[Impact of Self-Reported Fatigue on ACL Injuries in Alpine Skiing: A Sex Comparison]. / Einfluss von subjektiver Ermüdung auf vordere Kreuzbandverletzungen beim alpinen Skifahren: Ein Geschlechtervergleich.

INTRODUCTION: In recreational alpine skiing, about one third of all injuries affect the knee joint, and the most common diagnosis in adult male and female skiers is a tear of the anterior cruciate ligament (ACL), which makes up 15 - 21 % of all injuries. General preventive recommendations to reduce the incidence of ski injuries include avoiding fatigue. However, it seems unclear to what extent ACL injuries in male and female recreational skiers are related to perceived fatigue. METHODS: This study was conducted as a prospective questionnaire-based investigation in two Austrian ski injury clinics during the five winter seasons between 2009/2010 and 2013/2014. In total, 588 skiers (67.9 % females) with a mean age of 42.1 ±â€Š10.9 years were interviewed about demographics, skiing ability, skiing behaviour, fitness, day and time of accident, skiing duration and perceived fatigue at the moment of accident. RESULTS: ACL injured males reported a significantly higher skiing ability and fitness level as well as a more risky behaviour on ski slopes compared to females. About one third of males and females injured their ACL within the first day of the ski trip and about 57 % within the first two days, with no sex differences. However, a significantly higher number of female skiers sustained an ACL injury during the first hour of skiing (28 vs. 17 %) as well as during the first two hours of skiing compared to males (52 vs. 44 %). About 81 % of males and females felt no fatigue or just a trace of fatigue in their legs at the time of accident, with no sex differences. CONCLUSION: Based on the findings of this study, fatigue does not seem to be a major risk factor for an ACL injury among male and female recreational skiers.

Impact of environmental factors on knee injuries in male and female recreational skiers.

In alpine skiing, the knee represents the dominant injury location with marked gender differences. Snow, slope and weather conditions as well as altitude and low temperatures are thought to influence the prevalence of knee injuries. Therefore, ski patrol injury reports were used to compare gender-specific prevalence of knee injuries with regard to several environmental factors including the actual air temperatures. A total of 1039 non-contact knee injuries were reported with a corresponding prevalence of knee injuries of 44.4% (males: 30.1%; females: 57.4%). Temperature quartiles of all recorded injuries were calculated to compare gender-specific prevalence of knee injury with regard to temperatures. Comparing the first quartile (mean temperature -11°C) with the fourth quartile (mean temperature +3°C), the prevalence of knee injury in female skiers was higher at low ambient temperatures (61% vs 50%, odds ratio: 1.60, 95% confidence interval: 1.16-2.22; P=0.005) while no such association was found for male skiers. Additionally, knee-injured females showed a twofold prevalence when skiing during snowfall compared with females with other injuries (15.4% vs 8.6%; P=0.001). No other environmental factor showed a significant association with the gender-specific prevalence of knee injury. In conclusion, low ambient temperature and snowfall are important environmental risk factors for knee injuries in female skiers.

ACL injury mechanisms and related factors in male and female carving skiers: a retrospective study.

In recreational alpine skiing, ACL injury risk is 3 times greater in females. However, since the introduction of carving skis ACL injury risk seems to have decreased. No study has yet investigated the distribution of ACL injury mechanisms in male and female carving skiers. Therefore, the aim of the study was to investigate potential gender specific differences of ACL injury mechanisms and related factors among carving skiers. In total, 220 recreational carving skiers (59 males and 161 females) suffering from an ACL injury volunteered for this study. Demographic data, skiing ability, equipment related and environmental factors, circumstances and causes for the fall, and type of fall (injury mechanisms) were collected by questionnaire. The forward twisting fall is the most reported ACL injury mechanism in both gender (p=0.672) accounting for 54% of all injuries, although male and female skiers differed significantly with regard to circumstances of fall (p=0.001) and actions when ACL injury occurred (p=0.04). Bindings not releasing at the time point of accident occurred 2.6 times more with females than with males (p=0.005). The forward twisting fall seems to have become the dominant ACL injury mechanism both in male and female recreational skiers since the introduction of carving skis.

Interaction of potential intrinsic and extrinsic risk factors in ACL injured recreational female skiers.

The aim of this study was to investigate the interaction of potential intrinsic and extrinsic risk factors in ACL injured recreational female skiers. 93 female recreational skiers who had suffered a non-contact ACL injury and 93 age-matched controls completed a self-reported questionnaire relating to intrinsic risk factors (menstrual history, BMI, previous knee injuries, self reported weekly sports participation) and extrinsic risk factors (type of ski used, time of last binding adjustment, snow condition, weather and slope difficulty). A logistic regression model revealed the following independent ACL injury risk factors for female recreational skiers: icy snow conditions (odds ratio, 24.33; 95% confidence interval, 6.8-86.5, P<0.001), skiing during snowfall (odds ratio, 16.63; 95% confidence interval, 1.8-152.1, P=0.013), use of traditional skis (odds ratio, 10.49; 95% confidence interval, 2.0-54.5, P=0.005), and preovulatory phase of menstrual cycle (odds ratio, 2.59; 95% confidence interval, 1.2-5.5, P=0.013). In conclusion, ACL injuries in female recreational skiers are the result of a complex interaction of intrinsic and extrinsic risk factors.

Long-term significance of gestational carbohydrate intolerance: a longitudinal study.

Severe forms of GDM have been conclusively associated with significantly increased risk of developing DM later on in life. The long-term significance of GIGT has not yet been definitely elucidated. The study was set up to compare the present carbohydrate metabolism status and anthropomorphic characteristics of women diagnosed as suffering from abnormal carbohydrate tolerance during pregnancy eight years previously with those recorded as having normal glucose tolerance. The prevalence of present abnormal glucose tolerance was significantly higher in women who had been noted to have carbohydrate intolerance during their pregnancy, the prevalence depending on the gestational severity (10.0% in normal glucose tolerance, 36.4% in borderline GIGT; 66.7% in GIGT). Women whose overweight or obese status persists or develops after their pregnancy were statistically more likely to develop abnormal glucose tolerance later on in life (11.9-12.5% in normal-overweight BMI, 38.2% in obese BMI). A maternal and sibling, but not paternal, family history of diabetes was also a statistically significant risk factor. GIGT appears to be a definite risk factor for the development of carbohydrate metabolism problems later on in life, this being related to the severity during pregnancy and the presence or development of obesity. It is proposed that women diagnosed to suffer from GIGT should be regularly monitored after the pregnancy, particularly if other risk factors such as obesity are also present.

Risk factors for gestational impaired glucose tolerance in the Maltese population: a cross-sectional study.

Screening criteria for impaired carbohydrate metabolism problems during pregnancy include the use of specified risk factors, which are generally considered to be inadequate. The value of these risk factors in a population characterised by a high prevalence of abnormal carbohydrate metabolism is investigated. The study identified biological characteristics such as a maternal age >35 years, previous early pregnancy loss, a maternal family history of DM/IGT, pre-prandial glucosuria and an operative delivery with resuscitation as significant risk factors for the development of G-IGT. There appeared to be no statistical association with a history of multiparity, previous perinatal loss, congenital anomalies or macrosomia and a parental and grandparent family history of DM/IGT. There appeared to be a statistical difference in fasting blood glucose values, but no difference in glycosated haemoglobin. The risk factors for the development of G-IGT are shown to have a high specificity and negative predictive value, but overall moderate to low sensitivity and positive predictive values when used in isolation. The prevalence of the various identified risk factors was very high, a feature which would require at least a third of the population to be screened with an oral glucose tolerance test. These features suggest that the historical and clinical risk criteria are not ideal screening tools to identify G-IGT and a routine early third-trimester oral glucose tolerance test remains the ideal screening tool to identify these cases.

Retinopathy in Maltese type 2 diabetic patients.

Since diabetes is a major health problem in Malta a study was conducted to gain a better insight into one of its most common complications, that of retinopathy. A random sample of 200 cases of adult onset diabetes with retinopathy who attended the main hospital's diabetes clinic was assessed by an experienced ophthalmologist. Non-proliferative retinopathy was subdivided into three degrees of severity according to the number of microaneurysms, haemorrhages, exudates, and intraretinal microvascular abnormalities present while proliferative retinopathy included also advanced eye disease. Data on medical and family histories was gathered from personal interrogation and counterchecked from hospital files. A medical examination searched for other concomitant disease. The 124 females and 73 males were similarly aged with a mean of 59.5 +/- 11.5 years. The mean age at onset of diabetes was 44.4 +/- 7.9 years: no significant differences were seen between the grades of retinopathy or the sexes. Onset of eye disease was first detected at a mean age of 56.9 +/- 7.0 years. The great majority (82%) of retinopathy cases occurred after 10 years of diabetes. Males appeared to develop eye disease (especially non-proliferative) at a younger age (53.4 +/- 7.6 vs 58.9 +/- 6.6 years, p < 0.01) and after a shorter duration of diabetes (10.1 +/- 6.6 vs 14.0 +/- 7.8 years, p < 0.001) than females. Severity of retinopathy was strongly associated (p < 0.001), in females rather more than in males, with poor glycaemic control, use of insulin, presence of proteinuria and decreasing vision; and less markedly (p < 0.01) with duration of diabetes of more than 10 years, neuropathy and glaucoma.(ABSTRACT TRUNCATED AT 250 WORDS)

Epidemiology in Malta from routine health information.

OBJECTIVE: To estimate the prevalence of diabetes in the Maltese Islands from data regarding drug consumption, and to assess the prescribing habits and management attitudes of local doctors. METHODOLOGY: The prescribed average daily dose of each type of anti-diabetic drug was calculated from random representative samples of patients (total 1,444) attending the Health Department's primary and secondary health centres as well as of patients seeing their private practitioners. This constituted circa 16% of the total estimated number of diabetics on drug therapy in Malta. The quantities of drugs consumed were obtained both from Government and private industry sources, whilst relevant data on therapy modalities, including proportions of patients on a combination of anti-diabetic preparations, were obtained from records held at the Dept. of Health. RESULTS: Applying the appropriate formulae (as proposed by Eurodiab. subarea C 1989 programme) the global prevalence of diabetes worked out to be 5.22%, an underestimate of circa 12% of the figure extrapolated from the recent population based epidemiological studies. Overall 51% of cases were treated with 'diet only', whilst less than 10% of subjects were managed with insulin. Compared to patients attending the better staffed and equipped health centres, those seeing their private physicians were proportionately less frequently put on insulin (5.7% vs 11.7%), and were prescribed a slightly higher mean daily dose (1.7 vs. 1.4 tab) of glibenclamide suggesting the need of better education of the patient (and probably also of the physician). CONCLUSION: This type of study proved to be relatively simple and inexpensive to perform. Although it cannot replace epidemiological field surveys it can still give a reasonably fair (albeit with limitations) estimate of diabetes prevalence in a population. Moreover it permits an important insight into local public health indicating ways to improve diabetes care.

The effect of diabetes and impaired glucose tolerance on mortality in Malta.

A random sample of the middle-aged population of Malta was studied in a diabetic survey in 1981. Among the 1537 survey responders, in 659 men and 878 women aged 40 years or more the prevalence of diabetes was 16% in men and 18% in women, and that of IGT 5% in both sexes. By the end of 1985, 90 subjects (49 men: 41 women) had died. Mortality/100 (95% CI) was among subjects with normal, impaired glucose tolerance and diabetes in the age group 40-59 years 12 (5-19), 25 (23-73), and 61 (17-148), and in the age group of more than 60 years, 102 (68-136), 148 (59-237), and 178 (122-234), respectively. Age standardized mortality/1000 was in men 51, 28, and 100, and in women 34, 33, and 72 in the three categories of glucose tolerance, respectively. Among diabetic subjects aged 40-64 years the risk of death was increased seven-fold as compared with normoglycaemic subjects. Among men there was an inverse association between body mass index and mortality in all categories of glucose tolerance. Among women, no clear trend between body mass index and mortality was found. The relative risk of death for subjects with diabetes adjusting for age, sex, and body mass index was 2.2 (odds ratio: 95% CI 1.40 to 3.42) as compared with non-diabetic subjects. The age-adjusted survival curves for normoglycaemic subjects were similar for men and women. Among subjects with abnormal glucose tolerance the survival was slightly better in women than in men (p = 0.056). About half of the deaths were from cardiovascular disease and 7% from diabetes mellitus.

Low physical activity and worsening of glucose tolerance: results from a 2-year follow-up of a population sample in Malta.

The relationship between the level of habitual physical activity and glucose intolerance was examined cross-sectionally and during a 2-year follow-up among a sample of 388 subjects in Malta. At baseline, the subjects were classified into three categories of physical activity, which was inversely related to the 2-h post challenge blood glucose (P = 0.02). In a multivariate analysis, age (standardized regression coefficient 0.23; P less than 0.001), family history of diabetes (0.20; P less than 0.001), and physical activity (-0.18; P = 0.002) were the strongest predictors of the 2-h blood glucose at baseline. The age standardized 2-year risk of glucose intolerance, i.e. impaired glucose tolerance or diabetes was consistently and inversely related to the level of physical activity. Among subjects with normal glucose tolerance at baseline (n = 127) those with low physical activity had a 2.7 times higher risk of glucose intolerance during follow-up than those with high physical activity (P = 0.1), and even a 3.7-fold risk of glucose intolerance at baseline (n = 196) when both the subjects with normal and impaired glucose tolerance at baseline were considered together (P = 0.005). Similar trends were observed for the risk of diabetes. The suggested protective effect of physical activity was independent of body mass, a family history of diabetes and gender. Within the limits of this small study we conclude that physical activity may have some importance in the primary prevention of impaired glucose tolerance and, possibly, non-insulin-dependent diabetes mellitus.

Abnormal glucose tolerance in the Maltese. A population-based longitudinal study of the natural history of NIDDM and IGT in Malta.

A population-based longitudinal study of abnormal glucose tolerance in the adult Maltese, carried out within the WHO-assisted National Diabetes Programme, has recently been completed. During the 6-year interval abnormal as compared to normal glucose tolerance was found to be related to a significantly higher mortality: the age-adjusted relative risks of death were 3.3 times in diabetic females and greater than 2 times in IGT and diabetic males. In the repeat epidemiological survey 1422 subjects (66.8% of the initial sample) were reinvestigated with the oral GTT being interpreted according to WHO's 1985 recommendations. The age-standardised prevalence rates, in the 35-69-year-old males and females, were respectively 12.89% and 13.24% for IGT and 9.07% and 10.77% for diabetes. These gradually increased after age 40, IGT peaking in the 60+ year groups and diabetes 10 years later. Heredity (especially diabetes in close relatives) seemed a major influence, whilst excess body weight appeared the more important associated environmental factor. The incidence levels (% per annum) of diabetes during the interval were 0.71 for normoglycaemics and 5.1 for IGTs; this seven times higher risk in the latter was slightly lower in females than males, but significantly higher in the less than 60-year-olds compared to older subjects. Of the initial IGTs 36% remained IGT and 33% reverted to normal glucose tolerance, whilst 11% of the initial normoglycaemics deteriorated to IGT. The determinants more strongly influencing worsening of glucose tolerance were age (greater than 50 years), baseline glycaemia (fasting greater than 5.5 mmol/l and a 2-h post-load glycaemia greater than 9.5 mmol/l) and initial body mass index (greater than 27 kg/m2). In conclusion the data permit a better insight into the natural history of, and risk factors for, disturbed glucose tolerance in this community.

Type 1 diabetes in the Maltese Islands.

The prevalence of Type 1 diabetes in Malta was estimated by identifying all cases aged less than 32 years by the end of 1987 who had attended the island's principal diabetic clinic. The age-adjusted prevalence rate for 0-19 year olds was 110.3 per 100,000 (girls 126.2 (n = 65), boys 95.3 (n = 52]. The mean annual incidence, during the period 1980-1987, in 0-19 year olds was 13.3 per 100,000 (n = 113, girls 14.1 and boys 12.6). Males developed Type 1 diabetes 2.1 years later than females (13.7 +/- 6.9 (+/- SD) vs 11.6 +/- 6.7 years). The commonest age of onset was 10 to 14 years. The peak period of onset occurred during the cooler months of November to February. The incidence rates are close to those in Nordic countries and indicate that Type 1 diabetes in Malta is underestimated.

Trends in mortality from major non-communicable diseases in the middle-aged population of Malta.

Trends in life expectancy and mortality from major non-communicable diseases in Malta were analyzed from the national vital statistics available. Most of the increased life expectancy during the 20th century in Malta took place between 1930 and 1960 and since then only a minor increase was observed. The peak in age standardized total mortality in men and women aged 40-69 years was during 1974-76. Total mortality in men was about 40% higher than that of women. The proportion of deaths from major non-communicable diseases (cardiovascular diseases, cancer and diabetes) of all deaths increased during 1968-82. In 1983-84 in the age group 45-64 cardiovascular diseases accounted for 54% of deaths in men and 43% in women, cancer 27% and 34%, and diabetes 3% and 11% in men and women, respectively. The international comparison of mortality data showed that mortality from both cardiovascular diseases, cancer and diabetes was clearly higher than in other European Mediterranean countries ranking among the highest in the whole Europe. Public health intervention programmes have initiated in Malta to reduce these high death rates in the future.