Shoulder injuries in adolescent elite handball players

Background: Handball is a physically demanding sport that includes jumping, running, side-cutting movements and frequent throwing. A high prevalence of shoulder problems and pain has been reported in adult handball players but the research on adolescent elite players is scarce. Several factors have been associated with shoulder injuries in handball players, but strong scientific evidence is lacking for most of the suggested risk factors. Objectives: The objectives of this thesis were to determine the prevalence of shoulder problems in adolescent elite handball players, to present reference values of shoulder strength in adolescent elite handball players and to investigate if adolescent elite hand- ball players with pre-season shoulder weakness, decreased shoulder range of motion (ROM), scapular dyskinesia or deceased joint position sense (JPS) have higher shoulder injury rates compared to players without these characteristics. Methods: The thesis is based on data from the Karolinska Handball Study, a prospective cohort study with, in total, 471 Swedish adolescent elite handball players (622 player seasons) from 10 handball-profiled secondary schools. At baseline the players filled in a questionnaire and then shoulder strength, JPS, ROM and scapula dyskinesia were measured. Thereafter, the players were monitored on a weekly basis regarding injuries and amount of handball training and matches. Prevalence ratios (PR) and hazard rate ratios (HRR) were calculated and any differences in shoulder strength between sex, playing position, school grade and playing level as well as side-to-side differences in shoulder strength were evaluated using t-tests. Results: In total, 110 players (23%) reported substantial shoulder problems during the competitive season. The prevalence was higher among females (PR 1.46, 95% 1.04-2.06) and backcourt players compared to 6-metre players (PR 1.58, 95% CI 1.08-2.32). Male players were stronger in all measures, regardless of normalisation to bodyweight or not (p<0.0001). Both male and female players were stronger in the dominant arm (p<0.001). In general, wing players and backcourt players were stronger than line players and goalkeepers. In females, the HRR for new shoulder injuries in players with lower isometric external rotational strength (IER) was 2.37 (95% CI 1.03-5.44), lower isometric internal rotational strength (IIR) 2.44 (95% CI 1.06-5.61), and in those with scapular dyskinesia 1.53 (95% CI 0.36-6.52). In males, the HRR for weaker IER was 1.02 (95% CI 0.44-2.36), for lower IIR 0.74 (95% CI 0.31-1.75), and for scapular dyskinesia 3.43 (95% CI 1.49-7.92). There were no associations between new shoulder injuries and deficits in ROM or JPS. Conclusions: The prevalence of substantial shoulder problems in adolescent elite hand- ball players is higher among females and backcourt players. Male players are stronger than female players in terms of both absolute strength and when normalised by body- weight. In both male and female players, wing players and backcourt players are, in general, stronger than line players and goalkeepers when normalised by bodyweight. Male players with pre-season scapula dyskinesia, and female players with pre-season internal or external rotation shoulder weakness, had an increased shoulder injury rate

New Public Management & Det svenska biståndet

Den västerländska byråkratiska modellen prisades länge som en effektiv och legitim metod för att förvalta den offentliga sektorn. I samband med västvärldens ekonomiska stagnation under 1970-talet höjdes dock allt fler röster, främst ifrån nyliberala kretsar, mot det man såg som en alltför kostsam och dyr förvaltningsmodell. Införandet av New Public Management-reformer i Sverige, såsom privatiseringen av skol och äldreomsorgen, har präglat mycket av den publika debatten och otaliga forskningsprojekt har lanserats för att avgöra dess effekter. I denna studie undersöker vi hur införandet av New Public Management-reformer, och hur dessa har påverkat det svenska biståndet inom SIDA. Studien är upplagd som en kvalitativ textanalys, där vi studerat styrdokument och propositioner ifrån det svenska biståndsarbetets formella grundade 1962 till och med den förra regeringens biståndsstrategi inför budgeten år 2013

Contemporary Nutrition Strategies to Optimize Performance in Distance Runners and Race Walkers

Distance events in Athletics include cross country, 10,000-m track race, half-marathon and marathon road races, and 20- and 50-km race walking events over different terrain and environmental conditions. Race times for elite performers span ∼26 min to >4 hr, with key factors for success being a high aerobic power, the ability to exercise at a large fraction of this power, and high running/walking economy. Nutrition-related contributors include body mass and anthropometry, capacity to use fuels, particularly carbohydrate (CHO) to produce adenosine triphosphate economically over the duration of the event, and maintenance of reasonable hydration status in the face of sweat losses induced by exercise intensity and the environment. Race nutrition strategies include CHO-rich eating in the hours per days prior to the event to store glycogen in amounts sufficient for event fuel needs, and in some cases, in-race consumption of CHO and fluid to offset event losses. Beneficial CHO intakes range from small amounts, including mouth rinsing, in the case of shorter events to high rates of intake (75–90 g/hr) in the longest races. A personalized and practiced race nutrition plan should balance the benefits of fluid and CHO consumed within practical opportunities, against the time, cost, and risk of gut discomfort. In hot environments, prerace hyperhydration or cooling strategies may provide a small but useful offset to the accrued thermal challenge and fluid deficit. Sports foods (drinks, gels, etc.) may assist in meeting training/race nutrition plans, with caffeine, and, perhaps nitrate being used as evidence-based performance supplements

Eccentric and Isometric Shoulder Rotation Strength and Range of Motion: Normative Values for Adolescent Competitive Tennis Players

[EN] The aim of this cross-sectional study was to investigate isometric internal rotation (IR), external rotation (ER), abduction (ABD), and eccentric external rotation (eccER) shoulder strength and rotational range of motion (ROM) in adolescent male and female competitive tennis players. Additional aims of the study were to provide a tennis-specific normative database based on a large sample of players to deepen the knowledge regarding shoulder strength and ROM for adolescent competitive tennis players, and to discuss differences based on sex, age, and level of play. Shoulder strength and ROM was assessed in 301 adolescent competitive tennis players, 176 boys and 125 girls with a mean age of 14.6 and 14.4 years, respectively. Outcome variables of interest were isometric IR and ER strength, ABD strength, eccER shoulder strength, intermuscular strength ratios ER/IR and eccER/IR, IR ROM, ER ROM, and total range of motion (TROM). A General Linear Model two-way ANOVA was used to analyze differences in sex, age, and level of play. The findings of this study demonstrated age, side, and sex differences in the shoulder isometric strength, the eccER strength and ROM in adolescent competitive tennis players. Furthermore, when strength was expressed as ratios ER/IR and eccER/IR both sexes showed a lower ratio for eccER/IR in national players (0.95 ± 0.22 and 0.95 ± 0.23) compared to regional players (1.01 ± 0.32 and 1.07 ± 0.29) for male and female players, respectively. In conclusion, this paper presents a tennis-specific normative database for shoulder rotation strength and ROM in adolescent male and female competitive players. The key points in this evaluation are strength values normalized to body mass, intermuscular ratios, and TROM.SIThis study was funded by the Swedish Naprapathic AssociationThe authors thank the Swedish Tennis Association, and they also want to express their gratitude to all regional and national players who participated in the SMASH study. A special thank you to Cecilia Palmqvist for coordinating the team. Clara Onell for back-office support. Thank you also to Filip Allerkrans, Kristin Haugland, Gustav Knutas, Jonathan Kull, Linnea Lindberg, Daniel Sjödin, Emilie Kristine Slatleim, and David Tveit for assistance in data collection

Large-scale benchmarking reveals false discoveries and count transformation sensitivity in 16S rRNA gene amplicon data analysis methods used in microbiome studies

BACKGROUND: There is an immense scientific interest in the human microbiome and its effects on human physiology, health, and disease. A common approach for examining bacterial communities is high-throughput sequencing of 16S rRNA gene hypervariable regions, aggregating sequence-similar amplicons into operational taxonomic units (OTUs). Strategies for detecting differential relative abundance of OTUs between sample conditions include classical statistical approaches as well as a plethora of newer methods, many borrowing from the related field of RNA-seq analysis. This effort is complicated by unique data characteristics, including sparsity, sequencing depth variation, and nonconformity of read counts to theoretical distributions, which is often exacerbated by exploratory and/or unbalanced study designs. Here, we assess the robustness of available methods for (1) inference in differential relative abundance analysis and (2) beta-diversity-based sample separation, using a rigorous benchmarking framework based on large clinical 16S microbiome datasets from different sources. RESULTS: Running more than 380,000 full differential relative abundance tests on real datasets with permuted case/control assignments and in silico-spiked OTUs, we identify large differences in method performance on a range of parameters, including false positive rates, sensitivity to sparsity and case/control balances, and spike-in retrieval rate. In large datasets, methods with the highest false positive rates also tend to have the best detection power. For beta-diversity-based sample separation, we show that library size normalization has very little effect and that the distance metric is the most important factor in terms of separation power. CONCLUSIONS: Our results, generalizable to datasets from different sequencing platforms, demonstrate how the choice of method considerably affects analysis outcome. Here, we give recommendations for tools that exhibit low false positive rates, have good retrieval power across effect sizes and case/control proportions, and have low sparsity bias. Result output from some commonly used methods should be interpreted with caution. We provide an easily extensible framework for benchmarking of new methods and future microbiome datasets. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1186/s40168-016-0208-8) contains supplementary material, which is available to authorized users

Training with low muscle glycogen enhances fat metabolism in well-trained cyclists

Purpose: To determine the effects of training with low muscle glycogen on exercise performance, substrate metabolism, and skeletal muscle adaptation. Methods: Fourteen well-trained cyclists were pair-matched and randomly assigned to HIGH-or LOW-glycogen training groups. Subjects performed nine aerobic training (AT; 90 min at 70% (V) over dotO(2max)) and nine high-intensity interval training sessions (HIT; 8 x 5-min efforts, 1-min recovery) during a 3-wk period. HIGH trained once daily, alternating between AT on day 1 and HIT the following day, whereas LOW trained twice every second day, first performing AT and then, 1 h later, performing HIT. Pretraining and posttraining measures were a resting muscle biopsy, metabolic measures during steady-state cycling, and a time trial. Results: Power output during HIT was 297 +/- 8 W in LOW compared with 323 +/- 9 W in HIGH (P < 0.05); however, time trial performance improved by similar to 10% in both groups (P < 0.05). Fat oxidation during steady-state cycling increased after training in LOW (from 26 +/- 2 to 34 +/- 2 mu mol.kg(-1).min(-1), P < 0.01). Plasma free fatty acid oxidation was similar before and after training in both groups, but muscle-derived triacylglycerol oxidation increased after training in LOW (from 16 +/- 1 to 23 +/- 1 mu mol.kg(-1).min(-1), P < 0.05). Training with low muscle glycogen also increased beta-hydroxyacyl-CoA-dehydrogenase protein content (P < 0.01). Conclusions: Training with low muscle glycogen reduced training intensity and, in performance, was no more effective than training with high muscle glycogen. However, fat oxidation was increased after training with low muscle glycogen, which may have been due to the enhanced metabolic adaptations in skeletal muscle

The developing hypopharyngeal microbiota in early life

BACKGROUND: The airways of healthy humans harbor a distinct microbial community. Perturbations in the microbial community have been associated with disease, yet little is known about the formation and development of a healthy airway microbiota in early life. Our goal was to understand the establishment of the airway microbiota within the first 3 months of life. We investigated the hypopharyngeal microbiota in the unselected COPSAC(2010) cohort of 700 infants, using 16S rRNA gene sequencing of hypopharyngeal aspirates from 1 week, 1 month, and 3 months of age. RESULTS: Our analysis shows that majority of the hypopharyngeal microbiota of healthy infants belong to each individual’s core microbiota and we demonstrate five distinct community pneumotypes. Four of these pneumotypes are dominated by the genera Staphylococcus, Streptococcus, Moraxella, and Corynebacterium, respectively. Furthermore, we show temporal pneumotype changes suggesting a rapid development towards maturation of the hypopharyngeal microbiota and a significant effect from older siblings. Despite an overall common trajectory towards maturation, individual infants’ microbiota are more similar to their own, than to others, over time. CONCLUSIONS: Our findings demonstrate a consolidation of the population of indigenous bacteria in healthy airways and indicate distinct trajectories in the early development of the hypopharyngeal microbiota. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1186/s40168-016-0215-9) contains supplementary material, which is available to authorized users