Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) Infections and Reinfections Among Fully Vaccinated and Unvaccinated University Athletes-15 States, January-November 2021.

BACKGROUND: Limited data currently exist on severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections among fully vaccinated persons or reinfections in college-aged populations. Centers for Disease Control and Prevention (CDC) partnered with National Collegiate Athletic Association (NCAA) institutions to analyze retrospective data and present characteristics of positive coronavirus disease 2019 (COVID-19) cases among student athletes 18 years of age and older. METHODS: De-identified, individual-level data contributed by 21 universities on 1378 student athletes who tested positive for SARS-CoV-2 from January through November 2021 (pre-Omicron) were examined to determine percentages of infection among unvaccinated, partially vaccinated, and fully vaccinated individuals (breakthrough infections) as well as reinfections. Comparisons by demographic characteristics and regions were also made to further characterize these infections. RESULTS: Among the 1378 student athletes positive for SARS-CoV-2, 1070 (77.6%) were infected when unvaccinated and 22.4% (n = 308) were infected after full vaccination. There was a significant difference between Black (14.7%, n = 40) and White (23.9%, n = 168) student athletes who experienced a SARS-CoV-2 infection after being fully vaccinated (P < .01). Proportions of infections among fully vaccinated individuals did not differ statistically by sex (p = 0.06). CONCLUSIONS: This article adds to the knowledge of SARS-CoV-2 infections among fully vaccinated individuals in college-aged populations. The level of infections among fully vaccinated student athletes indicates the need for maintaining precautions to prevent infection. Further study of COVID-19 vaccination, infection, and reinfection among the well-resourced and diverse population of student athletes might contribute further understanding of factors that play a role in health equity among young adults.

Gender bias in sports medicine: an international assessment of sports medicine physicians' perceptions of their interactions with athletes, coaches, athletic trainers and other physicians.

OBJECTIVES: To evaluate the difference between female and male sports medicine physicians regarding disrespectful attitudes and sexual harassment perceived from athletes, coaches, physicians, athletic trainers (ATs) and organisations/administrations. METHODS AND STUDY DESIGN: anonymous survey was distributed to sports medicine physicians practicing in 51 countries. χ2 analysis was used to detect differences between female and male sports medicine physicians and logistic regression analysis was used to determine the independent variables that affect disrespectful attitudes and sexual harassment from sports participants. RESULTS: 1193 sports medicine physicians (31.9% female) participated from 51 countries. The survey revealed that female physicians, compared with male physicians, perceive significantly more disrespect or have their judgement questioned more by the following categories: male and female athletes, male and female coaches, female physicians with more years of experience, male physicians (regardless of years of experience), male and female ATs and organisation/administrations (all p<0.05). The only category where the frequency of disrespect was perceived equally by male and female physicians was during their interactions with female physicians who have the same or lesser years of experience. Female sports medicine physicians noted more sexual harassment than male physicians during interactions with male athletes, coaches, ATs and physicians (all p<0.001). In the logistic regression, gender was a related factor for perceiving disrespect, especially from male coaches (OR=2.01) and physicians with more years of experience (OR=2.18). CONCLUSIONS: Female sports medicine physicians around the world experience disrespectful attitudes, questioning of their judgement and are sexually harassed significantly more often than male counterparts.

"Shared Decision-Making" in Athletes With Known Cardiac Disease: Interpretation and Implementation in the Real World.

OBJECTIVE: Recommendations for addressing sporting eligibility and disqualification in athletes with heart disease have traditionally used a paternalistic approach with cardiologists making a binary "yes-no" decision. This paradigm has recently evolved to a shared decision-making model recognizing and respecting the autonomy of the athlete while instituting safeguards to mitigate risk where possible. How well this paradigm is understood or has been integrated into the athletic trainer (AT) community is unknown. DESIGN: Athletic trainers from the Ohio High School Athletic Association were surveyed. RESULTS: Of 107 ATs who responded, we found that the majority had not heard of the term "shared decision-making" in the context of sporting participation [62.6%, confidence interval (CI) 0.53-0.72 vs 37.4%, CI 0.28-0.47]. Furthermore, we found large discrepancies as to how ATs would interpret and implement recommendations from cardiologists. CONCLUSIONS: This study highlights the need to educate and improve communication between AT, sports medicine physicians, and sports cardiologists if shared decision-making strategies are to become widely implemented.

International study of physicians' opinion on physician-patient sex concordance when treating athletes.

BACKGROUND: The effect of physician-patient sex concordance in medicine has been reported in many studies. Whether physicians believe that the sex concordance between physician and athlete influences treatment has not been investigated. OBJECTIVE: To determine whether physicians believe that the sex concordance between physician and athlete influences treatment. DESIGN: Cross-sectional study. SETTING: Online survey. PARTICIPANTS: One thousand one hundred ninety-three sports medicine physicians in 51 countries. Participants were sports medicine physicians trained in orthopedics (n = 443 [37.1%]) and nonorthopedics (n = 750 [62.9%]). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Participants were asked to decide whether sex of the physician made them better suited to care for athletes of concordant or different sexes along with their personal background. RESULTS: Orthopedic sports medicine physicians agreed less than nonorthopedic sports medicine physicians regarding the statement "MALE sports medicine physicians are better suited than their female counterparts to care for MALE athletes" (odds ratio [OR] 0.56, 95% confidence interval [CI] 0.35-0.91, p = .02), and compared to sports medicine physicians based in Europe, those based in Asia agreed more to this statement (OR 7.91, 95% CI 4.60-13.60, p < .01). In addition, regarding the statement "FEMALE sports medicine physicians are better suited than their male counterparts to care for FEMALE athletes," compared to sports medicine physicians based in Europe, those based in Asia (OR 9.12, 95% CI 5.63-14.79, p < .01) and North America (OR 2.18, 95% CI 1.46-3.25, p < .01) agreed more and orthopedic sports medicine physicians agreed less than nonorthopedic sports medicine physicians (OR 0.61, 95% CI 0.39-0.93, p = .02) to this statement. CONCLUSIONS: Sports medicine physicians trained in orthopedics felt sex concordance was less important than physicians trained in other specialties. Asian sports medicine physicians believed sex concordance was more important compared to physicians in other regions.

Athlete Sleep Behavior Questionnaire in Japanese (ASBQ-J): An Adaptation and Validation Study.

Purpose: The Athlete Sleep Behavior Questionnaire (ASBQ) is an 18-item self-reported questionnaire that can be used to screen for sleep disorders in athletes and assess environmental, behavioral, and sports-related factors along with sleep disorders. This study aimed to analyze the reliability and validity of the ASBQ translated into Japanese (ASBQ-J). Patients and Methods: 111 female collegiate athletes completed both the initial test and retest. Independent variables were what kind of sports they perform, level as an athlete, grade (freshman, sophomore, junior, senior), and age. The reliability of the survey was assessed using Cronbach's alpha and intraclass correlation, and Pearson's correlation coefficient was calculated to determine the correlation between the total ASBQ scores and three components which were routine/environmental, behavioral, and sports factors. Results: A total of 37.8% of athletes had ASBQ scores equal or less than 36 indicating good sleep. However, 19.8% of athletes scored more than 42, indicating poor sleep. Cronbach alpha was 0.62 and 0.65 for test and retest, respectively. Intraclass correlation was 0.78 (P < 0.01), indicating sufficient internal consistency and test-retest validity. Mean ASBQ scores were 38.5 ± 5.0 and 37.0 ± 6.5 for test and retest, respectively, and it was not significantly different between the two groups (P = 0.37). The correlation coefficients between the ASBQ-J and component scores were all statistically significant (all P < 0.01). Conclusion: ASBQ-J is a reliable questionnaire for assessing sleep disorders in athletes whose primary language is Japanese.

An international study on attitudes and opinions regarding female sports medicine physicians during pregnancy and the postpartum period.

OBJECTIVES: Supporting female sports medicine physicians to simultaneously be mothers and pursue professional careers is crucial to maintain gender diversity in sports medicine physicians. The purpose of this study is to understand the attitudes toward female sports medicine physicians during pregnancy and postpartum. METHODS: An anonymous online survey was distributed to sports medicine physicians practicing in 51 different countries. They were asked how comfortable they felt with female sports medicine physicians working on the sidelines of sporting events during pregnancy, if the female sports medicine physicians were as productive as their male counterparts after giving birth, and how satisfied they were with the percentage of female sports medicine physicians in their country. Data were analyzed using the chi-square test, and multivariate logistic regression analysis was performed to identify independent variables. RESULTS: In total, 1193 physicians (380 [31.9%] female) were included for analysis. Physicians in Asia were the least comfortable with pregnant sports medicine physicians working on the sidelines and those in North America were the most comfortable (odds ratio = 0.28 and 2.51, 95% confidence interval 0.18-0.44 and 1.55-4.06, respectively). More experienced sports medicine physicians (odds ratio = 1.01, 95% confidence interval 1.00-1.03; p < 0.05) and divorced physicians (odds ratio = 0.33, 95% confidence interval 0.12-0.91; p < 0.05) were less comfortable with pregnant female sports medicine physicians working on sidelines, and those trained in orthopedics were less likely to agree that female sports medicine physicians were equally as productive as male counterparts postpartum (odds ratio = 0.29, 95% confidence interval 0.10-0.88; p < 0.05). Female physicians were less satisfied with the percentage of female sports medicine physicians in their country (odds ratio = 0.41, 95% confidence interval 0.27-0.60; p < 0.01) than their male counterparts. CONCLUSIONS: Female sports medicine physicians may experience bias in their practice during pregnancy and postpartum.

Current Clinical Concepts: Management of Common Lumbar Spine Posterior Column Disorders in Young, Active Individuals.

Although posterior column disorders, such as spondylolysis and spondylolisthesis, are not commonly encountered in the general population, athletic trainers frequently see these conditions in athletic and active individuals due to the repetitive spinal extension and rotational loads placed on the pars interarticularis while participating in sport. Athletic trainers can successfully evaluate patients with posterior column disorders by performing a complete and comprehensive clinical examination to identify the location of pain, test spinal stability, and recognize compensatory movement patterns. Conservative management typically leads to a successful outcome in this population, with rest, bracing, and the use of therapeutic exercise having the best supporting evidence. In this Current Clinical Concepts review, we outlined the etiology and risk factors frequently associated with disorders of the posterior column. Additionally, we synthesized the literature for common evaluation techniques and interventions associated with the posterior column and provided a proposed rehabilitation progression to use in a younger, athletic population.

Racial and Ethnic Diversity of Athletic Trainers of the National Collegiate Athletic Association: A Retrospective Study.

CONTEXT: Athletic trainers (ATs) are the most visible members of the sports medicine team and are responsible for the health and well-being of student-athletes (SAs). OBJECTIVE: Quantifying the representation from Black, Indigenous, and People of Color (BIPOC) ATs in National Collegiate Athletic Association (NCAA) member institutions has not been previously studied. DESIGN: Retrospective study Setting: National Collegiate Athletic Association's (NCAA) Demographic Database Participants: NCAA teams' athletic personnel at NCAA member institutions. MAIN MEASURES: Chi-square tests were employed to assess differences in racial and ethnic frequencies across division, calendar year and gender. Linear regressions models were used to examine change in racial and ethnic distributions of head and assistant ATs over time. RESULTS: The majority of NCAA athletic trainers were categorized as white (88%), which was reflected in both head (90.8%) and assistant (87.2%) AT positions. Black ATs made up the largest proportion of a specific racial/ethnicity group within BIPOC ATs (3.4% of head ATs, 4.6% of assistant ATs), with the next most prevalent being Hispanic (2.8% of head ATs, 3.9% of assistant ATs). Historically Black College and Universities (HBCUs) showed higher proportions of BIPOC ATs in both head and assistant categories compared to non-HBCU institutions. Division I schools had the greatest AT racial/ethnicity diversity in comparison to Division II and Division III (p<0.0001). In our linear regression models, we found statistically significant increases in many of the racial/ethnic categories for both head and assistant ATs. CONCLUSIONS: Our study demonstrates that BIPOC ATs represent a small proportion of the ATs currently working at NCAA member institutions. Although there has been an increase in BIPOC athletic trainers over the past ten years, a large racial and ethnic discordance gap still exists between student athletes and the ATs caring for them. Future studies may identify barriers encountered by BIPOC ATs and the effectiveness of current diversity initiatives.

Prevalence of Clinical and Subclinical Myocarditis in Competitive Athletes With Recent SARS-CoV-2 Infection: Results From the Big Ten COVID-19 Cardiac Registry.

Importance: Myocarditis is a leading cause of sudden death in competitive athletes. Myocardial inflammation is known to occur with SARS-CoV-2. Different screening approaches for detection of myocarditis have been reported. The Big Ten Conference requires comprehensive cardiac testing including cardiac magnetic resonance (CMR) imaging for all athletes with COVID-19, allowing comparison of screening approaches. Objective: To determine the prevalence of myocarditis in athletes with COVID-19 and compare screening strategies for safe return to play. Design, Setting, and Participants: Big Ten COVID-19 Cardiac Registry principal investigators were surveyed for aggregate observational data from March 1, 2020, through December 15, 2020, on athletes with COVID-19. For athletes with myocarditis, presence of cardiac symptoms and details of cardiac testing were recorded. Myocarditis was categorized as clinical or subclinical based on the presence of cardiac symptoms and CMR findings. Subclinical myocarditis classified as probable or possible myocarditis based on other testing abnormalities. Myocarditis prevalence across universities was determined. The utility of different screening strategies was evaluated. Exposures: SARS-CoV-2 by polymerase chain reaction testing. Main Outcome and Measure: Myocarditis via cardiovascular diagnostic testing. Results: Representing 13 universities, cardiovascular testing was performed in 1597 athletes (964 men [60.4%]). Thirty-seven (including 27 men) were diagnosed with COVID-19 myocarditis (overall 2.3%; range per program, 0%-7.6%); 9 had clinical myocarditis and 28 had subclinical myocarditis. If cardiac testing was based on cardiac symptoms alone, only 5 athletes would have been detected (detected prevalence, 0.31%). Cardiac magnetic resonance imaging for all athletes yielded a 7.4-fold increase in detection of myocarditis (clinical and subclinical). Follow-up CMR imaging performed in 27 (73.0%) demonstrated resolution of T2 elevation in all (100%) and late gadolinium enhancement in 11 (40.7%). Conclusions and Relevance: In this cohort study of 1597 US competitive athletes with CMR screening after COVID-19 infection, 37 athletes (2.3%) were diagnosed with clinical and subclinical myocarditis. Variability was observed in prevalence across universities, and testing protocols were closely tied to the detection of myocarditis. Variable ascertainment and unknown implications of CMR findings underscore the need for standardized timing and interpretation of cardiac testing. These unique CMR imaging data provide a more complete understanding of the prevalence of clinical and subclinical myocarditis in college athletes after COVID-19 infection. The role of CMR in routine screening for athletes safe return to play should be explored further.

Assessment of sleep health in collegiate athletes using the Athlete Sleep Screening Questionnaire.

STUDY OBJECTIVES: The objective of this study was to characterize sleep health in a large, diverse population of college athletes. The study utilized the Athletic Sleep Screening Questionnaire, a clinically validated questionnaire, designed to screen athletes for a clinically significant degree of poor sleep health, and to determine if they require intervention. METHODS: College athletes from 4 different National College Athletic Association institutions were surveyed using the Athletic Sleep Screening Questionnaire. Descriptive information including sex, sport, and college year was also collected. The Athletic Sleep Screening Questionnaire was scored according to prior clinically validated methods to determine a sleep difficulty score, clinical sleep problem category (none, mild, moderate, or severe), and need for assessment by a physician due to poor sleep health. RESULTS: A total of 1055 surveys were collected with a 95% response rate. Respondents were 36% female, 64% male, and included athletes competing in 15 different sports. Approximately 25% of participants were found to have a clinically meaningful problem with their sleep. Athletes entering their second or higher year of college were more likely to report worse sleep compared to those entering their first year (one-way analysis of variance, Kruskall-Wallis P < .001). CONCLUSIONS: A substantial portion of college athletes experience poor sleep health and would benefit from interventions aimed at improving sleep. The Athletic Sleep Screening Questionnaire appears to be a cost- and time-efficient way to evaluate sleep health in a large athletic population.

Osteoid Osteoma Masquerading as Cholelithiasis: A Case Report.

CASE: We present a case report of an 18-year-old woman who presented to a general surgeon with a several month history of intermittent right upper quadrant pain, strongly suggestive of symptomatic cholelithiasis and underwent a laparoscopic cholecystectomy. She was eventually found to have an osteoid osteoma (OO) of the right eighth rib. She was treated with radiofrequency ablation with complete resolution of symptoms 1 month after treatment. CONCLUSIONS: In cases where a patient's age and risk factors would make the diagnosis of cholelithiasis less likely, OO should be added to the differential diagnosis of symptomatic right upper quadrant pain.

Atypical presentation of popliteal artery entrapment syndrome: involvement of the anterior tibial artery.

Popliteal artery entrapment syndrome (PAES) is a rare condition that should be suspected in a young patient with exertional lower extremity pain. We report the case of an 18-year-old female volleyball player with bilateral exertional lower extremity pain who had been previously diagnosed with tendinitis and periostitis. Diagnostic studies showed entrapment of the left popliteal artery and the left anterior tibial artery. To our knowledge, there has only been 1 previous report of anterior tibial artery involvement in PAES.

Microvascular perfusion and intramuscular temperature of the calf during cooling.

PURPOSE: The study's purpose was to examine how the microvascularity of the gastrocnemius changed after a cryotherapy intervention based on subcutaneous tissue thickness. A secondary purpose was to compare intramuscular temperature change to subcutaneous tissue thickness. METHODS: This was a single-blinded crossover study; each subject received both conditions (cryotherapy or sham). Subjects had baseline measurements of blood flow, blood volume, and intramuscular temperature recorded at 1 cm into the muscle belly of the medial gastrocnemius. The randomized condition was applied for 10, 25, 40, or 60 min, depending on subcutaneous tissue thickness. Immediate posttreatment microvascular measures were taken. After a designated rewarming period, again based on subcutaneous tissue thickness, measurements were retaken. At least 48 h separated the two conditions. RESULTS: There were significant condition × time interactions for blood flow (P = 0.01), blood volume (P = 0.022), and intramuscular temperature (P < 0.001). For blood flow and volume, the cryotherapy condition maintained baseline levels, whereas the sham condition increased immediately after treatment and rewarming. For intramuscular temperature, the cryotherapy condition caused a decrease in intramuscular temperature from baseline compared with no change in the sham condition from baseline. Intramuscular temperature change was significantly correlated to subcutaneous tissue thickness (r = 0.49, P = 0.05). CONCLUSIONS: Cryotherapy did not decrease blood flow and blood volume from resting levels, although the intramuscular temperature decreased. An intramuscular change of 7°C-9°C may not be cold enough to cause local vasoconstriction.