Imbalance of the eccentrically-activated external rotator cuff muscles versus the concentrically-activated internal rotator cuff muscles is a primary risk factor for glenohumeral joint injuries in overhead activity athletes. Nonisokinetic dynamometer based strength training studies, however, have focused exclusively on resulting concentric instead of applicable eccentric strength gains of the external rotator cuff muscles. Furthermore, previous strength training studies did not result in a reduction in glenoumeral joint muscle imbalance, thereby suggesting that currently used shoulder strength training programs do not effectively reduce the risk of shoulder injury to the overhead activity athlete. Two collegiate women tennis teams, consisting of 12 women, participated in this study throughout their preseason training. One team (n = 6) participated in a 5-week, 4 times a week, external shoulder rotator muscle strength training program next to their preseason tennis training. The other team (n = 6) participated in a comparable preseason tennis training program, but did not conduct any upper body strength training. Effects of this strength training program were evaluated by comparing pre- and posttraining data of 5 maximal eccentric external immediately followed by concentric internal contractions on a Kin-Com isokinetic dynamometer (Chattecx Corp., Hixson, Tennessee). Overall, the shoulder strength training program significantly increased eccentric external total work without significant effects on concentric internal total work, concentric internal mean peak force, or eccentric external mean peak force. In conclusion, by increasing the eccentric external total exercise capacity without a subsequent increase in the concentric internal total exercise capacity, this strength training program potentially decreases shoulder rotator muscle imbalances and the risk for shoulder injuries to overhead activity athletes.

ObjectiveTo determine the association of dementia-related psychosis (DRP) with death and use of long-term care (LTC); we hypothesized that DRP would be associated with increased risk of death and use of LTC in patients with dementia.MethodsA retrospective cohort study was performed. Medicare claims from 2008 to 2016 were used to define cohorts of patients with dementia and DRP. Outcomes were LTC, defined as nursing home stays of >100 consecutive days, and death. Patients with DRP were directly matched to patients with dementia without psychosis by age, sex, race, number of comorbid conditions, and dementia index year. Association of DRP with outcomes was evaluated using a Cox proportional hazard regression model.ResultsWe identified 256,408 patients with dementia. Within 2 years after the dementia index date, 13.9% of patients developed DRP and 31.9% had died. Corresponding estimates at 5 years were 25.5% and 64.0%. Mean age differed little between those who developed DRP (83.8 ± 7.9 years) and those who did not (83.1 ± 8.7 years). Patients with DRP were slightly more likely to be female (71.0% vs 68.3%) and white (85.7% vs 82.0%). Within 2 years of developing DRP, 16.1% entered LTC and 52.0% died; corresponding percentages for patients without DRP were 8.4% and 30.0%, respectively. In the matched cohort, DRP was associated with greater risk of LTC (hazard ratio [HR] 2.36, 2.29–2.44) and death (HR 2.06, 2.02–2.10).ConclusionsDRP was associated with a more than doubling in the risk of death and a nearly 2.5-fold increase in risk of the need for LTC.

Based on current law enforcement officer (LEO) duties, musculoskeletal injury risk is elevated due to the unpredictable nature of physically demanding tasks. The purpose of this 4-week study was to determine the effectiveness of a 15-min post-shift standardized occupational specific training program. The standardized program was designed to improve lower-body strength and speed to aid physically demanding task performance. Seven male LEOs completed the program after their 12-h shift. Subjects were required to use the department fitness center to perform the 15-min standardized program consisting of a dynamic warm-up, 4 sets of 3 repetitions on hex-bar deadlift and four 20-m sprints. Two minutes of rest was required between each set of 3 repetitions on hex-bar deadlift and 1 min of rest between each 20-m sprint. A dependent T-test was used between pre-test and post-test scores for hex-bar deadlift (HBD) and sprint. Data revealed significant improvements in relative lower-body strength with HBD (p ≤ 0.001). However, insignificant results were demonstrated with the 20-m sprint (p ≤ 0.262). In conclusion, a 15-min post-shift workout can improve lower-body strength as measured by the hex-bar deadlift. However, data indicated running speed may require a different training approach to improve the 20-m sprint.

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The purpose of this study was to develop a field test capable of measuring upper-body power through the use of a common weight-training apparatus, a Smith machine (SM), set up for bench press (BP) movement. A small, battery-operated digital timing device was designed and constructed to allow a precise calculation of power (in conjunction with measures of distance and force) for this specific movement, which involved an explosive press from the chest to a position just short of full arm extension. In pilot work, 1 repetition maximums (1RM) were determined on the SM BP for 3 male subjects, and by subsequently testing power on the same subjects at varying resistances, an average relative percentage of the 1RM-producing peak power values was found by power curve analysis for test standardization. Reliability was assessed (using 11 men) by SM power measurements taken over 3 days on the SM fitted with the timer. An intraclass R (0.998) indicated a high correlation between the 3 separate field-test trials. Finally, 8 male subjects were used to compare SM scores with a criterion measure, the Linea Isokinetic BP station (Loredan Biomedical, Inc., Sacramento CA). A Pearson product moment coefficient found a high correlation between the field test (SM) and Linea power scores (r ϭ 0.987). A 2-tailed dependent t-test between the field and criterion scores was not significant, suggesting that no consistent error variable was present. It can be concluded that this is a valid field test of power for this movement.

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BackgroundPatient medication adherence is multidimensional and poses significant concerns to health care professionals. One aspect of adherence is a patient forgetting to take their prescribed medication, which may be improved with reminder packaging (RP). The objective of this analysis was to assess the impact of RP on patient adherence to antihypertensive therapy.MethodsThis retrospective, propensity score-matched study evaluated patients switching to a single-pill combination of valsartan-hydrochlorothiazide in RP compared with patients remaining on the combination without reminder packaging (non-RP). Patients receiving combination therapy between April 1, 2009 and July 31, 2010 were eligible for inclusion. Patients were propensity score-matched on baseline adherence and background demographic variables, including comorbidities. Medication possession ratio, proportion of days covered, time to refill, and time to discontinuation were evaluated as primary measures of subsequent adherence and persistence.ResultsIn a total of 9266 matched patients (4633 participants in both cohorts), adherence was significantly higher in the RP cohort compared with patients in the non-RP cohort (medication possession ratio, RP 80% versus non-RP 73%; proportion of days covered, RP 76% versus non-RP 63%; both P < 0.001). Refill timing was 10 days for RP patients versus 16 days for non-RP patients (P < 0.001). Similar trends were observed with respect to time to discontinuation (RP 196 days, non-RP 174 days; P < 0.001). A higher proportion of RP patients remained on therapy compared with non-RP patients, with patients in the RP group being 17% less likely to discontinue therapy compared with patients in the non-RP group (hazards ratio 0.833; 95% confidence interval 0.793–0.875).ConclusionThis real-world assessment of differences in adherence and persistence rates demonstrated that patients receiving RP were more adherent and persistent with their treatment regimens.