The New Zealand Rugby Injury and Performance Project: V. Epidemiology of a season of rugby injury

OBJECTIVE: To describe the incidence, nature, and circumstances of injury experienced by a cohort of rugby union players during a full competitive club season. METHODS: A prospective cohort study followed up 356 male and female rugby players throughout the 1993 competitive club season. Players were interviewed by telephone each week to obtain information on the amount of rugby played and the injury experienced. RESULTS: Detailed information was collected for 4403 player-games and 8653 player-practices. A total of 671 injury events were reported, of which 569 were rugby related. The injury rate for games was higher than that for practices (rate ratio 8.3). At 10.9 injuries per 100 player- games, males had a higher rate of injury than females at 6.1 injuries per 100 player-games (

State firearm laws, race and law enforcement-related deaths in 16 US states: 2010-2016

The aim of this study was to assess the association between state firearm legislation and law enforcement-related deaths (LEDs) and its modification by race. We used secondary data from an ecological cohort of 16 states (2010 to 2016), using the National Violent Death Reporting System (NVDRS), the State Firearm Law Database and additional public sources. Poisson regression with generalised estimating equations and inverse probability of exposure weights to account for time-varying confounding were used to quantify the association. LEDs were also disaggregated by race (Black vs non-Black). A total of 1593 LEDs took place during the 6-year study period. After adjusting for confounders, the IRR among non-Blacks was 0.48 (95% CI 0.26 to 0.89) and 1.53 (95% CI 0.93 to 2.54) among Blacks. Our findings highlight the fact that increased firearm provisions may decrease rates of LED among non-Black American individuals-an association not observed among Black Americans

Current physical and mental health of former collegiate athletes

Background: There is a dearth of research on the current health of former collegiate athletes. Purpose: To examine the current health and related correlates in a cohort of former collegiate athletes who played in a diverse range of men’s and women’s sports with various levels of contact. Study Design: Cross-sectional study; Level of evidence, 3. Methods: Former collegiate athletes (N = 3657) were asked to complete an online questionnaire addressing sports history, medical history, and demographics. The questionnaire also included the Veterans RAND 12-Item Health Survey (VR-12), which yielded 2 composite scores for physical (PCS) and mental (MCS) health. The VR-12 PCS and MCS scores were compared with published US normative data using t tests and analyses of variance. Results: Mean PCS and MCS scores of the 797 respondents with complete data (21.9% of target sample; average, 14.5 years since last played collegiate sport) were 53.0 ± 6.1 and 51.7 ± 9.4, respectively. When stratified by age and sex, PCS and MCS scores were similar to normative scores in the United States. Lower PCS scores were associated with sustaining ≤3 concussions, playing in collision sports during college, and sustaining a career-ending injury (all, P <.001). No association was found between concussion and MCS scores (P =.06). Among former collegiate athletes, prevalent medical conditions included anxiety (16.2%), hypercholesterolemia/high cholesterol (10.6%), and depression (10.4%). Additionally, 5.8% screened positive for alcohol dependence, and 5.8% screened positive for disordered eating (eg, binge eating, purging). These findings were more prevalent than those reported by the World Health Organization as representative of the US population. Conversely, there was a lower prevalence of depression, bipolar disorders, and attention deficit disorder, with or without hyperactivity (ADD/ADHD), than in the World Health Organization US population data sample. Conclusion: Former collegiate athletes appear similar to the general US population on many aspects of mental and physical health. However, observed health deficits associated with previous sports injuries warrant ongoing monitoring of the health and well-being of former collegiate athletes

Head Impact Biomechanics Differ Between Girls and Boys Youth Ice Hockey Players

The influence of sex on head impact biomechanics is unknown for youth ice hockey. We sought to determine sex differences in head impact severity and frequency in youth ice hockey players. Male (n = 110) and female (n = 25) players (13–16 years old) were recruited from a local hockey organization. Players wore helmets instrumented with the Head Impact Telemetry System for all competitions and practices throughout the season. Seven team-seasons were captured. Random intercepts general mixed linear models determined whether linear acceleration and rotational acceleration differed by sex. Linear regression models evaluated the relationship between sex and impact frequency. All head impact biomechanics were natural log-transformed as their distributions were right-skewed. Females sustained fewer impacts per player than males (27 fewer impacts per player-season, p < 0.0001) even when analysis was limited to games only (21 fewer impacts per player-season, p < 0.0001). The linear acceleration was higher among females (1.07 g; 95% CI 1.00, 1.13; p = 0.04). There were no other meaningful sex differences in head impact severity. Female players are not permitted to body check, and this likely explains why they sustain fewer head impacts than males. However, as a result, females likely sustain a higher proportion of head impacts through illegal or unintentional head contact, and these impacts may result in more force being delivered to the head

The first decade of web-based sports injury surveillance (2004-2005 through 2013-2014): Methods of the National collegiate athletic Association injury surveillance program and high school reporting information online

Objective: To describe the methods of the National Collegiate Athletic Association (NCAA) Injury Surveillance Program (ISP) and High School Reporting Information Online (HS RIO) system as a complement to the sport-specific manuscripts that will follow. Background: The NCAA-ISP and HS RIO collect injury and exposure data from samples of collegiate and high school sports programs, respectively. The NCAA-ISP, which the NCAA has maintained since 1982, was relaunched as a Web-based platform at the beginning of the 2004-2005 academic year. In 2005, the HS RIO was introduced to capture data on high school athletes and modeled after the NCAA-ISP. Relevant data are shared with the NCAA and high school sport and policy committees to develop evidence-based rules and programs that help protect the health and safety of student-athletes. Description: The NCAA-ISP and HS RIO monitor participation in school-sanctioned competitions and practices that occur from the first preseason practice to the final postseason contest for more than 25 sports. For this series of publications in the Journal of Athletic Training, injury information on 13 sports at the collegiate level during the 2004-2005 through 2013-2014 academic years and the high school level during the 2005-2006 through 2013-2014 academic years was evaluated. Conclusions: Athletic trainers have been a vital source of data collection over the past decade to help produce the largest datasets of collegiate and high school sports injuries. Such data have helped various sport and policy committees advance protocols that aim to increase sports safety. This series of publications will aid by continuing to provide data to stakeholders in the sports community

Epidemiology of ankle sprains and chronic ankle instability

Objective: To provide a focused overview of the existing literature on the epidemiology of acute ankle sprains (lateral, medial, and high/syndesmotic) with an emphasis on incidence studies from the United States. In addition, we provide a brief overview of chronic ankle instability (CAI), posttraumatic osteoarthritis, and injury prevention to contribute to our understanding of the epidemiology of these injuries and the current state of the science on ankle sprains and ankle instability in sports medicine. Background: Acute ankle sprains are one of the most common musculoskeletal injuries, with a high incidence among physically active individuals. Additionally, acute ankle sprains have a high recurrence rate, which is associated with the development of CAI. Understanding the epidemiology of these injuries is important for improving patients’ musculoskeletal health and reducing the burden of lower limb musculoskeletal conditions. Description: Acute ankle-sprain incidence rates are summarized among the general population, as well as among physically active populations, including organized athletics and military personnel, with a focus on incidence in the United States. The link between a prior ankle sprain and a future acute ankle sprain is described. We also discuss the association between the incident ankle sprain and adverse, long-term outcomes such as CAI and posttraumatic osteoarthritis. Finally, we summarize injury-prevention successes and future directions for research and prevention. Clinical Applications: This information is useful for health care providers to understand the expected incidence rates of acute ankle sprains, be aware of the association between ankle sprains and negative short- and long-term outcomes, and be familiar with existing injury-prevention programs

Evaluation of a Medicaid Lock-in Program

Background: "Lock-in" programs (LIPs) identify beneficiaries demonstrating potential overutilization of opioids, and other controlled substances, and restrict their access to these medications. LIPs are expanding to address the opioid crisis and could be an effective tool for connecting people to opioid use disorder treatment. We examined the immediate and sustained effects of a Medicaid LIP on overdose risk and use of medication-assisted treatment (MAT) for opioid use disorder. Methods: We analyzed North Carolina Medicaid claims from July 2009 through June 2013. We estimated daily risk differences and ratios of MAT use and overdose during lock-in and following release from the program, compared with periods before program enrollment. Results: The daily probability of MAT use during lock-in and following release was greater, when compared with a period just before LIP enrollment [daily risk ratios: 1.50, 95% confidence interval (CI): 1.18-1.91; 2.27, 95% CI: 1.07-4.80; respectively]. Beneficiaries' average overdose risk while enrolled in the program and following release was similar to their risk just before enrollment (daily risk ratios: 1.01, 95% CI: 0.79-1.28; 1.12, 95% CI: 0.82-1.54; respectively). Discussion: North Carolina's Medicaid LIP was associated with increased use of MAT during enrollment, and this increase was sustained in the year following release from the program. However, we did not observe parallel reductions in overdose risk during lock-in and following release. Identifying facilitators of MAT access and use among this population, as well as potential barriers to overdose reduction are important next steps to ensuring effective LIP design

Association of State Firearm Legislation With Female Intimate Partner Homicide

Introduction: The aim of this study was to assess the association between state firearm legislation and female intimate partner homicide. Methods: In 2017, the authors conducted a secondary data analysis of 16 states from 2010 to 2014, using data from the National Violent Death Reporting System, the State Firearm Law Database, and additional public sources. Poisson regression analyses quantified the association between the number of state restrictive firearm legislative provisions and the female population-based intimate partner homicide rate. For etiologic reasons, intimate partner homicide was disaggregated into homicide–suicide (intimate partner homicide followed by perpetrator suicide) and homicide-only intimate partner homicide (intimate partner homicide in the absence of perpetrator suicide). Results: There were 1,693 female intimate partner homicide deaths in the 16 states during 2010–2014; 67% were homicide-only intimate partner homicide. The number of state-level legislative provisions related to firearm restrictions ranged from four (Alaska) to 95 (Massachusetts). The intimate partner homicide rate in states with zero to 39 provisions was 1.16 per 100,000 person years (95% CI=1.10, 1.22) and in states with >40 provisions was 0.68 per 100,000 person years (95% CI=0.61, 0.72). The incidence of female intimate partner homicide was 56% lower in states with ≥40 legislative provisions (adjusted incidence rate ratio=0.44, 95% CI=0.28, 0.68), relative to states with zero to 39 provisions. This protective association was stronger for homicide-only intimate partner homicide than homicide–suicide intimate partner homicide. Conclusions: More state-level restrictive firearm legislation is associated with a lower rate of female intimate partner homicides

Laboratory Validation of Two Wearable Sensor Systems for Measuring Head Impact Severity in Football Players

Wearable sensors can measure head impact frequency and magnitude in football players. Our goal was to quantify the impact detection rate and validity of the direction and peak kinematics of two wearable sensors: a helmet system (HITS) and a mouthguard system (X2). Using a linear impactor, modified Hybrid-III headform and one helmet model, we conducted 16 impacts for each system at 12 helmet sites and 5 speeds (3.6–11.2 m/s) (N = 896 tests). Peak linear and angular accelerations (PLA, PAA), head injury criteria (HIC) and impact directions from each device were compared to reference sensors in the headform. Both sensors detected ~96% of impacts. Median angular errors for impact directions were 34° for HITS and 16° for X2. PLA, PAA and HIC were simultaneously valid at 2 sites for HITS (side, oblique) and one site for X2 (side). At least one kinematic parameter was valid at 2 and 7 other sites for HITS and X2 respectively. Median relative errors for PLA were 7% for HITS and -7% for X2. Although sensor validity may differ for other helmets and headforms, our analyses show that data generated by these two sensors need careful interpretation

Cost of Outpatient Arthroscopic Anterior Cruciate Ligament Reconstruction Among Commercially Insured Patients in the United States, 2005-2013

Background: Despite the significance of anterior cruciate ligament (ACL) injuries, these conditions have been under-researched from a population-level perspective. It is important to determine the economic effect of these injuries in order to document the public health burden in the United States. Purpose: To describe the cost of outpatient arthroscopic ACL reconstruction and health care utilization among commercially insured beneficiaries in the United States. Study Design: Economic and decision analysis; Level of evidence, 3. Methods: The study used the Truven Health Analytics MarketScan Commercial Claims and Encounters database, an administrative claims database that contains a large sample (approximately 148 million) of privately insured individuals aged <65 years and enrolled in employer-sponsored plans. All claims with Current Procedural Terminology (CPT) code 29888 (arthroscopically aided ACL reconstruction or augmentation) from 2005 to 2013 were included. “Immediate procedure” cost was computed assuming a 3-day window of care centered on date of surgery. “Total health care utilization” cost was computed using a 9-month window of care (3 months preoperative and 6 months postoperative). Results: There were 229,446 outpatient arthroscopic ACL reconstructions performed over the 9-year study period. Median immediate procedure cost was $9399.49. Median total health care utilization cost was$13,403.38. Patients who underwent concomitant collateral ligament (medial [MCL], lateral [LCL]) repair or reconstruction had the highest costs for both immediate procedure ($12,473.24) and health care utilization ($17,006.34). For patients who had more than 1 reconstruction captured in the database, total health care utilization costs were higher for the second procedure than the first procedure ($16,238.43 vs$15,000.36), despite the fact that immediate procedure costs were lower for second procedures ($8685.73 vs$9445.26). Conclusion: These results provide a foundation for understanding the public health burden of ACL injuries in the United States. Our findings suggest that further research on the prevention and treatment of ACL injuries is necessary to reduce this burden