Introducing the Concept of Exercise Holidays for Human Spaceflight - What Can We Learn From the Recovery of Bed Rest Passive Control Groups.

In an attempt to counteract microgravity-induced deconditioning during spaceflight, exercise has been performed in various forms on the International Space Station (ISS). Despite significant consumption of time and resources by daily exercise, including around one third of astronauts' energy expenditure, deconditioning-to variable extents-are observed. However, in future Artemis/Lunar Gateway missions, greater constraints will mean that the current high volume and diversity of ISS in-flight exercise will be impractical. Thus, investigating both more effective and efficient multi-systems countermeasure approaches taking into account the novel mission profiles and the associated health and safety risks will be required, while also reducing resource requirements. One potential approach is to reduce mission exercise volume by the introduction of exercise-free periods, or "exercise holidays". Thus, we hypothesise that by evaluating the 'recovery' of the no-intervention control group of head-down-tilt bed rest (HDTBR) campaigns of differing durations, we may be able to define the relationship between unloading duration and the dynamics of functional recovery-of interest to future spaceflight operations within and beyond Low Earth Orbit (LEO)-including preliminary evaluation of the concept of exercise holidays. Hence, the aim of this literature study is to collect and investigate the post-HDTBR recovery dynamics of current operationally relevant anthropometric outcomes and physiological systems (skeletal, muscular, and cardiovascular) of the passive control groups of HDTBR campaigns, mimicking a period of 'exercise holidays', thereby providing a preliminary evaluation of the concept of 'exercise holidays' for spaceflight, within and beyond LEO. The main findings were that, although a high degree of paucity and inconsistency of reported recovery data is present within the 18 included studies, data suggests that recovery of current operationally relevant outcomes following HDTBR without exercise-and even without targeted rehabilitation during the recovery period-could be timely and does not lead to persistent decrements differing from those experienced following spaceflight. Thus, evaluation of potential exercise holidays concepts within future HDTBR campaigns is warranted, filling current knowledge gaps prior to its potential implementation in human spaceflight exploration missions.

Intermittent short-arm centrifugation is a partially effective countermeasure against upright balance deterioration following 60-day head-down tilt bed rest.

This study investigated whether artificial gravity (AG), induced by short-radius centrifugation, mitigated deterioration in standing balance and anticipatory postural adjustments (APAs) of trunk muscles following 60-day head-down tilt bed rest. Twenty-four participants were allocated to one of three groups: control group (n = 8); 30-min continuous AG daily (n = 8); and intermittent 6 × 5 min AG daily (n = 8). Before and immediately after bed rest, standing balance was assessed in four conditions: eyes open and closed on both stable and foam surfaces. Measures including sway path, root mean square, and peak sway velocity, sway area, sway frequency power, and sway density curve were extracted from the center of pressure displacement. APAs were assessed during rapid arm movements using intramuscular or surface electromyography electrodes of the rectus abdominis; obliquus externus and internus abdominis; transversus abdominis; erector spinae at L1, L2, L3, and L4 vertebral levels; and deep lumbar multifidus muscles. The relative latency between the EMG onset of the deltoid and each of the trunk muscles was calculated. All three groups had poorer balance performance in most of the parameters (all P < 0.05) and delayed APAs of the trunk muscles following bed rest (all P < 0.05). Sway path and sway velocity were deteriorated, and sway frequency power was less in those who received intermittent AG than in the control group (all P < 0.05), particularly in conditions with reduced proprioceptive feedback. These data highlight the potential of intermittent AG to mitigate deterioration of some aspects of postural control induced by gravitational unloading, but no protective effects on trunk muscle responses were observed.NEW & NOTEWORTHY This study presents novel insights into the effect of artificial gravity (AG) on the deterioration of standing balance and anticipatory postural adjustments (APAs) of trunk muscles induced by 60-day strict head-down bed rest. The results indicated severe balance dysfunction and delayed APAs during rapid arm movement. AG partially mitigated the deterioration in standing balance and may thus be considered as a potential countermeasure for future planetary surface explorations. Optimization of AG protocols might enhance effects.

Adult ADHD screening scores and hospitalization due to pedestrian injuries: a case-control study.

BACKGROUND: The aim of this study was to investigate the association between adult ADHD screening scores and hospitalization due to pedestrian injuries in a sample of Iranian pedestrians. METHODS: Through a case-control study, a case population of 177 pedestrians injured by the vehicles in road traffic crashes were compared with 177 controls who lacked a record of intentional or unintentional injuries enrolled from various wards of Imam Reza University Hospital which is a specialty teaching hospital located in the same city with similar referral level. The cases and controls had an age range of 18-65 years and were matched on gender and age. ADHD symptom profile was assessed using the Persian Self-report Screening Version of the Conner's Adult ADHD Rating Scales (CAARS-S:SV). The association of ADHD screening score and pedestrian injuries was investigated using multiple binary logistic regression to investigate the independent effect of ADHD index score on belonging to case group. Both crude and adjusted odds ratios were reported. RESULTS: Men comprised 86.4% of the study subjects. The crude odds ratios for all the four ADHD subscales to be associated with pedestrian injuries were 1.05, 1.08, and 1.04 for the subscales A (attention deficit), B (hyperactivity/impulsiveness) and ADHD index respectively. However, the association for subscale A was not statistically significant with a borderline p-value. The final multivariate analysis showed that variables associated with pedestrian injuries in the road traffic crashes were ADHD Index score (OR = 1.06, 95% CI: 1.01-1.12); economic status (including household income and expenditure capacity); educational level and total walking time per 24 h. CONCLUSIONS: Adult ADHD screening score can predict pedestrian injuries leading to hospitalization independently from sex, age, economic status, educational level and pedestrian exposure to traffic environment (average walking time).

Fall-related injuries for three ages groups - Analysis of Swedish registry data 1999-2013.

INTRODUCTION: The objective of this study was to analyze which factors (including factors pertaining to the individual, the household, and the local area) increase the risk of fall injuries for the three age groups with the highest risk for fall injuries in Sweden. METHOD: The study combined longitudinal data covering the period 1999-2013 from several different official registries from Statistics Sweden as well as from the Swedish health care system and fitted the models to data using mixed model regressions. RESULTS: Three age groups had a markedly heightened risk for fall injuries: 1-3-year olds, 12-14 year olds, and the elderly (65+). The home was the most common location for fall injuries, as about 40% of all fall injuries occur in the home. Only for the elderly strong predictors for fall injuries were found, and these were: age, single household, and special housing. CONCLUSIONS: There is preventive potential in the special residences for the elderly and disabled. People living in these special residences make up a strongly selected group that needs extra safe environments. Our findings indicate that their needs are currently not meet. Practical applications: Design of special residences for the elderly and disabled should aim at reducing the consequences of falling.

Cognitive Distortions as Trauma-Specific Irrational Beliefs Among Burn Patients.

Burn injuries are most certainly stressful events, particularly when permanent disfigurement is a result. This situation can lead to the onset of irrational beliefs which can in turn lead to long-term psychological problems such as depression, anxiety, shame, guilt, posttraumatic stress, etc. The objective of this study is to explore the irrational beliefs among burn patients and its correlates in an Iranian sample. This cross-sectional study included 329 patients who had experienced disfigurement, as result of burn injuries. In order to assess irrational beliefs, a Scale for Irrational Thoughts after Burning was used. To identify correlated variables with irrational beliefs, both bivariate and multivariate analysis methods were conducted. In multivariate linear regression, forward strategy was used for building the model. The results of bivariate analysis showed that the location of the burn on bodies (body parts generally exposed in social environment or parts culturally perceived as sensitive areas of body), marital status, urbanities, age group, geographical areas, etiology of burning, and intent of injury had significant relationships with irrational beliefs (P < .05). Using forward linear regression, gender, marital status, geographical areas, etiology of burning, body burn by location (body parts generally exposed in social environment or parts culturally perceived as sensitive areas of body), and intent of injury had significant correlation with irrational beliefs. The models predicted 15.5% (P < .001) of irrational beliefs. Considering to irrational beliefs and development of facilities for screening is necessary. Moreover, consultation with mental health experts after burn injuries is highly recommended.

Horse-related incidents and factors for predicting injuries to the head.

OBJECTIVES: Head injuries are the leading cause of death in horse-related injury events and, even since the introduction of helmets, represent a sizeable proportion of all horse-related injuries. Falls from horseback and kicks to the head are the most frequent type of incident causing head injuries, but it is unknown whether these incidents are predictors of head injury. This study aimed to investigate head injuries and the association between incident type and head injury. METHOD: Retrospective review of 7815 horse-related injury events was conducted. Data were gathered from hospitals, local healthcare centres and public dental services in Skaraborg, Sweden. Binary logistic regression was used to analyse the association between the incident type and occurrence of head injury while controlling for risk factors. RESULTS: Approximately 20% of riders sustained a head injury, mostly soft tissue injuries (56.3%) and concussions (33.4%). A fall from or with the horse was the primary cause of head injury (63.9%). Those who fell from a carriage or other height or who were injured through contact with the horse had no difference in the likelihood of head injury when compared with those that fell from or with the horse. However, those who sustained an injury without any horse contact had lower odd of head injury (OR: 0.640, p<0.00005, 95% CI 0.497 to 0.734). Additionally, the older the rider, the lower the odds of head injury (OR=0.989, p<0.00005, 95% CI 0.985 to 0.993). CONCLUSION: Improved protection for those suffering falls from horseback as well as those who are kicked in the head should be investigated.

Community-level football injury epidemiology: traumatic injuries treated at Swedish emergency medical facilities.

Background: Despite the popularity of the sport, few studies have investigated community-level football injury patterns. This study examines football injuries treated at emergency medical facilities using data from three Swedish counties. Methods: An open-cohort design was used based on residents aged 0-59 years in three Swedish counties (pop. 645 520). Data were collected from emergency medical facilities in the study counties between 1 January 2007 and 31 December 2010. Injury frequencies and proportions for age groups stratified by sex were calculated with 95% confidence intervals (95% CIs) and displayed per diagnostic group and body location. Results: Each year, more than 1/200 person aged 0-59 years sustained at least one injury during football play that required emergency medical care. The highest injury incidence was observed among adolescent boys [2009 injuries per 100 000 population years (95% CI 1914-2108)] and adolescent girls [1413 injuries per 100 000 population years (95% CI 1333-1498)]. For female adolescents and adults, knee joint/ligament injury was the outstanding injury type (20% in ages 13-17 years and 34% in ages 18-29 years). For children aged 7-12 years, more than half of the treated injuries involved the upper extremity; fractures constituted about one-third of these injuries. Conclusions: One of every 200 residents aged 0-59 years in typical Swedish counties each year sustained a traumatic football injury that required treatment in emergency healthcare. Further research on community-level patterns of overuse syndromes sustained by participation in football play is warranted.

Psychometric Properties of a New Instrument for Assessing Irrational Thoughts in Burn Victims (Scale of Irrational Thoughts After Burn Injuries).

The objective of this study was to develop and evaluate a scale for assessing irrational thoughts among burned patients. The present study was mixed (qualitative-methodologic) which was performed in several stages such as investigating similar or related scales, interviewing with patients and psychologists. Content validity was calculated by modified KAPPA basis on relevance and clarity. The reliability of the scale was measured using internal consistency and the test-retest method. To determine the construct validity, exploratory factor analysis approach using maximum likelihood extraction with varimax rotation was conducted. A total of 329 burned patients were recruited from Tehran, Tabriz, and Kermanshah provinces of Iran. Modified kappa scores were 0.80 and 0.91 for relevance and clarity of the items included in scale. The Cronbach alpha for overall scale, subscale 1, and subscale 2 were 0.89, 0.88, and 0.8, respectively. Test-retest reliability was also acceptable (intraclass correlation coefficient = 0.80). The best solution from the maximum likelihood analysis of the 39 items of the scale revealed two factors corresponding to the two subscales with 14 items that subscale 1 (self-acceptance) consisted of 10 statements accounting for 60% of the variance (eigenvalue = 5.04) and subscale 2 (distastefulness and pity) consisted of four statements accounting for 40% of the variance (eigenvalue = 1.53). The scale reflects acceptable levels of validity and reliability in assessing the irrational thoughts among Iranian patients. Moreover, the testing populations of both patients with burned faces and patients with other burned body parts indicates that the scale may also be applicable for patients' burn disfigurements on any part of their bodies.

A comparison of unintentional injury patterns occurring in two Swedish communities in 1978 and in 2008.

Surveillance and analyses of unintentional injuries can be used to help prioritise community prevention efforts. This study describes changes in local patterns for unintentional injuries resulting in deaths, hospitalisations, and outpatient visits to health care clinics and emergency rooms, comparing information from two different study periods, 1978 and 2008, in the Swedish communities of Falköping and Lidköping. Injury cases were analysed, and confidence intervals were derived. The study results show that while most injuries decreased comparing the first study period to the second, these changes were only significant in terms of decreases in outpatient care. This study points to the importance of more systematic collection data of injury events treated at the outpatient level, particularly for communities where there are relatively low numbers of injury-related deaths and hospitalisations.

Twenty-five years of bicycle helmet promotion for children in Skaraborg District, Sweden.

The purpose of this study is to describe some of the results of a long-term bicycle helmet campaign for children in Skaraborg District, Sweden. The hospital discharge data for bicycle-related injuries occurring in children under the age of 15 were reviewed, to assess changes in patterns for head and other body injuries. The study shows that head injuries to children as a result of bicycle injuries were reduced between 94 and 99% in the study areas. The tremendous gains in safety for children who ride bicycles in Skaraborg District were the result of not only national policy changes that occurred in the latter half of this study period but also the result of local collaborations based on the Safe Communities model, which were organised during the first part of the study period.

Tracing the utility of injury surveillance data in Pretoria (South Africa) and Borås (Sweden).

Our research attempted to study the factors that influenced the use of injury data in two cities, representing different injury and socio-economic profiles. In Pretoria, the South African capital city, injury data uptake was constrained by, among other factors, the transitional institutional environment, stakeholders' suspicion of research and the absence of safety promotion champions. In the Swedish city of Borås, injury data uptake was facilitated by well-established research agency-municipality partnerships, injury prevention champions, a receptive political and knowledge driven environment and dedicated resources. The study signified the role of a range of content issues, contextual arrangements, social actors who may or may not operate from a perspective of sufficient consensus and institutional communication processes that may either facilitate or hinder the multiple employment and rapid movement of data along the 'ladder of knowledge utilisation'. Safety promotion researchers may need to expand their roles beyond data production to improve data utility.

Is Sweden still a role model for safety? An overview of unintentional injury data over the past two decades.

This study investigates injury-related mortality and hospitalisations, during 1987-2007 in Sweden. Injuries were classified according to International Classification of Diseases (ICD)--8 for pre-1987 injuries, ICD-9 for 1987-1996 injuries and ICD-10 for injuries occurring in 1997 and later. Data on mortality from injuries during 1987-2007 were collected from Sweden's national Cause-of-Death Register, while data concerning injury diagnoses leading to hospitalisation stays of at least 24 h, occurring during 1987-2007, were obtained from the national Patient Register. Crude rates were derived for injury-related deaths and injury-related hospitalisations for age-gender groups, using population data from Statistics Sweden. Our results showed a mixed picture of injury-related hospitalisations and deaths over the study period. Absolute numbers of injury-related deaths and injury-related hospitalisations decreased over time for the population as a whole and for many, but not all, age-gender groups. When assessing crude injury-related death rates and crude injury-related hospitalisation rates over time, as categorised by gender and age groupings, we also found unchanging or increased risks for injury-related deaths and/or hospitalisations for several age-gender groups. While Sweden has made remarkable progress in reducing injury-related deaths and hospitalisations, there are clear differences in risk that remain.

Epidemiology of minor and moderate burns in rural Ardabil, Iran.

Epidemiology of minor burns is not well defined worldwide. The aim of this study was to examine epidemiological features of minor and moderate burn events that could be beneficial for prevention purposes. The study was conducted in Ardabil province in north-west Iran in 2005-2006. A total of 1700 minor and moderate burns were studied using a pretested questionnaire. Using the SAS 9.1 statistical program analyses were made. Females comprised the majority of cases (n=1000, 58.8%) and children, aged six and younger, made up 36.4% of burn victims. The majority of burns were caused by hot water and tea with the primary containers being kettles in 37.8%, cups or glasses in 24.2%, pots in 13.6% and samovars in 7.9%. Samovars, gas stoves, valors and picnic gas stoves were the primary heating devices involved in burns. In 56% of the cases, overturning of liquid containers was the primary injury mechanism of scalds. 43% had a second-degree burn with a mean total body surface area of 1.3%. This study provides possible beneficial information for burn prevention in the Ardabil area and other similar settings.

The risks of using samovars as the main tea-preparing facility in some Eastern countries.

Samovars are the main tea-making devices in some Eastern countries. In part of a joint Iran-Sweden research project on epidemiology and prevention of burns, 265 households in a rural area were entered into a cross-sectional study in which safety status of samovars used and unsafe behaviours in using them were assessed. Samovars were the main device used to boil water for making tea in 75% of the households; 55.2% of samovars were placed in the kitchen, 20% in the living room and the remainder elsewhere. The device was placed where the floor surface was uneven in 15.1% of the houses. It was placed in traffic areas in at least 20.7% and where it was accessible to preschool children in 60%. Only 11.5% of the 194 kerosene samovars examined had a national standard maintenance mark. Mean volume capacity of samovars was 6.9 l (6.4-7.4 l). A tap problem was observed in 17.4% of samovars, an unstable base in 7.7%, an unstable teapot in 13.4%, unstable handles in 7.2%, broken handles in 5.7%, an unstable water container in 13.4% and an unstable container lid in 5.1%. With most of the samovars there were technical problems making them unsafe. Behaviours in using samovars were also unsafe.

Differences in child injury hospitalizations in Sweden: the use of time-trend analysis to compare various community injury-prevention approaches.

AIM: Sweden's child injury fatality rates are among the lowest in the world. The country has engaged in a number of community injury-prevention programmes. The purpose of this study was to compare child injury hospitalization rates from the Skaraborg District with the rest of Sweden. Our study hypothesis was that municipalities that offered comprehensive child injury-prevention programmes would see significant decreases in their child injury hospitalization rates, compared with other areas. METHODS: The study areas comprised three groups, consisting of municipalities in Skaraborg that had adapted the Safe Communities approach to injury prevention programmes, other municipalities in the District, and the rest of Sweden. The aim of the analysis was twofold: (1) to fit time trends for children's injuries in various areas in an integrated manner; and (2) to compare time trends across locations between community safety-promotion programmes as well as with the control areas. Panel data models and parametric splines were used. RESULTS: There were differences between incidence rates in the study areas and with regard to gender. There was a steep decrease in injury rates in one of the Safe Communities study areas for both genders. CONCLUSIONS: The methods applied in this analysis reveal more detailed and sophisticated time trends than the usual simple linear regression approach. The model provided a clearer view of the interactions of gender, area, and time as they impacted on children's injuries, and allowed for better insight into the impact of safety programmes.

Injury mortality in local communities in Sweden and in the three Baltic States: implications for prevention.

This study provides a comparative time-trend evaluation of injury mortality in local communities in Sweden and the three Baltic States, considering their national socio-political and economic situations and with analysis of local injury prevention structures and activities. Data for the period from 1990 to 2002 were gathered from national statistical offices for the cities of Borås, Tartu, Jelgava and Kaunas and from WHO databases for national level analyses. The death rates for Borås remained relatively stable over the time period, while the Baltic communities had increasing rates until 1994 and seemed to stabilize after 1997. The differences in injury mortality in the studied communities were highest for the 0 - 19 year age group and especially in the 20 - 64 year age group, but not for the 65+ year age group. Local communities in the Baltic States should consider coordinated safety promotion and injury prevention programmes as a complement to national safety promotion framework.

Survival of immersions during recreational boating events in Alaska, 1999-2004.

OBJECTIVE: This retrospective study analyzed records of boating or other watercraft-related events in Alaska from 1999-2004, where at least one drowning occurred, to identify factors associated with survivors of these same events. DATA: Records of recreational boating events involving at least one fatality were obtained through the U.S. Coast Guard. Group rescue responses and rescue assistance responses by others outside the parties were categorized and analyzed. We conducted t tests and odds ratios to analyze inter-group differences. RESULTS: There were 32 immersion events involving 36 fatalities (F-group members) and 72 immersed survivors (S-group.) Analysis of behaviors during and after immersion events showed that two-thirds of the S-group avoided submersion. Most survivors (59%) demonstrated effective exit strategies. Rescue attempts by members of a traveling party resulted in the greatest number of survivors, followed by self rescue attempts. MAJOR CONCLUSIONS: This study helps build a case for the need for more detailed surveillance systems to identify factors that contribute to submersion avoidance. This study also points out the need for enforcement, education, and engineering controls to help improve survival of cold water immersions.

Effectiveness of community-based injury prevention. Long-term injury rate levels, changes, and trends for 14 Swedish WHO-designated Safe Communities.

This study investigates the injury rate levels, changes, and trends between 1987 and 2002 for the 14 Swedish municipalities designated as WHO Safe Communities. The injury rate was defined as the number of injured patients discharged from hospital per 1000 persons. Injury rates were age standardised. Each municipality was compared with its respective municipality group, according to a classification of Sweden's 288 municipalities into nine groups based on numerous structural parameters. The average injury rate levels for the 14 WHO-designated Safe Community municipalities ranged from 11.54 to 19.09 per 1000 population during the study period, which was defined as the time period during which a municipality's injury prevention program has been operational. Eleven of 14 municipalities had higher levels than their corresponding municipality groups. Five of the 14 municipalities "outperformed" their respective municipality groups and achieved a greater relative injury rate decrease during the study period. The trends for the 14 municipalities in relation to their municipality groups showed an inconsistent pattern, with only four municipalities exhibiting overall favourable trends for the study period.

Factors associated with injuries occurring aboard vessels in Alaska: differences between residents and nonresidents.

BACKGROUND: Over the past decade, visitors to Alaska have spent increasing amounts of time engaged in water-based recreational activities aboard vessels of various sizes. Serious vessel-related injuries to travelers in Alaska involve not only medical care from unfamiliar health care providers and facilities but also entail the loss of vacation time and the need for injured travelers to return to their homes under less than optimal traveling conditions. METHODS: This study employed a retrospective, case-comparison analysis to identify differences in factors associated with recreational injuries acquired aboard watercraft that resulted in hospitalizations of residents and nonresidents of Alaska during 1991 to 2000. Tests of proportions were conducted to elucidate differences in demographic characteristics and injury precursors between the two subgroups. Specific injury outcomes were then tested for significance using odds ratios. RESULTS: Alaska residents and nonresidents demonstrated significant differences for both demographic factors and factors describing events leading to injuries, and for injury outcomes. Nonresidents were more likely to be 65 years or older, female, and aboard cruise ships when injuries occurred. Nonresidents were more likely to suffer fracture injuries, to suffer injuries with Abbreviated Injury Scores greater than 2, to experience posthospital discharges to sites other than their homes, and to experience postinjury disabilities. CONCLUSIONS: Alaska residents and nonresidents in this study showed significant differences in demographics, precipitating events, and injury outcomes. The findings lend support for targeted safety promotion programs.

Bicycle helmet use in Sweden during the 1990s and in the future.

This paper describes how the use of bicycle helmets in Sweden has changed for different categories of cyclists from 1988 to 2002, and it also estimates future trends in voluntary wearing of bicycle helmets up to the year 2010. Observational studies of the use of bicycle helmets were conducted once a year from 1988 to 2002 at 157 sites in 21 cities. The subjects observed were children cycling to school (average n = 5471/year) and in their free time (average n = 2191/year), and adults cycling to workplaces and on public bike paths (average n = 29 368/year). The general trend in helmet use from 1988 to 2002 was determined by linear regression analysis, and the results were also employed to estimate future helmet wearing for the period 2003-2010. Differences in helmet use according to gender and size of city were analysed by chi-square tests. From 1988 to 2002, all categories of cyclists showed an upward trend in helmet use (p < 0.01, p < 0.001). Helmet wearing increased from about 20 to 35% among children (< or =10 years) cycling during free time, from approximately 5 to 33% among school children, and from around 2 to 14% in adults. Total average helmet use rose from about 4 to 17%. However, during the last 5 years of the study period (1998-2002), none of the categories of cyclists studied showed an upward trend in helmet wearing. It is estimated that approximately 30% of cyclists will wear helmets voluntarily by the year 2010, if helmet promotion activities are continued at the same level as previously. The results suggest that Sweden will probably not reach its official goal of 80% helmet use unless a national bicycle helmet law is passed.