Muscle strength is associated with lower diastolic blood pressure in schoolchildren.

Cardiorespiratory fitness (CRF) provides protection against the elevated blood pressure in overweight youth. Less is known regarding any similar protective effect of muscular fitness. We investigated how handgrip strength, an easy to implement measure of muscular strength, interacted with CRF and BMI to determine blood pressure in youth. We measured systolic (SBP) and diastolic (DBP) blood pressure, handgrip strength (HG), CRF and body mass index (BMI) in n=7329 10-16year-olds (47% girls). We defined elevated blood pressure as >91st percentile and Good HG as >33rd percentile. Participants were classified as Fit or Unfit and as Normal or Overweight/Obese based on international standards. The prevalence of elevated SBP was 23%, and 44% of participants had elevated DBP. In unfit participants Good HG was associated with lower SBP (z=0.41 (95%CI: 0.20-0.61) and DBP (z=0.29 (95%CI: 0.12-0.47). In Overweight/Obese participants, DBP was z=0.24 (95%CI: 0.14-0.34) lower in the Good (versus Low) HG group. Overweight/Obese participants with Good HG also had a 32% lower risk of elevated DBP (OR: 0.68, 95%CI: 0.57-0.82). This association was attenuated but remained important after adjusting for BMI (20% risk reduction, OR: 0.80, 95%CI: 0.63-1.01). Muscular fitness appears to play some protective role against the risk of elevated blood pressure; particularly for the more prevalent measure: elevated DBP (44%). Effects may be restricted to Overweight / Obese or unfit youth, who have an increased risk of elevated BP and also may be less likely to engage in traditional cardiorespiratory fitness training. Research to determine the effects of muscular fitness training on blood pressure is warranted in these subgroups.

Athletic performance and birth month: is the relative age effect more than just selection bias?

The aim of this study was to determine if month of birth affects performance in 3 tests of physical function in children and adolescents. We measured cardiorespiratory fitness, handgrip strength and lower-body power expressed them relative to (whole year) age then compared scores between calendar year birth-months. We also expressed test performance as the likelihood of achieving criterion-referenced fitness standards. There were significant main effects of birth-month for cardiorespiratory fitness (F=4.54, p<0.001), strength (F=6.81, p<0.001) and power (F=3.67, p<0.001). Children born in November were fitter and more powerful than those born at other times, particularly the summer months (April, May and June). October-born children were stronger than those born in all months except September and November. This relationship was evident despite controlling for decimal age and despite no significant inter-month differences in anthropometric characteristics.There is a clear physical advantage for those born in the autumn and this may explain some of the bias in sports selection attributed to the relative age effect, particularly when the British school-year (September) cut-off is used.

Effect of a simulated soccer match on the functional hamstrings-to-quadriceps ratio in amateur female players.

The purpose of this study was to investigate the effect of a simulated soccer test on the functional hamstrings-to-quadriceps ratio (H(ecc) : Q(con)) in female soccer players. Fourteen amateur players (age, 26.1 ± 4.6 years; height, 168 ± 12 cm; body mass, 62.7 ± 5.5 kg; body fat, 23.7 ± 2.2%) performed the modified Loughborough Intermittent Shuttle Test (modified LIST). Isokinetic strength assessments of the hamstrings and quadriceps on the dominant and non-dominant legs at 120°/s were performed before and immediately after the modified LIST. H(ecc) : Q(con) was calculated as the ratio of the peak eccentric torque of the hamstrings to the peak concentric torque of the quadriceps. A two-way univariate analysis of variance was used to assess the effect of time and leg dominance on H(ecc) : Q(con). The main results showed that the modified LIST led to a significant decrease in H(ecc) : Q(con) in the dominant (-14.1%) and non-dominant legs (-8.0%) (P = 0.02). However, this decrease was not significantly different between dominant and non-dominant legs (P = 0.42). These results reflect a greater risk of hamstrings tears and ACL sprains at the end of soccer matches.

Contextual considerations using the 'control-chaos continuum' for return to sport in elite football - Part 1: Load planning.

The 'control-chaos continnum' is an adaptable framework developed to guide the on-pitch rehabilitation process in elite football. One of the key objectives of the continuum is to progressively return players to their preinjury chronic running load, while incorporating the qualitative aspects of movement and cognitive stresses integral to competitive match-play. Whilst injury and player-specific considerations are key to an individualised rehabilitation approach, a host of contextual factors also play an important role in return to sport (RTS) planning. In this article, we highlight some key intrinsic and extrinsic contextual factors for the practitioner to consider in the RTS planning process to help mitigate reinjury risk upon a return to team training. While a return to chronic running load is generally a critical component of the framework, we highlight circumstances in elite football where it is a less relevant factor in RTS decision-making.

Return to sport and beyond following intramuscular tendon hamstring injury: A case report of an English Premier League football player.

BACKGROUND: Hamstring strain injuries are the most common type of injury in elite football and are associated with a high risk of reinjury, particularly those involving the intramuscular tendon (IMT). Limited information is available regarding the rehabilitation and return to sport (RTS) processes following such injuries. This case study describes the clinical presentation of an elite football player following IMT hamstring injury, their on- and off-pitch rehabilitation alongside performance monitoring throughout RTS and beyond. CASE SCENARIO: An elite football player suffered a grade 2c hamstring injury during an English Premier League (EPL) match. The player underwent early post-injury management, alongside progressive off-pitch physical preparation. The 'control-chaos continuum' was used as a framework for on-pitch rehabilitation to prepare the player for a return to full team training and competition. Objective and subjective markers of the player's response to progressive on- and off-pitch loading were monitored throughout RTS and beyond. OUTCOMES: The player returned to on-pitch rehabilitation after 11 days, to full team training having achieved weekly pre-injury chronic running load outputs after 35 days and played in the EPL 40 days post-injury. The player did not suffer reinjury for the rest of the EPL season. CONCLUSION: An understanding the unique structural and mechanical properties of the IMT, alongside expected RTS timeframes are important to inform rehabilitation and decision-making processes post-injury. Performance and frequent load-response monitoring throughout RTS and beyond, in conjunction with practitioner experience and effective communication are critical in facilitating effective RTS and reduce risk of reinjury following IMT injury.

Drill design using the 'control-chaos continuum': Blending science and art during return to sport following knee injury in elite football.

Establishing the level of risk, planning and adapting the return to sport (RTS) process following a complex knee injury involves drawing on a combination of relevant high-quality evidence and practitioner experience. On-pitch rehabilitation is a critical element of this process, providing an effective transition from rehabilitation to team training. The 'control-chaos continuum' (CCC) is an adaptable framework for on-pitch rehabilitation moving from high control to high chaos, progressively increasing running load demands and incorporating greater perceptual and neurocognitive challenges within sport-specific drills. Drills are a key element of the CCC, and are designed to ensure specificity, ecological validity and maintaining player interest. We showcase drill progression through the phases of the CCC, highlighting the use of constraints to create drills that incorporate the physical, technical, tactical and injury-specific needs of the player. We also provide recommendations to help practitioners create training session content using the CCC to help replicate the demands of team training within their own environment.

Handgrip strength in English schoolchildren.

AIMS: The aims of this study were to evaluate patterns of handgrip (HG) strength in relation to gender and age in English schoolchildren and to compare this with existing data and produce reference data for this population. METHODS: The HG of 7147 English schoolchildren (3773 boys and 3374 girls) aged 10-15.9 years was measured using a portable Takei handgrip dynamometer (Takei Scientific Instruments Co. Ltd, Tokyo, Japan). Centile data were produced using the Generalized Additive Models for Location, Scale and Shape. Z-scores were generated using existing data for European children. Age and gender interactions were analysed using analysis of covariance. RESULTS: In boys and girls, significant increases in HG were found between every age-group (p < 0.001). Boys were significantly stronger than girls at every age (p < 0.001) and the boys' age-related increase was significantly greater than the girls' (p < 0.001). CONCLUSION: This study provides reference data for handgrip strength in English schoolchildren. Handgrip strength in English children is broadly similar to existing European data, after adjusting for mass and stature. These data could be used for clinical or athletic screening of low and high strength in this population.

Reducing mortality risk by targeting specific air pollution sources: Suva, Fiji.

Health implications of air pollution vary dependent upon pollutant sources. This work determines the value, in terms of reduced mortality, of reducing ambient particulate matter (PM2.5: effective aerodynamic diameter 2.5µm or less) concentration due to different emission sources. Suva, a Pacific Island city with substantial input from combustion sources, is used as a case-study. Elemental concentration was determined, by ion beam analysis, for PM2.5 samples from Suva, spanning one year. Sources of PM2.5 have been quantified by positive matrix factorisation. A review of recent literature has been carried out to delineate the mortality risk associated with these sources. Risk factors have then been applied for Suva, to calculate the possible mortality reduction that may be achieved through reduction in pollutant levels. Higher risk ratios for black carbon and sulphur resulted in mortality predictions for PM2.5 from fossil fuel combustion, road vehicle emissions and waste burning that surpass predictions for these sources based on health risk of PM2.5 mass alone. Predicted mortality for Suva from fossil fuel smoke exceeds the national toll from road accidents in Fiji. The greatest benefit for Suva, in terms of reduced mortality, is likely to be accomplished by reducing emissions from fossil fuel combustion (diesel), vehicles and waste burning.

Airborne ultrafine particles in a Pacific Island country: Characteristics, sources and implications for human exposure.

The Pacific Islands carry a perception of having clean air, yet emissions from transport and burning activities are of concern in regard to air quality and health. Ultrafine particle number concentrations (PNCs), one of the best metrics to demonstrate combustion emissions, have not been measured either in Suva or elsewhere in the Islands. This work provides insight into PNC variation across Suva and its relationship with particle mass (PM) concentration and composition. Measurements over a short monitoring campaign provide a vignette of conditions in Suva. Ambient PNCs were monitored for 8 day at a fixed location, and mobile PNC sampling for two days. These were compared with PM concentration (TSP, PM10, PM2.5, PM1) and are discussed in relation to black carbon (BC) content and PM2.5 sources, determined from elemental concentrations; for the October 2015 period and longer-term data. Whilst Suva City PM levels remained fairly low, PM2.5 = 10-12 µg m-3, mean PNC (1.64 ± 0.02 × 104 cm-3) was high compared to global data. PNCs were greater during mobile sampling, with means of 10.3 ± 1.4 × 104 cm-3 and 3.51 ± 0.07 × 104 cm-3 when travelling by bus and taxi, respectively. Emissions from road vehicles, shipping, diesel and open burning were identified as PM sources for the October 2015 period. Transport related ultrafine particle emissions had a significant impact on microscale ambient concentrations, with PNCs near roads being 1.5 to 2 times higher than nearby outdoor locations and peak PNCs occurring during peak traffic times. Further data, particularly on transport and wet-season exposures, are required to confirm results. Understanding PNC in Suva will assist in formulating effective air emissions control strategies, potentially reducing population exposure across the Islands and in developing countries with similar emission characteristics. Suva's PNC was high in comparison to global data; high exposures were related to transport and combustion emissions, which were also identified as significant PM2.5 sources.

Etiology of musculoskeletal injuries in amateur breakdancers.

AIM: The aim of this study was to assess the incidence of musculoskeletal injuries in breakdancers and investigate the association with training habits. METHODS: Forty-six males and sixteen females completed a questionnaire regarding their training and competition habits (frequency, warm-up and stretching, strength training, protective equipment, move types and supervision) and the musculoskeletal injuries sustained as a result of breakdancing in the previous 12 months. The effects of training habits and sex on injury rates were analyzed by a Mann-Whitney Test and a Kruskal-Wallis Test, while a stepwise linear regression analysis assessed the link between injury rates and quantitative risk factors. RESULTS: The injury rate was 4.02 injuries per 1000 h, with no significant difference between males and females (P>0.05). The main injuries affected were the knee (23.4%) and wrist (15.3%), and females were characterized by a significantly greater number of finger injuries and a lower number of shoulder injuries that males (P<0.05). In addition, of all the factors evaluated, only the amount of time spent performing breakdance training showed a significant association with injury rate (P<0.05). CONCLUSION: These results suggest that interventions should focus on protecting specific body parts and improving training quality and recovery.

Pulmonary inflammation and fibrosis following subacute inhalational exposure to silica: determinants of progression.

To evaluate components of the pulmonary cellular response to inhaled silica that might be determinants of progression to fibrosis, we developed a model of the early stages of chronic human silicosis. Groups of mice were subacutely exposed either to alpha-quartz or to nonfibrogenic titanium dioxide dust as a control. Induction of lesions by inhaled silica was dependent upon the size distribution and dose of the particles. A novel observation was that low intensity exposure to silica evoked reversible inflammatory lesions that were characterized by focal aggregation of particle-laden alveolar macrophages near terminal airways. In contrast, higher intensity exposure elicited progressive pulmonary inflammation, including a significant perivascular influx of T-lymphocytes early in the response. The airspace inflammatory lesions exhibited a statistically significant decline in numerical density over time. Meanwhile, deposition of collagen was observed at perivascular locations, which were anatomically distinct from the initial foci of inflammation, and the numerical density of fibrotic lesions increased significantly with time. We speculate that this pattern of response might be related to alveolar clearance mechanisms being overwhelmed, followed by translocation and sequestration of particles in the interstitium, subsequently leading to T-lymphocyte recruitment and ultimately to the development of fibrosis.

Bellini duct carcinoma with ovarian metastasis.

We report a case of collecting duct carcinoma presenting as pyelonephritis with hypercalcemia and metastasis to the ovary. Case management and literature review being presented.

A para-testicular primitive neuroectodermal tumor in an adult: a case report and literature review.

OBJECTIVE: The authors describe the salient clinical, radiologic and histopathologic features of an extremely rare para-testicular primitive neuroectodermal tumor in a 25 year-old man. INTERVENTION: Excisional biopsy of the tumor en bloc was performed. Adjuvant VAdriaC-based chemotherapy (Vincristine, Doxorubicin, and Cyclophosphamide) was given post-operatively. MAIN OUTCOME MEASURES: Histopathologic examination and immunohistochemical studies were performed on formaldehyde-fixed, paraffin-embedded tumor tissue. RESULTS: Histologic examination showed an undifferentiated small cell tumor. The tumor cells stained positively with MIC-2, a marker specific for primitive neuroectodermal tumors. The patient is 12 months post surgery and has completed adjuvant chemotherapy with no evidence of recurrent disease. CONCLUSIONS: This highly unusual, peripheral primitive neuroectodermal tumor should be considered in the differential diagnosis of undifferentiated small cell neoplasms of the genitourinary system in adults, from the kidney to the testicle. We present a patient with a PNET treated based on a Ewing's family of tumors protocol.

Characterisation and source identification of PM10 aerosol samples collected with a high volume cascade impactor in Brisbane (Australia).

PM10 (particulate matter with aerodynamic diameter < 10 microm) samples of Brisbane air were collected and fractionated into six size fractions (< 0.5, 0.5-0.61, 0.61-1.3, 1.3-2.7, 2.7-4.9 and 4.9-10 microm) with a high volume cascade impactor. The chemical composition of the samples was analysed by techniques including Ion Beam Analysis. On average, 42% of the aerosol mass is in the > 2.7-microm size fraction, with the < 0.5-microm size fraction also contributes 41% of the aerosol mass. The composition of the < 1.3-microm aerosols is significantly different to that of the > 1.3-microm aerosols. The aerosol mass and concentrations of chemical components related to human activities show a bimodal size-distribution pattern, with most of the mass in the accumulation range (< 0.65 microm). The size geometric mean of aerosol mass is 0.96 microm in the samples collected from an industrial/residential site, and is 1.74 microm in the samples collected from a suburban site. The size geometric mean of concentrations of chemical components related to human activities ranges from 0.16 to 0.57 microm. The concentrations of crustal matter and sea salt show a unimodal size-distribution pattern, and with geometric means of 3.73 and 4.12 microm, respectively. Four source factors were resolved by multivariate analysis techniques for the size-fractionated aerosol samples, namely the soil, sea salt, organics and vehicular exhausts factors. The source fingerprints of the factors vary in the size ranges and have implications on the formation and dispersal processes of the particles. On average, the soil and sea salt factors contribute more than 80% of the aerosol mass in the > 2.7-microm fractions, while the organics and vehicular exhausts factors explain almost all the aerosol mass in the < 0.61-microm fractions.

Size distribution and sources of aerosol in Launceston, Australia, during winter 1997.

As part of a pilot study into the chemical and physical properties of Australian fine particles, a suite of aerosol samples was collected at Ti Tree Bend in Launceston, Tasmania, during June and July 1997. This period represents midwinter in the Southern Hemisphere, a period when aerosol sources in Launceston are dominated by smoke from domestic wood burning. This paper describes the results from this measurement campaign, with the aim of assessing the effect of wood smoke on the chemical and physical characteristics of ambient aerosol. A micro orifice uniform deposit impactor (MOUDI) was used to measure the size distributions of the aerosol from 0.05 to 20 microns aerodynamic diameter. Continuous measurements of fine particle mass were made using a PM2.5 tapered element oscillating microbalance (TEOM) and light scattering coefficients at 530 nm were measured with nephelometers. Mass size distributions tended to be bimodal, with the diameter of the dominant mode tending to smaller sizes with increases in total mass. Non-sea salt potassium and polycyclic aromatic hydrocarbons (PAHs) were used as chemical tracers for wood smoke. Wood smoke was found to increase absolute particle mass (enough to regularly exceed air quality standards), and to concentrate mass in a single mode below 1 micron aerodynamic diameter. The acid-base equilibrium of the aerosol was altered by the wood smoke source, with free acidity hydrogen ion, non-sea salt sulfate, and ammonium concentrations being higher and the concentration of all species, including nitrate (to differing extents), focused in the fine particle size ranges. The wood smoke source also heavily influenced the aerosol scattering efficiency, adding to a strong diurnal cycle in both mass concentration and light scattering.

[Methodology for the assessment of activities in primary health care]. / Metodologia de avaliação do trabalho na atenção primaria à saúde.

A case study assessed health care activities in a primary health care facility to help develop methodologies of care work assessment and of the proposal of leading categories for the said processes, based on the work process. This study was developed at the Centro de Saúde Escola of the Faculdade de Medicina of the Universidade de São Paulo, using as empirical material the assessment of the care activities aimed at the emergency care and programmed care of 'chronic' patients (patients suffering from hypertension and diabetes). The analysis of these assessments which considered different moments of the work process (working objects, activity of agents, analysis of the working means and result of the work) suggest the need of creating analytical categories that will make workable the understanding of this process, inserting each moment to the work as a whole. The analytical categories proposed are: 1) workability as a means of making effective the proposed actions; 2) strategic effectiveness as a measure of the scope of the results that have been observed among patients and/or the population and that can be the result of the actions performed.

[Process assessment in the care for patients with chronic degenerative disease in a basic health unit]. / Avaliação do processo de atendimento a pacientes portadores de doença crônico-degenerativa em uma unidade básica de saúde.

The efficacy of health actions, related to arterial hypertension and used as a strategy to decrease morbimortality due to cardiovascular diseases, in accordance with the "risk approach" and carried out in a Primary Health Care Clinic is assessed. These actions are based on the detection of arterial hypertension in the adult population attended at the Clinic and on the control of blood pressure levels in hypertensive individuals in which other known risk factors continue to be controlled, as well as on further treatment of eventual complications. Data relating to the 3,793 patients who were attended at least once by doctors of the adult sector of a training health-center located in S. Paulo county (Brazil) during the period from June 1990 to May 1991, inclusive, were evaluated. This evaluation was made according to each diagnosis undertaken as well as to the concentration of each type of consultation whether occasional, or follow-up. Of these 3,793 patients analysed, 839 presented arterial hypertension and/or diabetes, and were grouped into four categories: the exclusively hypertensive, the hypertensive with other associated chronic diseases (except diabetes), the diabetic and the diabetic with arterial hypertension. The results of this study brought the following aspects to light: 1) The low coverage of hypertensive individuals and diabetics being attended by the health service when only the population attended by the health service is taken into consideration. 2) The incidence of patients diagnosed as hypertensive in occasional consultations who did not return to the health service for medical follow-up indicates the difficulties involved in attracting such individuals permanently.(ABSTRACT TRUNCATED AT 250 WORDS)