Incidencia de lesiones deportivas en futbol base durante una temporada / Incidence of sports injuries in academy football during a season

Antecedentes El fútbol constituye una práctica deportiva que empieza a edades tempranas y exige una gran demanda física, sobre todo de los miembros inferiores. Objetivo Determinar la incidencia de lesiones, así como su naturaleza y relación con la posición de juego y categoría en una población de futbolistas federados masculinos jóvenes en sus diferentes categorías no seniors durante una temporada deportiva. Material y método Se realizó un estudio observacional retrospectivo mediante cuestionarios autorrellenables en 128 futbolistas pertenecientes a los equipos del fútbol base del Marbella club de fútbol. Resultados Se registraron un total de 254 lesiones. La categoría juvenil presenta una incidencia más alta (p=0,002). Las lesiones más numerosas fueron los esguinces de tobillo y las lesiones musculares de gemelos. Conclusiones La incidencia lesional guarda una relación directa con la categoría no siendo así con la posición de juego. Los programas de prevención de lesiones deben adecuarse a las exigencias de cada categoría en futbol base (AU)

Background Soccer is a sports practice that begins at an early age and requires a great physical demand, especially of the lower limbs. Objective To determine the incidence of injuries, as well as their nature and relationship with the game position and category in a population of young male federated soccer players in their different non-senior categories during a sports season. Material and method A retrospective observational study was carried out using self-filled questionnaires in 128 soccer players belonging to the base soccer teams of the Marbella soccer club. Results A total of 254 injuries were recorded. The juvenile category presents a higher incidence (P=.002). The most numerous injuries were ankle sprains and calf muscle injuries. Conclusions The incidence of injuries is directly related to the category, not being so with the playing position. Injury prevention programs must be adapted to the demands of each category in youth soccer (AU)

Dolor lumbar crónico y pronación unilateral o bilateral del pie / Low back pain and unilateral or bilateral pronation of the foot

Antecedentes y objetivo: Diferentes estudios han defendido la relación entre la pronación del pie y el dolor lumbar crónico (DLC). Sin embargo, no se hallan artículos que analicen la repercusión que puede existir entre la postura en pronación de un solo pie y su influencia en el DLC frente a la pronación en ambos pies. Por ello, se ha planteado evaluar la intensidad del dolor lumbar en sujetos pronadores con un índice de postura del pie (IPP) superior a+6 en un pie comparado con sujetos con pronación superior a+6 en ambos pies. Material y método: Estudio observacional transversal con muestreo por conveniencia en una muestra total de 116 sujetos. Se comparó el DLC en un grupo con dolor lumbar crónico y posición pronada de un pie (IPP, superior a+6), frente a un grupo de sujetos con DLC e IPP superior a+6 en ambos. Como herramientas de valoración de la variable dependiente se utilizó la escala visual analógica (EVA) y el Índice de discapacidad de Oswestry (IDO) para dolor lumbar. Resultados: No se encontró correlación entre la posición unilateral o bilateral en pronación y la intensidad del DLC. La pronación de un solo pie no pareció mostrarse como mayor factor de riesgo en el DLC que la bilateral (IDO p = 0,700; EVA p = 0,235). Conclusiones: No se encuentran diferencias estadísticas en el DLC en el grupo de pacientes con un IPP del pie en pronación frente a los sujetos con posición en pronación bilateral. Futuros estudios son necesarios

Background and objectives: Different studies have defended the relationship between the pronated foot and chronic low back pain (CLBP). Nevertheless, according to current knowledge, there is no evidence on the possible influence of pronation of one foot or both feet and the intensity of the CLBP. The aim of this study was to evaluate the intensity of the CLBP in subjects with one or two pronated feet with a foot posture index (FPI, superior to +6) in one foot compared with subjects with CLBP and FPI of+6 in both feet. Material and method: A cross-sectional study was conducted with convenience sampling, composed of 116 subjects who presented with CLBP and with two or at least one pronated foot. The CLBP was compared in one group with CLBP and one foot in the pronated position (foot posture index (FPI)>+6), against a group of subjects with CLBP and an FPI>+6 in both feet. The visual analogue scale (VAS) and the Oswestry low back pain index (ODI) were used as tools for assessing the dependent variable. Results: There were no significant differences between the unilateral or bilateral foot pronation and the intensity of the CLBP. The pronation of only one foot does not seem to be a greater risk factor in CLBP than bilateral pronation (ODI: p = .700; VAS: p = .235). Conclusions: There is no evidence of a higher rate of chronic low back pain in the group of patients with a pronated position of one foot compared to subjects with both feet pronated, as assessed with the VAS and ODI scale. Further studies are necessary

Limitación del movimiento de flexión dorsal del tobillo en sujetos pronadores con dolor lumbar crónico / Limited ankle dorsiflexion in subjects with pronated feet and low back pain

Antecedentes: Estudios han relacionado la posible influencia entre los desequilibrios de la biomecánica del pie y el dolor lumbar crónico (CLBP). Según indican algunos autores la limitación del movimiento de la flexión dorsal (FD) de la articulación tibioperonea-astragalina del pie (TPA) puede presentarse como un factor de riesgo en el dolor lumbar crónico. Objetivo: Evaluar el dolor lumbar crónico en sujetos con pies pronadores con limitación de la flexión dorsal del tobillo en al menos un pie, frente a sujetos pronadores con movilidad normal del tobillo. Material y método: estudio descriptivo transversal con muestreo por conveniencia realizado en una muestra compuesta por 126 sujetos con dolor lumbar crónico y pies pronados. Se comparó un grupo de sujetos con CLBP que presentaron limitación de la flexión dorsal de al menos un tobillo, frente a otro grupo de pronadores con CLBP y rango de movimiento normal de tobillo. Como herramientas de valoración de la variable dependiente se utilizó la escala visual analógica (EVA) y el Índice de discapacidad por dolor lumbar de Oswestry (ODI). Resultados: Se encontró correlación positiva entre la limitación de FD de la TPA en sujetos pronadores con CLBP frente al grupo de pronadores con CLBP y FD normal (EVA 4 ± 0,22; ODI: 11,85% ± 1,21). La limitación del movimiento de FD de TPA parece mostrarse como un factor de riesgo en el CLBP (EVA 5,3 ± 0,22; ODI: 17,90% ± 1,42; valor de p ODI = 0,004; EVA 0,009). Conclusiones: Se evidencia un mayor CLBP en el grupo de pronadores con limitación de FD de al menos una TPA frente al grupo de sujetos pronadores con rango normal de movimiento

Background: The influence between the imbalances in foot biomechanics and chronic low back pain (CLBP) has been described in different studies. Some authors suggest that the reduced ankle (TPA) dorsiflexion (FD) can present as a risk factor in chronic low back pain. Objective: To evaluate low back pain in subjects with pronated feet and limited ankle dorsiflexion compared to those with pronated feet and normal mobility of ankle. Material and method: A cross-sectional study with convenience sampling was performed on 126 subjects with chronic low back pain and pronated feet. Participants were divided into two groups, both with pronated feet but one with reduced FD in at least one foot and the other with normal FD of TPA movement. A visual analogue scale (VAS) and the Oswestry Low Back Pain Index (ODI) were used as tools for assessing the dependent variable. Results: After the analysis of the data, a positive correlation was found between the limited FD of the movement of the TPA in pronated feet subjects with CLBP versus those who had normal mobility of TPA and pronated feet (VAS 4 ± 0,22; ODI: 11.85% ± 1.21). The limitation of the joint range of the ankle seemed to be a risk factor in CLBP in pronator subjects (VAS 5.3 ± 0.22; ODI: 17.90% ± 1.42) (ODI scale = 0.004, VAS 0.009). Conclusions: There is evidence of a higher rate of chronic lumbar pain in pronated patients with reduced ankle dorsiflexion as assessed with a VAS and the ODI scale

[And if it happened to children? Adapting medical care during terrorist attacks with multiple pediatric victims]. / Et si c'était des enfants ? Adaptation de la prise en charge médicale en cas d'attentats terroristes avec de nombreux enfants victimes.

In light of the recent terrorist attacks in Europe, we need to reconsider the organization of rescue and medical management and plan for an attack involving multiple pediatric victims. To ensure quick surgical management, but also to minimize risk for on-site teams (direct threats from secondary terrorist attacks targeting deployed emergency services), it is crucial to evacuate patients in a swift but orderly fashion. Children are vulnerable targets in terrorist attacks. Their anatomical and physiological characteristics make it likely that pediatric victims will suffer more brain injuries and require more, often advanced, airway management. Care of multiple pediatric victims would also prove to be a difficult emotional challenge. Civilian medical teams have adapted the military-medicine principles of damage control in their medical practice using the MARCHE algorithm (Massive hemorrhage, Airway, Respiration [breathing], Circulation, Head/Hypothermia, Evacuation). They have also learned to adapt the level of care to the level of safety at the scene. Prehospital damage control principles should now be tailored to the treatment of pediatric patients in extraordinary circumstances. Priorities are given to hemorrhage control and preventing the lethal triad (coagulopathy, hypothermia, and acidosis). Managing hemorrhagic shock involves quickly controlling external bleeding (tourniquets, hemostatic dressing), using small volumes for fluid resuscitation (10-20ml/kg of normal saline), quickly introducing a vasopressor (noradrenaline 0.1µg/kg/min then titrate) after one or two fluid boluses, and using tranexamic acid (15mg/kg over 10min for loading dose, maximum 1g over 10min). Prehospital resources specifically dedicated to children are limited, and it is therefore important that everyone be trained and prepared for a scene with multiple pediatric patients.

Duration of lack of money for basic needs and growth delay in the Quebec Longitudinal Study of Child Development birth cohort.

OBJECTIVE: To examine the relationship between duration of lack of money for basic needs and growth delay in a birth cohort. METHODOLOGY: Mothers of children (n = 1929) from the Quebec Longitudinal Study of Child Development (QLSCD) participating when the children were ages 2(1/2) and 4 years were interviewed at home and data were extracted from birth records. Children's height at 4 years old was transformed into an age- and sex-adjusted z-score. A z-score under the 10th percentile of the Centers for Disease Control and Prevention population growth curve was equated with growth delay. Lack of money for basic needs (paying for rent, electricity and/or heating, clothing, medications or other needs) when the children were ages 2(1/2) and 4 years was reported by the mother. RESULTS: Only 2.5% of children experienced two episodes of lack of money for basic needs. Logistic regression analyses showed that, after adjusting for confounding variables, the probability of growth delay at 4 years among children whose families experienced two episodes of lack of money was higher than for their peers who had not lacked money (OR 3.43; 95% CI 1.54 to 7.66). Experiencing lack of money only at 2(1/2) years showed higher but not significant odds of growth delay at 4 years (OR 1.51; 95% CI 0.84 to 2.72), whereas the likelihood of growth delay was similar for children who experienced lack of money only at 4 years and for their counterparts who never lacked money (OR 0.74; 95% CI 0.26 to 2.11). CONCLUSION: In an industrialised country toddlers whose families experienced persistent lack of money for basic needs are more likely to have growth delay even after controlling for neonatal conditions and their mothers' characteristics.

Validation of a measure of maternal perception of the child's health status.

BACKGROUND: The main objective of this population-based and cross-sectional study was to determine the validity of maternal perception as an indicator of the 17-month-old child's health status. METHODS: Data from this study came from the Quebec Longitudinal Study of Child Development (QLSCD, Round 1999) which was based on a representative sample of babies born in Québec in 1997 and 1998. The analyses were based on the 2045 children aged 17 months who participated in the survey in 1999. Maternal perception of the child's health status was examined as a function of a series of children's health indicators, namely the presence of acute health problems (last 3 months), asthma attacks since birth, presence of chronic problem and hospitalizations during the previous 12 months. Confounding influences of both maternal and child-related characteristics were controlled in the analyses. RESULTS: Sequential logistic regressions indicated that maternal perception was strongly associated with the different health indicators even after controlling for confounding variables. However, a significant interaction between the child's gender and the presence of chronic health problems was observed. The association between maternal perception of the child's health and the presence of chronic health problems was stronger for boys than for girls. CONCLUSIONS: The analyses confirm that the mother's perception of the health status of her 17-month-old child corresponds with the actual health status of the child as reflected by the presence or absence of selected health problems.

Fricción transversa profunda y podología deportiva / Deep transverse friction and sportive podology

A la hora de planificar el tratamiento de las lesiones deportivas, el abanico terapéutico del que dispone el podólogo se puede catalogar como amplio. En este artículo pretendemos ampliar un poco más dicho abanico presentando una técnica que bien utilizada y combinada convenientemente con otras opciones terapéuticas, nos va a proporcionar mayor eficacia y, sobre todo, una mayor rapidez en la recuperación de la lesión, reduciendo, de manera importante el período de inactividad del deportista (AU)

Socio-economic disparities in preterm birth: causal pathways and mechanisms.

Preterm birth is the leading cause of infant mortality in industrialised societies. Its incidence is greatly increased among the socially disadvantaged, but the reasons for this excess are unclear and have been relatively unexplored. We hypothesise two distinct sets of causal pathways and mechanisms that may explain social disparities in preterm birth. The first set involves chronic and acute psychosocial stressors, psychological distress caused by those stressors, increased secretion of placental corticotropin releasing hormone (CRH), changes in sexual behaviours or enhanced susceptibility to bacterial vaginosis and chorioamnionitis, cigarette smoking or cocaine use, and decidual vasculopathy. The second hypothesised pathway is a gene-environment interaction based on a highly prevalent mutation in the gene for methylenetetrahydrofolate reductase (MTHFR), combined with low folate intake from the diet and from prenatal vitamin supplements, consequent hyperhomocysteinemia, and decidual vasculopathy. We propose to test these hypothesised pathways and mechanisms in a nested case-control study within a prospectively recruited and followed cohort of pregnant women with singleton pregnancies who deliver at one of four Montreal hospitals that serve an ethnically and socio-economically diverse population. Following recruitment during the late first or early second trimester, participating women are seen at 24-26 weeks, when a research nurse obtains a detailed medical and obstetric history; administers several scales to assess chronic and acute stressors and psychological function; obtains blood samples for CRH, red blood cell and plasma folate, homocysteine, and DNA for the MTHFR mutation; and performs a digital and speculum examination to measure cervical length and vaginal pH and to obtain swabs for bacterial vaginosis and fetal fibronectin. After delivery, each case (delivery at < 37 completed weeks following spontaneous onset of labour or prelabour rupture of membranes) and two controls are selected for placental pathological examination, hair analysis of cotinine, cocaine, and benzoylecgonine, and analysis of stored blood and vaginal specimens. Statistical analysis will be based on multiple logistic regression and structural equation modelling, with sequential construction of models of potential aetiological determinants and covariates to test the hypothesised causal pathways and mechanisms. The research we propose should improve understanding of the factors and processes that mediate social disparities in preterm birth. This improved understanding should help not only in developing strategies to reduce the disparities but also in suggesting preventive interventions applicable across the entire socio-economic spectrum.

Caracterizacion del pie del deportista universitario: su relacion con el esguince de tobillo / Characterisation of university sportsmen's feet: relationship with sprained ankles

Las diferencias anatómicas existentes en los atletas pueden implicar cambios importantes en el gesto deportivo. Los distintos gestos deportivos pueden influir de forma positiva, con la mejora del rendimiento físico, o de forma negativa, disminuyéndolo o favoreciendo la aparición de lesiones. Sabemos de la existencia de cierta predisposición anatómica y funcional a la hora de sufrir determinadas lesiones. De este punto, se deriva la importancia de realizar una valoración apropiada de las distintas estructuras anatómicas del atleta para actuar en consecuencia, bien con medidas preventivas, paliativas o terapéuticas. Entre las lesiones deportivas hemos estudiado el esguince lateral externo del tobillo por ser la más frecuente de la extremidad inferior. El análisis de la huella plantar en estática nos puede dar información sobre el comportamiento funcional de la extremidad inferior. Así mismo, diferentes anomalías funcionales van a presentar su reflejo en una alteración del apoyo en dinámica. En nuestro estudio, realizado a una población de deportistas universitarios de alto nivel (n=70), la exploración clínica nos permitió hacer una clasificación según las diferentes alteraciones en el apoyo (pie plano, pie normal y pie cavo). Se hizo también un registro de otras anomalías qué no atendían a tal clasificación (Rotaciones tibiales, genus de rodilla, hallux abductus valgus...).Los esguinces de tobillo presentaron una mayor incidencia en aquellos sujetos en los que la huella se desviaba de los criterios de normalidad, tanto para los pies cavos como los pies planos. El 33 por ciento de sujetos con un apoyo normal sufrieron esguince de tobillo en comparación con el 66 de sujetos con pies cayos o planos que también padecieron dicha lesión. Es curioso observar que en el grupo con otras anomalías sólo el 23 por ciento de sujetos presentaron esguinces. Las alteraciones del apoyo no se presentaron aisladas, sino asociadas a otros factores determinantes en el aumento de la incidencia por grupos. Así los sujetos con pie plano presentaban una hiperlaxitud ligamentaria que los predisponían a sufrir dicha lesión. Basándose en los resultados obtenidos, se proponen una serie de exploraciones básicas encaminadas a descartar las principales alteraciones morfofuncionales en la estática del pie (AU)

Socio-economic disparities in pregnancy outcome: why do the poor fare so poorly?

In this paper, we review the evidence bearing on socio-economic disparities in pregnancy outcome, focusing on aetiological factors mediating the disparities in intrauterine growth restriction (IUGR) and preterm birth. We first summarise what is known about the attributable determinants of IUGR and preterm birth, emphasising their quantitative contributions (aetiological fractions) from a public health perspective. We then review studies relating these determinants to socio-economic status and, combined with the evidence about their aetiological fractions, reach some tentative conclusions about their roles as mediators of the socio-economic disparities. Cigarette smoking during pregnancy appears to be the most important mediating factor for IUGR, with low gestational weight gain and short stature also playing substantial roles. For preterm birth, socio-economic gradients in bacterial vaginosis and cigarette smoking appear to explain some of the socio-economic disparities; psychosocial factors may prove even more important, but their aetiological links with preterm birth require further clarification. Research that identifies and quantifies the causal pathways and mechanisms whereby social disadvantage leads to higher risks of IUGR and preterm birth may eventually help to reduce current disparities and improve pregnancy outcome across the entire socio-economic spectrum.

[Recruitment of Montreal women of very low socioeconomic status for a randomized clinical study]. / Le recrutement d'un groupe de femmes montréalaises de status socio-économique très faible dans une étude clinique randomisée.

Studies show that it is difficult to recruit women of low socioeconomic status as clinical research participants. Such an objective was attained though as our results demonstrate in an evaluative study of a program implemented to lower the percentage of low birthweight in four CLSCs of the Island of Montreal between 1994 and 1996. The global recruitment strategy enabled us to reach 56.2% of our goal in 1994 and 77.4% in 1996. Two conclusions can be drawn from this result: the effectiveness of the three methods of recruitment varied according to each participating CLSC, and the global strategy, combined with the mobilization of community resources, was successful in enrolling women of low socioeconomic status.

[The Edinburgh Postnatal Depression Scale: the validity of its Quebec version for a population low socioeconomic status mothers]. / L'échelle de dépression postnatale d'Edimbourg: validité au Québec auprès de femmes de statut socio-économique faible.

This paper investigates the construct validity and reliability of a Quebec version of the Edinburgh Postnatal Depression Scale (EPDS) for a population of low-socioeconomic-status mothers. This scale was constructed for the specific purpose of measuring mothers' symptoms of depression during the postnatal period in an effort to alleviate the validity problems that could arise from depression scales intended for the general population. Two hundred and twenty-four mothers participating in a Quebec prevention program, "Naître égaux, grandir en santé" (Martin & Boyer, 1995) filled out the EPDS between the 22nd and the 35th day postpartum. A confirmatory factor analysis, conducted with LISREL, gives a 2-factor structure for the EPDS, the first representing symptoms of depression and the second symptoms of anxiety. This structure differs from the one presented by Cox, Holden, and Sagovsky (1987), authors of the EPDS. It corresponds, however to the results of other authors who looked at the EPDS with confirmatory factor analysis (Pop, Komproe, & van Son, 1992) and indicates a good construct validity. The reliability of the scale also appears satisfactory, with a Cronbach alpha co-efficient of 0.82.

[Conjugal violence during pregnancy: a literature review.]. / Violence conjugale pendant la grossesse : recension des écrits.

Conjugal violence is a complicated issue which scope and consequences are increasingly documented. Among the many facets of the phenomenon, its occurrence during pregnancy is particularly worrisome. This article reviews the scientific literature pertaining to this issue. After establishing the prevalence of conjugal violence during pregnancy, the authors examine the major studies analyzing factors associated with this violence as well as its consequences for the mother and the infant. The article concludes that the current informations, although partial, are sufficient to justify early detection of conjugal violence in order to help future mothers efficiently.

Socio-environmental factors and postnatal depressive symptomatology: a longitudinal study.

This study analyses the relationships between stressful life conditions and postnatal depressive symptomatology in a group of women of low socioeconomic status (SES) and a group of women of high SES from the third to the ninth week postpartum. Nulliparous pregnant women were recruited from the prenatal care clinics of four hospitals. Multiple linear regression analyses demonstrated that after accounting for SES group membership and depressive symptomatology during pregnancy, early postnatal chronic stressors (frequent conflictual episodes with network members, maternal health problems) and social support were linked to later postnatal depressive symptomatology.

[Factors associated with low birth weight: a multivariate analysis]. / Facteurs associés à la naissance des enfants de faible poids: une analyse multivariée.

The low birth weight of infants is a major public health problem of unknown cause in Benin. We recruited 4,213 pregnant women from a maternity ward in Cotonou for a prospective study. The women were interviewed and further information was obtained from their maternity records. The women were followed until delivery. We found that 6.9% of the births occurred pre-term and there was intrauterine growth retardation in 10.9% of cases. Multiple regression analysis showed that the risks of giving birth to underweight infants were highest for women who were themselves underweight, who had complications due to bleeding or malaria or had social and psychological risk factors. For these particular women, unwanted pregnancy (ORa = 1.60; CI = 1.30-2.00) and lifting heavy loads (ORa = 1.30; CI = 1.10-1.60) were high risk factors. However, adequate prenatal care (ORa = 0.85; CI = 0.69-0.99) and having given birth before were protective factors, reducing the likelihood of a low birth weight. These results have implications for preventive care, in terms of nutrition during pregnancy and psychosociological factors.

Depressive symptoms in the late postpartum among low socioeconomic status women.

BACKGROUND: Postpartum depression has been the focus of much research in the past 15 years, but little is known about factors associated with depression of longer duration or later onset. The purpose of this longitudinal study was to analyze the relationship between stressful life conditions and postnatal depression in a group of women of low socioeconomic status from the third week to the sixth month postpartum. METHODS: Nulliparas who met criteria for low socioeconomic status were recruited from the prenatal care clinics of four Montreal hospitals. Questionnaires were verbally administered in the home at 30 weeks' gestation, at 3 and 9 weeks postpartum, and at 6 months postpartum. Blockwise multiple linear regression analyses were performed by entering predictor variables that included sociodemographic characteristics, chronic stressors, life events, and social support network. RESULTS: Sixty-eight women participated in the study. At 6 months postpartum, 38.2 percent of the mothers had a Beck Depression Inventory score of 10 or more. After accounting for previous depression, analyses indicated that chronic stressors (maternal health problems, infant difficulty, lack of money for basic needs, frequent conflicts with network members) and poor social support (informational and emotional) were associated with postnatal depressive symptoms. CONCLUSIONS: Health practitioners should recognize that high depressive symptomatology frequently occurs among low socioeconomic status first-time mothers at six months postpartum. Chronic stressors and inadequate social support are the most important factors associated with this problem.

Metabolic and anti-atherogenic effects of long-term benfluorex in dyslipidemic insulin-resistant sand rats (Psammomys obesus).

Benfluorex is a clinical lipid-lowering agent with antihyperglycemic properties. The effect of long-term oral treatment (10 mg/kg/day for 7.5 months) on carbohydrate and lipid metabolism and aortic morphology was investigated in 24 insulin-resistant sand rats receiving a standard laboratory diet supplemented with cholesterol (2%). Untreated controls (n=34) developed impaired glucose tolerance, hyperinsulinemia, hypertriglyceridemia, hypercholesterolemia and elevated plasma LDL- and VLDL-cholesterol, positively correlated with the proportion of the thoracic aorta displaying oil red O-positive atherosclerosis; ultrastructural examination showed intimal lipid deposits, foam cells, polymorph infiltrates and fibrosis. Benfluorex-treated animals showed significant decreases in glucose intolerance, hyperinsulinemia, hypertriglyceridemia, hypercholesterolemia, and plasma LDL- and VLDL-cholesterol, with no evidence of aortic atheroma. The metabolic benefits of benfluorex may protect against the long-term development of atherosclerosis in the insulin-resistant dyslipidemic syndrome.