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Background/aimRugby union (‘rugby’) presents an above-average risk of injury to participants. BokSmart is a South African nationwide intervention that aims to reduce rugby-related injuries in players. This is achieved by educating coaches and referees to improve injury behaviour of players. Thus, the aim of this study was to assess if the receipt of injury-prevention education was associated with player behaviour.MethodsJunior (n=2279) and senior (n=1642) players, who attended merit-based South African Rugby tournaments (2008–2012), completed an anonymous questionnaire. Logistic regressions investigated if player injury-prevention behaviours were associated with the receipt of education on the same topic. Additionally, players' preferred sources of education were explored through frequency and χ2 analyses.ResultsOf the 16 injury-prevention behaviours, 12 (75%) were associated with receiving education on that topic. The four behaviours not associated with education were: warming-up (before training and matches), and avoiding heat and massage post injury. Of the seven possible sources of this education, the majority of players chose either coaches or physiotherapists as their preferred media. In comparison with junior players, more senior players chose physiotherapists instead of coaches for warming-up and cooling-down education.ConclusionsThe results of this study support, to a large degree, the strategy of BokSmart—influence of player behaviour through coach education. However, these findings also suggest that BokSmart could target team physiotherapists in addition to coaches and referees with their safety education. Also, players might have different preferences for this education depending on their age.

Youth have very high participation and injury rates in sport. Sport is the leading cause of injury in youth. Sport injury reduces future participation in physical activity which adversely affects future health. Sport injury may lead to overweight/obesity and post-traumatic osteoarthritis. The objective of the systematic review and meta-analysis was to evaluate the efficacy of injury prevention neuromuscular training strategies in youth sport. Three electronic databases were systematically searched up to September 2014. Studies selected met the following criteria: original data; analytic prospective design; investigated a neuromuscular training prevention strategy intervention(s) and included outcomes for injury sustained during sport participation. Two authors assessed the quality of evidence using Downs and Black (DB) criteria. Meta-analyses including randomised controlled trials only (RCTs) to ensure study design homogeneity were completed for lower extremity and knee injury outcomes. Of 2504 potentially relevant studies, 25 were included. Meta-analysis revealed a combined preventative effect of neuromuscular training in reducing the risk of lower extremity injury (incidence rate ratio: IRR=0.64 (95% CI 0.49 to 0.84)). Though not statistically significant, the point estimate suggests a protective effect of such programmes in reducing the risk of knee injury (IRR=0.74 (95% CI 0.51 to 1.07)). There is evidence for the effectiveness of neuromuscular training strategies in the reduction of injury in numerous team sports. Lack of uptake and ongoing maintenance of such programmes is an ongoing concern. A focus on implementation is critical to influence knowledge, behaviour change and sustainability of evidence informed injury prevention practice.

Background Ankle sprain is the most common sports-related injury with a high rate of recurrence and associated costs. Recent studies have emphasised the effectiveness of both neuromuscular training and bracing for the secondary prevention of ankle sprains. Aim To evaluate the effectiveness of combined bracing and neuromuscular training, or bracing alone, against the use of neuromuscular training on recurrences of ankle sprain after usual care. Methods 384 athletes, aged 18–70, who had sustained a lateral ankle sprain, were included (training group n=120; brace group n=126; combi group n=138). The training group received an 8-week home-based neuromuscular training programme, the brace group received a semirigid ankle brace to be worn during all sports activities for 12 months, and the combi group received both the training programme, as well as the ankle brace, to be worn during all sports activities for 8 weeks. The main outcome measure was self-reported recurrence of the ankle sprain. Results During the 1-year follow-up, 69 participants (20%) reported a recurrent ankle sprain: 29 (27%) in the training group, 17 (15%) in the brace group and 23 (19%) in the combi group. The relative risk for a recurrent ankle sprain in the brace group versus the training group was 0.53 (95% CI 0.29 to 0.97). No significant differences were found for time losses or costs due to ankle sprains between the intervention groups. Conclusions Bracing was superior to neuromuscular training in reducing the incidence but not the severity of self-reported recurrent ankle sprains after usual care.

Introduction To counteract the recently observed increase in forearm fractures in children worldwide, an educational programme to improve fall skills was developed. In this 8-week programme children learned basic martial arts falling techniques in their physical education classes. In this study, the effectiveness of this educational programme to improve fall skills was evaluated. Methods A cluster randomised controlled trial was conducted in 33 primary schools. The intervention group received the educational programme to improve falling skills during their physical education (PE) classes whereas the control group received their regular PE curriculum. At baseline (October 2009) and follow-up (May 2010), a questionnaire was completed by the children about their physical activity behaviours. Furthermore, fall-related injuries were registered continuously during an entire school-year. Results A total of 36 incident injuries was reported in the intervention group, equalling an injury incidence density (IID) of 0.14 fall-related injuries per 1000 h of physical activity (95% CI 0.09 to 0.18). In contrast, 96 injuries were reported by the control group corresponding to an IID of 0.26 (95% CI 0.21 to 0.32). However, because intracluster correlation was high (ICC=0.46), differences in injury incidence were not statistically significant. When activity level was taken into account, a trend was shown suggesting that the ‘falling is a sport’ programme was effective in decreasing falling-related injury risk, but only in the least active children. Discussion and conclusion Although results did not reach significance because of strong clustering effects, a trend was found suggesting that a school-based educational programme to improve falling skills may be more beneficial for the prevention of falling-related injuries in children with low levels of habitual physical activity.

Background The rapidly increasing burden of chronic disease is diffi cult to reconcile with the large, compelling body of literature that demonstrates the substantial preventive and therapeutic benefi ts of comprehensive lifestyle intervention, including physical activity, smoking cessation and healthy diet. Physical inactivity is now the fourth leading independent risk factor for death caused by non-communicable chronic disease. Although there have been efforts directed towards research, education and legislation, preventive efforts have been meager relative to the magnitude of the problem. The disparity between our scientifi c knowledge about chronic disease and practical implementation of preventive approaches now is one of the most urgent concerns in healthcare worldwide and threatens the collapse of our health systems unless extraordinary change takes place. Findings The authors believe that there are several key factors contributing to the disparity. Reductionism has become the default approach for healthcare delivery, resulting in fragmentation rather than integration of services. This, in turn, has fostered a disease-based rather than a health-based model of care and has produced medical school curricula that no longer accurately refl ect the actual burden of disease. Trying to ‘fi t’ prevention into a disease-based approach has been largely unsuccessful because the fundamental tenets of preventive medicine are diametrically opposed to those of disease-based healthcare. Recommendation A clinical discipline within medicine is needed to adopt disease prevention as its own reason for existence. Sport and exercise medicine is well positioned to champion the cause of prevention by promoting physical activity. Conclusion This article puts forward a strong case for the immediate, increased involvement of clinical sport and exercise medicine in the prevention and treatment of chronic disease and offers specifi c recommendations for how this may begin.

Purpose The aim of the present study was to investigate the effect of the JUMP-in programme on sports participation, overall physical activity (PA), shuttle run score and body composition in 6–12-year-old children. Methods JUMP-in is a school-based strategy combining environmental policy, neighbourhood, parents- and personal components. A controlled trial was carried out in 19 primary schools including 2848 children (50% boys). Measures were performed at the beginning of the first school year (T0: 2006) and repeated at the end of the first (T1: 2007) and second school year (T2: 2008). Results A significant beneficial intervention effect was found on organised sports participation (OR 2.8 (2.2 to 3.6)). Effects were stronger for girls (OR 3.6 (2.3 to 5.6)), and for Moroccan (OR 4.2 (3.6 to 5.7)) and Turkish children (OR 3.2 (1.9 to 5.2)). Participation in organised sports was associated with increased shuttle run score. No significant intervention effects on overall daily PA rates and body composition were observed. Conclusion The present study proves that a school-based strategy combining environmental and personal interventions was successful in improving structural sports participation among children.

Objective To determine if cross-sectional differences exist using SCAT3 scores for non-concussed England footballers with and without disability. Design Cross-sectional between group comparison of first-time collected SCAT3 scores. Setting All England team doctors and physiotherapists commenced between 1st August 2013 and 31st July 2014 standardised annual SCAT3 testing on England footballers following the Zurich 2012 concussion guidelines. Participants A convenience sample of England national football team players (total: 249; male: 174, female: 75), of whom 185 were athletes without disability (male: 119; female: 66) and 64 athletes with disability (male learning disability: 17; male cerebral palsy: 28; male blind: 10; female deaf: 9). Assessment and outcome measures Comparison between groups of median SCAT3 section scores was made with the non-parametric Mann-Whitney-Wilcoxon ranked-sum test. Main results Compared to male footballers without disability, male footballers with disability scored significantly higher for total number of symptoms and symptom severity. However, male footballers with learning disability demonstrated no difference with total number of symptoms and scored significantly lower on immediate memory and delayed recall . Male blind footballers scored significantly higher for total concentration and delayed recall. Male footballers with cerebral palsy scored significantly higher on balance testing and significantly lower on immediate memory. Conclusions The results of this study suggest that significant cross-sectional between-group variability exists in SCAT3 section scores when non-concussed footballers with disability are compared to footballers without disability. Future concussion consensus guidelines should recognise these between group differences and generate separate SCAT3 guidelines for the growing number of elite athletes living with disability. Competing interests None.

Background Exercise-based interventions have consistently been associated with a reduction in injury rates in sports such as football. Although the injury burden in rugby union (‘rugby’) is high, such interventions have not been evaluated in rugby. Objective To evaluate the effectiveness of the BokSmart Safe Six on (i) the injury risk profile and burden in junior rugby players in South Africa, and (ii) the injury prevention behavioural determinants of the coaches of these players. Design A pragmatic cluster-randomised controlled trial, with no blinding of groups. Setting Male youth rugby players from two geographically-separated locations in South Africa over the 2017 rugby playing season. Patients (or Participants) Youth rugby players (14–16 year old) (n=160 players in the intervention group; n=160 in the control group) will be recruited from the Western Cape Schools Premier Division. This sample size provides sufficient power to detect meaningful differences. Interventions (or Assessment of Risk Factors) The teams will be randomly allocated to groups that either: (i) have the BokSmart Safe Six coach-delivered exercise intervention in their warm-up (experimental group), or (ii) continue with their usual warm-up (control group). Injury risk profiles will be assessed on all players through musculoskeletal screening performed at the beginning, middle and end of the trial. Epidemiological measurements include injury surveillance at all matches and training sessions, and exposure to the various warm-up exercises (including BokSmart Safe Six exercises). Behavioural determinants of coaches will be assessed before and after the intervention through standardised theory of planned behaviour questionnaires and focus groups. Main Outcome Measurements Comparison in injury risk profiles and burden of injury between the intervention and control groups. Changes in the behavioural determinants of coaches.

Background The injury burden in rugby union is relatively high compared to other team sports. Therefore rugby would benefit by having effective injury prevention programmes. Exercise-based interventions have successfully reduced injuries in soccer studies, but evidence on exercise-based interventions in tackle collision sports, such as rugby, is limited. Objective To systematically examine the evidence of exercise-based intervention programmes reducing injuries in tackle collision sports. Design Systematic review. Setting PubMed, EbscoHost and Web of Science were searched for articles published between January 1995 and December 2015. The methodological quality was assessed using an adapted Cochrane Bone Joint and Muscle Trauma Group quality assessment tool. Patients (or Participants) N/A as this is a systematic review abstract. Interventions (or Assessment of Risk Factors) The inclusion criteria were: 1) all types of randomised controlled trials and cohort studies 2) sporting codes: American, Australian and Gaelic football, rugby union and rugby league 3) participants of any age or sex 4) exercise-based, prehabilitative intervention, and 5) primary outcome was injury number or incidence. The exclusion criteria were: 1) full-text of the article was unavailable 2) the article was unavailable in English. Main Outcome Measurements Effectiveness, and injury number or incidence. Results Nine studies with a total of 3517 participants were included in this review. Seven studies showed a statistically significant decrease in their primary outcome (injuries). These studies included three different sporting codes and various age groups, making it difficult to be confident about the inferences. The two studies that had the highest methodological quality showed no statistically significant decrease in injury incidence following an exercise-based intervention. Conclusions There is a lack of consistent evidence from high-level studies that exercise-based interventions in tackle collision sports reduce injuries.

Background Field hockey is a team sport with a high amount of running, stepping manoeuvres and player/material contact. Consequently, it can be expected that injury risk is high. Yet, little is know about injuries in this sport.\n\nObjective To measure the prevalence of injury during a field hockey season.\n\nDesign Prospective cohort.\n\nSetting A field hockey season of the Dutch elite division.\n\nParticipants 83 field hockey players (54 women and 29 men) of 5 different teams selected by convenience. Four players dropped out the study (1 woman and 3 men).\n\nIndependent variables Hours of sport exposure (specific training [i.e., on the field], additional training [e.g, fitness training], and competition).\n\nMain Outcome Measurements Prevalence of injury.\n\nResults In total, field hockey players spent 9,063 hours in hockey specific training, 3,378 in additional training and 2,412 in competition. The total hours of sport exposure was 14,853. A total of 143 injuries were recorded (63% overuse and 37% traumatic). This corresponds to a rate of 9.6 injuries per 1,000 hours of sport exposure. The average prevalence of injury was 26.7% (ranging from 9.6% to 49.1% per two weeks). Lower limbs were the most reported injury location (58.4%), followed by lumbar and thoracic spine/thorax (20.2%), upper limbs (17.8%) and head/neck (3.6%).\n\nConclusions This study establishes the extent and pattern of injuries in Dutch field hockey elite players. The next step, according to van Mechelen's sequence of prevention (1992), is to investigate the aetiology and mechanism of such injuries in order to develop and introduce preventive measures.

Background South Africa has 14 Provincial Rugby regions (9Unions9). Although rugby-related catastrophic injuries have been reported at 2.0 per 100 000 players per year, the comparative risk between each of these SA Unions has not yet been quantified. Understanding the difference in injury risk between Unions is important for potential intervention modifications. Objective The objective of this study was to compare the catastrophic injury incidence rates between the 14 SA Unions. Design A prospective, population-based study was conducted across all SA Unions between 2008–2014. Setting The number of verified players (males and females; under-seven age group to adult; amateur and professional) in each Union was obtained from SA Rugby9s 2013 Census. Patients (or Participants) Catastrophic injuries were analysed using BokSmart9s serious injury database. Interventions (or Assessment of Risk Factors) Union-specific injury incidence rates with 95% Confidence Intervals were calculated. Catastrophic injuries (Acute Spinal Cord Injuries (ASCI) and Traumatic Brain Injuries (TBI)) within Unions were compared statistically using a Poisson regression with Incidence Rate Ratios (IRR) and a 95% level of confidence (p Results Catastrophic injury incidence rates per Union ranged from 1.8 per 100 000 players (95% CI: 0.0 to 6.5) to 7.9 (95%CI: 0.0 to 28.5). The Union with the highest incidence rate of permanent outcome ASCIs was reported at 7.1 per 100 000 players (95% CI: 0.0 to 17.6). Compared to this Union, five (n=5/14, 36%) of the Unions had significantly lower injury incidence rates of ASCI. Conclusions Regional differences in catastrophic injury incidence rates exist in SA and interventions should be tailored accordingly. Future studies should investigate the underlying reasons contributing to these regional differences.

Occurrence of Parkinson’s disease (PD) has been reported to be associated with environmental factors, notably those associated with employment in the agricultural industry.1 Some have suggested that the agent associated with agriculture is pesticide exposure, although no specific class of pesticide has been identified.2 We suggest that besides pesticides, endotoxin (lipopolysaccaride, LPS) may also be an environmental factor. Endotoxin is a common airborne environmental and occupational contaminate in agricultural3 and other industries.4,5 Endotoxins are part of the outer …