Publications by authors named "Amanda Black"

191 Publications

Influence of antibiotics given during labour and birth on body mass index z scores in children in the All Our Families pregnancy cohort.

Pediatr Obes 2021 Aug 19:e12847. Epub 2021 Aug 19.

Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada.

Background/objectives: Little is known about obesity risk associated with intrapartum antibiotic prophylaxis (IAP). Our objective was to determine if maternal antibiotic exposure during birth is associated with child body mass index (BMI) z scores in the first 3 years of life.

Methods: In 2008 to 2010, 3388 pregnant women were recruited to the All Our Families study. Here, we included women with available data from obstetrical records on antibiotic use during birth (n = 1303) and children with at least one valid BMI z score (final sample n = 1262). The primary outcome was infant BMI z score at 1, 2 and 3 years of age.

Results: IAP occurred in 432 of 1262 women. Children exposed to IAP had significantly higher mean [standard error (SE)] BMI z scores (1.071 [0.087] unit) at 1 year of age compared to non-exposed infants (0.744 [0.064] unit). Although the association was no longer significant after adjustment for confounding factors in the growth trajectory model, IAP resulted in a 0.255 unit increase in BMI z score at 1 year of age. Differences in BMI z score between exposed and non-exposed at baseline (year 1) only remained significant in sensitivity analysis.

Conclusion: The potential association between maternal IAP and increased infant BMI z score at 1 year of age should be confirmed in other cohorts and warrants investigation of interventions to mitigate this possible risk.
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http://dx.doi.org/10.1111/ijpo.12847DOI Listing
August 2021

Sport participation and injury rates in high school students: A Canadian survey of 2029 adolescents.

J Safety Res 2021 09 14;78:314-321. Epub 2021 Jul 14.

Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Canada; Alberta Children's Hospital Research Institute, University of Calgary, Canada; O'Brien Institute for Public Health, University of Calgary, Canada; Hotchkiss Brain Institute, University of Calgary, Canada; Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Canada; Department of Pediatrics, Cumming School of Medicine, University of Calgary, Canada.

Introduction: The objective of this study is to examine sport and recreational (S&R) activity participation and injury rates (IR) in high school students (ages 14-19).

Methods: High school students (N = 24 schools, n = 2,029; 958 male, 1,048 female, 23 identified 'other' or missing; ages 14-19) in Alberta completed a web-based survey during class (October 2018-March 2019). Students identified their top three sports for participation in the past year. Primary outcome measures included IR for (a) any S&R-related injury, (b) most serious S&R-related injury resulting in medical attention, and (c) most serious injury resulting in restriction from S&R for at least one day.

Results: In total, 1763/2029 (86.89%) respondents [861/958 (89.87%) male, 886/1048 (84.54%) female, 16/23 (69.57%) identifying as 'other' or missing] participated in an S&R activity in the past year. Top sports for male participation were basketball (33.08%; 95% CI 27.67-39.00), ice hockey (20.46%; 95% CI 14.87-27.47), and soccer (19.42%; 95% CI 15.67-23.80). Top sports for female participation were dance (22.52%; 95% CI 17.98-27.82), basketball (18.32%; 95% CI 14.32-23.14), and badminton (17.84%; 95% CI 13.35-23.43). Of the 1,971 students completing the S&R injury question, 889 reported at least one injury during the past year [(IR = 45.10 injuries/100 students/year (95% CI 39.72-50.61)]. The medical attention IR was 29.09 injuries/100 students/year (95% CI 24.49-34.17) and time loss IR was 36.00 injuries/100 students/year (95% CI 30.47-41.93).

Conclusions: High school student S&R IRs are high with 29% of adolescents reporting at least one medical attention injury within the past year. Injury prevention strategies targeting youth are necessary. Practical Application: Participation in S&R activities has multiple physical, psychological, and health benefits for adolescents, but some S&R activities also have greater risks of injury. This study informs the next sports to target for implementation of optimal prospective surveillance and injury prevention strategies among high school aged students.
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http://dx.doi.org/10.1016/j.jsr.2021.06.008DOI Listing
September 2021

Standard assessments of climate forecast skill can be misleading.

Nat Commun 2021 07 16;12(1):4346. Epub 2021 Jul 16.

CSIRO Oceans & Atmosphere, Hobart, TAS, Australia.

Assessments of climate forecast skill depend on choices made by the assessor. In this perspective, we use forecasts of the El Niño-Southern-Oscillation to outline the impact of bias-correction on skill. Many assessments of skill from hindcasts (past forecasts) are probably overestimates of attainable forecast skill because the hindcasts are informed by observations over the period assessed that would not be available to real forecasts. Differences between hindcast and forecast skill result from changes in model biases from the period used to form forecast anomalies to the period over which the forecast is made. The relative skill rankings of models can change between hindcast and forecast systems because different models have different changes in bias across periods.
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http://dx.doi.org/10.1038/s41467-021-23771-zDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8285537PMC
July 2021

Committee Opinion No. 419: Coercion Free Contraceptive Care.

J Obstet Gynaecol Can 2021 Sep 7;43(9):1107-1111. Epub 2021 Jul 7.

London, ON.

Objective: To provide guidance on culturally competent contraception counselling that is free of coercion and promotes shared decision-making and patient autonomy.

Target Population: Individuals of reproductive age who seek contraception or counselling for family planning.

Options: Contraception counselling is provided within a rights-based family planning framework, where the individual's beliefs, culture, preferences, and ability to use the chosen method are respected.

Outcomes: To promote patient autonomy in decision-making surrounding family planning, including the right to access and use their contraceptive method of choice, to decline contraception or use less effective methods of contraception, and to freely choose to discontinue a method of contraception, as well as the right to unbiased, non-coercive contraception counselling and evidence-based information from their health care provider BENEFITS, HARMS, AND COSTS: Implementation of these recommendations would reduce real or perceived coercive contraceptive care, particularly among vulnerable populations, resulting in improved patient autonomy and a better patient experience in health care settings.

Evidence: Databases searched: MEDLINE, Cochrane, PubMed, and CanLII. Medical terms used: contraception, family planning services, informed consent, coercion, decision making, sterilization, permanent contraception, counselling. Legal terms searched: forced sterilization, and aboriginal. Initial search conducted in 2020 and updated in 2021.

Intended Audience: This committee opinion is intended for health care providers (obstetricians, gynaecologists, family physicians, general surgeons, nurse practitioners, nurses, midwives, undergraduate/postgraduate medical trainees, and other health care providers) who provide sexual and reproductive health services.
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http://dx.doi.org/10.1016/j.jogc.2021.07.001DOI Listing
September 2021

Reality Check 2: The Cost-Effectiveness of Policy Disallowing Body Checking in Non-Elite 13- to 14-Year-Old Ice Hockey Players.

Int J Environ Res Public Health 2021 06 11;18(12). Epub 2021 Jun 11.

Department of Paediatrics, Cumming School of Medicine, University of Calgary, Calgary, AB T3B 6A8, Canada.

Sport-related injuries are the leading cause of injury in youth and are costly to the healthcare system. When body checking is disallowed in non-elite levels of Bantam (ages 13-14 years) ice hockey, the injury rate is reduced, but the impact on costs is unknown. This study compared rates of game injuries and costs among non-elite Bantam ice hockey leagues that disallow body checking to those that did not. : An economic evaluation was conducted alongside a prospective cohort study comparing 608 players from leagues where body checking was allowed in games (Calgary/Edmonton 2014-2015, Edmonton 2015-2016) with 396 players from leagues where it was not allowed in games (Vancouver, Kelowna 2014-2015, Calgary in 2015-2016). The effectiveness measure was rate of game injuries per 1000 player-hours. Costs were estimated based on associated healthcare use within the publicly funded healthcare system as well as privately paid healthcare costs. Probabilistic sensitivity analysis was conducted using bootstrapping. Disallowing body checking reduced the rate of injuries by 4.32 per 1000 player-hours (95% CI -6.92, -1.56) and reduced public and total healthcare system costs by $1556 (95% CI -$2478, -$559) and $1577 (95% CI -$2629, -$500) per 1000 player-hours, respectively. These finding were robust in over 99% of iterations in sensitivity analyses in the public healthcare and the total healthcare system perspectives. There was no statistically significant difference in privately paid healthcare costs (-$65 per 1000 player-hours (95% CI -$220, $99)). Disallowing body checking in non-elite 13-14-year-old ice hockey nationally would prevent injuries and reduce public healthcare costs.
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http://dx.doi.org/10.3390/ijerph18126322DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8296129PMC
June 2021

Canadian High School Rugby Coaches Readiness for an Injury Prevention Strategy Implementation: Evaluating a Train-the-Coach Workshop.

Front Sports Act Living 2021 31;3:672603. Epub 2021 May 31.

Faculty of Kinesiology, Sport Injury Prevention Research Centre, University of Calgary, Calgary, AB, Canada.

Canadian rugby coach injury prevention beliefs and attitudes have not been studied, yet are key to informing injury prevention strategy implementation. Despite neuromuscular training (NMT) warm-up success in reducing injury, adoption of these programs is variable. Therefore, objectives of this study included (1) describing Canadian youth rugby coach injury prevention beliefs and attitudes and current warm-up practices and (2) evaluating intention to use a rugby-specific NMT warm-up. High school rugby coaches completed a questionnaire before and after a rugby-specific NMT warm-up workshop. The pre-workshop questionnaire captured demographics, current warm-up practice, and NMT warm-up knowledge and use. Both questionnaires captured injury prevention beliefs, attitudes and behavioral intention. Forty-eight coaches participated in the workshops. Pre-workshop, 27% of coaches were aware of NMT warm-ups. Coaches primarily included aerobic and stretching components, while balance components were not common in their warm-ups over the past year. Additionally, 92% of coaches agreed to some extent they would "complete a rugby-specific warm-up program prior to every game and training session this season." Post-workshop, 86% of coaches agreed to some extent that they would use the program in every rugby session. No differences were observed between pre- and post-workshop intention to implement the warm-up ( = 0.10). This is the first study to examine current Canadian youth rugby coach warm-up practices and intention to use NMT warm-ups. Canadian rugby coach intention to use a rugby-specific NMT warm-up is high, providing ample opportunity to investigate the efficacy of a NMT warm-up in youth rugby.
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http://dx.doi.org/10.3389/fspor.2021.672603DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8200819PMC
May 2021

An Economic Evaluation of Disallowing Body Checking in 11- to 12-Year-Old Ice Hockey Leagues.

Sports Health 2021 Jun 6:19417381211021551. Epub 2021 Jun 6.

Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.

Background: After a national policy change in 2013 disallowing body checking in Pee Wee ice hockey games, the rate of injury was reduced by 50% in Alberta. However, the effect on associated health care costs has not been examined previously.

Hypothesis: A national policy removing body checking in Pee Wee (ages 11-12 years) ice hockey games will reduce injury rates, as well as costs.

Study Design: Cost-effectiveness analysis alongside cohort study.

Level Of Evidence: Level 3.

Methods: A cost-effectiveness analysis was conducted alongside a cohort study comparing rates of game injuries in Pee Wee hockey games in Alberta in a season when body checking was allowed (2011-2012) with a season when it was disallowed after a national policy change (2013-2014). The effectiveness measure was the rate of game injuries per 1000 player-hours. Costs were estimated based on associated health care use from both the publicly funded health care system and privately paid health care cost perspectives. Probabilistic sensitivity analysis was conducted using bootstrapping.

Results: Disallowing body checking significantly reduced the rate of game injuries (-2.21; 95% CI [-3.12, -1.31] injuries per 1000 player-hours). We found no statistically significant difference in public health care system (-$83; 95% CI [-$386, $220]) or private health care costs (-$70; 95% CI [-$198, $57]) per 1000 player-hours. The probability that the policy of disallowing body checking was dominant (with both fewer injuries and lower costs) from the perspective of the public health care system and privately paid health care was 78% and 92%, respectively.

Conclusion: Given the significant reduction in injuries, combined with lower public health care system and private costs in the large majority of iterations in the probabilistic sensitivity analysis, our findings support the policy change disallowing body checking in ice hockey in 11- and 12-year-old ice hockey leagues.
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http://dx.doi.org/10.1177/19417381211021551DOI Listing
June 2021

Factors Associated With Clinical Recovery After Concussion in Youth Ice Hockey Players.

Orthop J Sports Med 2021 May 5;9(5):23259671211013370. Epub 2021 May 5.

Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada.

Background: The identification of factors associated with clinical recovery in youth after sports-related concussion could improve prognostication regarding return to play (RTP).

Purpose: To assess factors associated with clinical recovery after concussion in youth ice hockey players.

Study Design: Cohort study; Level of evidence, 2.

Methods: Participants were part of a larger longitudinal cohort study (the Safe to Play study; N = 3353). Included were 376 ice hockey players (age range, 11-17 years) from teams in Calgary and Edmonton, Canada, with 425 physician-diagnosed ice hockey-related concussions over 5 seasons (2013-2018). Any player with a suspected concussion was referred to a sports medicine physician for diagnosis, and a Sport Concussion Assessment Tool (SCAT) form was completed. Time to clinical recovery was based on time between concussion and physician clearance to RTP. Two accelerated failure time models were used to estimate days to RTP clearance: model 1 considered symptom severity according to the SCAT3/SCAT5 symptom evaluation score (range, 0-132 points), and model 2 considered responses to individual symptom evaluation items (eg, headache, neck pain, dizziness) of none/mild (0-2 points) versus moderate/severe (3-6 points). Other covariates were time to physician first visit (≤7 and >7 days), age group (11-12, 13-14, and 15-17 years), sex, league type (body checking and no body checking), tandem stance (modified Balance Error Scoring System result ≥4 errors out of 10), and number of previous concussions (0, 1, 2, and ≥3).

Results: The complete case analysis (including players without missing covariates) included 329 players (366 diagnosed concussions). The median time to clinical recovery was 18 days. In model 1, longer time to first physician visit (>7 days) (time ratio [TR], 1.637 [95% confidence interval (CI), 1.331-1.996]) and greater symptom severity (TR, 1.016 [95% CI, 1.012-1.020]) were significant predictors of longer clinical recovery. In model 2, longer time to first physician visit (TR, 1.698 [95% CI, 1.399-2.062]), headache (moderate/severe) (TR, 1.319 [95% CI, 1.110-1.568]), and poorer tandem stance (TR, 1.249 [95% CI, 1.052-1.484]) were significant predictors of longer clinical recovery.

Conclusion: Medical clearance to RTP was longer for players with >7 days to physician assessment, poorer tandem stance, greater symptom severity, and moderate/severe headache at first visit.
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http://dx.doi.org/10.1177/23259671211013370DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8114271PMC
May 2021

Body checking in non-elite adolescent ice hockey leagues: it is never too late for policy change aiming to protect the health of adolescents.

Br J Sports Med 2021 May 20. Epub 2021 May 20.

Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada.

Objectives: The objective of this study is to evaluate the effect of policy change disallowing body checking in adolescent ice hockey leagues (ages 15-17) on reducing rates of injury and concussion.

Methods: This is a prospective cohort study. Players 15-17 years-old were recruited from teams in non-elite divisions of play (lower 40%-70% by division of play depending on year and city of play in leagues where policy permits or prohibit body checking in Alberta and British Columbia, Canada (2015-18). A validated injury surveillance methodology supported baseline, exposure-hours and injury data collection. Any player with a suspected concussion was referred to a study physician. Primary outcomes include game-related injuries, game-related injuries (>7 days time loss), game-related concussions and game-related concussions (>10 days time loss).

Results: 44 teams (453 player-seasons) from non-body checking and 52 teams (674 player-seasons) from body checking leagues participated. In body checking leagues there were 213 injuries (69 concussions) and in non-body checking leagues 40 injuries (18 concussions) during games. Based on multiple multilevel mixed-effects Poisson regression analyses, policy prohibiting body checking was associated with a lower rate of injury (incidence rate ratio (IRR): 0.38 (95% CI 0.24 to 0.6)) and concussion (IRR: 0.49; 95% CI 0.26 to 0.89). This translates to an absolute rate reduction of 7.82 injuries/1000 game-hours (95% CI 2.74 to 12.9) and the prevention of 7326 injuries (95% CI 2570 to 12083) in Canada annually.

Conclusions: The rate of injury was 62% lower (concussion 51% lower) in leagues not permitting body checking in non-elite 15-17 years old leagues highlighting the potential public health impact of policy prohibiting body checking in older adolescent ice hockey players.
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http://dx.doi.org/10.1136/bjsports-2020-103757DOI Listing
May 2021

The Impact of COVID-19 on High School Student-Athlete Experiences with Physical Activity, Mental Health, and Social Connection.

Int J Environ Res Public Health 2021 03 29;18(7). Epub 2021 Mar 29.

Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, AB T2N 1N4, Canada.

COVID-19 restrictions led to reduced levels of physical activity, increased screen usage, and declines in mental health in youth; however, in-depth understandings of the experiences of high school student-athletes have yet to be explored. To describe the experiences of the COVID-19 pandemic on student-athletes' physical activity, social connection, and mental health, 20 high school student-athletes living in Calgary, Alberta participated in semi-structured interviews, designed using phenomenography. Participants reported variations in physical activity, social connections, and mental health which were influenced by stay-at-home restrictions and weather. Access to resources, changes to routines, online classes, and social support all influenced engagement in physical activity. School and sports provided opportunities for in-person social connections, impacted by the onset of the pandemic. Participants reported their mental health was influenced by social connections, online classes, and physical activity. Findings from this study will inform the development of resources for high school student-athletes amidst COVID-19.
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http://dx.doi.org/10.3390/ijerph18073515DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8036482PMC
March 2021

Active & Safe Central: using a mixed-methods design and the RE-AIM framework to evaluate a sport and recreational injury prevention resource for practitioners in Canada.

BMJ Open 2021 01 12;11(1):e039070. Epub 2021 Jan 12.

British Columbia Injury Research and Prevention Unit, BC Children's Hospital, Vancouver, British Columbia, Canada.

Objectives: An online, evidence-based resource was created to support the development of sport and recreational injury prevention programmes. The resource, called Active & Safe Central (www.activesafe.ca), provides evidence-based information across the public health approach for a number of sport and recreational activities. The objective of this project was to evaluate the perceived usefulness of Active & Safe Central as an educational tool.

Design: A mixed-methods study design, guided by the RE-AIM (reach, effectiveness, adoption, implementation and maintenance) framework, was used to evaluate Active & Safe Central.

Setting: Data were collected using an online survey, available to all users of the site, and focus groups (n=2) that took place in Vancouver and Toronto, Canada.

Participants: Survey respondents (n=87) were recruited online, including parents, coaches, youth and adult athletes, and teachers. Focus group participants (n=16) were key stakeholders and end users, recruited from academia, local health sectors, sport and recreational organisations, and not-for-profit injury prevention organisations.

Results: Post launch, there were 1712 users visiting the website 2306 times (sessions), with the majority representing new users, over returning users (87.5% and 12.5%, respectively). There were 6340 page visits, with the most popular pages including soccer, playgrounds and ice hockey. Active & Safe Central was reported as a credible source of evidence-based sport and recreational information and that the site would be recommended to others. Information collected from focus group participants was used to inform necessary adaptations to the online platform, including critical navigation issues, visualisations and interactivity. The major themes that emerged from focus group and survey data included increased awareness of injury prevention recommendations and that the recommendations would be used in one's own sporting activity and/or practice.

Conclusions: The results of the evaluation suggest the tool is a useful resource for sport and recreational injury information that has significant potential to impact prevention practice.
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http://dx.doi.org/10.1136/bmjopen-2020-039070DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7805371PMC
January 2021

Internal Training Load Measures in Elite Adolescent Ballet Dancers.

J Dance Med Sci 2020 Nov;24(4):175-182

Prevention Research Centre, Faculty of Kinesiology, Alberta Children's Hospital Research Institute, and O'Brien Institute for Public Health, University of Calgary, Calgary, Alberta, Canada.

Training load has been identified as a risk factor for musculoskeletal injury in sport, but little is known about the effects of training load in dance. The purpose of this study was to describe adolescent dancers' internal training load (ITL) and compare objective and subjective measures of ITL using heart rate (HR) training impulse methods and session Rating of Perceived Exertion (sRPE), respectively. Fifteen female elite adolescent ballet dancers at a vocational dance school volunteered to participate in the study. Internal training load data using HR and sRPE were collected over 9 days of multiple technique classes at the midpoint of the dancers' training year. Heart rate data were quantified using Edwards' training impulse (ETRIMP) and Banister's training impulse (BTRIMP), and sRPE was estimated from the modified Borg 0 to 10 scale and class duration. Descriptive statistics (median [M], and interquartile range [IQR]) were determined in arbitrary units (AU), and were as follows for all classes combined: ETRIMP: M = 134 AU (IQR = 79 to 244 AU); BTRIMP: M = 67 AU (IQR = 38 to 109); sRPE: M = 407 AU (IQR = 287 to 836 AU). The association and agreement between objective and subjective ITL measures in ballet and pointe class was assessed using Spearman correlations (r) and adjusted Bland-Altman 95% limits of agreement (LOA), respectively, with alpha set at 0.05. A significant moderate positive correlation was found between ETRIMP and BTRIMP in pointe class (r = 0.8000, p = 0.0031). The mean difference (LOA) between ETRIMP and BTRIMP was 121 AU (33 to 210 AU) in ballet and 43 AU (-3 to 88 AU) in pointe. It is concluded that some, but not all, measures of ITL in elite adolescent ballet dancers are comparable. Additional research is needed to examine the utilization of ITL measures for evaluating dance-related injury risk, as well as the application of ITL to inform the development of effective injury prevention strategies for this high-risk population.
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http://dx.doi.org/10.12678/1089-313X.24.4.175DOI Listing
November 2020

Pre- and postsurgical medical therapy for endometriosis surgery.

Cochrane Database Syst Rev 2020 11 18;11:CD003678. Epub 2020 Nov 18.

Department of Obstetrics & Gynecology, Máxima Medical Center, Veldhoven, Netherlands.

Background: Endometriosis is a common gynaecological condition affecting 10% to 15% of reproductive-age women and may cause dyspareunia, dysmenorrhoea, and infertility. One treatment strategy is combining surgery and medical therapy to reduce the recurrence of endometriosis. Though the combination of surgery and medical therapy appears to be beneficial, there is a lack of clarity about the appropriate timing of when medical therapy should be used in relation with surgery, that is, before, after, or both before and after surgery, to maximize treatment response.

Objectives: To determine the effectiveness of medical therapies for hormonal suppression before, after, or both before and after surgery for endometriosis for improving painful symptoms, reducing disease recurrence, and increasing pregnancy rates.

Search Methods: We searched the Cochrane Gynaecology and Fertility (CGF) Group trials register, CENTRAL, MEDLINE, Embase, PsycINFO, CINAHL, and two trials registers in November 2019 together with reference checking and contact with study authors and experts in the field to identify additional studies.

Selection Criteria: We included randomized controlled trials (RCTs) which compared medical therapies for hormonal suppression before, after, or before and after, therapeutic surgery for endometriosis.

Data Collection And Analysis: Two review authors independently extracted data and assessed risk of bias. Where possible, we combined data using risk ratio (RR), standardized mean difference or mean difference (MD) and 95% confidence intervals (CI). Primary outcomes were: painful symptoms of endometriosis as measured by a visual analogue scale (VAS) of pain, other validated scales or dichotomous outcomes; and recurrence of disease as evidenced by EEC (Endoscopic Endometriosis Classification), rAFS (revised American Fertility Society), or rASRM (revised American Society for Reproductive Medicine) scores at second-look laparoscopy.

Main Results: We included 26 trials with 3457 women with endometriosis. We used the term "surgery alone" to refer to placebo or no medical therapy. Presurgical medical therapy compared with placebo or no medical therapy Compared to surgery alone, we are uncertain if presurgical medical hormonal suppression reduces pain recurrence at 12 months or less (dichotomous) (RR 1.10, 95% CI 0.72 to 1.66; 1 RCT, n = 262; very low-quality evidence) or whether it reduces disease recurrence at 12 months - total (AFS score) (MD -9.6, 95% CI -11.42 to -7.78; 1 RCT, n = 80; very low-quality evidence). We are uncertain if presurgical medical hormonal suppression decreases disease recurrence at 12 months or less (EEC stage) compared to surgery alone (RR 0.88, 95% CI 0.78 to 1.00; 1 RCT, n = 262; very low-quality evidence). We are uncertain if presurgical medical hormonal suppression improves pregnancy rates compared to surgery alone (RR 1.16, 95% CI 0.99 to 1.36; 1 RCT, n = 262; very low-quality evidence). No trials reported pelvic pain at 12 months or less (continuous) or disease recurrence at 12 months or less. Postsurgical medical therapy compared with placebo or no medical therapy We are uncertain about the improvement observed in pelvic pain at 12 months or less (continuous) between postsurgical medical hormonal suppression and surgery alone (MD -0.48, 95% CI -0.64 to -0.31; 4 RCTs, n = 419; I = 94%; very low-quality evidence). We are uncertain if there is a difference in pain recurrence at 12 months or less (dichotomous) between postsurgical medical hormonal suppression and surgery alone (RR 0.85, 95% CI 0.65 to 1.12; 5 RCTs, n = 634; I = 20%; low-quality evidence). We are uncertain if postsurgical medical hormonal suppression improves disease recurrence at 12 months - total (AFS score) compared to surgery alone (MD -2.29, 95% CI -4.01 to -0.57; 1 RCT, n = 51; very low-quality evidence). Disease recurrence at 12 months or less may be reduced with postsurgical medical hormonal suppression compared to surgery alone (RR 0.30, 95% CI 0.17 to 0.54; 4 RCTs, n = 433; I = 58%; low-quality evidence). We are uncertain about the reduction observed in disease recurrence at 12 months or less (EEC stage) between postsurgical medical hormonal suppression and surgery alone (RR 0.80, 95% CI 0.70 to 0.91; 1 RCT, n = 285; very low-quality evidence). Pregnancy rate is probably increased with postsurgical medical hormonal suppression compared to surgery alone (RR 1.22, 95% CI 1.06 to 1.39; 11 RCTs, n = 932; I = 24%; moderate-quality evidence). Pre- and postsurgical medical therapy compared with surgery alone or surgery and placebo There were no trials identified in the search for this comparison. Presurgical medical therapy compared with postsurgical medical therapy We are uncertain about the difference in pain recurrence at 12 months or less (dichotomous) between postsurgical and presurgical medical hormonal suppression therapy (RR 1.40, 95% CI 0.95 to 2.07; 2 RCTs, n = 326; I = 2%; low-quality evidence). We are uncertain about the difference in disease recurrence at 12 months or less (EEC stage) between postsurgical and presurgical medical hormonal suppression therapy (RR 1.10, 95% CI 0.95 to 1.28; 1 RCT, n = 273; very low-quality evidence). We are uncertain about the difference in pregnancy rate between postsurgical and presurgical medical hormonal suppression therapy (RR 1.05, 95% CI 0.91 to 1.21; 1 RCT, n = 273; very low-quality evidence). No trials reported pelvic pain at 12 months or less (continuous), disease recurrence at 12 months - total (AFS score) or disease recurrence at 12 months or less (dichotomous). Postsurgical medical therapy compared with pre- and postsurgical medical therapy There were no trials identified in the search for this comparison. Serious adverse effects for medical therapies reviewed There was insufficient evidence to reach a conclusion regarding serious adverse effects, as no studies reported data suitable for analysis.

Authors' Conclusions: Our results indicate that the data about the efficacy of medical therapy for endometriosis are inconclusive, related to the timing of hormonal suppression therapy relative to surgery for endometriosis. In our various comparisons of the timing of hormonal suppression therapy, women who receive postsurgical medical therapy compared with no medical therapy or placebo may experience benefit in terms of disease recurrence and pregnancy. There is insufficient evidence regarding hormonal suppression therapy at other time points in relation to surgery for women with endometriosis.
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http://dx.doi.org/10.1002/14651858.CD003678.pub3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8127059PMC
November 2020

Mendelian randomization analyses suggest a role for cholesterol in the development of endometrial cancer.

Int J Cancer 2021 01 7;148(2):307-319. Epub 2020 Aug 7.

Behavioral and Epidemiology Research Group, American Cancer Society, Atlanta, Georgia, USA.

Blood lipids have been associated with the development of a range of cancers, including breast, lung and colorectal cancer. For endometrial cancer, observational studies have reported inconsistent associations between blood lipids and cancer risk. To reduce biases from unmeasured confounding, we performed a bidirectional, two-sample Mendelian randomization analysis to investigate the relationship between levels of three blood lipids (low-density lipoprotein [LDL] and high-density lipoprotein [HDL] cholesterol, and triglycerides) and endometrial cancer risk. Genetic variants associated with each of these blood lipid levels (P < 5 × 10 ) were identified as instrumental variables, and assessed using genome-wide association study data from the Endometrial Cancer Association Consortium (12 906 cases and 108 979 controls) and the Global Lipids Genetic Consortium (n = 188 578). Mendelian randomization analyses found genetically raised LDL cholesterol levels to be associated with lower risks of endometrial cancer of all histologies combined, and of endometrioid and non-endometrioid subtypes. Conversely, higher genetically predicted HDL cholesterol levels were associated with increased risk of non-endometrioid endometrial cancer. After accounting for the potential confounding role of obesity (as measured by genetic variants associated with body mass index), the association between genetically predicted increased LDL cholesterol levels and lower endometrial cancer risk remained significant, especially for non-endometrioid endometrial cancer. There was no evidence to support a role for triglycerides in endometrial cancer development. Our study supports a role for LDL and HDL cholesterol in the development of non-endometrioid endometrial cancer. Further studies are required to understand the mechanisms underlying these findings.
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http://dx.doi.org/10.1002/ijc.33206DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7757859PMC
January 2021

Association between concussion education and concussion knowledge, beliefs and behaviours among youth ice hockey parents and coaches: a cross-sectional study.

BMJ Open 2020 08 23;10(8):e038166. Epub 2020 Aug 23.

Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada.

Objectives: To examine the association between self-reported exposure to concussion education and knowledge, beliefs and self-reported behaviour among parents and coaches of youth ice hockey players.

Design: Cross-sectional.

Setting: Community ice hockey teams from Calgary and Edmonton, Alberta, Canada.

Participants: Parents and coaches of ice hockey players (ages 11-17, all divisions of play).

Primary And Secondary Outcome Measures: Participants completed a questionnaire developed and validated to measure concussion knowledge, beliefs and concussion management behaviour (ie, coaches removing athletes from play; parents taking children with suspected concussions to physicians) consistent with the Health Action Process Approach (HAPA). The questionnaire examined specific HAPA constructs (ie, risk perception, outcome expectancies, action self-efficacy, intention, action planning, maintenance self-efficacy, recovery self-efficacy) relevant to concussion management behaviour.

Results: Participants included 786 parents (31.8% with coaching experience) and 10 non-parent coaches. Of the participants, 649 (82.6%) previously received concussion education. Based on a multivariable regression analysis adjusting for coaching experience, previous history of a child sustaining one or more concussions, first aid experience and cluster by team, exposure to concussion education was associated with a mean score difference of 1.36 (95% CI 0.68 to 2.03), p<0.0001, in the knowledge score. Exposure to concussion education was not significantly associated with any of the HAPA constructs based on Wilcoxon rank-sum tests.

Conclusion: Exposure to concussion education may be associated with small overall differences in concussion knowledge but may not be associated with significant differences in beliefs or intended behaviours related to concussion management among youth hockey parents and coaches.When providing education or recommendations for concussion education sources to coaches and parents, educational strategies grounded in behavioural change theory that specifically target the motivators of behavioural change should be considered.
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http://dx.doi.org/10.1136/bmjopen-2020-038166DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7445332PMC
August 2020

NAMS 2019 Pre-Meeting Symposium, September 2019, Chicago Illinois: The Perimenopause.

Menopause 2020 07;27(7):735-745

Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Diego, La Jolla, CA.

The North American Menopause Society held the 2019 Pre-Meeting Symposium on September 25, 2019, in Chicago, Illinois, to review the current state of the science related to the physiology of the perimenopause and to address management of the most prevalent and pressing clinical issues. The perimenopause, as defined by the Stages of Reproductive Aging Workshop + 10, encompasses the menopause transition as well as the first year following menopause, the final menstrual period. This phase in the continuum of women's reproductive lives had been one of the least well understood. Fortunately, contributions from a number of prospective, longitudinal, decades-long studies have provided a better understanding of the perimenopause, whereas posing important new questions related to symptom interaction and linkages between symptoms and long-term health. There is now added clarity to distinguish the effects of reproductive hormonal changes from aging. The variation in symptoms, including vasomotor symptoms, among women over time including differences in experiences by ethnicity and race, provides paradigm shifts in clinical perspective. Refinements in understanding the character, timing, and potential predictive markers for menstrual cycles during the transition have emerged. From the perspective of myriad clinical management challenges, significant progress in recommendations for evaluation and therapeutic approaches has been achieved. Finally, recognizing the menopause transition as an opportunity to initiate positive lifestyle changes to enhance future health was emphasized.
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http://dx.doi.org/10.1097/GME.0000000000001571DOI Listing
July 2020

Self-reported Prostate Cancer Progression Status Is Accurate: A Validation Study.

Epidemiology 2020 05;31(3):441-447

National Cancer Institute, National Institutes of Health, Rockville, MD.

Background: Studies of prostate cancer progression are important for discovering risk factors that may increase the risk of prostate cancer-specific death; however, little is known about the validity of self-reported prostate cancer progression.

Methods: We conducted a validation study of self-reported prostate cancer progression in the Prostate, Lung, Colorectal, and Ovarian (PLCO) Cancer Screening Trial and in a prostate cancer cohort enrolled in a Fred Hutchinson Cancer Research Center (FHCRC)-based study. We calculated measures of validity for self-reported progression, including sensitivity, specificity, positive predictive value, and negative predictive value using medical records as the gold standard.

Results: Our results suggest that ascertaining prostate cancer progression-related events (i.e., prostate-specific antigen elevation, recurrence, metastasis, and use of secondary treatment) through self-report may be a viable option for identifying men whose disease has progressed after diagnosis or initial therapy, particularly when multiple questions related to progression are included in the assessment (aggregate cluster of questions: sensitivity = 0.76 [PLCO]; 0.93 [FHCRC], specificity = 0.80 [PLCO]; 0.97 [FHCRC]). With an aggregate positive predictive value of 0.50 (PLCO), however, our PLCO results suggest that additional medical record verification of self-reported progression events may be necessary to rule out false positives. Most individuals reporting no evidence of progression-related events, however, were true negatives (aggregate negative predictive value = 0.92 [PLCO]; 0.98 [FHCRC]). Thus, there may be limited utility to investing resources in chart review to confirm self-reported nonevents.

Conclusion: Ascertaining prostate cancer progression through self-report provides an efficient and valid approach to enhancing existing cancer cohorts with updated data on progression status. See video abstract at, http://links.lww.com/EDE/B658.
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http://dx.doi.org/10.1097/EDE.0000000000001170DOI Listing
May 2020

Soil microbial diversity in adjacent forest systems - contrasting native, old growth kauri (Agathis australis) forest with exotic pine (Pinus radiata) plantation forest.

FEMS Microbiol Ecol 2020 05;96(5)

Bio-Protection Research Centre, Lincoln University, P.O. Box 85084, Lincoln 7674, New Zealand.

Globally, the conversion of primary forests to plantations and agricultural landscapes is a common land use change. Kauri (Agathis australis) is one of the most heavily impacted indigenous tree species of New Zealand with <1% of primary forest remaining as fragments adjacent to pastoral farming and exotic forest plantations. By contrasting two forest systems, we investigated if the fragmentation of kauri forests and introduction of pine plantations (Pinus radiata) are significantly impacting the diversity and composition of soil microbial communities across Waipoua kauri forest, New Zealand. Using next generation based 16S rRNA and ITS gene region sequencing, we identified that fungal and bacterial community composition significantly differed between kauri and pine forest soils. However, fungal communities displayed the largest differences in diversity and composition. This research revealed significant shifts in the soil microbial communities surrounding remnant kauri fragments, including the loss of microbial taxa with functions in disease suppression and plant health. Kauri dieback disease, caused by Phytophthora agathidicida, currently threatens the kauri forest ecosystem. Results from this research highlight the need for further investigations into how changes to soil microbial diversity surrounding remnant kauri fragments impact tree health and disease expression.
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http://dx.doi.org/10.1093/femsec/fiaa047DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7161737PMC
May 2020

Contraception for Adolescents

J Clin Res Pediatr Endocrinol 2020 Feb;12(Suppl 1):28-40

Department of Obstetrics and Gynecology, University of Ottawa; and The Ottawa Hospital Research Institute, Ottawa, Canada

Although pregnancy and abortion rates have declined in adolescents, unintended pregnancies remain unacceptably high in this age group. The use of highly effective methods of contraception is one of the pillars of unintended pregnancy prevention and requires a shared decision making process within a rights based framework. Adolescents are eligible to use any method of contraception and long-acting reversible contraceptives, which are “forgettable” and highly effective, may be particularly suited for many adolescents. Contraceptive methods may have additional non-contraceptive benefits that address other needs or concerns of the adolescent. Dual method use should be encouraged among adolescents for the prevention of both unintended pregnancies and sexually transmitted infections. Health care providers have an important role to play in ensuring that adolescents have access to high quality and non-judgmental reproductive health care services and contraceptive methods in adolescent-friendly settings that recognize the unique biopsychosocial needs of the adolescent.
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http://dx.doi.org/10.4274/jcrpe.galenos.2019.2019.S0003DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7053440PMC
February 2020

Risk of Prostate Cancer-related Death Following a Low PSA Level in the PLCO Trial.

Cancer Prev Res (Phila) 2020 04 29;13(4):367-376. Epub 2020 Jan 29.

Division of Cancer Epidemiology and Genetics, NCI, Bethesda, Maryland.

Longer-than-annual screening intervals have been suggested to improve the balance of benefits and harms in prostate cancer screening. Many researchers, societies, and guideline committees have suggested that screening intervals could depend on the prostate-specific antigen (PSA) result. We analyzed data from men ( = 33,897) ages 55-74 years with a baseline PSA test in the intervention arm of the Prostate, Lung, Colorectal and Ovarian Cancer Screening trial (United States, 1993-2001). We estimated 5- and 10-year risks of aggressive cancer (Gleason ≥8 and/or stage III/IV) and 15-year risks of prostate cancer-related mortality for men with baseline PSA ≤ 0.5 ng/mL ( = 4,862), ≤1 ng/mL ( = 15,110), and 1.01-2.5 ng/mL ( = 12,422). A total of 217 men died from prostate cancer through 15 years, although no men with PSA ≤ 1 ng/mL died from prostate cancer within 5 years [95% confidence interval (CI), 0.00%-0.03%]. The 5-year incidence of aggressive disease was low (0.08%; 95% CI, 0.03%-0.12%) for men with PSA ≤ 1 ng/mL, and higher for men with baseline PSA 1.01-2.5 ng/mL (0.51%; 95% CI, 0.38%-0.74%). No men aged ≥65 years with PSA ≤ 0.5 ng/mL died from prostate cancer within 15 years (95% CI, 0.00%-0.32%), and their 10-year incidence of aggressive disease was low (0.25%; 95% CI, 0.00%-0.53%). Compared with white men, black men with PSA ≤ 1 ng/mL had higher 10-year rates of aggressive disease (1.6% vs. 0.4%; < 0.01). Five-year screening intervals may be appropriate for the 45% of men with PSA ≤ 1 ng/mL. Men ages ≥65 years with PSA ≤ 0.5 ng/mL could consider stopping screening. Substantial risk disparities suggest appropriate screening intervals could depend on race/ethnicity.
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http://dx.doi.org/10.1158/1940-6207.CAPR-19-0397DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7339970PMC
April 2020

Mouthguard use in youth ice hockey and the risk of concussion: nested case-control study of 315 cases.

Br J Sports Med 2020 Jul 14;54(14):866-870. Epub 2020 Jan 14.

Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada

Background: Concussion is the most common injury in youth ice hockey. Whether mouthguard use lowers the odds of concussion remains an unanswered question.

Objective: To determine the association between concussion and mouthguard use in youth ice hockey.

Methods: Nested case-control design. Cases and controls were identified from two prospective cohort studies using valid injury surveillance methods. Cases were players concussed during a game or practice; controls were players who sustained a non-concussion injury during a game or practice. The primary exposure was mouthguard use at time of injury; mouthguard type (dental custom fit or off the shelf) was a secondary exposure. Physician-diagnosed or therapist-suspected concussion was the primary outcome. Dental injury was a secondary outcome. Multilevel logistic regression with random effect at a team level was used to obtain ORs for the mouthguard effect, adjusted for level of play, age group, position, concussion history, mechanism of injury, cohort, session type and body checking policy.

Results: Among cases, 236/315 (75%) were wearing a mouthguard at time of injury, while 224/270 (83%) controls were wearing a mouthguard at time of injury. Any mouthguard use was associated with an adjusted OR for concussion of 0.36 (95% CI 0.17 to 0.73). Off-the-shelf mouthguards were associated with a 69% lower odds of concussion (adjusted OR: 0.31; 95% CI 0.14 to 0.65). Dental custom-fit mouthguards were associated with a non-significant 49% lower odds of concussion (adjusted OR: 0.51; 95% CI 0.22 to 1.10). No dental injuries were identified in either cohort.

Conclusion: Mouthguard use was associated with lower odds of concussion. Players should be required to wear mouthguards in youth ice hockey.
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http://dx.doi.org/10.1136/bjsports-2019-101011DOI Listing
July 2020

Baseline Performance of High School Rugby Players on the Sport Concussion Assessment Tool 5.

J Athl Train 2020 Feb 9;55(2):116-123. Epub 2020 Jan 9.

Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Canada.

Context: Version 5 of the Sport Concussion Assessment Tool (SCAT5) was released in 2017 with an additional 10-word list option in the memory section and additional instructions for completing the symptom scale.

Objective: To provide reference scores for high school rugby union players on the SCAT5, including immediate memory using the 10-word list, and examine how age, sex, and concussion history affected performance.

Design: Cross-sectional study.

Setting: Calgary, Alberta high schools.

Patients Or Other Participants: High school rugby union players (ages 15-18 years) participating in a 2018 season cohort study (n = 380, males = 210, females = 170).

Main Outcome Measure(s): Sport Concussion Assessment Tool 5 scores, including total number of symptoms (of 20), symptom severity (of 132), 10-word immediate memory (of 30), delayed memory (of 10), modified Standardized Assessment of Concussion (of 50), and balance examination (of 30).

Results: The median number of symptoms reported at baseline ranged from 5 to 8 across sex and age stratifications. Median symptom severity was lowest in males with no concussion history (7; range, 0-28) and highest in females with a concussion history (13, range = 0-45). Median total scores on immediate memory were 2-3 (range = 0-4) for males and 21 (range = 9-29) for females. Median total scores were 3 (range = 0-4) on digits backward and 7 (range = 0-20) on delayed memory (all groups). Based on simultaneous quantile (q) regression at 0.50 and 0.75, adjusted for age and concussion history, being female was associated with a higher total symptoms score (q0.75 β = 2.85; 99% confidence interval [CI] = 0.33, 5.37), higher total symptom severity score (q0.75 β = 8.00; 99% CI = 2.83, 13.17), and lower number of errors on the balance examination (q0.75 β = -3.00; 99% CI = -4.85, -1.15). Age and concussion history were not associated with any summary measures.

Conclusions: The 10-word list option in the memory section reduced the likelihood of a ceiling effect. A player's sex may be an important consideration when interpreting the SCAT5 after concussion.
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http://dx.doi.org/10.4085/1062-6050-123-19DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7017900PMC
February 2020

Proceedings From the Ice Hockey Summit III: Action on Concussion.

Clin J Sport Med 2021 May;31(3):e150-e160

Human Kinetics, University of Ottawa, Ottawa, ON, Canada.

Objectives: The Ice Hockey Summit III provided updated scientific evidence on concussions in hockey to inform these 5 objectives: (1) describe sport related concussion (SRC) epidemiology; (2) classify prevention strategies; (3) define objective, diagnostic tests; (4) identify treatment; and (5) integrate science and clinical care into prioritized action plans and policy.

Methods: Our action plan evolved from 40 scientific presentations. The 155 attendees (physicians, athletic trainers, physical therapists, nurses, neuropsychologists, scientists, engineers, coaches, and officials) voted to prioritize these action items in the final Summit session.

Results: To (1) establish a national and international hockey database for SRCs at all levels; (2) eliminate body checking in Bantam youth hockey games; (3) expand a behavior modification program (Fair Play) to all youth hockey levels; (4) enforce game ejection penalties for fighting in Junior A and professional hockey leagues; (5) establish objective tests to diagnose concussion at point of care; and (6) mandate baseline testing to improve concussion diagnosis for all age groups.

Conclusions: Expedient implementation of the Summit III prioritized action items is necessary to reduce the risk, severity, and consequences of concussion in the sport of ice hockey.
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http://dx.doi.org/10.1097/JSM.0000000000000745DOI Listing
May 2021

La contraception au Canada : Un clin d'œil au passé et un regard vers l'avenir.

Authors:
Amanda Black

J Obstet Gynaecol Can 2019 Dec;41 Suppl 2:S309-S313

Département d'obstétrique et de gynécologie, Université d'Ottawa et; L'Institut de recherche de l'Hôpital d'Ottawa, Ottawa, Ont.. Electronic address:

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http://dx.doi.org/10.1016/j.jogc.2019.10.022DOI Listing
December 2019

Contraception in Canada: A Nod to the Past and Look Into the Future.

Authors:
Amanda Black

J Obstet Gynaecol Can 2019 Dec;41 Suppl 2:S305-S308

Department of Obstetrics and Gynecology, University of Ottawa and; The Ottawa Hospital Research Institute, Ottawa, ON. Electronic address:

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http://dx.doi.org/10.1016/j.jogc.2019.09.001DOI Listing
December 2019

Adapting the Dynamic, Recursive Model of Sport Injury to Concussion: An Individualized Approach to Concussion Prevention, Detection, Assessment, and Treatment.

J Orthop Sports Phys Ther 2019 11 14;49(11):799-810. Epub 2019 Oct 14.

Synopsis: The risk factors of concussion may be categorized as intrinsic (internal factors specific to the individual) or extrinsic (external factors related to the environment or sport). Identifying these factors is part of an individualized, patient-centered approach to prevention, assessment, and management of concussion. In most cases, the symptoms of concussion resolve in the initial few days following the injury, and a strategy involving a gradual return to sport and school is recommended. When symptoms persist for longer than 7 to 10 days, a multifaceted interdisciplinary assessment to guide treatment is recommended. This article applies the dynamic, recursive model of sport injury to sport-related concussion and summarizes the process of individualized assessment and management following concussion in athletes of all ages, with a focus on physical rehabilitation. .
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http://dx.doi.org/10.2519/jospt.2019.8926DOI Listing
November 2019

Does disallowing body checking in non-elite 13- to 14-year-old ice hockey leagues reduce rates of injury and concussion? A cohort study in two Canadian provinces.

Br J Sports Med 2020 Apr 6;54(7):414-420. Epub 2019 Sep 6.

Department of Paediatrics, Cumming Scjhool of Medicine, University of Calgary, Calgary, Alberta, Canada.

Objective: To compare rates of injury and concussion among non-elite (lowest 60% by division of play) Bantam (ages 13-14 years) ice hockey leagues that disallow body checking to non-elite Bantam leagues that allow body checking.

Methods: In this 2-year cohort study, Bantam non-elite ice hockey players were recruited from leagues where policy allowed body checking in games (Calgary/Edmonton 2014-2015, Edmonton 2015-2016) and where policy disallowed body checking (Kelowna/Vancouver 2014-2015, Calgary 2015-2016). All ice hockey game-related injuries resulting in medical attention, inability to complete a session and/or time loss from hockey were identified using valid injury surveillance methodology. Any player suspected of having concussion was referred to a study physician for diagnosis and management.

Results: 49 body checking (608 players) and 33 non-body checking teams (396 players) participated. There were 129 injuries (incidence rate (IR)=7.98/1000 hours) and 54 concussions (IR=3.34/1000 hours) in the body checking teams in games. After policy change, there were 31 injuries (IR=3.66/1000 hours) and 17 concussions (IR=2.01/1000 hours) in games. Policy disallowing body checking was associated with a lower rate of all injury (adjusted incidence rate ratio (IRR)=0.44; 95% CI: 0.27 to 0.74). The point estimate showed a lower rate of concussion (adjusted IRR=0.6; 95% CI: 0.31 to 1.18), but this was not statistically significant.

Conclusion: Policy change disallowing body checking in non-elite Bantam ice hockey resulted in a 56% lower rate of injury. There is growing evidence that disallowing body checking in youth ice hockey is associated with fewer injuries.
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http://dx.doi.org/10.1136/bjsports-2019-101092DOI Listing
April 2020

Sex specific associations in genome wide association analysis of renal cell carcinoma.

Eur J Hum Genet 2019 10 23;27(10):1589-1598. Epub 2019 Jun 23.

Russian N.N. Blokhin Cancer Research Centre, Moscow, Russian Federation.

Renal cell carcinoma (RCC) has an undisputed genetic component and a stable 2:1 male to female sex ratio in its incidence across populations, suggesting possible sexual dimorphism in its genetic susceptibility. We conducted the first sex-specific genome-wide association analysis of RCC for men (3227 cases, 4916 controls) and women (1992 cases, 3095 controls) of European ancestry from two RCC genome-wide scans and replicated the top findings using an additional series of men (2261 cases, 5852 controls) and women (1399 cases, 1575 controls) from two independent cohorts of European origin. Our study confirmed sex-specific associations for two known RCC risk loci at 14q24.2 (DPF3) and 2p21(EPAS1). We also identified two additional suggestive male-specific loci at 6q24.3 (SAMD5, male odds ratio (OR) = 0.83 [95% CI = 0.78-0.89], P = 1.71 × 10 compared with female odds ratio (OR) = 0.98 [95% CI = 0.90-1.07], P = 0.68) and 12q23.3 (intergenic, OR = 0.75 [95% CI = 0.68-0.83], P = 1.59 × 10 compared with OR = 0.93 [95% CI = 0.82-1.06], P = 0.21) that attained genome-wide significance in the joint meta-analysis. Herein, we provide evidence of sex-specific associations in RCC genetic susceptibility and advocate the necessity of larger genetic and genomic studies to unravel the endogenous causes of sex bias in sexually dimorphic traits and diseases like RCC.
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http://dx.doi.org/10.1038/s41431-019-0455-9DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6777615PMC
October 2019

Consensus canadien sur la contraception (partie 3 de 4): chapitre 7 - Contraception intra-utérine.

J Obstet Gynaecol Can 2019 Jun;41 Suppl 1:S1-S23

Québec (Québec) (coprésidente).

Objectif: Fournir des lignes directrices aux fournisseurs de soins quant à l'utilisation de modes de contraception pour la prévention de la grossesse et quant à la promotion d'une sexualité saine.

Issues: Orientation des praticiens canadiens en ce qui concerne l'efficacité globale, le mécanisme d'action, les indications, les contre-indications, les avantages n'étant pas liés à la contraception, les effets indésirables, les risques et le protocole de mise en œuvre des modes de contraception abordés; planification familiale dans le contexte de la santé sexuelle et du bien-être général; méthodes de counseling en matière de contraception; et accessibilité et disponibilité des modes de contraception abordés au Canada. RéSULTATS: La littérature publiée a été récupérée par l'intermédiaire de recherches menées dans MEDLINE et The Cochrane Library entre janvier 1994 et janvier 2015 au moyen d'un vocabulaire contrôlé (p. ex. contraception, sexuality, sexual health) et de mots clés (p. ex. contraception, family planning, hormonal contraception, emergency contraception) appropriés. Les résultats ont été restreints aux analyses systématiques, aux études observationnelles et aux essais comparatifs randomisés / essais cliniques comparatifs publiés en anglais entre janvier 1994 et janvier 2015. Les recherches ont été mises à jour de façon régulière et intégrées à la directive clinique jusqu'en juin 2015. La littérature grise (non publiée) a été identifiée par l'intermédiaire de recherches menées dans les sites Web d'organismes s'intéressant à l'évaluation des technologies dans le domaine de la santé et d'organismes connexes, dans des collections de directives cliniques, dans des registres d'essais cliniques et auprès de sociétés de spécialité médicale nationales et internationales.

Valeurs: La qualité des résultats a été évaluée au moyen des critères décrits dans le rapport du Groupe d'étude canadien sur les soins de santé préventifs (Tableau 1). CHAPITRE 7 : CONTRACEPTION INTRA-UTéRINE: Déclarations sommaires RECOMMANDATIONS.
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http://dx.doi.org/10.1016/j.jogc.2019.02.124DOI Listing
June 2019
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