Athletes&... more Athletes' psychological characteristics are important for understanding sports injury mechanisms. We examined the relevance of psychological factors in an integrated model of overuse injury risk in athletics/track and field. Swedish track and field athletes (n=278) entering a 12-month injury surveillance in March 2009 were also invited to complete a psychological survey. Simple Cox proportional hazards models were compiled for single explanatory variables. We also tested multiple models for 3 explanatory variable groupings: an epidemiological model without psychological variables, a psychological model excluding epidemiological variables and an integrated (combined) model. The integrated multiple model included the maladaptive coping behaviour self-blame (p=0.007; HR 1.32; 95% CI 1.08 to 1.61), and an interaction between athlete category and injury history (p<0.001). Youth female (p=0.034; HR 0.51; 95% CI 0.27 to 0.95) and youth male (p=0.047; HR 0.49; 95% CI 0.24 to 0.99) athletes with no severe injury the previous year were at half the risk of sustaining a new injury compared with the reference group. A training load index entered the epidemiological multiple model, but not the integrated model. The coping behaviour self-blame replaced training load in an integrated explanatory model of overuse injury risk in athletes. What seemed to be more strongly related to the likelihood of overuse injury was not the athletics load per se, but, rather, the load applied in situations when the athlete's body was in need of rest.
To use epidemiological data and a standardized economic model to compare projected costs for obes... more To use epidemiological data and a standardized economic model to compare projected costs for obesity prevention in late adolescence accrued using a cross-sectional weight classification for selecting adolescents at age 15 years compared with a longitudinal classification. All children born in a Swedish county (population 440 000) in 1991 who participated in all regular measurements of height and weight at ages 5, 10 and 15 years (n=4312) were included in the study. The selection strategies were compared by calculating the projected financial load resulting from supply of obesity prevention services from providers at all levels in the health care system. The difference in marginal cost per 1000 children was used as the primary end point for the analyses. Using the cross-sectional selection strategy, 3.8% of adolescents at age 15 years were selected for evaluation by a pediatric specialist, and 96.2% were chosen for population-based interventions. In the trajectory-based strategy, 2.4...
Using time geographic theory for representation of population mixing, we set out to analyze the r... more Using time geographic theory for representation of population mixing, we set out to analyze the relative impact from precautionary behaviors on outbreaks of pandemic influenza in Europe and Asia. We extended an existing simulator environment with behavioral parameters from a population survey to model different behaviors. We found that precautionary behaviors even among a minority of the population can have a decisive effect on the probability of the outbreak to propagate. The results also display that assumptions strongly influences the outcome. Depending on the interpretation of how many "children" are kept from "school", R(0) changes from a range where outbreak progression is possible to a range where it is improbable in both European (R(0)=1.77/1.23) and Asian (R(0)=1.70/1.05) conditions. We conclude that unprompted distancing can have a decisive effect on pandemic propagation. An important response strategy can be to promote voluntary precautionary behavior ...
The global spread of a novel A (H1N1) influenza virus in 2009 has highlighted the possibility of ... more The global spread of a novel A (H1N1) influenza virus in 2009 has highlighted the possibility of a devastating pandemic similar to the 'Spanish flu' of 1917-1918. Responding to such pandemics requires careful planning for the early phases where there is no availability of pandemic vaccine. We set out to compute a Neighborhood Influenza Susceptibility Index (NISI) describing the vulnerability of local communities of different geo-socio-physical structure to a pandemic influenza outbreak. We used a spatially explicit geo-physical model of Linköping municipality (pop. 136,240) in Sweden, and employed an ontology-modeling tool to define simulation models and transmission settings. We found considerable differences in NISI between neighborhoods corresponding to primary care areas with regard to early progress of the outbreak, as well as in terms of the total accumulated share of infected residents counted after the outbreak. The NISI can be used in local preparations of physical ...
To ensure health and well-being for their athletes, sports organizations must offer preventive me... more To ensure health and well-being for their athletes, sports organizations must offer preventive measures against sexual abuse. The aim of this study was to design and evaluate feasibility of a research protocol for cross-sectional epidemiological studies of sexual abuse in athletics. Examination of the requirements on the study of sexual abuse in athletics was followed by iterated drafting of protocol specifications and formative evaluations. The feasibility of the resulting protocol was evaluated in a national-level study among elite athletics athletes (n = 507) in Sweden. The definition of sexual abuse, the ethical soundness of the protocol, reference populations and study of co-morbidity, and the means for athlete-level data collection were identified as particularly complex issues in the requirements analyses. The web-based survey defined by the protocol facilitates anonymous athlete self-reporting of data on exposure to sexual abuse. 198 athletes (39%) fully completed the feasib...
Lecture Notes of the Institute for Computer Sciences, Social Informatics and Telecommunications Engineering, 2010
Computer simulations have emerged as important tools in the preparation for outbreaks of infectio... more Computer simulations have emerged as important tools in the preparation for outbreaks of infectious disease. To support the collaborative planning and responding to the outbreaks, reports from simulations need to be transparent (accessible) with regard to the underlying ...
Journal of science and medicine in sport / Sports Medicine Australia, Jan 5, 2014
Consistency in routines for reporting injury has been a focus of development efforts in sports ep... more Consistency in routines for reporting injury has been a focus of development efforts in sports epidemiology for a long time. To gain an improved understanding of current reporting practices, we applied the Injury Definitions Concept Framework (IDCF) in a review of injury reporting in a subset of the field. Meta-narrative review, An analysis of injury definitions reported in consensus statements for different sports and studies of injury epidemiology in athletics (track and field) published in PubMed between 1980 and 2013 was performed. Separate narratives for each of the three reporting contexts in the IDCF were constructed from the data. Six consensus statements and 14 studies reporting on athletics injury epidemiology fulfilled the selection criteria. The narratives on sports performance, clinical examination, and athlete self-report contexts were evenly represented in the eligible studies. The sports performance and athlete self-report narratives covered both professional and com...
Failure to incorporate the beliefs and attitudes of the public into theoretical models of prepare... more Failure to incorporate the beliefs and attitudes of the public into theoretical models of preparedness has been identified as a weakness in strategies to mitigate infectious disease outbreaks. We administered a cross-sectional telephone survey to a representative sample (n = 443) of the Swedish adult population to examine whether self-reported intentions to improve personal hygiene and increase social distancing during influenza outbreaks could be explained by trust in official information, self-reported health (SF-8), sociodemographic factors, and determinants postulated in protection motivation theory, namely threat appraisal and coping appraisal. The interviewees were asked to make their appraisals for two scenarios: a) an influenza with low case fatality and mild lifestyle impact; b) severe influenza with high case fatality and serious disturbances of societal functions. Every second respondent (50.0%) reported high trust in official information about influenza. The proportion that reported intentions to take deliberate actions to improve personal hygiene during outbreaks ranged between 45-85%, while less than 25% said that they intended to increase social distancing. Multiple logistic regression models with coping appraisal as the explanatory factor most frequently contributing to the explanation of the variance in intentions showed strong discriminatory performance for staying home while not ill (mild outbreaks: Area under the curve [AUC] 0.85 (95% confidence interval 0.82;0.89), severe outbreaks AUC 0.82 (95% CI 0.77;0.85)) and acceptable performance with regard to avoiding public transportation (AUC 0.78 (0.74;0.82), AUC 0.77 (0.72;0.82)), using handwash products (AUC 0.70 (0.65;0.75), AUC 0.76 (0.71;0.80)), and frequently washing hands (AUC 0.71 (0.66;0.76), AUC 0.75 (0.71;0.80)). We conclude that coping appraisal was the explanatory factor most frequently included in statistical models explaining self-reported intentions to carry out non-pharmaceutical health actions in the Swedish outlined context, and that variations in threat appraisal played a smaller role in these models despite scientific uncertainties surrounding a recent mass vaccination campaign.
ABSTRACT Background Athletics is one of the most popular global sports, but little is known of in... more ABSTRACT Background Athletics is one of the most popular global sports, but little is known of injury patterns among élite athletic athletes. Injury prevalence has been proposed to be the most valid measure of injury burden in sports where athletes practice long hours and are at risk for overuse problems. Objective To compare two different indicators of injury prevalence in athletics as measures of the injury burden among adult and youth élite athletics athletes. Design Cross-sectional epidemiological study using web-based data collection. Setting Swedish élite youth (U17) and adult athletics athletes. Data were collected in April 2009. Participants 278 youth and adult athletes (91%) submitted a web-based questionnaire from an eligible study population of 301 athletes. Assessment of risk factors Athlete's sex, age and anatomical body regions were assessed as risk factors. Main outcome measures 1-year prevalence of musculoskeletal injuries causing at least 3 weeks of partial or complete absence from practice and competition; point prevalence of musculoskeletal injury. Results The 1-year injury prevalence was 43.6%. Among the age groups, the prevalence was 48.1% for adult and 37.1% for youth athletes. The point prevalence of injury was 36.2%, 38% among adult athletes and 33% among youth athletes. Female youth athletes had a tendency towards higher 1-year (p=0.06) and point (p=0.025) injury prevalence than male youth athletes. There was no sex difference in injury prevalence among the senior athletes. A majority of the injuries (74% 1-year prevalence; 78% point prevalence) reported by the athletes were located to the lower extremities. Conclusion Using either the point or 1-year retrospective window definition of prevalence, currently approximately 4 out of 10 Swedish élite athletic athletes have injuries that interfere with their performance of sports activities. Most injuries are located to the lower extremities. Prospective epidemiological studies investigating individual risk factors for athletic injuries are warranted.
BackgroundWhile athletes and coaches, government policy-makers, and sports managers need evidence... more BackgroundWhile athletes and coaches, government policy-makers, and sports managers need evidence for decision-making, unambiguous terms and definitions for reporting and analyzing sports injuries across settings are lacking.ObjectiveTo define unambiguous concepts for reporting sports injuries across settings.DesignMeta-analysis of sports injury-related concepts followed by development of an integrated conceptual framework and appraisal of current sports injury definition practices.SettingDefinitions used in the scientific
ABSTRACT Background Epidemiological studies of injury have mainly been performed on team sports. ... more ABSTRACT Background Epidemiological studies of injury have mainly been performed on team sports. Present methods for data collection and analysis neglect important features of individual sports. Aims To develop a study protocol for large-scale epidemiological studies of injuries in individual sports, exemplified by athletics. Design Structured information system development. Specification of the study protocol was preceded by an examination of requirements on injury surveillance in individual sports and iterated drafting of protocol specifications, and followed by formative evaluations. A preliminary protocol was evaluated in a pilot study involving athletic coaches and athletes and revised into the final version. Setting Swedish youth and adult elite athletics. Participants Six elite athletics coaches and 22 athletic athletes. Results The requirements analysis showed that the central demand on a study protocol to be used for epidemiological surveillance in athletics is to enable detailed analyses of overuse injuries, which subsequently requires continuous and prospective collection of athlete self-reported data. The study protocol fulfils these requirements by using a web-based athlete diary for collection of data regarding exposure to practice and competition as well as injuries. In addition, the requirements analysis showed that the study protocol should cover collection of detailed baseline data, including injury history, subject characteristics and a psychological profile. The evaluation data showed that the preliminary protocol only needed minor revisions at the level of web-questionnaire design. Conclusion The resulting study protocol for injury surveillance is specifically targeted at individual sports. It can be employed in surveillance preceding intervention programs for preventing injuries and suffering among both adult elite and youth athletes. Electronic data capture is crucial for injury surveillance in individual sports, such as athletics in order to ensure high validity of data.
BackgroundAthletics is one of the most popular global sports, but also one of the most demanding ... more BackgroundAthletics is one of the most popular global sports, but also one of the most demanding with regard to human physical capacities. There are few prospective epidemiological studies available on athletic injury in populations of élite athletes.ObjectiveTo describe annual injury incidence rates among adult and youth elite athletics athletes.DesignProspective cohort study using web-based data collection.SettingSwedish élite youth (U17) and adult
Athletes&... more Athletes' psychological characteristics are important for understanding sports injury mechanisms. We examined the relevance of psychological factors in an integrated model of overuse injury risk in athletics/track and field. Swedish track and field athletes (n=278) entering a 12-month injury surveillance in March 2009 were also invited to complete a psychological survey. Simple Cox proportional hazards models were compiled for single explanatory variables. We also tested multiple models for 3 explanatory variable groupings: an epidemiological model without psychological variables, a psychological model excluding epidemiological variables and an integrated (combined) model. The integrated multiple model included the maladaptive coping behaviour self-blame (p=0.007; HR 1.32; 95% CI 1.08 to 1.61), and an interaction between athlete category and injury history (p<0.001). Youth female (p=0.034; HR 0.51; 95% CI 0.27 to 0.95) and youth male (p=0.047; HR 0.49; 95% CI 0.24 to 0.99) athletes with no severe injury the previous year were at half the risk of sustaining a new injury compared with the reference group. A training load index entered the epidemiological multiple model, but not the integrated model. The coping behaviour self-blame replaced training load in an integrated explanatory model of overuse injury risk in athletes. What seemed to be more strongly related to the likelihood of overuse injury was not the athletics load per se, but, rather, the load applied in situations when the athlete's body was in need of rest.
To use epidemiological data and a standardized economic model to compare projected costs for obes... more To use epidemiological data and a standardized economic model to compare projected costs for obesity prevention in late adolescence accrued using a cross-sectional weight classification for selecting adolescents at age 15 years compared with a longitudinal classification. All children born in a Swedish county (population 440 000) in 1991 who participated in all regular measurements of height and weight at ages 5, 10 and 15 years (n=4312) were included in the study. The selection strategies were compared by calculating the projected financial load resulting from supply of obesity prevention services from providers at all levels in the health care system. The difference in marginal cost per 1000 children was used as the primary end point for the analyses. Using the cross-sectional selection strategy, 3.8% of adolescents at age 15 years were selected for evaluation by a pediatric specialist, and 96.2% were chosen for population-based interventions. In the trajectory-based strategy, 2.4...
Using time geographic theory for representation of population mixing, we set out to analyze the r... more Using time geographic theory for representation of population mixing, we set out to analyze the relative impact from precautionary behaviors on outbreaks of pandemic influenza in Europe and Asia. We extended an existing simulator environment with behavioral parameters from a population survey to model different behaviors. We found that precautionary behaviors even among a minority of the population can have a decisive effect on the probability of the outbreak to propagate. The results also display that assumptions strongly influences the outcome. Depending on the interpretation of how many "children" are kept from "school", R(0) changes from a range where outbreak progression is possible to a range where it is improbable in both European (R(0)=1.77/1.23) and Asian (R(0)=1.70/1.05) conditions. We conclude that unprompted distancing can have a decisive effect on pandemic propagation. An important response strategy can be to promote voluntary precautionary behavior ...
The global spread of a novel A (H1N1) influenza virus in 2009 has highlighted the possibility of ... more The global spread of a novel A (H1N1) influenza virus in 2009 has highlighted the possibility of a devastating pandemic similar to the 'Spanish flu' of 1917-1918. Responding to such pandemics requires careful planning for the early phases where there is no availability of pandemic vaccine. We set out to compute a Neighborhood Influenza Susceptibility Index (NISI) describing the vulnerability of local communities of different geo-socio-physical structure to a pandemic influenza outbreak. We used a spatially explicit geo-physical model of Linköping municipality (pop. 136,240) in Sweden, and employed an ontology-modeling tool to define simulation models and transmission settings. We found considerable differences in NISI between neighborhoods corresponding to primary care areas with regard to early progress of the outbreak, as well as in terms of the total accumulated share of infected residents counted after the outbreak. The NISI can be used in local preparations of physical ...
To ensure health and well-being for their athletes, sports organizations must offer preventive me... more To ensure health and well-being for their athletes, sports organizations must offer preventive measures against sexual abuse. The aim of this study was to design and evaluate feasibility of a research protocol for cross-sectional epidemiological studies of sexual abuse in athletics. Examination of the requirements on the study of sexual abuse in athletics was followed by iterated drafting of protocol specifications and formative evaluations. The feasibility of the resulting protocol was evaluated in a national-level study among elite athletics athletes (n = 507) in Sweden. The definition of sexual abuse, the ethical soundness of the protocol, reference populations and study of co-morbidity, and the means for athlete-level data collection were identified as particularly complex issues in the requirements analyses. The web-based survey defined by the protocol facilitates anonymous athlete self-reporting of data on exposure to sexual abuse. 198 athletes (39%) fully completed the feasib...
Lecture Notes of the Institute for Computer Sciences, Social Informatics and Telecommunications Engineering, 2010
Computer simulations have emerged as important tools in the preparation for outbreaks of infectio... more Computer simulations have emerged as important tools in the preparation for outbreaks of infectious disease. To support the collaborative planning and responding to the outbreaks, reports from simulations need to be transparent (accessible) with regard to the underlying ...
Journal of science and medicine in sport / Sports Medicine Australia, Jan 5, 2014
Consistency in routines for reporting injury has been a focus of development efforts in sports ep... more Consistency in routines for reporting injury has been a focus of development efforts in sports epidemiology for a long time. To gain an improved understanding of current reporting practices, we applied the Injury Definitions Concept Framework (IDCF) in a review of injury reporting in a subset of the field. Meta-narrative review, An analysis of injury definitions reported in consensus statements for different sports and studies of injury epidemiology in athletics (track and field) published in PubMed between 1980 and 2013 was performed. Separate narratives for each of the three reporting contexts in the IDCF were constructed from the data. Six consensus statements and 14 studies reporting on athletics injury epidemiology fulfilled the selection criteria. The narratives on sports performance, clinical examination, and athlete self-report contexts were evenly represented in the eligible studies. The sports performance and athlete self-report narratives covered both professional and com...
Failure to incorporate the beliefs and attitudes of the public into theoretical models of prepare... more Failure to incorporate the beliefs and attitudes of the public into theoretical models of preparedness has been identified as a weakness in strategies to mitigate infectious disease outbreaks. We administered a cross-sectional telephone survey to a representative sample (n = 443) of the Swedish adult population to examine whether self-reported intentions to improve personal hygiene and increase social distancing during influenza outbreaks could be explained by trust in official information, self-reported health (SF-8), sociodemographic factors, and determinants postulated in protection motivation theory, namely threat appraisal and coping appraisal. The interviewees were asked to make their appraisals for two scenarios: a) an influenza with low case fatality and mild lifestyle impact; b) severe influenza with high case fatality and serious disturbances of societal functions. Every second respondent (50.0%) reported high trust in official information about influenza. The proportion that reported intentions to take deliberate actions to improve personal hygiene during outbreaks ranged between 45-85%, while less than 25% said that they intended to increase social distancing. Multiple logistic regression models with coping appraisal as the explanatory factor most frequently contributing to the explanation of the variance in intentions showed strong discriminatory performance for staying home while not ill (mild outbreaks: Area under the curve [AUC] 0.85 (95% confidence interval 0.82;0.89), severe outbreaks AUC 0.82 (95% CI 0.77;0.85)) and acceptable performance with regard to avoiding public transportation (AUC 0.78 (0.74;0.82), AUC 0.77 (0.72;0.82)), using handwash products (AUC 0.70 (0.65;0.75), AUC 0.76 (0.71;0.80)), and frequently washing hands (AUC 0.71 (0.66;0.76), AUC 0.75 (0.71;0.80)). We conclude that coping appraisal was the explanatory factor most frequently included in statistical models explaining self-reported intentions to carry out non-pharmaceutical health actions in the Swedish outlined context, and that variations in threat appraisal played a smaller role in these models despite scientific uncertainties surrounding a recent mass vaccination campaign.
ABSTRACT Background Athletics is one of the most popular global sports, but little is known of in... more ABSTRACT Background Athletics is one of the most popular global sports, but little is known of injury patterns among élite athletic athletes. Injury prevalence has been proposed to be the most valid measure of injury burden in sports where athletes practice long hours and are at risk for overuse problems. Objective To compare two different indicators of injury prevalence in athletics as measures of the injury burden among adult and youth élite athletics athletes. Design Cross-sectional epidemiological study using web-based data collection. Setting Swedish élite youth (U17) and adult athletics athletes. Data were collected in April 2009. Participants 278 youth and adult athletes (91%) submitted a web-based questionnaire from an eligible study population of 301 athletes. Assessment of risk factors Athlete's sex, age and anatomical body regions were assessed as risk factors. Main outcome measures 1-year prevalence of musculoskeletal injuries causing at least 3 weeks of partial or complete absence from practice and competition; point prevalence of musculoskeletal injury. Results The 1-year injury prevalence was 43.6%. Among the age groups, the prevalence was 48.1% for adult and 37.1% for youth athletes. The point prevalence of injury was 36.2%, 38% among adult athletes and 33% among youth athletes. Female youth athletes had a tendency towards higher 1-year (p=0.06) and point (p=0.025) injury prevalence than male youth athletes. There was no sex difference in injury prevalence among the senior athletes. A majority of the injuries (74% 1-year prevalence; 78% point prevalence) reported by the athletes were located to the lower extremities. Conclusion Using either the point or 1-year retrospective window definition of prevalence, currently approximately 4 out of 10 Swedish élite athletic athletes have injuries that interfere with their performance of sports activities. Most injuries are located to the lower extremities. Prospective epidemiological studies investigating individual risk factors for athletic injuries are warranted.
BackgroundWhile athletes and coaches, government policy-makers, and sports managers need evidence... more BackgroundWhile athletes and coaches, government policy-makers, and sports managers need evidence for decision-making, unambiguous terms and definitions for reporting and analyzing sports injuries across settings are lacking.ObjectiveTo define unambiguous concepts for reporting sports injuries across settings.DesignMeta-analysis of sports injury-related concepts followed by development of an integrated conceptual framework and appraisal of current sports injury definition practices.SettingDefinitions used in the scientific
ABSTRACT Background Epidemiological studies of injury have mainly been performed on team sports. ... more ABSTRACT Background Epidemiological studies of injury have mainly been performed on team sports. Present methods for data collection and analysis neglect important features of individual sports. Aims To develop a study protocol for large-scale epidemiological studies of injuries in individual sports, exemplified by athletics. Design Structured information system development. Specification of the study protocol was preceded by an examination of requirements on injury surveillance in individual sports and iterated drafting of protocol specifications, and followed by formative evaluations. A preliminary protocol was evaluated in a pilot study involving athletic coaches and athletes and revised into the final version. Setting Swedish youth and adult elite athletics. Participants Six elite athletics coaches and 22 athletic athletes. Results The requirements analysis showed that the central demand on a study protocol to be used for epidemiological surveillance in athletics is to enable detailed analyses of overuse injuries, which subsequently requires continuous and prospective collection of athlete self-reported data. The study protocol fulfils these requirements by using a web-based athlete diary for collection of data regarding exposure to practice and competition as well as injuries. In addition, the requirements analysis showed that the study protocol should cover collection of detailed baseline data, including injury history, subject characteristics and a psychological profile. The evaluation data showed that the preliminary protocol only needed minor revisions at the level of web-questionnaire design. Conclusion The resulting study protocol for injury surveillance is specifically targeted at individual sports. It can be employed in surveillance preceding intervention programs for preventing injuries and suffering among both adult elite and youth athletes. Electronic data capture is crucial for injury surveillance in individual sports, such as athletics in order to ensure high validity of data.
BackgroundAthletics is one of the most popular global sports, but also one of the most demanding ... more BackgroundAthletics is one of the most popular global sports, but also one of the most demanding with regard to human physical capacities. There are few prospective epidemiological studies available on athletic injury in populations of élite athletes.ObjectiveTo describe annual injury incidence rates among adult and youth elite athletics athletes.DesignProspective cohort study using web-based data collection.SettingSwedish élite youth (U17) and adult
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