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Background Injuries are a common occurrence in military recruit training, however due to differences in the capture of training exposure, injury incidence rates are rarely reported. Our aim was to determine the musculoskeletal injury epidemiology of military recruits, including a standardised injury incidence rate. Methods Epidemiological systematic review following the PRISMA 2020 guidelines. Five online databases were searched from database inception to 5 th May 2021. Prospective and retrospective studies that reported data on musculoskeletal injuries sustained by military recruits after the year 2000 were included. We reported on the frequency, prevalence and injury incidence rate. Incidence rate per 1000 training days (Exact 95% CI) was calculated using meta-analysis to allow comparisons between studies. Observed heterogeneity (e.g., training duration) precluded pooling of results across countries. The Joanna Briggs Institute Quality Assessment Checklist for Prevalence Studies assessed study quality. Results This review identified 41 studies comprising 451,782 recruits. Most studies ( n  = 26; 63%) reported the number of injured recruits, and the majority of studies ( n  = 27; 66%) reported the number of injuries to recruits. The prevalence of recruits with medical attention injuries or time-loss injuries was 22.8% and 31.4%, respectively. Meta-analysis revealed the injury incidence rate for recruits with a medical attention injury may be as high as 19.52 injuries per 1000 training days; and time-loss injury may be as high as 3.97 injuries per 1000 training days. Longer recruit training programs were associated with a reduced injury incidence rate ( p  = 0.003). The overall certainty of the evidence was low per a modified GRADE approach. Conclusion This systematic review with meta-analysis highlights a high musculoskeletal injury prevalence and injury incidence rate within military recruits undergoing basic training with minimal improvement observed over the past 20 years. Longer training program, which may decrease the degree of overload experienced by recruit, may reduce injury incidence rates. Unfortunately, reporting standards and reporting consistency remain a barrier to generalisability. Trial registration PROSPERO (Registration number: CRD42021251080).

We are conducting a research program to cocreate, implement and evaluate an injury prevention intervention for the Western Australia (WA) Police Force Recruit Training Academy. This programme of research has three primary phases: (1) cocreate an injury prevention intervention for the WA Police Force with WA Force recruits, WA Police Force staff, health professionals and injury prevention experts, (2) implement the injury prevention intervention into WA Police Force Recruit training and (3) evaluate the reach, effectiveness, adoption, implementation and maintenance of the injury prevention intervention. Our research programme includes the involvement of consumers, industry partners and researchers. To ensure collaboration and to measure our consumer, industry partner and researcher involvement, we have developed a protocol, including qualitative and quantitative evaluation, to address potential barriers to involvement. Thus, this protocol details our consumer, industry partner and researcher involvement plan across all three phases of this 5-year project and how we will evaluate their experience and influence. Our primary objective is to ensure meaningful consumer, industry partner and researcher involvement at all stages of the research process and evaluate how the research programme was influenced by consumer, industry partner and researcher involvement.

Objective: Exploring how body composition and musculoskeletal characteristics relate to physical performance may provide insights for optimising training outcomes. We explored if body composition and musculoskeletal characteristics were associated with tactical and cardiorespiratory performance. Methods: A cross-sectional study of police recruits within the Western Australia Police Force was performed. Total and regional body composition was assessed using Dual-energy X-ray Absorptiometry, with the tibial morphology and mid-thigh muscle cross-sectional area assessed using peripheral Quantitative Computed Tomography. Tactical performance was measured with a Physical Performance Evaluation, and cardiorespiratory fitness assessed using the Beep Test. Variables that were significant in univariate regressions progressed to generalised linear models, assessing relationships between measures and performance outcomes. Results: Twenty-seven recruits aged 21–51 years (40.7% female) participated. Better tactical performance was associated with lower body fat percentage (p < 0.001), lower body mass index (p < 0.001), higher appendicular muscle mass (p = 0.005), and a lower proximal (66%) tibia polar cross-section moment of inertia (p = 0.007). Better cardiorespiratory fitness was associated with lower body fat percentage (p = 0.004), higher appendicular lean mass (p = 0.006), a lower proximal (66%) tibia polar cross-section moment of inertia (p = 0.005), and a higher mid-thigh muscle cross-sectional area (p < 0.001). Conclusions: Various body composition and musculoskeletal characteristics are associated with tactical performance and cardiorespiratory fitness in WA police recruits. Lower body fat percentage and higher appendicular muscle mass were associated with both better cardiorespiratory fitness and tactical performance, highlighting the potential relevance of these characteristics in preparing police recruits for operational duties.

A healthy police force is a key component of a well-functioning society, yet 1 in 20 law enforcement recruits drop out of the recruit training programme due to injury. This drop-out rate has substantial economic and workforce ramifications. In the Western Australia Police Force, one in five recruits suffers a musculoskeletal injury during the recruit training programme, causing time-loss from work. We will now identify the critical elements of an injury prevention intervention and investigate the needs, experiences and suggested solutions to address potential implementation challenges. Our objective is to co-create an intervention with content and context experts, specifically for Western Australia Police Force recruits, to reduce injury prevalence, incidence rates and burden. A mixed-method participatory action research approach will guide intervention cocreation. Phase 1 will include concept mapping and phase 2 will include focus groups. This research will develop an intervention that the Western Australia Police Force can deliver to reduce injury prevalence, incidence rates and burden among recruits. The effectiveness of the intervention in reducing injury burden, economic burden and implementation will be evaluated.

Lower income is associated with high incident cardiovascular disease (CVD) and mortality. CVD is an important cause of morbidity and mortality in cancer survivors. However, there is limited research on the association between income, CVD, and mortality in this population. This study utilized nationally representative data from the National Health and Nutrition Examination Survey (NHANES), a cross-sectional survey evaluating the health and nutritional status of the US population. Our study included NHANES participants aged ≥20 years from 2003-2014, who self-reported a history of cancer. We evaluated the association between income level, prevalence of CVD, and all-cause mortality. All-cause mortality data was obtained through public use mortality files. Income level was assessed by poverty-income ratio (PIR) that was calculated by dividing family (or individual) income by poverty guideline. We used multivariable-adjusted Cox proportional hazard models through a backward elimination method to evaluate associations between PIR, CVD, and all-cause mortality in cancer survivors. This cohort included 2,464 cancer survivors with a mean age of 62 (42% male) years. Compared with individuals with a higher PIR tertiles, those in the lowest PIR tertile had a higher rate of pre-existing CVD and post-acquired CVD. In participants with post-acquired CVD, the lowest PIR tertile had over two-fold increased risk mortality (Hazard Ratio (HR) = 2.17; 95% CI: 1.27-3.71) when compared to the highest PIR tertile. Additionally, we found that PIR was as strong a predictor of mortality in cancer survivors as CVD. In patients with no CVD, the lowest PIR tertile continued to have almost a two-fold increased risk of mortality (HR = 1.72; 95% CI: 1.69-4.35) when compared to a reference of the highest PIR tertile. In this large national study of cancer survivors, low PIR is associated with a higher prevalence of CVD. Low PIR is also associated with an increased risk of mortality in cancer survivors, showing a comparable impact to that of pre-existing and post-acquired CVD. Urgent public health resources are needed to further study and improve screening and access to care in this high-risk population.

Children have mild severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) confirmed disease (COVID-19) compared to adults and the immunological mechanisms underlying this difference remain unclear. Here, we report acute and convalescent innate immune responses in 48 children and 70 adults infected with, or exposed to, SARS-CoV-2. We find clinically mild SARS-CoV-2 infection in children is characterised by reduced circulating subsets of monocytes (classical, intermediate, non-classical), dendritic cells and natural killer cells during the acute phase. In contrast, SARS-CoV-2-infected adults show reduced proportions of non-classical monocytes only. We also observe increased proportions of CD63+ activated neutrophils during the acute phase to SARS-CoV-2 in infected children. Children and adults exposed to SARS-CoV-2 but negative on PCR testing display increased proportions of low-density neutrophils that we observe up to 7 weeks post exposure. This study characterises the innate immune response during SARS-CoV-2 infection and household exposure in children. Childhood infection with SARS CoV2 is associated with a milder course of infection but the immunopathogenesis of this remains unclear. Here the authors explore immunological differences in the innate immune system during acute and convalescent SARS CoV2 infection in the young.

Hessell et al . report that post-exposure treatment with HIV-1–specific neutralizing antibodies clears SHIV infection from the blood and tissues of infant rhesus macaques. Prevention of mother-to-child transmission (MTCT) of HIV remains a major objective where antenatal care is not readily accessible. We tested HIV-1–specific human neutralizing monoclonal antibodies (NmAbs) as a post-exposure therapy in an infant macaque model for intrapartum MTCT. One-month-old rhesus macaques were inoculated orally with the simian-human immunodeficiency virus SHIV SF162P3 . On days 1, 4, 7 and 10 after virus exposure, we injected animals subcutaneously with NmAbs and quantified systemic distribution of NmAbs in multiple tissues within 24 h after antibody administration. Replicating virus was found in multiple tissues by day 1 in animals that were not treated. All NmAb-treated macaques were free of virus in blood and tissues at 6 months after exposure. We detected no anti-SHIV T cell responses in blood or tissues at necropsy, and no virus emerged after CD8 + T cell depletion. These results suggest that early passive immunotherapy can eliminate early viral foci and thereby prevent the establishment of viral reservoirs.

Purpose Adjuvant endocrine therapy (AET) often causes debilitating endocrine symptoms that compromise quality of life (QOL) in women diagnosed with hormone receptor positive breast cancer (BC). We examined whether greater levels of physical activity (PA) or prolonged sitting were associated with reduced side effects or worse side effects of AET, respectively. Methods We used parallel process latent growth curve models to examine longitudinal patterns in PA and sitting behaviors, and their association with endocrine symptoms and QOL over 3 years of follow‐up in 554 female BC survivors undergoing AET. Results At baseline, women were a mean age of 59 years, mostly white (72%), with overweight/obesity (67%), and approximately 50% were within 1 year of diagnosis. Unconditional models showed significant increases in PA (p < 0.01) over time but no change in sitting. Endocrine symptoms, general and BC‐specific QOL all significantly worsened over time (p < 0.01). Parallel process models showed no cross‐sectional or longitudinal associations between PA and endocrine symptoms. Higher levels of baseline PA were associated with higher baseline QOL scores (p = 0.01) but changes in PA were not associated with changes in QOL. Conversely, more sitting at baseline was associated with worse endocrine symptoms, general and BC specific QOL (ps <0.01). At baseline, having better QOL scores was associated with increases in sitting (ps <0.01), while having worse endocrine symptoms was associated with a slower rate of increase in sitting (p < 0.01). Increases in sitting time were also associated with a slower rate of increase in endocrine symptoms (p = 0.017). Model fit statistics (x2, CFI, TLI, SRMR) were acceptable. Conclusion Both PA and sitting behaviors are important for the management of symptoms and in maintaining QOL in BC survivors. Women with already high symptom burden do not increase sitting time further but having better general and BC specific QOL to begin with means a greater decline over time. Adjuvant endocrine therapy (AET) often causes debilitating endocrine symptoms that compromise quality of life (QOL) in women diagnosed with hormone receptor positive breast cancer (BC). We used parallel process latent growth curve models to examine longitudinal patterns in PA and sitting behaviors, and their association with endocrine symptoms and QOL over 3 years of follow‐up in 554 female BC survivors undergoing AET. Parallel process models showed no cross‐sectional or longitudinal associations between PA and endocrine symptoms.

Purpose Black women often experience poorer breast cancer-related outcomes and higher mortality than white women. A contributor to this disparity may relate to the disproportionate burden of cancer treatment-related cardiovascular (CV) toxicities. The objective of this review is to identify studies that report racial differences in CV toxicity risk. Methods Medline and Embase were searched for studies that assessed CV toxicities as the outcome(s) and included Black and White women with breast cancer. Studies were selected based on inclusion/exclusion criteria and through the use of multiple reviewers. Results The review included 13 studies following a review of 409 citations and 49 full-text articles. All studies were retrospective and 8/13 utilized data from the Surveillance, Epidemiology, and End Results–Medicare linked database. Trastuzumab was the most frequently studied treatment. The proportion of Black women in these studies ranged from 5.5 to 63%. A majority of studies reported a higher risk of CV toxicity amongst Black women when compared to white women (93%). Black women had up to a two times higher risk of CV toxicity (HR, 2.73 (CI, 1.24 to 6.01)) compared to white women. Only one study evaluated the role of socioeconomic factors in explaining racial differences in CV toxicity; however, the disparity remained even after adjusting for these factors. Conclusions There is a critical need for more longitudinal studies that evaluate multilevel factors (e.g., psychosocial, biological) that may help to explain this disparity. Implications for Cancer Survivors Black cancer survivors may require additional surveillance and mitigation strategies to decrease disproportionate burden of CV toxicities.

Objective To report on the development and preliminary findings of a community‐based cancer registry, including the community‐engaged approach to recruitment, participant profile, and distribution of cancer risk factors by race/ethnicity and geography. Methods Community outreach and engagement best practices were used to recruit a diverse convenience sample of Virginia residents (≥18 years) that oversampled residents living in rural areas, defined as Rural‐Urban Continuum Codes (RUCC) 4–9 and African American (AA)/Black residents. Multiple survey administration methods included electronic (e‐survey) and in‐person survey by community‐based staff. Results At the time of this analysis, 595 participants are enrolled; 73% are rural, 46% are AA/Black. AA/Black participants reported similar education but lower income (p < 0.01) and health literacy (p < 0.01), lower alcohol use (p < 0.001), fewer sedentary behaviors (p = 0.01), but greater BMI (p < 0.05) compared to White participants. Rural residents reported significantly lower household income (p < 0.001) and greater use of Medicaid (p = 0.01) compared to urban participants. Biennial mammography was reported by 82% of women aged 45–74 years old and colonoscopy by 77% of participants ≥50 years old. Tobacco use was reported by 17%; no differences in cancer screening or tobacco use were identified by geography or by race. Conclusion and relevance Community engagement strategies successfully enrolled diverse residents within the cancer service area. AA/Black participants reported fewer cancer risk behaviors, similar educational attainment but lower income and health literacy compared to White respondents. Nuanced examinations of interactions among multilevel factors are needed to understand how individual, community, and institutional factors converge to maintain cancer disparities among AA/Black Virginians. Additional findings indicate a need for tobacco cessation, lung cancer screening, obesity treatment, and prevention initiatives. Community outreach and engagement builds bidirectional relationships among community members, patients, and researchers to prioritize community cancer needs. The Virginia Living Well Research and Registry (VALW) (currently n = 595) was developed to build bidirectional exchange relationships and collect critical longitudinal cancer prevention and control data within the cancer center catchment area.