Παρασκευή, 27 Μαΐου 2016

A study identifying factors related to the home delivery attended by the midwives in the health center of Mawasangka, Middle Buton Regency

Source: International Journal of Medical Science and Public Health
Risnawati Zuhaeni, Sukri Palutturi, Syamsiar Russeng, Hasanuddin Nuru Pasi.
Background: The location and person who help the baby delivery would directly affect mothers health. Objective: To identify factors related to the home delivery attended by the midwives in the Health Center of Mawasangka, Middle Buton Regency. Materials and Methods: This is a cross-sectional study with 100 mothers as participants who met the inclusive criteria, and they were chosen by using the purposive sampling technique. Result: The result showed that respondents who chose to give birth at home with and without assistance of the midwives were 78 (78%) and 22 (22%) respondents, respectively. The statistical analysis using the 2-test showed that the factors significantly related to the utilization of the midwives assistance in the home delivery were the attitudes (p = 0.002

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Advocacy for a responsive health system to control diabetes: learning from western Indian state Gujarat, India

Source: International Journal of Medical Science and Public Health
Sandul Yasobant, Deepak Saxena, Mayur Trivedi, Kumar Gaurav, Sushil Patel, Mayur Patel.
Background: Health advocacy is vital for the attainment of better health outcomes. First step in the process of advocacy is to identify the problems followed by potential interventions. Along with the need of advocacy, one needs to understand and recognize that the sustainability and effectiveness of any program can be enhanced only by the commitment of policymakers. Keeping this background, this study tried to document that, how advocacy works to make a health system responsive to control diabetes burden in one of the western Indian state, Gujarat. Objectives: Present study aims to document the initiatives undertaken by the Government for control of diabetes followed by advocacy at different level of the health system. Materials and Methods: Interventions in the form of training and advocacy mobilization were carried out in three districts of Gujarat namely Mehsana district (Rural), Vadodara district (Tribal), and Ahmedabad district (Urban). Responses by the health system were documented with reference to diabetes management and access to diabetic care. Results: Awareness about availability of services was done with frontline health workers. Participation of medical college in training of health-care providers, improved the capacity and managerial effectiveness on diabetic management. Specific budgetary provision for diabetes management, improved availability of antidiabetes drugs by public-private-partnership (PPP) and supply of Auto-Analyzer to all the health facilities and enhancing Management of Information System (MIS) through advocacy found to be effective. Conclusion: Targeted advocacy at different level was successful. Key advocacy strategies such as training to all health-care providers, involving community-level health workers with incentives improving access to diabetic care, ensuring availability of diabetic drugs through PPP and developing MIS increased reporting of diabetes cases. Further studies are required in other parts of developing nation to understand the key strategies applicable to respective settings.

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Mental health of females after mastectomy: a qualitative case study, Gujarat, India

Source: International Journal of Medical Science and Public Health
Poonam Trivedi, Megha Soni, Deepak Saxena.
Background: Breast cancer (Ca) is by far the most frequent cancer among women globally. It is now the most common Ca in both developed and developing regions. In India, Ca breast is the first common cause of Ca diagnosed in women and it is estimated to increase in coming years. Although with the availability of treatment, the survival rate of patients has increased, still limited research on the postsurgical mental status of females having Ca breast especially from India. Objectives: Present study explores the mental status of females who underwent mastectomy surgery. Materials and Methods: A qualitative study (mainly in-depth interviews) was conducted among females of Ca breast who underwent mastectomy. Themes include self-reaction and reaction of family members at the time of diagnosis and reaction during pre- and postsurgery period. Coping mechanism adopted pre- and postsurgery were also documented. Interviews were analyzed using Atlas Ti software. Results: The result indicates immense fear of disfigurement, which leads to denial for the surgery. There was also intense fear of relapse, which causes anticipatory waiting for next checkup. Strong social support, high family functioning, and faith in God are reported to be positive personal resources for coping. Conclusion: Present study explores various mental health issues that a woman has to face during diagnosis and the rest of the life, and narrates an urgent need for counseling for the patients and family members. The result of this study reinforces the need for counseling and to consolidate physical and psychological rehabilitation to ensure permanent cancer care.

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Cholesterol lowering property of garlic (Allium sativum) on patients with hypercholesterolemia

Source: International Journal of Medical Science and Public Health
Preety Lachhiramka, Sujay Patil.
Background: Cardiovascular disease especially atherosclerotic coronary heart disease (CHD) accounts for a large population of all deaths and disability worldwide. Elevated lipid levels have a strong association with cardiovascular events. Objectives: Study aim is to reduce cholesterol levels with garlic supplementation. Materials and Methods: It is a prospective, interventional open-label study to see the effect of garlic on serum cholesterol levels. Study was conducted in the Department of Pharmacology and Therapeutics, Rajendra Institute of Medical Sciences, Ranchi. Fifty Healthy subjects with elevated cholesterol levels between 240 and 330 mg/dL were enrolled. Subjects were given 3 g of raw garlic daily for a total period of 90 days. Follow-up was done on 30th, 60th, and 90th day after starting treatment. Results: In male patients, the serum cholesterol level showed significant decrease of 13% (P

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Public health expenditure of BRICS countries – an empirical analysis

Source: International Journal of Medical Science and Public Health
Jaya Veerasamy Arun, Dharumaraj Kumar.
Background: Health expenditure is vital as it increases labor productivity which further induces growth and development. Health-care expenses in BRICS countries are not only inadequate and access to them varies across countries which are mainly influenced by the socioeconomic conditions as well as by the health policies in place. Objective: The purpose of this study was to analyze the per capita public health expenditure of BRICS countries in relation to exogenous explanatory variables. Materials and Methods: The study used panel data of five countries from 1995 to 2013. Data for the per capita public health expenditure, per capita GDP, and the other six variables were obtained from the World Bank. Hausman test was in favor of fixed effect panel data regression model to determine the effects of public health expenditure on health outcomes. Result: The results indicate per capita GDP, death rate, life expectancy at birth, and infant mortality rate under five were significantly contributing to the increase in the per capita public health expenditure. Variables such as infant mortality rate and percent of population above 65 years show negative correlation with that of per capita public health expenditure. Conclusion: The findings imply that public health expenditure plays a crucial role in providing better health care to people in BRICS countries. The policy implication is that government of respective BRICS countries has to increase its budgetary allocation to the health sector to catch up with the standard of human capital achieved by developed countries.

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Late Stone Age human remains from Ishango (Democratic Republic of Congo): New insights on Late Pleistocene modern human diversity in Africa

Publication date: July 2016
Source:Journal of Human Evolution, Volume 96
Author(s): I. Crevecoeur, A. Brooks, I. Ribot, E. Cornelissen, P. Semal
Although questions of modern human origins and dispersal are subject to intense research within and outside Africa, the processes of modern human diversification during the Late Pleistocene are most often discussed within the context of recent human genetic data. This situation is due largely to the dearth of human fossil remains dating to the final Pleistocene in Africa and their almost total absence from West and Central Africa, thus limiting our perception of modern human diversification within Africa before the Holocene.Here, we present a morphometric comparative analysis of the earliest Late Pleistocene modern human remains from the Central African site of Ishango in the Democratic Republic of Congo. The early Late Stone Age layer (eLSA) of this site, dated to the Last Glacial Maximum (25–20 Ky), contains more than one hundred fragmentary human remains. The exceptional associated archaeological context suggests these remains derived from a community of hunter-fisher-gatherers exhibiting complex social and cognitive behaviors including substantial reliance on aquatic resources, development of fishing technology, possible mathematical notations and repetitive use of space, likely on a seasonal basis.Comparisons with large samples of Late Pleistocene and early Holocene modern human fossils from Africa and Eurasia show that the Ishango human remains exhibit distinctive characteristics and a higher phenotypic diversity in contrast to recent African populations. In many aspects, as is true for the inner ear conformation, these eLSA human remains have more affinities with Middle to early Late Pleistocene fossils worldwide than with extant local African populations. In addition, cross-sectional geometric properties of the long bones are consistent with archaeological evidence suggesting reduced terrestrial mobility resulting from greater investment in and use of aquatic resources.Our results on the Ishango human remains provide insights into past African modern human diversity and adaptation that are consistent with genetic theories about the deep sub-structure of Late Pleistocene African populations and their complex evolutionary history of isolation and diversification.

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The Use of Targeted Marker Subsets to Account for Population Structure and Relatedness in Genome-Wide Association Studies of Maize (Zea mays L.)

A typical plant genome-wide association study (GWAS) uses a mixed linear model (MLM) that includes a trait as the response variable, a marker as an explanatory variable, and fixed and random effect covariates accounting for population structure and relatedness. Although effective in controlling for false positive signals, this model typically fails to detect signals that are correlated with population structure or are located in high linkage disequilibrium (LD) genomic regions. This result likely arises from each tested marker being used to estimate population structure and relatedness. Previous work has demonstrated that it is possible to increase the power of the MLM by estimating relatedness (i.e., kinship) with markers that are not located on the chromosome where the tested marker resides. To quantify the amount of additional significant signals one can expect using this so-called K_chr model, we reanalyzed Mendelian, polygenic and complex traits in two maize (Zea mays L.) diversity panels that have been previously assessed using the traditional MLM. We demonstrated that the K_chr model could find more significant associations, especially in high LD regions. This finding is underscored by our identification of novel genomic signals proximal to the tocochromanol biosynthetic pathway gene ZmVTE1 that are associated with a ratio of tocotrienols. We conclude that the K_chr model can detect more intricate sources of allelic variation underlying agronomically important traits, and should therefore become more widely used for GWAS. To facilitate the implementation of the K_chr model, we provide code written in the R programming language.

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Diversifying Selection Between Pure-Breed and Free-Breeding Dogs Inferred from Genome-Wide SNP Analysis

Domesticated species are often composed of distinct populations differing in the character and strength of artificial and natural selection pressures, providing a valuable model to study adaptation. In contrast to pure-breed dogs that constitute artificially maintained inbred lines, free-ranging dogs are typically free-breeding, i.e. unrestrained in mate choice. Many traits in free-breeding dogs (FBDs) may be under similar natural and sexual selection conditions to wild canids, while relaxation of sexual selection is expected in pure-breed dogs. We used a Bayesian approach with strict false-positive control criteria to identify FST-outlier SNPs between FBDs and either European or East Asian breeds, based on 167,989 autosomal SNPs. By identifying outlier SNPs located within coding genes, we found four candidate genes under diversifying selection shared by these two comparisons. Three of them are associated with the Hedgehog (HH) signalling pathway regulating vertebrate morphogenesis. A comparison between FBDs and East Asian breeds also revealed diversifying selection on BBS6 gene, which was earlier shown to cause snout shortening and dental crowding via disrupted HH signalling. Our results suggest that relaxation of natural and sexual selection in pure-breed dogs as opposed to FBDs could have led to mild changes in regulation of the HH signalling pathway. HH inhibits adhesion and migration of neural crest cells from neural tube, and minor deficits of these cells during embryonic development have been proposed as the underlying cause of "domestication syndrome". This suggests that the process of breed formation involved the same genetic and developmental pathways as the process of domestication.

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Long Terminal Repeat Retrotransposon Content in Eight Diploid Sunflower Species Inferred from Next-Generation Sequence Data

The most abundant transposable elements (TEs) in plant genomes are Class I long terminal repeat (LTR) retrotransposons represented by superfamilies gypsy and copia. Amplification of these superfamilies directly impacts genome structure and contributes to differential patterns of genome size evolution among plant lineages. Utilizing short-read Illumina data and sequence information from a panel of Helianthus annuus (sunflower) full-length gypsy and copia elements, we explore the contribution of these sequences to genome size variation among eight diploid Helianthus species and an outgroup taxon, Phoebanthus tenuifolius. We also explore transcriptional dynamics of these elements in both leaf and bud tissue via RT-PCR. We demonstrate that most LTR retrotransposon sublineages (i.e., families) display patterns of similar genomic abundance across species. A small number of LTR retrotransposon sublineages exhibit lineage specific amplification, particularly in the genomes of species with larger estimated nuclear DNA content. RT-PCR assays reveal that some LTR retrotransposon sublineages are transcriptionally active across all species and tissue types, whereas others display species-specific and tissue-specific expression. The species with the largest estimated genome size, Helianthus agrestis, has experienced amplification of LTR retrotransposon sublineages, some of which have proliferated independently in other lineages in the Helianthus phylogeny.

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A Genome-Wide Association Study for Regulators of Micronucleus Formation in Mice

In mammals the regulation of genomic instability plays a key role in tumor suppression and also controls genome plasticity, which is important for recombination during the processes of immunity and meiosis. Most studies to identify regulators of genomic instability have been performed in cells in culture or in systems that report on gross rearrangements of the genome, yet subtle differences in the level of genomic instability can contribute to whole organism phenotypes such as tumour predisposition. Here we performed a genome-wide association study in a population of 1379 outbred Crl:CFW(SW)-US_P08 mice to dissect the genetic landscape of micronucleus formation, a biomarker of chromosomal breaks, whole chromosome loss, and extra-nuclear DNA. Variation in micronucleus levels is a complex trait with a genome-wide heritability of 53.1%. We identify seven loci influencing micronucleus formation (false discovery rate<5%), and define candidate genes at each locus. Intriguingly at several loci we find evidence for sex-specific genetic effects in micronucleus formation, with a locus on chromosome 11 being specific to males.

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A dual-learning paradigm can simultaneously train multiple characteristics of walking

Impairments in human motor patterns are complex: what is often observed as a single global deficit (e.g., limping when walking) is actually the sum of several distinct abnormalities. Motor adaptation can be useful to teach patients more normal motor patterns, yet conventional training paradigms focus on individual features of a movement, leaving others unaddressed. It is known that under certain conditions, distinct movement components can be simultaneously adapted without interference. These previous "dual-learning" studies focused solely on short, planar reaching movements, yet it is unknown whether these findings can generalize to a more complex behavior like walking. Here we asked whether a dual-learning paradigm, incorporating two distinct motor adaptation tasks, can be used to simultaneously train multiple components of the walking pattern. We developed a joint-angle learning task that provided biased visual feedback of sagittal joint angles to increase peak knee or hip flexion during the swing phase of walking. Healthy, young participants performed this task independently or concurrently with another locomotor adaptation task, split-belt treadmill adaptation, where subjects adapted their step length symmetry. We found that participants were able to successfully adapt both components of the walking pattern simultaneously, without interference, and at the same rate as adapting either component independently. This leads us to the interesting possibility that combining rehabilitation modalities within a single training session could be used to help alleviate multiple deficits at once in patients with complex gait impairments.

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Metaplasticity in human primary somatosensory cortex: effects on physiology and tactile perception

Theta-burst stimulation (TBS) over human primary motor cortex evokes plasticity and metaplasticity, the latter contributing to the homeostatic balance of excitation and inhibition. Our knowledge of TBS-induced effects on primary somatosensory cortex (SI) is limited, and it is unknown whether TBS induces metaplasticity within human SI. Sixteen right-handed participants (6 females, mean age 23 yr) received two TBS protocols [continuous TBS (cTBS) and intermittent TBS (iTBS)] delivered in six different combinations over SI in separate sessions. TBS protocols were delivered at 30 Hz and were as follows: a single cTBS protocol, a single iTBS protocol, cTBS followed by cTBS, iTBS followed by iTBS, cTBS followed by iTBS, and iTBS followed by cTBS. Measures included the amplitudes of the first and second somatosensory evoked potentials (SEPs) via median nerve stimulation, their paired-pulse ratio (PPR), and temporal order judgment (TOJ). Dependent measures were obtained before TBS and at 5, 25, 50, and 90 min following stimulation. Results indicate similar effects following cTBS and iTBS; increased amplitudes of the second SEP and PPR without amplitude changes to SEP 1, and impairments in TOJ. Metaplasticity was observed such that TOJ impairments following a single cTBS protocol were abolished following consecutive cTBS protocols. Additionally, consecutive iTBS protocols altered the time course of effects when compared with a single iTBS protocol. In conclusion, 30-Hz cTBS and iTBS protocols delivered in isolation induce effects consistent with a TBS-induced reduction in intracortical inhibition within SI. Furthermore, cTBS- and iTBS-induced metaplasticity appear to follow homeostatic and nonhomeostatic rules, respectively.

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Intrinsic excitability differs between murine hypoglossal and spinal motoneurons

Motoneurons differ in the behaviors they control and their vulnerability to disease and aging. For example, brain stem motoneurons such as hypoglossal motoneurons (HMs) are involved in licking, suckling, swallowing, respiration, and vocalization. In contrast, spinal motoneurons (SMs) innervating the limbs are involved in postural and locomotor tasks requiring higher loads and lower movement velocities. Surprisingly, the properties of these two motoneuron pools have not been directly compared, even though studies on HMs predominate in the literature compared with SMs, especially for adult animals. Here we used whole cell patch-clamp recording to compare the electrophysiological properties of HMs and SMs in age-matched neonatal mice (P7–P10). Passive membrane properties were remarkably similar in HMs and SMs, and afterhyperpolarization properties did not differ markedly between the two populations. HMs had narrower action potentials (APs) and a faster upstroke on their APs compared with SMs. Furthermore, HMs discharged APs at higher frequencies in response to both step and ramp current injection than SMs. Therefore, while HMs and SMs have similar passive properties, they differ in their response to similar levels of depolarizing current. This suggests that each population possesses differing suites of ion channels that allow them to discharge at rates matched to the different mechanical properties of the muscle fibers that drive their distinct motor functions.

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Training Blue light drive on commentary

U.K. Drivertraining seems to be mutch like Norwegian. Good job with the commentary ..! I could not run my mouth that fast, -getting thirsty just listening to him :-) Here in Norway you can only test 3 times in life, seen as not talented enough if you need more. ExEMTNor

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Training Blue light drive on commentary

U.K. Drivertraining seems to be mutch like Norwegian. Good job with the commentary ..! I could not run my mouth that fast, -getting thirsty just listening to him :-) Here in Norway you can only test 3 times in life, seen as not talented enough if you need more. ExEMTNor

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Training Blue light drive on commentary

U.K. Drivertraining seems to be mutch like Norwegian. Good job with the commentary ..! I could not run my mouth that fast, -getting thirsty just listening to him :-) Here in Norway you can only test 3 times in life, seen as not talented enough if you need more. ExEMTNor

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Flight medic: day-in-the life with ORNGE air ambulance

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Flight medic: day-in-the life with ORNGE air ambulance

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Flight medic: day-in-the life with ORNGE air ambulance

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Visit Telrepco at Booth # 61 at the CT EMS Expo

Telrepco will be at booth #61 at the CT EMS Expo in Uncasville, CT at the Mohegan Sun Casino on Friday June 3rd from 8 am to 7pm and Saturday June 4th from 8am to 3:30pm. We wanted to take this opportunity to introduce ourselves and give you a preview of the products we will be showcasing at the conference, as well as some information on the services Telrepco offers to help you fulfill your facilities ...

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Flight medic: day-in-the life with ORNGE air ambulance

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Is 'EMS Bingo' a big deal to EMTs and paramedics?

An "EMS Bingo" card photo, posted to the Facebook account of a Florida EMT, received a strong rebuke from a local television station and a critique from a former EMT.

The photo, captioned "Happy EMS Week!," showed a bingo card with squares for gunshot wound, stabbing, seizures, diabetic patient and motor vehicle crash. The card also has squares for common EMS jargon, which isn't always layperson friendly, like "code brown."

Many EMS1 readers sounded off in the news story comments about the "EMS Bingo" card, the dramatic news reporting and what the public's reaction to the card might say about their understanding of the challenges of EMS.

Big deal: not to EMS1 readers
Despite the news coverage worrying that "EMS Bingo" might give hard-working first responders a black eye, there was no sign of concern in the article or EMS1 Facebook comments that this is a big deal.

Most readers had just the opposite reaction. 'EMS Bingo' and similar memes are an opportunity to find brightness in an otherwise challenging work day.

Little deal: some caution is needed
For some readers the bingo card is not concerning, but rather there is a need to keep it on the down low. Here are a few of the comments that thought 'EMS Bingo' might be a little problematic.

"Wow the media must be bored. Don't keep it displayed, and keep it for downtime fun; it's that simple. I have nothing against the game whatsoever, but we do need to remain professional." – Jeri Kay Thompson

"We did this for EMS week this year. We didn't keep them in the ambulances like this. I don't see it being a big deal." – CJ Geeker

"It's a joke, and as long as the patients and family don't see it, what's the big deal" You know what's offensive, the pay we work for, the hours we work, and the overall conditions we put up with." – Sean Davis

"If it was posted in the Medic, then yes, that is not appropriate." – Mike Chapel

"Really" I'm with all the rest of you guys that are tired of living in a world where people get offended if you look at them. Personally I wouldn't put this in my ambulance, but yes I definitely find this funny and good way to deal with the stress that can occur in our field." – John Parker

No deal: Need to understand EMS and dispatch
Overwhelmingly, comment writers took the stance that 'EMS Bingo' is no big deal and everyone involved in the news reporting was being overly sensitive.

"If the people complaining did this just one day they would realize things like this are coping mechanisms. It's the same with dispatch. You have to be able to cope or you cannot do your job. These kind of games are there too. It is better than someone being mad because all they ever see or hear is the bad. It's not like the 911 call comes in to invite everyone over to lunch!" – Teresa Bull

"Not even going to watch the video because I can tell it would just aggravate me." – Candi Hicks

"Get a grip folks! America is full of a bunch of folks walking around looking for things that offend them!" – Van Yates

I carried a Bingo card in my spare uniform bag. Humor helped me deal with all the levels of insanity that I saw on the job. When I had 'Bingoed' on a card, I would 'level up!' It was an inside joke that, yes, to someone who didn't know me would have been offensive." – Sarah Gardiner

"Good lord! It's a joke! In this job you can either laugh it off or cry it out! I don't see an issue here. If this silly joke offends you then your skin isn't thick enough to be in this profession. Get over yourself." – Andrew Togolo

"Many occupations have this kind of game. There is a Wal-Mart Bingo, Nurses Bingo, etc. When people work in stressful jobs there needs to be a little bit of humor to relieve the pressures of stress. This is where you say 'screw 'em if they can't take a joke' or have a little fun. It's not like these people say, 'Yeah! I got bingo' when they are on a call. Chill out, people!" – Christine Matthews

"I've worked high risk and emergency areas forever. If you don't blow off a little steam you'll go crazy. Let's put this in perspective people. Don't worry be happy." – Karen Langord

"EMTs should be offended when we get called ambulance drivers, get late-night calls from people who have been throwing up for a week but decided it got worse at 3 a.m., and when people need a ride to the hospital to get a fix." – Terri Johnson

"I do not think this is offensive, it's what we do, things that some experience on a daily basis." – Jean Serson

"As a paramedic, I dont find this offensive. We deal with high stress on many calls. Yes, we do get a warped sense of humor. But look what we deal with and remain calm, while others around us are wigging out. We are here to help those we can, if you find how we deal with this field...then try a day in our truck!!" – Dave Law

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Faculty, EMS/Paramedic Instructor - Northcentral Technical College

The EMS/Paramedic Faculty position will work 45 out of 52 weeks per year. Individual will be knowledgeable to teach Paramedic courses in addition to the EMS area which include, but not limited to First Responder, EMT-Basic and EMT-IV. Classes are offered throughout the district and travel may be required.

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6 ways paramedics can improve their wellness

Injury, disibility and even death are a risk that every first responder accepts when entering the profession. Yet I am pretty sure that not a single responder has willingly decided to destroy their future by slowly poisoning their bodies to the point of metabolic syndrome, diabetes, obesity, PTSD and heart disease.

Here are a few truths of the EMS profession. Chronic stress activation, both good stress and bad stress, will slowly affect your allostatic balance.

Allostatic load is wear and tear on the body, which worsens over time when an individual is exposed to repeated or chronic stress. It represents the physiological consequences of chronic exposure to fluctuating or heightened neural or neuroendocrine response that results from repeated or chronic stress [1].

The issue we must deal with as first responders is the complete inability to manage the allostatic load. It is often a blend of stress from the job, stress at home, work-life imbalance, chronic fatigue, environmental stress and physical stress.

As you lose the ability to maintain balance and the scales tip out of your favor, a predictable but deadly syndrome begins to occur. It goes like this.

You can no longer sleep. When you do sleep it's broken and of poor quality so your body never has he chance to heal. The chronic activation of stress hormones causes you to crave high-fat and high-sugar foods.

First responders often struggle to balance their allostatic load

The constant fatigue and poor food choices make it impossible to exercise because of the inflammation in your body causing pain, which is the number one barrier to fitness. No one wants to exercise when they are so weighed and worn down physically, emotionally and cognitively.

This begs the question of exactly how does a paramedic or EMT invest in wellness when the job stacks the deck against them"

Eat clean
Food must heal the body, not harm it. Yet we are exposed to more processed and chemical-laden foods than ever before.

The first step in investing in your wellness is to get clean, which means that you must learn to avoid and then replace the five evil foods with foods that will help to restore the allostatic balance. The five evil foods to remove from your diet immediately are:

  1. White bread
  2. White rice
  3. White pasta
  4. White potatoes
  5. Cow's milk

These white refined foods are essentially nutrient-free and high-sugar products. They are pushed on us because they are cheap and easy to produce.

Food is color coded. The darker the color of non-processed, non-refined food the better it is for you. Instead of white rice eat brown, black or multi-grain rice.

Better yet cut out the rice completely. Eat quinoa or amaranth, which is very high in protein, vitamins and minerals.

Instead of the white bread eat an ezekiel, multigrain or oatmeal-based bread. Even better is to cut the bread completely out of your diet.

Instead of white pasta try a quinoa, spinach or whole-wheat pasta. Instead of a white potato eat a sweet potato.

Also on this spectrum are the other whites, like cream sauces, ranch dressing and mayonnaise. These are the hidden white evils.

There are a lot of great natural and healthy substitutes, like soy mayo, Braggs amino acid soy sauce substitute and even salsa in place of ketchup, which is loaded with sugar. These healthy foods are almost always found on the top shelf in most stores.

The final facet of clean eating is the hardest one. Avoid red meat and eat a lot more dark leafy greens and dark colored fruits. Red meat is a known carcinogen so simply swap it out with chicken or fish.

Cold-water fish like salmon and tuna also boost your intake of good fatty acids, omega-3 and 6, so they pack quite a punch on the healthy side. Just make sure that they wild and not farm-raised.

Fill the tank
I recently taught at the National Strength and Conditioning Associations' tactical strength and conditioning conference. I was amazed by how much research was presented on what shift work, allostatic imbalance, dehydration and poor diet was really doing to your wellness. Below are some of the biggest takeaways from the conference.

1. Increase DHA intake
We need more docosahexaenoic acid, also known as DHA or fish oil, as well as its plant-based cousin flax or chia seeds. One study showed that risk of suicide increased significantly when our brains are deficient of DHA.

Plus, the study also showed DHA reduced the risk of heart disease. DHA also lowers the catabolic effect on the body from physical stress, part of the allostatic load. Recommendations for DHA range from 1,000 mg to 3,000 mg daily.

2. Vitamin D is our next culprit
Low levels of vitamin D are well known to contribute to heart disease, diabetes and depression. During the 2015 tactical strength and conditioning conference, a study showed that soldiers who died by suicide had up to 30 percent lower vitamin D levels than other soldiers.

Another study documented that people with higher vitamin D levels in the blood also had higher levels of testosterone, which is known to be drastically low due to chronic allostatic imbalance.

3. The elephant in the room is testosterone.
Lack of sleep plus high abdominal fat plus lack of exercise can cause low testosterone. Low T is known to cause an increased risk of heart disease, diabetes and atherosclerosis. I strongly recommend that all men get their testosterone levels checked during their annual physical.

4. More deep, uninterrupted sleep
We all need more sleep, especially sleep that is deep and uninterrupted. Broken sleep is currently an accepted occupational hazard and one that definitely needs to change. To promote better sleep off duty, research shows that magnesium, tryptophan, melatonin and 5-HTP supplements taken around bedtime are helpful.

5. Meet daily magnesium requirements
Magnesium, especially for firefighters and responders working in hot environments, is lost through sweating. It's estimated that 68 percent of the population is not meeting it's USDA magnesium requirements. When magnesium is low, cardiovascular risks and systemic markers of inflammation increase.

6. Consider zinc replenishment
Zinc, another essential mineral, is found to be low in up to 42 percent of the population. Zinc can lower systemic inflammation and improve sleep patterns. Low zinc levels are also associated with lower testosterone levels. Supplements, like ZMA which has zinc and magnesium, can help replenish those levels as well as promote better sleep.

The bottom line is simple. First, eat a lot more whole and natural foods. Every meal should have a green leafy vegetable.

Nuts are a great source of good fats and have an added benefit of being high in all the minerals discussed in this article. Plus nuts are high in protein.

Second, avoid processed and fast foods. If you must eat them make good choices. Third, learn what foods make your body feel good versus just satisfying hunger and master the art of food substitution to avoid the white foods.

Finally, get an annual physical and have your blood analyzed before running to the store to stock up on supplements.

Work referenced
1. Dr. Mark Abel, TSAC 2016 presentation

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Postinfectious and sporadic functional gastrointestinal disorders have different prevalences and rates of overlap: Results from a controlled cohort study 3 years after acute giardiasis

Neurogastroenterology & Motility

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Thermoregulation in boys and men exercising at the same heat production per unit body mass



Child–adult thermoregulatory comparisons may be biased by differences in metabolic heat production ( \(\dot{H}_{\text{p}}\) ). We compared thermoregulatory responses of boys and men exercising at two intensities prescribed to elicit either a fixed \(\dot{H}_{\text{p}}\) per unit body mass (BM) or a fixed absolute \(\dot{H}_{\text{p}}\) .


Ten boys (10–12 years) and 10 men (19–25 years) performed 4 × 20-min cycling at a fixed \(\dot{H}_{\text{p}}\) per BM (W kg−1) at 35 °C and 35 % relative humidity (MENREL). Men also cycled (MENABS) at the same absolute \(\dot{H}_{\text{p}}\) (in W) as the boys.


\(\dot{H}_{\text{p}}\) was lower in boys compared with MENREL, but similar to MENABS (mean ± SD, 233.6 ± 38.4, 396.5 ± 72.3, 233.6 ± 34.1 W, respectively, P < 0.001). Conversely, \(\dot{H}_{\text{p}}\) per unit BM was similar between boys and MENREL, and lower in MENABS (5.7 ± 1.0, 5.6 ± 0.8 and 3.3 ± 0.3 W kg−1, respectively; P < 0.001). The change in rectal temperature was similar between boys and MENREL (0.6 ± 0.2 vs. 0.7 ± 0.2 °C, P = 0.92) but was lower in MENABS (0.3 ± 0.2 °C, P = 0.004). Sweat volume was lower in boys compared to MENABS (500 ± 173 vs. 710 ± 150 mL; P = 0.041), despite the same evaporative heat balance requirement (E req) (199.1 ± 34.2 vs. 201.0 ± 32.7 W, P = 0.87).


Boys and men demonstrated similar thermoregulatory responses to 80 min of exercise in the heat performed at a fixed \(\dot{H}_{\text{p}}\) per unit BM. Sweat volume was lower in boys compared to men, despite similarities in absolute \(\dot{H}_{\text{p}}\) and E req.

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6 ways paramedics can improve their wellness

Understand the importance of balancing clean eating with stress to achieve your wellness, fitness and health goals

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Staff Turnover in Assertive Community Treatment ( Act ) Teams: The Role of Team Climate


Staff turnover in Assertive Community Treatment (ACT) teams can result in interrupted services and diminished support for clients. This paper examines the effect of team climate, defined as team members' shared perceptions of their work environment, on turnover and individual outcomes that mediate the climate-turnover relationship. We focus on two climate dimensions: safety and quality climate and constructive conflict climate. Using survey data collected from 26 ACT teams, our analyses highlight the importance of safety and quality climate in reducing turnover, and job satisfaction as the main mediator linking team climate to turnover. The findings offer practical implications for team management.

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Functional and structural cortical characteristics after restricted focal motor cortical infarction evaluated at chronic stage – indications from a preliminary study


Publication date: Available online 26 May 2016
Source:Clinical Neurophysiology
Author(s): Petro Julkunen, Sara Määttä, Laura Säisänen, Elisa Kallioniemi, Mervi Könönen, Pekka Jäkälä, Ritva Vanninen, Selja Vaalto
ObjectiveTo assess the inter-hemispheric differences in neuronal function and structure of the motor cortex in a small group of chronic stroke patients having suffered a restricted ischemic lesion affecting hand motor representation. GABAergic intracortical inhibition, known to be affected by stroke lesion, was also investigated.MethodsEight patients exhibiting little or no motor impairment were studied using transcranial magnetic stimulation (TMS) and diffusion weighted imaging (DWI) >15 months from diagnosis. Resting motor threshold (MT) for 50μV and 2mV motor evoked potentials, and short-interval intracortical inhibition (SICI) were measured from hand muscles. Apparent diffusion coefficients (ADCs) were analyzed from the DWI for the primary motor cortex (M1), the supplementary motor area (SMA) and thalamus for reflecting changes in neuronal organization.ResultsThe MTs did not differ between the affected (AH) and unaffected hemisphere (UH) in 50μV responses, while the MTs for 2mV responses were higher (p=0.018) in AH. SICI was weakened in AH (p=0.008). ADCs were higher in the affected M1 compared to the unaffected M1 (p=0.018) while there were no inter-hemispheric differences in SMA or thalamus.ConclusionsInter-hemispheric asymmetry and neuronal organization demonstrated abnormalities in the M1. However, no confident inference can be made whether the observed alterations in neurophysiological and imaging measures have causal role for motor rehabilitation in these patients.SignificanceNeurophysiological changes persist and are detectable using TMS years after stroke even though clinical symptoms have normalized.

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Diabetes increases morbidities of colonic diverticular disease and colonic diverticular hemorrhage: a systematic review and meta-analysis

American Journal of Therapeutics

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Paramedic launches write-in campaign for president

Paramedic Charles Robichaud calls on voters to consider him as a write-in candidate in the 2016 presidential election

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Age-dependent characteristics of feedback evaluation related to monetary gains and losses


Publication date: Available online 25 May 2016
Source:International Journal of Psychophysiology
Author(s): Zsófia Kardos, Brigitta Tóth, Roland Boha, Bálint File, Márk Molnár
Monitoring the consequences of actions is of crucial importance in order to optimize behavior to the challenges of the environment. Recently the age-related aspects of this fundamentally important cognitive processing have been brought into the focus of investigation since behavioral monitoring and related control mechanisms are widely known to be affected by aging. Processing of feedback stimuli is a core mechanism for rapid evaluation of the functionally significant aspects of outcome, guiding behavior towards avoidance or approach. The aim of the present study was to analyze the age-related alterations in the most prominent electrophysiological correlates of feedback processing, the feedback-related negativity (FRN) and the P3 event-related potential components, using a two-choice-single-outcome gambling task with two amounts of monetary stakes. In terms of behavioral indices higher proportion of risky choices was observed after loss than after gain events in both groups. In the young the FRN component was found to be an indicator of the goodness of outcome (loss or gain), and the P3 showed a complex picture of feedback evaluation with selective sensitivity to large amount of gain. In contrast, in the elderly group outcome valence had no effect on the amplitude of the FRN, and the P3 was also insensitive of the complex outcome properties. As the ERP-correlates of feedback processing are not as pronounced in the elderly, it is suggested that normal aging is accompanied by an alteration of the neural mechanisms signaling the most salient feedback stimulus properties.

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Renal function in nucleos(t)ide analog-treated patients with chronic hepatitis B: A systematic literature review and network meta-analysis

Advances in Therapy

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Student advice: 7 ways to understand EMS traumatic stress

A psychology Ph.D. student asked the EMS sub-Reddit for help to better understand the EMS profession. Reddit user sandel23 is "looking to do my dissertation on the effects of traumatic exposure within EMS occupations" and wants to learn more about shift schedules, frequency to difficult calls, coping strategies and the most stressful aspects of the job to better design a research study.

I completed research methods at the dawn of the Internet age. But since I have a few thoughts, I am making myself an ad hoc member of sandel23's dissertation committee. Here is how sandel23 can understand EMS and the potential scope of traumatic stress.

1. Read stories from The Code Green Campaign
These very personal and often disturbing stories are written by EMS providers as part of an ongoing effort to break the silence about mental illness in public safety.

2. Talk to the traumatic stress experts
Several EMS providers have dedicated themselves to understanding traumatic stress in EMS. Schedule one-to-one phone interviews with representatives from:

I am sure this list is incomplete and there are other experts to seek out, but that is part of the scoping process and literature reviews for a Ph.D. student.

3. Complete ride alongs
Use your status and credentials as an academic researcher to schedule ride alongs with fire-based and private EMS agencies. 911 emergency calls are great for seeing traumatic incidents and life-threatening medical emergencies that might trigger an acute traumatic stress experience.

But broaden your experience with chronic stress triggers by including ride time with an ambulance crew that spends its day taking renal failure patients to and from dialysis, discharging patients from the emergency department to home, and wandering the halls of a skilled nursing facility to find the paperwork for a direct admit sepsis patient. Find out how your community prepares and enables EMS to respond to high-frequency users with psychiatric illness

If time allows, spend eight hours sitting next to a 911 call taker in the city or county dispatch center. Listen in to calls — from the trivial to the fatal. While you are there, ask which homeless shelter calls for an ambulance most often. Then spend a day at the shelter trying to understand the needs of the patients in the moments before ambulances are called and observe how EMS providers respond to those patients.

4. Read about EMS from our strongest storytellers
Reading and digesting dozens of journal articles and several books a month is integral to the graduate school experience. A handful of books from EMT and paramedic authors will give you insights into shift length, traumatic things EMS providers see on the job and how some providers cope — or fail to cope — with the feelings of being the safety net for their community's under-insured and uninsured. Two of the best are:

Kelly Grayson's books, currently hard to come by are just as good, and you won't go wrong by reading any of the books Grayson recommends.

5. Talk to EMS providers who are victims of violence
If traumatic stress exists on a continuum of severity, violence is likely at the extreme. Patients routinely assault EMS providers. EMTs and paramedics are also attacked by co-workers, but those incidents are likely less frequently reported.

Any EMS professional who feels unsafe at work and in danger from their co-workers might be differently affected by traumatic stress than an EMS provider who feels emotionally safe — free from fear of bullying and harassment — and physically safe because of an intentional workplace violence prevention program.

6. Traumatic stress can be fatal
We are just beginning to understand the occurrence of suicide in public safety professionals. The Firefighter Behavioral Health Alliance is attempting to collect and verify the frequency of suicide, which may exceed line of duty deaths from all other causes combined. Perhaps your research will help us understand the scope of the problem, how traumatic stress is caused and how it is mitigated.

7. Report your findings
Finally, keep us posted on your research design progress and research findings. Publication in a peer-reviewed journal is important. Even more noteworthy is returning actionable findings and recommendations to the profession you plan to study. Any Ph.D. candidate studying paramedics and EMTs is welcome to submit article ideas to editor@ems1.com

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Differences in Chloride Gradients Allow for Three Distinct Types of Synaptic Modulation by Endocannabinoids

Endocannabinoids can elicit persistent depression of excitatory and inhibitory synapses, reducing or enhancing (disinhibiting) neural circuit output, respectively. In this study, we examined whether differences in Cl- gradients can regulate which synapses undergo endocannabinoid-mediated synaptic depression vs. disinhibition using the well-characterized central nervous system (CNS) of the medicinal leech, Hirudo verbana. Exogenous application of endocannabinoids or capsaicin elicits potentiation of pressure (P) cell synapses and depression of both polymodal (Npoly) and mechanical (Nmech) nociceptive synapses. In P synapses, blocking Cl- export prevented endocannabinoid-mediated potentiation, consistent with a disinhibition process that has been indicated by previous experiments. In Nmech neurons, which are depolarized by GABA due to an elevated ECl, endocannabinoid-mediated depression was prevented by blocking Cl- import, indicating that this decrease in synaptic signaling was due to depression of excitatory GABAergic input (disexcitation). Npoly neurons are also depolarized by GABA, but endocannabinoids elicit depression in these synapses directly and was only weakly affected by disruption of Cl- import. Consequently, the primary role of elevated ECl may be to protect Npoly synapses from disinhibition. All forms of endocannabinoid-mediated plasticity required activation of TRPV channels. Endocannabinoid/TRPV-dependent synaptic plasticity could also be elicited by distinct patterns of afferent stimulation with low frequency stimulation (LFS) eliciting endocannabinoid-mediated depression of Npoly synapses, and high-frequency stimulus (HFS) eliciting endocannabinoid-mediated potentiation of P synapses and depression of Nmech synapses. These findings demonstrate a critical role of differences in Cl- gradients between neurons in determining the sign, potentiation vs. depression, of synaptic modulation under normal physiological conditions.

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Acute pancreatitis following scoliosis surgery: description and clinical course in 14 adolescents

European Spine Journal

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Measurement of inflammation in eosinophilic esophagitis using an eosinophil peroxidase assay

The American Journal of Gastroenterology

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Once daily versus multiple daily mesalamine therapy for mild to moderate ulcerative colitis: a meta-analysis

Colorectal Disease

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Adverse event reporting for proton pump inhibitor therapy: An overview of systematic reviews

Otolaryngology - Head and Neck Surgery

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Prognostic impact of carcinoembryonic antigen (CEA) on patients with metastatic pancreatic cancer: a retrospective cohort study


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Race/ethnicity-specific disparities in cancer incidence, burden of disease, and overall survival among patients with hepatocellular carcinoma in the United States


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Altered tryptophan hydroxylase 2 expression in enteric serotonergic nerves in Hirschsprung’s-associated enterocolitis

World Journal of Gastroenterology

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A Method by Which to Assess the Scalability of Field-Based Fitness Tests of Cardiorespiratory Fitness Among Schoolchildren


Previous research has reported the validity and reliability of a range of field-based tests of children's cardiorespiratory fitness. These two criteria are critical in ensuring the integrity and credibility of data derived through such tests. However, the criterion of scalability has received little attention. Scalability determines the degree to which tests developed on small samples in controlled settings might demonstrate real-world value, and is of increasing interest to policymakers and practitioners. The present paper proposes a method by which the scalability of cardiorespiratory field-based tests suitable for school-aged children might be assessed. We developed an algorithm to estimate scalability based on a six-component model; delivery, evidence of operating at scale, effectiveness, costs, resource requirements and practical implementation. We tested the algorithm on data derived through a systematic review of research that has used relevant fitness tests. A total of 229 studies that had used field based cardiorespiratory fitness tests to measure children's fitness were identified. Initial analyses indicated that the 5-min run test did not meet accepted criteria for reliability, whilst the 6-min walk test likewise failed to meet the criteria for validity. Of the remainder, a total of 28 studies met the inclusion criteria, 22 reporting the 20-m shuttle-run and seven the 1-mile walk/run. Using the scalability algorithm we demonstrate that the 20-m shuttle run test is substantially more scalable than the 1-mile walk/run test, with tests scoring 34/48 and 25/48, respectively. A comprehensive analysis of scalability was prohibited by the widespread non-reporting of data, for example, those relating to cost-effectiveness. Of all sufficiently valid and reliable candidate tests identified, using our algorithm the 20-m shuttle run test was identified as the most scalable. We hope that the algorithm will prove useful in the examination of scalability in either new data relating to existing tests or in data pertaining to new tests.

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Flexible dropped head deformity following laminectomy for cervical spondylotic myelopathy: a case series and review of literature


Flexible dropped head deformity (FDHD) following laminectomy for cervical spondylotic myelopathy is a debilitating entity. Patients need to support their head manually to look forward in standing or sitting position. FDHD is different from rigid dropped head deformity in patients with post-laminectomy kyphosis or ankylosing spondylitis and has only once been described after surgery to the cervical spine.

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The role of human parvovirus B19 and hepatitis C virus in the development of thyroid disorders

Reviews in Endocrine and Metabolic Disease

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Should spinal magnetic resonance imaging (MRI) scans be used to determine the duration of therapy for spinal tuberculosis?

BACKGROUND CONTEXT: National guidelines for treatment of spinal TB (sTB) recommend a 6-month quadruple chemotherapy regimen. Spinal magnetic resonance imaging (MRI) is increasingly used to monitor disease progression as optimal treatment duration remains uncertain.

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Health and Economic Burden of Running-Related Injuries in Dutch Trailrunners: A Prospective Cohort Study



Trailrunning is becoming very popular. However, the risk and burden of running-related injuries (RRI) in trailrunning is not well established.


To investigate the prevalence, injury rate, severity, nature, and economic burden of RRIs in Dutch trailrunners.


This prospective cohort study included 228 trailrunners aged 18 years or over (range 23–67), and was conducted between October 2013 and December 2014. After completing the baseline questionnaire, the Oslo Sports Trauma Research Center Questionnaire on Health Problems was administered every 2 weeks to collect data on RRIs. Participants who reported RRIs were asked about healthcare utilization (direct costs) and absenteeism from paid work (indirect costs). RRI was defined as disorders of the musculoskeletal system or concussions experienced or sustained during participation in running.


The mean prevalence of RRIs measured over time was 22.4 % [95 % confidence interval (CI) 20.9–24.0], and the injury rate was 10.7 RRIs per 1000 h of running (95 % CI 9.4–12.1). The prevalence was higher for overuse (17.7 %; 95 % CI 15.9–19.5) than for acute (4.1 %; 95 % CI 3.3–5.0) RRIs. Also, the injury rate was higher for overuse (8.1; 95 % CI 6.9–9.3) than for acute (2.7; 95 % CI 2.0–3.4) RRIs. The median of the severity score was 35.0 [25–75 %, interquartile range (IQR) 22.0–55.7], and the median of the duration of RRIs was 2.0 weeks (IQR 2.0–6.0) during the study. The total economic burden of RRIs was estimated at €172.22 (95 % CI 117.10–271.74) per RRI, and €1849.49 (95 % CI 1180.62–3058.91) per 1000 h of running. An RRI was estimated to have a direct cost of €60.92 (95 % CI 45.11–94.90) and an indirect cost of €111.30 (95 % CI 61.02–192.75).


The health and economic burden of RRIs presented in this study are significant for trailrunners and for society. Therefore, efforts should be made in order to prevent RRIs in trailrunners.

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