Investigation of growth, development, and factors associated with injury in elite schoolboy footballers: prospective study

Objective To investigate the differences between skeletal and chronological age and to assess the role of maturity status, anthropometric data, and football related variables in explaining injury statistics in elite schoolboy footballers

Overview of Cardiac Rehabilitation Evidence, Benefits and Utilisation

Historically, the main objective of cardiac rehabilitation (CR) as an exercise-based programme was to restore or improve patients’ regular physical activity after a cardiac event. Since then CR has evolved into a comprehensive secondary prevention programme, the objectives of CR, and indications and contraindications for its use have also developed in sophistication. Current CR programmes are designed to stabilise or even reverse the progression of heart disease by controlling all modifiable risk factors. They are also concerned with improving patients’ quality of life by restoring their wellbeing. All this should be achieved with the maximum safety levels to patients. The first part of this review details on how CR evolved from a simple exercise programme to a comprehensive secondary prevention programme in the past few decades. The second part sets an example of modern CR provision, pathway and guidelines in a top leading country in this field, the UK. Keywords: cardiac rehabilitation, secondary prevention, coronary artery diseas

Has Toxicity Testing Moved into the 21st Century? A Survey and Analysis of Perceptions in the Field of Toxicology.

BackgroundTen years ago, leaders in the field of toxicology called for a transformation of the discipline and a shift from primarily relying on traditional animal testing to incorporating advances in biotechnology and predictive methodologies into alternative testing strategies (ATS). Governmental agencies and academic and industry partners initiated programs to support such a transformation, but a decade later, the outcomes of these efforts are not well understood.ObjectivesWe aimed to assess the use of ATS and the perceived barriers and drivers to their adoption by toxicologists and by others working in, or closely linked with, the field of toxicology.MethodsWe surveyed 1,381 toxicologists and experts in associated fields regarding the viability and use of ATS and the perceived barriers and drivers of ATS for a range of applications. We performed ranking, hierarchical clustering, and correlation analyses of the survey data.ResultsMany respondents indicated that they were already using ATS, or believed that ATS were already viable approaches, for toxicological assessment of one or more end points in their primary area of interest or concern (26-86%, depending on the specific ATS/application pair). However, the proportions of respondents reporting use of ATS in the previous 12 mo were smaller (4.5-41%). Concern about regulatory acceptance was the most commonly cited factor inhibiting the adoption of ATS, and a variety of technical concerns were also cited as significant barriers to ATS viability. The factors most often cited as playing a significant role (currently or in the future) in driving the adoption of ATS were the need for expedited toxicology information, the need for reduced toxicity testing costs, demand by regulatory agencies, and ethical or moral concerns.ConclusionsOur findings indicate that the transformation of the field of toxicology is partly implemented, but significant barriers to acceptance and adoption remain. https://doi.org/10.1289/EHP1435

In the modern era of percutaneous coronary intervention: Is cardiac rehabilitation engagement purely a patient or a service level decision?

Aims: Despite the proven benefits of cardiac rehabilitation (CR), utilization rates remain below recommendation in the percutaneous coronary intervention cohort in most European countries. Although extensive research has been carried out on CR uptake, no previous study has investigated the factors that lead patients to attend the initial CR baseline assessment (CR engagement). This paper attempts to provide new insights into CR engagement in the growing percutaneous coronary intervention population. Methods and results: In total, we analysed data on 59,807 patients who underwent percutaneous coronary intervention during 2013 to 2016 (mean age 65 years; 25% female). Twenty factors were hypothesized to have a direct impact on CR engagement and they were grouped into four main categories; namely socio-demographic factors, cardiac risk factors, medical status and service-level factors. A binary logistic regression model was constructed to examine the association between CR engagement and tested factors. All but one of the proposed factors had a statistically significant impact on CR engagement. Results showed that CR engagement decreases by 1.2% per year of age (odds ratio 0.98) and is approximately 7% lower (odds ratio 0.93) in female patients, while patients are 4.4 times more likely to engage if they receive a confirmed joining date (odds ratio 4.4). The final model achieved 86.6% sensitivity and 49.0% specificity with an area under the receiver operating characteristic curve of 0.755. Conclusion: The present results highlight the important factors of the likelihood of CR engagement. This implies that future strategies should focus on factors that are associated with CR engagement

Is Weight Gain Inevitable for Patients Trying to Quit Smoking as Part of Cardiac Rehabilitation?

The literature is uncertain about the extent to which those who attend cardiac rehabilitation (CR) gain weight while trying to quit smoking. This study aimed to determine the extent of CR-based smoking cessation provision and whether CR, as delivered in routine practice, is associated with helping patients quit smoking and avoid weight gain. Data from the UK National Audit of Cardiac Rehabilitation database, between April 2013 and March 2016, were used. Smoking status is categorised as smokers and quitters assessed by patient self-report. Outcomes included body weight, blood pressure, depression, and physical activity. A multiple linear regression model was constructed to understand the effect of continuing smoking or quitting smoking on CR outcomes. CR outcome scores were adjusted by the baseline CR score for each characteristic. An e-survey collected information about the smoking cessation support offered to patients attending CR. A total of 2052 smokers (58.59 ± 10.49 years, 73.6% male) and 1238 quitters (57.63 ± 10.36 years, 75.8% male) were analysed. Overall, 92.6% of CR programmes in the United Kingdom (UK) offer smoking cessation support for CR attenders. Quitting smoking during CR was associated with a mean increase in body weight of 0.4 kg, which is much less than seen in systematic reviews. Quitters who attended CR also had better improvements in physical activity status and psychosocial health measures than smokers. As delivered in routine practice, CR programmes in the UK adhere to the guideline recommendations for smoking cessation interventions, help patients quit smoking, and avoid weight gain on completion of C

Determinants of walking fitness in patients with heart failure attending cardiac rehabilitation

Introduction Patients with heart failure (HF) attending cardiac rehabilitation (CR) benefit in terms of improved quality of life, physical fitness and reduced hospital admissions. Too few patients with HF attend CR and little data exist on the characteristics of those who do especially in respect of physical fitness. This study evaluates the extent by which clinical and demographic factors determine walking fitness in patients with a primary diagnosis of HF. Methods Clinical data from the British Heart Foundation National Audit of Cardiac Rehabilitation identified 1519 patients with HF who completed an incremental shuttle walk test (ISWT). Stepwise regression accounting for age, gender and multiple potential confounders assessed their contribution to total walking distance. Results Mean age was 64.5 (SD 12.70) years with a range of ISWT distances across gender and associated comorbidities from 215 to 282 m. Walking distance reduced by 4.9 m for each year increase in age above mean age (p30 was associated with 28.5 m reduction in walking distance (p<0.001). HF severity failed to improve the regression model fit or achieve significance in the analysis Conclusions Age, gender and the presence of pulmonary disease or depression were highly significant factors in predicting walking fitness in patients with HF. The study also produced a set of reference values based on these four factors to aid the interpretation of walking fitness in patients with HF