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1. Demographic Characteristics and Their Association with Instantaneous Lower Extremity Injury Occurrence in a Division I Athletic Population

   https://doi.org/10.4085/1062-6050-0673.21  

   Kelley, Elisabeth A.; Hogg, Jennifer A.; Gao, Lani; Waxman, Justin P.; Shultz, Sandra J. (July 2022, Journal of Athletic Training)

   Context Temporal prediction of lower extremity (LE) injury risk will benefit clinicians by allowing them to better leverage limited resources and target athletes most at risk. Objective To characterize instantaneous risk of LE injury by demographic factors sex, sport, body mass index (BMI), and previous injury history. Instantaneous injury risk was defined as injury risk at any given point in time following baseline measurement. Design Descriptive epidemiology study. Setting NCAA Division I athletic program. Patients or Other Participants 278 NCAA Division I varsity student-athletes (119 males, 159 females). Main Outcome Measure(s) LE injuries were tracked for 237±235 days. Sex-stratified univariate Cox regression models investigated the association between time to first LE injury and BMI, sport, and previous LE injury history. Relative risk ratios and Kaplan-Meier curves were generated. Variables identified in the univariate analysis were included in a multivariate Cox regression model. Results Females displayed similar instantaneous LE injury risk compared to males (HR=1.29, 95%CI=[0.91,1.83], p=0.16). Overweight athletes (BMI>25 kg/m2) had similar instantaneous LE injury risk compared with athletes with BMI<25 kg/m2 (HR=1.23, 95%CI=[0.84,1.82], p=0.29). Athletes with previous LE injuries were not more likely to sustain subsequent LE injury than athletes with no previous injury (HR=1.09, 95%CI=[0.76,1.54], p=0.64). Basketball (HR=3.12, 95%CI=[1.51,6.44], p=0.002) and soccer (HR=2.78, 95%CI=[1.46,5.31], p=0.002) athletes had higher risk of LE injury than cross-country athletes. In the multivariate model, females were at greater LE injury risk than males (HR=1.55, 95%CI=[1.00,2.39], p=0.05), and males with BMI>25 kg/m2 were at greater risk than all other athletes (HR=0.44, 95%CI=[0.19,1.00], p=0.05). Conclusions In a collegiate athletic population, previous LE injury history was not a significant contributor to risk of future LE injury, while being female or being male with BMI>25 kg/m2 resulted in increased risk of LE injury. Clinicians can use these data to extrapolate LE injury risk occurrence to specific populations. 

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2. Impact of Obesity on Timing of Tracheotomy: A Multi‐institutional Retrospective Study

   https://doi.org/10.1002/lary.31586  

   Yousef, Andrew; Soliman, Shady I; Solomon, Isaac; Panuganti, Bharat A; Francis, David O; Pang, John; Klebaner, Dasha; Asturias, Alicia; Alattar, Ali; Wood, Samuel; et al (November 2024, The Laryngoscope)

   ObjectiveTo examine the impact of increased body mass index (BMI) on (1) tracheotomy timing and (2) short‐term surgical complications requiring a return to the operating room and 30‐day mortality utilizing data from the Multi‐Institutional Study on Tracheotomy (MIST). MethodsA retrospective analysis of patients from the MIST database who underwent surgical or percutaneous tracheotomy between 2013 and 2016 at eight institutions was completed. Unadjusted and adjusted logistic regression analyses were used to assess the impact of obesity on tracheotomy timing and complications. ResultsAmong the 3369 patients who underwent tracheotomy, 41.0% were obese and 21.6% were morbidly obese. BMI was associated with higher rates of prolonged intubation prior to tracheotomy accounting for comorbidities, indication for tracheotomy, institution, and type of tracheostomy (p = 0.001). Morbidly obese patients (BMI ≥35 kg/m²) experienced a longer duration of intubation compared with patients with a normal BMI (median days intubated [IQR 25%–75%]: 11.0 days [7–17 days] versus 9.0 days [5–14 days];p < 0.001) but did not have statistically higher rates of return to the operating room within 30 days (p = 0.12) or mortality (p = 0.90) on multivariable analysis. This same finding of prolonged intubation was not seen in overweight, nonobese patients when compared with normal BMI patients (median days intubated [IQR 25%–75%]: 10.0 days [6–15 days] versus 10.0 days [6–15 days];p = 0.36). ConclusionBMI was associated with increased duration of intubation prior to tracheotomy. Although morbidly obese patients had a longer duration of intubation, there were no differences in return to the operating room or mortality within 30 days. Level of Evidence3Laryngoscope, 134:4674–4681, 2024 

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3. A Remote Health Coaching, Text-Based Walking Program in Ethnic Minority Primary Care Patients With Overweight and Obesity: Feasibility and Acceptability Pilot Study

   https://doi.org/10.2196/31989  

   Smart, Mary H; Nabulsi, Nadia A; Gerber, Ben S; Gupta, Itika; Di Eugenio, Barbara; Ziebart, Brian; Sharp, Lisa K (January 2022, JMIR Formative Research)

   Background Over half of US adults have at least one chronic disease, including obesity. Although physical activity is an important component of chronic disease self-management, few reach the recommended physical activity goals. Individuals who identify as racial and ethnic minorities are disproportionally affected by chronic diseases and physical inactivity. Interventions using consumer-based wearable devices have shown promise for increasing physical activity among patients with chronic diseases; however, populations with the most to gain, such as minorities, have been poorly represented to date. Objective This study aims to assess the feasibility, acceptability, and preliminary outcomes of an 8-week text-based coaching and Fitbit program aimed at increasing the number of steps in a predominantly overweight ethnic minority population. Methods Overweight patients (BMI >25 kg/m2) were recruited from an internal medicine clinic located in an inner-city academic medical center. Fitbit devices were provided. Using 2-way SMS text messaging, health coaches (HCs) guided patients to establish weekly step goals that were specific, measurable, attainable, realistic, and time-bound. SMS text messaging and Fitbit activities were managed using a custom-designed app. Program feasibility was assessed via the recruitment rate, retention rate (the proportion of eligible participants completing the 8-week program), and patient engagement (based on the number of weekly text message goals set with the HC across the 8-week period). Acceptability was assessed using a qualitative, summative evaluation. Exploratory statistical analysis included evaluating the average weekly steps in week 1 compared with week 8 using a paired t test (2-tailed) and modeling daily steps over time using a linear mixed model. Results Of the 33 patients initially screened; 30 (91%) patients were enrolled in the study. At baseline, the average BMI was 39.3 (SD 9.3) kg/m2, with 70% (23/33) of participants presenting as obese. A total of 30% (9/30) of participants self-rated their health as either fair or poor, and 73% (22/30) of participants set up ≥6 weekly goals across the 8-week program. In total, 93% (28/30) of participants completed a qualitative summative evaluation, and 10 themes emerged from the evaluation: patient motivation, convenient SMS text messaging experience, social support, supportive accountability, technology support, self-determined goals, achievable goals, feedback from Fitbit, challenges, and habit formation. There was no significant group change in the average weekly steps for week 1 compared with week 8 (mean difference 7.26, SD 6209.3; P=.99). However, 17% (5/30) of participants showed a significant increase in their daily steps. Conclusions Overall, the results demonstrate the feasibility and acceptability of a remotely delivered walking study that included an HC; SMS text messaging; a wearable device (Fitbit); and specific, measurable, attainable, realistic, and time-bound goals within an ethnic minority patient population. Results support further development and testing in larger samples to explore efficacy. 

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4. Detecting Body Mass Index from a Facial Photograph in Lifestyle Intervention

   https://doi.org/10.3390/technologies6030083  

   Barr, Makenzie; Guo, Guodong; Colby, Sarah; Olfert, Melissa (September 2018, Technologies)

   This study aimed to identify whether a research participant’s body-mass index (BMI) can be correctly identified from their facial image (photograph) in order to improve data capturing in dissemination and implementation research. Facial BMI (fBMI) was measured using an algorithm formulated to identify points on each enrolled participant’s face from a photograph. Once facial landmarks were detected, distances and ratios between them were computed to characterize facial fatness. A regression function was then used to represent the relationship between facial measures and BMI values to then calculate fBMI from each photo image. Simultaneously, BMI was physically measured (mBMI) by trained researchers, calculated as weight in kilograms divided by height in meters squared (adult BMI). Correlation analysis of fBMI to mBMI (n = 1210) showed significant correlation between fBMI and BMIs in normal and overweight categories (p < 0.0001). Further analysis indicated fBMI to be less accurate in underweight and obese participants. Matched pair data for each individual indicated that fBMI identified participant BMI an average of 0.4212 less than mBMI (p < 0.0007). Contingency table analysis found 109 participants in the ‘obese’ category of mBMI were positioned into a lower category for fBMI. Facial imagery is a viable measure for dissemination of human research; however, further testing to sensitize fBMI measures for underweight and obese individuals are necessary. 

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5. Effects of Obesity and Fall Risk on Gait and Posture of Community- Dwelling Older Adults

   https://doi.org/10.36001/ijphm.2019.v10i1.2750  

   Lockhart, T.E. (January 2019, International journal of prognostics and health management)

   Epidemiological studies link increased fall risk to obesity in older adults, but the mechanism through which obesity increases falls and fall risks is unknown. This study investigates if obesity (Body Mass Index: BMI>30 kg/m2) influenced gait and standing postural characteristics of community dwelling older adults leading to increased risk of falls. One hundred healthy older adults (age 74.0±7.6 years, range of 56-90 years) living independently in a community participated in this study. Participants' history of falls over the previous two years was recorded, with emphasis on frequency and characteristics of falls. Participants with at least two falls in the prior year were classified as fallers. Each individual was assessed for postural stability during quiet stance and gait stability during 10 meters walking. Fall risk parameters of postural sway (COP area, velocity, path-length) were measured utilizing a standard forceplate coupled with an accelerometer affixed at the sternum. Additionally, parameters of gait stability (walking velocity, double support time, and double support time variability) were assessed utilizing an accelerometer affixed at the participant's sternum. Gait and postural stability analyses indicate that obese older adults who fell have significantly altered gait pattern (longer double support time and greater variability) exhibiting a loss of automaticity in walking and, postural instability as compared to their counterparts (i.e., higher sway area and path length, and higher sway velocity) further increasing the risk of a fall given a perturbation. Body weight/BMI is a risk factor for falls in older adults as measured by gait and postural stability parameters. 

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