Cancer care for Ukrainian refugees: Strategic impact assessments in the early days of the conflict.

BACKGROUND: The invasion of Ukraine by Russia in February 2022 has resulted in destruction of healthcare infrastructure and triggered the largest wave of internally displaced populations and refugees since World War Two. Conflicts in transitioned countries such as Ukraine create new non-communicable disease (NCD) challenges, especially for cancer care for refugees and humanitarian assistance in host countries. In the early days, rapid attempts were made to model possible impacts. METHODS: By evaluating open source intelligence used in the first three months of the conflict through snowball search methods, we aimed to address: (i) burden of cancer in Ukrainian population, specifically considering translating to the refugees population, and its cancer care capacity; ii) baseline capacity/strengths of cancer systems in initial host countries. Moreover, using a baseline scenario based on crude cancer incidence in Ukraine, and considering data from UNHCR, we estimated how cancer cases would be distributed across host countries. Finally, a surveillance assessment instrument was created, intersecting health system's capacity and influx of internally displaced populations and refugees. FINDINGS AND CONCLUSIONS: The total new cancer patients per month in pre-conflict Ukraine was estimated as 13,106, of which < 1 % are paediatric cases. The estimated cancer cases in the refugee population (combining prevalent and incident), assuming 7.5 million refugees by July 2022 and a female:male ratio of 9:1, was 33,121 individuals (Poland: 19284; Hungary: 3484; Moldova: 2651; Slovakia: 2421; Romania: 5281). According to our assessments, Poland is the only neighbouring country classified as green/yellow for cancer capacity, i.e. sufficient ablility to absorb additional burden into national health system; Slovakia we graded as yellow, Hungary and Romania as yellow/red and Moldova as red.

Ischemic heart disease is associated with lower cortical volumetric bone mineral density of distal radius.

UNLABELLED: In this study, high-resolution peripheral quantitative computed tomography (HR-pQCT) was used to investigate geometric, volumetric and microstructural parameters at the distal radius and at the distal tibia in participants with ischaemic heart disease. We found that, compared with participants without ischaemic heart disease, they had substantially lower cortical volumetric bone mineral density (BMD) at the distal radius. INTRODUCTION: HR-pQCT captures novel aspects of bone geometry and volumetric bone mineral density (vBMD) and offers the ability to measure bone microarchitecture, but data relating measures obtained from this technique in patients with ischemic heart disease (IHD) are lacking. METHODS: Here, we report an analysis from the Hertfordshire Cohort Study, where we were able to study associations between measures obtained from HR-pQCT of distal radius and distal tibia in 350 participants (184 men and 166 women) aged 71.5-80.5 years with or without IHD (e.g. heart attack, angina or heart failure; n = 75 and n = 275, respectively). RESULTS: Analyses for all participants (men and women together) revealed that cortical vBMD (Ct.vBMD) was lower (p < 0.001) and cortical thickness (Ct.th) was not different (p = 0.519), whereas cortical porosity (Ct.Po) was higher (p = 0.016) in participants with IHD at the distal radius. Moreover, trabecular microarchitectural parameters were not significantly different in patients with IHD (p > 0.05 for all). Adjustment for a priori confounders (age, gender, body mass index, smoking status, alcohol consumption, high blood pressure and diabetes mellitus) did not materially affect the relationship described for Ct.vBMD (p = 0.002), but differences in Ct.Po were attenuated. Analyses in men alone revealed that only Ct.vBMD was lower at the distal radius in participants with IHD with and without adjustment for a priori confounders (p = 0.0002 and p = 0.004, respectively), whereas no statistical differences were found in women, although patterns of differences were similar in both sexes. Moreover, no association was found between IHD and bone parameters at the distal tibia either in men or women. CONCLUSIONS: We have demonstrated that IHD is associated with lower Ct.vBMD of the distal radius.

1994 entry-level athletic training salaries.

In this study, I examined salaries for entry-level positions in athletic training during the year 1994. An entry-level position was defined as a position to be filled with an athletic trainer certified by the NATA, with no full-time paid employment experience. According to the "Placement Vacancy Notice" (NATA, Dallas, TX) and "BYLINE" (Athletic Trainer Services, Inc, Mt Pleasant, MI), there were 432 entry-level vacancies in hospital/clinics, college/universities, and high school settings. A total of 271 surveys (63%) were returned. Overall, beginning salaries for entry-level athletic training positions were $23,228 (+/-$3,177) for a bachelor's degree and $25,362 (+/-$3,883) for a master's degree. A stipend ($4,216 +/- $2,039) was included in 86% of the high school positions. The term of contract for high school was usually a 10-month position (10.0 +/- .9 months), hospital/clinic, 12-months (11.7 +/- .7 months), while the college/university varied from 9 to 12 months (10.5 +/- 1.2 months). Also included in the study was fringe benefit information: pension (other than Social Security), life, medical, dental, and vision insurance. Continued studies are recommended to establish salary norms and trends for entry-level positions so that athletic trainers will understand what monetary compensation to expect for their services.

1992 entry-level athletic trainer salaries.

The purpose of this study was to examine the salaries for entry-level positions in athletic training during the year 1992. An entry-level position was defined as an athletic trainer, certified by the National Athletic Trainers' Association (NATA), with no full-time paid employment experience. According to the "Placement Vacancy Notice" published by the NATA, there were 234 entry-level vacancies in the hospital/clinic, 135 with the college/university, and 58 at the high school setting. A survey was designed and mailed to the location of each of these 427 entry-level positions. Distribution of responses was 78 (33%), 55 (41%), and 23 (40%) for hospital/clinic, college/university, and high school, respectively. Overall, beginning salaries for entry-level athletic training positions were $23,108 (+/- $3,309) for a bachelor's degree and $25,223 (+/- $3, 794) for a master's degree. A stipend ($4,219 +/- $1,458) was included in most of the high school positions. Term of contract for high school was usually 10 months (10.2 +/- 0.8 months), hospital/clinic was 12 months (11.9 +/- 0.6 months), while the college/university varied from 9 to 12 months (10.8 +/- 1.3 months). Further studies are recommended to establish salary norms and trends for entry-level positions so that athletic trainers will understand what monetary compensation is expected for their services.

Comparison of three methods of assessing muscle strength and imbalance ratios of the knee.

Three strength measurement methods for determining muscle strength and imbalance ratios of the knee were compared in 41 (23 female, 18 male) NCAA Division I track and field athletes. Peak quadriceps extensions and hamstring flexions were measured isotonically, isometrically, and isokinetically. Isokinetic measurements were performed on a Cybex II at 60 degrees /s. Isometric extension and flexion measurements were performed using the Nicholas Manual Muscle Tester (Lafayette Instruments; Lafayette, Ind). Isotonic measurements were done on both Universal and Nautilus apparatuses. Testing order was randomized to avoid a treatment order effect. A repeated measures ANOVA and a post hoc Tukey test were used to compare the three methods of assessing strength and imbalance ratios of the knee. Absolute strength values were significantly different according to gender and mode of testing. Bilateral strength imbalance ratios for knee flexion were significantly lower for the Nautilus leg curl machine. Ipsilateral strength imbalance ratios were significantly greater for the Cybex II. Our results indicated that absolute strength values cannot be interchanged between testing modes. Except for Cybex II (ipsilateral) and Nautilus (bilateral knee flexion), strength imbalance ratios could be interchanged.

Comparison of the histochemical and contractile properties of human triceps surae.

The purpose of the study was to compare the contractile properties determined from an electrically stimulated twitch with histochemically determined fibre type parameters of the human triceps surae. Muscle samples were obtained from the medial head of the gastrocnemius of ten male athletes. Ages ranged from 20 to 29 years. Muscle samples from the belly of the medial gastrocnemius muscle were obtained using the needle biopsy technique. The samples were treated histochemically for myosin ATPase to classify the fibres as either slow twitch (ST) or fast twitch (FT) and to determine fibre areas. Surface electrical stimulation was used to determine muscle twitch parameters. The contractile variables of the muscle twitch were latency (L), time to peak force (TPF), peak force (PF), half-contraction time (1/2 CT) and half-relaxation time (1/2 RT). Backward elimination procedures for dependent variables were used to determine which contractile properties best represented the histochemical profile of the muscles. Prediction formulas were developed for FT and ST percentages (R2 = 0.98, p < 0.001), relative area percentage (R2 = 0.87, p < 0.001), and ST area (R2 = 0.85, p < 0.01). It was concluded that the use of the electrotensiometer (ETM) protocol was a valid testing procedure when studying physiological relationships of histochemical properties in intact human skeletal muscle.

Comparison of the histochemical and contractile properties of human gastrocnemius muscle.

Contractile and histochemical properties of the human gastrocnemius muscle were compared in 21 male athletes ranging from 20 to 29 years of age. Surface electrical stimulation was used to determine muscle twitch parameters. The contractile variables of the muscle twitch were: latency (L), time to peak force (TPF1 and TPF2), peak force (Pf1 and Pf2), half-contraction time (1/2 CT), and half-relaxation time (1/2 RT). Muscle samples from the belly of the medial gastrocnemius muscle were obtained using the needle biopsy technique. The samples were treated histochemically for myosin ATPase in order to classify the fibers as slow twitch (ST) or fast twitch (FT) and to determine fiber areas. Multiple correlations were performed between the contractile and histochemical variables. The results demonstrated significant (p < 0.05) positive relationships between the calculated twitch recordings and percentage of FT fibers (R = 0.85), percentage of ST fibers (R = 0.85), relative percent area of FT fibers (R = 0.84), and relative percent area of ST fibers (R = 0.84). The results suggest that fiber type percentage and relative percent area determined using myosin ATPase are related to electrically stimulated isometric contractile properties. J Orthop Sports Phys Ther 1991;13(6):322-328.