Prospective study of maturation and injury in elite handball academy. Could ‘maturational status’ be a risk factor for injury incidence in different handball team categories?

The objective of this study is to describe the relationship between injury incidence (IL) and maturity in male elite handball's player (HbP). Prospective study during two seasons, evaluating the sports injuries, maturity status and exposure time in hours in 133 young handball's players, under the UEFA methodology model for epidemiological studies. We discuss the maturity stage with different parameters, the Tanner's stage, puberty stages, peak high velocity, testicular volume, and the bone age. Finally, 190 injuries for a total of 34.222 h of exposure were registered. The average total Injury Incidence (IIn) by categories was 5,6 injury/1000 h of exposure. Injury Incidence during competition: 21,8 injuries/1000 hs and in training: 3,1 injuries/1000 hs without statistically significant between IIn, chronological age and different maturity stage by ANOVA. The multivariate statistical analysis registers tendency associations between IIn in competition for category (P = 0,07), and the IIn in training for Tanner stage (P = 0,091) and puberty (P = 0,021). In conclusion: there is not a significant difference in total IIn by ages categories in handball players but there is statistically significance tendency respect to some maturity parameters under a multivariate analysis. This last result must be considered when planning training seasons and strategies for injury prevention in the context of the formative handball. (AU)

The use of face masks and the impact on heart rate variability during baseline ECG

We compared electrocardiograms (ECGs) findings with one year difference between each other with and without use of face mask at the moment to be tested. The first ECG was done one year before without face mask, and the second ECG with a mask one year later after 3 months of mandatory use for epidemiological COVID-19 pandemic justifications in healthy youth elite athletes.ResultsRegarding heart rate variability (HRV), an increase in RMSSD was recorded when the test was performed with a mask (M): 108.5 ± 90 ms vs. No mask (NM): 72.9 ± 54.2 ms (p <0.002). And also an increase in SDNN, when the test was done with a M: 86.2 ± 47.2 ms vs. NM: 65.9 ± 43.5 ms (p <0.036).ConclusionsThe results on ECG are consistent with the increasing predominance of parasympathetic regulation, which is responsible for regulation of the autonomic loop when the subject is using face mask. (AU)

A comparison of FELS and Tanner-Whitehouse II skeletal ages in male youth soccer players from the Middle East.

OBJECTIVES: To assess measurement agreement between FELS and Tanner-Whitehouse (TW) II skeletal ages in male youth soccer players from the Middle East. METHODS: We examined agreement between FELS and TW-II skeletal ages using data collected between- and within-subjects (n = 1057 observations) for 409 male, full-time, academy student-athletes recruited as part of the Qatar Football Association national soccer development programme (chronological age range, 9.8 to 18 years; annual screening range, one to seven visits). The Bland-Altman method for repeated measurements estimated the limits of agreement describing the expected range of differences for 95% of pairs of future FELS and TW-II skeletal ages determined on similar individuals from the reference population. RESULTS: The mean difference for TW-II versus FELS protocols was 0.02 years (95% confidence interval, -0.04 to 0.08 years) with lower and upper limits of agreement ranging from -1.39 years (95% confidence interval, -1.48 to -1.30 years) to 1.43 years (95% confidence interval, 1.34 to 1.52 years). CONCLUSION: Differences for 95% of pairs of future skeletal ages determined with FELS and TW-II methods in this population could be as high as ~3 years for some people that suggested protocols may not be interchangeable in youth Middle Eastern athletes. Justification of skeletal age protocol selection rests on knowledge of measurement bias and variability of expected growth estimations for rationalized application to a population of interest.

Skeletal maturation in male elite youth athletes from the Middle East.

OBJECTIVES: To examine the timing and intensity of skeletal maturation of the radius-ulna-short (RUS) bones in elite youth Arab athletes. METHODS: We compared SuperImposition by Translation And Rotation (SITAR) models with different spline degrees of freedom and transformation expressions to summarize 492 longitudinal measurements for individual RUS bones scores assessed from 99 male academy student-athletes (chronological age range, 11.4 to 18 years; annual screening range, four to seven visits). RESULTS: The SITAR model with 5 degrees of freedom and untransformed chronological age was superior to the other models. The mean growth curve increased with age and showed a mid-pubertal double-kink at a RUS score of ~600 bone score units (au). The SITAR model revealed a first peak in the skeletal maturation velocity curve of ~206 au·year-1 occurred at ~13.5 years. The mean age at the second and largest peak occurred at 15.1 years (95% confidence interval [CI], 14.9 to 15.3 years), with the respective estimated peak skeletal ossification rate of 334 au·year-1 (95% CI, 290 to 377 au·year-1 ). The mean age at peak height velocity was 13.5 years (95% CI, 13.3 to 13.7 years), with peak height velocity of 10 cm·year-1 (95% CI, 9.6 to 10.4 cm·year-1 ). CONCLUSION: Application of the SITAR method confirmed two peaks in the skeletal maturation velocity curve, with the second and largest rate of ossification occurring at a relatively later timing of ~1.5 years than the height growth spurt. Knowledge of the RUS bones timing and intensity can be important to advance strategies for athlete performance development purposes.

Association Between Magnetic Resonance Imaging Findings and Time to Return to Sport After Muscle Injuries in High-Level Youth Athletes.

OBJECTIVE: To describe the relationship between magnetic resonance imaging (MRI) findings and time to return to sport (RTS) from muscle injuries in youth athletes. DESIGN: Prospective collection of injury surveillance data over 6 seasons (2014-2015 to 2019-2020) and reanalysis of MRIs by a radiologist blinded to RTS time after the data collection period. SETTING: National sports academy and sports medicine hospital. PARTICIPANTS: Male youth (11-19 years) athletes participating in the football (soccer) or athletics (track and field) programs with a muscle injury. INDEPENDENT VARIABLES: Magnetic resonance imaging findings (eg, grade and location) in time-loss muscle injuries. MAIN OUTCOME VARIABLES: Injury incidence, distributions, and RTS time. RESULTS: In total, 353 time-loss muscle injuries were recorded for 1089 athlete-seasons, of which 85 satisfied our inclusion criteria (MRI within 14 days). Return to sport time was significantly longer for reinjuries compared with index injuries. Associations between MRI findings and RTS time were specific to the muscle group, with significant differences in RTS time observed between categories of structure, location, and grade. The largest number of injuries was to the hamstrings (n = 46), where injuries involving the tendon were more severe than those involving the myotendinous junction and muscle, proximal injuries were more severe than mid-portion and distal, and longer RTS time was observed for higher injury grade ( P < 0.05). CONCLUSIONS: Muscle injuries in youth are diverse and cannot be treated as a single injury type. Specific injury durations can be expected depending on injury characteristics such as reinjury, location, structure, and grade.

The Percentage of Mature Height as a Morphometric Index of Somatic Growth: A Formal Scrutiny of Conventional Simple Ratio Scaling Assumptions.

PURPOSE: To assess conventional assumptions that underpin the percentage of mature height index as the simple ratio of screening height (numerator) divided by actual or predicted adult height (denominator). METHODS: We examined cross-sectional data from 99 academy youth soccer players (chronological age range, 11.5 to 17.7 y) skeletally immature at the screening time and with adult height measurements available at follow-up. RESULTS: The y-intercept value of -60 cm (95% confidence interval, -115 to -6 cm) from linear regression between screening height and adult height indicated the failure to meet the zero y-intercept assumption. The correlation coefficient between present height and adult height of .64 (95% confidence interval, .50 to .74) was not equal to the ratio of coefficient of variations between these variables (CVx/CVy = 0.46) suggesting Tanner's special circumstance was violated. The non-zero correlation between the ratio and the denominator of .21 (95% confidence interval, .01 to .39) indicated that the percentage of mature height was biased low for players with generally shorter adult height, and vice versa. CONCLUSION: For the first time, we have demonstrated that the percentage of mature height is an inconsistent statistic for determining the extent of completed growth, leading to potentially biased inferences for research and applied purposes.

Relative Skeletal Maturity and Performance Test Outcomes in Elite Youth Middle Eastern Soccer Players.

PURPOSE: This study aimed to explore the influence of differences in relative skeletal maturity on performance test outcomes in elite youth soccer players from the Middle East. METHODS: We integrated skeletal age and performance assessments using mixed-longitudinal data available for 199 outfield players (chronological age range, 11.7 to 17.8 yr) enrolled as academy student-athletes (annual screening range, 1 to 5 visits). Skeletal age was determined as per the Tanner-Whitehouse II protocol. Relative maturity was calculated as the difference (∆) between Tanner-Whitehouse II skeletal age minus chronological age. Performance test outcomes of interest were 10-m sprinting, 40-m sprinting, countermovement jump height, and maximal aerobic speed. Separate random-effects generalized additive models quantified differences in performance test outcomes by relative skeletal maturity. Estimated differences were deemed practically relevant based on the location of the confidence interval (95% CI) against minimal detectable change values for each performance test outcome. RESULTS: For 40-m sprinting, differences of +0.51 s (95% CI, +0.35 to +0.67 s) and +0.62 s (95% CI, +0.45 to +0.78 s) were practically relevant for relative maturity status of ∆ = -1.5 yr versus ∆ = +0.5 and ∆ = +1 yr, respectively. For countermovement jump height, a difference of -8 cm (95% CI, -10 to -5 cm) was practically relevant for ∆ = -1.5 yr versus ∆ = +1 yr relative maturity status comparison. Effects for 10-m sprinting and maximal aerobic speed were unclear. CONCLUSIONS: Integration of skeletal age and performance assessments indicated that conventional maturity status classification criteria were inconsistent to inform player development processes in our sample. Between-player differences in test performance may depend on a substantial delay in skeletal maturation (∆ ≤ -1.5 yr) and the performance outcome measure.

Apophysitis Among Male Youth Soccer Players at an Elite Soccer Academy Over 7 Seasons.

BACKGROUND: Apophyseal injuries are common in children and adolescent athletes. These injuries are believed to be caused by repetitive overloading, which can create inflammatory and degenerative conditions in growing bone prominences. However, their prevalence, diagnosis, and treatment in young soccer players have been understudied. PURPOSE: To evaluate characteristics of apophyseal injuries in adolescent athletes at an elite soccer academy. STUDY DESIGN: Case series; Level of evidence, 4. METHODS: All apophyseal injuries between July 2008 and June 2015 were evaluated. For each injury, the authors recorded the type and location, age of the player, injury date, imaging modalities, and time absent from training/competition. RESULTS: Over the 7 seasons of this study, 210 apophyseal injuries were documented, including 172 simple apophyseal injuries and 38 apophyseal avulsion fractures. The rate of apophyseal injuries was 0.35 per 1000 hours of training exposure. A total of 196 (93.3%) cases were primary injuries, and the rest (6.7%) were reinjuries. Ultrasonography was the most commonly used imaging modality for diagnosis (172 cases; 81.9%). The most common location of apophyseal injuries was the anterior inferior iliac spine (AIIS). Return to sport was faster in athletes with apophyseal injury at the ischiopubic ramus, those with simple apophyseal injuries, and younger athletes. CONCLUSION: The most common location for apophyseal injury among soccer players was the AIIS. Return to training and competition differed according to injury location, type of apophyseal injury, and age.

Tanner-Whitehouse and Modified Bayley-Pinneau Adult Height Predictions in Elite Youth Soccer Players from the Middle East.

PURPOSE: To provide the first scrutiny of adult height prediction protocols based on automated Greulich-Pyle and Tanner-Whitehouse (TW) skeletal ages applied to elite youth soccer players from the Middle East. METHODS: We examined the application of modified Bayley-Pinneau (BoneXpert®), TW-II, and TW-III protocols using mixed-longitudinal data available for 103 subjects (chronological age range, 19.4 to 27.9 yr) previously enrolled as academy student-athletes (annual screening range, one to six visits). Random-effects generalized additive models quantified the presence of systematic mean differences between actual versus predicted adult height. Effects were deemed practically equivalent based on the location of the confidence interval (95% CI) against a realistic difference value of Δ = ± 1 cm. Each model pooled residual standard deviation described the actual precision of height predictions and was used to calculate a 95% prediction interval. RESULTS: The BoneXpert® method overpredicted adult height systematically at chronological ages in the range of approximately 13.5 to 14.5 yr (95% CI range, -1.9 to -1 cm) and Greulich-Pyle skeletal ages between 13.5 and 15 yr (95% CI range, -3.1 to -1 cm). Effects based on TW-II were practically equivalent across the chronological and skeletal age measurement ranges, with this protocol yielding adult height predictions with a precision (standard deviation) of approximately ±2.6 cm. The mean TW-III effects indicated systematic adult height overpredictions until the attainment of 14.5 and 15 yr of chronological age (95% CI range, -3.8 to -1.1 cm) and TW-III skeletal age (95% CI range: -5.2 to -2.3 cm), respectively. CONCLUSIONS: Tanner-Whitehouse-II adult height prediction method provided more consistent estimates and can be considered the method of choice for talent development purposes in youth soccer players from the Middle East.

COVID-19: Analysis of cavitary air inspired through a mask, in competitive adolescent athletes

Introduction: Due to the mandatory use of a mask in the context of the COVID-19 pandemic, and the authorization to do outdoor sports in Catalonia, we set out to evaluate the physiological impact of the hypoxia and hypercapnia generated by the mask during aerobic exercise.Methods46 adolescent competitive athletes (35 women, 11 men) were evaluated. Measurements were taken of ambient air, at rest intra-mask, and during a stress test intra-mask. The concentration of O2 and CO2 intra-mask and the O2 Saturation were evaluated.ResultsThe O2 of ambient air in the laboratory: 20.9%; Basal intra-mask O2: 18.0±0.7% and intra-mask O2 during exercise: 17.4±0.6% (p<0.0001). The CO2 was: 0.05±0.01% environmental; baseline intra-mask: 1.31±0.5%, and during exercise intra-mask: 1.76±0.6% (p<0.0001). Baseline O2 saturation with mask was 98.4±0.6% and immediately after exercise was 97.1±2.8% (p<0.03). During the exercise intra-mask, 30% of the young athletes exceeded 2% of CO2 and 22% breathed oxygen with a concentration lower than 17%.ConclusionsThe use of masks generate hypercapnic hypoxia during exercise. One third of the subjects exceed the CO2 threshold of 2%. (AU)

Injury incidence and injury patterns by category, player position, and maturation in elite male handball elite players.

The aim of this cohort study is to estimate the influence of position, category, and maturity status on the incidence and pattern of injury in handball players, across two seasons. Injury registration from 164 players-season (12-27 years) was conducted, and players were categorized into youth (133) and adults (31), and per position: 27 goalkeepers, 67 backs, 70 wings and pivots. Maturity status in youth players was also measured by testicular volume on clinical examination (32 immature, 101 mature). 190 injuries occurred during 34 221 hours of exposure. Injury incidence in youth was 6.0 per 1000 total hours [CI 95%, 4.8-7.2] (14.9 match [9.7-20.1] and 3.7 training hours [2.7-4.6]; n= 142 injuries), and in adults 6.5 per 1000 total hours [4.4-8.6] (22.2 match [8.8-35.6] and 3.0 training hours [1.3-4.6]; n=48 injuries). There were significant differences in knee (P=0.01) and cartilage injury (P=0.05) according to playing position. There were significant differences according to age category in ankle (P=0.03), head (P=0.01), thigh (P=0.05) and muscular injury (P= 0.02), and apophysitis (P=0.04) for biological maturity state. Adult handball players had more ankle and muscle injuries than youths. Pivot and wings (2nd line) had more knee and cartilage problems. A higher incidence of apophysitis was found in immature youth players.

Hamstring and other thigh injuries in children and young athletes.

BACKGROUND: In adults, hamstring injuries may lead to long periods of rehabilitation and carry a definite risk of recurrence. However, no studies detail how these injuries affect young athletes. OBJECTIVE: To describe and analyze injuries in the hamstring area in young athletes. To identify risk factors for injuries to the hamstring area in this age group, which will make it possible to design and optimize prevention plans. METHODS: The study population consisted of 1157 young athletes with an average age of 13.56 years, all members of the Barcelona Football Club. Injuries to the hamstring area over three consecutive seasons (from July 2007 to June 2010) were analyzed. RESULTS: The 50 injuries in the hamstring muscle complex included 14 injuries to the biceps femoris, 17 to the semitendinosus-semimembranosus complex, 10 cases of delayed onset muscle soreness (DOMS), and nine avulsion of the ischial tuberosity. Hamstring injuries were first identified in young athletes starting from age nine, with an age-related increased rate up to the age of 15, and a lower incidence at age 14, 16, and 18. The average time lost following an hamstring injury was 21 days and 43.4 days following avulsion from the ischium. The highest incidence of injuries occurred in football players. CONCLUSIONS: Hamstring injuries in this group of young athletes are less prevalent than in adults.

Matching-adjusted indirect treatment comparison of ribociclib and palbociclib in HR+, HER2- advanced breast cancer.

BACKGROUND: Ribociclib (RIBO) and palbociclib (PALBO), combined with letrozole (LET), have been evaluated as treatments for hormone receptor-positive, human epidermal growth factor receptor 2-negative advanced breast cancer in separate Phase III randomized controlled trials (RCTs), but not head-to-head. Population differences can lead to biased results by classical indirect treatment comparison (ITC). Matching-adjusted indirect comparison (MAIC) aims to correct these differences. We compared RIBO and PALBO in hormone receptor-positive/human epidermal growth factor receptor 2-negative advanced breast cancer using MAIC. METHODS: Patient-level data were available for RIBO (MONALEESA-2), while only published summary data were available for PALBO (PALOMA-2). Weights were assigned to MONALEESA-2 patient data such that mean baseline characteristics matched those reported for PALOMA-2; the resulting matched cohort was used in comparisons. Limited by the results reported in PALOMA-2, progression-free survival (PFS) was the primary comparison. Cox regression models were used to calculate adjusted hazard ratios (HRs) for PFS, before indirect treatment comparison (ITC) was performed with 95% confidence intervals. An exploratory analysis was performed similarly for overall survival using earlier PALBO data (PALOMA-1). Grade 3/4 adverse events were also compared. RESULTS: Racial characteristics, prior chemotherapy setting, and the extent of metastasis were the most imbalanced baseline characteristics. The unadjusted PFS HRs were 0.556 (0.429, 0.721) for RIBO+LET versus LET alone and 0.580 (0.460, 0.720) for PALBO+LET versus LET alone. MAIC adjustment resulted in an HR of 0.524 (0.406, 0.676) for RIBO+LET versus LET. PFS ITC using unadjusted trial data produced an HR of 0.959 (0.681, 1.350) for RIBO versus PALBO, or 0.904 (0.644, 1.268) with MAIC. Unadjusted overall survival HR of RIBO versus PALBO was 0.918 (0.492, 1.710); while exploratory MAIC was 0.839 (0.440, 1.598). ITC of grade 3/4 adverse events yielded a risk ratio of 0.806 (0.604, 1.076). CONCLUSION: MAIC was performed for RIBO and PALBO in the absence of a head-to-head trial: though not statistically significant, the results favored RIBO.

Health-related quality of life of postmenopausal women with hormone receptor-positive, human epidermal growth factor receptor 2-negative advanced breast cancer treated with ribociclib + letrozole: results from MONALEESA-2.

PURPOSE: Evaluate patient-reported outcomes (PROs) for postmenopausal women with hormone receptor-positive (HR+), human epidermal growth factor receptor 2-negative (HER2-) advanced breast cancer treated with first-line ribociclib plus letrozole. METHODS: In the phase III MONALEESA-2 study (NCT01958021), 668 patients were randomized 1:1 to ribociclib (600 mg/day; 3-weeks-on/1-week-off) plus letrozole (2.5 mg/day) or placebo plus letrozole. PROs were assessed using the European Organisation for Research and Treatment of Cancer core quality-of-life (EORTC QLQ-C30) and breast cancer-specific (EORTC QLQ-BR23) questionnaires. Changes from baseline and time to deterioration in health-related quality of life (HRQoL) were analyzed using linear mixed-effect and stratified Cox regression models, respectively. Exploratory analysis of area-under-the-curve for change from baseline in pain score (AUC-pain) was performed. RESULTS: On-treatment HRQoL scores were consistently maintained from baseline and were similar between arms. A clinically meaningful (> 5 points) reduction in pain score was observed as early as Week 8 and was maintained up to Cycle 15 in the ribociclib arm. A statistically significant increase in mean AUC-pain was also observed in the ribociclib arm. Scores for all other EORTC QLQ-C30 and EORTC QLQ-BR23 domains were maintained from baseline and were similar between arms. CONCLUSIONS: HRQoL was consistently maintained from baseline in postmenopausal women with HR+, HER2- advanced breast cancer receiving ribociclib plus letrozole and was similar to that observed in the placebo plus letrozole arm. Together with the improved clinical efficacy and manageable safety profile, these PRO results provide additional support for the benefit of ribociclib plus letrozole in this patient population.

Estudio prospectivo de maduración, desarrollo e incidencia lesional en balonmano formativo de élite. ¿Puede el estado madurativo ser un factor determinante de la incidencia lesional en balonmano? / Prospective study of maturity, development, and injury incidence in a professional Handball Academy. Could ‘maturational status’ be a risk factor for injury incidence in different handball team categories?

El objetivo de este estudio es describir la relación entre incidencia lesional (IL) y estado madurativo de jugadores varones de balonmano formativo (BmF) de alto nivel competicional. Se analizan durante 2 temporadas la incidencia de lesión deportiva de forma prospectiva en 133 jugadores, los criterios de maduración biológica y la carga física de exposición. Se siguieron los criterios para estudios de epidemiología lesional según el consenso UEFA. Las variables utilizadas para analizar el estado madurativo son los estadios de Tanner, la pubertad, el pico de velocidad de crecimiento, el volumen testicular y la edad ósea. Se registraron 190 lesiones para un total de 34.222 h de exposición. La IL total media de todas las categorías fue de 5,6 lesiones/1.000 h de exposición. En competición, el valor fue de 21,8 lesiones/1.000 h, y en entrenamiento, de 3,1 lesiones/1.000 h. No se encontraron diferencias estadísticamente significativas entre IL, la edad cronológica y los diferentes estados madurativos por ANOVA. El análisis estadístico multivariante registra cierta tendencia entre las asociaciones de IL en competición para categoría (p = 0,07), y en la IL en entrenamientos para Tanner (p = 0,091) y pubertad (p = 0,021). En conclusión, si bien no se detectaron diferencias significativas en la IL por edades en jugadores de BmF, sí se aprecia una tendencia real en determinados estadios madurativos mediante el análisis multivariante. Esto deberá tenerse en cuenta para planificación entrenamientos y estrategias de prevención de la lesión deportiva en el contexto del BmF

The objective of this study is to determine the relationship between injury incidence (IL) and maturity stage in male elite handball players. A prospective study was conducted during two seasons, evaluating the sports injuries, maturity status and exposure time in hours in 133 young handball players, using the UEFA methodology model for epidemiological studies. The maturity stage with different parameters is presented, as well as Tanner’s stage, puberty stages, peak high velocity, testicular volume, and the bone age. Finally, 190 injuries from a total of 34,222 hours of exposure were registered. The mean total Injury Incidence (IL) by categories was 5.6 injuries/1000 hours of exposure. Injury incidence during competition: 21.8 injuries/1000 hours and in training: 3.1 injuries/1000 h, with no statistically significant differences between IL, chronological age, and different maturity stages using ANOVA. The multivariate statistical analysis showed a tendency of associations between IL in competition category (P = .07), and the IL in training for Tanner (P = .091) and puberty (P = .021). In conclusion: There was a significant difference in total IL by age categories in handball players, and there was a statistically significance tendency as regards some maturity stages using multivariate analysis. This last result should be taken into account when planning training seasons and strategies for injury prevention in the context of the handball training

Certificació de l'aptitud esportiva en l'edat pediàtrica / Certificación de la aptitud deportiva en la edad pediátrica / Preparticipation physical evaluation in children

Fonament: la certificació medicoesportiva té com a objectiu prevenir i diagnosticar possibles alteracions que poguessin condicionar la pràctica esportiva en l'infant i l'a-dolescent. L'aspecte més important és la prevenció de lamort sobtada, situació dramàtica que ha generat gran in-terès i al mateix temps ansietat, tant entre la població general com entre les diferents institucions esportives. Objectiu: establir un criteri de certificació medicoesportivaen l'edat pediàtrica, analitzant i argumentant la disparitatde criteris entre la proposta europea i l'americana. Mètode: revisió bibliogràfica. Conclusions: la pràctica esportiva en infants i adolescentsexigeix un control de salut portat a terme pel pediatre i unarevisió medicoesportiva que ha de fer l'especialista enmedicina de l'esport, i que permetrà la certificació de l'ap-titud esportiva. En aquesta revisió incidirem en l'historialclínic i en l'exploració dels aparells locomotor i cardiovascular, d'acord amb l'algoritme d'actuació de la propostacatalana de prevenció de la mort sobtada de l'esportista. Laresta de l'exploració mèdica per aparells no difereix de laque fa el pediatre de capçalera en els controls de salu

Fundamento. La certificación médico-deportiva tiene como objetivo prevenir y diagnosticar posibles alteraciones que pudieran condicionar la práctica deportiva en el niño/a y adolescente. El aspecto más importante radica en la prevención de la muerte súbita, situación dramática que ha generado gran interés y al mismo tiempo ansiedad, tanto en la población general como en las diferentes instituciones deportivas. Objetivo. Establecer un criterio de certificación médico-deportiva, analizando y argumentando la disparidad de criterios entre la propuesta europea y la americana. Método. Revisión bibliográfica. Conclusiones. La práctica deportiva en niños/as y adolescentes exige un control de salud llevado a cabo por el pediatra y una revisión médico-deportiva realizada por el especialista en medicina del deporte, que permitirá la certificación de la aptitud deportiva. En esta revisión, incidiremos en el historial clínico, la exploración de los aparatos locomotor y cardiovascular, según el algoritmo del consenso catalán de prevención de la muerte súbita en deportistas. El resto de la exploración médica por aparatos no difiere de la que realiza el pediatra de cabecera en los controles de salud (AU)

Background. The aim of preparticipation physical evaluation for thletics is to prevent and diagnose conditions that would contraindicate the practice of sports for children and adolescents. The most important objective is to prevent sudden death, a dramatic situation that has generated great interest and anxiety in the general population as well as among athletic institutions. Objective. To define consensus criteria for preparticipation physical evaluation, considering the disparities between the European and the American proposals. Method. Literature review. Conclusions. The practice of sports in children and adolescents requires a medical evaluation for fitness by the pediatrician and by sports medicine. In this review, we focus on medical history and musculoskeletal and cardiovascular examination, following the guidelines of the Catalan consensus for prevention of sudden death in athletes. The rest of the medical examination does not differ from the exploration performed by the pediatrician in the routine health checks (AU)

Epidemiología lesional del balonmano de elite: estudio retrospectivo en equipos profesional y formativo de un mismo club / Epidemiology of injuries in elite handball: Retrospective study in professional and academy handball team

Objetivo: Evaluar la incidencia y el patrón lesional en el balonmano de elite. Método: Estudio retrospectivo y transversal de 496 jugadores, de 29 equipos (divididos por categorías según edad y nivel), durante 5 temporadas (2007-2012), de un club del sur de Europa. El equipo médico evaluó las lesiones y el tiempo de exposición por equipos. Se siguieron los criterios epidemiológicos según consenso UEFA y codificación OSICS-10. Resultados: Se registraron 557 lesiones con 117.723 h de exposición totales. La incidencia lesional media de los equipos fue: 4,9 lesiones/1.000 h de exposición. Para el equipo Senior A (Profesional) fue de 4,3 (DE 1,8); Senior B, 3,4 (DE 1,6); Juvenil, 5,6 (DE 1,4); Cadete A, 5,5 (DE 2,5); Cadete B, 5,7 (DE 3,2), e Infantil, 4,9 (DE 1,9). No hubo diferencias estadísticamente significativas entre ellos, aunque los seniors tuvieron la mayor cantidad de horas de exposición (p < 0,001).Las localizaciones más frecuentes fueron tobillo (18,1%), rodilla (15,3%), muslo (12,9%) y región lumbar (10,6%). Las estructuras afectadas con más frecuencia fueron la lesión ligamentosa (27,3%) y la lesión «muscular por mecanismo indirecto» (20,5%). Esta última más en el Senior A, y la lesión ligamentosa en las categorías inferiores, aunque no se registraron diferencias significativas entre categorías. Conclusión: El patrón y la incidencia lesional en el balonmano de elite es uniforme entre los equipos de diferentes categorías, con pequeñas diferencias que deberán tenerse en cuenta para optimizar los programas de prevención en cada categoría del balonmano formativo de elite

Objective: To evaluate the injury incidence and pattern of injuries in elite handball by different ages. Method: A retrospective, cross sectional study, was conducted over 5 seasons (2007-2012), analyzing a total of 496 players, 29 teams (from different categories separated by age and performance level) of the same club in southern Europe. The same medical team has assessed the injuries and exposure time by teams. Epidemiological criteria according to UEFA and consensus OSICS-10 diagnostic coding were followed. Results: A total of 57 injuries were recorded during 117,723 hours of total exposure. There was a mean team injury incidence of 4.9 injuries/1000 hours of total exposure. For the Senior A (Professional Senior) it was was 4.3 (SD 1.8), Senior B (Amateur 18-28 years) 3.4 (SD 1.6), Youth (U-18 year) 5.6 (SD 1.4), Cadete A (U-16 year) 5.5 (SD 2.5), Cadete B (U-15 year) 5.7 (SD 3.2) and Infantil (U-14 year) 4.9 (SD 1.9). There were no statistically significant differences between categories, although seniors teams had more hours of exposure compared to other teams (P < 0.001). The most frequently affected sites were ankle (18.1%), knee (15.3%), thigh (12.9%) and lumbar region (10.6%). The most common type of injury to all teams was the sprain (27.3%) and non-traumatic muscle injury (20.5%). Muscle injuries were more common at Senior A (Professional) level, but in lower level teams it was the sprain, although there is no significant differences between them. Conclusion: The pattern and incidence of injury in elite handball is uniform between teams from different categories at the same club; with a few differences between each other that you should take this into account to optimize a preventions programs in each category of elite handball training

Beneficios de la actividad física para la salud en la infancia y la adolescencia / Beneficial effects of physical activity for the health of children and adolescents

Fundamento. La actividad física es necesaria durante la infancia y la adolescencia para promover un desarrollo saludable tanto físico, psíquico como social. El sedentarismo va en aumento y condicionará la aparición de enfermedades prevalentes en la infancia y la adultez. Muchas de estas se podrían prevenir, retrasar o mejorar con dieta y/o actividad física. Objetivo. Argumentar y brindar datos para combatir el sedentarismo y promover la práctica de actividad física en las edades pediátricas, desde la consulta de atención primaria(AU)

Background. Physical activity is necessary during childhood and adolescence to promote a healthy physical, psychological, and social development. Sedentary lifestyles are becoming more prevalent and may result in an increase in the incidence of common diseases during childhood and adulthood. Some of these diseases could be prevented, delayed, or improved with changes in the dietary or physical activity habits. Objective. To provide evidence-based recommendations that may help the primary health care provider in promoting physical activity and combating sedentary lifestyles in children. Method. Literature review. Conclusions. We describe the benefits of physical activity in different aspects of children and adolescents health (growth and development, cardiovascular and respiratory systems, body composition, metabolism, and psychosocial development), and review the problems generated by sedentary lifestyles in our environment. We also provide information on the different components of physical fitness that have an impact on health, and provide recommendations to avoid sedentary lifestyles and to promote physical activity. Finally, we emphasize the criteria of intensity, time, and type of activity that are recommended for each age group(AU)