Human papillomavirus vaccination and social inequality: results from a prospective cohort study.

We investigated the effect of social inequalities on the uptake of human papillomavirus (HPV) vaccination, combining data from a feasibility study conducted in 2007-2008 in 2817 secondary schoolgirls in two UK primary-care trusts, with census and child health records. Uptake was significantly lower in more deprived areas (P<0·001) and in ethnic minority girls (P=0·013). The relatively small proportion of parents who actively refused vaccination by returning a negative consent form were more likely to come from more advantaged areas (P<0·001). Non-responding parents were from more deprived (P<0·001) and ethnic minority (P=0·001) backgrounds. Girls who did not receive HPV vaccination were less likely to have received all their childhood immunizations particularly measles, mumps and rubella (MMR). Different approaches may be needed to maximize HPV vaccine uptake in engaged and non-responding parents, including ethnic-specific approaches for non-responders.

A survey of adolescent experiences of human papillomavirus vaccination in the Manchester study.

BACKGROUND: There is little information on girls' experiences of human papillomavirus (HPV) vaccination in the prevention of cervical cancer. We investigated the views of adolescent girls who had been offered the vaccine as part of a feasibility study conducted in Manchester. METHODS: All 12 to 13-year-old girls in two primary care trusts were offered three doses of Cervarix (manufactured by GlaxoSmithKline). A letter was sent to 1084 parents who had consented to research follow-up. It requested parents to pass a questionnaire regarding HPV vaccination to their daughters to complete and post back in a prepaid envelope. RESULTS: A total of 553 girls completed the questionnaire. Altogether, 77% (422) had shared with their parents in the vaccine decision. In all, 42% (n=13) of girls, whose parents refused vaccination, stated that they wanted the vaccine, whereas 10% (50) of those who were vaccinated did not want the vaccine. Although 54% (277) said the vaccine was very important to them, 39% (153) of vaccinated girls thought they might not recommend it to others. The vaccine was perceived to be painful and there were exaggerated rumours of serious adverse events and needle scares. A total of 79% (420) of girls agreed with a statement that vaccination reminded them of the risks of sexual contact, but 14% (73) agreed they might take more sexual risks because they had been vaccinated. CONCLUSION: Girls of this age form their own views on HPV vaccination but parental support for vaccination remains important, especially for completing the three doses. By discussing the vaccine, parents can encourage their daughters to determine the importance and implications of HPV vaccination.

Parental attitudes and information needs in an adolescent HPV vaccination programme.

We sent a questionnaire to 38% (1084) of 2817 parents whose daughters had been offered human papillomavirus vaccination and who had agreed to participate. Of these, 60% (651) returned a questionnaire. Responses suggested that fact sheets and parent information evenings confirmed, rather than changed, consent decisions. The views of active refusers on safety and efficacy may be difficult to change, lowering vaccine coverage.

Seasonal Incidence and Nature of Cricket Injuries among Elite South African Schoolboy Cricketers

Objective. To identify the incidence and nature of injuries sustained by elite South African schoolboy cricketers. Design. Data were collected retrospectively using a questionnaire. Cricketers recalled all injuries from June 2003 to May 2004. Setting. The population consisted of 196 cricketers representing all provincial teams in the 2004 under-19 Coca-Cola Khaya Majola cricket week. Results. Sixty-seven injuries were sustained by 196 cricketers; with an incidence of 34.2during the period under review. Injuries occurred during matches (71.6); throughout the season due to repetitive stresses sustained during matches and practices (14.9); during practice (11.9) and during other forms of training (1.5). Bowling accounted for 50.7of the injuries; fielding 32.8; batting 14.9and the remaining 1.5occurred while warming up or training. The primary mechanism of injury occurred during the delivery stride and follow through of the fast bowler (34.3). Eighty seven per cent of the injuries were first-time injuries while 13were recurrent. Most injuries (40.6) reported were severe and took the cricketers more than 21 days to recover. Cricketers were more prone to injury during December and January. Conclusion. The incidence and nature of injuries have been recorded and potential risk factors for injury have been identified. It is suggested that coaches and cricketers partake in continuous educational processes that focus on all the physical; mental and technical components necessary for success in cricket; with a national database

A Review of Cricket Injuries and the Effectiveness of Strategies to Prevent Cricket Injuries at all Levels

Objective. This review evaluates the scientific research on cricket injuries; including long-term injury surveillance studies; the consensus statement paper for injury surveillance; specific counter-measures to reduce the risk of cricket injuries and finally identifies areas of future concern. Results. The literature shows that three major cricketplaying countries; Australia; England and South Africa; have collected long-term injury data. While these sets of data show definite trends; it was not always possible tomake direct comparisons between data collected in various countries. As a result a consensus statement paper with regards to definitions and methods to calculate injuryrates; incidence and prevalence was developed. The first study using this newly accepted injury surveillance method showed injury patterns in West Indies domestic andnational cricket teams. There have been three primary studies carried out with regards to interventions aimed at reducing the risk of injury to fast bowlers. These includeda coaching interventions programme; the use of a bowling aid in an attempt to modify bowling technique and a study that evaluated the recommended bowling workloadsin young cricketers. The implications of the changes to the laws relating to the bowling action and the increased usage of the sliding stop in fielding are reviewed. Conclusion. From the review it is evident that there is a need to continue with injury surveillance; as well as a need to continue with and increase the number of studies that evaluate the efficacy of intervention strategies in order to reduce the risk of injury to cricketers

Rib impingement in first class cricketers: case reports of two patients who underwent rib resection.

Two first class cricket bowlers presented with costoiliac pain secondary to rib impingement. In both patients, conservative management of the injury had failed to improve symptoms. Surgical resection of the affected rib was undertaken. At follow up, both patients had made a good recovery and had returned to competitive cricket.

Effect of different types of cricket batting pads on the running and turning speed in cricket batting.

The aim of this study was to compare a batsman's running and turning speed during three runs while wearing either traditional batting pads or one of two models of newly designed cricket batting pads. Fifteen cricketers participated. The running and turning speeds were measured on three different days with players using the three pairs of batting pads for each trial in random order. The weights of the pads were 1.85 kg, 1.70 kg and 1.30 kg for P1, P2 and P3 respectively. Each player had to run three runs (3 x 17.68m), with the times recorded at the completion of each run, as well as the time to cover the distance from 5 m before and after the turn at the end of the first run. The fastest time from two trials for each pair of pads was retained for analysis. An analysis of variance (ANOVA) with repeated measures was used to determine the differences between the mean times of the three trials. The results showed no significant differences between the types of batting pads and the time to complete the run-three-runs test (P1 = 10.67 +/- 0.48 s; P2 = 10.67 +/- 0.43; P3 = 10.69 +/- 0.44 s), the turning time (P1 = 2.34 +/- 0.18 s; P2 = 2.32 +/- 0.18 s; P3 = 2.35 +/- 0.19 s) and to complete the third run (P1 = 3.49 +/- 0.44 s; P2 = 3.53 +/- 0.34 s; P3 = 3.51 +/- 0.36 s). Of the 45 trials of three runs used for analysis, P1 recorded the fastest time on 16 trials (36%), P2 on 19 trials (42%) and P3 on 10 trials (22%). The results showed no significant differences in the running or turning speeds, although there may be some practical relevance to using the newly designed cricket batting pads.

Methods for injury surveillance in international cricket.

BACKGROUND: The varying methods of cricket injury surveillance projects have made direct comparison of published studies in this field impossible. METHODS: A consensus regarding definitions and methods to calculate injury rates in cricket was sought between researchers in this field. This was arrived at through a variety of face-to-face meetings, email communication and draft reviews between researchers from six of the major cricket-playing nations. RESULTS: It is recommended that a cricket injury is defined as any injury or other medical condition that either: (a) prevents a player from being fully available for selection for a major match or (b) during a major match, causes a player to be unable to bat, bowl or keep wicket when required by either the rules or the team's captain. Recommended definitions for injury incidence (for matches, training sessions and seasons) and injury prevalence are also provided. It is proposed that match injury incidence is calculated using a denominator based on a standard time estimated for player exposure in matches, for the purposes of simplicity. This will allow all injury surveillance systems, including those with limited resources, to make calculations according to a standard definition. CONCLUSION: The consensus statement presented provides a standard which, if followed, allows meaningful comparison of injury surveillance data from different countries and time periods, which will assist in the possible identification of risk factors for injury in cricket.

A comparison of the ball rebound characteristics of wooden and composite cricket bats at three approach speeds.

The primary aim of this study was to compare the rebound characteristics of wooden and composite cricket bats. The rebound characteristics of two 'experimental' bats manufactured from composite material were compared with three English willow bats and one Kashmir willow bat. The bats were tested using a specially designed testing rig, which propelled a 156 g Kookaburra cricket ball at three impact speeds: fast-medium, 67 km x h(-1); fast, 101 km x h(-1); and express, 131 km x h(-1) on to the bats mounted in position so that the ball impacts occurred at the position where the blade of the bats was the thickest. The rebound characteristics of the bats were calculated by measuring the approach and rebound speeds of the ball as it passed through a light beam positioned a short distance away from the point of impact. The statistical software package SAS was used to test for significant differences (p < 0.05) between the average rebound characteristics of the bats. Further, Scheffé's method was used as a post hoc comparison to determine whether differences existed between the composite and willow bats. When the composite and traditional willow bats were compared, the results showed no significant differences between the three average approach speeds, while the composite bats showed significantly smaller rebound speeds and coefficient of restitution at all three approach speeds. Thus, the rebound characteristics of the composite bats were significantly less than the traditionally designed English willow wooden bats and would not enhance performance by allowing the batsman to hit the ball harder, assuming all other factors, such as bat speed, mass distribution and the impact point, were the same for the bats. Further study is required to determine the physical properties of composite and wooden bats to enhance their impact characteristics.

Methods for injury surveillance in international cricket.

BACKGROUND: The varying methods of cricket injury surveillance have made direct comparison of published studies in this field impossible. METHODS: A consensus regarding definitions and methods to calculate injury rates in cricket was sought between researchers in this field. This was arrived at through a variety of face to face meetings, email communication, and draft reviews between researchers from six of the major cricket playing nations. RESULTS: It is recommended that a cricket injury is defined as any injury or other medical condition that either (a) prevents a player from being fully available for selection for a major match or (b) during a major match, causes a player to be unable to bat, bowl, or keep wicket when required by either the rules or the team's captain. Recommended definitions for injury incidence (for matches, training sessions, and seasons) and injury prevalence are also provided. It is proposed that match injury incidence is calculated using a denominator based on a standard time estimated for player exposure in matches, for the purposes of simplicity. This will allow all injury surveillance systems, including those with limited resources, to make calculations according to a standard definition. CONCLUSION: The consensus statement presented provides a standard which, if followed, allows meaningful comparison of injury surveillance data from different countries and time periods, which will assist in the possible identification of risk factors for injury in cricket.

Dissociation between back pain and bone stress reaction as measured by CT scan in young cricket fast bowlers.

BACKGROUND: Bone stress reaction is prevalent among cricket fast bowlers. Few studies have addressed the sensitivity and specificity of imaging for diagnosis, and follow up assessment has been poorly investigated. OBJECTIVE: To determine whether there was an association between back pain and bone stress reaction as measured by computed tomography (CT) scan in young cricket fast bowlers. METHODS: Ten young cricket fast bowlers were included in the study. Nine bowlers presented to a physiotherapy practice with low back pain and were later diagnosed with lumbar stress fractures, while one was an experienced bowler with no pain. All players had a CT scan after presenting to the physiotherapy practice. Pain was assessed according to a subjective scale (0-10) where 10 represented the player's subjective, maximum pain score. Recovery and rehabilitation of all players was monitored until they returned to full participation. RESULTS: There was no consistency in the relationship between pain and CT scan results. For example, one subject had evidence of un-united stress fractures after 15 months of rest but had experienced moderate pain for only 2 weeks after the onset of symptoms, in contrast to another subject who had intermittent pain for 11 months even though CT scan showed multiple stress fractures ranging from partially healed to fully healed status at 3 months. CONCLUSION: There is dissociation between back pain and bone stress reaction as measured by CT scan. Therefore, CT scan does not provide objective evidence for ongoing management or decision concerning return to sport in cricket fast bowlers.

Back injuries in young fast bowlers--a radiological investigation of the healing of spondylolysis and pedicle sclerosis.

OBJECTIVE: To demonstrate the efficacy of various radiological diagnostic modalities in assessing lower back pain in young fast bowlers. METHODS: Ten cricketers who presented to either a physiotherapist or a doctor with suspected spondylolysis underwent an X-ray, a single photon emission computed tomography (SPECT) bone scan and a computed tomography (CT) scan to assess the severity of the injury. Three and 12 months after the initial CT scan, second and third CT scans were performed in order to assess whether healing had taken place. After the initial radiological investigation the subjects diagnosed with spondylolysis or pedicle sclerosis underwent prescribed intervention and rehabilitation which included physiotherapy modalities, postural correction, and specific individually graded flexibility, stabilisation, strengthening and cardiovascular programmes. RESULTS: Radiographs were normal in 8 subjects, while 2 had evidence of sclerosis. The isotope scan showed increased uptake in all of the subjects. The CT scans showed no fracture (N = 3), partial fractures (N = 3), complete fractures (N = 2) and old fractures bilaterally (N = 2). When the follow-up CT scan was carried out at 3 months, 1 of the subjects had developed a partial fracture of the left pars interarticularis on the inferior border, which showed complete union when CT scanned at 12 months. At 3 months the partial and complete fractures showed progressive healing in 2 subjects, with complete healing in all the other cases. Complete healing was achieved in all subjects at 12 months, with the exception of 1 subject who showed near-complete union, with a small area of fibrous union on the inferior border and 2 old bilateral fractures that remained un-united. RESULTS: From the results it is evident that when a young fast bowler presents with backache after bowling, it would be appropriate to do an X-ray, a bone scan and a CT scan to make the diagnosis. Discontinuing the fast bowling and following an active rehabilitation programme should result in spontaneous resolution and healing of the fractures. If it is not detected early a fibrous or non-union fracture could result.

Cricket injuries: a longitudinal study of the nature of injuries to South African cricketers.

OBJECTIVE: To determine the incidence and nature of injuries sustained by elite cricketers during a three season period in order to identify possible injury patterns. METHODS: Thirty six physiotherapists and 13 doctors working with 11 provincial and the South African national teams completed a questionnaire for each cricketer who presented with an injury during each season to determine anatomical site of injury, month of injury during the season, diagnosis, mechanism of injury, whether it was a recurrence of a previous injury, whether the injury had recurred again during the season, and biographical data. RESULTS: A total of 436 cricketers sustained 812 injuries. Bowling (41.3%), fielding and wicketkeeping (28.6%), and batting (17.1%) accounted for most of the injuries. The lower limbs (49.8%), upper limbs (23.3%), and back and trunk (22.8%) were most commonly injured. The injuries occurred primarily during first class matches (27.0%), limited overs matches (26.9%), and practices (26.8%) during the early part of the season. Acute injuries made up 64.8% of the injuries. The younger players (up to 24 years) sustained 57% of the first time injuries, and the players over 24 years of age sustained 58.7% of the injuries that recurred from a previous season. The injuries were mainly soft tissue injuries predominantly to muscle (41.0%), joint (22.2%), tendon (13.2%), and ligament (6.2%). The primary mechanism of injury was the delivery and follow through of the fast bowler (25.6%), overuse (18.3%), and fielding (21.4%). CONCLUSION: The results indicate a pattern of cause of injury, with the young fast bowler most likely to sustain an acute injury to the soft tissues of the lower limb while participating in matches and practices during the early part of the season.

Incidence and nature of epidemiological injuries to elite South African cricket players.

OBJECTIVES: The study investigated the incidence and nature of injuries sustained by elite cricketers during a season and the possible risk factors associated with these injuries. METHODS: Fourteen physiotherapists and three doctors recorded 163 injuries sustained by 88 cricketers. RESULTS: Bowling accounted for 40.5% of the injuries, while fielding and batting accounted for 25.6% and 21.5% of the injuries, respectively. The injuries occurred while practising for or playing in club (3.7%), provincial 'B' (8.0%), provincial (51.5%) and international (36.8%) matches and occurred primarily during 4- and 5-day (33.1%) and 1-day (27.0%) matches. First-time injuries made up 63.6% of the injuries, recurrent injuries from previous seasons made up 28.4% and 8.0% of the injuries recurred again at a later stage during the season. Of the injuries 62.6% were acute, 14.7% chronic and 22.7% were acute injuries on existing chronic injuries. The majority of the injuries were muscle (37.4%), joint (20.9%) and tendon (15.3%) injuries. The primary mechanisms of injury were as a result of overuse (30.7%); running to catch or field (15.3%); during the bowling delivery or follow-through (12.3%); and being struck by the ball while batting (11.0%). CONCLUSIONS: Coaches, players and the medical support team need to be aware of the incidence, nature and cause of injuries, so that the risk of injury can be further reduced.

Psychological and physical health effects of sexual assaults and nonsexual traumas among male and female United States Army soldiers.

Lifetime trauma history was assessed in a health study of active duty United States Army soldiers. Five hundred fifty-five male and 573 female soldiers in the sample were asked whether they had ever experienced 14 different potentially traumatic experiences, including sexual assaults, violent stressors to self, and terrifying events that occurred to others and were secondarily traumatic through exposure by gaining information or as a witness to the event. Most soldiers had experienced multiple traumas, and premilitary exposure to events was much more common than exposure to events after entering the military. Global measures of current psychological distress and physical health symptoms were predicted by the lifetime number of sexual assaults and traumas to self. Social support from military unit leaders moderated the relationship between accumulated exposure to traumas and both health measures, whereas unit cohesion was directly associated with fewer mental health problems.

A review of batting in men's cricket.

In this review, we critically evaluate the scientific research into the morphology and physiology of cricket batsmen. We consider all aspects of the motor control of this skill, in the context of research into dynamic interceptive actions, the biomechanics (kinematics and kinetics) of the various phases of batting strokes and injuries to batsmen. Some attention is also devoted to batting equipment and to psychological factors in batting. Because of the lack of published scientific research into women's cricket, this review focuses on the men's game and covers research on batsmen of various playing standards. For the future, we see as a high priority research into injury mechanisms, rather than simple injury statistics, and the role of cricket equipment design in injury prevention. A second priority is for multi- or inter-disciplinary research, linking the biomechanics of batting to the underlying motor control of the movements and the effect of environmental information. Biomechanical studies of the variability of the batsman's movements are needed, and these should be related to the compensatory variability proposal of ecological psychology. Clearly, there is also a need for scientific research into batting in women's cricket, which has been inadequately researched to date.

The impact absorption characteristics of cricket batting helmets.

To determine whether the helmets currently used by cricket batsmen offer sufficient protection against impacts of a cricket ball, the impact absorption characteristics of six helmets were measured using the drop test at an impact velocity equivalent to a cricket ball with a release speed of 160 km x h(-1) (44.4 m x s(-1)). An accelerometer transducer attached to a 5.0 kg striker was dropped from a height of 3.14 m onto the batting helmets to measure the impact characteristics at the three different impact sites: right temple, forehead and back of the helmet. These data were further expressed as a percentage above (-) or below (+) the recommended safety standard of 300 g. The results indicate that the force absorption characteristics of the helmets showed inter- and intra-helmet variations, with 14 of the 18 impact sites (66.7%) assessed meeting the recommended safety standards. Helmets 1, 2 and 4 succeeded in meeting the safety standards at all impact sites; helmets 5 and 6 both failed at the back and forehead, while helmet 3 failed at all impact sites. These differences were due to the structure and composition of the inner protective layer of the helmets. The helmets that succeeded in meeting the standards were made with a moulded polystyrene insert, a heat-formed ethylene vinyl acetate (EVA) insert, or EVA with a relatively high density that allows a minimal amount of movement of the helmet at ball impact.

Effects of premilitary and military trauma on the development of post-traumatic stress disorder symptoms in female and male active duty soldiers.

We surveyed more than 1,000 female and male active duty soldiers to assess the effect of premilitary and military trauma on their psychological well-being. Questionnaire data were obtained on pertinent demographic information, history of trauma exposure, and symptoms of post-traumatic stress disorder (PTSD). The results indicated significant gender differences in the types of traumatic events experienced, with females reporting more sexual traumas and males reporting more nonsexual traumas. In addition, males reported experiencing more military-related traumas, whereas females reported experiencing more premilitary traumas. The prevalence of PTSD symptoms was 8.6% for females and 5% for males. Recommendations are presented that may help mitigate development of PTSD symptoms in the future.