A collagen prolyl 4-hydroxylase inhibitor reduces adhesions after tendon injury

Collagen synthesis inhibition potentially can reduce adhesion formation after tendon injury but also may affect cutaneous wound healing. We hypothesized that a novel orally administered collagen synthesis inhibitor (CPHI-I) would substantially reduce flexor tendon adhesions after injury, without any clinically important effect on cutaneous wound healing. The experiments were performed in a rat model with an in-continuity crush injury model in the rat hindfoot flexor tendon to provoke adhesion formation. Assays of dermal collagen production and the rate of healing of an excised wound were performed to assess cutaneous wound healing. Animals in the treatment groups received CPHI-I for 1, 2, or 6 weeks and were assessed at either 2 or 6 weeks. The work of flexion in the injured digit was reduced in the CPHI-I-treated animals compared with control animals, (0.188 J versus 0.0307 J at 2 weeks, and 0.0231 J versus 0.0331 J at 6 weeks) The cutaneous wound healing rate was similar in all animals, but dermal collagen synthesis was reduced in the treated animals. The CPHI-I seems to reduce tendon adhesion, and although collagen synthesis was reduced in cutaneous wounds, CPHI-I did not retard wound healing.

Using police crash databases for injury prevention research - a comparison of opt-out and opt-in approaches to study recruitment

Objective: The study aimed to examine the difference in response rates between opt-out and opt-in participant recruitment in a population-based study of heavy-vehicle drivers involved in a police-attended crash. Methods: Two approaches to subject recruitment were implemented in two different states over a 14-week period and response rates for the two approaches (opt-out versus opt-in recruitment) were compared. Results: Based on the eligible and contactable drivers, the response rates were 54% for the optout group and 16% for the opt-in group. Conclusions and Implications: The opt-in recruitment strategy (which was a consequence of one jurisdiction’s interpretation of the national Privacy Act at the time) resulted in an insufficient and potentially biased sample for the purposes of conducting research into risk factors for heavy-vehicle crashes. Australia’s national Privacy Act 1988 has had a long history of inconsistent practices by state and territory government departments and ethical review committees. These inconsistencies can have profound effects on the validity of research, as shown through the significantly different response rates we reported in this study. It is hoped that a more unified interpretation of the Privacy Act across the states and territories, as proposed under the soon-to-be released Australian Privacy Principles will reduce the recruitment challenges outlined in this study.

Personal injury in motor accident in NSW - procedural requirements under Motor Accidents Insurance Act 1988 (NSW)

In Hooper v Robinson [2002] QDC 080 (District Court of Queensland, D 4841 of 2001, McGill DCJ, 19.4.2002) McGill DCJ considered the application of the decision in John Pfeiffer Pty Ltd v Rogerson [2000] 203 CLR 503 to notice requirements such as in s42 of NSW Motor Accident Insurance Act 1988 and concluded such provisions are now substantive.

Study Protocol - Alcohol Management Plans (AMPs) in remote indigenous communities in Queensland: their impacts on injury, violence, health and social indicators and their cost-effectiveness

Background In 2002/03 the Queensland Government responded to high rates of alcohol-related harm in discrete Indigenous communities by implementing alcohol management plans (AMPs), designed to include supply and harm reduction and treatment measures. Tighter alcohol supply and carriage restrictions followed in 2008 following indications of reductions in violence and injury. Despite the plans being in place for over a decade, no comprehensive independent review has assessed to what level the designed aims were achieved and what effect the plans have had on Indigenous community residents and service providers. This study will describe the long-term impacts on important health, economic and social outcomes of Queensland’s AMPs. Methods/Design The project has two main studies, 1) outcome evaluation using de-identified epidemiological data on injury, violence and other health and social indicators for across Queensland, including de-identified databases compiled from relevant routinely-available administrative data sets, and 2) a process evaluation to map the nature, timing and content of intervention components targeting alcohol. Process evaluation will also be used to assess the fidelity with which the designed intervention components have been implemented, their uptake and community responses to them and their perceived impacts on alcohol supply and consumption, injury, violence and community health. Interviews and focus groups with Indigenous residents and service providers will be used. The study will be conducted in all 24 of Queensland’s Indigenous communities affected by alcohol management plans. Discussion This evaluation will report on the impacts of the original aims for AMPs, what impact they have had on Indigenous residents and service providers. A central outcome will be the establishment of relevant databases describing the parameters of the changes seen. This will permit comprehensive and rigorous surveillance systems to be put in place and provided to communities empowering them with the best credible evidence to judge future policy and program requirements for themselves. The project will inform impending alcohol policy and program adjustments in Queensland and other Australian jurisdictions. The project has been approved by the James Cook University Human Research Ethics Committee (approval number H4967 & H5241).

Eccentric hamstring strength and hamstring injury risk in Australian footballers

Purpose Is eccentric hamstring strength and between limb imbalance in eccentric strength, measured during the Nordic hamstring exercise, a risk factor for hamstring strain injury (HSI)? Methods Elite Australian footballers (n=210) from five different teams participated. Eccentric hamstring strength during the Nordic was taken at the commencement and conclusion of preseason training and in season. Injury history and demographic data were also collected. Reports on prospectively occurring HSIs were completed by team medical staff. Relative risk (RR) was determined for univariate data and logistic regression was employed for multivariate data. Results Twenty-eight HSIs were recorded. Eccentric hamstring strength below 256N at the start of preseason and 279N at the end of preseason increased risk of future HSI 2.7 (relative risk, 2.7; 95% confidence interval, 1.3 to 5.5; p = 0.006) and 4.3 fold (relative risk, 4.3; 95% confidence interval, 1.7 to 11.0; p = 0.002) respectively. Between limb imbalance in strength of greater than 10% did not increase the risk of future HSI. Univariate analysis did not reveal a significantly greater relative risk for future HSI in athletes who had sustained a lower limb injury of any kind within the last 12 months. Logistic regression revealed interactions between both athlete age and history of HSI with eccentric hamstring strength, whereby the likelihood of future HSI in older athletes or athletes with a history of HSI was reduced if an athlete had high levels of eccentric strength. Conclusion Low levels of eccentric hamstring strength increased the risk of future HSI. Interaction effects suggest that the additional risk of future HSI associated with advancing age or previous injury was mitigated by higher levels of eccentric hamstring strength.

Injury prevention among friends : the benefits of school connectedness

Unsafe road behaviors, violence and alcohol use, are primary contributors to adolescent injury. Research suggests that adolescents look out for their friends and engage in protective behavior to reduce others' risk-taking and that school connectedness is associated with reduced injury-risks. This study examined the role of school connectedness in willingness to protect and prevent friends from involvement in alcohol use, fights and unlicensed driving. Surveys were completed at two time points, six months apart, by 545 13-14 year olds from seven Australian high schools. Females were significantly more likely than males to report willingness to protect their friends. School connectedness significantly and positively predicted willingness to protect across all three injury-risk behaviors, after accounting for sex and own involvement in injury-risk behaviors. School connectedness may therefore be an important factor to target in school-based prevention programs, both to reduce adolescents' own injury-risk behavior and to increase injury prevention among friends.

Psychological predictors of injury in elite athletes

The Queensland Academy of Sport (QAS) supports over 600 high-level athletes across 20 sports. Given the high cost of injuries (e.g., time out of sport and consequent detraining, expense of rehabilitation, adverse social and economic effects), comprehensive injury management and prevention has become a priority for the QAS. Considering the potential for developing cost-effective, preventative programs, knowledge gained by examination of psychological screening predictors of injury may also prove beneficial for the broader sports medicine community. Aims were to: Objectively summarise existing injury characteristics, including the creation of population-specific norms for scholarship holders at the QAS. Assess relationships between injuries, specific medical factors (e.g., asthma, back pain) and psychological risk factors including life stress, mood, previous psychological diagnoses and disordered eating behaviour over a three-year period. Evaluate the effectiveness of the psychological component of the QAS Health Screening Questionnaire.

Biceps femoris long-head architecture: A reliability and retrospective injury study

Purpose: To determine i) the reliability of two-dimensional ultrasonography for the assessment of biceps femoris long head (BFlh) architectural characteristics; ii) if limbs with a history of strain injury in the BFlh display different architecture and eccentric strength compared to uninjured limbs. Methods: This case-control study (control [n=20], injured group [n=16], males) assessed the BFlh architecture at rest and during graded isometric contractions using two-dimensional ultrasonography. The control group were assessed three times (>24hrs apart) to determine reliability. Previously injured individuals were evaluated once. Results The assessment of BFlh architecture was highly reliable (intraclass correlations >0.90). Fascicle length (p<0.001; d range: 0.67 to 1.34) and fascicle length relative to muscle thickness (p<0.001; d range: 0.58 to 0.85) of the previously injured BFlh were significantly less than the contralateral uninjured BFlh at all intensities. Pennation angle of the previously injured BFlh was significantly greater (p<0.001; d range: 0.62 to 0.88) than the contralateral uninjured BFlh at all intensities. Eccentric strength in the previously injured limb was significantly lower than the contralateral limb (-15.4%; -52.5N; 95% CI=-28.45 to -76.23; p<0.001, d=0.56). Conclusion These data indicate that two-dimensional ultrasonography is reliable for assessing BFlh architecture at rest and during graded isometric contractions. Fascicle length, fascicle length relative to muscle thickness and pennation angle are significantly different in previously injured BFlh compared to an uninjured contralateral BFlh. Eccentric strength of the previously injured limb is also significantly lower than the uninjured contralateral limb. These findings have implications for rehabilitation and injury prevention practices which should consider altered architectural characteristics.

Alcohol-related emergency department injury presentations in Queensland adolescents and young adults over a 13-year period

Introduction and Aims. The rate of alcohol-related emergency department (ED) presentations in young people has increased dramatically in recent decades. Injuries are the most common type of youth alcohol-related ED presentation, yet little is known about these injuries in young people. This paper describes the characteristics of alcohol-related ED injury presentations in young people over a 13-year period and determines if they differ by gender and/or age group (adolescents: 12–17 years; young adults: 18–24 years). Design and Method. The Queensland Injury Surveillance Unit (QISU) database collects injury surveillance data at triage in participating EDs throughout Queensland, Australia. A total of 4667 cases of alcohol-related injuries in young people (aged 12–24 years) were identified in the QISU database between January 1999 and December 2011, using an injury surveillance code and nursing triage text-based search strategy. Results. Overall, young people accounted for 38% of all QISU alcohol-related ED injury presentations in patients aged 12 years or over. The majority of young adults presented with injuries due to violence and falls, whereas adolescents presented due to self-harm or intoxication without other injury. Males presented with injuries due to violence, whereas females presented with alcohol-related self-harm and intoxication. Discussion and Conclusions. There is a need for more effective ways of identifying the degree of alcohol involvement in injuries among young people presenting to EDs.

Boosting the effects of a curriculum based injury prevention program through a school connectedness intervention : final report to NRMA-ACT Road Safety Trust

Injury is the leading cause of death among young people (AIHW, 2008). A primary contributing factor to injury among adolescents is risk taking behaviour, including road related risks such as risky bicycle and motorcycle use and riding with dangerous or drink-drivers. Injury rates increase dramatically throughout adolescence, at the same time as adolescents are becoming more involved in risk taking behaviour. Also throughout this period, adolescents‟ connectedness to school is decreasing (Monahan, Oesterle & Hawkins, 2010; Whitlock, 2004). School connectedness refers to „the extent to which students feel personally accepted, respected, included, and supported by others in the school‟ (Goodenow, 1993, p. 80), and has been repeatedly shown to be a critical protective factor in adolescent development. For example, school connectedness has been shown to be associated with decreased risk taking behaviour, including violence and alcohol and other drug use (e.g., Resnick et al., 1997), as well as with decreased transport risk taking and vehicle related injuries (Chapman et al., accepted April 2011). This project involved the pilot evaluation of a school connectedness intervention (a professional development program for teachers) to reduce adolescent risk taking behaviour and injury. This intervention has been developed for use as a component of the Skills for Preventing Injury in Youth (SPIY) curriculum based injury prevention program for early adolescents. The objectives of this research were to: 1. Implement a trial School Connectedness intervention (professional development program for teachers) in ACT high schools, and evaluate using comparison high schools. 2. Determine whether the School Connectedness program impacts on adolescent risk taking behaviour and associated injuries (particularly transport risks and injuries). 3. Evaluate the process effectiveness of the School Connectedness program.