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Changes in Clinical Measures and Tissue Adaptations in Collegiate Swimmers Across a Competitive Season
Get PDFBackground: Due to high training volume, competitive swimmers incur shoulder pain and injury1, but certain physical characteristics, such as shoulder ROM and endurance, and tissue adaptations such as posterior capsule thickness (PCT) and supraspinatus tendon structure may also be risk factors. Decreased endurance and ROM have been found in competitive swimmers along with being related to pain2. However, no longitudinal studies have examined pain and disability, range of motion, training volume, shoulder endurance and tendon structure over the course of a competitive season.
Purpose: The purpose of this study was to: 1) to assess shoulder pain and disability, internal rotation (IR) and external rotation (ER) and horizontal adduction (HADD) ROM, and posterior shoulder endurance longitudinally over a competitive collegiate season, and 2) determine if there is a relationship between swimming yardage, supraspinatus tendon organization and posterior capsule thickness.
Methods: 17 male and 13 female Division III swimmers aged 19.6 ± 1.1 years participated. Pain and disability were assessed using the Penn Shoulder Score and the Disability of Arm Shoulder Hand sports module. Internal rotation (IR), external rotation (ER), and horizontal adduction (HA) were measured using a digital inclinometer. Shoulder endurance was measured using the Posterior Shoulder Endurance Test (PSET). Anterior, center, and posterior supraspinatus tendon images were collected by locating the anterior aspect of the tendon insertion and moving posteriorly. The ultrasound images were analyzed using custom MATlab software to quantify tissue organization. All measures were found in the beginning (T1), middle (T2), and end (T3) of the season. Repeated measure ANOVAs were used to compare longitudinal changes across time. If p-values were found to be ≤ 0.05, follow-up paired t-tests with Bonferroni corrections were used to compare T1, T2, and T3. This protocol was IRB-approved and participants signed a written consent form.
Results: An increase in swimming yardage from T1 to T2 was followed by a significant decrease in yardage to finish the swimming season (Table 1). Disability decreased and endurance increased throughout the season with no observed changes in pain. IR and HA ROM decreased significantly between all timepoint comparisons. Tendon banding frequency did not change over time (Table 2).
Discussion: Large amounts of IR during the pull phase and late initiation of ER during the recovery phase have been associated with a high risk of impingement4. The relationship between pain, disability, and range of motion may suggest that a reduction of IR could protect the swimmers’ shoulder by limiting impingement through the pull and recovery phases. However, further investigation is required to confirm. The lack of statistical significance longitudinally in tendon organization is not surprising since there were no changes in pain, a decrease in disability, and an increase in endurance.
Conclusion/Clinical Relevance: Further research is required to understand the relationship between training volume, tendon organization, and disability. Collegiate swimmers demonstrate increased endurance and decreased disability over the course of the season. It may suggest that the loss of ROM is a positive adaptation and may be protective
Exploring mindfulness and its psychosocial correlates in a population of low-income, female, tobacco smokers with young children
Get PDFBackground: Tobacco use is the leading preventable cause of disease and death in the US and smoking rates are high in low-income populations (28% vs. 17% of those living above the poverty line).1,2 Consequently, low-income groups have elevated tobacco-related disease risk exacerbating health disparities.3,4 Mindfulness has been associated with positive effects on psychosocial, physical and mental health outcomes, which has increased interest in using mindfulness as an adjunctive treatment for smoking cessation and relapse prevention.5,6 However, research on mindfulness in relation to such factors in underserved populations is lacking.
Purpose/Hypothesis: The purpose of this research is to investigate the psychometric qualities and correlates of the Cognitive and Affective Mindfulness Scale (CAMS-R)7 in a sample of low-income, mostly minority women who smoke cigarettes. It is hypothesized that the CAMS-R will be reliable, and mindfulness will be associated with known barriers to cessation.
Methods: Secondary analysis of self-report data from 12-month follow-up in a large, randomized smoking cessation trial, Babies Living Safe and Smokefree,8 was used to explore mindfulness and its relationship to known cessation barriers and facilitators. Temple University IRB approval was received before data collection. CAMS-R items were summed to create a composite score.
Results: The sample of women (N=187) was mostly (72%) African American, average age was 30 years old, ~28% had less than a high school degree/GED and on average smoked ~9 cigarettes/day. The CAMS-R was reliable (α=.74). Zero-order correlations showed higher mindfulness was significantly correlated with greater social support (p < .01). Higher mindfulness was significantly correlated with lower depressive symptoms, social constraints, household chaos, sleep disturbances, childhood trauma, life stressors, and chronic mental, and physical health conditions (p\u27s < .01 except physical health p < .05).
Conclusions/Relevance: The sample had higher CAMS-R scores compared to central tendency scores in broader populations. The high scores may indicate an amenable characteristic of mindfulness that could be trained for interventions. Yet, more research is needed on feasibility/acceptability in this population. Higher mindfulness is inversely related to many negative health and psychosocial factors which are known barriers to cessation, as well as positively related to social support, an important facilitator of cessation. The interplay between social support and mindfulness should be explored, as each is theorized as a “stress buffer.” research should investigate psychosocial factors as potential mediators in mindfulness interventions for smoking cessation targeting vulnerable female smokers
Sexual Misconduct: Are You Aware?
Get PDFSexual misconduct, a continuum of unwanted acts and behaviors that ranges from discrimination to assault, is a growing concern in health care. There is often a power dynamic involved, with the perpetrator having greater positional power than the victim. Both health care providers and educators in health care programs need to be aware of sexual misconduct. This includes using consent when working with a patient and/or student as wells as being sensitive to how varying contextual factors impact how actions and conversations are received. Schools and programs have a responsibility to educate individuals on prevention and recognition of sexual misconduct, reporting sexual misconduct, and responding to sexual misconduct
An Ecologic Analysis of Comorbidities in Patients with COVID-19 in Philadelphia and New York City
Get PDFObjective: Early scientific reports of the COVID-19 pandemic suggested that the coronavirus was associated with more serious disease and mortality in older adults. However, additional research suggested that those with underlying comorbidities, including obesity, type 2 diabetes, heart and respiratory diseases were most at risk for more severe outcomes. As a result, most studies focused on comorbidities among those who were hospitalized or critically ill. There is a need to understand how common comorbidities are associated with overall risk of infection. This analysis aimed to explore the relationship between COVID-19 infection and common comorbidities. Methods: An ecologic analysis explored aggregate case counts of COVID-19 cases across zip codes compared to area-level estimates of health-related variables and outcomes in Philadelphia, PA and New York City, NY. Results: The analysis found that small area-estimated rates of obesity and asthma were significant ecologic predictors of population-based rates of COVID-19 cases in New York City. In contrast, small area-estimates rates of arthritis were significant predictors in Philadelphia. Conclusions: There are important area-level variations in COVID-19 infections that are correlated with variations in other chronic conditions, suggesting that factors that influence health disparities may affect the distribution of COVID-19. 
Risk Factors to the Sex Trafficking Victimization of Female Refugees
No full textThis is a theory-building paper which examines three sections of risk factors and conditions that contribute to the vulnerability of female refugees to sexual exploitation throughout the forced migration process. In looking at the underlying individual demographics which transcend the stages of the migration process, age, economic status, and marital status are acknowledged as relevant risk factors to the sex trafficking victimization of female refugees. In addition, the use of smugglers, the danger level of pathways, the level of border security throughout the journey, and who refugees are traveling with all serve as conditions that contribute to the vulnerability of female refugees. Lastly, regarding destination conditions, refugee camps are acknowledged as a site of enhanced risk to exploitation, and camps’ level of oversight and proper accommodation are identified as variables that increase risk and vulnerability. This is done through the content analysis of research literature and organizational reports of correlated studies relating to sex trafficking of the larger female population and sexual and gender-based violence (SGBV) against female refugees. The purpose is to provide a framework for answering the following question: Under what conditions do female refugees fall victim to human sex trafficking?
Keywords: risk factors, female refugees, vulnerability, sexual exploitation, forced migration, sex trafficking, victimization, sexual and gender-based violenc
Effects of Vestibular Training on Postural Control of Healthy Adults
Get PDFBackground: Postural stability depends on the integration of multisensory inputs to drive motor outputs. When visual and somatosensory input is available and reliable, this reduces the postural control system’s reliance on the vestibular system. Despite this, vestibular loss can still cause severe postural dysfunction (1,2). Training one or more of the three sensory systems can alter sensory weighting and change postural behavior. Vestibular activation exercises, including horizontal and vertical headshaking, influence vestibular-ocular and -motor responses and have been showed to be effective in vestibular rehabilitation (3–8).
Purpose/Hypothesis: To assess sensory reweighting of postural control processing and vestibular-ocular and -motor responses after concurrent vestibular activation with postural training. It was hypothesized that the effect of this training would significantly alter the pattern of sensory weighting by changing the ratio of visual, somatosensory and vestibular dependence needed to maintain postural stability, and significantly decrease vestibular responses.
Methods: Forty-two young healthy individuals (22 females; 23.0+3.9 years; 1.6+0.1 meters) were randomly assigned into four groups: 1) visual feedback weight shift training (WST) coupled with an active horizontal headshake (HHS), 2) same WST with vertical headshake (VHS), 3) WST with no headshake (NHS) and 4) no training/headshake control (CTL) groups. The headshake groups performed an intensive body WST together with horizontal or vertical rhythmic headshake at 80 to 120 beats/minute. The NHS group performed the WST with no headshake while the controls did not perform any training. Five 15-minute training sessions were performed on consecutive days for one week with the weight shift exercises involving upright limits of stability activities on a flat surface, foam or rocker board (Fig. 1). All groups performed baseline- and post-assessments including sensory organization test (SOT) and force platform ramp perturbations, coupled with electromyographic (EMG) recordings. A video head impulse test was also used to record horizontal vestibulo-ocular reflex (VOR) gain. A between- and within-group repeated measures ANOVA was used to analyze five COP sway variables, the equilibrium and composite scores and sensory ratios of the SOT as well as EMG signals and horizontal VOR gain. Similarly, COP variables, EMG, as well as vestibular reflex data (vertical VOR, vestibulo-collic reflex [VCR] and vestibulo-spinal [VSR] gains) during ramp perturbations were analyzed. Alpha level was set at p<.05.
Results: The training showed a significant somatosensory downweighting (p=.050) in the headshake groups compared to the other groups. Training also showed significant decreased horizontal VOR gain (p=.040), faster automatic postural response (p=.003) (Figs. 2-4) with improved flexibility (p=.010) in the headshake groups. Muscle activation pattern in medial gastrocnemius (p=.033) was significantly decreased in the headshake.
Conclusion: The concurrent vestibular activation and weight shift training modifies vestibular-dependent responses after the training intervention as evidenced in somatosensory downweighting, decreased VOR gain, better postural flexibility and faster automatic postural response. Findings suggest this is predominantly due to vestibular adaptation and habituation of VOR, VCR and VSR which induced sensory reweighting.
Clinical relevance: Findings may be used to guide the development of a vestibular-postural rehabilitation intervention in impaired neurological populations, such as with vestibular disorders or sensory integration problems
Letter from the Editors
No full textWe are delighted to welcome you to the inaugural issue of CommonHealth, an interdisciplinary, peer-reviewed, open-access journal of the College of Public Health at Temple University.
Establishment of this journal is an exciting milestone and a natural next step in our trajectory of growth and leadership in public health education and research. The College of Public Health (CPH) is home to more than 50 academic programs within 17 disciplines. Our departments have earned 24 program-specific accreditations and four of our graduate programs are within the top 25% nationwide. In 2017, the College received full accreditation by the Council on Education for Public Health. One of the key differentiators of CPH is our active research community and commitment to interdisciplinary research and education. In 2018, the work of CPH investigators was supported by over $22 million dollars in funding. Students at every level in CPH participate in meaningful collaborations with faculty, receive hands-on research training, and produce impactful research.
We are cordially inviting authors from Temple University and the public health community at large to submit their original research, research commentary, clinical innovation and practice, teaching innovation and practice, community connection articles, and multimedia submissions to CommonHealth. We look forward to seeing your scholarship.  
The Intersectionality of the Committee on the Elimination of Discrimination against Women
No full textThis article examines the conditions under which the Committee on the Elimination of Discrimination Against Women (the Committee) evaluates an individual case brought against a state using an intersectional lens. It also analyzes the extent to which the Committee’s understanding of a state’s culture affects its evaluation of a case from an intersectional lens. As the global understanding of women’s rights begins to encompass a broader range of cultural perspectives and intersecting identities, understanding the jurisprudence of the Committee, which is responsible for interpreting the main international women’s rights treaty known as CEDAW, necessitates consideration for the extent to which the Committee incorporates this broader intersectional analysis into its legal reasoning. Utilizing concepts from literature on intersectionality and culture, the article analyzes the Committee’s legal reasoning in seven cases, comparing them by topic, by state, and by the Committee’s understanding of a state’s culture. It suggests the Committee is more likely to interpret the Convention using an intersectional framework when it identifies a state’s culture as a contributing factor to systemic discrimination against an individual’s intersecting identities, which it is more likely to do in cases involving nonWestern states. This article will contribute to existing scholarship on the jurisprudence of CEDAW by integrating literature on intersectionality and culture to examine the Committee’s legal reasoning in individual decisions. It will also articulate the conditions under which individual women obtain justice for gender-based discrimination under CEDAW, shifting the MUNDI Gabos 2 focus of existing human rights literature from abstract theory to women’s lived experiences
Yemen: the Worst Humanitarian Crisis in the World, Ignored
No full textDecades of rising tensions and several years of civil war later, Yemen and its dire humanitarian crisis have been forgotten by much of the mainstream media and the West. The effects of this humanitarian crisis have left two thirds of Yemen’s population in need of humanitarian assistance and thousands of Yemeni people dead. Yemen’s humanitarian crisis contains a triple threat to the people of Yemen -- conflict, famine, and cholera. Given the nature of the topic, in order to provide a balanced and well-rounded assessment of the situation, research was conducted through news articles from the United States, Turkey, the United Kingdom, and the United Nations, as well as research from the World Bank. In this paper, the causes of Yemen’s humanitarian crisis are examined,
including Yemen’s civil war between government forces and Houthi rebels and the intervention of foreign powers, such as Saudi Arabia and the international coalition it leads. By examining these causes in conjunction with the harsh realities of the humanitarian crisis, I argue that the global community must uphold their responsibility to protect while guarding against states’ self- serving actions at the expense of the masses.
Note: The research and writing for this paper were completed in February and early March 2019. Thus, the research presented in this paper reflects the humanitarian crisis in Yemen as of early 2019. Statistics and analysis may have changed since then