Preventing Sport Injuries: Improving Performance

International Journal of Preventive Medicine (Int J Prev Med)2008-78023320120307Preventing Sport Injuries: Improving Performance527527ENDepartment of Sport Injuries, School of Physical Education and Sports Sciences, University of Isfahan, Isfahan, Iran and Department of Nutrition, Food and Exercise Sciences, Florida State University, Tallahassee, FL, USA2012030720120307Approximately a decade ago, the FIFA Medical Assessment and Research Centre (F-MARC) developed an injury prevention program so-called “The 11” which was aimed to reduce injuries among male and female amateur football players aged 14 years and older. The “11” was designed on the basis of information and data which was available of research on injury and structured as warm-up program to reduce ankle and knee sprains, groin and hamstring strains in football players. The “11” – includes 10 exercises focusing on core stability, balance, dynamic stabilization and eccentric hamstrings strength and the 11th component was fair play. This program initially used in some countries such as New Zealand and Norway. Steffen and coworkers,[1] in a randomized controlled trial, investigated the effect of the ‘‘11’’ on injury risk in female youth football and reported no effect of the injury prevention program in the injury risk, probably due to its low compliance with the program. In contrast, Junge and coworkers,[2] found a positive effect of the 11 on Swiss amateur football players since 11.5% incidence of match injuries was decreased and because 25.3% incidence of training injuries was declined using the program. It should be noted that before the 11 prevention program, another program called prevent injury and enhance performance (PEP) was used by some athletes and Mandelbaum et al.[3] reported that this training program may have a direct benefit in minimizing the rate of anterior cruciate ligament injuries in female football players. Since the 11 and  other program were not very successful at their effectiveness and had some weakness, so they led to an expert group including scientists from the Santa Monica Orthopaedic and Sports Medicine Research Foundation, the Oslo Sports Trauma Research Center and the F-MARC, developed the comprehensive warm-up exercise program. The new comprehensive prevention program known as “The 11+” and it include important exercises and running exercises and is a favor warm-up program which can be used in matches and training. This program established in 2006. The 11+ consisted of running exercises, strength, balance and jumping exercises and finally speed running with some football-specific movements. This warm-up program “11+” should be implemented, at the initial of training sessions with frequency of at least twice a week for about 20 minutes. This prevention program is also useful to perform prior to matches, but only the running exercises should be performed. Soligard et al,[4] in a randomized controlled trial investigated the effect of a 11+ on the risk of injuries in female youth football and reported a significant lower risk of injuries overall, overuse injuries and severe injuries. They claimed that the 11+ program can prevent injuries and reduce risk of injuries in young female football players. Brito coworkers,[5] reported that 11+ training program improved muscle strength and balance around the knee joint. Since the results of Soligard et al,[4] cannot be generalized to male player, and also efficacy of the 11+ program on physical fitness is unknown, Zarei, Alizadehh and Rahnama,[6] studied the effectiveness of “11+” program, on injuries and performance of Iranian young male soccer players. Daneshjoo and coworkers,[7] recently investigated the isokinetic strength effects of FIFA’s “the 11+” injury prevention training programs on youth professional male soccer players and reported an improvement in isokinetic knee strength in concentric and eccentric mode at different angular velocities in both dominant and non-dominant leg in youth professional male soccer players. Although, the aforementioned studies are important which have looked at the role played by the 11+ on reducing injuries among youth football players, yet more prospective investigations should be conducted to see if the same results occur. Future research should investigate the importance of the 11+ program in adult football players and also needs to be modified to meet the standards of other sports disciplines. All training program should try to prevent as many sport injuries as possible and help athletes improve performance.http://ijpm.mui.ac.ir/index.php/ijpm/article/view/527http://ijpm.mui.ac.ir/index.php/ijpm/article/download/527/398

International Journal of Preventive Medicine (Int J Prev Med)2008-78023320110628What Are the Next Steps in Designing an Orthosis for Paraplegic Subjects?148148ENDepartment of Rehabilitation, Isfahan University of Medical Sciences, Isfahan, Iran201104012011062520110622Background: Over the years, various types of orthoses have been designed to assist subjects with spinal cord injury (SCI) to stand and walk. However, the functional performance of the orthoses has not been adequate, that is, patients experience stability problems, consume excessive energy during ambulation, and generally require assistance in donning and doffing the devices. This research is aimed at categorizing the available orthoses designed specifically for SCI patients and to compare the available orthoses according to the energy consumption, stability analysis, and gait parameters. Methods: An electronic search was done in PubMed, Embase, and ISI Web of Knowledge databases to extract data related to 1960 – 2010. The available orthoses were characterized based on the level of stabilization they provided and the source of power used. The orthoses were compared based on the stability, energy consumption, and gait performance parameters, according to the results of various studies collected from the literature review. Results: Among various orthoses designed for paraplegic subjects, the mechanical orthoses seemed to have a better performance. Moreover, donning and doffing of the mechanical orthosis was easier for the subjects. Conclusion: Although the HGO has better functional performance than other available orthoses, the subjects are more willing to use the RGO. The new design of orthoses must allow easy donning and doffing by the users, have enough stability during walking and standing, and enable the patients to change the alignment of the orthosis to suit their needs. Keywords: Orthosis, spinal cord injury, walkinghttp://ijpm.mui.ac.ir/index.php/ijpm/article/view/148http://ijpm.mui.ac.ir/index.php/ijpm/article/download/148/399

International Journal of Preventive Medicine (Int J Prev Med)2008-78023320111002LDL Particle Size and Reactive Oxygen Metabolites in Dyslipidemic Patients364364ENDivision of Preventive Medicine, Clinical Research Institute, National Hospital Organization Kyoto Medical Center, Kyoto and Department of Clinical Laboratory Medicine, Jichi Medical University, Shimotsuke-City, Tochigi, JapanDivision of Preventive Medicine, Clinical Research Institute, National Hospital Organization Kyoto Medical Center, Kyoto, JapanDepartment of Clinical Laboratory Medicine, Jichi Medical University, Shimotsuke-City, Tochigi, JapanDivision of Preventive Medicine, Clinical Research Institute, National Hospital Organization Kyoto Medical Center, Kyoto, Japan2011092720110927Objectives: Small dense low‑density lipoprotein (sdLDL) which has a small LDL particle size with greater susceptibility to oxidation is regarded as a risk marker for cardiovascular disease. The diacron reactive oxygen metabolites (d‑ROMs) test has recently been introduced as an oxidative stress‑related marker in the clinic. The aim of the present study was to investigate the correlation between the mean LDL particle size and the oxidative stress status as evaluated by the d‑ROMs in dyslipidemic patients. Methods: The study included 278 dyslipidemic patients (121 male and 157 female, mean age, 60 years). Clinical data including the conventional atherosclerotic risk factors in addition to the mean LDL particle size measured with the gel electrophoresis and the d‑ROMs were collected. Results: Male patients had a significantly smaller mean LDL particle size than females (262.2 ± 7.5 [SD] vs. 264.3 ± 6.7 Å, P<0.05), while female patients had a significantly higher d‑ROMs level than males (318 ± 68 vs. 350 ± 72 U. Carr., P<0.01). A multiple regression analysis revealed that there was an independent, significant, and inverse correlation between the mean LDL particle size and the d‑ROMs (β=−0.19, P<0.05). Conclusions: These findings of the co‑existence of both markers suggest that sdLDL and oxidative stress can be cooperative in atherogenesis, possibly leading to the incidence of CVD, in dyslipidemic patients. Keywords: d‑ROMs test, hyperlipidemia, mean LDL particle size, oxidative stress, small dense LDL http://ijpm.mui.ac.ir/index.php/ijpm/article/view/364http://ijpm.mui.ac.ir/index.php/ijpm/article/download/364/400

International Journal of Preventive Medicine (Int J Prev Med)2008-78023320111018Should We Look for Celiac Disease among all Patients with Liver Function Test Abnormalities?6060ENDepartment of Gastroenterology and Hepatology, Isfahan University of Medical Sciences and Poursina Hakim Research Institute and Iranian Celiac Association, Isfahan, IranPoursina Hakim Research Institute, Isfahan, IranPoursina Hakim Research Institute and Iranian Celiac Association, Isfahan, IranPoursina Hakim Research Institute, Isfahan, IranPoursina Hakim Research Institute, Isfahan, Iran201011092011101520111015Background: Celiac disease (CD) has been found in up to 10% of the patients presenting with unexplained abnormal liver function tests (LFT). As there is no precise data from our country in this regard, we investigated the prevalence of CD in patients presenting with abnormal LFT. Methods: From 2003 to 2008, we measured IgA anti-tissue transglutaminase (t-TG) antibody (with ELISA technique) within the first-level screening steps for all patients presenting with abnormal LFT to three outpatient gastroenterology clinics in Isfahan, IRAN. All subjects with an IgA anti-tTG antibody value of >10 μ/ml (seropositive) were undergone upper gastrointestinal endoscopy and duodenal biopsy. Histopathological changes were assessed according to the Marsh classification. CD was defined as being seropositive with Marsh I or above in histopathology and having a good response to gluten free diet (GFD). Results: During the study, 224 patients were evaluated, out of which, 10 patients (4.4%) were seropositive for CD. Duodenal biopsies were performed in eight patients and revealed six (2.7%) cases of Marsh I or above (four Marsh IIIA, two Marsh I), all of them had good response to GFD. The overall prevalence of CD among patients with hypertransaminasemia, autoimmune hepatitis, and cryptogenic cirrhosis was determined as 10.7% (3/28), 3.4% (2/59), and 5.3% (1/19), respectively. Conclusion: Serological screening with IgA anti-tTG antibody test should be routinely performed in patients presenting with abnormal LFT and especially those with chronic liver diseases including hypertransaminasemia, autoimmune hepatitis, and cryptogenic cirrhosis. Keywords: Autoimmune hepatitis, celiac disease, hypertransaminasemia, liver disease, liver transplant http://ijpm.mui.ac.ir/index.php/ijpm/article/view/60http://ijpm.mui.ac.ir/index.php/ijpm/article/download/60/401

International Journal of Preventive Medicine (Int J Prev Med)2008-78023320120307Establishment of Health Clinics as Mass Screening and Referral Systems for Chronic Non-communicable Diseases in Primary Health Care528528ENDepartment of Health, Isfahan Provincial Health Office, Isfahan University of Medical Sciences, Isfahan, IranDepartment of Health, Isfahan Provincial Health Office, Isfahan University of Medical Sciences, Isfahan, IranDepartment of Health, Isfahan Provincial Health Office, Isfahan University of Medical Sciences, Isfahan, IranDepartment of Health, Isfahan Provincial Health Office, Isfahan University of Medical Sciences, Isfahan, IranDepartment of Health, Isfahan Provincial Health Office, Isfahan University of Medical Sciences, Isfahan, IranDepartment of Health, Isfahan Provincial Health Office, Isfahan University of Medical Sciences, Isfahan, IranDepartment of Health, Isfahan Provincial Health Office, Isfahan University of Medical Sciences, Isfahan, IranDepartment of Health, Isfahan Provincial Health Office, Isfahan University of Medical Sciences, Isfahan, IranDepartment of Health, Isfahan Provincial Health Office, Isfahan University of Medical Sciences, Isfahan, IranDepartment of Health, Isfahan Provincial Health Office, Isfahan University of Medical Sciences, Isfahan, IranDepartment of Health, Isfahan Provincial Health Office, Isfahan University of Medical Sciences, Isfahan, Iran2012030720120307Background: This study aimed to establish a comprehensive screening and referral system for chronic non-communicable diseases (CNCD) in the routine primary health care, and to determine the prevalence of diabetes, pre-diabetes, metabolic syndrome, and dyslipidemia in adult population invited by public announcement to the Health clinics in Isfahan, Iran. Methods: This survey was conducted from March 2010, and the current paper presents data obtained until November 2011. To provide health services for prevention and control of CNCDs, with priority of type2 diabetes mellitus, Health clinics were established in different parts of Isfahan city with a population of approximately 2,100,000 in Iran. The general populations aged 30 years and above were invited to the Health clinics by public announcement. Results: A total of 198972 participants were screened. The mean age of participants was 47.8 years (48.5 men, 47.3 women), with a range of 1 to 95 years old and standard deviation of 12.3 years (12.7 men, 12.1 women). Overall, 22% of participants had impaired fasting glucose, 25% had hypercholesterolemia, 31% had hypertriglyceridemia, and 20% had metabolic syndrome. Conclusion: The high prevalence of dysglycemia and diabetes in our survey may serve as confirmatory evidence about the importance of mass screening and early diagnosis of CNCDs’ risk factors. Our model of establishing Health clinics, as a comprehensive referral system in the routine primary health care can be adopted by Middle Eastern countries, where CNCDs notably diabetes are an emerging health problem. Keywords: Screening, diabetes, metabolic syndrome, prevention.http://ijpm.mui.ac.ir/index.php/ijpm/article/view/528http://ijpm.mui.ac.ir/index.php/ijpm/article/download/528/402

International Journal of Preventive Medicine (Int J Prev Med)2008-78023320110813Socioeconomic Status and Incidence of Traffic Accidents in Metropolitan Tehran: A Population based Study284284ENMD, PhD Candidate, Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran and Kashan University of Medical Sciences, Kashan, IranDepartment of Epidemiology and Biostatistics, chool of Public Health, Tehran University of Medical Sciences, Tehran, IranAssociate Professor, Department of Epidemiology and Biostatistics, School of Public Health and Oncopathology Research Centre, Tehran University of Medical Sciences, Tehran, IranAssociate Professor, Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, IranProfessor, Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran2011073020110811Background: Population‑based estimates of traffic accidents (TAs) are not readily available for developing countries. This study examined the contribution of socioeconomic status (SES) to the risk of TA among Iranian adult s. Methods: A total of 64,200people aged ≥18years were identified from 2008 Urban Health Equity Assessment and Response Tool (Urban HEART) survey. 22,128 households were interviewed to estimate the overall annual incidence, severity and socioeconomic determinants of TAs for males and females in Iranian capital over the preceding year. Wealth index and house value index were constructed for economic measurement. Weighted estimates were computed adjusting for complex survey design. Logistic regression models were used to examine individual and SES measures as potential determinants of TAs in adults. Results: The overall incidence of traffic accident was 17.3(95% CI 16.0, 18.7) per 1000 per year. TA rate in men and women was 22.6(95% CI 20.6, 24.8) and 11.8(95% CI 10.4, 13.2), respectively. The overall TA mortality rate was 26.6(95% CI 13.4, 39.8) per 100,000 person‑years, which was almost three times higher in men than that for women (40.4 vs. 12.1 per 100,000person‑years). Lower economic level was associated with increased incidence and mortality of TA. Association between SES and incidence, and severity and mor tality of TA were identified. Conclusion: TAs occur more in lower socioeconomic layers of the society. This should be taken seriously into consideration by policy makers, so that preventive programs aimed at behavioral modifications in the society are promoted to decrease the health and economic burden imposed by TAs. Keywords: Accidents, incidence, socioeconomic status, traffichttp://ijpm.mui.ac.ir/index.php/ijpm/article/view/284http://ijpm.mui.ac.ir/index.php/ijpm/article/download/284/403

International Journal of Preventive Medicine (Int J Prev Med)2008-78023320110727The Estimation of Direct Medical Costs of Treating Patients With Chronic Hepatitis B and C in Iran273273ENDepartment of Gastroenterology, Isfahan Liver Disease Research Center, School of Medicine, Isfahan University of Medical Sciences, Isfahan, IranHealth Management and Economics Research Center, Isfahan University of Medical Sciences, Isfahan, IranEpidemiologist, School of Medicine, Isfahan University of Medical Sciences, Isfahan, IranDepartment of Academic Member of Medical Informatics, School of Health Management and Information Sciences, Isfahan University of Medical Sciences, Isfahan, IranArchitect, Young Researchers Club, Khorasgan Branch, Islamic Azad University, Isfahan, IranDepartment of Internal Medicine, School of Medicine, Isfahan University of Medical Sciences, Isfahan, IranDepartment of Obstetrics and Gynecology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran2011072520110725Background: The objective of this study is to estimate the average diagnosis and treatment costs of chronic hepatitis B and C, with respect to different therapeutic strategies in Iran. Methods: This is a descriptive, analytical, and cross‑sectional study carried out on patients with hepatitis B and C, who were referred to the Liver Disease Research Center for Prevention and Treatment of Hepatitis, Isfahan University of Medical Sciences, in 2011. We have estimated the direct medical costs including doctors’ fees, cost of para‑clinical tests, medical treatments, and liver biopsy, in different treatment strategies. Findings: The results of this study showed that the total cost of diagnostic services for hepatitis B virus (HBV) and hepatitis C virus (HCV) patients, with state medical tariffs, was US$ 1499.07 and US$ 2084.89, respectively. The patients’ profiles showed that there were currently seven therapeutic strategies available to treat HBV patients. The total cost of treatment strategies varied significantly from US$ 73 to US$ 8256. There were also four main strategies for HCV patients, each of these could be applied in two periods of time. The total cost of these treatment strategies showed a high disc repancy from US$ 242 t o US$ 8256. Conclusion: The results confirmed that the total direct medical cost for an HBV patient in Iran exceeded US$ 5.5 Milliard in 2011. The results implied that the market price of direct medical cost of HBV and HCV patients in Iran is much higher than the estimated state costs. These costs would likely be saved or reduced by effective disease management and early prevention. Keywords: Direct medical costs, hepatitis B, hepatitis C http://ijpm.mui.ac.ir/index.php/ijpm/article/view/273http://ijpm.mui.ac.ir/index.php/ijpm/article/download/273/404

International Journal of Preventive Medicine (Int J Prev Med)2008-78023320111129Aphorisms and Short Phrases as Pieces of Knowledge in the Pedagogical Framework of the Andalusian School of Public Health288288ENGrupo de Investigación en Atención Farmacéutica, University of Granada, Granada, SpainGrupo de Investigación en Atención Farmacéutica, Unit of Pharmacogenetics, University Hospital Virgen de las Nieves, University of Granada, Granada, SpainLa Zubia Health Area, Andalusian Health Service, Granada, SpainUniversidad del Valle Teaching Unit, Cali, ColombiaHospital Infanta Luisa, Sevilla, SpainLicinio de la Fuente Primary Care Health Center, Andalusian Health Service, SpainResearch Unit, Hospital Universitario San Cecilio, Granada and CIBER/EHD, Instituto de Salud Carlos III, SpainHospital Universitario Puerta del Mar, Servicio Andaluz de Salud, Cádiz, SpainHospital La Inmaculada, Andalusian Health Service, Huercal-Overa, Almería, SpainSevilla’s Primary Care Area Research Unit, Andalusian Health Service, CIBER/OBN Instituto de Salud Carlos III, Spain2011073120111129Background: Bearing in mind the philosophical pedagogical significance of short phrases for the training of researchers in the health care ambit, we hence have studied the aphorisms and striking phrases expressed during the epidemiology course at the Andalusian School of Public Health. Methods: Belonging to the qualitative type and applied through the establishment of a multidisciplinary focus group made up of ten post-graduated students, where one of them acted as a moderator. The collection of information lasted four months. Information was classified in two ways: Firstly, aphorisms and short phrases with a pedagogical impact; and secondly, data with statistical, epidemiological, epistemological, pragmatic, or heuristic component, and for scientific diffusion. It was decided to perform a triangulation that included a descriptive presentation and a basic categorical analysis. The two teachers with a highest interpretative load have been identified . Results: A total of 127 elements, regarded as of interest by the focus group, were collected. Forty-four of them (34.6%) were aphorisms, and 83 were short phrases with a pedagogical load (65.3%). Most of all them were classified as statistical elements (35.4%) followed by epistemological (21.3%) and epidemiological (15.7%) elements. There was no tendency towards aphorisms or short phrases (P > 0.05) among the teachers with more informative representation. Conclusion: There has been a tilt in the contents towards the statistical area to the detriment of the epidemiological one. Concept maps have visualized classifications. This sort of qualitative analysis helps the researcher review contents acquired during his/her training process. Keywords: Aphorisms, epidemiology, expert testimony, focus group, knowledge, metaphor, qualitative research http://ijpm.mui.ac.ir/index.php/ijpm/article/view/288http://ijpm.mui.ac.ir/index.php/ijpm/article/download/288/405

International Journal of Preventive Medicine (Int J Prev Med)2008-78023320110628Body Mass Index or Microalbuminuria, Which One is More Important for the Prediction and Prevention of Diastolic Dysfunction in Non diabetic Hypertensive Patients?131131ENCardiologist, School of Medicine, Isfahan University of Medical Sciences, Isfahan, IranAssociate Professor of intervention of Cardiology, Hypertension Research Center, Isfahan Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, IranInternist and Cardiologist Sub Special, School of Medicine, Elam University of Medical Sciences, Elam, IranDepartment of Biochemistry, Isfahan Cardiovascular Research Centre, Isfahan Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran2011022020110625Background: Numerous studies have now demonstrated that heart failure with a normal ejection fraction (HFnlEF) is common. Hypertension is also the most commonly associated cardiac condition in patients with HFnlEF. Despite the observed link between microalbuminuria, obesity, and cardiovascular disorders, this question has remained ― ‘Which is more important for the prediction and prevention of diastolic dysfunction in non‑diabetic hypertensive patients?’ Methods: The current study was a cross‑section study conducted on a total of 126 non‑diabetic hypertensive patients screened to identify those with hypertension. Urine creatinine was measured by the picric acid method and urine albumin content was measured by a sensitive, nephelometric technique. The urinary albumin/creatinine ratio (UACR) was determined as an indicator of microalbuminuria. Complete two‑dimensional, doppler, and tissue‑doppler echocardiography was performed and the recording of the diastolic function parameters was carried out. Results: High body mass index and high systolic blood pressure were positively correlated with the appearance of left ventricular hypertrophy, whereas, the UACR index had no significant relationship with hypertrophy. Multivariable analysis also showed that advanced age and systolic blood pressure were significantly associated with the E/E annulus parameter. Conclusion: According to our investigation obesity is more important than microalbuminuria for the prediction and prevention of diastolic dysfunction in non‑diabetic hypertensive patients. Keywords: Hypertension, microalbuminuria, heart failure, obesity http://ijpm.mui.ac.ir/index.php/ijpm/article/view/131http://ijpm.mui.ac.ir/index.php/ijpm/article/download/131/406

International Journal of Preventive Medicine (Int J Prev Med)2008-78023320120307Vitamin and Mineral Supplements: Do We Really Need Them?529529ENDepartment of Public Health Analysis, School of Community Health and Policy, Morgan State University, Baltimore, MD, USA and Digestive Disease Research Center, Tehran University of Medical Sciences, Tehran, IranDepartment of Medicine, Division of Hematology, John Hopkins School of Medicine, Baltimore, MD, USA2012030720120307In the United States, 40 – 50% of the men and women 50 years of age or older regularly use multivitamin/mineral (MVM) supplements, making the annual sales of these supplements over $11 billion. However, the question remains whether using MVM supplements is beneficial to health. This article reviews the results of randomized studies of MVM supplements and individual vitamins/mineral supplements in relation to overall mortality and incidence of chronic diseases, particularly cancer and ischemic heart disease. The results of large-scale randomized trials show that, for the majority of the population, there is no overall benefit from taking MVM supplements. Indeed, some studies have shown increased risk of cancers in relation to using certain vitamins. Keywords: vitamins, minerals, cancer, coronary heart disease, mortality.http://ijpm.mui.ac.ir/index.php/ijpm/article/view/529http://ijpm.mui.ac.ir/index.php/ijpm/article/download/529/407