Epidemiology of Shoulder Instability in the National Football League

Background: Shoulder instability is a common and potentially debilitating injury among collision sport athletes that can lead to long-term damage of the glenohumeral joint. Limited data exist regarding instability among elite athletes in the National Football League (NFL). Purpose: To describe the epidemiology of shoulder instability in the NFL from 2012 through 2017. Study Design: Descriptive epidemiology study. Methods: The NFL’s injury database was reviewed for shoulder instability injuries resulting in missed time during the study inclusion dates. Injuries were classified by type and direction, as well as timing, setting, and mechanism. Median missed time was determined for the different types and directions of instability. Incidence rates for game-related injuries were calculated based on timing during the season and player position. Finally, the relationship between player position and instability direction was assessed. Results: During the 6-year study period, 355 players sustained 403 missed-time shoulder instability injuries. Most injuries occurred during games (65%) via a contact mechanism (85%). The overall incidence rate of game-related instability was 3.6 injuries per 100,000 player-plays and was highest during the preseason (4.9 per 100,000 player-plays). The defensive secondary position accounted for the most injuries, but quarterbacks had the highest incidence rate in games (5.5 per 100,000 player-plays). Excluding unspecified events (n = 128; 32%), 70% (n = 192) of injuries were subluxations and 30% (n = 83) were dislocations; 75% of dislocations were anterior, while subluxations were more evenly distributed between the anterior and posterior directions (45% vs 52%, respectively). Players missed substantially more time after dislocation compared with subluxation (median, 47 days vs 13 days, respectively). When instability direction was known, the majority of instability events among quarterbacks and offensive linemen were posterior (73% and 53%, respectively), while anterior instability was most common for all other positions. Conclusion: Shoulder instability is a common injury in the NFL and can result in considerable missed time. Dislocations occur less frequently than subluxations but lead to greater time lost. While most dislocations are anterior, more than half of subluxations are posterior, which is likely the result of repetitive microtrauma to the posterior capsulolabral complex sustained during sport-specific motions such as blocking. The risk of instability varies by player position, and position may also influence instability direction.

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The number of acute cerebrovascular events in Israel: a forecast until 2040

Israel Journal of Health Policy Research ◽

10.1186/s13584-019-0337-1 ◽

2019 ◽

Vol 8 (1) ◽

Author(s):

Assaf Ben Shoham ◽

Sigal Liberant-Taub ◽

Mor Sharon ◽

Inbar Zucker

Keyword(s):

Population Growth ◽

Incidence Rate ◽

Developed Countries ◽

Incidence Rates ◽

Annual Incidence ◽

Annual Number ◽

Cerebrovascular Event ◽

Population Forecasts ◽

Cerebrovascular Events

Abstract Background Acute cerebrovascular event is one of the leading causes of death in Israel and is the primary cause of neurological disability in adults. Although some evidence indicates that the incidence rate of acute cerebrovascular events in developed countries is stable or has been decreasing over the past decades, the number of events is expected to increase in these countries due to projected changes in size and composition of the population. The purpose of this study was to provide a forecast of the number of acute cerebrovascular events in Israel for the coming decades. Methods We used data from the National Stroke Registry at the Israel Center for Disease Control and data from the long-term population forecasts of the Israeli Central Bureau of Statistics. We generated forecasts of the annual number of acute cerebrovascular events based on the mean annual incidence rates during 2014–2016 within population subgroups defined by gender, age, and ethnicity, and on the projected population size of these subgroups for 2015–2040. The forecasts were generated for various assumptions as to trends in the incidence rate and for alternatives as to the projected population growth. Results Based on the intermediate population growth alternative, the annual number of acute cerebrovascular events is expected to increase from 18,400 to 38,500, 34,800 or 26,400 events, assuming constant annual incidence rates, decreasing annual incidence rates at a rate of 2% every 5 years, or decreasing annual incidence rates at a rate of 7.25% every 5 years, respectively. Whereas, presently, events affecting Arab patients account for 15% of acute cerebrovascular events and events affecting patients over 80 account for 33% of acute cerebrovascular events, by 2040 events affecting Arab patients will account for more than 21% of the events and events affecting patients over 80 will account for 42% of the events. Conclusions In view of the expected increase in the number of acute cerebrovascular events and the changes in the demographic composition of adults suffering from such events, and in order to allow for optimal care and equity, it is imperative to evaluate the preparedness of care provision and the geographical deployment of treatment services in the short and long term.

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Alcohol Consumption in Victims of Violence: A Trend Study for the Period 1970–1998

Psychological Reports ◽

10.2466/pr0.2000.87.3.803 ◽

2000 ◽

Vol 87 (3) ◽

pp. 803-811 ◽

Cited By ~ 2

Author(s):

Johannes Kingma

Keyword(s):

Alcohol Consumption ◽

Incidence Rate ◽

Linear Trend ◽

Incidence Rates ◽

University Hospital ◽

Significant Linear Trend ◽

Male Predominance ◽

Victims Of Violence ◽

The University

This 29-yr. retrospective study is about alcohol consumption by victims of violence intentionally injured ( N = 13,048) and general patients unintentionally injured ( N = 296,544) who were treated for their injuries at the Trauma Center of the University Hospital Groningen (The Netherlands) during the period 1970–1998 The incidence rate for general patients with alcohol consumption was statistically significantly greater than the incidence rate of victims of violence with alcohol consumption. A long-term significant linear trend was observed for both types of patients during the 29-yr. period. However, the increase in incidence rate among the general patients with alcohol consumption was four times greater than the increase in incidence rate for the victims of violence with alcohol consumption. Makes predominated in both types of patients (with and without alcohol consumption). The statistically significant highest incidence rates (and male predominance) were found in the age group 20–24 years for both categories of patients.

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Biomechanical analysis of the right elevated glenohumeral joint in violinists during legato-playing

Technology and Health Care ◽

10.3233/thc-219001 ◽

2021 ◽

pp. 1-10

Author(s):

Anne-Sophie Saffert ◽

Maximilian Melzner ◽

Sebastian Dendorfer

Keyword(s):

Potential Problem ◽

Glenohumeral Joint ◽

Elevation Angle ◽

Biomechanical Analysis ◽

Repetitive Movements ◽

The Right ◽

Violin Playing ◽

The Relationship ◽

Shoulder Elevation

BACKGROUND: Many statistics reveal that violin players suffer most often from musculoskeletal disorders compared to musicians of other instrument groups. A common phenomenon, especially observed in violin beginners, is the tendency to elevate the right shoulder during playing the violin. This can probably lead to serious disorders in long-term practice with repetitive movements. OBJECTIVE: For this reason, this study investigated the relationship between the right shoulder elevation and the force in the right glenohumeral joint during violin playing. It was hypothesized that the forces in the right glenohumeral joint are higher during playing with the right shoulder raised compared to playing in normal posture. METHODS: Motion capture data from four experienced violinists was recorded and processed by means of musculoskeletal simulation to get the force and elevation angle while playing with raised shoulder and in normal position. RESULTS: The results indicate that the absolute values of the resulting force, as well as the forces in the mediolateral, inferosuperior, and anteroposterior directions, are higher in playing the violin with the shoulder raised than in a normal posture. CONCLUSIONS: Elevating the right shoulder while playing the violin may pose a potential problem.

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Secondary Malignancies in CML Patients – Data From the German CML Study IV

Blood ◽

10.1182/blood.v120.21.3746.3746 ◽

2012 ◽

Vol 120 (21) ◽

pp. 3746-3746 ◽

Cited By ~ 2

Author(s):

Manuel Barreto Miranda ◽

Michael Lauseker ◽

Ulrike Proetel ◽

Annette Schreiber ◽

Benjamin Hanfstein ◽

...

Keyword(s):

General Population ◽

Confidence Interval ◽

Incidence Rate ◽

Interferon Alpha ◽

Research Funding ◽

Incidence Rates ◽

Primary Cancer ◽

Secondary Malignancies

Abstract Abstract 3746 Introduction: The increase of overall survival in chronic myeloid leukemia (CML) requires closer long-term observation in the face of a potential carcinogenicity of tyrosine kinase inhibitors (TKIs). Preclinical studies with imatinib in rats showed neoplastic changes in kidneys, urinary bladder, urethra, preputial and clitoral glands, small intestine, parathyroid glands, adrenal glands, and nonglandular stomach. Two epidemiologic studies on patients with chronic myeloproliferative neoplasms (CMPN) and CML (Frederiksen H et al., Blood 2011; Rebora P et al., Am J Epidemiol 2010) found an increased risk of secondary malignancies compared with the general population independent of treatment. In contrast, in a recent analysis of patients with CML and CMPN treated with TKI (Verma D et al., Blood 2011) a decreased risk of secondary malignancies was reported. Aims: To further elucidate the risk of TKI treated CML patients for the development of secondary malignancies we analysed data of the CML study IV, a randomized 5-arm trial (imatinib 400 mg vs. imatinib 800 mg vs. imatinib 400 mg in combination with interferon alpha vs. imatinib 400 mg in combination with AraC vs. imatinib 400 mg after interferon failure). Patients and methods: From February 2002 to April 2012, 1551 CML patients in chronic phase were randomized, 1525 were evaluable. Inclusion criteria allowed the history of primary cancer if the disease was in stable remission. Forty-nine malignancies were reported in 43 patients before the diagnosis of CML. If relapses occurred within 5 years after diagnosis of primary cancer they were not considered for further analysis. Median follow-up was 67.5 months. Age-standardized incidence rates were calculated from the age-specific rates using the European standard population (1976). Results: In total, 67 secondary malignancies in 64 patients were found in CML patients treated with TKI (n=61) and interferon alpha only (n=3). Twelve of these patients developed neoplasms after diagnosis of a primary cancer before diagnosis of CML, 5 patients with metastases or recurrence of the first malignancy (range of diagnosis 5–19 years after primary cancer). Median time to secondary malignancy was 2.5 years (range 0.1–8.3 years). The types of neoplasms were: prostate (n=9), colorectal (n=6), lung (n=6), non Hodgkin's lymphoma (NHL; n=7), malignant melanoma (n=5), skin tumors (basalioma n=4 and squamous cell carcinoma n=1), breast (n=5), pancreas (n=4), kidney (n=4), chronic lymphocytic leukemia (n=3), head and neck (n=2), biliary (n=2), sarcoma (n=2), and esophagus, stomach, liver, vulva, uterus, brain, cancer of unknown origin (each n=1). With these numbers the age-standardized incidence rates of secondary malignancies in CML patients were calculated: 534 cases per 100,000 for men (confidence interval [350;718]), and 582 for women (confidence interval [349;817]). The incidence rates of the general population in Germany were 450 and 350 cases, respectively (“Krebs in Deutschland 2007/2008”, 8th ed., Robert Koch Institute, 2012). The incidence rate of NHLs was higher for CML patients than for the general population but this is not significant. Conclusions: In our cohort, the incidence rate of secondary neoplasms in CML patients was slightly increased compared to the general population. The most common secondary malignancies in CML patients under treatment were cancers of the skin, prostate, colon, lung and NHL. Since the occurrence of secondary neoplasia increases over time, long-term follow-up of CML patients is warranted. Disclosures: Müller: Novartis, BMS: Consultancy, Honoraria, Research Funding. Hochhaus:Novartis, BMS, MSD, Ariad, Pfizer: Consultancy Other, Honoraria, Research Funding. Hehlmann:Novartis: Research Funding.

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Tuberculosis reinfection rate as a proportion of total infection rate correlates with the logarithm of the incidence rate: a mathematical model

Journal of The Royal Society Interface ◽

10.1098/rsif.2008.0184 ◽

2008 ◽

Vol 6 (30) ◽

pp. 11-15 ◽

Cited By ~ 26

Author(s):

Pieter W Uys ◽

Paul D van Helden ◽

John W Hargrove

Keyword(s):

Incidence Rate ◽

Empirical Data ◽

Incidence Rates ◽

Simple Relationship ◽

A Value ◽

High Incidence ◽

Low Incidence ◽

First Time ◽

The Relationship ◽

Range Of Values

In a significant number of instances, an episode of tuberculosis can be attributed to a reinfection event. Because reinfection is more likely in high incidence regions than in regions of low incidence, more tuberculosis (TB) cases due to reinfection could be expected in high-incidence regions than in low-incidence regions. Empirical data from regions with various incidence rates appear to confirm the conjecture that, in fact, the incidence rate due to reinfection only, as a proportion of all cases, correlates with the logarithm of the incidence rate, rather than with the incidence rate itself. A theoretical model that supports this conjecture is presented. A Markov model was used to obtain a relationship between incidence and reinfection rates. It was assumed in this model that the rate of reinfection is a multiple, ρ (the reinfection factor), of the rate of first-time infection, λ . The results obtained show a relationship between the proportion of cases due to reinfection and the rate of incidence that is approximately logarithmic for a range of values of the incidence rate typical of those observed in communities across the globe. A value of ρ is determined such that the relationship between the proportion of cases due to reinfection and the logarithm of the incidence rate closely correlates with empirical data. From a purely theoretical investigation, it is shown that a simple relationship can be expected between the logarithm of the incidence rates and the proportions of cases due to reinfection after a prior episode of TB. This relationship is sustained by a rate of reinfection that is higher than the rate of first-time infection and this latter consideration underscores the great importance of monitoring recovered TB cases for repeat disease episodes, especially in regions where TB incidence is high. Awareness of this may assist in attempts to control the epidemic.

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Effect of Playing and Training at Altitude on Concussion Incidence in Professional Football

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967118794928 ◽

2018 ◽

Vol 6 (12) ◽

pp. 232596711879492

Author(s):

James G. Connolly ◽

John T. Nathanson ◽

Stanislaw Sobotka ◽

Syed Haider ◽

Alex Gometz ◽

...

Keyword(s):

High Altitude ◽

National Football League ◽

Incidence Rates ◽

Protective Effects ◽

Acute Effects ◽

High Group ◽

Home Team ◽

Low Altitude ◽

And Training

Background: Despite the increased attention to sports-related concussion, the literature lacks information about the environmental factors that contribute to concussion incidence. Previous investigators have noted a decreased rate of concussion in football games played at higher altitude. Purpose/Hypothesis: The purpose of this study was to investigate whether the protective effects of altitude on concussion rate, as described by previous investigators, were due to acute effects of altitude exposure or chronic adaptations to training at altitude. Our hypothesis was that these protective effects are not attributable to relative cerebral edema that occurs in conditions of altitude-associated hypobaric hypoxia, known as the “slosh effect,” but rather result from long-term adaptations to training at altitude. Study Design: Descriptive epidemiology study. Methods: Athletes from the 2012, 2013, 2014, and 2015 National Football League (NFL) seasons were included in this analysis of publicly available data. Concussion rates were subdivided into 4 groups: (1) low-altitude teams playing below 644 feet (low-low), (2) low-altitude teams playing above 644 feet (low-high), (3) high-altitude teams playing below 644 feet (high-low), and (4) high-altitude teams playing above 644 feet (high-high). Results: Away teams had a significantly higher rate of concussion (0.32 concussions per exposure) compared with their home team counterparts (0.27 concussions per exposure; P = .03). Teams training and playing at high altitude had a 28% decreased concussion rate, which was significantly lower compared with concussion incidence rates for overall, low-low, and high-low groups ( P < .05). In comparison, teams that trained at altitude but played below 644 feet had the highest rate of concussion, at 0.36 concussions per exposure ( P < .05). Conclusion: These data indicate that living and training at altitude may have a protective effect on concussion rate, as evidenced by the significant reduction in the high-high group and the lack of an effect in the low-high group. However, teams from low altitude playing at high altitude did not have a statistically significant reduction in concussion rate. These results show that the slosh theory does not completely explain the effects of altitude on concussion incidence rate in the NFL. Further analyses are needed to investigate the true cause of altitude-induced protection in the NFL.

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Koala habitat use and population density: using field data to test the assumptions of ecological models

Australian Mammalogy ◽

10.1071/am12023 ◽

2013 ◽

Vol 35 (2) ◽

pp. 160 ◽

Cited By ~ 11

Author(s):

William Ellis ◽

Sean FitzGibbon ◽

Alistair Melzer ◽

Robbie Wilson ◽

Steve Johnston ◽

...

Keyword(s):

Field Data ◽

Model Parameters ◽

Diet Choice ◽

Limited Data ◽

Phascolarctos Cinereus ◽

The Relationship ◽

Term Data ◽

Conservation Decisions ◽

Conservation And Management

In principle, conservation planning relies on long-term data; in reality, conservation decisions are apt to be based upon limited data and short-range goals. For the koala (Phascolarctos cinereus), frequently reliance is made on the assumption that indirect signs can be used to indicate behavioural preferences, such as diet choice. We examined the relationship between the use of trees by koalas and the presence of scats beneath those trees. Tree use was associated with scat presence on 49% of occasions when koalas were radio-tracked in both central Queensland (n = 10 koalas) and south-east Queensland (n = 5 koalas), increasing to 77% of occasions when trees were rechecked the following day. Koala densities were correlated with scat abundance at sites with koala density between ~0.2 and 0.6 koalas per hectare. Our results confirm that scat searches are imprecise indicators of tree use by koalas, but demonstrate that these searches can be used, with caveats, to estimate koala population densities. We discuss how errors in estimating or applying predictive model parameters can bias estimates of occupancy and show how a failure to validate adequately the assumptions used in modelling and mapping can undermine the power of the products to direct rational conservation and management efforts.

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Long-term (>10-year) clinical follow-up after young embolic stroke/TIA of undetermined source

International Journal of Stroke ◽

10.1177/1747493019884520 ◽

2019 ◽

pp. 174749301988452 ◽

Cited By ~ 2

Author(s):

M Nassif ◽

ME Annink ◽

H Yang ◽

TCD Rettig ◽

YBWEM Roos ◽

...

Keyword(s):

Incidence Rate ◽

Recurrent Stroke ◽

Young Patients ◽

Incidence Rates ◽

Embolic Stroke ◽

Vascular Events ◽

Tertiary Center ◽

New Onset

Background To date, the pathophysiology of first-ever and recurrent stroke/TIA still remains unclear in young patients with embolic stroke/TIA of undetermined source (ESUS). Clinical studies with long-term follow-up in young ESUS patients are necessary to investigate the underlying pathophysiology of first-ever and recurrent stroke/TIA in this patient population, in particular the role of new-onset atrial fibrillation. Aims Our aim was to study the long-term (>10-year) clinical outcome of young patients (<50 years) with ESUS. Methods This cohort study included all patients aged ≤ 50 years who underwent transoesophageal echocardiography for diagnostic work-up of ESUS during 1996–2008 from one tertiary center. All patients were contacted by telephone between September–November 2018 to update clinical information from medical records. The clinical outcomes of this study were incidence rates of all-cause and cardiovascular mortality, recurrent stroke/TIA, new-onset clinical AF, and ischemic vascular events. Results In total, 108 patients (57% female, mean age 40 ± 7.2 years [range 19–50 years], n = 72 stroke) were included. Across clinical follow-up (median 13[IQR 10–16] years), 24 patients died ( n = 14 cardiovascular). The 15-year incidence rate of recurrent stroke/TIA was 15% (incidence rate = 1.09[95%CI 0.54–1.65]/100 patient-years) and a 5.5% incidence of new-onset clinical AF (incidence rate = 0.44[95%CI 0.09–0.79]/100 patient-years) following ESUS. Conclusions The incidence of recurrent stroke/TIA is relatively high during long-term clinical follow-up of young patients with ESUS. In contrast, new-onset clinical AF is relatively low and therefore may not play an important part in the pathophysiology of first-ever and recurrent stroke/TIA of these patients.

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Incidence of invasive breast cancer in women treated with testosterone implants: a prospective 10-year cohort study

BMC Cancer ◽

10.1186/s12885-019-6457-8 ◽

2019 ◽

Vol 19 (1) ◽

Cited By ~ 3

Author(s):

Rebecca L. Glaser ◽

Anne E. York ◽

Constantine Dimitrakakis

Keyword(s):

Breast Cancer ◽

Cohort Study ◽

Postmenopausal Women ◽

Incidence Rate ◽

Invasive Breast Cancer ◽

Incidence Rates ◽

Term Therapy ◽

Testosterone Therapy ◽

Historical Controls

Abstract Background Testosterone implants have been used for over eighty years to treat symptoms of hormone deficiency in pre and postmenopausal women. Evidence supports that androgens are breast protective. However, there is a lack of data on the long-term effect of testosterone therapy on the incidence of invasive breast cancer (IBC). This study was specifically designed to investigate the incidence of IBC in pre and postmenopausal women (presenting with symptoms of androgen deficiency) treated with subcutaneous testosterone implants or testosterone implants combined with anastrozole. Methods The 10-year prospective cohort study was approved in March 2008 at which time recruitment was initiated. Recruitment was closed March 2013. Pre and postmenopausal women receiving at least two pellet insertions were eligible for analysis (N = 1267). Breast cancer incidence rates were reported as an unadjusted, un-weighted value of newly diagnosed cases divided by the sum of ‘person-time of observation’ for the at-risk population. Incidence rates on testosterone therapy were compared to age-specific Surveillance Epidemiology and End Results (SEER) incidence rates and historical controls. Bootstrap sampling distributions were constructed to verify comparisons and tests of significance that existed between our results and SEER data. Results As of March 2018, a total of 11 (versus 18 expected) cases of IBC were diagnosed in patients within 240-days following their last testosterone insertion equating to an incidence rate of 165/100000 p-y, which is significantly less than the age-matched SEER expected incidence rate of 271/100000 p-y (p < 0.001) and historical controls. Conclusion Long term therapy with subcutaneous testosterone, or testosterone combined with anastrozole, did not increase the incidence of IBC. Testosterone should be further investigated for hormone therapy and breast cancer prevention.

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Multi-Center Calibration of the Second Reference Material for Thromboplastin, Rabbit, Plain, Coded CRM 149R

Thrombosis and Haemostasis ◽

10.1055/s-0038-1648132 ◽

1991 ◽

Vol 65 (03) ◽

pp. 263-267 ◽

Cited By ~ 3

Author(s):

A M H P van den Besselaar ◽

R M Bertina

Keyword(s):

Reference Material ◽

Standard Error ◽

Standard Errors ◽

Sensitivity Index ◽

Long Term Stability ◽

Significant Bias ◽

The Mean ◽

The Relationship ◽

International Sensitivity Index

SummaryIn a collaborative trial of eleven laboratories which was performed mainly within the framework of the European Community Bureau of Reference (BCR), a second reference material for thromboplastin, rabbit, plain, was calibrated against its predecessor RBT/79. This second reference material (coded CRM 149R) has a mean International Sensitivity Index (ISI) of 1.343 with a standard error of the mean of 0.035. The standard error of the ISI was determined by combination of the standard errors of the ISI of RBT/79 and the slope of the calibration line in this trial.The BCR reference material for thromboplastin, human, plain (coded BCT/099) was also included in this trial for assessment of the long-term stability of the relationship with RBT/79. The results indicated that this relationship has not changed over a period of 8 years. The interlaboratory variation of the slope of the relationship between CRM 149R and RBT/79 was significantly lower than the variation of the slope of the relationship between BCT/099 and RBT/79. In addition to the manual technique, a semi-automatic coagulometer according to Schnitger & Gross was used to determine prothrombin times with CRM 149R. The mean ISI of CRM 149R was not affected by replacement of the manual technique by this particular coagulometer.Two lyophilized plasmas were included in this trial. The mean slope of relationship between RBT/79 and CRM 149R based on the two lyophilized plasmas was the same as the corresponding slope based on fresh plasmas. Tlowever, the mean slope of relationship between RBT/79 and BCT/099 based on the two lyophilized plasmas was 4.9% higher than the mean slope based on fresh plasmas. Thus, the use of these lyophilized plasmas induced a small but significant bias in the slope of relationship between these thromboplastins of different species.

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