The Lack of General Knowledge about Mental Illness

The Lack of General Knowledge about Mental Illness In our world today, we have a generally poor understanding of mental illness in two distinct ways: we don ´t understand the dangers that mental illness can present to people as they go about their everyday lives, and we don ´t understand how to properly care for people that suffer from mental illness. However, if we better understand when, why, and how mentally ill people can become violent, and if we can better understand how to identify and treat the illnesses these people suffer from, we can drastically improve the lives of many people. People should know more about what some mental ill people can actually do. Some of them might act deviant and break informal social rules. For example,†¦show more content†¦These kinds of guns have a low shot per time rate, which makes them less dangerous. However, in The United States of America it does not take long to acquire a gun. It looks like people here will never give up their right of owning a gun, but everyone should realize something has to change. It would be a good start to look at the health history and to make a psychological test to every single potential buyer of a firearm. Only people that pass the test would be able to purchase and possess a gun. As a result, the mental ill that cannot control themselves and are dangerous, would not have a gun. If this situation truly happened, there would be unethical people that would want to make some money and would sell the firearms to people who did not pass the test. Therefore, another law would have to be promulgated that would strictly sanction those unmoral people. In my opinion, it should also be mandatory for mental ill people to tell their employers or supervisors about their health situation; specially, if their job makes them responsible for the health or safety of other people, like a doctor or a bus driver. I am sure that none of the parents I know would want their children to be driven to school by a bus driver that hides a mental health problem from the families and their boss. The bus driver would be acting wrong in this situation if his problem decreases his driving capabilities, because it could cause the loss of many children.Show MoreRelatedIntroduction Of Ibm Spss Statistics 21 Essay1734 Words   |  7 Pagesstigma from Survey A to Survey B. Prior to the educational intervention, 60.7% of participants believed that someone with a mental disorder should be kept in a psychiatric or mental hospital, compared to 45% following the intervention. Prior to the intervention, 79.1% of participants reported that they would seek outside hel p if they thought that they might have a mental illness and 17.4% of participants reported that they would keep it to themselves, compared to 83.3% who would seek outside help andRead MoreUnmet Needs of the Mentally Ill Population893 Words   |  4 Pages Mental illness in a year’s time invades about 5 to 7 percent of the adult population and 5 to 9 percent of the children population. This means millions of adults and children are disabled by mental illness every year. (National Alliance on Mental Illness, 2012) Given this information, how is the public reacting toward the mentally ill population? How is health care taking care of this population? And why is the mentally ill population falling through the cracks with the current mental healthRead MoreMental Health Awareness And Improvement Act802 Words   |  4 PagesMental Health Awareness and Improvement Act The shortage of aid for treating mental health disorders is often disregarded as inconsequential because of a lack of awareness surrounding the subject. Both the general public and policy makers seem blind to the prevalence of the problem, even though mental illness affects 1 in 5 Americans and costs the country an estimated $247 billion dollars annually (Blumenthal, 2015). The Mental Health Awareness and Improvement Act of 2015 was written to address mentalRead MoreLaw Enforcement Interactions With The Mentally Ill Community1674 Words   |  7 Pageslimited, especially in rural areas. General hospital-based emergency services can also be difficult to access because of bed reductions, and only offer treatment to those only that are seriously ill (e.g. be actively delusional or suicidal). As Eric Macnaughton states in his study BC Early Intervention Study found that over 30% of people with a serious mental illness had contact with the police (1999). While making or attempting to make their first contact with the mental health system. With the increaseRead MoreThe Stigma Of Mental Illness Essay1657 Words   |  7 Pagesor older, live with mental illness. This number represents 18.1% of all U.S. adults (National Institute of Mental Health, 2014). Stigma toward those who are seen as different have existed for as long as civilization itself, with the stigma for mental illness being one of the most prominent and long lasting that society has had to face throughout its ages (Arboleda-Florez Stuart, 2012). Increased understanding and awareness for those individuals suffering from mental illness is necessary for usRead MoreThe Inclusion Of Education On Mental Illness1461 Words   |  6 PagesArguing For the Inclusion of Education on Mental Illness Mental illness affects millions of people around the world. What is surprising, however, is the lack of public information and education about mental illness. With the amount of undiagnosed mental illnesses and disorders as well as the number of suicide attempts that occur daily, it should become a priority for the education system to introduce public classes on mental illness for not just adults or teens but for younger children as well. EducatingRead MoreThe Other Day, While Visiting Relatives1503 Words   |  7 PagesThe other day, while visiting relatives, I observed an interesting conversation. Two of my cousins were arguing about the plans for the evening. They could not decide where to go, and, as it seemed, the conversation kept getting more and more emotionally charged. The frustration among my cousins grew, until one accused the other of being â€Å"bipolar†. The â€Å"accuser† in the conversation said that because his brother was â€Å"flaky and could not m ake up his mind†. When asked, what my cousin meant by sayingRead MoreEssay On One Child Policy1122 Words   |  5 PagesFactbook). Stroke, heart diseases, and cancers are the leading causes of death in China similar to the United States; however, the obesity rate is 32% in the USA and only 6% in China due to a more healthy diet and daily exercise (The World Factbook). Mental illness even though it is covered by health insurance in China creates a high disease burden, exceeding infectious, cardiovascular, or neoplastic diseases (Patel et al., 2016). Part II: A specific health challenge The Sustainable Development Goals (SDG)Read MoreMisrepresentation Of Depression Throughout Society1720 Words   |  7 Pagesdisorder seek treatment for their illness (Holmes). Just as many people avoid seeing a physician, people will avoid facing mental health because of the fear that something is wrong. Through stigmas created in society, mental illness is viewed as unnatural, and having a therapist or taking medication is the easy way out. Many articles and books may offer help for surviving the difficult times in one’s life, but if the person in question is suffering from mental illness, advice can often do more harmRead MoreDepression: Facts vs. False1172 Words   |  5 Pages Depression has become a world-wide epidemic that is still doubted by the general public. Classified as an illness, it affects men and women, young and old, black and white, both mentally and physically. Many believe that depression is simply a creative choice one’s mind, but mental and physical depression is a true debilitating condition. By dictionary definition, depression is a severe despondency and dejection, typically felt over a period of time and accompanied by feelings of hopelessness and

Should Parents Be Responsible For Their Children Being Obese

Eating in America America is known as one of the unhealthiest, obese countries in the world. As a citizen of the United States I would have to agree. We are constantly eating out and super sizing are meals and losing all sense of what a healthy diet means and this has become a very big problem for young children and adults. Would everyone agree to this fact? I believe not. It has come down to convenience for some people to grab something to eat thru a drive thru restaurant instead of cooking a home cooked meal. People are stating that they are happy with whom they are and yet I feel passing on to their children their bad eating habits. Should parents be responsible for their children being obese? We need to teach our children better. Would one agree with the saying, â€Å"You are what you eat†? The way the majority of Americans eat is unhealthy, everywhere you look there is a fast food restaurant on every corner and the obesity rate in America is much higher than any other country. The percentages of American children and teens have doubled in the last decade. Two-thirds of adults in this country are either overweight or obese and at least 300,000 Americans die each year from obese related diseases such as diabetes, Heart disease, Cardiomyopathy, Respiratory disorders, Hypertension, and Sleep apnea. The United States food industry aggressively markets high-fat, high-sugar, super sized foods. We are advertising to drive are cars more than walking in today’s society. Schools areShow MoreRelatedChild Obesity Is A World s Problem1198 Words   |  5 Pagesit on the parents. Some people have also said that the child should be responsible for their own weight, and that they need to make their own choice. Others even maintain that the government should interfere. The reality is that child obesity is a world’s problem that is taking away years of life of young adults. This is a serious, complex problem that can affect someone’s life drastically. These children are not able to get involved in a sports club. It has been said that these children have a lowerRead MoreShould Parents Be Responsible For Obesity Of Their Children?1410 Words   |  6 PagesDilaida Jimenez Professor: Eva Gubalova English 162-62 September 12, 2013 Should Parents Be Responsible For Obesity of Their Children? Obesity is a problem that is growing increasingly in the children’s population in the United States. Statistics of the Centers for Disease Control and Prevention claims that â€Å"obesity now affects 17% of all children and adolescent in the United States, triple the rate from just one generation ago†. The doctors say that this medical condition is easiest to detectRead MoreChild Obesity Is A World s Problem1211 Words   |  5 PagesIn discussion of child obesity, the parents have stated that fast food is the main contributor of this issue. On the other hand, there are tons of people who blame it on the parents. Some people have also said that the children should be responsible for their own weight, and that they need to make their own choices. Others even maintain that the government should interfere. The reality is that child obesity is a world’s problem that is taking away years of life of young adults. This is a seriousRead MoreThe Prevalence Of Overweight And Obese Children911 Words   |  4 PagesThe number of overweight and obese children is only increasing. It is important for children to eat adequate nutrients to ensure development, growth, and health (Brown et al., 2013). Children can become obese if they lack exercise, consume high fat and/or empty caloric foods, and watch their family eat or over eat unhealthy foods. Brown et al. (2013) implies adequate nutrition can improve a child’s academic performance in school, reduce tardiness and absences by decreasing the chances of a childRead MoreMcdonalds : A Favorite Toy Of My Girl1376 Words   |  6 PagesHello Kitty, My Little Pony, etc. The indoor playgrounds have the kids pleading with their parents to take them to McDonalds for Happy Meals. In a child’s eye what could be better? A tasty fried meal, playground time, and a toy! Should I worry so much about my children’s diet? Are these meals a potential threat to their overall health? Am I creating bad habits that will last a lifetime? All parents should be conscious of their children’s diet and the foods they consume. Processed foods loaded withRead MoreSocial Labeling And Stigmatizing Minority Children827 Words   |  4 Pagesbe obese than non-minorities, thus I do not want to provide an image of social labeling and stigmatizing minority children who are overweight. There are many factors that play in role in children being obese that must be taken into accounts. One of the factors, the income status of the parents and how it generally affects the child quality of life, living environment. For example, if the parents have a low yearly income it can factor in the child being obese in comparison to a child’s parent havingRead MoreChildhood Obesity : A Controversial Dilemma999 Words   |  4 Pagesdiscussion of Childhood obesity, one controversial predicament has been that, whether parents are being responsible enough, and are the ones to be blamed for their child’s health, and most important of all, their nutrition. In which they need to be held accountable for their decision making, towards their child’s healthy lifestyle. On the other hand, supporters, and those in favor of this specific idea, suggest that parents, and the newly parenting, has is it that, it must be mandatory that they must haveRead MoreObesity Among Children Are Lack Of Exercise And Bad Eating Habits Essay1521 Words   |  7 PagesAccording to the Centers for Disease Control, obesity among children has tripled in the past twenty years. Other causes for obesity in children are lack of exercise and bad eating habits. Americans need to stop blaming fast food companies and take their own responsibility for providing a healthy nutrition diet for children. Obesity is a very common disease in America that can one day lead to death. Parents need to help their children choose what is healthy for their body to consume. To help themRead MoreEnough Blame From The Fast Food Industry1195 Words   |  5 Pagesnutritional food businesses declining, there by leaving the fast food industry responsible to provide adequate nutrition for countless numbers of young American adults. As well as sympathizing with a group of children suing McDonalds for apparently making them â€Å"fat’. As an obese child, David recalls the limited options of nutritional food in and outside of his household. With what seems like no other options, children all over America are now turning to fast food as a means of quick, cheap, and anRead MoreChildhood Obesity : Parents Change Their Own Habits1252 Words   |  6 PagesChildhood obesity can only stop if parents change their own habits to promote a healthier lifestyle for their family. Parents don t realize it, but they influence children majorly. If a parent is accustom to eating fastfood and snacking multiple times between meals, drinking soda all the time it becomes regular routine for them. Their child will began to learn that same exact routine . Those â€Å"couch potato† parents will usually watch television all day and lack exercise. Children see those things and tend

Anthem Essay- Comparing It to the Bible Free Essays

Compare and Contrast of Adam and Eve and Equality 7-2521 In the novel Anthem, Equality 7-2521’s circumstance of rebellion create similarities and differences to the story of Adam and Eve in the Bible. Adam and Eve’s sin can be compared to Equality 7-2521’s sins. Adam and Eve break one and only rule in the Garden of Eden by eating the fruit from the tree of the knowledge of good and evil. We will write a custom essay sample on Anthem Essay- Comparing It to the Bible or any similar topic only for you Order Now God gives Adam and Eve a permission to eat any fruit in the Garden of Eden except for the fruit from the tree of the knowledge of good and evil. A serpent tempts Eve to eat the fruit from the tree of the knowledge of good and evil, and she gives some to Adam who was with her. Equality 7-2521 breaks many laws in his dystopian society where it is a sin to â€Å"be alone, ever and at any time, for this is the great transgression and the root of all evil† (Rand 17). He had the courage to seek and find knowledge from the Unmentionable Times, and to love the woman of his choice. Adam and Eve and Equality 7-2521 are aware of what will happen next, but they still fall into temptation and are condemned from their societies. Expulsion of Adam and Eve from the Garden of Eden and the story of Equality 7-2521 are similar by falling into temptation, yet knowing that it is wrong. Adam and Eve’s reaction toward their sin can be contrasted by Equality 7-2521’s reaction. Adam and Eve break their one and only rule by eating the fruit from the tree of the knowledge of good and evil. â€Å"Then the eyes of [Adam and Eve] opened, and they knew that they were naked† (ESV Bible, Genesis 3:7). They made themselves loincloths from sewing fig leaves together and hid themselves from the presence of God among the trees. They were afraid of God, and they were ashamed of themselves. Equality 7-2521 is not ashamed of what he did, nor did he fear anything. Equality7-2521 â€Å"only [wishes] to be away, away from the City and from the air that touches upon the air of the city† (76). He runs away to the Uncharted Forest after his disastrous event at the World Council of Scholars knowing that there â€Å"is no road back for [him], and no redemption† (76). As his journey go deeper into the Uncharted Forest, he is both physically and spiritually walking away from collectivism and the city. Instead of being afraid and ashamed of his sin, like Adam and Eve, Equality 7-2521 does not understand the people in his society and runs away to the Uncharted Forest. While Adam and Eve are forced out from the Garden of Eden, Equality 7-2521 runs away from his society hoping to seek freedom. Expulsion of Adam and Eve from the Garden of Eden and the story of Equality 7-2521 are different by their reactions toward their sins. Adam and Eve and Equality 7-2521 wants something new, something different that will make their lives better. They risk all the circumstances that will come to them after the great sins they make. Adam and Eve fall into temptation by a serpent because they want to be as good or be better than God, their creator. Equality 7-2521 risk many days to seek and find knowledge which was not allowed. Every mankind desire to have something better than what they have, sometimes risking things knowing what circumstances are following. Every mankind is thrown with certain circumstances in their life to learn from them. How to cite Anthem Essay- Comparing It to the Bible, Essays

Cosmetic marketing free essay sample

The cosmetic and beauty industry is a competitive market with four classifications. Prestige counts as the department stores and specialty stores in which beauty products are sold. The Bay, Macy’s, Sephora and MAC fall under the prestige classification. Mass merchandisers are classified as broad. This could be Costco and Sam’s Club. Avon and Mary Kay are classified as alternate and involve direct sales. The final classification is specialty. The Body Shop and Bath and Body Works fall into this category as well as specific products/product lines sold at spas and salons. The industry made nearly $35 billion in 2010. The industry experienced a yearly growth of about 4% from the four years before. The growth of the market is expected to stay around the same until the year 2015. It is estimated that the value will grow to $42 billion. External Influences on the Market Economic Trends The obvious ongoing recession has led to many consumers trading down on some products and as a result they become accustomed to buying lower-priced products (Lennard, 2011). We will write a custom essay sample on Cosmetic marketing or any similar topic specifically for you Do Not WasteYour Time HIRE WRITER Only 13.90 / page While drug store brands might not offer consumers  the same benefits that high-end brands like M.A.C. can, they cost much less. High-end products can really take a bite out of your budget which can deter consumers from spending their money on our brand. With a poor economy such as this one, people are finding ways to save their money. The reality is that drugstore brands do offer some great products and so there is an industry concern that consumer might continue these habits as financial pressures ease up in the future (Carrillo, 2007). However, the market for cosmetics has fared better than other industries because consumers view these products as affordable luxuries. People are competing in a tough employment market and as a result they need to look their best to convey confidence in an image-conscious society (Carrillo, 2007). Many high -end brands take advantage of this opportunity as their products are often promoted by professional men and women. 1 Demographic Trends The use of cosmetics has become more commonplace among men in today’s society. Although women continue to outnumber men, the male population is expected to grow at a somewhat faster rate (Denise Smith, 26 J). This can be used to our advantage as it would provide us with an opportunity to increase penetration of cosmetics and fragrances among the growing male consumer base. An increasing population will also benefit the cosmetics industry (Denise Smith, 26 J). While an ageing population could prove to be unfavourable, teenagers and young adults are the most avid users of cosmetics and fragrances. This generation is also very brand-conscious, often with the disposable income and a pride in appearance making them more likely to pay more for premium-priced products that promise additional benefits. Social Trends Social trends change with time but it is important to keep up with these trends. Knowing what’s going on in the industry and in the market helps brands so that profit can be maximized. Now more than ever, there is a lot of money to be made in the cosmetics industry. Consumers are constantly searching for new products and to keep up with demand, companies are regularly introducing new products in the market. These products offer older women a chance to look younger while promising glamour to younger women (Lennard, 2011). Magazines have huge beauty sections because advertisers pay a lot of money for glossy ads about numerous products. So while it cost’s companies little money to produce items, women and girls will are ready to pay huge amounts of cash to buy it. Today, beauty goes hand in hand with youth so many women look for products that will reduce their aged appearance. Looking old is undesirable in today’s society (Lennard, 2011) . As a result, many companies in this industry offer products that reduce wrinkles, facial lines and spots. These are represented as occurrences that need to be treated as soon as possible. Celebrities are used by many cosmetic companies to promote products because it gives their brand a lot of exposure. While many celebrities might not actually use these products, consumers truly believe these products will make them look as attractive as women seen in movies and on TV. Media has a growing influence over what is portrayed as beautiful in today’s society (Pitman, 2011).

African Diasporic Culture across the World Influences, Transformations and Interactions

Introduction: African Diasporas Around the World In the modern world, the process of culture fusion is no longer a miracle – due to immigration and emigration, cultures and national traits are mixed in the most unbelievable fashion, which leads to the development of completely new traditions.Advertising We will write a custom essay sample on African Diasporic Culture across the World: Influences, Transformations and Interactions specifically for you for only $16.05 $11/page Learn More However, it is important to keep in mind that it is not only the cultural backdrop of the new location that shapes the specifics of a certain diaspora, but also the attitudes which the local people shape towards the newcomers, as well as the political aspects of the given state. Because of years of colonialism and racial capitalism, the African diasporic culture has shaped a rather vague idea of collective consciousness and deviated considerably from its racial ident ity. Racial Capitalism and African Diasporic Culture: Against Prejudices There is no doubt that retaining the national specifics in the atmosphere of a completely different culture and absolutely different traditions is incredibly hard. No matter how strong and solid the diaspora is, it has to take into account the ideas and principles of the country which the given diaspora is located in, which affects the recognition of the national identity. Thus, even with all the integrity that the African diasporas have, they have been affected by the principles of the states which they were located in. The given phenomenon presumably has had a negative effect on the African diasporas, according to Clarke and Thomas: â€Å"global capitalism and its development models are destroying cultural diversity and creating a monoculture,’ – they â€Å"identify ‘Americanization’ as solely imperialist and nonnegotiable† (Clarke and Thomas 346). Still, it has to be admitt ed that the above-mentioned idea of the impact which capitalistic postulates have had on the culture in the African diasporas is rather radical; as Clarke and Thomas explain, capitalism had both the negative and the positive effect on the diasporas.Advertising Looking for essay on ethnicity studies? Let's see if we can help you! Get your first paper with 15% OFF Learn More For instance, in Jamaican African diasporas, capitalism enhanced the promotion of the Black culture: â€Å"This emphasis on capitalism and consumerism has, more recently, been linked to the elevation of a racial identity† (Clarke and Thomas 348). As an economic strategy which the African people are not quite familiar with, capitalism has offered the Western model of development with no regard as to the specifics of African culture whatsoever. At the same time, however, capitalism has opened a range of new opportunities for the African diasporas, which means that the latter can possibly make ef ficient use of some of the Western ideas. Colonialism and African Diasporic Culture: The Question of Power Knowing the true reasons behind immigration shape one’s personality a lot. There is no secret to anyone that the African population left the continent being enslaved. As a result, two adages pervade the collective consciousness of the older African Diasporas of transatlantic slavery and colonialism respectively: ‘We are here because you brought us here’ and ‘We are here because you were there’ (223). However, it is worth mentioning that the given attitude, as Clarke and Thomas explain, are rather the features of the older members of diasporas, while the younger ones are less concerned about the colonialist issues. It is essential to mention, though, that not all African diasporas were subdued to the impact of colonialism; some of the diasporas were located in the places where the colonial aspect was far not that obvious and left less tangible ef fect on shaping the African diasporic mood. As Clarke and Thomas emphasize, â€Å"The Dominican dreamscape emphasized national autonomy in the face of dwindling Spanish colonialism, continuing Haitian economic and political dominance, and rising American imperialism† (59). Thus, it can be considered that there are certain differences among the world African diasporas in term of colonial moods and the way in which the Africans responded to the colonial attitudes. In most cases, however, it was the impact of the dominating state that shaped the African immigrants and their attitude towards their own country and the state which they lived in.Advertising We will write a custom essay sample on African Diasporic Culture across the World: Influences, Transformations and Interactions specifically for you for only $16.05 $11/page Learn More African Diasporic Culture vs. the Western Culture: The Conflict That Never Dies Speaking of the scale to which the o ther cultures affect the African diasporas, one must mention that for a group of people who are to live in a foreign country and follow its traditions and rules, the African people have actually managed to keep their ones quite successfully, at the same time fully integrating into the foreign community. Despite the fact that the foreign culture has been dominating over the African communities for a considerable amount of time, there is still enough of national spirit among the members of diasporas; in certain cases, the Africans even managed to reinforce their cultural specific, as Clarke and Thomas claim: â€Å"a modern plantation economy, political and economic subordination to a centralized state, and a stable national identity (a â€Å"we† diametrically opposed to â€Å"them†)† (Clarke and Thomas 60) allowed to create more or less stable diaspora within the Dominican Republic. However, the process of assimilation is irreversible, which means that, sooner or later, there will be little left of the African lifestyle among the members of the diasporas unless they become social reclusive. It seems that, to keep their integrity intact, African diasporas, like the diasporas of any other nations have to give up any attempts to become a part of the dominating culture. Since both suggestions are practically impossible, a reasonable compromise can be suggested. While African diasporas retain their traditions and national values, they can accept some of the Western ideas in order to match the economical and financial development of the latter. Conclusion: Across the Boundaries of Space and Time Hence, it can be considered that the African diasporas should be given credit for at least trying to keep their national identity. However, it cannot be argued that, after years spent under the aegis of other states and cultures, it has developed several specific features which cannot be associated with the traditional African culture anymore. On the one h and, constantly keeping in mind the question â€Å"Why we are here?†, the African diasporas were trying to retain their national identity; on the other hand, the impact of the Western culture is slowly taking its toll on the African diasporas. In addition, the impact which capitalism has had on the national identity of the members of the African diasporas all over the world cannot be described as positive either; with the focus on what is more marketable than what is linked to the national identity more, the African diasporas are facing the threat of losing their national identities completely.Advertising Looking for essay on ethnicity studies? Let's see if we can help you! Get your first paper with 15% OFF Learn More Rethinking their values and the outside influence, African diasporas can possibly retain their national culture and identity. Works Cited Clarke, K Maxine, and Deborah A. Thomas. Globalization and Race: Transformation  in the Cultural Production of Blackness. Durham: Duke University Press. 2006. Print. This essay on African Diasporic Culture across the World: Influences, Transformations and Interactions was written and submitted by user Aiyana Hurst to help you with your own studies. You are free to use it for research and reference purposes in order to write your own paper; however, you must cite it accordingly. You can donate your paper here.

Effects of global warming on human health, human welfare and human settlements

Effects of global warming on human health, human welfare and human settlements Global warming is the gradual increase in earth’s surface temperature. The increased temperature leads to an increased melting of snow and ice. The resultant of the melting is an increased global sea level. It is estimated that between 1906 and 2005, earth’s surface temperatures raised by 0.74  Ã‚ ±Ã‚  0.18  Ã‚ °C (Ernesto 8-23). In 1998, Kyoto protocol was developed as a preventive measure to further global warming. This paper discusses the effects of global warming on human health, human welfare and human settlements.Advertising We will write a custom essay sample on Effects of global warming on human health, human welfare and human settlements specifically for you for only $16.05 $11/page Learn More Effects on human health There are some diseases that have been triggered and caused by the increased temperatures on earth, they include skin cancer, skin diseases and pulmonary diseases; some of these diseases are caused by direct integratio n while others are as a result of indirect effects of global warming. When some areas are heated, a wave of hot air that moves from one the region of high temperatures to the areas of low temperatures; these heats may carry with them some diseases like tuberculosis that affect the people. At the high temperatures, some viruses and bacteria are able to multiply resulting to increased health complications on the people; such viruses include Hantavirus. Melting of icecaps, reduce the freshness of water, when the saline intrusion of water is increased, then people are likely to suffer some related diseases (Colleen 5-8). Effects on human settlement Global warming has resulted to extreme weather conditions, some situations that cannot allow productive agriculture or hinders a comfortable life of the settlers. When lands and climate fail to support productive agriculture, then people living in the areas are more likely to move to other places; this leads to land that have been left to be consumed by effects of weather while others, which are believed to be productive are over populated. Populations that live in risk prone areas are more likely to suffer loss of land to the increasing sea level and risks of dangerous waves; when the temperatures increase; they lead to melting of the ice caps that lead to an increased water levels on seas and oceans. When the water levels increase, they reclaim coastal lands leading to resettlement of the coastal people (Colleen 12). Effects on human welfare When temperatures increase, they affect the quality of life in the world; people are not enjoying their life to their fullest. Increased temperatures have an effect on human psychology and socially he can have limited enjoyment of life. The massive campaigns on the probable effects of global warming are not working well with human welfare. The diseases that can be directly or indirectly be attributed to global warming have a negative effect on human welfare. Global warming is like ly to have negative effects on people’s economies, geography, urban planning, and sociology, when the above attributes of life have been affected, then the human welfare is affected negatively.Advertising Looking for essay on environmental studies? Let's see if we can help you! Get your first paper with 15% OFF Learn More When icecaps melt and water levels increase; recreational features and places are reduced, at coastal places, there are higher risks of high tides and waves that are dangerous to human beings thus reducing relational activities along the coast (Colleen 23). Conclusion Global warming is the increase in earth surface temperature, which results in increased global sea level. The major cause of global warming is human activities especially in this era of industrialization; it has a negative effect on human health, settlement and welfare. Colleen, Reid. Analyses of the Effects of Global Change on Human Health and Welfare and Human Systems . U.S. Environmental Protection Agency, Sep. 2008. Web. Print. Ernesto , Zedillo. Global warming: looking beyond Kyoto. Washington: Brookings Institution Press, 2008.Print.

Three Brothers Movie Review Example | Topics and Well Written Essays - 1750 words

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Legal Framework in Employment Essay Example | Topics and Well Written Essays - 3250 words

Legal Framework in Employment - Essay Example The burden to prove that the employee has been unfairly dismissed lies with the employer to give sufficient reasons to justify the dismissal. Employers have defences in law to justify their reasons and prove that the dismissal was fair. This was seen in (British Leyland (UK) Ltd v Swift, 1981), where the court held that the test that should be applied when determining whether there has been a fair dismissal was whether it was reasonable for the employer to have dismissed the employee on the basis of gross misconduct which had been found. The same was seen in (Iceland Frozen Foods Limited v Jones, 1983) where the band of reasonableness test was laid down. It was held that, in determining the fairness of dismissal, the employment tribunal ought to consider whether the conduct of the employer was reasonable. The provisions of the Employment Rights Act, 1996, protect employees under a contract of employment. One provision is involved that every employee has the right not to be unfairly dismissed by their employer, (Employment Relations Act 1996, s 94). Following this Act Craig is covered by the provisions of the Act, to claim a remedy for unfair dismissal under section 94. If employees want to qualify for protection under section 94, they must have been in continuous employment for a period that is not less than one year before the end of the effective date when their contract is terminated, (Employment Relations Act 1996, s 108). The issue of whether an employee would have been dismissed anyway irrespective of the procedural failings, was set forth in the Polkey rule, (Polkey v AE Dayton Services Ltd, 1987). The Employments Rights Act in section 94 makes provisions that employees have the right not to be unfairly dismissed from employment. procedural fairness examines whether the dismissal was carried out in a procedurally fair manner. This is in

Tourism industry Essay Example | Topics and Well Written Essays - 500 words

Tourism industry - Essay Example It has also helped in better cultural understanding through the interchange of ideas between host and guest communities. Though mass tourism provides different economic and social benefits, it is also associated with different negative impacts on social, economic as well as environment aspects of a community. Tourism can be sustainable only if it is managed carefully (United Nations Environment Programme, 2014; Mirbabayev, n.d.). Taking into concern the various impacts of the mass tourism on environment and economy, there has been an idea of imposing taxes on mass tourism in additional to the already high taxes on various tourism requirements such as hotels, flight charges and other rentals. This idea may help in eliminating certain tourism related issues but it fails to realise the impact that it can cause to the tourism industry. In fact, tourism taxes in some countries have become an easy and a trendy fashion for governments to collect revenue from visitors in order to cover the government expenses. The tourism industry is taxed by methods of direct taxation to the tourists or units associated or involved in tourism (Gooroochurn & Sinclair, 2003; Rinaldi, n.d.). Such hikes in taxes not only force the tourists to go to other cheaper destinations but also have a serious effect on the local residents. For example, the Hawaiian Tourism industry experienced fall in tourism in 2007 owing to effects of various direct along with indirect tax hikes, which affected more than 75% of jobs in the state. The tourist shifted elsewhere taking their spending with them and the taxpayers were left with budget deficit owing to that the state economy was also weakened (Nothdurft, 2009). Similar example can be taken from fact that Caribbean Tourism was impacted negatively due the government aviation taxes in tourism (Caribbean journal, 2013) Tourism taxes are also being levied in the local level, which is creating more tax

Injury Risk in Elite Basketball Players

Injury Risk in Elite Basketball Players The elite basketball player is considered in this piece not only in terms of his potential for injury but also in terms of the potential of the physiotherapist and other sports professionals, to give advice, support and guidance so that he may practice his chosen sport as safely as is reasonably possible. We have looked at the nature, incidence and sites of injuries sustained. We have looked at the two most commonly injured sites (the knee and ankle) in specific detail. We have also discussed the relevant modalities of treatment that a physiotherapist can provide for their clients. There appears to be considerable controversy in the current literature, particularly in the field of pre-exercise stretching. As this is commonly accepted practice by participants, coaches, trainers and sports medicine professionals alike, we have reviewed the arguments both for and against in some detail. We have paid particular attention to its value in the prophylaxis of injury and the evidence to support it. The role of the physiotherapist in education and training of the elite athlete is also discussed. There are a number of sources quoted who regard it as a prime responsibility of the physiotherapist to give the athlete the information to allow them to train and participate as safely and effectively as possible. We have also considered the role of the physiotherapist in the prophylaxis of injury by looking at the various modalities of treatment and intervention that can be employed to make the field of play a safer place. In addition to the main-stream elite basketball player we have also looked at the role of the physiotherapist in the role of helping the disabled basketball player, some of whom have achieved elite status in their own right. They have their own specific problems and these are reviewed and discussed. Lastly we look at the specific gender differences in the sport. With many women finding that the sport is attractive, they participate at a top level of achievement. We look at the reasons why they have a different injury profile to men, both in terms of numbers of injuries but also in terms of the frequency of specific types of injury. The mechanisms of this difference is discussed together with the means whereby it can be addressed. Introduction Basketball is a world-wide sport practised by children in their backyard, adolescents in their playground, amateurs in their league games and elite athletes in their world-stage arenas. It is – by any standards – a fast game with inevitable physical contact, both intentional and accidental. Both these factors lead to the potential for injury. The explosive effort for the fast moves leads to particular pattern of muscle, ligament and tendon injury (see on) and the physical contact can lead to bruises, dislocations, fractures another injuries. It is a sport that is enjoyed by both sexes. Although it was originally conceived primarily as a male sport (for the YMCA)in an era when female participation in sport was a rarity, women now participate in it to elite levels and suffer injury to a similar extent to their male counterparts. The game itself has evolved dramatically since its humble beginnings when Dr James Naismith nailed two peach baskets at the ends of his gymnasium in 1891 (hence the name basketball) It was developed as a tool for fitness training by the YMCA. By 1927 The Harlem Globetrotters had been formed and by 1936 it was included as an Olympic sport. According to FIBA (Basketball governing body) over 400 million people play basketball on a world-wide basis Training for the fitness needed to play the sport can also lead touts own problems. One huge study by Ruhr M Kuala et al. (1994) (1) found that of all the injuries associated with basketball, 50% occurred during the matches and 50% occurred during training for the matches. This should be contrasted with the finding in study by Meeuwisse et al.(2) where injuries during the game were 3.7 times as likely to occur as in training. One could reasonably conclude that a large proportion of the injuries sustained in the â€Å"cut and thrust† of a full scale match are part of the risk package accepted in playing the game. The huge proportion of injuries sustained whilst training, however, should be largely preventable, as training should be ideally undertaken in carefully controlled circumstances. The physiotherapist, personal trainer and sports medicine specialist are ideally placed to advise and oversee poor practice in the training arena and to give advice and guidance to maximise training efficiency and to reduce the toll of injury. Any experienced sports care professional will tell you that the single most important factor in determining the likelihood of sustaining an injury is the occurrence of a previous injury (2). It therefore follows that prevention of any injury will help, not only in improving the immediate efficiency of the player, but will also confer protection against the possibility of recurring injury in any given site. Before we consider the mechanisms and prophylaxis of injuries in basketball, it would be prudent to consider the observed injuries from the sport, both in absolute number and site. The study by Meeuwisse(2003) (2) followed a cohort of 142 basketball players over a two year period and discovered that 44.7% of the players were injured in that time frame. As they recorded over 200 injuries in that time, it is clear that many players were injured more than once. The study by Ruhr M Kuala et al. (1994) (1) will be extensively quoted in this piece as it provides an enormous amount of meticulously collected data which has a high degree of confidence in its validity. It was based in Finland where the population has a particularly regimented system of bureaucratic personal information storage, especially with regard to injury and healthcare details. The entire population has to be registered with a nationally based health insurance, which records every accident and injury. This is of enormous value to studies such as this, as accurate statistics about entities such as specific sporting injuries can be derived comparatively easily. The study is also important in this specific regard as it encompasses an enormous cohort of basketball players analysing 39,541person years of basketball experience and 3,472 specific injuries. It’s worth considering the patterns of injury found in some detail as it has an impact on the deliberations in this piece. In terms of age distribution, it was found that injuries in thunder 15 yr. age group were comparatively rare and that the injury rate peaked in the 20 – 24 yr. age groups. Percentage of injuries by sites in basketball players (These results are slightly modified with some trivia removed) Injury Site % of total Lower limb Total 56.0 Thigh 2.5 Knee 15.8 Leg 2.0 Ankle 31.4 Foot 4.0 Other 0.4 Upper Limb total 19.3 Upper arm + Shoulder 2.6 Forearm and elbow 1.3 Palm + wrist Fingers 11.1 Other 0.4 Other Sites Total 24.7 Teeth 5.2 Eyes 3.0 Head + neck 7.4 Thorax + Abdomen 1.5 Back 5.4 Pelvis 0.9 Multiple sites 1.4 There are clearly a number of striking trends in these figures. The lower limbs sustaining the most injuries with 56% of the total. The ankle and knee taking the lion’s share of these. These results are clearly fairly predictable with the nature of the sport being one of sudden changes of acceleration and direction, many changes of direction(pivoting) involving turning forces impinging maximally on the knee and ankle. Both joints are intrinsically unstable for these modalities of movements. They are designed to be most effective in walking and running in a straight line. Although they can accommodate twisting movements, they are much less mechanically sound in these directions. The possibility of unanticipated, and therefore unraced, impacts is endemic in the sport and will increase the possibility of injury to these joins in particular. The upper limb has a substantial tally of injuries with the bulk being to the palm, wrist and fingers. Although it is not specified in this particular study, any experienced clinician would expect to see substantial proportion of hyperextensions and dislocations to the fingers and sprains and strains to the wrist (this is partially amplified in the next section). For a sport that involves considerable manipulative and throwing skills, it is, perhaps, surprising that the shoulder and upper arm account for only 2.6% of all the injuries. In contrast to the comments made about the knee and ankle, one can postulate that the shoulder, by virtue of its design to accommodate a much greater range and compass of movement, is less likely to be injured in the way that the knee and ankle are. Also, in the course of the normal game, it is subject to rather less overall mechanical force as both the knee and ankle have to assimilate peak loads of several times the body weight whereas the shoulder, unless involved in a fall, does not. Of the â€Å"Other Sites†, the neck and back are the commonest sites for injury. To a large extent, this again is a reflection of the explosive nature of the game with frequent changes of direction and velocity with high levels of acceleration. Having recognised the major sites of injury it is now prudent to discuss the main types of injury. Percentage injury by type in basketball players (These results are slightly modified with some trivia removed) Injury type + site % of total Sprains +strains 61.3 Knee 12.4 Ankle 29.5 Bruises + Wounds 22.2 Fractures 12.6 Fracture (other than dental) 7.6 Foot + ankle 18.5 Lower limb (other) 3.8 Fingers Palm + wrist 57.0 Upper limb (other) 4.2 Other (nondental) 16.6 Dental 4.9 Dislocations 1.7 Knee 0.5 Shoulder + elbow 0.3 Fingers 0.3 Others 2.2 Sprains and strains are the commonest type of injury in this sport with the ankle being the most frequently injured site in this respect. Considerable amounts of work and research have been done(2,3,4,5,6,7,8) to try to find mechanisms whereby ankle injuries can beat least reduced in both frequency and severity. This will be discussed in detail later. Knee strains and sprains are the next most frequent at12.4%. Similar amounts of work have been done to find ways of minimising knee injuries (9,10,11). The knee injury is notorious for producing long-term debilitating problems as not only is the acute injury painful and potentially debilitating in itself, but there is also the potential for Anterior Cruciate Ligament (ACL) damage and meniscal damage and wear as well. This may not be immediately apparent but may contribute to morbidity at a later date. This study (1) found that knee injuries were the most common cause of permanent disability In the longer term. During the time frame of this study, four basketball players sustained permanent injuries. In specific relation to knee and ankle injury, the Meiuwess study(2) found that the situation can be further amplified by the finding that the greatest number of injuries which resulted in seven or more sessions being lost in a season arose from the knee. Equally striking was the fact that the most common injury that involved less than seven sessions being lost, were injuries to the ankle. This underlines the comment made earlier that knee injuries tend to be potentially more serious than ankle injuries Bruises and wounds account for over 1/5th of the total types of injury and fractures account for just over 1/10th. In line with the comments made earlier about the frequency of hand, finger and wrist injury, it will come as no surprise therefore to see that the hand and wrist accounts for over half of the total of fractures. The foot and ankle account for 18.5% of total fractures. This is a reversal of the figures relating to site of injury. It would therefore appear that the hand gets injured less frequently that the foot, but when it does, it’s more likely to sustain the more serious (fracture) type of injury. Although the foot is more likely to be injured, it is more likely to suffer a strain or sprain rather than a fracture. In the study by Home et al.,(2004) (12) There was an unexpected, and slightly worrying, conclusion. They found that, in a study of fractures in sport, that (for men at least) basketball was the sport that put the participants at greatest risk of sustaining a fracture. The Knee and Basketball As we have already discussed, a knee injury is potentially more serious than just the implication of the immediate acute injury. For that reason, and for the fact that it is one of the two most commonly injured areas, we will look at the knee as a specific entity. We know that the single most important predictor for further injury is the past history of a preceding original injury. The knee is also significant insofar as the normal maxim of rest a joint until the inflammation has settled is rarely practical, as the knee is essential for locomotion and, as any experienced clinician knows, the vast majority of patients with resolving knee injuries will wait until the pain subsides to a tolerable level, and then start to walk on it. This effectively means that the joint is being stressed while resolving inflammation is present. Initially this may manifest itself as no more than a mildly aching knee, but it is likely that menisci, cruciate ligaments and articular surfaces are all being stressed in a â€Å"less than optimal† state. It is likely, on a first principles basis, that this type of mechanism may be, in part at least, responsible for the increased levels of arthritis and arthritis that is observed in lifelong athletes. (13,14) The paper by Meeuwisse (2) has been quoted several times in this piece. It is worth remembering that his team found that the knee waste joint which, if injured, gave rise to the longest periods of incapacity. It is therefore prudent to consider the mechanisms of injury, the treatment of those injuries and, possibly more importantly in the context of this piece, what can be done to minimise the incidence and impact of those injuries. We would commend an excellent paper by Bahr (2001) (3) on the subject. He discusses (amongst other things) the current thinking on knee injuries. He makes comment on the increasing incidence of cruciate ligament injuries. These injuries are seen with greatest frequency in athletes who participate in sports that involve â€Å"pivoting† – a movement which involves a fixed foot on the floor being used as a fulcrum topspin the body around – a movement which can put huge rotational stresses on the knee joint. As has been observed earlier in this piece, the knee is designed primarily to be efficient in dealing with movement in a sagittal plane. It is very poorly adapted to deal with rotational stresses. Bahr observes that the maximal incidence of cruciate ligament injury is in the 15-25 yr. old age group and in women three to five times more frequently than in men (see on) (14). He also refers to the post-injury, long-term complications of abnormal joint mechanics and the early onset of degenerative joint disease (15). Significantly he points to the fact that, although there has been an increasing trend recently (mainly because of improved operating techniques) to attempt to repair menisci and cruciate ligaments, this has not been accompanied by an apparent reduction in the rate of post-traumatic osteoarthritis. Similarly, arthroscopic repair of isolated meniscal damage has not been shown to reduce the incidence of arthritis. These factors all mitigate the argument that, although treatment is important, the identification of risk factors that predispose to injury is even more important. The Anterior Cruciate Ligament (ACL) is commonly injured in circumstances that many athletes would consider as normal or routine for their particular sport. Frequently the damage occurs without direct physical contact to the knee (9). This is strong evidence to support the â€Å"design fault† explanation of the aetiology. There is recent anecdotal data to suggest that improving the control of the knee may have an impact in reducing the incidence of these injuries. This views supported in a paper by Carafe (10) who looked at improving the proprioceptive and balance mechanisms in footballers over a three season period. They reported an 87% decrease in the incidence of injuries to the ACL. It may be significant that they studied semi-professional and amateur footballers who, presumably, did not train as efficiently of as skilfully as their professional footballer counterparts and therefore there was probably considerable room for improvement. Similarly constructed studies have shown similar pattern of improvement in young female football (11) and handball (16) players using a similar programme of training over a season. As has been pointed out earlier, such changes are more likely to be noticeable in females because of the higher incidence of ACL injury in the first place. Bahr points out that these studies were too small to allow a proper statistical evaluation of the reduction of injury to the ACL specifically, but there is sufficient evidence to conclude that the risk of serious knee injury can be significantly reduced by the introduction of structured training exercises that focus on improving the neuron-muscular control of the knee. Bahr makes the very salient point that balance (proprioceptive)training is not yet universally recognised by coaches and trainers as useful tool. As a result, he argues that it is the responsibility of doctors and physiotherapists to disseminate the knowledge that such training does reduce the incidence of serious short-term (and therefore long-term) knee injury. Anterior knee pain is a common, sometimes chronic presenting symptom in any sports related health professional’s clinic. There are many theories as to its aetiology and it is notoriously resistant to treatment. An unattributed paper (quoted by Minerva in the BMJ) (17)refers to Jumper’s knee where the pain is maximal near the attachment of the patella ligament. Ultrasound of the region can show an area of increased echogenicity in the inferior pole of the patella. Minerva quotes the study as observing that of 100 athletes seen in one clinic,18 had to give up their sport for over a year and about 1/3rd needed surgery in order to try to get resolution of the problem. In conclusion to this section we would refer the reader to the excellent paper by Adams WB (2004) (18) who reviews the current thinking on treatment options on both overuse syndromes and trauma tithe knee. The Ankle and Basketball As we have seen earlier, the ankle is the single most commonly injured site in the body during basketball comprising 31.4% of all the injuries observed (1) and ankle strains and sprains were the single commonest mechanism of injury observed with 1/3rd of all such injuries and 1/5th of all fractures. We will therefore also consider the ankles a special case. Bahr (3) quotes that in round figures 20% of sports related injuries involve the ankle. The vast majority of ankle injuries are simple sprains of the lateral and medial ankle ligaments. Proper functional care will allow the patient to return to work within a few days, or at worst a few weeks, with minimal squeal. Some sprains are found to cause prolonged disability in the form of chronic instability or persistent pain. Prophylaxis of injury is discussed elsewhere in this piece but it should be noted that taping and bracing are commonly employed techniques for protection, but their efficacy has only been demonstrated in sportsmen with a history of previous injury (5,6).There is little doubt that taping and bracing will reduce the incidence of sprains and result in less severe strains. â€Å"High-top† basketball boots have been introduced recently on the assumption that similar boots (18a) (viz. ski boots) reduce the incidence of ankle injury, but it has not yet produced any specific evidence that sprains and strains are reduced. Braces seen to be more effective than tape in preventing sprains of the ankle (7,8) Bracing has the advantage that it is more acceptable in terms of comfort for long-term use (6). Taping is commonly used but appears to be less effective than braces because it relies on adhesion to the skin to exert its protective influence. It can cause skin irritation and has to be reapplied on virtually every occasion where potential stress can occur. One of the major problems of doing research into ankle injuries is that qualitative and subjective measurements such as pain and immobility can be easily assessed, but the ankle joint is a very functionally complex structure and quantitative measurements of anything other than flexion/extension or rotation an very difficult. Its therefore heartening to read of a Dutch group who are developing a specially designed goniometer to use in researching the pathology of the ankle joint (19). This is only mentioned for the sake of completeness and we do not propose to go into any detail about the instrument. There is an excellent article by McKay on ankle injuries in basketball (20) but this is discussed at some length in the section on prophylaxis of injuries. Treatment of injuries The treatment of sports related injuries is a vast topic and specialism in itself. The sports medicine medical specialist and the physiotherapist sports specialist are technically knowledgeable people who have had to assimilate a vast quantity of information relative to their specialisation. It is therefore not proposed to present the topic in any great detail but to cover the elements of treatment of acute injuries and their subsequent treatment that are specifically important to the field of basketball. We will also present a brief literature review of some of the most recent papers in the field. In general terms, the old adage of ICE (immobilisation, compression and elevation) (20b) is a useful first-aid mnemonic which will help to minimise injury prior to assessment by a more specialist professional. In this article it is proposed to look primarily at the aspects of treatment which impinge on the areas covered in this piece and broad overviews. We shall restrict ourselves here to a brief literature review of some of the most important recent papers The area of dental trauma is highlighted in the analysis by Kujalaet al. (1994) (1) with 5.0% of all basketball injuries being dental. Airport by Randall (2005) (21) discusses the impact of dental injuries and suggests that sports field medical personnel should have at least basic training in the first-aid of dental injuries so that they can, at least, provide appropriate care until a dental specialist can be properly involved. A particularly controversial issue is raised by Dietzel and Hedlund(2005) (22) They review the current controversy about the use of analgesic and anti-inflammatory injections both in the acute phase of injury (to allow continued participation in a sporting event) or in the chronic recovery phase. This is a particularly well balanced article which evaluates both sides of the arguments for and against the use of injectable medications. Sanchez et al.(2005) (23) review the desperately important area of management of the potentially spine-injured athlete. This is an area which has had substantial changes in management techniques in the recent past. This paper is a particularly useful review of techniques of diagnosis and stabilisation of the injured athlete. Very significantly it highlights the role of pre-injury planning – so often overlooked – on the sports field. There are two recent papers which examine the thorny problem of concussion on the sports field (24,25). This has long posed a problem for the supervising healthcare specialist, both in terms of immediate diagnosis and subsequent action and treatment. The working â€Å"rule of thumb† has been that any player with definite signs of concussion(impaired consciousness or increased level of confusion) should be taken off the field and not returned to play for 48 hrs. In practice, this advice may be ignored by coaches who are anxious to keep their best players on the field and who may be ignorant of the potential side effects. McKean (24) and Johnston et al. (25) review the arguments in coherent manner and present the current thinking in a modern context. Injury types in relation to position played There are few studies that actually compare the rates and types of injury with actual position played on the court. Given the fact that Kuala, (1) reports that 50% of injuries are sustained in training rather than on the court, this may prove to be rather academic. The study by Meeuwisse (2003) (2), was one of the few that looked at this issue and regarded it as purely peripheral to the main mechanism of injury. However , they summed up the findings of the study in the phrase â€Å"Centres had the highest rate of injury, followed by guards, and then forwards. The relative risk of re-injury was significantly increased by previous injuries to the elbow, shoulder, knee, hand, lower spine or pelvis, and by concussions.† As part of their conclusions the research team commented that the predictive risk factors for injury were, in order of importance: previous injury, number of games played, the number of player contacts during a game, player position, and court location (this is a reference to the proximity to a hospital). In real terms, the players position is of much less importance in predicting injury than many other factors Clinical considerations The clinical implications of basketball injury must be viewed in the context of the benefits derived from playing any competitive sport– or indeed pursuing any degree of fitness. Virtually any sporting endeavour has a downside and indeed risks associated with it, but equally there are very considerable benefits to be gained as well. By concentrating (by necessity) on the risks of injury in basketball in this article we do not wish to ignore the balancing perspective of the health gains to also be derived. Clearly, one of the major benefits to be gained is the concurrent increase in cardiovascular fitness (13) This is in addition to the less easily quantifiable benefits of general fitness, social interaction, increase in self-confidence and satisfaction in participation which are common to most sporting endeavours. The study by Kuala et al. (1993) (13) looked at the incidence of degenerative joint conditions in elite athletes. It found that participation in sports generally could lead to premature osteoarthritis. Specifically it found that, in the elite international athletes studied there was a greater than predicted admission rate to hospital for treatments for osteoarthritis of the hip, knee and ankle. Very significantly, in the context of this article on physiotherapy, it concluded that proper treatment of injuries to these joints could significantly reduce the incidence of premature osteoarthritis in this group. It should be noted that this was a large control moderated study of over 2000 international athletes so the findings are clearly significant Disability and basketball It is important not to ignore the fact that basketball is played, not only by able-bodied sportsmen but also by those who have a concurrent disability as well. This group also presents a professional problem for the physiotherapist as. Not only are there the â€Å"normal â€Å"considerations for the able-bodied player that we have discussed in this piece, but also there may well be disability-specific considerations in the disabled player which will tax the physiotherapist every bit as much as those in their able-bodied counterparts. In consideration of this we would commend the reader to an excellent article by Chula (1994) (26) which discusses inconsiderable depth, the whole issue of sports specific medical considerations for people with a disability. The use of sports for the disabled as a therapeutic measure was championed by Sir Ludwig Guttmann, who was a specialist in spinal injuries. He pointed out not only the obvious physical benefits to be gained in improving functions of the body which the paraplegic ortetraplegic had not fully exploited in their pre-injury state togetherwith the obvious cardiovascular benefits that could be obtained, but healso pointed to the psychological benefits to be gained by socialisingand competing against others. The Disabled Person’s Employment Act (1944) was the first majorlegislative landmark in the effective rehabilitation of the disabledperson back into society and other legislation relating todiscrimination generally has helped the disabled person to achievelevels of attainment in sport that would have been unthinkable half acentury ago. The comments that have been made in this piece in relation toable-bodied people obviously apply, in general terms, to the disabledperson as well. Clearly it depends on the nature of the disability asto what specific measures need to be employed specifically, but thebasic principles are the same. Muscle groups need to be developed inorder to protect the joints that they work over. This is particularlyrelevant to the knee. Appropriate proprioceptive skills need to beenhanced if the risk of injury is to be kept to an acceptable minimum.More specific considerations that may involve the occupationaltherapist as well as the physiotherapist may include the prevention ofpressure problems from a wheelchair or calliper or the use ofrestraints in a patient who has sudden muscular spasms, so that theyare not thrown out of the wheelchair. The experienced physiotherapist will be well aware of the benefitsof sport in the disabled in improving strength, co-ordination andendurance. Basketball, in particular, is commonly employed in thewheelchair-bound patient, who has to learn transferable skills in orderto propel the wheel chair accurately as well as catch, intercept andpass the ball. Prophylaxis and pre-injury actions Earlier in this piece we briefly discussed a paper by Sanchez (23).and commended it for its tackling of the problem of anticipating an injury. This involved a significant amount of pre-planning andorganisation on the court and field of play. Such issues are of vitalimportance to the athletes although they may not either realise orappreciate it at the time. This type of forward thinking can lead to dramatic reductions in morbidity (or even in mortality) and should be the concern of each and every healthcare professional who is working in the field of acute sports injury. Prophylaxis can be considered not only as actual pre-planning thecourse of action needed if an injury is sustained (viz. are theresplints, bandages, sterile water and gloves etc. available?) but equally it can be considered as the correct training and preparation ofboth the players and the game officials, so that the game itself can beplayed in conditions of optimum safety. Although the first of these two considerations is clearly important, in the context of this piece, weshall consider the second element in detail. Prophylaxis of injury is a major concern. We have discussed thepredictive value of a pre-existing injury. It follows that, if thatinjury can be prevented, then the subject is statistically less likelyto suffer a further injury. Common sense is behind the definitive recommendation in the paperby Kuala et al., (1) where he states that, in an attempt to reduce the incidence of injuries in basketball, specific preventative measuresshould be employed to reduce the number of violent contacts betweenplayers. He cites improving the drafting of game rules so that violentinfringements of the rules can be mo Injury Risk in Elite Basketball Players Injury Risk in Elite Basketball Players The elite basketball player is considered in this piece not only in terms of his potential for injury but also in terms of the potential of the physiotherapist and other sports professionals, to give advice, support and guidance so that he may practice his chosen sport as safely as is reasonably possible. We have looked at the nature, incidence and sites of injuries sustained. We have looked at the two most commonly injured sites (the knee and ankle) in specific detail. We have also discussed the relevant modalities of treatment that a physiotherapist can provide for their clients. There appears to be considerable controversy in the current literature, particularly in the field of pre-exercise stretching. As this is commonly accepted practice by participants, coaches, trainers and sports medicine professionals alike, we have reviewed the arguments both for and against in some detail. We have paid particular attention to its value in the prophylaxis of injury and the evidence to support it. The role of the physiotherapist in education and training of the elite athlete is also discussed. There are a number of sources quoted who regard it as a prime responsibility of the physiotherapist to give the athlete the information to allow them to train and participate as safely and effectively as possible. We have also considered the role of the physiotherapist in the prophylaxis of injury by looking at the various modalities of treatment and intervention that can be employed to make the field of play a safer place. In addition to the main-stream elite basketball player we have also looked at the role of the physiotherapist in the role of helping the disabled basketball player, some of whom have achieved elite status in their own right. They have their own specific problems and these are reviewed and discussed. Lastly we look at the specific gender differences in the sport. With many women finding that the sport is attractive, they participate at a top level of achievement. We look at the reasons why they have a different injury profile to men, both in terms of numbers of injuries but also in terms of the frequency of specific types of injury. The mechanisms of this difference is discussed together with the means whereby it can be addressed. Introduction Basketball is a world-wide sport practised by children in their backyard, adolescents in their playground, amateurs in their league games and elite athletes in their world-stage arenas. It is – by any standards – a fast game with inevitable physical contact, both intentional and accidental. Both these factors lead to the potential for injury. The explosive effort for the fast moves leads to particular pattern of muscle, ligament and tendon injury (see on) and the physical contact can lead to bruises, dislocations, fractures another injuries. It is a sport that is enjoyed by both sexes. Although it was originally conceived primarily as a male sport (for the YMCA)in an era when female participation in sport was a rarity, women now participate in it to elite levels and suffer injury to a similar extent to their male counterparts. The game itself has evolved dramatically since its humble beginnings when Dr James Naismith nailed two peach baskets at the ends of his gymnasium in 1891 (hence the name basketball) It was developed as a tool for fitness training by the YMCA. By 1927 The Harlem Globetrotters had been formed and by 1936 it was included as an Olympic sport. According to FIBA (Basketball governing body) over 400 million people play basketball on a world-wide basis Training for the fitness needed to play the sport can also lead touts own problems. One huge study by Ruhr M Kuala et al. (1994) (1) found that of all the injuries associated with basketball, 50% occurred during the matches and 50% occurred during training for the matches. This should be contrasted with the finding in study by Meeuwisse et al.(2) where injuries during the game were 3.7 times as likely to occur as in training. One could reasonably conclude that a large proportion of the injuries sustained in the â€Å"cut and thrust† of a full scale match are part of the risk package accepted in playing the game. The huge proportion of injuries sustained whilst training, however, should be largely preventable, as training should be ideally undertaken in carefully controlled circumstances. The physiotherapist, personal trainer and sports medicine specialist are ideally placed to advise and oversee poor practice in the training arena and to give advice and guidance to maximise training efficiency and to reduce the toll of injury. Any experienced sports care professional will tell you that the single most important factor in determining the likelihood of sustaining an injury is the occurrence of a previous injury (2). It therefore follows that prevention of any injury will help, not only in improving the immediate efficiency of the player, but will also confer protection against the possibility of recurring injury in any given site. Before we consider the mechanisms and prophylaxis of injuries in basketball, it would be prudent to consider the observed injuries from the sport, both in absolute number and site. The study by Meeuwisse(2003) (2) followed a cohort of 142 basketball players over a two year period and discovered that 44.7% of the players were injured in that time frame. As they recorded over 200 injuries in that time, it is clear that many players were injured more than once. The study by Ruhr M Kuala et al. (1994) (1) will be extensively quoted in this piece as it provides an enormous amount of meticulously collected data which has a high degree of confidence in its validity. It was based in Finland where the population has a particularly regimented system of bureaucratic personal information storage, especially with regard to injury and healthcare details. The entire population has to be registered with a nationally based health insurance, which records every accident and injury. This is of enormous value to studies such as this, as accurate statistics about entities such as specific sporting injuries can be derived comparatively easily. The study is also important in this specific regard as it encompasses an enormous cohort of basketball players analysing 39,541person years of basketball experience and 3,472 specific injuries. It’s worth considering the patterns of injury found in some detail as it has an impact on the deliberations in this piece. In terms of age distribution, it was found that injuries in thunder 15 yr. age group were comparatively rare and that the injury rate peaked in the 20 – 24 yr. age groups. Percentage of injuries by sites in basketball players (These results are slightly modified with some trivia removed) Injury Site % of total Lower limb Total 56.0 Thigh 2.5 Knee 15.8 Leg 2.0 Ankle 31.4 Foot 4.0 Other 0.4 Upper Limb total 19.3 Upper arm + Shoulder 2.6 Forearm and elbow 1.3 Palm + wrist Fingers 11.1 Other 0.4 Other Sites Total 24.7 Teeth 5.2 Eyes 3.0 Head + neck 7.4 Thorax + Abdomen 1.5 Back 5.4 Pelvis 0.9 Multiple sites 1.4 There are clearly a number of striking trends in these figures. The lower limbs sustaining the most injuries with 56% of the total. The ankle and knee taking the lion’s share of these. These results are clearly fairly predictable with the nature of the sport being one of sudden changes of acceleration and direction, many changes of direction(pivoting) involving turning forces impinging maximally on the knee and ankle. Both joints are intrinsically unstable for these modalities of movements. They are designed to be most effective in walking and running in a straight line. Although they can accommodate twisting movements, they are much less mechanically sound in these directions. The possibility of unanticipated, and therefore unraced, impacts is endemic in the sport and will increase the possibility of injury to these joins in particular. The upper limb has a substantial tally of injuries with the bulk being to the palm, wrist and fingers. Although it is not specified in this particular study, any experienced clinician would expect to see substantial proportion of hyperextensions and dislocations to the fingers and sprains and strains to the wrist (this is partially amplified in the next section). For a sport that involves considerable manipulative and throwing skills, it is, perhaps, surprising that the shoulder and upper arm account for only 2.6% of all the injuries. In contrast to the comments made about the knee and ankle, one can postulate that the shoulder, by virtue of its design to accommodate a much greater range and compass of movement, is less likely to be injured in the way that the knee and ankle are. Also, in the course of the normal game, it is subject to rather less overall mechanical force as both the knee and ankle have to assimilate peak loads of several times the body weight whereas the shoulder, unless involved in a fall, does not. Of the â€Å"Other Sites†, the neck and back are the commonest sites for injury. To a large extent, this again is a reflection of the explosive nature of the game with frequent changes of direction and velocity with high levels of acceleration. Having recognised the major sites of injury it is now prudent to discuss the main types of injury. Percentage injury by type in basketball players (These results are slightly modified with some trivia removed) Injury type + site % of total Sprains +strains 61.3 Knee 12.4 Ankle 29.5 Bruises + Wounds 22.2 Fractures 12.6 Fracture (other than dental) 7.6 Foot + ankle 18.5 Lower limb (other) 3.8 Fingers Palm + wrist 57.0 Upper limb (other) 4.2 Other (nondental) 16.6 Dental 4.9 Dislocations 1.7 Knee 0.5 Shoulder + elbow 0.3 Fingers 0.3 Others 2.2 Sprains and strains are the commonest type of injury in this sport with the ankle being the most frequently injured site in this respect. Considerable amounts of work and research have been done(2,3,4,5,6,7,8) to try to find mechanisms whereby ankle injuries can beat least reduced in both frequency and severity. This will be discussed in detail later. Knee strains and sprains are the next most frequent at12.4%. Similar amounts of work have been done to find ways of minimising knee injuries (9,10,11). The knee injury is notorious for producing long-term debilitating problems as not only is the acute injury painful and potentially debilitating in itself, but there is also the potential for Anterior Cruciate Ligament (ACL) damage and meniscal damage and wear as well. This may not be immediately apparent but may contribute to morbidity at a later date. This study (1) found that knee injuries were the most common cause of permanent disability In the longer term. During the time frame of this study, four basketball players sustained permanent injuries. In specific relation to knee and ankle injury, the Meiuwess study(2) found that the situation can be further amplified by the finding that the greatest number of injuries which resulted in seven or more sessions being lost in a season arose from the knee. Equally striking was the fact that the most common injury that involved less than seven sessions being lost, were injuries to the ankle. This underlines the comment made earlier that knee injuries tend to be potentially more serious than ankle injuries Bruises and wounds account for over 1/5th of the total types of injury and fractures account for just over 1/10th. In line with the comments made earlier about the frequency of hand, finger and wrist injury, it will come as no surprise therefore to see that the hand and wrist accounts for over half of the total of fractures. The foot and ankle account for 18.5% of total fractures. This is a reversal of the figures relating to site of injury. It would therefore appear that the hand gets injured less frequently that the foot, but when it does, it’s more likely to sustain the more serious (fracture) type of injury. Although the foot is more likely to be injured, it is more likely to suffer a strain or sprain rather than a fracture. In the study by Home et al.,(2004) (12) There was an unexpected, and slightly worrying, conclusion. They found that, in a study of fractures in sport, that (for men at least) basketball was the sport that put the participants at greatest risk of sustaining a fracture. The Knee and Basketball As we have already discussed, a knee injury is potentially more serious than just the implication of the immediate acute injury. For that reason, and for the fact that it is one of the two most commonly injured areas, we will look at the knee as a specific entity. We know that the single most important predictor for further injury is the past history of a preceding original injury. The knee is also significant insofar as the normal maxim of rest a joint until the inflammation has settled is rarely practical, as the knee is essential for locomotion and, as any experienced clinician knows, the vast majority of patients with resolving knee injuries will wait until the pain subsides to a tolerable level, and then start to walk on it. This effectively means that the joint is being stressed while resolving inflammation is present. Initially this may manifest itself as no more than a mildly aching knee, but it is likely that menisci, cruciate ligaments and articular surfaces are all being stressed in a â€Å"less than optimal† state. It is likely, on a first principles basis, that this type of mechanism may be, in part at least, responsible for the increased levels of arthritis and arthritis that is observed in lifelong athletes. (13,14) The paper by Meeuwisse (2) has been quoted several times in this piece. It is worth remembering that his team found that the knee waste joint which, if injured, gave rise to the longest periods of incapacity. It is therefore prudent to consider the mechanisms of injury, the treatment of those injuries and, possibly more importantly in the context of this piece, what can be done to minimise the incidence and impact of those injuries. We would commend an excellent paper by Bahr (2001) (3) on the subject. He discusses (amongst other things) the current thinking on knee injuries. He makes comment on the increasing incidence of cruciate ligament injuries. These injuries are seen with greatest frequency in athletes who participate in sports that involve â€Å"pivoting† – a movement which involves a fixed foot on the floor being used as a fulcrum topspin the body around – a movement which can put huge rotational stresses on the knee joint. As has been observed earlier in this piece, the knee is designed primarily to be efficient in dealing with movement in a sagittal plane. It is very poorly adapted to deal with rotational stresses. Bahr observes that the maximal incidence of cruciate ligament injury is in the 15-25 yr. old age group and in women three to five times more frequently than in men (see on) (14). He also refers to the post-injury, long-term complications of abnormal joint mechanics and the early onset of degenerative joint disease (15). Significantly he points to the fact that, although there has been an increasing trend recently (mainly because of improved operating techniques) to attempt to repair menisci and cruciate ligaments, this has not been accompanied by an apparent reduction in the rate of post-traumatic osteoarthritis. Similarly, arthroscopic repair of isolated meniscal damage has not been shown to reduce the incidence of arthritis. These factors all mitigate the argument that, although treatment is important, the identification of risk factors that predispose to injury is even more important. The Anterior Cruciate Ligament (ACL) is commonly injured in circumstances that many athletes would consider as normal or routine for their particular sport. Frequently the damage occurs without direct physical contact to the knee (9). This is strong evidence to support the â€Å"design fault† explanation of the aetiology. There is recent anecdotal data to suggest that improving the control of the knee may have an impact in reducing the incidence of these injuries. This views supported in a paper by Carafe (10) who looked at improving the proprioceptive and balance mechanisms in footballers over a three season period. They reported an 87% decrease in the incidence of injuries to the ACL. It may be significant that they studied semi-professional and amateur footballers who, presumably, did not train as efficiently of as skilfully as their professional footballer counterparts and therefore there was probably considerable room for improvement. Similarly constructed studies have shown similar pattern of improvement in young female football (11) and handball (16) players using a similar programme of training over a season. As has been pointed out earlier, such changes are more likely to be noticeable in females because of the higher incidence of ACL injury in the first place. Bahr points out that these studies were too small to allow a proper statistical evaluation of the reduction of injury to the ACL specifically, but there is sufficient evidence to conclude that the risk of serious knee injury can be significantly reduced by the introduction of structured training exercises that focus on improving the neuron-muscular control of the knee. Bahr makes the very salient point that balance (proprioceptive)training is not yet universally recognised by coaches and trainers as useful tool. As a result, he argues that it is the responsibility of doctors and physiotherapists to disseminate the knowledge that such training does reduce the incidence of serious short-term (and therefore long-term) knee injury. Anterior knee pain is a common, sometimes chronic presenting symptom in any sports related health professional’s clinic. There are many theories as to its aetiology and it is notoriously resistant to treatment. An unattributed paper (quoted by Minerva in the BMJ) (17)refers to Jumper’s knee where the pain is maximal near the attachment of the patella ligament. Ultrasound of the region can show an area of increased echogenicity in the inferior pole of the patella. Minerva quotes the study as observing that of 100 athletes seen in one clinic,18 had to give up their sport for over a year and about 1/3rd needed surgery in order to try to get resolution of the problem. In conclusion to this section we would refer the reader to the excellent paper by Adams WB (2004) (18) who reviews the current thinking on treatment options on both overuse syndromes and trauma tithe knee. The Ankle and Basketball As we have seen earlier, the ankle is the single most commonly injured site in the body during basketball comprising 31.4% of all the injuries observed (1) and ankle strains and sprains were the single commonest mechanism of injury observed with 1/3rd of all such injuries and 1/5th of all fractures. We will therefore also consider the ankles a special case. Bahr (3) quotes that in round figures 20% of sports related injuries involve the ankle. The vast majority of ankle injuries are simple sprains of the lateral and medial ankle ligaments. Proper functional care will allow the patient to return to work within a few days, or at worst a few weeks, with minimal squeal. Some sprains are found to cause prolonged disability in the form of chronic instability or persistent pain. Prophylaxis of injury is discussed elsewhere in this piece but it should be noted that taping and bracing are commonly employed techniques for protection, but their efficacy has only been demonstrated in sportsmen with a history of previous injury (5,6).There is little doubt that taping and bracing will reduce the incidence of sprains and result in less severe strains. â€Å"High-top† basketball boots have been introduced recently on the assumption that similar boots (18a) (viz. ski boots) reduce the incidence of ankle injury, but it has not yet produced any specific evidence that sprains and strains are reduced. Braces seen to be more effective than tape in preventing sprains of the ankle (7,8) Bracing has the advantage that it is more acceptable in terms of comfort for long-term use (6). Taping is commonly used but appears to be less effective than braces because it relies on adhesion to the skin to exert its protective influence. It can cause skin irritation and has to be reapplied on virtually every occasion where potential stress can occur. One of the major problems of doing research into ankle injuries is that qualitative and subjective measurements such as pain and immobility can be easily assessed, but the ankle joint is a very functionally complex structure and quantitative measurements of anything other than flexion/extension or rotation an very difficult. Its therefore heartening to read of a Dutch group who are developing a specially designed goniometer to use in researching the pathology of the ankle joint (19). This is only mentioned for the sake of completeness and we do not propose to go into any detail about the instrument. There is an excellent article by McKay on ankle injuries in basketball (20) but this is discussed at some length in the section on prophylaxis of injuries. Treatment of injuries The treatment of sports related injuries is a vast topic and specialism in itself. The sports medicine medical specialist and the physiotherapist sports specialist are technically knowledgeable people who have had to assimilate a vast quantity of information relative to their specialisation. It is therefore not proposed to present the topic in any great detail but to cover the elements of treatment of acute injuries and their subsequent treatment that are specifically important to the field of basketball. We will also present a brief literature review of some of the most recent papers in the field. In general terms, the old adage of ICE (immobilisation, compression and elevation) (20b) is a useful first-aid mnemonic which will help to minimise injury prior to assessment by a more specialist professional. In this article it is proposed to look primarily at the aspects of treatment which impinge on the areas covered in this piece and broad overviews. We shall restrict ourselves here to a brief literature review of some of the most important recent papers The area of dental trauma is highlighted in the analysis by Kujalaet al. (1994) (1) with 5.0% of all basketball injuries being dental. Airport by Randall (2005) (21) discusses the impact of dental injuries and suggests that sports field medical personnel should have at least basic training in the first-aid of dental injuries so that they can, at least, provide appropriate care until a dental specialist can be properly involved. A particularly controversial issue is raised by Dietzel and Hedlund(2005) (22) They review the current controversy about the use of analgesic and anti-inflammatory injections both in the acute phase of injury (to allow continued participation in a sporting event) or in the chronic recovery phase. This is a particularly well balanced article which evaluates both sides of the arguments for and against the use of injectable medications. Sanchez et al.(2005) (23) review the desperately important area of management of the potentially spine-injured athlete. This is an area which has had substantial changes in management techniques in the recent past. This paper is a particularly useful review of techniques of diagnosis and stabilisation of the injured athlete. Very significantly it highlights the role of pre-injury planning – so often overlooked – on the sports field. There are two recent papers which examine the thorny problem of concussion on the sports field (24,25). This has long posed a problem for the supervising healthcare specialist, both in terms of immediate diagnosis and subsequent action and treatment. The working â€Å"rule of thumb† has been that any player with definite signs of concussion(impaired consciousness or increased level of confusion) should be taken off the field and not returned to play for 48 hrs. In practice, this advice may be ignored by coaches who are anxious to keep their best players on the field and who may be ignorant of the potential side effects. McKean (24) and Johnston et al. (25) review the arguments in coherent manner and present the current thinking in a modern context. Injury types in relation to position played There are few studies that actually compare the rates and types of injury with actual position played on the court. Given the fact that Kuala, (1) reports that 50% of injuries are sustained in training rather than on the court, this may prove to be rather academic. The study by Meeuwisse (2003) (2), was one of the few that looked at this issue and regarded it as purely peripheral to the main mechanism of injury. However , they summed up the findings of the study in the phrase â€Å"Centres had the highest rate of injury, followed by guards, and then forwards. The relative risk of re-injury was significantly increased by previous injuries to the elbow, shoulder, knee, hand, lower spine or pelvis, and by concussions.† As part of their conclusions the research team commented that the predictive risk factors for injury were, in order of importance: previous injury, number of games played, the number of player contacts during a game, player position, and court location (this is a reference to the proximity to a hospital). In real terms, the players position is of much less importance in predicting injury than many other factors Clinical considerations The clinical implications of basketball injury must be viewed in the context of the benefits derived from playing any competitive sport– or indeed pursuing any degree of fitness. Virtually any sporting endeavour has a downside and indeed risks associated with it, but equally there are very considerable benefits to be gained as well. By concentrating (by necessity) on the risks of injury in basketball in this article we do not wish to ignore the balancing perspective of the health gains to also be derived. Clearly, one of the major benefits to be gained is the concurrent increase in cardiovascular fitness (13) This is in addition to the less easily quantifiable benefits of general fitness, social interaction, increase in self-confidence and satisfaction in participation which are common to most sporting endeavours. The study by Kuala et al. (1993) (13) looked at the incidence of degenerative joint conditions in elite athletes. It found that participation in sports generally could lead to premature osteoarthritis. Specifically it found that, in the elite international athletes studied there was a greater than predicted admission rate to hospital for treatments for osteoarthritis of the hip, knee and ankle. Very significantly, in the context of this article on physiotherapy, it concluded that proper treatment of injuries to these joints could significantly reduce the incidence of premature osteoarthritis in this group. It should be noted that this was a large control moderated study of over 2000 international athletes so the findings are clearly significant Disability and basketball It is important not to ignore the fact that basketball is played, not only by able-bodied sportsmen but also by those who have a concurrent disability as well. This group also presents a professional problem for the physiotherapist as. Not only are there the â€Å"normal â€Å"considerations for the able-bodied player that we have discussed in this piece, but also there may well be disability-specific considerations in the disabled player which will tax the physiotherapist every bit as much as those in their able-bodied counterparts. In consideration of this we would commend the reader to an excellent article by Chula (1994) (26) which discusses inconsiderable depth, the whole issue of sports specific medical considerations for people with a disability. The use of sports for the disabled as a therapeutic measure was championed by Sir Ludwig Guttmann, who was a specialist in spinal injuries. He pointed out not only the obvious physical benefits to be gained in improving functions of the body which the paraplegic ortetraplegic had not fully exploited in their pre-injury state togetherwith the obvious cardiovascular benefits that could be obtained, but healso pointed to the psychological benefits to be gained by socialisingand competing against others. The Disabled Person’s Employment Act (1944) was the first majorlegislative landmark in the effective rehabilitation of the disabledperson back into society and other legislation relating todiscrimination generally has helped the disabled person to achievelevels of attainment in sport that would have been unthinkable half acentury ago. The comments that have been made in this piece in relation toable-bodied people obviously apply, in general terms, to the disabledperson as well. Clearly it depends on the nature of the disability asto what specific measures need to be employed specifically, but thebasic principles are the same. Muscle groups need to be developed inorder to protect the joints that they work over. This is particularlyrelevant to the knee. Appropriate proprioceptive skills need to beenhanced if the risk of injury is to be kept to an acceptable minimum.More specific considerations that may involve the occupationaltherapist as well as the physiotherapist may include the prevention ofpressure problems from a wheelchair or calliper or the use ofrestraints in a patient who has sudden muscular spasms, so that theyare not thrown out of the wheelchair. The experienced physiotherapist will be well aware of the benefitsof sport in the disabled in improving strength, co-ordination andendurance. Basketball, in particular, is commonly employed in thewheelchair-bound patient, who has to learn transferable skills in orderto propel the wheel chair accurately as well as catch, intercept andpass the ball. Prophylaxis and pre-injury actions Earlier in this piece we briefly discussed a paper by Sanchez (23).and commended it for its tackling of the problem of anticipating an injury. This involved a significant amount of pre-planning andorganisation on the court and field of play. Such issues are of vitalimportance to the athletes although they may not either realise orappreciate it at the time. This type of forward thinking can lead to dramatic reductions in morbidity (or even in mortality) and should be the concern of each and every healthcare professional who is working in the field of acute sports injury. Prophylaxis can be considered not only as actual pre-planning thecourse of action needed if an injury is sustained (viz. are theresplints, bandages, sterile water and gloves etc. available?) but equally it can be considered as the correct training and preparation ofboth the players and the game officials, so that the game itself can beplayed in conditions of optimum safety. Although the first of these two considerations is clearly important, in the context of this piece, weshall consider the second element in detail. Prophylaxis of injury is a major concern. We have discussed thepredictive value of a pre-existing injury. It follows that, if thatinjury can be prevented, then the subject is statistically less likelyto suffer a further injury. Common sense is behind the definitive recommendation in the paperby Kuala et al., (1) where he states that, in an attempt to reduce the incidence of injuries in basketball, specific preventative measuresshould be employed to reduce the number of violent contacts betweenplayers. He cites improving the drafting of game rules so that violentinfringements of the rules can be mo