A sports-related injury prevention program for Dutch youth volleyball players: Process evaluation alongside a quasi-randomized controlled trial.

OBJECTIVE: This process evaluation aimed to gain insight into the implementation of the VolleyVeilig Youth program by Dutch volleyball clubs within the context of an effectiveness trial. METHODS: We applied the UK Medical Research Council framework for process evaluations and assessed the context, implementation and mechanisms of impact. Trainers participating in the effectiveness trial were asked to complete a questionnaire at the end of the study. A subsample of the trainers based on the self-reported adherence score was invited to participate in an interview accordingly. We used a thematic analysis to present the data. RESULTS: Thirty-one trainers (100%) completed the questionnaire, and seven agreed to participate in an interview. Although adherence gradually decreased over the volleyball season, most trainers reported partially adhere with the program until the end of the study. The main themes included factors associated with the (1) VolleyVeilig Youth program, (2) trainer, (3) players, and (4) volleyball club. CONCLUSION: Although (partial) adherence to the VolleyVeilig Youth program was high in this study, implementation strategies must be developed to target the barriers reported by the trainers before the program can be successfully implemented nationwide in the Netherlands.

Clotting factor activity levels and bleeding risk in people with haemophilia playing sports.

BACKGROUND: Improved treatment options for people with haemophilia (PWH) have increased the possibilities for sports participation, but the risk of sports-induced bleeding (SIB) is still considered considerable by many. AIM: To assess sports associated injury- and bleeding risk in PWH and to assess clotting levels associated with safe sports participation. METHODS: Sports injuries and SIBs were prospectively collected for 12 months in PWH aged 6-49 without inhibitors playing sports at least once weekly. Injuries were compared according to factor levels, severity, joint health, sports risk category and sports intensity. Factor activity at the time of injury was estimated using a pharmacokinetic model. RESULTS: 125 participants aged 6-49 (41 children, 90% haemophilia A; 48% severe, 95% severe on prophylaxis) were included. Sports injuries were reported by 51 participants (41%). Most participants (62%) reported no bleeds at all and only 16% reported SIBs. SIBs were associated with factor levels at time of injury (OR: 0.93/%factor level (CI 0.88-0.99); p = .02), but not with haemophilia severity (OR: 0.62 (CI 0.20-1.89); p = .40), joint health, sports risk category or sports intensity. PWH with factor levels <10% during sports injury had a bleeding risk of 41% versus 20% in those with higher (>10%) factor levels. CONCLUSION: The results of this study emphasize the importance of clotting factor levels in prevention of bleeds. This information is vital for patient counselling and tailoring prophylactic treatment with clotting factors and non-replacement therapy.

Stability of clustering of lifestyle risk factors in the Dutch adult population and the association with mental health.

BACKGROUND: Lifestyle factors often co-occur in clusters. This study examines whether clusters of lifestyle risk factors, such as smoking, alcohol use, physical inactivity, poor diet, sexual risk behaviour, cannabis and other drug use, change over time in a representative sample of Dutch adults. Additionally, the association between mental health and self-reported depression of lifestyle clusters was examined. METHODS: Each year cross-sectional data of approximately 7500 individuals of 18 years and older from the annual Dutch Health Survey of 2014-2019 were used. Clusters were determined by a two-step cluster analysis. Furthermore, regression analyses determined the association between clusters of lifestyle risk factors and mental health. RESULTS: Results show six clusters composed of one, multiple or no lifestyle risk factors. The clusters remained relatively stable over time: in some clusters, the number of people slightly changed between 2014 and 2019. More specifically, clusters that increased in size were the cluster with no lifestyle risk factors and the cluster with multiple lifestyle risk factors. Furthermore, results show that clusters with none to a few lifestyle risk factors were associated with better mental health and a lower prevalence of self-reported depression compared with clusters with multiple lifestyle risk factors. CONCLUSIONS: The clustering of lifestyle risk factors remained stable over time. People with multiple lifestyle risk factors had poorer mental health than those without risk factors. These findings may emphasize the need for intervention strategies targeting this subgroup with multiple lifestyle risk factors.

Effectiveness of a warm-up programme to reduce injuries in youth volleyball players: a quasi-experiment.

OBJECTIVES: To establish the effectiveness of the 'VolleyVeilig' programme on reducing injury rate, injury burden and injury severity in youth volleyball players. METHODS: We conducted a quasi-experimental prospective study over one season of youth volleyball. After randomisation by competition region, we instructed 31 control teams (236 children, average age 12.58±1.66) to use their usual warm-up routine. The 'VolleyVeilig' programme was provided to 35 intervention teams (282 children, average age 12.90±1.59). This programme had to be used during each warm-up before training sessions and matches. We sent a weekly survey to all coaches, collecting data on each player's volleyball exposure and injuries sustained. Multilevel analyses estimated differences in injury rates and burden between both groups, and we used non-parametric bootstrapping to compare the differences in injury numbers and injury severity. RESULTS: We found an overall reduction in injury rates of 30% for intervention teams (HR 0.72; 95% CI 0.39 to 1.33). Detailed analyses revealed differences for acute (HR 0.58; 95% CI 0.34 to 0.97) and upper extremity injuries (HR 0.41; 95% CI 0.20 to 0.83). Compared with control teams, the intervention teams had a relative injury burden of 0.39 (95% CI 0.30 to 0.52) and a relative injury severity of 0.49 (95% CI 0.03 to 0.95). Only 44% of teams fully adhered to the intervention. CONCLUSION: We established that the 'VolleyVeilig' programme was associated with reduced acute and upper extremity injury rates and lower injury burden and severity in youth volleyball players. While we advise implementation of the programme, programme updates to improve adherence are needed.

Effectiveness of a judo-specific injury prevention programme: a randomised controlled trial in recreational judo athletes.

OBJECTIVES: To evaluate the effectiveness of a trainer-supervised judo-specific injury prevention warm-up programme on overall injury prevalence. METHODS: We conducted a two-arm, cluster randomised controlled trial; the Injury Prevention and Performance Optimization Netherlands (IPPON) study. Judo athletes aged≥12 years were randomised by judo school to IPPON intervention or control group who performed their usual warm-up. Primary outcome was overall injury prevalence (%) over the follow-up period (16-26 weeks) measured fortnightly with the Oslo Sports and Trauma Research Centre Questionnaire. A modified intention-to-treat analysis was performed due to COVID-19, with estimates for the primary outcome obtained using generalised linear mixed models. Secondary outcomes included: prevalence of severe injuries, overall incidence, time-loss injuries, exposure, adherence and experiences of trainers and athletes. RESULTS: 269 judo athletes (IPPON: 117, Control: 152) were included. Mean injury prevalence over 16-26 weeks was 23% (95% CI 20% to 26%) in the IPPON and 28% (95% CI 25% to 30%) in the control group. We observed no significant difference of all reported injuries (OR 0.72 in favour of the IPPON group; 95% CI 0.37 to 1.39). Secondary outcomes also demonstrated no significant differences between groups. Specifically, no significant difference of severe injuries was reported (OR 0.80 in favour of the IPPON group; 95% CI 0.36 to 1.78). All trainers and 70% of athletes perceived the IPPON intervention as successful. CONCLUSION: The IPPON intervention did not significantly reduce the overall and severe injury prevalence. Despite this, we suggest the IPPON intervention be considered as an useful alternative to regular judo warm-up, given the high adherence and the positive clinical experiences of trainers and athletes. TRIAL REGISTRATION NUMBER: NTR7698.

Physical activity, sports participation and exercise-related constraints in adult women with primary hypothyroidism treated with thyroid hormone replacement therapy.

Awareness of physical activity (PA) constraints in patients with primary hypothyroidism on thyroid hormone replacement therapy (THR) is important. Hence, this cross-sectional matched case-control study aimed to determine PA and sports participation (SP) in patients with hypothyroidism on THR in comparison to control subjects. Accordingly, survey questions were selected from the National Survey on Injuries and Physical Activity in the Netherlands (IPAN), supplemented with questions related to self-reported clinical characteristics and exercise-related constraints (ERC) of patients. In total, 1,724 female patients (mean age 53.0 years ±11.6) and 1,802 controls (mean age 52.6 ± 13.2) were included. Compared to controls, patients were less likely to comply with the moderate-intensity PA guideline (OR 0.70; 95% CI: 0.611-0.803), although patients were more actively participating in sports (OR 1.40; 95% CI: 1.156-1.706). Two-thirds of patients reported that hypothyroidism was limiting their PA performance. These limitations were more pronounced in patients with autoimmune thyroiditis (AIT) than in patients with hypothyroidism from other aetiology (OR 1.93; 95% CI: 1.518-2.457), representing disease-specific exercise intolerance. In order to establish effective intervention programmes to encourage regular PA in hypothyroid patients on THR with exercise intolerance, further research is warranted to better understand PA barriers.

A systematic review of injuries in recreational field hockey: From injury problem to prevention.

The purpose of this study was to gather information from scientific literature related to all steps of Van Mechelen's "sequence of prevention" for injuries applied to youth and adult recreational field hockey players. A systematic review was conducted in Medline via Pubmed and in SPORTDiscus via EBSCOhost. Twenty-six original studies were included. Regarding injury incidence (step 1) results showed several overall injury incidence rates (youth: 1.47 per 1,000 Athlete Exposure (AE) time-loss (TL) injury up to 11.32 per 1,000 AE TL ánd non-time loss (NTL) injury, adults: 2.2 NTL injury per 1,000 AE, 15.2 injury per 1,000 hours of sports participation). Considering games and practices, most injuries were sustained in games (youth: 4.9, adults: 7.87 per 1,000 AE). Considering body parts, highest injury incidence rates were found in body parts in the lower extremities (youth: knee injuries in games (0.33 per 1,000 AE), adults: hamstring injuries in pre-season (0.75 per 1,000 AE)) and injuries in the head/face/eye (youth: 0.66 and adults: 0.94 head/face/eye, 0.71 head/face and 0.63 concussion per 1,000 AE). Regarding aetiology (step 2), no studies were found. Regarding the efficacy of available interventions (step 3 and 4), one study was found among youth players, describing a warm-up programme.

Effectiveness of a nationwide intervention to increase helmet use in Dutch skiers and snowboarders: an observational cohort study.

OBJECTIVE: Helmet use in Dutch recreational skiers and snowboarders (DRSS) remains low. This study evaluated the effects of exposure to a nationwide intervention on relevant determinants of helmet use and helmet use in DRSS. METHODS: The intervention mapping protocol was used to develop an in-season intervention programme targeted at adult DRSS. A prospective single-cohort study was conducted to evaluate the impact of intervention exposure on determinants of helmet use (ie, knowledge about head injury risk and preventive measures, risk perception, attitudes to head injury risk and helmet use and intention to helmet use) and self-reported helmet use. A random sample of 363 DRSS from an existing panel participated in this study. Data were collected using online questionnaires before and immediately after the 2010/2011 intervention season. In a separate sample of 363 DRSS, intervention reach was assessed after the 2010/2011 season. RESULTS: Overall, no significant associations were found between intervention exposure and the determinants of helmet use. However, subgroup analyses revealed intervention effects on risk perception and knowledge in specific subpopulations. Intervention exposure had a significant, positive effect on helmet use in DRSS (ß=0.23; 95% CI 0.017 to 0.44). Subgroup analyses revealed that this effect was found in: (1) skiers, (2) female DRSS, (3) young skiers and (4) intermediate skiers. Overall, intervention reach was 28.1%, with differences found between skiers and snowboarders. CONCLUSIONS: Exposure to a nationwide intervention programme was associated with increased self-reported helmet use in DRSS. Differences were found in intervention effectiveness and reach between subpopulations. These differences must be taken into account when developing and evaluating future interventions.

Long-term prognosis of acute lateral ankle ligamentous sprains: high incidence of recurrences and residual symptoms.

BACKGROUND: Acute lateral ankle ligamentous sprains (ALALS) are common injuries. This injury does not always have a favourable long-term outcome. Studies reporting the prognosis of ALALS after functional treatment are scarce. OBJECTIVE: To determine the prognosis of functionally treated ALALS, in terms of recurrent ALALS and residual symptoms. STUDY DESIGN: Retrospective cohort study. SETTING: Patients were recruited from 20 family practices, nine physical therapy practices, the emergency departments of a regional hospital and a university hospital. PATIENTS: Adult patients with an ALALS caused by an inversion trauma were invited to participate in this study 2.5-5 years after their initial injury. INDEPENDENT VARIABLES: Functional treatment of the initial ALALS. MAIN OUTCOME MEASURES: Acute lateral ankle ligamentous sprain recurrences and residual symptoms. RESULTS: A total of 44 patients were included, with an average follow-up period after the initial ankle sprain of 204 weeks (range 150-274 weeks). Eight patients (18.1%) had reinjured their ankle. Explicit pain around the ankle joint at physical examination was experienced by 45.5%. Clinical symptoms of anterior ankle impingement were present in 25% (all athletes), with radiologically confirmed tibiotalar osteophyte bone formation in 82% of them. CONCLUSIONS: A large proportion of patients with ALALS experience recurrences and persistent symptoms after their initial ankle injury. The high percentage of patients with anterior ankle impingement syndromes illustrates the need for early assessment of this impairment in patients with persistent complaints.

Reconsidering injury severity: Looking beyond the maximum abbreviated injury score.

BACKGROUND: Injury severity is often determined by anatomical measures such as the Maximum Abbreviated Injury Score (MAIS). Yet, it is suggested that MAIS provides a limited view on injury severity as the overall burden of trauma is multidimensional, including psychological problems and health care costs for example. It is unclear if MAIS as a single criterion can serve as a proper indicator for overall injury severity, since it has not been compared with other severity measures for different types of injuries. Consequently, scientists and policymakers using MAIS as primary measure for injury severity may have insufficient information for prioritizing prevention policy and research. This study explores the relation between MAIS and other injury severity measures for ten different injury types to determine if MAIS is indicative for the overall burden of trauma. METHODS: Trauma patients filled in a questionnaire six months after they visited an emergency department in the Netherlands. In total, 3.698 patients registered in the Dutch Injury Surveillance System responded. The following injury types are included: injuries to the head-brain, face, spinal cord, internal organs, upper and lower extremities, and hips. The questionnaire consisted of questions about the impact of patients' injury regarding quality of life (EQ-5D+), perceived severity, subjective distress (IES-R), anxiety and depression (HADS) and healthcare use. RESULTS: Logistic regression showed that MAIS was significantly related to hospital stay, quality of life and cognitive complaints. A lack of association was found between MAIS and perceived severity, distress, anxiety and depression. Furthermore, Z-score analysis showed that the relation between severity measures differs between injury types. CONCLUSIONS: MAIS is an anatomical-based discriminative measure for injury severity that correlates with several other severity measures including hospital stay and healthcare costs. However, MAIS is not always a proper indicator for severity when severity involves the patient's psychological burden or perceived health status. In sum, the accuracy of MAIS as an indicator for injury severity depends on the definition of severity and the injury type. Therefore, caution is needed when using and interpreting MAIS as an indicator for injury severity in research or policymaking.

Can running-related injuries be prevented through an online behavioural intervention in adult novice runners? Results of a randomised controlled trial.

Objective: To evaluate the effectiveness of the Runfitcheck on time until the onset of a new running-related injury (RRI) among adult novice runners. Methods: A three-arm randomised controlled trial was conducted over 7 months. Adult novice runners completed a baseline online questionnaire on their characteristics, running activity, RRIs and injury preventive behaviour. Runners were randomly allocated to one of two intervention groups or the control group (n=238). One intervention group obtained access to the Runfitcheck (n=252), an online intervention to encourage injury preventive behaviour, and was fortnightly promoted to use Runfitcheck; the other intervention group (n=251) was directed towards the Runfitcheck once. Runners were followed for 4 months, not all starting at the same time over 7 months. The main outcome measure was time to a new RRI using the Oslo Sports Trauma Research Centre Overuse Injury Questionnaire, and was analysed with survival analysis Cox regression. Generalised estimating equations (GEE) were used to gain insight into the effectiveness of the Runfitcheck. Results: The time to the occurrence of the first RRI did not differ between the study groups (Wald χ2=0.893). GEE analysis showed no difference in the risk of a new RRI in the group that was referred to the Runfitcheck once (OR 1.22, 95% CI 0.86 to 1.74) nor in the active approach group (OR 1.01, 95% CI 0.71 to 1.45) compared with the control group. Furthermore, the onset of the new RRIs did not change over time (OR 0.96, 95% CI 0.91 to 1.01). Conclusions: The online intervention Runfitcheck was ineffective in reducing the instantaneous risk of new RRIs in adult novice runners. More research is needed to determine how injuries in novice runners can be prevented. Trial registration number: Dutch Trial Registry (ID: NL7823).

Mixed-methods process evaluation of the injury prevention Warming-up Hockey programme and its implementation.

Warming-up Hockey (WUP) is an effective injury prevention programme to reduce acute field hockey injuries among youth. This paper describes the process evaluation of the nationwide scaling-up. We conducted a mixed-methods process evaluation from September 2019 to December 2020 according to the Reach, Effectiveness, Adoption, Implementation and Maintenance (RE-AIM) framework, focusing on the intervention and its implementation. We collected data through questionnaires, interviews and web/app analytics. Participants were trainers/coaches, technical/board members of hockey clubs (TBMs) and employees of the Royal Dutch Hockey Federation (KNHB). In total, 226 trainers/coaches (61 via WUP and 165 via training courses) and 14 TBMs filled in questionnaires. Ten individuals (four trainers/coaches, four TBMs and two KNHB employees) participated in semistructured interviews. The study showed the following results according to the RE-AIM framework. Reach: According to web/app analytics, 1492 new accounts were registered. Effectiveness: Overall, users were satisfied with WUP and the implementation strategies, and believed WUP could reduce field hockey injuries. Adoption: 63% of the trainers/coaches (enrolled via WUP) indicated they used WUP. Implementation: Most trainers/coaches did not use WUP during every training session or match. Most TBMs promoted WUP in their club. Implementation barriers included lack of integration with other training programmes, 'know-it-all' trainers, lack of supervision on WUP use and delayed start of implementation. Facilitators included perceived added value, information need on injury prevention in small clubs and tailored communication. Maintenance: Users planned to use WUP occasionally. The KNHB intended to integrate WUP in their newly developed Knowledge Platform. To conclude, WUP was evaluated as a useful programme, but adherence to WUP was challenging. Timely preparation and creating an implementation plan based on stakeholder input, including communication at key moments during the sports season and tailored communication, were found to be important during implementation. Findings can be useful for others planning to implement evidence-based injury prevention programmes on a larger scale.

Characteristics of Fitness-Related Injuries in The Netherlands: A Descriptive Epidemiological Study.

Although general information is available, specifically detailed information on gym-based fitness-related injuries in the general recreational fitness population is lacking. The aim of our study was to obtain more insight into injuries occurring as a result of gym-based fitness activities. A descriptive online epidemiological study was conducted in November 2020. The survey was distributed by a market research agency to members of their research panel. A total of 494 Dutch fitness participants aged ≥ 18 years (mean 38.9; 59% male) who had sustained a fitness-related injury in the preceding 12 months were included in the study. Most injuries occurred during strength training, individual cardio exercise, yoga/Pilates, cardio exercise in group lessons, and CrossFit. The shoulder, leg, and knee were the most common injured body parts; 73.1% of the injuries occurred during unsupervised gym-based fitness activities, and 46.2% of the injuries occurred during one specific exercise or when using a specific fitness device: running (e.g., on the treadmill) (22.8%); bench press (11.8%); or squats (9.6%). Overuse or overload (n = 119), missteps and sprains (n = 48), or an incorrect posture or movement (n = 43) were most often mentioned as causes of injury. Conclusions: Most self-reported gym-based fitness-related injuries occur during strength training and individual cardio exercise. Special attention should be given to the shoulder during strength training and to the lower extremities during cardio exercise. Injury prevention interventions should be able to be carried out without supervision.

More people more active, but there is a counter site. Novice athletes are at highest risk of injury in a large population-based retrospective cross-sectional study.

OBJECTIVES: To evaluate whether in fitness-related activities and recreational running over time, there is an increase in the number of novice sports athletes and whether these novice athletes have an increased injury rate compared with their experienced counterparts. METHODS: Data were collected from a large population-based retrospective cross-sectional study, 'Injuries and Physical Activity in the Netherlands' (IPAN). Athletes aged ≥18 years were included. We used descriptive statistics to describe the characteristics of athletes and their injuries. The number of athletes and injuries were calculated for each year and, where applicable, for each sport separately. The injury incidence rate was expressed as the number of injuries per 1000 hours of exposure. Logistic regression analyses were performed with non-extrapolated data to analyse the differences in injury risk for novice and experienced athletes included in this study, separate for fitness-related activities and running. RESULTS: Over the 5 years, 9209 fitness athletes reported 370 fitness-related injuries, 5426 runners reported 537 running-related injuries. Weighted data showed that, in 2010-2014, the inflow of novice fitness athletes slightly decreased, whereas the inflow of novice runners slightly increased. In each year, injury risk was higher in novice athletes compared with experienced athletes for both fitness-related activities and running. The injury incidence rates in running are much higher than in fitness-related activities. CONCLUSIONS: Over the years 2010-2014, the absolute number of novice athletes in fitness-related activities and running together increased. Although most injuries occurred in experienced athletes, injury risk was higher in novice athletes in both sports.

[The Lifestyle Monitor: prevalence rates for health policy]. / De Leefstijlmonitor: Cijfers voor gezondheidsbeleid.

The Lifestyle Monitor (LSM) was launched in 2013 on behalf of the Ministry of Health, Welfare and Sports to reorganize the multiple data collections in the field of lifestyle and health in the Netherlands. The reorganization should enhance the efficiency and coherence of the lifestyle and health data collections and should provide unambiguous figures for policymakers. This article describes the background and content (including the lifestyle-themes) of the LSM and the tasks and roles of the collaborating parties involved. The measurement methods used and requirements for data requests are described as well. Finally, some examples of figures and trends over the period 2014-2020 to underpin the health policy are described.

Performance goals of runners are associated with the occurrence of running-related injuries.

OBJECTIVE: The aim of this study was to evaluate the relationship between running performance goals and running-related injuries (RRIs). DESIGN: Retrospective cross-sectional study. SETTING: A total of 970 recreational runners filled in an online questionnaire to collect data on personal characteristics, their running activities, RRIs, and running goals. PARTICIPANTS: 970 recreational runners, 1) without a running performance goal, who 2) trained to complete a certain distance, and who 3) trained to complete a certain distance and to participate in a specific running event. MAIN OUTCOME MEASURES: RRI, defined as any physical complaint developed during running in the previous 12 months. RESULTS: A statistically significant relationship was found between runners who trained for a specific running event and who also wanted to run a certain distance (OR 2.0, 95%CI 1.23-2.98) compared with runners without a running goal. (Hinder from a) Previous injury (OR 3.9, 95%CI 2.79-5.42), overweight (OR 1.6, 95%CI 1.10-2.21), and training for more than 22.5 h/year (OR 1.7, 95%CI 1.04-2.72 and OR 2.3, 95%CI 1.42-3.81) were also associated with RRIs. CONCLUSION: Running to achieve running goals, specifically running to complete a certain distance and to participate in an event, is associated with the occurrence of an RRI.

Child safety in cars: An observational study on the use of child restraint systems in The Netherlands.

OBJECTIVE: To minimize children's injuries due to car accidents, children must be transported in approved child restraint systems (CRS). The European Union optimized child protection by implementing R129 legislation for CRS in 2013. However, compliance with CRS recommendations after introduction of this newer standard has been scarcely evaluated. The main objectives of this study were to determine the prevalence of various types of CRS misuse and to investigate the use of ISOFIX and i-Size seats and parental knowledge regarding safe transportation of children in cars 5 years after the introduction of the newer R129 standard. METHODS: During a cross-sectional observational study in the summer of 2018, parking lots of sites in the Netherlands were visited by researchers. Arriving or departing Dutch drivers who transported children under 9 years old were interviewed by means of a questionnaire and the misuse of CRS was directly observed using a checklist. Misuse was defined as CRS inappropriate for the child (based on height and weight) and/or CRS wrongly installed in the car and/or child improperly restrained in CRS. RESULTS: In total, 392 drivers and 470 children were included in the study. Results showed that 83% of the children were transported with at least 1 misuse of their CRS: 7% of the CRS were inappropriate for the child, 49% of the CRS were wrongly installed in the car, and 59% of the children were improperly restrained in a CRS. Most CRS were installed using the seat belt (88%) compared to ISOFIX (12%). ISOFIX usage did not result in less CRS installation misuse (P = .338). The number of observed i-Size CRS was low (n = 13, 3%). Most drivers were familiar with ISOFIX (76%), but only 13% of the drivers had heard of i-Size. CONCLUSIONS: For 9 out of 10 children, CRS misuse was observed. Many children were transported in an appropriate CRS, but various mistakes were made when installing the CRS in the car and restraining children in the CRS. Moreover, ISOFIX usage did not result in statistically significant less CRS installation misuse compared to traditional seat belt usage, and i-Size CRS are still rather unknown 5 years after their introduction.

Physical Activity in Women With Hypothyroidism on Thyroid Hormone Therapy: Associated Factors and Perceived Barriers and Benefits.

BACKGROUND: The purpose of this study was to analyze factors associated with physical activity (PA) and to identify perceived barriers and benefits of PA among patients with hypothyroidism on thyroid hormone therapy. METHODS: This survey-based cross-sectional study was conducted among members of the Dutch thyroid patient organization. Self-reported data on respondents' PA levels and demographic, clinical, and physical health variables were collected. Moreover, perceived barriers and benefits to PA were identified. Respondents were categorized as physically active when meeting the recommended Dutch PA guidelines and physically inactive otherwise. To compare physically active and inactive respondents, potential confounders were entered into univariate analyses. Factors showing significant correlations (P < .20) were added to a multivariate model to determine the associated factors of PA. RESULTS: About 1724 female respondents (mean age 53.0 [11.6] y) were included; 16.1% reported meeting the PA recommendations. Multivariate analysis showed that factors associated with PA included levothyroxine/liothyronine therapy, comorbidities, self-perceived physical fitness, and diminished physical endurance. Overall, physically related barriers to PA were rated highest. CONCLUSIONS: The vast majority of treated hypothyroid respondents are physically inactive and experience long-term exercise intolerance. Considering the health implications of physical inactivity, promotion of regular PA is of key importance in this population.

Trends in sports-related emergency department visits in the Netherlands, 2009-2018.

OBJECTIVES: We aim to describe time trends of severe sports-related emergency department (ED) visits in the Netherlands, from 2009 to 2018. METHODS: Data were extracted from the Dutch Injury Surveillance System by age, gender, sports activity and injury diagnosis, from 2009 to 2018. Absolute numbers and time trends of severe sports-related ED visits were calculated. RESULTS: Between 2009 and 2018, the overall numbers of severe sports-related ED visits in the Netherlands have significantly decreased by 14% (95% CI -19% to -9%). This trend was seen among men (-12%; 95% CI -18% to -6%), women (-19%; 95% CI -26% to -11%) and individuals aged 18-34 years (-19%; 95% CI -28% to -10%). The number of ED visits has significantly decreased over time in soccer (-15%; 95% CI -24% to -6%), ice-skating (-80%; 95% CI -85% to -73%) and in inline/roller skating (-38%; 95% CI -55% to -15%). This was not the case in road cycle racing (+135%; 95% CI +85% to +198%) and mountain bike racing (+80%; 95% CI +32% to+146%). In terms of sports injury diagnoses, the number of fractured wrists (-15%; 95% CI -24% to -5%), fractured hands (-37%; 95% CI -49% to -21%), knee distortions (-66%; 95% CI -74% to -55%), and fractured lower legs (-38%; 95% CI -55% to -14%) significantly decreased over time. CONCLUSION: Our study shows a promising reduction in the number of severe sports-related ED visits across most age groups and sports activities. As the number of ED visits increased in road cycle and mountain bike racing, it is important to find out what caused these increases. Furthermore, it is essential to determine trends in exposure hours and to evaluate and implement injury prevention programmes specific for these sports activities.

A Tailored Web-based Advice Tool for Skiers and Snowboarders: Protocol for a Randomized Controlled Trial.

BACKGROUND: Being active in sports has many positive health effects. The direct effects of engaging in regular physical activity are particularly apparent in the prevention of several chronic diseases, including cardiovascular disease, diabetes, cancer, hypertension, obesity, depression, and osteoporosis. Besides the beneficial health effects of being active, sports participation is unfortunately also associated with a risk of injuries. In the case of many sports injuries (eg, winter sports) preventive measures are not compulsory, which means that a behavioral change in sports participants is necessary to increase the use of effective measures, and subsequently prevent or reduce injuries in sports. OBJECTIVE: The evidence-based Wintersportklaar online intervention has been developed to stimulate injury preventive behavior among skiers and snowboarders. In this article, the design of the effectiveness study will be described. METHODS: A randomized controlled trial with a follow-up period of four months during the winter sport season will be conducted. The participants consist of inexperienced skiers and snowboarders. At baseline, skiers and snowboarders in the intervention and control groups are asked to report the injury preventive measures they usually take during their preparation for their winter sport holiday. One and three months after baseline, skiers and snowboarders are asked to report retrospectively in detail what measures they took regarding injury prevention during their current winter sport preparation and winter sport holiday. Descriptive analyses (mean, standard deviation, frequency, range) are conducted for the different baseline variables in both study groups. To evaluate the success of the randomization, baseline values are analyzed for differences between the intervention and control groups (chi square, independent T tests and/or Mann-Whitney test). Chi square tests and/or logistic regression analyses are used to analyze behavioral change according to the intention to treat principle (as initially assigned). RESULTS: The project was funded in 2016 and enrolment was completed in 2017. Data analysis is currently under way and the first results are expected to be submitted for publication in 2018. CONCLUSIONS: To combat the negative side effects of sports participation, the use of injury preventive measures is desirable. As the use of injury prevention is usually not compulsory in skiing and snowboarding, a behavioral change is necessary to increase the use of effective injury preventive measures in winter sports. TRIAL REGISTRATION: Dutch Trial Registry NTR6233; http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=6233 (Archived by WebCite at  http://www.webcitation.org/6wXZPzjUi).