Background Figure skaters typically jump in only one direction, landing on the same leg. Current prevention programs in figure skating lack knowledge about the importance of jumping direction in injury etiology.Objective To describe lateralisation (handedness, footedness, jumping direction) in female competitive figure skaters and its association with injury risk.Design One-year retrospective cohort study.Setting All licensed competitive figure skaters (n=400) in the southeastern region of Sweden.Participants 137 female figure skaters (mean age 12.9 (SD 3.0) years). Assessment of Risk Factors Lateralisation data and significant sports injury episodes for one year were reported by skaters. Associations were analyzed between handedness and jump-landing leg and between lateralization (right-sided/left-sided/mixed) and injury-sidedness (right/left/bilateral).Main Outcome Measurements Significant sports injury episode with time loss from sports >21 days. Results Most skaters reported right-side handedness (93%), footedness (87%) and landing leg (85%). The jumping direction (landing leg) was associated with handedness/footedness (p=0.035). Forty-two skaters (31%) had suffered a significant sports injury episode. Fifty-nine injuries (64% overuse/36% traumatic) were reported; 48 (83%) were located to the lower extremities; 35% of the lower extremity injuries involved only the landing leg. No association between left-sidedness and overuse injury episode (p=0.463) or traumatic injury (p=0.760) incidence during the study period was observed. Neither was any association found between lateralisation and distribution of injury to sides (p=0.328).Abstract 863 Figure 1 DAGitty on theoretically potential pathways between lateralisation, asymmetrical loading and injury aetiology. In figure skating, you specialise very early in jumping/spining in only one direction(thus all jumps on the sme leg). Accumulated load (skating level, years as a figure skater, training hours) may contribute to a component of exhaustion and more asymmertical loading enhancing lateralisation. The degree of laterlisation may affect balance, coordination and injury location. Athletes prone to left-wise dexterity skate with their “creative” brain and may be more prone to injury when exhaused, as well as having worse mental health in terms of body image, anxiety and depressin indicators. Blue node = outcome and ancestors of the outcome.Green node = exposure. Light grey node = unobserved (latent). Green arrow = casual path.View this table:Abstract 863 Table 1 Localization of injuries sustained in the last 12 months (n=59) with regard to lateralization injuries categorized into overuse and traumatic injuries, respectively.Conclusions Right-side handedness, footedness, and jump landing leg dominated in female competitive figure skaters. No association was found between the side that injury was sustained and the skater’s jumping direction. The relatively small size of the study implies that the risk of type 1 error must be considered. The results can be used to inform injury prevention programs for figure skaters. More research is needed on the contribution of laterality and asymmetric loading.

Objectives To examine whether universal prevention via a digital health platform can reduce the injury incidence in athletics athletes aged 12-15 years and if club size had an influence on the effect of the intervention. Methods This was a cluster randomised trial where young athletics athletes were randomised through their club following stratification by club size into intervention (11 clubs; 56 athletes) and control (10 clubs; 79 athletes) groups. The primary endpoint was time from baseline to the first self-reported injury. Intervention group parents and coaches were given access to a website with health information adapted to adolescent athletes and were encouraged to log in and explore its content during 16 weeks. The control group continued training as normal. Training exposure and injury data were self-reported by youths/parents every second week, that is, eight times. The primary endpoint data were analysed using the log-rank test. Cox proportional hazards regression was used to analyse the second study aim with intervention status and club size included in the explanatory models. Results The proportion of completed training reports was 85% (n=382) in the intervention group and 86% (n=545) in the control group. The injury incidence was significantly lower (HR=0.62; chi(2)=3.865; p=0.049) in the intervention group. The median time to first injury was 16 weeks in the intervention group and 8 weeks in the control group. An interaction effect between the intervention and stratification factor was observed with a difference in injury risk between athletes in the large clubs in the intervention group versus their peers in the control group (HR 0.491 (95% CI 0.242 to 0.998); p=0.049). Conclusions A protective effect against injury through universal access to health information adapted for adolescent athletes was observed in youth athletics athletes. The efficacy of the intervention was stronger in large clubs.

Background Although figure skating attracts several hundred thousand participants worldwide, there is little knowledge about physical health and sports injuries among young skaters.Objective To describe the health status of a geographically-defined Swedish population of licensed competitive figure skaters and to examine injury determinants.Design Cross-sectional.Setting All licensed competitive skaters in the south-eastern region of Sweden.Participants In total, 142 (36%) of 400 skaters participated, 137 (96%) of whom were girls (mean (SD) age: 12.9 (SD 3.0) years). Participating boys (n=5) were excluded from further analysis.Assessment of Risk Factors Age, skating level, eating habits, relative energy deficiency indicators, and training habits were assessed.Main Outcome Measurements The primary outcome measure was the one-year prevalence of a severe sports injury episode (time loss>21 days). The secondary outcome measure was the point prevalence of an ongoing sports injury.Results The one-year prevalence of a severe sports injury episode was 31%, which in the multiple model, was associated with older age (odds ratio (OR) 1.2, 95% confidence interval (CI) 1.1–1.4; p=0.002) and an increased number of skipped meals per week (OR 1.1, 95% CI 1.0–1.3; p=0.014). The point prevalence of an ongoing injury episode was 19%, which was associated with older age (OR 1.4, 95% CI 1.2–1.7; p<0.001) and an increased number of skipped meals per week (OR 1.1, 95% CI 1.0–1.3; p=0.049).Conclusions One-third of young female Swedish competitive figure skaters had sustained a severe injury episode during the past year, and a fifth reported an ongoing episode. Older age and an increased number of skipped meals per week were associated with a sports injury episode. Further prospective studies of injury determinants among competitive figure skaters are warranted before the findings are broadly applied in intervention programs.

Mindre än två månader – så kort kan tiden enligt uppskattningar vara från upptäckten av ett virus med pandemisk potential till dess att virusets spridning över världen når exponentiell takt. Nationella regeringar och myndigheter har därför kort tid på sig för att i samråd med internationella organ planera och införa åtgärder för att hindra eller begränsa smittspridningen inom respektive land.

I det tidiga skedet av en viruspandemi är kunskapen om virusets natur och spridningsvägar låg. Detta ställer prediktion av pandemins utveckling inför metodologiska utmaningar. Under år 2020 har prediktionsmodeller legat till grund för nationellt beslutsfattande och vårdplanering inom sjukvårdsregioner i Sverige. Det är viktigt att klarlägga tillförlitligheten och precisionen i dessa modeller relaterat till den faktiska utvecklingen av covid-19 i landet. Målsättningen med den här studien var att:

1. Beskriva modeller för prediktion av spridning av covid-19 och relaterad sjukvårdsbelastning i Sverige publicerade mellan 2020-01-01 och 2020-12-31 (prediktioner, scenarion, prognoser etc.), samt
2. Utvärdera modellerna ur kvalitetssynpunkt och jämföra modellerat/predicerat utfall med det observerade utfallet under den aktuella tidsperioden.

Studien genomfördes som en systematisk litteraturgenomgång och resultatsyntes (sammanställning). För ändamålet utfördes sökningar efter vetenskapliga publikationer (vetenskapligt granskade innan publicering), preprints (artiklar av vetenskaplig karaktär som publiceras öppet utan föregående granskning) samt den grå litteraturen (rapporter och underlag publicerade av organisationer och myndigheter). Studieprotokollet är registrerat i databasen för strukturerade litteratursynteser och metaanalyser PROSPERO (International prospective register of systematic reviews) dnr CRD42021229514 (tillgänglig: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021229514).

I litteratursökningen identifierades initialt 1478 artiklar; 892 genom systematisk sökning efter kollegialt granskade vetenskapliga artiklar, 566 genom explorativ sökning i preprint-arkiv, samt 20 rapporter via uppslagssökning i den grå litteraturen. Efter granskning av sammanfattningar och därefter hela titlar med avseende på urvalskriterierna kvarstod totalt 33. Elva av dessa uteslöts på grund av risk för påverkan från felkällor. Av de 22 titlar som ingick i den avslutande resultatsyntesen var omkring hälften vetenskapliga publikationer och de övriga var myndighetsrapporter.

Den detaljerade analysen visade att prediktionernas faktiska precision och tillförlitlighet sällan rapporterades tillsammans med modellerna. Endast ett fåtal artiklar beskrev någon form av validering och bara två modeller hade utvärderats framåtblickande (prospektivt). När vi gjorde en sekundär utvärdering mot faktiska data fann vi att bara två modeller av beläggning på intensivvårdsavdelningar och fyra modeller av antalet dödsfall överensstämde tillfredsställande med det faktiska utfallet. Att jämföra modeller och dra slutsatser var dock svårt då somliga prediktioner publicerades avsevärt före den tidsperiod som de gällde, medan andra publicerades i anknytning till perioden eller i efterhand.

Avsaknaden av metodologiskt väl utförda utvärderingar begränsar möjligheterna att samla erfarenheter om värdet av att vid framtida pandemier använda prediktionsmodellering. Förutom brister gällande validering och utvärdering noterade vi att dokumentationen av modellerna, och redovisningen av de antaganden som gjorts, generellt var otillräcklig.

Trots dessa brister måste prediktionsmodellerna anses ha bidragit positivt till förståelsen av pandemins utveckling i Sverige under 2020 och möjligheterna att genomföra interventioner. Exempelvis visade modellerna att smittspridningen kunde förväntas skilja sig avsevärt åt mellan de svenska sjukvårdsregionerna. Scenariomodellerna visade även hur förändringar i sociala kontaktmönster har samband med smittspridning givet olika fasta antaganden. Bidraget skulle ha varit ännu mer värdefullt om rapporteringen av modellerna hade varit tydligare med om de ansågs vara prediktioner, eller om de skulle betraktas som en del av större scenarion med alternativa utvecklingar givet olika antaganden.

Vi drar slutsatserna att forskare, myndigheter och andra organ som publicerar pandemimodeller måste vara tydliga i sin kommunikation med avseende på avsedda mottagare (andra forskare, myndigheter, allmänheten, etc.), avsikten med modellen (scenario eller prediktion), data och antaganden som använts, samt hur tillförlitligheten i utfallet ska tolkas. I synnerhet behöver rapporteringen av pandemimodeller vara tydlig med avseende på om modellerna ska betraktas som prediktioner av en trolig utveckling, eller som scenarier som beskriver hypotetiska förlopp givet olika antaganden.

Vid framtida pandemier behöver kunskap om prediktioners tillförlitlighet grundläggas redan tidigt under spridningsförloppet. Utvärderingsprotokoll bör skapas och registreras i internationella databaser för forskningsprotokoll före initiering av datainsamlingen. Rutiner för samarbete mellan nationella myndigheter, sjukvårdsregioner och akademiska institutioner behöver etableras för att sammanföra modelleringskompetens och data.

Fortsatt utvecklingsarbete och forskning behövs om utvärderingsmetoder för pandemimodeller. Förutom att prediktioner måste vara tillförlitliga och begripliga, ska scenariomodeller generera realistiska scenarier. Därför behöver metoder för utvärdering av scenariomodellers interna logik, rimlighet och pluralism utvecklas.

OBJECTIVES: To investigate whether self-reported health complaints and choice of heat stress prevention strategies during the taper predicted peaking at an athletics championship in hot conditions.

DESIGN: Cohort study.

METHODS: Data on health and heat stress prevention were collected before the 2015 World Athletics Championship in Beijing, China. Peaking was defined using the athlete's pre-competition ranking and final competition rank. Baseline and endpoint data were fitted into multiple logic regression models.

RESULTS: Two hundred forty-five (29%) of 841 eligible athletes participated. Both sprint/power (Odds ratio (OR) 0.33 (95% Confidence interval (CI) 0.11 to 0.94), P=0.038) and endurance/combined events (OR 0.38 (95% CI 0.14 to 1.00), P=0.049) athletes having sustained concern-causing health complaints during the taper were less likely to peak. Endurance/combined events athletes who chose pre-cooling to mitigate heat stress were less likely to peak (OR 0.35 (95% CI 0.15 to 0.80), P=0.013), while sprint/power athletes reporting a sudden-onset injury complaint during the taper displayed increased peaking (OR 4.47 (95% CI 1.28 to 15.59), P=0.019).

CONCLUSIONS: Health complaints that caused the athlete concern during the taper were predictive of failure to peak at a major athletics competition. Sprint/power athletes who experienced an acute injury symptom during the taper appeared to benefit from rest. Pre-cooling strategies seem to require further validation during real-world endurance/combined events. It appears that athletics athletes' self-reported health should be monitored during the taper, concerns addressed, and heat stress prevention strategies individually tested before championships in hot conditions.

The mothers nutritional literacy is an important determinant of child malnourishment. We assessed the effect of a smartphone-based maternal nutritional education programme for the complementary feeding of undernourished children under 3 years of age in a food-secure middle-income community. The study used a randomised controlled trial design with one intervention arm and one control arm (n = 110; 1:1 ratio) and was performed at one well-child clinic in Urmia, Iran. An educational smartphone application was delivered to the intervention group for a 6-month period while the control group received treatment-as-usual (TAU) with regular check-ups of the childs development at the well-child centre and the provision of standard nutritional information. The primary outcome measure was change in the indicator of acute undernourishment (i.e., wasting) which is the weight-for-height z-score (WHZ). Children in the smartphone group showed greater wasting status improvement (WHZ +0.65 (95% Confidence Interval (CI) +/- 0.16)) than children in the TAU group (WHZ +0.31 (95% CI +/- 0.21); p = 0.011) and greater reduction (89.6% vs. 51.5%; p = 0.016) of wasting caseness (i.e., WHZ < 2; yes/no). We conclude that smartphone-based maternal nutritional education in complementary feeding is more effective than TAU for reducing undernourishment among children under 3 years of age in food-secure communities.

Objective To compare injury rates among professional mens football teams that have a winter break in their league season schedule with corresponding rates in teams that do not. Methods 56 football teams from 15 European countries were prospectively followed for seven seasons (2010/2011-2016/2017)-a total of 155 team-seasons. Individual training, match exposure and time-loss injuries were registered. Four different injury rates were analysed over four periods within the season, and linear regression was performed on team-level data to analyse the effect of winter break on each of the injury rates. Crude analyses and analyses adjusted for climatic region were performed. Results 9660 injuries were reported during 1 447 011 exposure hours. English teams had no winter break scheduled in the season calendar: the other European teams had a mean winter break scheduled for 10.0 days. Teams without a winter break lost on average 303 days more per season due to injuries than teams with a winter break during the whole season (pamp;lt;0.001). The results were similar across the three periods August-December (p=0.013), January-March (pamp;lt;0.001) and April-May (p=0.050). Teams without a winter break also had a higher incidence of severe injuries than teams with a winter break during the whole season (2.1 severe injuries more per season for teams without a winter break, p=0.002), as well as during the period JanuaryMarch (p=0.003). A winter break was not associated with higher team training attendance or team match availability. Climatic region was also associated with injury rates. Conclusions The absence of a scheduled winter break was associated with a higher injury burden, both before and during the two periods following the time that many European teams take a winter break. Teams without a winter break (English clubs) had a higher incidence of severe injuries following the time of the year that other teams (other European clubs) had their scheduled break.

Objective To examine associations between lifetime sexual and physical abuse, and the likelihood of injury within and outside sport in athletes involved in competitive athletics.

Methods A cross sectional study was performed among the top 10 Swedish athletics athletes using 1 year prevalence of sports and non-sports injuries as the primary outcome measure. Associations with sociodemographic characteristics, lifetime abuse history and training load were investigated. Data were analysed using simple and multiple logistic regression models.

Results 11% of 197 participating athletes reported lifetime sexual abuse; there was a higher proportion of women (16.2%) than men (4.3%) (P=0.005). 18% reported lifetime physical abuse; there was a higher proportion of men (22.8%) than women (14.3%) (P=0.050). For women, lifetime sexual abuse was associated with an increased likelihood of a non-sports injury (OR 8.78, CI 2.76 to 27.93; P<0.001). Among men, increased likelihood of a non-sports injury was associated with more frequent use of alcoholic beverages (OR 6.47, CI 1.49 to 28.07; P=0.013), while commencing athletics training at >13 years of age was associated with a lower likelihood of non-sports injury (OR 0.09, CI 0.01 to 0.81; P=0.032). Lifetime physical abuse was associated with a higher likelihood of sports injury in women (OR 12.37, CI 1.52 to 100.37; P=0.019). Among men, athletes with each parents with ≤12 years formal education had a lower likelihood of sustaining an injury during their sports practice (OR 0.37, CI 0.14 to 0.96; P=0.040).

Conclusions Lifetime sexual and physical abuse were associated with an increased likelihood of injury among female athletes. Emotional factors should be included in the comprehension of injuries sustained by athletes.

Den här rapporten beskriver arbetet med att utveckla prognosmodellen samt den utvecklade Excel-baserade modellen. Den nya modellen skiljer sig från tidigare använda metoder och modeller främst genom att databasen Concise används som datakälla men också genom att man i den generella trend-prognosen kan ändra prognosperioder, göra befolkningsjusteringar och på ett transparent sätt införa manuella justeringar. Den skiljer sig också från tidigare modeller genom att den använder skilda ar-betsböcker för att beräkna kostnader för förmånsläkemedel, slutenvårdsläkemedel och smittskydds-läkemedel.

Det är tänkt att rapporten ska kunna användas som manual och instruktionsbok för användare av modellen. Den förklarar även hur modellen är uppbyggd och hur man väljer ut och importerar dataset från Concise och SCB som källor för den generella trendprognosen. I avsnittet Trendanalys förklaras vilka statistiska metoder som används i modellen. Avsnittet Excelboken beskriver hur trendprognosen tas fram. I slutet av rapporten redogörs för modellens validering och begränsningar.