Impact of COVID-19 on the physical activity, quality of life and mental health of adolescent athletes: a 2-year evaluation of over 17 000 athletes.

PURPOSE: To evaluate the changes in mental health, quality of life (QOL) and physical activity (PA) among adolescent athletes during the COVID-19 pandemic as organised sports resumed. METHODS: Adolescent athletes completed surveys including demographic and sport participation information, 7-item Generalized Anxiety Disorder, 9-item Patient Health Questionnaire, Pediatric Quality of Life Inventory and the Hospital for Special Surgery Pediatric Functional Activity Brief Scale in May 2020 following COVID-19-related sport cancellations (Spring20) and after returning to sports in May 2021 (Spring21). The groups were balanced by inverse propensity score weighting and compared using analysis of variance models and ordinal regression models. RESULTS: 17 421 participants were included (Spring20=13 002; Spring21=4419; 16.2±1.2 years; 53% female). Anxiety was significantly lower (better) in Spring21 (Spring20=7.0, 95% CI 6.9 to 7.1; Spring21=4.9, 95% CI 4.8 to 5.0, p<0.001), as was the prevalence of moderate to severe anxiety (Spring20=29.4%, Spring21=17.1%, p<0.001). Depression was significantly improved in Spring21 (Spring20=7.6, 95% CI 7.5 to 7.7; Spring21=4.6, 95% CI 4.5 to 4.8, p<0.001), as was the prevalence of moderate to severe depression (Spring20=32.2%, Spring21=15.4%, p<0.001). Athletes in Spring21 reported higher QOL (Spring20=79.6, 95% CI 79.3 to 79.9; Spring21=84.7, 95% CI 84.4 to 85.0, p<0.001) and increased levels of PA (Spring20=13.8, 95% CI 13.6 to 13.9; Spring21=22.7, 95% CI 22.6 to 22.9, p<0.001). CONCLUSION: Early COVID-19 sports restrictions were associated with worsening mental health in adolescents. In 2021, after returning to sports, athletes reported significant improvements in mental health, QOL and PA, although mental health adversities remain an important priority.

Reported COVID-19 Incidence in Indoor Winter Sports Among US High-School Athletes.

OBJECTIVE: To evaluate the association between COVID-19 incidence among high-school athletes participating in different indoor winter sports and attending schools with in-person versus virtual instructional delivery. DESIGN: Cross-sectional survey. SETTING: US high schools. PARTICIPANTS: High-school athletic directors. INDEPENDENT VARIABLES: Indoor winter sports, school instructional delivery method, and state COVID-19 incidence. MAIN OUTCOME MEASURES: Surveys were distributed to high-school athletic directors throughout the United States regarding sport reinitiation and COVID-19 cases in winter 2020 to 2021. Separate mixed effects Poisson regression models were developed to evaluate the associations between reported COVID-19 incidence and (1) different sports and (2) school instructional delivery method, while adjusting for the background, state COVID-19 incidence. RESULTS: Four hundred thirty schools had restarted fall sports, representing 31 274 athletes on 1404 teams from 14 states. One thousand four hundred sixty cases of COVID-19 were reported, representing a case rate of 4668 cases per 100 000 athletes and an incidence rate of 58.7 cases per 100 000 player-days. Reported COVID-19 incidence was greatest among girls' hockey (82.1 cases per 100 000 player-days (95% CI, 56.8-115) and boys' hockey [76.7 (61.8-94.2)] and lowest among swimming [39.0 (31.1-48.2)] and gymnastics [28.5 (13.1-54.2)]. No difference in reported COVID-19 incidence was identified among athletes attending schools with virtual versus in-person instruction [incidence rate ratio = 0.86 (0.52-1.4)]. CONCLUSIONS: In this nationwide survey of US high-school athletic directors regarding indoor winter sports, reported COVID-19 incidence was lower in noncontact sports but unrelated to school instructional delivery method. This information may help guide decision-making regarding high-school sport participation during the COVID-19 pandemic.

Contribution of Lean Mass Distribution on Aerobic Fitness and Performance in NCAA Division I Female Rowers.

ABSTRACT: Haraldsdottir, K, Sanfilippo, J, Dawes, S, and Watson, A. Contribution of lean mass distribution on aerobic fitness and performance in NCAA division I female rowers. J Strength Cond Res 36(7): 1956-1960, 2022-The purpose of this study was to determine the relative influence of total lean body mass (LBM), body fat percentage (BF%), upper extremity lean mass (ULM), lower extremity lean mass (LLM), and trunk lean mass (TLM) on maximal aerobic capacity (V̇o2max) and time to exhaustion (Tmax) in female collegiate rowers. One hundred seven female collegiate rowers (aged 18-22 years) performed maximal progressive rowing ergometer testing to determine V̇o2max and Tmax. Body mass, LBM, BF%, ULM, LLM, and TLM were determined by using dual-energy x-ray absorptiometry. Separate multivariable linear regression models were performed to predict V̇o2max and Tmax by using LBM and BF% as predictors. In addition, separate linear regression models were used to predict V̇o2max and Tmax with ULM, LLM, and TLM as covariates. Subjects were aged 20 ± 3 years. V̇o2max was significantly predicted by LBM (r2 = 0.29, p < 0.001), but not BF% (r2 = 0.002, p = 0.79). Similarly, Tmax was significantly predicted by LBM (r2 = 0.25, p < 0.001), but not BF% (r2 = 0.003, p = 0.19). V̇o2max was significantly predicted by LLM (r2 = 0.12, p < 0.01), but not ULM (r2 = 0.08, p = 0.68) or TLM (r2 = 0.09, p = 0.17), and Tmax was significantly predicted by TLM (r2 = 0.09, p = 0.02), but not ULM (r2 = 0.07, p = 0.89) or LLM (r2 = 0.08, p = 32). Among female collegiate rowers, whole body LBM is a significant predictor of both V̇o2max and Tmax. However, LLM is a stronger predictor of V̇o2max while TLM is a stronger predictor Tmax, although each of these relationships has a low coefficient of determination. These findings suggest that aerobic fitness and performance may be influenced by regions of lean mass differently.

[Liver surgeries in Iceland 2013-2017 - Comparison with Sweden in terms of quality registration].

INTRODUCTION: Cancers in the liver, bile duct system, gallbladder as well as metastases of the liver, have poor prognosis. Their treatment is comparable, with surgery being the most widespread, available curative treatment. Surgical treatment is anatomical or non-anatomical resection of the liver where the tumor and the adjacent liver tissue are removed. MATERIALS/METHODS: A list of patients diagnosed with cancer in the liver, bile duct system, gallbladder or metastases of the liver, during the time period 2013-2017, was obtained from the Icelandic Cancer Registry. Additional information was retrieved from medical records and entered into the electronic quality registration forms of Landspítalinn. A comparison was made between Sweden and Iceland. RESULTS: In total 108 patients were diagnosed with primary cancer of the liver, of which 24 (22%) underwent liver surgery. Of 264 diagnosed with liver metastases 38 (14%) underwent surgical treatment. A total of 63% of all reported cases were discussed at a multidisciplinary team meeting in Iceland but 93% in Sweden (p<0.0001). A sum of 29 patients (43%) developed complications within 30 days of surgery. Number of partial liver resections per 100.000 inhabitants were 2-8 in Iceland versus 4-13 in Sweden. The difference was even more apparent in patients with liver metastases. CONCLUSION: Liver surgeries performed in Iceland seem to be comparable to Sweden in terms of complications and post operative mortality. In Iceland, considerably fewer operations are performed per capita, especially on liver metastases which could be explained by the fact that fewer patients are discussed at multidisciplinary team meetings.

Exercise-induced irregular right heart flow dynamics in adolescents and young adults born preterm.

BACKGROUND: Preterm birth has been linked to an elevated risk of heart failure and cardiopulmonary disease later in life. With improved neonatal care and survival, most infants born preterm are now reaching adulthood. In this study, we used 4D flow cardiovascular magnetic resonance (CMR) coupled with an exercise challenge to assess the impact of preterm birth on right heart flow dynamics in otherwise healthy adolescents and young adults who were born preterm. METHODS: Eleven young adults and 17 adolescents born preterm (< 32 weeks of gestation and < 1500 g birth weight) were compared to 11 young adult and 18 adolescent age-matched controls born at term. Stroke volume, cardiac output, and flow in the main pulmonary artery were quantified with 4D flow CMR. Kinetic energy and vorticity were measured in the right ventricle. All parameters were measured at rest and during exercise at a power corresponding to 70% VO2max for each subject. Multivariate linear regression was used to perform age-adjusted term-preterm comparisons. RESULTS: With exercise, stroke volume increased 10 ± 21% in term controls and decreased 4 ± 18% in preterm born subjects (p = 0.007). This resulted in significantly reduced capacity to increase cardiac output in response to exercise stress for the preterm group (58 ± 26% increase in controls, 36 ± 27% increase in preterm, p = 0.004). Elevated kinetic energy (KEterm = 71 ± 22 nJ, KEpreterm = 87 ± 38 nJ, p = 0.03) and vorticity (ωterm = 79 ± 16 s-1, ωpreterm = 94 ± 32 s-1, p = 0.01) during diastole in the right ventricle (RV) suggested altered RV flow dynamics in the preterm subjects. Streamline visualizations showed altered structure to the diastolic filling vortices in those born preterm. CONCLUSIONS: For the participants examined here, preterm birth appeared to result in altered right-heart flow dynamics as early as adolescence, especially during diastole. Future studies should evaluate whether the altered dynamics identified here evolves into cardiopulmonary disease later in life. Trial registration None.

Impact of in-season injury on quality of life and sleep duration in female youth volleyball athletes: a prospective study of 2073 players.

OBJECTIVES: The psychological impacts of injuries in youth athletes remain poorly defined. The purpose of this study was to evaluate the influence of injury on quality of life (QOL) and sleep in female high school volleyball athletes. METHODS: 2073 female high school volleyball players (15.6±1.1 years) completed the Pediatric Quality of Life survey (total QOL, physical, social, school, emotional and psychosocial function) and reported average sleep duration at the start and end of the season. Injury data were collected by school athletic trainers. Mixed effects linear regression models were used to compare changes in QOL and sleep duration during the season between (1) injured and uninjured athletes and (2) injured athletes who did or did not suffer a season-ending injury. RESULTS: Time-loss injuries were reported in 187 athletes with complete preseason and postseason data. During the season, injured athletes demonstrated a greater decrease in total QOL (ß=-1.3±0.5, p=0.012), as well as physical function (ß=-1.6±0.6, p=0.012), school function (ß=-2.0±0.76, p=0.01) and psychosocial function domains (ß=-1.2±0.6, p=0.039) compared with uninjured athletes. Athletes who sustained a season-ending injury had a significantly greater decrease in total QOL (ß=-6.8±2.0, p=0.006) and physical function (ß=-17±2.9, p<0.001) compared with injured athletes who were able to return to play during the season. CONCLUSION: In-season injuries are associated with significant decreases in total QOL as well as physical and psychosocial function. Healthcare providers should consider the impacts of injuries on QOL and sleep in youth athletes in order to optimise management and improve overall health.

Psychosocial Impacts of Sports-related Injuries in Adolescent Athletes.

ABSTRACT: Adolescence represents a time of tremendous physical, social, and emotional growth, and sport participation can provide significant mental health benefits for young athletes. Injuries are unfortunately common in sports and represent a threat to the short- and long-term health of athletes. While injury management has typically revolved around the minimization of pain and the restoration of physical function, emerging evidence suggests that the psychological consequences of injury may be significant, potentially jeopardizing return to play, increasing subsequent reinjury risk, and even leading to the development of mental health disorders. The majority of this research has been conducted in adult athletes and less is known about outcomes in youth athletes following injury. This review examines what is known about the psychosocial impact of sports injuries in youth athletes to identify areas of future research and to aid clinicians in the management of this population.

Mindfulness in Athletes.

ABSTRACT: Interventions to promote athlete health and performance have traditionally been focused on the physical elements of injury and training. More recently, however, increasing attention has been placed on the mental aspects of athlete health, with emerging evidence suggesting that injury risk and athletic performance are significantly affected by athlete well-being. Mindfulness meditation has been shown to have significant benefits for a number of physical and mental health outcomes in various clinical populations, and recent research has explored how mindfulness may enhance athletic performance, improve athlete mental health, reduce injury risk, and perhaps even facilitate recovery from injury. As awareness of mindfulness as a noninvasive, low-risk, and accessible intervention increases in the Western society, use among athletes has increased as well. Health care providers should be aware of this evidence in order to guide athletes regarding the use of mindfulness as an intervention to potentially improve athlete health and performance.

Blunted cardiac output response to exercise in adolescents born preterm.

PURPOSE: Premature birth is associated with lasting effects, including lower exercise capacity and pulmonary function, and is acknowledged as a risk factor for cardiovascular disease. The aim was to evaluate factors affecting exercise capacity in adolescents born preterm, including the cardiovascular and pulmonary responses to exercise, activity level and strength. METHODS: 21 preterm-born and 20 term-born adolescents (age 12-14 years) underwent strength and maximal exercise testing with thoracic bioimpedance monitoring. Baseline variables were compared between groups and ANCOVA was used to compare heart rate, cardiac output (Q) and stroke volume (SV) during exercise between groups while adjusting for body surface area. RESULTS: Preterm-borns had lower maximal aerobic capacity than term-borns (2.0 ± 0.5 vs. 2.5 ± 0.5 L/min, p = 0.01) and lower maximal power (124 ± 26 vs. 153 ± 33 watts, p < 0.01), despite similar physical activity scores. Pulmonary function and muscular strength did not differ significantly. Although baseline Q and SV did not differ between groups, preterm adolescents had significantly lower cardiac index (Qi) at 50, 75 and 100% of maximal time to exhaustion, driven by SV volume index (SVi, 50% max time: 53.0 ± 9.0 vs. 61.6 ± 11.4; 75%: 51.7 ± 8.4 vs. 64.3 ± 11.1; 100%: 51.2 ± 9.3 vs. 64.3 ± 11.5 ml/m2, all p < 0.01), with similar heart rates. CONCLUSION: Otherwise healthy and physically active adolescents born very preterm exhibit lower exercise capacity than term-born adolescents. Despite similar baseline cardiovascular values, preterm-born adolescents demonstrate significantly reduced Qi and SVi during incremental and maximal exercise.

Comparing prenatal screening experiences of Icelandic women who received false-positive and true-negative first-trimester combined screening results in Iceland in 2012-2016.

First-trimester combined screening (FTS) has been offered to all pregnant women in Iceland since 2003. Individuals with high-risk FTS results are offered an invasive test option with a ≤1% risk of fetal loss. This study gives insight into the prenatal screening and diagnosis experiences and preferences of 101 women who underwent FTS in Iceland in the years 2012-2016, comparing the experience of those who received false-positive FTS results to those who received true-negative results. Retrospective patient-reported anxiety levels at the time of receiving FTS results were significantly higher in those who received false-positive results compared to those who received true-negative results. For a subset of these participants, the anxiety lasted through pregnancy, and for a smaller subset, it lasted even longer. Non-invasive prenatal testing (NIPT) is currently not offered in Iceland, aside from the rare exceptional case. Given the extremely low false-positive rates of NIPT, we believe NIPT is worth considering as Iceland's standard first-tier screening method for trisomy 13, 18, and 21. We believe the findings of this study are beneficial not only for Iceland but also for other countries where FTS is the first-tier prenatal screening method or the only offered test. Additionally, only 21% of participants in our study reported that they had heard of NIPT, which emphasizes the need for comprehensive NIPT pretest information to be available prior to its uptake to ensure informed and autonomous decision-making.

[Gallstones - review].

The prevalence of gallstones is 20 % making it one of the most common causes for admissions to surgical wards. It seems that admissions and operations for gallstone disease are increasing. Gallstones are formed in the gallbladder but can also form in the biliary tree and most are made of cholesterol which is absorbed from the diet. Risk factors for gallstones and gallstone related disease are for example female gender, obesity and rapid weight loss. Most patients with gallstones never experience any symptoms but the risk of presenting with complications related to gallstones is two percent per year. Patients with gallstones can present with pain or other more serious complications that demand surgical treatment and follow-up. This article will cover pathophysiology, complications, diagnosis and treatment of gallstone disease.

[Inflammatory fibroid polyp in the jejunum - a case report].

Inflammatory fibroid polyps (IFP) are rare type of benign tumours found in the gastrointestinal tract. IFP´s are in most cases small in size and without symptoms but can cause intussuception and haemorrhage. We present a case of a 25 year old female who presented with abdominal pain and symptoms and signs of anemia, hemoglobin was 36 g/L upon arrival. Further workup revealed a large tumor in the small intestine. The patient underwent a partial resection of the proximal jejunum. Pathology of the specimen showed inflammatory fibroid polyp.

Early Pulmonary Vascular Disease in Young Adults Born Preterm.

Rationale: Premature birth affects 10% of live births in the United States and is associated with alveolar simplification and altered pulmonary microvascular development. However, little is known about the long-term impact prematurity has on the pulmonary vasculature.Objectives: Determine the long-term effects of prematurity on right ventricular and pulmonary vascular hemodynamics.Methods: Preterm subjects (n = 11) were recruited from the Newborn Lung Project, a prospectively followed cohort at the University of Wisconsin-Madison, born preterm with very low birth weight (≤1,500 g; average gestational age, 28 wk) between 1988 and 1991. Control subjects (n = 10) from the same birth years were recruited from the general population. All subjects had no known adult cardiopulmonary disease. Right heart catheterization was performed to assess right ventricular and pulmonary vascular hemodynamics at rest and during hypoxic and exercise stress.Measurements and Main Results: Preterm subjects had higher mean pulmonary arterial pressures (mPAPs), with 27% (3 of 11) meeting criteria for borderline pulmonary hypertension (mPAP, 19-24 mm Hg) and 18% (2 of 11) meeting criteria for overt pulmonary hypertension (mPAP ≥ 25 mm Hg). Pulmonary vascular resistance and elastance were higher at rest and during exercise, suggesting a stiffer vascular bed. Preterm subjects were significantly less able to augment cardiac index or right ventricular stroke work during exercise. Among neonatal characteristics, total ventilatory support days was the strongest predictor of adult pulmonary pressure.Conclusions: Young adults born preterm demonstrate early pulmonary vascular disease, characterized by elevated pulmonary pressures, a stiffer pulmonary vascular bed, and right ventricular dysfunction, consistent with an increased risk of developing pulmonary hypertension.

Heart rate recovery after maximal exercise is impaired in healthy young adults born preterm.

PURPOSE: The long-term implications of premature birth on autonomic nervous system (ANS) function are unclear. Heart rate recovery (HRR) following maximal exercise is a simple tool to evaluate ANS function and is a strong predictor of cardiovascular disease. Our objective was to determine whether HRR is impaired in young adults born preterm (PYA). METHODS: Individuals born between 1989 and 1991 were recruited from the Newborn Lung Project, a prospectively followed cohort of subjects born preterm weighing < 1500 g with an average gestational age of 28 weeks. Age-matched term-born controls were recruited from the local population. HRR was measured for 2 min following maximal exercise testing on an upright cycle ergometer in normoxia and hypoxia, and maximal aerobic capacity (VO2max) was measured. RESULTS: Preterms had lower VO2max than controls (34.88 ± 5.24 v 46.15 ± 10.21 ml/kg/min, respectively, p < 0.05), and exhibited slower HRR compared to controls after 1 and 2 min of recovery in normoxia (absolute drop of 20 ± 4 v 31 ± 10 and 41 ± 7 v 54 ± 11 beats per minute (bpm), respectively, p < 0.01) and hypoxia (19 ± 5 v 26 ± 8 and 39 ± 7 v 49 ± 13 bpm, respectively, p < 0.05). After adjusting for VO2max, HRR remained slower in preterms at 1 and 2 min of recovery in normoxia (21 ± 2 v 30 ± 2 and 42 ± 3 v 52 ± 3 bpm, respectively, p < 0.05), but not hypoxia (19 ± 3 v 25 ± 2 and 40 ± 4 v 47 ± 3 bpm, respectively, p > 0.05). CONCLUSIONS: Autonomic dysfunction as seen in this study has been associated with increased rates of cardiovascular disease in non-preterm populations, suggesting further study of the mechanisms of autonomic dysfunction after preterm birth.

[Percutaneous cholecystostomy as treatment for acute cholecystitis at Landspitali University Hospital 2010 - 2016].

INTRODUCTION: Acute cholecystitis is one of the most common reasons for acute admission in abdominal surgery. The recom-mended therapy is cholecystectomy but occasionally that is not possible and a conservative treatment with intravenous antibiotics is used. Should the patient not respond to conservative treatment a percutaneous catheter can be placed in the gallbladder (cholecystostomy). The aim of the study was to look at the frequency of which cholecystostomies were used and the complication rates at Landspitali, The National University Hospital of Iceland. MATERIALS AND METHODS: A retrospective study where patient charts of those with ICD - diagnosis numbers K80 - 85 at Landspitali University Hospital looked at and patients who received cholecystostomies were identified in the period from 2010 - 2016. Clinical information was registered in Excel. Descriptive statistics were used. RESULTS: A total of 4423 patients were diagnosed with biliary disease during the study period. 1255 (28%) of them had acute cholecystitis with mean age of 58 years (range: 18 - 99). A cholecystostomy was put in 88 patients (14%), mean age 71 years (range: 28 - 92). A transhepatic route was used for 62 (70%) and the drain was in place for an average of 12 days (range: 0 - 87). A secondary cholangiography was performed in 71 cases. Seventeen patients were discharged home with the cholecystostomy in place. Half of the patients underwent a laparoscopic cholecystectomy 101 days from drain insertion (range: 30 - 258). A total of 28 complications were noted in 27 patients (31%) and the most common complication was dislodgement of the catheter (n=20). Five patients (6%) died within thirty days of the intervention, three from septic shock and two from reasons unrelated to the treatment. CONCLUSIONS: Cholecystostomy is not a common choice of treatment for acute cholecystitis at Landspitali, The National University Hospital of Iceland. Few serious complications arise from the treatment and no patients died in relation to the intervention.

Intraperitoneal injection of MSC-derived exosomes prevent experimental bronchopulmonary dysplasia.

Mesenchymal stromal cell (MSC) derived exosomes mediate tissue protection and regeneration in many injuries and diseases by modulating cell protein production, protecting from apoptosis, inhibiting inflammation, and increasing angiogenesis. In the present study, daily intraperitoneal injection of MSC-derived exosomes protected alveolarization and angiogenesis in a newborn rat model of bronchopulmonary dysplasia (BPD) induced by 14 days of neonatal hyperoxia exposure (85% O2). Exosome treatment during hyperoxia prevented disruption of alveolar growth, increased small blood vessel number, and inhibited right heart hypertrophy at P14, P21, and P56. In vitro, exosomes significantly increased tube-like network formation by HUVEC, in part through a VEGF mediated mechanism. In summary, daily intraperitoneal injection of exosomes increased blood vessel number and size in the lung through pro-angiogenic mechanisms. MSC-derived exosomes therefore have both anti-inflammatory and pro-angiogenic mechanism to protect the lung from hyperoxia induced lung and heart disease associated with BPD.

The risk of developing a mismatch repair deficient colorectal cancer after undergoing cholecystectomy.

OBJECTIVES: Mismatch repair deficient (dMMR) colorectal cancer (CRC) is caused by inactivation of the MMR DNA repair system, most commonly via epigenetic inactivation of the MLH1 gene, and these tumors occur most frequently in the right colon. The objective was to determine whether cholecystectomy (CCY) increases the risk of a dMMR CRC by comparing CCY incidence in patients with dMMR CRC and proficient MMR (pMMR) CRC to unaffected controls. MATERIALS AND METHODS: All patients diagnosed with CRC in Iceland from 2000 to 2009 (n = 1171) were included. They had previously been screened for dMMR by immunohistochemistry (n = 129 were dMMR). Unaffected age- and sex-matched controls (n = 17,460) were obtained from large Icelandic cohort studies. Subjects were cross-referenced with all pathology databases in Iceland to establish who had undergone CCY. Odds ratios were calculated using unconditional logistic regression. RESULTS: Eighteen (13.7%) dMMR CRC cases and 90 (8.7%) pMMR CRC cases had undergone CCY compared to 1532 (8.8%) controls. CCY-related odds ratios (OR) were 1.06 (95% CI 0.90-1.26, p = .577) for all CRC, 1.16 (95% CI 0.66-2.05 p = .602) for dMMR CRCand 1.04 (95% CI 0.83-1.29, p = .744) for pMMR CRC. Furthermore, OR for dMMR CRC was 0.51 (95% CI 0.16-1.67, p = .266), 2.04 (95% CI 0.92-4.50, p = .080) and 1.08 (95% CI 0.40-2.89, p = .875) <10 years, 10-20 years and >20 years after a CCY, respectively. CONCLUSIONS: There was no evidence of increased risk of developing dMMR CRC after CCY although a borderline significantly increased 2-fold risk was observed 10-20 years after CCY. Larger studies are warranted to examine this further.

Changes in Quality of Life Among Collegiate Athletes During COVID-19.

BACKGROUND: The COVID-19 pandemic has had a significant effect on the mental health of athletes. How this has affected quality of life (QoL), specifically in the college population, is poorly defined. HYPOTHESIS: During the COVID-19 pandemic, the mental and physical QoL will have decreased in collegiate athletes as compared with before the pandemic. STUDY DESIGN: Cross-sectional study. LEVEL OF EVIDENCE: Level 3. METHODS: Division I athletes from a total of 23 varsity teams at a single institution completed surveys between 2018 and 2022. QoL was assessed using the Veterans RAND 12-Item Health Survey (VR-12). VR-12 scores were separated into mental component scores (MCS) and physical component scores (PCS). Separate linear mixed effects models evaluated changes in MCS and PCS from pre-COVID to during COVID overall, as well as differences in changes by sex and sport type (individual, team). RESULTS: For all athletes, the PCS increased (54.6 [95% CI 54.4-54.7] vs 55.1 [54.9-55.3]; P < 0.01) and the MCS decreased (55.2 [54.9-55.5] vs 53.5 [53.1-53.8]; P < 0.01) from pre-COVID to during COVID. When evaluating for sex, women demonstrated a greater increase in PCS (0.57 ± 0.22; P = 0.01) and greater decrease in MCS (1.06 ± 0.38; P < 0.01). With respect to sport type, individual sports demonstrated a greater decrease in MCS (1.46 ± 0.39; P < 0.01), but no interaction was identified for PCS (0.42 ± 0.23; P = 0.07). CONCLUSION: Collegiate athletes demonstrated a decrease in their self-reported mental QoL during the COVID-19 pandemic, as compared with before the pandemic. This effect was most evident in women and in individual sports. Athletes also reported an increase in physical QoL during COVID that was also larger in women, but not related to sport. CLINICAL RELEVANCE: This study demonstrates the impact of the COVID-19 pandemic on collegiate athletes' QoL, including negative effects on mental health. It also identifies cohorts of athletes (women, individual) who may be more significantly affected.

The Associations Between Wellbeing and Injury Differ by Time Loss in Collegiate Athletes.

BACKGROUND: Self-reported wellbeing measures such as mood and soreness have been identified as predictors of injury risk. However, most research has focused on investigating time-loss injuries even though nontime-loss injuries are more prevalent. HYPOTHESIS: Impairments in sleep and subjective wellbeing would be associated with increased injury for both time-loss and nontime-loss injuries. STUDY DESIGN: Prospective longitudinal study. LEVEL OF EVIDENCE: Level 3. METHODS: During 2022, 127 athletes completed a daily survey that inquired about training load and sleep from the previous day along with mood, stress, and soreness on the current day. Incidence of injury was also monitored using documentation provided by athletes' respective athletic trainers. Mixed effect models were used to analyze the relationship between wellbeing and sleep measures with injury. RESULTS: Self-reported wellbeing, based most closely on soreness the day of injury, by National Collegiate Athletic Association Division 1 collegiate athletes was predictive of time-loss injuries, whereas no significant relationship was identified for nontime-loss injuries. Specifically, 1 unit increase in soreness was associated with a 39% increase in odds of sustaining a time-loss injury. CONCLUSION: This study found that subjective wellbeing and sleep have a different relationship with injury dependent upon whether the resulting injury leads to time loss. CLINICAL RELEVANCE: Self-reported wellbeing appears to be a relevant predictor of injury among collegiate athletes for time-loss injuries.

Mindfulness Practice Is Associated With Improved Well-Being and Reduced Injury Risk in Female NCAA Division I Athletes.

BACKGROUND: Injury in sport is an inherent risk to participation, and it can have devastating consequences for the athlete, both mentally and physically. Previous research has found that impairments in well-being can increase the risk of injury, and that various forms of mindfulness training and practice can improve well-being and mental health in various populations. HYPOTHESIS: Mindfulness would be associated with greater well-being and lower risk of injury. STUDY DESIGN: Cohort study. LEVEL OF EVIDENCE: Level 3. METHODS: A total of 21 female Division I athletes underwent a formal 6-week mindfulness training program and were encouraged to continue mindfulness exercises. The athletes completed daily surveys on their smartphones in relation to mood, muscle readiness (soreness), readiness to train, energy level, daily training load, and whether they had participated in mindfulness training that day. Linear mixed effects models were used to evaluate well-being variables and mindfulness state, and separate mixed effects logistics regression models were used to evaluate injury incidence and wellness variables. RESULTS: On days with mindfulness practice, athletes reported higher mood (19.6 [18.8-20.3] vs 19.4 [18.6-20.1, P = 0.03), muscle readiness (18.9 [17.8-20.0] vs 18.6 [17.5-19.6], P = 0.03), readiness to train (78.7 [75.9-81.5] vs 77.4 [74.7-80.2], P < 0.01), and energy level (19.3 [18.6-20.1] vs 18.8 [18.1-19.5, P < 0.01) than on the days when they did not participate in mindfulness training. Mindfulness practice was associated with significantly reduced likelihood of suffering an acute injury the following day (odds ratio, 0.42; 95% CI, 0.42-0.43; P < 0.01). CONCLUSION: On an individual level, participation in mindfulness by female collegiate athletes was associated with a dramatic reduction in injury risk the following day. In addition, mindfulness was associated with significantly improved mood, muscle readiness, readiness to train, and energy level. CLINICAL RELEVANCE: These findings suggest that mindfulness training in athletes may improve well-being and reduce the risk of injury among high-level athletes.