use disorder (AUD, 6 studies) and those with hazardous or harmful consumption levels of alcohol (5 studies). 7 studies were quantitative and 4 were qualitative. The effect of alcohol advertising on alcohol use was only assessed in one small experimental study of young adult heavy drinkers, which found no apparent effect. Studies looking at other outcomes suggested that a significant proportion of people with or at risk of alcohol problems notice alcohol advertisements and can find them appealing, and that advertisements may have an effect on positive alcohol-related emotions and cognitions. Among people in recovery from an alcohol use disorder, findings suggested that there could be an effect on craving, and that alcohol marketing may be perceived to trigger a desire to drink.

Conclusions

Several studies report effects of alcohol marketing which may translate into effects on consumption. There is also evidence that alcohol marketing is perceived to act as a trigger by people in recovery from alcohol problems. Further longitudinal and experimental research is needed to determine whether alcohol marketing has a causal effect on alcohol use in this population.

Key messages

• The findings of the studies included in the review suggest that an effect of alcohol marketing in people with, or at risk of, an alcohol problem is likely.

• The impact of alcohol marketing on people with or at risk of an alcohol problem should be a concern for marketing regulators and a focus for future research.

93 The Effects of Kinesiophobia on Outcome following Total Knee Replacement: A Systematic Review

Aim

Kinesiophobia, the fear of physical movement and activity related to injury vulnerability, has been linked to sub-optimal outcomes following total knee replacement (TKR). This systematic review has two aims: to define the relationship between kinesiophobia and functional outcomes, pain and range of motion following TKR, and to evaluate published treatments for kinesiophobia following TKR.

Method

A primary search was performed in March 2020. English-language studies recruiting adult primary TKR patients, using the Tampa Scale of Kinesiophobia (TSK) were included. Study quality was assessed using the Newcastle Ottawa Scale for cohort or case control studies, and the Cochrane Collaboration Risk of Bias tool for randomised controlled trials.

Results

All thirteen included papers (82 identified) showed adequately low risk of methodological bias. TSK1 (activity avoidance) correlated with WOMAC functional score at 12 months in three studies (r = 0.20 p < 0.05, R = 0.317 p = 0.001, and correlation coefficient 0.197 p = 0.005). TSK score significantly correlated with mean active range of motion (ROM) at six months (105.33 (SD = 12.34) vs 85.53 (SD = 14.77) p = 0.000) post-operation. Three post-operative interventions improved TSK score vs control following TKR: a home-based functional exercise programme (TSK -14.30 (SD = 0.80) vs -2.10 (SD = 0.80) p < 0.001)), an outpatient CBT programme (TSK 27.76 (SD = 4.56) vs 36.54 (SD = 3.58), and video-based psychological treatment (TSK 24 (SD = 5) vs 29 (SD = 5) p < 0.01).

Conclusions

Kinesiophobia negatively affects functional outcomes up until one year post-operatively, while active ROM is reduced up to six months post procedure. Post-operative functional and psychological interventions can improve kinesiophobia following TKR.

108 Neck of Femur Fractures: Streamlined Approach to Improve Consenting Practices

Aim

Neck of femur fractures (NOFs) are synonymous with frailty, and successful outcomes are achieved with operative fixation. The United Kingdom’s General Medical Council guidance governing consent highlights the importance of thorough pre-operative discussion of risk with the patient. We aimed to audit consenting practices in NOF patients within our unit against the British Orthopaedic Association’s (BOA) criteria, with the addition of delirium as a risk factor.

Method

In cycle one all operatively managed NOFs over a two-month period in October-November 2019 were retrospectively reviewed. Consent forms 1 (CF1) and 4 (CF4) were assessed against BOA-endorsed criteria. Our intervention included a standardised sticker detailing 14 important risks was introduced and a departmental seminar on delirium. A second cycle was undertaken from August-October 2020 to close the audit loop

Results

No consent form documented all BOA-approved risk factors in cycle one (N = 35). Of cycle two’s 35 patients, 70.8% CF1 were completed using the novel sticker. All of these had 100% BOA-approved risk documentation. Consent forms without the sticker in cycle two documented 9/14 risks (mean value). No CF4 had any risks documented in either cycle. Delirium was documented in 51% in total and in 75% patients with CF1. Delirium documentation improved from 2.9% in cycle one to 51.4% in cycle two.

Conclusions

Clear lapses in operative consenting processes were identified, especially regarding delirium and CF4 documentation. The introduction of a novel consent sticker drastically improved compliance with BOA guidance for CF1. Recognition and departmental education regarding delirium significantly reduced incidence between cycles.

92 Increased Proportion of Alcohol-Related Trauma in A South London Major Trauma Centre During Lockdown, A Cohort Study

Background

Alcohol has been associated with 10-35% trauma admissions and 40% trauma-related deaths globally. In response to the Covid-19 pandemic, the United Kingdom (UK) entered a state of ‘lockdown’ on 23rd March 2020. Restrictions were most significantly eased on 1st June 2020, when shops and schools re-opened. The purpose of this study was to quantify the effect of lockdown on alcohol-related trauma admissions.

Method

All adult patients admitted as ‘trauma calls’ to a London Major Trauma Centre (MTC) during April 2018 and April 2019 (pre-lockdown; N = 316), and 1st April – 31st May 2020 (lockdown; N = 191) had electronic patient records analysed. Patients’ blood alcohol level and records of intoxication were used to identify alcohol-related trauma. Trauma admissions from pre- and post-lockdown cohorts were compared using multiple regression analyses.

Results

Alcohol-related trauma was present in a significantly higher proportion of adult trauma calls during lockdown (lockdown 60/191 (31.4%), versus pre-lockdown 62/316 (19.6%); (Odds Ratio (OR) 0.83, 95% CI 0.38 to 1.28, p < 0.001). Lockdown was also associated with increased weekend admissions of trauma (lockdown 125/191 weekend (65.5%) vs pre-lockdown 179/316 (56.7%); OR -0.40, 95% CI -0.79 to -0.02, p = 0.041). No significant difference existed in the age, gender, or mechanism between pre-lockdown and lockdown cohorts (p > 0.05).

Conclusions

UK lockdown was independently associated with an increased proportion of alcohol-related trauma. Trauma admissions were increased during the weekend when staffing levels are reduced. With the possibility of subsequent global ‘waves’ of Covid-19, the risk of long-term repercussions of dangerous alcohol-related behaviour to public health must be addressed.

918 COVID-19: A Detailed Analysis on Fit-Testing for Respiratory Protective Equipment in the UK

Introduction

There is limited data in the literature regarding the adequacy of generic FFP3 masks and their facial fit to ensure adequate protection. Mask fit-testing is therefore essential to protect healthcare workers.

Method

Using the Freedom of Information Act, 137 acute NHS trusts in the UK were approached on the 26/3/2020 by an independent researcher to provide data on the outcome of fit testing at each site.

Results

85 Trusts responded to the FOI with 51 trusts providing pertinent data relevant to the FOI request. There was a total of 72 mask types used across 51 trusts. The commonest of which was the FFP3M1863 (used by 47/51 trusts, 92.16%). A positive correlation was found between staff members and number of mask types used (r = 0.75, P = <0.05).

Overall fit-testing pass rates were provided by 32 trusts. The mean percentage pass rate was 80.74%.

Gender specific failure rates were provided by seven trusts. 4386 males underwent fit-testing in comparison to 16305 females. Across all seven trusts 20.08% of men tested failed the fit-test while only 19.89% of women failed the fit-test.

Conclusions

Our results may be utilised in choosing respirators for fit testing programme in healthcare-workers during the COVID-19 pandemic.

186 Acute Kidney Injury in Skeletal Trauma Admissions to Intensive Care: An Under-Estimated Complication

Introduction

Acute kidney injury (AKI) is associated with prolonged admission and 3.5 times increased mortality for trauma patients requiring intensive care (ICU) treatment. Blunt trauma confers greater risk of AKI than penetrating trauma, potentially related to long bone fracture. The relationship between skeletal trauma and AKI in ICU has not previously been investigated.

Method

Retrospective data was analysed from 202 consecutive adult patients admitted to ICU with skeletal trauma from 01/06/2018 to 01/06/2019. AKI was defined by creatinine rise >1.5 times baseline.

Results

AKI was found in 70/202 (34.65%) patients aged 16-99 years, 138 males and 64 females. Mean limb Abbreviated Injury Scale (AIS) was significantly higher in AKI (AIS= 2.57 (SD 0.53) versus non-AKI AIS=2.38 (SD 0.61), p = 0.027). Other body regions and total Injury Severity Score (ISS) were non-significant.

AKI was associated with a significantly worse Glasgow Outcome Score (AKI 3.28 (SD 1.52) versus 4.02 (SD 1.08) p < 0.001), increased intensive care stay (AKI 7.03 (SD 8.30) days versus non-AKI 3.8 (SD 4.1) days p < 0.001) and increased 30-day mortality (AKI 18/70 (25.71%) versus non-AKI 10/132 (7.58%) p < 0.001)

Conclusions

Skeletal trauma patients have a high incidence of AKI, which was significantly correlated with severity of skeletal limb trauma but not overall ISS.

Fit-testing of respiratory protective equipment in the UK during the initial response to the COVID-19 pandemic

Background

Public Health England guidance stipulates the use of filtering facepiece (FFP3) masks for healthcare workers engaged in aerosol-generating procedures. Mask fit-testing of respiratory protective equipment is essential to protect healthcare workers from aerosolized particles.

Aim

To analyse the outcome of mask fit-testing across National Health Service (NHS) hospitals in the UK during the first wave of the coronavirus disease 2019 (COVID-19) pandemic.

Methods

Using the Freedom of Information Act, 137 NHS hospitals were approached on May 26^th, 2020 by an independent researcher to provide data on the outcome of fit-testing at each site.

Findings

Ninety-six hospitals responded to the request between May 26^th, 2020 to October 29^th, 2020. There was a total of 86 mask types used across 56 hospitals, 13 of which were used in at least 10% of these hospitals; the most frequently used was the FFP3M1863, used by 92.86% of hospitals. Overall fit-testing pass rates were provided by 32 hospitals with mean pass rate of 80.74%. The most successful masks, in terms of fit-test failure rates, were the Alpha Solway 3030V and the Alpha Solway S–3V (both reporting mean fit-test failures of 2%). Male- and female-specific pass and failure rates were provided by seven hospitals. Across the seven hospitals, 20.1% of men tested failed the fit-test for all masks used, whereas 19.9% of women tested failed the fit-test for all masks used. Failure rates were significantly higher in staff from Black, Asian, and Minority Ethnic (BAME) backgrounds 644/2507 (25.69%) across four hospitals.

Conclusion

Twenty percent of healthcare workers tested during the first response to the pandemic failed fit-testing for masks. A small sample revealed that this was most prominent in staff from BAME backgrounds.

7X multiplexed, optofluidic detection of nucleic acids for antibiotic-resistance bacterial screening

Rapid and accurate diagnosis of bacterial infections resistant to multiple antibiotics requires development of new bio-sensors for differentiated detection of multiple targets. This work demonstrates 7x multiplexed detection for antibiotic-resistance bacterial screening on an optofluidic platform. We utilize spectrally multiplexed multi-spot excitation for simultaneous detection of nucleic acid strands corresponding to bacterial targets and resistance genes. This is enabled by multi-mode interference (MMI) waveguides integrated in an optofluidic device. We employ a combinatorial three-color labeling scheme for the nucleic acid assays to scale up their multiplexing capability to seven different nucleic acids, representing three species and four resistance genes.

Development and Validation of the Short Healthy Eating Index Survey with a College Population to Assess Dietary Quality and Intake

Because diet quality (DQ) is associated with risk of chronic disease and is a common construct assessed in health-related research, validated tools to assess DQ are needed that have low respondent and researcher burden. Thus, content experts develop the Short Healthy Eating Index (sHEI) tool and an associated scoring system. The sHEI scoring system was then refined using a classification and regression tree (CRT) algorithm methodology with an iterative feedback process with expert review and input. The sHEI scoring system was then validated using a concurrent criterion validation process that included the sHEI DQ scores (calculated from responses from 50 participants) being compared to the participants' Healthy Eating Index scores derived from 24 h recalls. The total HEI score from the CRT algorithm highly correlated with the 24 h recall HEI score (0.79). For individual food group items, the correlation between the CRT algorithm scoring and the 24 h recall data scoring ranged from 0.44 for refined grains to 0.64 for whole fruits. The sHEI appears to be a valid tool for estimating overall dietary quality and individual items (with correlations > 0.49) for fruits, vegetables, dairy, added sugar, sugar from sugar-sweetened beverages, and calcium.

Development of an Instrument Measuring Perceived Environmental Healthfulness: Behavior Environment Perception Survey (BEPS)

OBJECTIVE

To create a tool to measure college students' perception of the healthfulness of their environment.

DESIGN

(1) Item generation, (2) cognitive interview testing and exploratory factor analysis, (3) item refinement/modification, (4) factor structure validation, and (5) criterion validation.

SETTING

Ten college campuses.

PARTICIPANTS

Time point 1 (n = 120 cognitive interviews; n = 922 factor analysis); time point 2 (n = 2,676), convenience sample of undergraduate students.

MAIN OUTCOME MEASURES

Cognitive interviews and survey data were used to assess perceptions about the environment.

ANALYSIS

Exploratory factor analysis, structural equation confirmatory factor analysis, correlations, and regressions.

RESULTS

Item generation resulted in 93 items. Items were eliminated based on cognitive interviews, exploratory factor analysis of pilot data, and elimination of cross-loading or weak loading items. In confirmatory analyses, a 21-item, 5-factor structure was the best fit for the data (χ² = 3,286.77, degrees of freedom = 189; comparative fit index = 0.840; root-mean-square error of approximation = 0.078). Environmental factors include physical activity (α = 0.68, 4 items), healthful eating (α = 0.86, 5 items), mental health (α = 0.85, 5 items), barriers to healthful eating (α = 0.70, 4 items), and peer influences (α = 0.73, 3 items). There were significant associations between scales and validation criteria (P < .05).

CONCLUSIONS AND IMPLICATIONS

The Behavior Environment Perception Survey is a novel instrument measuring perceptions of the healthfulness of the campus environment. Strengths include a development process involving 10 different universities, strong psychometric properties, and breadth of constructs.

Survey Development to Assess College Students' Perceptions of the Campus Environment

OBJECTIVE

We developed and tested a College Environmental Perceptions Survey (CEPS) to assess college students' perceptions of the healthfulness of their campus.

METHODS

CEPS was developed in 3 stages: questionnaire development, validity testing, and reliability testing. Questionnaire development was based on an extensive literature review and input from an expert panel to establish content validity. Face validity was established with the target population using cognitive interviews with 100 college students. Concurrent-criterion validity was established with in-depth interviews (N = 30) of college students compared to surveys completed by the same 30 students. Surveys completed by college students from 8 universities (N = 1147) were used to test internal structure (factor analysis) and internal consistency (Cronbach's alpha).

RESULTS

After development and testing, 15 items remained from the original 48 items. A 5-factor solution emerged: physical activity (4 items, α = .635), water (3 items, α = .773), vending (2 items, α = .680), healthy food (2 items, α = .631), and policy (2 items, α = .573). The mean total score for all universities was 62.71 (±11.16) on a 100-point scale.

CONCLUSION

CEPS appears to be a valid and reliable tool for assessing college students' perceptions of their health-related campus environment.

College Students' Health Behavior Clusters: Differences by Sex

OBJECTIVE

The study purpose was to identify clusters of weight-related behaviors by sex in a college student populations.

METHODS

We conducted secondary data analysis from online surveys and physical assessments collected in Project Young Adults Eating and Active for Health (YEAH) with a convenience sample of students on 13 college campuses in the United States. We performed 2-step cluster analysis by sex to identify subgroups with homogeneous characteristics and behaviors. We used 8 derivation variables: healthy eating; eating restraints; external cues; stress; fruit/vegetable intake; calories from fat; calories from sugar-sweetened beverages; and physical activity. Contribution of derivation variables to clusters was analyzed with a MANOVA test.

RESULTS

Data from 1594 students were included. Cluster analysis revealed 2-clusters labeled "Healthful Behavior" and "At-risk" for males and females with an additional "Laid Back" cluster for males. "At-risk" clusters had the highest BMI, waist circumference, elevated health risk, and stress and least healthy dietary intake and physical activity. The "Laid Back" cluster had normal weights and the lowest restrained eating, external cues sensitivity, and stress.

CONCLUSION

Identified differences in characteristics and attitudes towards weight-related behaviors between males and females can be used to tailor weight management programs.

Path Analysis of Campus Walkability/Bikeability and College Students' Physical Activity Attitudes, Behaviors, and Body Mass Index

PURPOSE

The purpose of this study was to assess the relationship between the walkability/bikeability of college campuses and students' body mass index (BMI) with student physical activity (PA) attitudes and behaviors as potential mediators.

DESIGN

Cross-sectional.

SETTING

Thirteen university campuses.

PARTICIPANTS

A total of 1384 student participants.

MEASURES

Walkability/bikeability environmental score (ES): 12-item audit assessed an average of 44 path segments per campus. Students were measured for height and weight and completed online surveys. Physical activity stage of change/behavior intentions were assessed using the transtheoretical model. The Cognitive Behavioral Physical Activity Questionnaire assessed outcome expectations, self-regulation, and personal barriers. International Physical Activity Questionnaire assessed walking-, moderate-, and vigorous-intensity PA.

ANALYSIS

Descriptive statistics, zero-order correlations, and path analysis with maximum likelihood estimation.

RESULTS

The overall model fit was good with χ² of 171.388 ( df = 18), P < .001, comparative fit index value of .95, and a root mean square of approximation of .079. After controlling for gender, there was a direct negative association between walkability/bikeability ES and BMI (β = -.085) and positive association between personal barriers and BMI (β = .134). Walkability/bikeability ES was positively associated with walking-intensity PA (β = .010). Self-regulation was positively associated with moderate-intensity PA (β = .213), which, in turn, was negatively associated with BMI (β = -.057).

CONCLUSIONS

The ease of walking and biking on a campus was related to college students' walking behavior and their BMI. Students' PA behavioral intentions were associated with moderate PA and lower BMI. These results provide evidence to focus on policies and structural supports for walkable/bikeable environments to supplement and enhance interventions encouraging individual behavior change for PA and weight management.

Relationships of Sleep Duration With Weight-Related Behaviors of U.S. College Students

This study describes sleep behaviors of U.S. college students (N = 1,252; 18-24 years old; 59% female) and examines associations of sleep duration with weight-related behaviors. More than one quarter of participants slept < 7 hr/night and had mean Pittsburgh Sleep Quality Index (PSQI) scores indicating poor sleep quality. There were significant differences for all PSQI scales among sleep duration categories, < 7 hr (n = 344), 7-8 hr (n = 449), ≥ 8 hr (n = 459) sleep/night. Compared to those who slept ≥ 8 hr, those who slept < 8 hr had significantly more negative eating attitudes (2% higher), poorer internal regulation of food (4% lower), and greater binge eating (4% higher) scores. Findings advocate for health care professionals to evaluate sleep behaviors of college students during office visits and promote good sleep behaviors.

Recruitment lessons learned from a tailored web-based health intervention Project Y.E.A.H. (Young Adults Eating and Active for Health)

Purpose

– Recruiting college students for research studies can be challenging. The purpose of this paper is to describe the lessons learned in the various recruitment strategies used for enrolling college students in a theory-based, tailored, and web-delivered health intervention at 13 US universities.

Design/methodology/approach

– The community-based participatory research (CBPR) model was used to develop a staged-tailored, web-based, randomized control trial, focussing on eating behavior, physical activity, and stress management. Participant feedback during baseline assessments was used to evaluate recruitment strategies.

Findings

– Findings from this feedback suggest that traditional recruitment strategies, such as newspaper ads and flyers, may not be the best approach for recruiting college students; instead, web-based efforts proved to be a better recruitment strategy.

Research limitations/implications

– This project included results from 13 US universities and thus may not be generalizable: more research is needed to determine successful recruitment methods for 18-24 years old college students.

Originality/value

– This paper lessens the gap regarding successful recruitment strategies for 18-24 years old college students.

Eat, sleep, work, play: associations of weight status and health-related behaviors among young adult college students

PURPOSE

To examine relationships of sleep, eating, and exercise behaviors; work time pressures; and sociodemographic characteristics by weight status (healthy weight [body mass index or BMI < 25] vs. overweight [BMI ≥ 25]) of young adults.

DESIGN

Cross-sectional.

SETTING

Nine U.S. universities.

SUBJECTS

Enrolled college students (N = 1252; 18-24 years; 80% white; 59% female).

MEASURES

Survey included the Pittsburgh Sleep Quality Index (PSQI), Three-Factor Eating Questionnaire (TFEQ), Satter Eating Competence Inventory (ecSI), National Cancer Institute Fruit/Vegetable Screener, International Physical Activity Questionnaire, Work Time Pressure items, and sociodemographic characteristics.

ANALYSIS

Chi-square and t-tests determined significant bivariate associations of sociodemographics, sleep behaviors, eating behaviors, physical activity behavior, and work time pressures with weight status (i.e., healthy vs. overweight/obese). Statistically significant bivariate associations with weight status were then entered into a multivariate logistic regression model that estimated associations with being overweight/obese.

RESULTS

Sex (female), race (nonwhite), older age, higher Global PSQI score, lower ecSI total score, and higher TFEQ Emotional Eating Scale score were significantly (p < .05) associated with overweight/obesity in bivariate analyses. Multivariate logistic regression analysis showed that sex (female; odds ratio [OR] = 2.05, confidence interval [CI] = 1.54-2.74), older age (OR = 1.35, CI = 1.21-1.50), higher Global PSQI score (OR = 1.07, CI = 1.01-1.13), and lower ecSI score (OR = .96, CI = .94-.98), were significantly (p < .05) associated with overweight/obesity.

CONCLUSION

Findings suggest that obesity prevention interventions for college students should include an education component to emphasize the importance of overall sleep quality and improving eating competence.

The Challenges of Changing Dietary Behaviors of Underserved Populations

The dietary behaviors of underserved populations contribute to diet-related health disparities. Behavior change is affected by many factors that may be grouped in four main categories; individual, interpersonal, institutional, and community and public factors.6However, underserved populations experience additional stressors that create greater barriers to achieving dietary behavior change. Researchers and health professionals are encouraged to work with and within underserved communities to provide appropriate and acceptable programming. This article highlights other stressors that make behavior change more challenging for underserved populations. Additionally, guidance to developing and implementing successful interventions to improve dietary behavior change in underserved populations is included.