Focus areas and methodological characteristics of North American-based health disparity research in sports medicine: a scoping review.

OBJECTIVE: Health disparities are widely prevalent; however, little has been done to examine and address their causes and effects in sports and exercise medicine (SEM). We aimed to summarise the focus areas and methodology used for existing North American health disparity research in SEM and to identify gaps in the evidence base. DESIGN: Scoping review. DATA SOURCES: Systematic literature search of PubMed, Scopus, SPORTDiscus, CINAHL Plus with Full Text, Web of Science Core Collection and Cochrane Central Register of Controlled Trials. ELIGIBILITY CRITERIA: Full-text, peer-reviewed manuscripts of primary research, conducted in North America; published in the year 2000 or after, in English; and focusing on organised sports were included. RESULTS: 103 articles met inclusion criteria. Articles were classified into five focus areas: access to and participation in sports (n=45), access to SEM care (n=28), health-related outcomes in SEM (n=24), provider representation in SEM (n=5) and methodology (n=1). Race/ethnicity (n=39), socioeconomic status (n=28) and sex (n=27) were the most studied potential causes of health disparities, whereas sexual orientation (n=5), location (rural/urban/suburban, n=5), education level (n=5), body composition (n=5), gender identity (n=4) and language (n=2) were the least studied. Most articles (n=74) were cross-sectional, conducted on youth (n=55) and originated in the USA (n=90). CONCLUSION: Health disparity research relevant to SEM in North America is limited. The overall volume and breadth of research required to identify patterns in a heterogeneous sports landscape, which can then be used to inform positive change, need expansion. Intentional research focused on assessing the intersectionality, causes and consequences of health disparities in SEM is necessary.

Sources of Information Utilized by Active Duty Service Members for Nutritional Supplement Safety and Efficacy.

INTRODUCTION: The increasing prevalence of nutritional supplement use in the United States, combined with the risk of adverse effects from these largely unregulated products, poses a significant challenge to health care professionals. The purpose of our study is to evaluate the use of nutritional supplements in an active duty military population, particularly those supplements with increased adverse effect profiles, and the sources of information that service members use to make decisions regarding the safety and efficacy of supplements. MATERIALS AND METHODS: The investigators distributed a voluntary, anonymous, self-report survey to a battalion of active duty service members to collect demographic data and information pertaining to the use of, adverse effects from, and sources of information utilized regarding the safety and efficacy of nutritional supplements. Statistical analysis utilized Fisher's exact test for categorical variables and Kruskal-Wallis test for numeric variables via SAS 9.4 (SAS Institute Inc., Cary, NC, USA). The Henry Ford Health System Institutional Review Board evaluated and approved the study. The battalion commander approved the study protocol before the distribution of the survey. RESULTS: Over 50% of respondents reported using high-risk nutritional supplements. Males were more likely to use high-risk supplements than females (54.3% vs. 28.1%; P = .0017). Non-Commissioned Officers were more likely to use high-risk supplements than Junior Enlisted soldiers (67.2% vs. 40.2%, P = .0037). Only 27% of respondents who used high-risk supplements utilized medical professionals as their source of knowledge regarding the safety and efficacy of supplements. Females were more likely than males to seek supplement information from medical professionals (28.1% vs. 10.6%; P = .0202). Company-Grade Officers were more likely to seek supplement information from medical professionals than Junior Enlisted soldiers (40.9% vs. 8.3%; P = .0018). There was no statistically significant difference found for the rate of high-risk supplement use and obtaining information from a medical professional (P = .6982). About 3% of respondents reported adverse or unintended effects of supplement use. CONCLUSIONS: The results of our study suggest that a minority of service members seek advice from medical professionals regarding nutritional supplements, women are more likely to do so than men, men may be more likely to use high-risk supplements than women, and Non-Commissioned Officers use high-risk supplements more often than Junior Enlisted. Limitations of this study include the voluntary self-report survey design, relatively small sample size, and single location. A larger, multicenter study would aid to alleviate these limitations in future studies. Numerous studies investigating nutritional supplement use and associated risks are present in the literature; however, the data comparing supplement use with sources of information regarding safety and efficacy are lacking.

Vitamin C Supplementation and Athletic Performance: A Review.

ABSTRACT: Many athletes utilize high-dose vitamin C supplementation to optimize athletic performance. A review of research over the past 10 years on the use of vitamin C and athletic performance show mixed results. Fourteen randomized control trials were reviewed. In most studies, vitamin C was used with at least one additional supplement, usually vitamin E. Three studies showed positive outcomes associated with decreased markers of muscle damage after intense exercise with some form of vitamin C supplementation. The remaining 11 articles showed either neutral or negative effects of high dose vitamin C supplementation on muscle damage, physical performance, perceived muscle soreness, and/or adaptations to training. Based on a lack of consistent data and potential for blunted physiologic adaptations to training, long-term high-dosage supplementation with vitamin C is not recommended. Athletes should obtain antioxidants through a nutrient-rich diet instead of through supplement use.

Online Sports Medicine Fellowship Education: The Genesis of a National Program and Year-1 Analysis.

ABSTRACT: The COVID-19 pandemic has created numerous challenges in all walks of life. One such challenge was the strain and subsequent effects on medical education, including the elimination of in-person learning opportunities. Consequently, in March of 2020, a nationwide Sports Medicine fellowship online education series was developed. Presentations were available for live and recorded viewing. Over the course of the 2020-2021 academic year, 38 presentations were offered, covering 45 topics. Live viewership totaled nearly 1600 through the year, while views of recorded lecture reached nearly 34,000. There was no statistical difference in the number of viewers for musculoskeletal versus nonmusculoskeletal topics in either the live (46.50 ± 35.37 vs. 43.38 ± 27.28 viewers, respectively; P = 0.77) or recorded formats (843.60 ± 337.66 vs 876.67 ± 624.70 viewers, respectively; P = 0.85). This article presents the novel approach to sports medicine education by the American Medical Society for Sports Medicine in the 2020-2021 academic year through the genesis the National Online Fellowship Education Program along with analyses of viewership data.

Sports Medicine Health Care Access in Michigan High Schools: Access to Athletic Trainers.

ABSTRACT: Disparities in access to health care services may lead to poor health outcomes. Health care encounters in the adolescent age group are often due to sport participation. The presence of an athletic trainer in high schools can improve health outcomes in adolescent athletes, but not all student-athletes have access to an athletic trainer. In the state of Michigan, many high schools do not provide athletic trainer access to their student athletes. Our aim was to determine factors associated with the presence or absence of athletic trainer access in Michigan high schools. Disparities are associated with student body population, student-athlete population, and average household income in the zip code in which the school is located.

Pelvic Avulsion Fractures in Adolescent Athletes: Analyzing the Effect of Delay in Diagnosis.

OBJECTIVE: To evaluate whether delay in the diagnosis of pelvic avulsion fractures in young athletes leads to prolonged treatment and prolonged return toward sport activities, whether fractures at certain locations are associated with a greater risk of diagnostic delay, and what reasons may exist for delay in diagnosis. DESIGN: Retrospective chart review of young patients who presented with pelvic region avulsion fracture to a community-based sports medicine clinic over a 19-year period. SETTING: Private practice, primary care sports medicine clinic. PATIENTS: Patients younger than 20 years diagnosed with pelvic region avulsion fracture. INTERVENTIONS: None, this was a retrospective study. MAIN OUTCOME MEASURES: Clearance for return toward sport activities. RESULTS: Two hundred twenty-five cases were reviewed for reasons for delay in diagnosis; 208 cases met criteria for the duration of treatment and return to play activities portions of the study. The mean time from date of injury diagnosis was 19.59 days, and the mean duration from date of injury to clearance for return to play advancement was 67.20 days. Duration of treatment varied slightly depending on timing of diagnosis, whereas duration from date of injury to clearance for return to play advancement varied greatly depending on diagnostic delay. Those who did not sense a "pop" at the time of injury were more likely to experience diagnostic delay, as were athletes with ischial tuberosity fractures. The most common cause of diagnostic delay was patient/family decision on when to seek care; misdiagnosis as a muscle strain was also common. CONCLUSIONS: Diagnostic delay of adolescent pelvic avulsion fractures may unnecessarily prevent athletes from returning to play within an optimal time frame. Our observations highlight a need for educating athletes and their families on when to seek initial or follow-up medical care as well as educating medical providers regarding the diagnosis of pelvic avulsion fractures.

Pelvic Region Avulsion Fractures in Adolescent Athletes: A Series of 242 Cases.

OBJECTIVE: The objective of this descriptive study was to evaluate pelvic region avulsion fractures in adolescents, including age of injury, location of injury, activity and mechanism at time of injury, treatments used, duration of treatment, and outcomes. DESIGN: This was a retrospective chart review of patients who presented with pelvic region avulsion fracture over a 19-year period. SETTING: Private practice, primary care sports medicine clinic. PATIENTS: All patients younger than 20 years of age diagnosed with an acute pelvic region avulsion fracture. INTERVENTIONS: There was no set intervention protocol. A variety of interventions and combination of interventions were used and determined by the treating physician on a case-by-case basis. MAIN OUTCOME MEASURES: Clearance for return toward sport activities. RESULTS: Of the 242 cases, 162 were male. Soccer was the most common sport at the time of injury, and running/sprinting was the most common mechanism. Males were generally older at presentation and were more likely than females to have anterior inferior iliac spine injuries, whereas females were more likely to have iliac crest avulsions. Conservative treatment was effective in all cases. Males were treated for a shorter duration than females, but this difference was not statistically significant. CONCLUSIONS: Pelvic avulsion fractures are a rare injury in adolescent athletes. Males are twice as likely to experience these injuries and are older at presentation compared to females. Conservative management leads to successful outcomes in most cases.

HPV Immunization in High School Student-Athletes Receiving Preparticipation Physical Evaluations at Mass Event Versus Other Venues.

BACKGROUND: The preparticipation physical evaluation (PPE) is a requirement for high school sport participation in most states, but its location and role in preventive health care for adolescents is often questioned. HYPOTHESIS: Athletes who had their PPE performed in an office setting, in particular) by their primary care physician (PCP), will have higher human papillomavirus (HPV) immunization rates than those who had their PPE done in a group setting at a mass-participation PPE. STUDY DESIGN: Retrospective cohort study. LEVEL OF EVIDENCE: Level 3. METHODS: The PPE forms and immunization records for athletes at a single high school were reviewed to determine the location of PPE, the signing practitioner, and HPV immunization status. RESULTS: A total of 488 athletes (286 males, 202 females) were included; 51% had received at least 1 dose of the HPV vaccine while 39% had completed the series. There was no significant difference in vaccination rates between examination in an office setting versus a group setting. Athletes receiving their PPE at an urgent care facility had significantly lower rates of HPV series completion than all other settings (29% vs 43%; P = 0.004). PPE completion by the athlete's PCP was associated with higher rates of vaccine series completion (46% vs 34%; P = 0.014). CONCLUSION: Athletes who completed their PPE in mass event and office-based settings had similar rates of HPV vaccine series initiation and completion. PPEs done at urgent care facilities were associated with low rates of vaccine series completion, while those done by a PCP were associated with higher rates. CLINICAL RELEVANCE: HPV immunization rates in athletes are low, and the PPE represents a potential opportunity to improve immunization rates.

Injectable Ketorolac and Corticosteroid Use in Athletes: A Systematic Review.

CONTEXT: The use of injectable medications to help athletes quickly return to the field of play after injury is common. Understanding the effects and risks of these medications will help providers make informed decisions regarding their use in this patient population. OBJECTIVE: To evaluate the utilization, efficacy, and adverse effects of injectable ketorolac and corticosteroids in athletes. DATA SOURCES: This systematic review followed the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. A systematic search of the literature was performed using multiple databases (PubMed, Embase, Cochrane, Web of Science, and ClinicalTrials.gov). Secondary references were appraised for relevant articles. No randomized controlled trials or other prospective studies were identified. Articles included retrospective database reviews and physician survey studies. STUDY SELECTION: A total of 6 studies met the inclusion and exclusion criteria and were reviewed by 2 independent reviewers with a third consulted in the case of disagreement, which was not needed. STUDY DESIGN: Systematic review. LEVEL OF EVIDENCE: Level 5. DATA EXTRACTION: Two reviewers recorded rate of use, effectiveness of treatment, and reported side effect data. RESULTS: Most studies centered around the football athlete, either professional or collegiate. Professional football game day use of intramuscular ketorolac declined from 93.3% (28/30) in 2002 to 48% in 2016. Collegiate football game day use of intramuscular ketorolac declined from 62% in 2008 to 26% in 2016. Game day corticosteroid injection was far lower than ketorolac usage. Both medications were reported to be effective with few adverse events. CONCLUSION: Use of injectable ketorolac is common but declining in professional and college football. Pain control efficacy is good, and risk of adverse events is low. The incidence of injectable corticosteroid use in athletes is unknown. Use of injectable corticosteroids in athletes allows for early return to sport activities with no reported complications.

Sportsman's hernia.

Sportsman's hernia (SH) is a controversial cause of chronic groin pain in athletes. Most commonly seen in soccer and ice hockey players, SH can be encountered in a variety of sports and in a variety of age groups. Although there are several reports of SH in women, it is almost exclusively found in men. SH is largely a clinical diagnosis of exclusion. History of chronic groin pain that is nonresponsive to treatment should raise suspicion of SH, but physical examination findings are subtle and most diagnostic tests do not definitively confirm the diagnosis. Conservative treatment of SH does not often result in resolution of symptoms. Surgical intervention results in pain-free return of full activities in a majority of cases.

Inflammatory bowel disease arthropathy.

Inflammatory bowel disease (IBD) is a common medical problem in the United States. There may be a genetic predisposition for the development of IBD. Gastrointestinal (GI) symptoms of IBD are often accompanied by symptoms in other body systems. Joint complaints are commonly noted in IBD patients, and may be the primary presenting complaint in some. The sports medicine physician must keep a high index of suspicion for IBD arthropathy in athletes who present with axial arthropathy or peripheral arthropathy that is not related to injury or overuse. Diagnosis may be difficult and relies on accurate diagnosis of the GI disease. Joint symptoms usually respond to treatment of the bowel disease. Other standard treatments of joint pain include ice, rest, rehabilitation exercises, and analgesics, although nonsteroidal anti-inflammatory drugs should be avoided as they may lead to a worsening of the GI symptoms. Exercise won't likely worsen IBD symptoms but whether exercise prevents IBD is still an area of debate.

The athlete with fatigue.

Fatigue is a common presenting complaint in primary care offices. Nearly everyone experiences fatigue at one time or another, typically caused by overexertion or lack of sleep. Fatigue in the athlete is problematic as it may affect training and competitive performance. The possible causes of fatigue are widely varied, and the workup of fatigue can be very frustrating for the patient and physician alike. Making an accurate diagnosis is important to help the athlete return to effective training and maximal performance. Overtraining syndrome is a possible cause, but at this time remains a diagnosis of exclusion.

Gastroesophageal reflux in athletes.

Gastroesophageal reflux (GER) and its associated symptoms are common among athletes. In the athlete, GER increases with intensity of exercise, is more common with endurance sports, and worse with postprandial exercise. GER has symptoms that overlap with other upper gastrointestinal (GI) conditions. Symptoms of GER can be difficult to distinguish from cardiac chest pain. GER may exacerbate asthma. Proposed mechanisms causing GER during exertion include altered GI blood flow and motor function, neuroendocrine changes, and mechanical effects. GER symptoms that interfere with activity may respond to lifestyle modification or pharmacologic therapy.

Diagnosis and management of headache in the weight-lifting athlete.

Weight lifters suffer from the same headache syndromes that affect all human beings. They are also susceptible to headache types brought on by their activity. Three headache syndromes, cervicogenic headache, benign exertional headache, and effort-induced migraine headache, appear to be more common in the weight-lifting athlete. This article discusses the diagnosis and treatment of these headache syndromes.

Pelvic and hip apophyseal avulsion injuries in young athletes.

Hip apophyseal injuries in young athletes are a fairly rare problem, and often go unrecognized by health professionals. These injuries can be extremely painful, and may take months to heal. Timely, accurate diagnosis is imperative so proper treatment can be initiated. In some cases, surgery is required.

Identifying and treating corneal abrasions.

Athletic activities cause up to 10% of all eye injuries in children(1) and account for 25% of severe eye injuries.(2) The sports most commonly associated with eye injury are baseball, basketball, tennis, and ice hockey,(1) but eye injury can occur in any sport.

Injection and aspiration techniques for the primary care physician.

Aspiration and injection techniques are useful, relatively safe office procedures. The physician must have a good understanding of the basic technique and pertinent anatomy. The indications, contraindications and specific injection and aspiration techniques are discussed.