Spatial epidemiological investigation of sport and leisure injuries in Victoria, Australia

Sport and leisure injuries are recognised as a public health issue in Australia. Despite the many health benefits associated with sport and leisure participation, there is a risk of sustaining injury during participation. To keep Australia active, there is a critical need to prevent injury occurrence. Epidemiological investigations in sport and leisure injuries have been largely examined by grouping of sports, age groups, sex and level of play. In addition, intrinsic (person-level) factors have been considered, such as strength, flexibility or previous injury history. These factors may not be sufficient to identify injury burden or prevent an increase in injury incidences. In the broader injury literature (e.g., road traffic crashes or drowning), it is known that injuries often cluster within specific places (i.e., road intersections or bodies of water). These specific geographic locations may also relate to sport and leisure injuries (e.g., sports grounds or facilities). Similarly, population-level factors such as socio-economic status or cultural groups within an area could influence the types of sports and leisure activities people participate in and consequently, the injuries that occur. A review presented in this PhD thesis revealed that there is very limited sport and leisure injury epidemiological information from a geographical perspective. To address this gap, and determine whether there is a spatial pattern in sport/leisure injuries, the aim of this PhD was to examine the geospatial distribution of sport/leisure injury hospitalisations and their association with a broad range of social and economic characteristics. This thesis uses spatial epidemiological methods to answer questions such as ‘Where do sports and leisure injuries occur?’ and ‘In whom do sports/leisure injuries occur?’ The main chapters present the results of the application of spatial epidemiological methods to describe the problem, to test hypotheses and to explore associations with possible explanatory variables. The findings showed a significant variation across metropolitan, regional and rural areas in the pattern and clustering of injuries when examining different sports, age groups and other variables such as education level. A secondary aim of this thesis was to consider the dissemination of sport and injury epidemiological data. As emphasised in the literature, there is limited spatial epidemiological information available to decision-makers and key stakeholders. At best, descriptive maps might be included in a report or research paper. However, these are static and limited to the results that the author chooses to present. Therefore, an important output from this PhD is a web-GIS application that has been specifically built to enable the exploratory analysis of sport/leisure injuries in Victoria. Sport and leisure injury prevention strategies and policy development relies on information about where, when, to whom and how sport/leisure injuries occur. This thesis demonstrates that a spatial epidemiological approach is an important and novel way to address epidemiological questions from a geographical perspective.Doctor of Philosoph

Variations in administration of Covid-19 vaccine during last 20 weeks at a vaccination center of Agra, Uttar Pradesh

Background: Covid-19 pandemic has created havoc around the world and vaccination is an effective tool against this demon. Study of variations in administration of daily doses of Covid-19 vaccine at vaccination centre can help in better resource management. Material & methods: This record based descriptive study was conducted among beneficiaries of Covid-19 vaccination at S. N. Medical College, Agra. Record of administration of daily doses and vaccine wastage, vaccination of different groups of beneficiaries and occurrence of various national and local events related to vaccination was also analyzed. Result: A total of 33,571 doses of any Covid-19 vaccine (Covaxin/Covishield) were administered during past 88 working days in 20 weeks expanded over 5 months. On an average 165 doses were administered every day by each team and overall vaccine wastage was 0.85%. Maximum average of 199 doses per day by each team was observed on Mondays. There are many peaks and drops in administration of daily doses of Covid-19 vaccine at our center which can be attributed to either some national or local events related to supply of vaccine at our center, addition of a new group of beneficiary, any news or political controversy related to Covid-19 vaccination etc. Conclusion: Understanding of spikes and drops in the curve of daily/weekly administration of Covid-19 vaccine, in view of occurrence of various national and local events related to vaccination, can help in better formulation of strategies specially related to human resource allocation for success of National Covid-19 vaccination program

Autophagy inhibition by chloroquine prevents increase in blood pressure and preserves endothelial functions

Purpose: To determine the effects of lysosomal inhibition of autophagy by chloroquine (CHQ) onhypertension-associated changes in the endothelial functions. Method: Angiotensin II (Ang II)-treated human endothelial cell line EA.hy926 and renovascularhypertensive rats were subjected to CHQ treatment (in vitro: 0.5, 1, and 2.5 μM; in vivo: 50 mg/kg/dayfor three weeks). Changes in the protein expressions of LC3b II (autophagosome formation marker) andp62 (autophagy flux marker) were assessed using immunoblotting. Cell migration assay, tubuleformation assay (in vitro), and organ bath studies (in vivo) were performed to evaluate the endothelialfunctions. Hemodynamic parameters were measured as well. Results: A higher expression of LC3b II and a reduced expression of p62 observed in the Ang II-treatedendothelial cells, as well as in the aorta of the hypertensive rats, indicated enhanced autophagy.Treatment with CHQ resulted in reduced autophagy flux (in vitro as well as in vivo) and suppressed AngII-induced endothelial cell migration and angiogenesis (in vitro). The treatment with CHQ was alsoobserved to prevent increase in blood pressure in hypertensive rats and preserved acetylcholineinducedrelaxation in phenylephrine-contracted aorta from the hypertensive rats. In addition, chloroquineattenuated Ang II-induced contractions in the aorta of normotensive as well as hypertensive rats. Conclusion: These observations indicated that CHQ lowers the blood pressure and preserves thevascular endothelial function during hypertension. Keywords: Angiotensin II, Autophagy, Chloroquine, Endothelial function, Hypertension, Vasculardysfunctio

Injury rate and patterns of Sydney grade cricketers : A prospective study of injuries in 408 cricketers

Background The grade cricket competition, also known as premier cricke

Community based interventional study to assess the impact of health education on alcohol use among adult males in Bareilly, Uttar Pradesh

Background: Alcoholic beverages have been a part of social life for millennia, yet societies have always found it difficult to understand or restrain their use. Apart from the health concerns, chronic alcoholism is one of the greatest causes for poverty in the country. Objective: To assess the impact of health education on alcohol use among adult males in Bareilly District, Uttar Pradesh. Material & Methods: A community based interventional study conducted in the Bareilly district among males aged >15 years during November 2015 to April 2017 taking a sample of 699 by 30 cluster sampling with PPS. Data was collected by home visit using WHO-AUDIT (Alcohol Use Disorder Identification Test) questionnaire. After data collection, health education was given to study population in form of speech, posters, short films and focus group discussion. One year after providing health education, AUDIT questionnaire was re-filled by current alcohol drinkers to know the impact of health education. Results: Prevalence of drinking alcohol is 30.47% i.e. 213 current drinkers. AUDIT Scores before and after Health education were positively correlated (r=.768, p=0.0001). There was a significant average difference between AUDIT Scores before and after Health education (t178=2.973, p=0.003). Conclusion: Health education has a positive impact on alcohol use therefore research focus should be on primary prevention by health education/behaviour change communication in primary and secondary care settings

Spatial epidemiology : A new approach for understanding and preventing sport injuries

In order to develop effective strategies to prevent sports injuries, we need to have an understanding of the people and populations who are most at risk of injury as well as the risk factors associated with sustaining injury. Spatial epidemiology is a method used to address questions of when, where, to whom and how health outcomes such as sports injuries occur at a population level, taking into account geographic variation. The aim of this article is to outline the potential application of spatial epidemiology to achieve a better understanding of sports injuries to inform prevention strategies

Electronic Health Records’ Support for Primary Care Physicians’ Situation Awareness: A Metanarrative Review

Objective: Situation awareness (SA) refers to people's perception and understanding of their dynamic environment. In primary care, reduced SA among physicians increases errors in clinical decision-making and, correspondingly, patients' risk of experiencing adverse outcomes. Our objective was to understand the extent to which electronic health records (EHRs) support primary care physicians (PCPs)' SA during clinical decision-making. Method: We conducted a metanarrative review of papers in selected academic databases, including CINAHL and MEDLINE. Eligible studies included original peer-reviewed research published between January 2012 and August 2020 on PCP-EHR interactions. We iteratively queried, screened, and summarized literature focused on EHRs supporting PCPs' clinical decision-making and care management for adults. Then, we mapped findings to an established SA framework to classify external factors (individual, task, and system) affecting PCPs' levels of SA (1-Perception, 2-Comprehension, and 3-Projection) and identified SA barriers. Results: From 1504 articles identified, we included and synthesized 19 studies. Study designs were largely noninterventional. Studies described EHR workflow misalignments, usability issues, and communication challenges. EHR information, including lab results and care plans, was characterized as incomplete, untimely, or irrelevant. Unmet information needs made it difficult for PCPs to obtain even basic SA, Level 1 SA. Prevalent barriers to PCPs developing SA with EHRs were errant mental models, attentional tunneling, and data overload. Conclusion: Based on our review, EHRs do not support the development of higher levels of SA among PCPs. Review findings suggest SA-oriented design processes for health information technology could improve PCPs' SA, satisfaction, and decision-making

Electronic Co-design (ECO-design) Workshop for Increasing Clinician Participation in the Design of Health Services Interventions: Participatory Design Approach

BackgroundParticipation from clinician stakeholders can improve the design and implementation of health care interventions. Participatory design methods, especially co-design methods, comprise stakeholder-led design activities that are time-consuming. Competing work demands and increasing workloads make clinicians’ commitments to typical participatory methods even harder. The COVID-19 pandemic further exacerbated barriers to clinician participation in such interventions. ObjectiveThe aim of this study was to explore a web-based participatory design approach to conduct economical, electronic co-design (ECO-design) workshops with primary care clinicians. MethodsWe adapted traditional in-person co-design workshops to web-based delivery and adapted co-design workshop series to fit within a single 1-hour session. We applied the ECO-design workshop approach to codevelop feedback interventions regarding abnormal test result follow-up in primary care. We conducted ECO-design workshops with primary care clinicians at a medical center in Southern Texas, using videoconferencing software. Each workshop focused on one of three types of feedback interventions: conversation guide, email template, and dashboard prototype. We paired electronic materials and software features to facilitate participant interactions, prototyping, and data collection. The workshop protocol included four main activities: problem identification, solution generation, prototyping, and debriefing. Two facilitators were assigned to each workshop and one researcher resolved technical problems. After the workshops, our research team met to debrief and evaluate workshops. ResultsA total of 28 primary care clinicians participated in our ECO-design workshops. We completed 4 parallel workshops, each with 5-10 participants. We conducted traditional analyses and generated a clinician persona (ie, representative description) and user interface prototypes. We also formulated recommendations for future ECO-design workshop recruitment, technology, facilitation, and data collection. Overall, our adapted workshops successfully enabled primary care clinicians to participate without increasing their workload, even during a pandemic. ConclusionsECO-design workshops are viable, economical alternatives to traditional approaches. This approach fills a need for efficient methods to involve busy clinicians in the design of health care interventions