The Effects of Trunk Muscle Training on Physical Fitness and Sport-Specific Performance in Young and Adult Athletes: A Systematic Review and Meta-Analysis.

Background The role of trunk muscle training (TMT) for physical ftness (e.g., muscle power) and sport-specifc performance measures (e.g., swimming time) in athletic populations has been extensively examined over the last decades. However, a recent systematic review and meta-analysis on the efects of TMT on measures of physical ftness and sport-specifc performance in young and adult athletes is lacking. Objective To aggregate the efects of TMT on measures of physical ftness and sport-specifc performance in young and adult athletes and identify potential subject-related moderator variables (e.g., age, sex, expertise level) and training-related programming parameters (e.g., frequency, study length, session duration, and number of training sessions) for TMT efects. Data Sources A systematic literature search was conducted with PubMed, Web of Science, and SPORTDiscus, with no date restrictions, up to June 2021. Study Eligibility Criteria Only controlled trials with baseline and follow-up measures were included if they examined the efects of TMT on at least one measure of physical ftness (e.g., maximal muscle strength, change-of-direction speed (CODS)/ agility, linear sprint speed) and sport-specifc performance (e.g., throwing velocity, swimming time) in young or adult competitive athletes at a regional, national, or international level. The expertise level was classifed as either elite (competing at national and/or international level) or regional (i.e., recreational and sub-elite). Study Appraisal and Synthesis Methods The methodological quality of TMT studies was assessed using the Physiotherapy Evidence Database (PEDro) scale. A random-efects model was used to calculate weighted standardized mean diferences (SMDs) between intervention and active control groups. Additionally, univariate sub-group analyses were independently computed for subject-related moderator variables and training-related programming parameters. Results Overall, 31 studies with 693 participants aged 11–37 years were eligible for inclusion. The methodological quality of the included studies was 5 on the PEDro scale. In terms of physical ftness, there were signifcant, small-to-large efects of TMT on maximal muscle strength (SMD =0.39), local muscular endurance (SMD =1.29), lower limb muscle power (SMD=0.30), linear sprint speed (SMD =0.66), and CODS/agility (SMD =0.70). Furthermore, a signifcant and moderate TMT efect was found for sport-specifc performance (SMD=0.64). Univariate sub-group analyses for subject-related moderator variables revealed signifcant efects of age on CODS/agility (p=0.04), with signifcantly large efects for children (SMD=1.53, p=0.002). Further, there was a signifcant efect of number of training sessions on muscle power and linear sprint speed (p≤0.03), with signifcant, small-to-large efects of TMT for>18 sessions compared to≤18 sessions (0.45≤SMD≤0.84, p≤0.003). Additionally, session duration signifcantly modulated TMT efects on linear sprint speed, CODS/agility, and sport-specifc performance (p≤0.05). TMT with session durations≤30 min resulted in signifcant, large efects on linear sprint speed and CODS/agility (1.66≤SMD≤2.42, p≤0.002), whereas session durations>30 min resulted in signifcant, large efects on sport-specifc performance (SMD=1.22, p=0.008). Conclusions Our fndings indicate that TMT is an efective means to improve selected measures of physical ftness and sportspecifc performance in young and adult athletes. Independent sub-group analyses suggest that TMT has the potential to improve CODS/agility, but only in children. Additionally, more (>18) and/or shorter duration (≤30 min) TMT sessions appear to be more efective for improving lower limb muscle power, linear sprint speed, and CODS/agility in young or adult competitive athletes.publishedVersio

Potential Impact of Benzodiazepine Use on the Rate of Hip Fractures in Five Large European Countries and the United States

Benzodiazepine use increases the risk of falls and has been associated with an increased risk of hip fractures. Our aim was to estimate the possible population impact of the use of benzodiazepines on the rate of hip fracture in France, Germany, Italy, Spain, the United Kingdom, and the United States. We conducted a literature review to estimate the pooled relative risk (RR) for hip fractures and use of benzodiazepines. Prevalence rates of benzodiazepine use in 2009 were calculated for each country using the IMS MIDAS database and three public databases in Denmark, the Netherlands, and Norway. Both the RR and prevalence rates were used for calculation of population attributable risks (PARs) of hip fractures associated with benzodiazepine use. The literature review showed an increased risk of hip fractures in benzodiazepine users (RR = 1.4, 95 % CI 1.2–1.6). Rate of benzodiazepine use showed considerable differences between countries, ranging from 4.7 % to 22.3 % of population ever in a 1-year period. These are reflected in results for the PARs; estimated attributions of benzodiazepines to the rate of hip fractures were 1.8 %, 95 % CI 1.1–2.6 (Germany); 2.0 %, 95 % CI 1.2–2.8 (United Kingdom); 5.2 %, 95 % CI 3.2–7.3 (Italy); 7.4 %, 95 % CI 4.5–10.0 (France); 8.0 %, 95 % CI 4.9–11.0 (United States); and 8.2 %, 95 % CI 5.1–12.0 (Spain). PAR estimates suggest that the potential attribution of benzodiazepine use on the population rate of hip fractures in the five specified European countries and the United States varies between 1.8 % and 8.2 %. During the next phase of the IMI-PROTECT study, a comparison with individual patient data will show whether this approach is valid

Inadequate knowledge about snakebite envenoming symptoms and application of harmful first aid methods in the community in high snakebite incidence areas of Myanmar

INTRODUCTION: Every year millions of people in developing countries suffer from snakebite, causing a large number of deaths and long term complications. Prevention and appropriate first aid could reduce the incidence and improve the health outcomes for those who suffer bites. However, many communities where snakebite is a major issue suffer from a lack of information about prevention and first aid measures that a family or community member could take to prevent severe envenoming, complications and poor outcomes. Myanmar suffers from a high burden of snakebites with a large number of deaths. As part of a health services and community development program, a community survey was conducted to identify communities' knowledge about snakebite and their sequelae, and knowledge and practice about first aid and health services use. METHOD: 4,276 rural residents of Kyaukse and Madaya townships in the Mandalay region were recruited by cluster sampling, involving random selection of 144 villages and random sampling of 30 households from each village. One adult member of each household was interviewed using a structured questionnaire. RESULTS: The incidence of snakebite was 116/100,000 people. Respondents reported 15 different types of snakes in the area, with Russell's Viper, Cobra and Green snakes as the most common. 88% of the people informed that working in the fields and forests was when most of the bites occur. A majority knew about snakebite prevention methods such as wearing long boots. However, only a few people knew about the specific symptoms caused by snakebites. Only 39% knew about the correct methods of first aid. More than 60% mentioned tourniquet as a first aid method, though this may cause significant complications such as ischaemia of the limb. 88% said that they would take a snakebite victim to a government hospital, and 58% mentioned availability of antivenom as the reason for doing this. At the same time, the majority mentioned that traditional methods existed for first aid and treatment and 25% mentioned at least one harmful traditional method as an effective measure that they might use. CONCLUSION: The community is aware of snakebites as a major public health issue and know how to prevent them. However, the high incidence of snakebites point to lack of application of preventive methods. The community recognise the need for treatment with antivenom. However, inadequate knowledge about appropriate first aid methods, and a reliance on using tourniquets require a targeted education program. Existing knowledge in communities, albeit insufficient, provides a good starting point for mass media educational campaigns.</p