Musculoskeletal Injuries Among Females in the Military: A Scoping Review

ABSTRACT Introduction Musculoskeletal injuries (MSKi) are a common challenge for those in military careers. Compared to their male peers, reports indicate that female military members and recruits are at greater risk of suffering MSKi during training and deployment. The objectives of this study were to identify the types and causes of MSKi among female military personnel and to explore the various risk factors associated with MSKi. Materials and Methods A scoping review was conducted over a 4-month time frame of English language, peer-reviewed studies published from 1946 to 2019. Search strategies for major biomedical databases (e.g., MEDLINE; Embase Classic + Embase; and the following EBM Reviews—Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, Database of Abstracts of Reviews of Effects, Health Technology Assessment, and the NHS Economic Evaluation Database) were developed by a senior medical information specialist and included 2,891 titles/abstracts. Study selection and data collection were designed according to the Population, Concept, and Context framework. Studies were included if the study population provided stratified data for females in a military context. Results From a total of 2,287 citations captured from the literature searches, 168 peer-reviewed publications (144 unique studies) were eligible for inclusion. Studies were identified from across 10 countries and published between 1977 and 2019. Study designs were primarily prospective and retrospective cohorts. Most studies assessed both prevalence/incidence and risk factors for MSKi (62.50%), with few studies assessing cause (13.69%). For MSKi of female recruits compared to active female members, the prevalence was higher (19.7%-58.3% vs. 5.5%-56.6%), but the incidence (0.02%-57.7% vs. 13.5%-71.9%) was lower. The incidence of stress fractures was found to be much higher in female recruits than in active members (1.6%-23.9% vs. 2.7%). For anthropometric risk factors, increased body fat was a predictor of MSKi, but not stress fractures. For physiological risk factors for both female military groups, being less physically fit, later menarche, and having no/irregular menses were predictors of MSKi and stress fractures. For biomechanical risk factors, among female recruits, longer tibial length and femoral neck diameter increased the risk of stress fractures, and low foot arch increased risk of an ankle sprain. For female active military members, differences in shoulder rotation and bone strength were associated with risk of MSKi. For biological sex, being female compared to male was associated with an increased risk of MSKi, stress fractures, and general injuries. The consequences of experiencing MSKi for active military included limited duties, time off, and discharge. For recruits, these included missed training days, limited duty days, and release. Conclusions This scoping review provides insight into the current state of the evidence regarding the types and causes of MSKi, as well as the factors that influence MSKi among females in the military. Future research endeavors should focus on randomized controlled trials examining training paradigms to see if women are more susceptible. The data presented in the scoping review could potentially be used to develop training strategies to mitigate some of the identified barriers that negatively impact women from pursuing careers in the military.

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Mapping multicenter randomized controlled trials in anesthesiology: a scoping review

Systematic Reviews ◽

10.1186/s13643-021-01776-5 ◽

2021 ◽

Vol 10 (1) ◽

Author(s):

Sylvain Boet ◽

Joseph K. Burns ◽

Olivia Cheng-Boivin ◽

Hira Khan ◽

Kendra Derry ◽

...

Keyword(s):

Knowledge Translation ◽

Randomized Controlled Trials ◽

Patient Outcomes ◽

Scoping Review ◽

Anesthetic Technique ◽

Future Research ◽

Control Group ◽

Controlled Trials ◽

Cochrane Central Register ◽

Randomized Controlled

Abstract Background Evidence suggests that there are substantial inconsistencies in the practice of anesthesia. There has not yet been a comprehensive summary of the anesthesia literature that can guide future knowledge translation interventions to move evidence into practice. As the first step toward identifying the most promising interventions for systematic implementation in anesthesia practice, this scoping review of multicentre RCTs aimed to explore and map the existing literature investigating perioperative anesthesia-related interventions and clinical patient outcomes. Methods Multicenter randomized controlled trials were eligible for inclusion if they involved a tested anesthesia-related intervention administered to adult surgical patients (≥ 16 years old), with a control group receiving either another anesthesia intervention or no intervention at all. The electronic databases Embase (via OVID), MEDLINE, and MEDLINE in Process (via OVID), and Cochrane Central Register of Control Trials (CENTRAL) were searched from inception to February 26, 2021. Studies were screened and data were extracted by pairs of independent reviewers in duplicate with disagreements resolved through consensus or a third reviewer. Data were summarized narratively. Results We included 638 multicentre randomized controlled trials (n patients = 615,907) that met the eligibility criteria. The most commonly identified anesthesia-related intervention theme across all studies was pharmacotherapy (n studies = 361 [56.6%]; n patients = 244,610 [39.7%]), followed by anesthetic technique (n studies = 80 [12.5%], n patients = 48,455 [7.9%]). Interventions were most often implemented intraoperatively (n studies = 233 [36.5%]; n patients = 175,974 [28.6%]). Studies typically involved multiple types of surgeries (n studies = 187 [29.2%]; n patients = 206 667 [33.5%]), followed by general surgery only (n studies = 115 [18.1%]; n patients = 201,028 [32.6%]) and orthopedic surgery only (n studies = 94 [14.7%]; n patients = 34,575 [5.6%]). Functional status was the most commonly investigated outcome (n studies = 272), followed by patient experience (n studies = 168), and mortality (n studies = 153). Conclusions This scoping review provides a map of multicenter RCTs in anesthesia which can be used to optimize future research endeavors in the field. Specifically, we have identified key knowledge gaps in anesthesia that require further systematic assessment, as well as areas where additional research would likely not add value. These findings provide the foundation for streamlining knowledge translation in anesthesia in order to reduce practice variation and enhance patient outcomes.

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The Distribution of Work-Related Musculoskeletal Disorders Among Nurses in Sub-Saharan Africa: A Scoping Review Protocol

10.21203/rs.3.rs-50166/v2 ◽

2021 ◽

Author(s):

Kagiso Kgakge ◽

Mbuzeleni Hlongwa ◽

Themba Ginindza

Keyword(s):

Risk Factors ◽

Musculoskeletal Disorders ◽

Mortality Risk ◽

Scoping Review ◽

Musculoskeletal Injuries ◽

Sub Saharan Africa ◽

World Health ◽

Future Research ◽

Economic Costs ◽

Sub Saharan

Abstract BackgroundAlthough measures have been put in place, musculoskeletal injuries are noticeable high among the nursing fraternity with Low back pain (LBP) being the most prevalent. It is evident that healthcare professionals are in constant exposure to occupational hazards such as musculoskeletal injuries as they discharge their professional duties. Not only does LBP affect the health of the nurses, it also creates a huge burden on the health systems with consequent poor performance at the workplace as well as economic burden. Therefore, the main objective of this study is to map evidence on the prevalence, incidence, mortality, risk factors and economic costs of musculoskeletal disorders (MSD) in sub Saharan Africa (SSA).Methods and analysisScoping review will be done to explore, describe and map literature on the prevalence, incidence, mortality, risk factors, and economic costs related to MSD among nurses in SSA. The search will be done using databases such as PubMed, MEDLINE, CINAHL, Google Scholar, nursing academic editions and World Health Organization (WHO) library databases. The search will look for primary studies within peer-reviewed articles as well as gray literature. In addition, the researcher will search the articles using keywords from the included studies as well as the list of references for related studies. The screening will be guided by the inclusion and exclusion criteria and the scoping review will be reported in accordance to PRISMA-P guidelines. The NVivo 12 data analysis software will be used to generate themes, and a thematic content analysis will be used to give the narrative account of the review.DiscussionAt the end, this study anticipates to uncover the relevant literature in SSA in regard to prevalence, incidence, mortality, risk factors and costs related to MSD among nurses; furthermore findings from this study will help in identifying research gaps, informing policy, priority in funding and planning and to guide future research.

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Complex Lifestyle and Psychological Intervention in Knee Osteoarthritis: Scoping Review of Randomized Controlled Trials

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph182312757 ◽

2021 ◽

Vol 18 (23) ◽

pp. 12757

Author(s):

Bryan Yijia Tan ◽

Tivona Thach ◽

Yasmin Lynda Munro ◽

Soren Thorgaard Skou ◽

Julian Thumboo ◽

...

Keyword(s):

Knee Osteoarthritis ◽

Scoping Review ◽

Psychological Intervention ◽

Care Delivery ◽

Data Extraction ◽

Psychosocial Interventions ◽

Current Evidence ◽

Future Research ◽

Controlled Trials ◽

Knee Oa

Knee osteoarthritis (OA) causes pain, disability and poor quality of life in the elderly. The primary aim was to identify and map out the current evidence for randomised controlled trials (RCTs) on complex lifestyle and psychosocial interventions for knee OA. The secondary aim was to outline different components of complex lifestyle and psychosocial interventions. Our scoping review searched five databases from 2000 to 2021 where complex lifestyle or psychosocial interventions for patients with knee OA were compared to other interventions. Screening and data extraction were performed by two review authors independently and discrepancies resolved through consensus and in parallel with a third reviewer. A total of 38 articles were selected: 9 studied the effectiveness of psychological interventions; 11 were on self-management and lifestyle interventions; 18 looked at multifaceted interventions. This review highlights the substantial variation in knee OA interventions and the overall lack of quality in the current literature. Potential areas of future research, including identifying prognostic social factors, stratified care models, transdisciplinary care delivery and technology augmented interventions, have been identified. Further high-quality RCTs utilizing process evaluations and economic evaluation in accordance with the MRC guidelines are critical for the development of evidence-based knee OA programs globally.

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Evolving injury profiles amid advancing sport: Musculoskeletal injuries in ringball players

South African Journal of Sports Medicine ◽

10.17159/2078-516x/2020/v32i1a8166 ◽

2020 ◽

Vol 32 (1) ◽

pp. 1-6

Author(s):

Blessing Mkhwanazi ◽

Julian David Pillay

Keyword(s):

Risk Factors ◽

South Africa ◽

Injury Prevention ◽

Response Rate ◽

Musculoskeletal Injuries ◽

Ankle Injuries ◽

Categorical Variables ◽

Future Research ◽

Current Season ◽

Kwazulu Natal

Background: Ringball, a sport historically derived from conventional basketball and netball, demonstrates the evolution of traditional sport. The variations between these sports may predispose players to different risk factors and consequent injuries and their impact, yet they are usually considered comparably. Objective: To determine the prevalence of musculoskeletal injuries and to profile injuries based on location, severity, and mechanisms of occurrence. A further objective was to compare the injuries sustained in ringball with that of basketball and netball. Methods: A questionnaire-based study, administered to 110 ringball players in KwaZulu-Natal, South Africa, was applied. Data were described and compared using frequencies/ percentages for categorical variables. Results: Seventy-six ringball players completed the questionnaire (69% response rate). The prevalence of at least one injury during/after the last or current season was 80% (n=61). The most commonly reported injury was to the foot/ankle (36%; n=33) followed by the knee (29%; n=27) and wrist (9%; n=8). The most common mechanisms of injury reported were landing (15%; n=9), jumping (9%; n=5), goal shooting (7%; n=4), defending (7%; n=4) and collision (7%; n=4). Discussion: Ringball shares similar injuries to that of basketball/netball, with foot/ankle injuries being the most prevalent. The prevalence of other injuries in ringball differed from basketball/netball, suggesting variations between these sports as a contributor to the injuries described. Conclusion: The evolution of sport and the modifications in rules/techniques may create a nuanced injury profile to those commonly identified. The combination of a sport’s uniqueness/modification and its similarities to other sports warrants the need for more tailored approaches to injury prevention and a platform for future research.

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Azithromycin in patients with Covid-19; a systematic review and metanalysis

10.1101/2021.08.03.21261414 ◽

2021 ◽

Author(s):

Luis Ayerbe ◽

Ivo Forgnone ◽

Carlos Risco-Risco ◽

Maria Perez-Pinar ◽

Salma Ayis

Keyword(s):

Systematic Review ◽

Clinical Severity ◽

Future Research ◽

Controlled Trials ◽

Clinical Settings ◽

Cochrane Central Register ◽

Random Effects Models ◽

Central Register ◽

Significant Difference ◽

Observational Design

Background: Azithromycin (AZM) has been widely used in the management of Covid-19. However, the evidence on its actual effects remains disperse and difficult to apply in clinical settings. This systematic review and metanalysis summarizes the studies on the beneficial and adverse effect of AZM in patients with Covid-19. Methods: The PRISMA 2020 statement criteria were followed. Randomized controlled trials (RCTs) and observational studies comparing clinical outcomes of patients treated, and not treated, with AZM, indexed until the 5th of July 2021, were searched in PubMed, Embase, The Web of Science, Scopus, The Cochrane Central Register of Controlled Trials, and MedRXivs. We used Random-effects models to estimate pooled effect size from aggregate data. Results: The initial search produced 4950 results. Finally, 16 studies, five RCTs and 11 with an observational design, with a total of 22984 patients, were included. The metanalysis showed no difference in mortality for those treated, or not, with AZM, OR: 0.95 (0.79-1.13). There was also no significant difference for those treated, and not, with AZM in need for hospital admission or time to admission from ambulatory settings, clinical severity, need for intensive care, or adverse effects. Conclusions: These results presented in this review do not support the use of AZM in the management of Covid-19. They also show that any harm caused to the patient who received it is unlikely. Future research on treatment for patients with Covid-19 may need to focus on other drugs

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664 Risk Factors for the Development of Transaminitis in Pediatric Burn Patients Treated with Oxandrolone

Journal of Burn Care & Research ◽

10.1093/jbcr/iraa024.280 ◽

2020 ◽

Vol 41 (Supplement_1) ◽

pp. S177-S177

Author(s):

Kate Pape ◽

Sarah Zavala ◽

Rita Gayed ◽

Melissa Reger ◽

Kendrea Jones ◽

...

Keyword(s):

Risk Factors ◽

Length Of Stay ◽

Pediatric Patients ◽

Burn Injury ◽

Total Body Surface Area ◽

Future Research ◽

Burn Patients ◽

Thermal Burn ◽

Increased Risk ◽

Significant Difference

Abstract Introduction Oxandrolone is an anabolic steroid that is the standard of care for burn patients experiencing hypermetabolism. Previous studies have demonstrated the benefits of oxandrolone, including increased body mass and improved wound healing. One of the common side effects of oxandrolone is transaminitis, occurring in 5–15% of patients, but little is known about associated risk factors with the development of transaminitis. A recent multicenter study in adults found that younger age and those receiving concurrent intravenous vasopressors or amiodarone were more likely to develop transaminitis while on oxandrolone. The purpose of this study was to determine the incidence and identify risk factors for the development of transaminitis in pediatric burn patients receiving oxandrolone therapy. Methods This was a multicenter, retrospective risk factor analysis that included pediatric patients with thermal burn injury (total body surface area [TBSA] > 10%) who received oxandrolone over a 5-year time period. The primary outcome of the study was the development of transaminitis while on oxandrolone therapy, which was defined as aspartate aminotransferase (AST) or alanine aminotransferase (ALT) >100 mg/dL. Secondary outcomes included mortality, length of stay, and change from baseline ALT/AST. Results A total of 55 pediatric patients from 5 burn centers met inclusion criteria. Of those, 13 (23.6%) developed transaminitis, and the mean time to development of transaminitis was 17 days. Patients who developed transaminitis were older (12 vs 6.4 years, p = 0.01) and had a larger mean %TBSA (45.9 vs 34.1, p = 0.03). The odds of developing transaminitis increased by 23% for each 1 year increase in age (OR 1.23, CI 1.06–1.44). The use of other concurrent medications was not associated with an increased risk of developing transaminitis. Renal function and hepatic function was not associated with the development of transaminitis. There was no significant difference in length of stay and mortality. Conclusions Transaminitis occurred in 23.6% of our study population and was associated with patients who were older and had a larger mean %TBSA burn. Older pediatric patients with larger burns who are receiving oxandrolone should be closely monitored for the development of transaminitis. Applicability of Research to Practice Future research is needed to identify appropriate monitoring and management of transaminitis in oxandrolone-treated pediatric burn patients.

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Diet and Food Allergy as Risk Factors for Asthma in the Arabian Gulf Region: Current Evidence and Future Research Needs

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph16203852 ◽

2019 ◽

Vol 16 (20) ◽

pp. 3852 ◽

Cited By ~ 3

Author(s):

Naser A. Alsharairi

Keyword(s):

Risk Factors ◽

Food Allergy ◽

Eastern Mediterranean ◽

Arabian Gulf ◽

Current Evidence ◽

Future Research ◽

Gulf Region ◽

Arabian Gulf Region ◽

Mediterranean Countries ◽

Increased Risk

Asthma is a chronic respiratory disease which is associated with higher levels of systemic inflammation. The causes of asthma remain poorly understood. Unhealthy diet and food allergy are potential risk factors for developing asthma. The prevalence of asthma in the Arabian Gulf region (AGR), and Kuwait, Saudi Arabia and Qatar in particular, is higher than in other Eastern Mediterranean countries. In the AGR, diets tend to be of low nutritional value due to high levels of total energy, cholesterol, sodium, added sugars and saturated fat, and low levels of fiber, fruit and vegetables. A few studies that include children and adults in the AGR have suggested a potential link between unhealthy diets/specific food allergens and increased risk of asthma, however, the association of food allergy with asthma is still a controversial issue. The aim of this commentary is to consider the evidence from the AGR regarding the effects of diet/food allergy on asthma risk that may be used to make recommendations for future research.

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Incidence and risk factors of non–device-associated pneumonia in an acute-care hospital

Infection Control and Hospital Epidemiology ◽

10.1017/ice.2019.300 ◽

2019 ◽

Vol 41 (1) ◽

pp. 73-79 ◽

Cited By ~ 2

Author(s):

Paula D. Strassle ◽

Emily E. Sickbert-Bennett ◽

Michael Klompas ◽

Jennifer L. Lund ◽

Paul W. Stewart ◽

...

Keyword(s):

Risk Factors ◽

Infection Prevention ◽

Acute Care Hospital ◽

Future Research ◽

Ventilator Associated Pneumonia ◽

Care Hospital ◽

Prevention Strategies ◽

Increased Risk ◽

Academic Teaching Hospital ◽

Male Sex

AbstractObjective:To update current estimates of non–device-associated pneumonia (ND pneumonia) rates and their frequency relative to ventilator associated pneumonia (VAP), and identify risk factors for ND pneumonia.Design:Cohort study.Setting:Academic teaching hospital.Patients:All adult hospitalizations between 2013 and 2017 were included. Pneumonia (device associated and non–device associated) were captured through comprehensive, hospital-wide active surveillance using CDC definitions and methodology.Results:From 2013 to 2017, there were 163,386 hospitalizations (97,485 unique patients) and 771 pneumonia cases (520 ND pneumonia and 191 VAP). The rate of ND pneumonia remained stable, with 4.15 and 4.54 ND pneumonia cases per 10,000 hospitalization days in 2013 and 2017 respectively (P = .65). In 2017, 74% of pneumonia cases were ND pneumonia. Male sex and increasing age we both associated with increased risk of ND pneumonia. Additionally, patients with chronic bronchitis or emphysema (hazard ratio [HR], 2.07; 95% confidence interval [CI], 1.40–3.06), congestive heart failure (HR, 1.48; 95% CI, 1.07–2.05), or paralysis (HR, 1.72; 95% CI, 1.09–2.73) were also at increased risk, as were those who were immunosuppressed (HR, 1.54; 95% CI, 1.18–2.00) or in the ICU (HR, 1.49; 95% CI, 1.06–2.09). We did not detect a change in ND pneumonia risk with use of chlorhexidine mouthwash, total parenteral nutrition, all medications of interest, and prior ventilation.Conclusion:The incidence rate of ND pneumonia did not change from 2013 to 2017, and 3 of 4 nosocomial pneumonia cases were non–device associated. Hospital infection prevention programs should consider expanding the scope of surveillance to include non-ventilated patients. Future research should continue to look for modifiable risk factors and should assess potential prevention strategies.

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LO29: Interventions at triage to improve emergency department throughput: a systematic review

CJEM ◽

10.1017/cem.2020.85 ◽

2020 ◽

Vol 22 (S1) ◽

pp. S17-S17

Author(s):

K. Grant ◽

C. Bayley ◽

E. Lang ◽

G. Innes

Keyword(s):

Emergency Department ◽

Assessment Tool ◽

Care Quality ◽

Risk Of Bias ◽

Future Research ◽

Controlled Trials ◽

Cochrane Central Register ◽

Meaningful Improvement ◽

Study Results ◽

Statistical Heterogeneity

Introduction: Emergency Department (ED) crowding is the primary threat to emergency care quality. Input and outflow factors are important factors, but EDs must optimize throughput efficiency by improving internal processes from triage to disposition, and triage is the first throughput phase. Triage throughput interventions exclude strategies that direct patients away from the ED (these modify input rather than throughput). Previous research has described physicians in triage, team triage, telemedical triage, and nurse practitioner (NP) or physician assistant (PA) led triage, but their impact has never been systematically evaluated. Methods: We conducted systematic database searches in Medline, Embase, CINAHL, and the Cochrane Central Register of Controlled Trials without the use of filters or language restrictions of all triage interventions that effected ED throughput (PROSPERO:CRD42019125651). Two independent reviewers screened studies. Study quality was assessed using the Cochrane Risk of Bias tool (version 2) for randomized controlled trials, and the National Heart, Lung, and Blood Institute quality assessment tool for other designs. Results: 18 studies met inclusion criteria (Cohen's k = 0.69). Study results were not pooled due to high statistical heterogeneity as assessed by chi-squared and I-squared statistics. Studies were grouped into physician led, NP or PA led, and team triage interventions. Six physician in triage interventions reported LOS changes between -82 and + 18 minutes. Five NP/PA led triage interventions resulted in LOS changes of -106 to + 19 minutes. Five team triage interventions reported LOS reductions of 4 to 34 minutes. One telemedicine triage study reported a non-significant 8 minute increase in LOS. Six physician at triage interventions yielded significant LWBS rate improvement (relative risk {RR}= 0.29-0.82). Team triage interventions generated LWBS rate changes ranging from meaningful improvement (RR = 0.58) to substantial deterioration (RR = 1.68). Five studies have low risk of bias, 11 studies have some risk of bias, and 2 studies have high risk of bias (Cohen's kappa = 0.58). Conclusion: Fourteen of 18 triage interventions reduced EDLOS and/or LWBS rate. Physician, NP and PA led triage were the most effective triage interventions. To aid widespread adoption, future research should focus on interrupted time series or RCT designs, and more comprehensive descriptions of the contextual factors affecting implementation of these interventions.

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Bone

10.1093/med/9780199533909.003.0006 ◽

2013 ◽

Author(s):

Leanne Saxon

Keyword(s):

Risk Factors ◽

Health Benefits ◽

Sports Participation ◽

Stress Fractures ◽

Bone Biology ◽

Positive Health ◽

Factors Associated ◽

Risk Of Injury ◽

Increased Risk

Sports participation has numerous positive health benefits; however, it is also associated with an increased risk of injury. While bone injuries in sport are less frequent than ligament tears, contusions, or surface wounds, they can be debilitating for an athlete because of the time needed for recovery. In this chapter I describe the incidence and cost of bone injuries in sport, fundamentals of bone biology and repair, risk factors associated with fractures, stress fractures, and periostitis, and review both current and possible future recommendations for the treatment of bone-related injuries....

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