Perceived social support and characteristics of social networks of families with children with special healthcare needs following the COVID-19 pandemic.

Background: Children with special healthcare needs (CSHCN) require more support than the average of their peers. Support systems for CSHCN were particularly affected by pandemic control measures. Perceived social support is a resource for health and wellbeing for CSHCN and their families. Associations of social support, mental health and socioeconomic status (SES) have been described. This study aims to (1) assess perceived social support in families with and without CSHCN; (2) describe structure and types of social networks of families with and without CSHCN; and (3) explore associations between perceived social support, disease complexity, child and caregiver mental health, and SES. Methods: This is the third of a sequential series of cross-sectional online surveys conducted among caregivers of children ≤ 18 years in Germany since the beginning of the COVID-19 pandemic, administered between 1st December 2022 and 10 March 2023. The Brief Social Support Scale (BS6) assessed perceived social support. Child and parental mental health were assessed using the Strengths and Difficulties Questionnaire (SDQ) and WHO-5 Wellbeing index. The CSHCN-Screener identified CSHCN. Descriptive statistics and linear regression modeling assessed associations between perceived social support, parent-reported child mental health problems, disease complexity, caregiver mental wellbeing and SES. Results: The final sample included 381 participants, among them 76.6% (n = 292) CSHCN. 46.2% (n = 176) of caregivers reported moderate, i.e., at least occasional social support. Social support was largely provided by informal social networks consisting of partners, relatives and neighbors/friends. Linear regression modeling revealed associations of lower perceived social support with higher disease complexity of the child, lower caregiver mental wellbeing, lower SES and increasing caregiver age. Conclusion: The results of this study describe inequalities in perceived social support according to disease complexity of the child, caregiver mental health and socioeconomic status. They highlight the importance of social support and support networks as a resource for wellbeing of caregivers and CSHCN. Moving on from the COVID-19 pandemic, recovery strategies should focus on low-threshold interventions based in the community to improve social support for families with CSHCN and actively involve caregivers in identifying needs and co-creating new approaches.

COVID-19 and spinal cord injury: clinical presentation, clinical course, and clinical outcomes of people hospitalised.

STUDY DESIGN: Retrospective study OBJECTIVES: To describe the presenting symptoms/signs, clinical course and outcomes in hospitalised people with spinal cord injury (SCI) and symptomatic COVID-19 infections. SETTING: One university hospital and two SCI centres in Switzerland. METHODS: Descriptive analysis of symptoms/signs, clinical course and outcomes of people with SCI with symptomatic COVID-19 infections and need for hospitalisation. RESULTS: Twenty-two people with SCI were included, 15 (68%) were male, median age 64.5 years (interquartile range, IQR, 52-73 years). Nine (41%) had tetraplegia, and eight (36%) were classified with motor-complete lesions. Frequent clinical symptoms were fever (59%), coughing (54%), fatigue (50%), and dyspnoea (27%). Most frequent complications were bacterial pulmonary superinfection (18%), and acute respiratory distress syndrome (18%). Fifteen persons (68%) needed oxygen therapy during the course of hospitalisation, and 7 (32%) people were ventilated. Median length of stay (LOS) was 23 days (IQR 15-35), varying by age for people under 60 years with a median LOS of 9 days (IQR 8-27), and for those older than 60 years with a median of 34 days (IQR 17-39), respectively. In total, 3 persons (14%) died during hospitalisation, all older with paraplegia. CONCLUSIONS: Typical symptoms like fever and coughing were not present in all people. People with tetraplegia did not demonstrate worse outcomes, on the contrary, they had shorter LOS, no difference in ventilation needs, and no higher mortality compared to people with paraplegia. Older people showed longer LOS. This study recommends close supervision of the SCI population to detect early signs and symptoms of COVID-19 infection.

Biocontrol potential of entomopathogenic nematodes against the grey maize weevil Tanymecus dilaticollis (Coleoptera: Curculionidae) adults.

The grey maize weevil, Tanymecus dilaticollis, is a polyphagous species, which is among the most important pests of maize in Southeastern Europe. The efficacy of commercial products with two species of entomopathogenic nematodes (EPNs), Steinernema carpocapsae and Heterorhabditis bacteriophora, was investigated against adults of the grey maize weevil under laboratory conditions. Nemastar®, containing S. carpocapsae was more effective on T. dilaticollis adults than Nematop® containing H. bacteriophora, when applied uniformly to the surface of the soil, on Petri dishes containing T. dilaticollis adults. Results showed that S. carpocapsae rates of 83-333 infective juveniles/adult caused > 94% mortality in T. dilaticollis adults, whereas H. bacteriophora caused 27-61%, adult mortality, after exposure of insects to the commercial products of EPNs for 15 days. The infection rates of EPNs increased with concentration applied and ranged from 70-83% and 19-64% for Nemastar® and Nematop®, respectively. Subsequent field and semi-field tests were conducted with Nemastar® (application rate of 50 million S. carpocapsae per 100 m2) in maize crops with biological (mycoinsecticide Naturalis®, biofungicides and fertilizers) and chemical seed treatment (Gaucho® FS 600; active ingredient: imidacloprid) in Knezha, Bulgaria. Nematodes were found only in the dead specimens, in open plots and cages sprayed with the commercial nematode product. Nematode sprayings contributed for higher maize yields in the open maize plots in the fields with different seed treatments. We suggest that the use of powder formulation of S. carpocapsae in combination with biologically treated maize seeds can contribute to minimize the use of chemical insecticides against the grey maize weevil. The results obtained can be used as a base to further tests to ascertain the efficacy of EPNs products before they can be recommended for use in the integrated approach to T. dilaticollis management.

Quantifying the Extent to Which Junior Performance Predicts Senior Performance in Olympic Sports: A Systematic Review and Meta-analysis.

BACKGROUND: To what extent does junior athletic performance predict senior athletic performance (i.e., in the highest, open-age category)? This question is the subject of a lively debate in the literature. Following traditional theories of giftedness and expertise, some researchers and practitioners have proposed that a high level of junior performance is a prerequisite for the development of a high level of later senior performance. Sceptics of this view hold that junior performance has limited predictive value for later senior performance, pointing to empirical evidence indicating that predictors (e.g., participation patterns) of junior performance and of senior performance differ. The straightforward way to resolve this controversy empirically is to test the correlation between junior and senior performance. OBJECTIVE: To provide robust and generalizable evidence on this issue, we performed a systematic review and meta-analysis of relevant studies. The aim was to quantify the overall correlation between junior and senior performance and then test whether correlations vary across junior age categories and subsamples (e.g., types of sports). METHODS: A systematic literature search was conducted in SPORTDiscus, Eric, ProQuest, PsychInfo, PubMed, Scopus, WorldCat, and Google Scholar from 27 January through 30 April 2022. We searched for original studies that recorded athletes' junior and senior performance longitudinally and included measures of association between junior and senior performance. Quality of evidence was evaluated using the Mixed Methods Appraisal Tool version for nonrandomized studies. RESULTS: The search yielded k = 129 effect sizes from N = 13,392 athletes from a wide range of Olympic sports, 62% male and 38% female, from 2006 to 2021. Four central findings emerged: (1) Overall, the meta-analytic pooled correlation between junior and senior performance was [Formula: see text] = 0.148. That is, junior performance explained only 2.2% of the reliable variance in senior performance. (2) The finding was robust across types of sports, sexes, wider or narrower performance ranges, national or international samples, and binary or continuous performance measures. (3) Effects varied across junior age categories: the younger the junior age category, the lower the correlation between junior and senior performance, with [Formula: see text] ranging from [Formula: see text] = - 0.052 to [Formula: see text] = 0.215. That is, across junior age categories, junior performance explained 0-4.6% of the reliable variance in senior performance. (4) The quality of primary studies was high. DISCUSSION: The results suggest that junior performance has very little, if any, predictive value for senior performance. The findings run counter to claims from traditional theories of both giftedness and expertise. From an applied perspective, talent selection typically begins around puberty or younger-age ranges where youth performance is uncorrelated or negatively correlated with later senior performance. The evidence presented here raises serious questions about the use of junior performance for talent selection purposes. A PRISMA-P protocol was registered at https://osf.io/gck4a/ .

Effects of Early Talent Promotion on Junior and Senior Performance: A Systematic Review and Meta-Analysis.

BACKGROUND: Does younger involvement in talent promotion programs (TPPs) facilitate the attainment of higher performance levels? This question is the subject of the present meta-analysis. Many national sport systems have established TPPs such as federations' junior squads (including under-age selection teams) and youth sport academies, and many are making expanding investments in TPPs. TPPs seek to select the most advanced youth high performers at young ages, around puberty or younger, and then strive to further accelerate their performance development. However, studies show 25-55% annual athlete turnover within TPPs. In this context, accelerated biological maturation (puberty, growth spurt), high relative age within one's birth year, and intensified sport-specific childhood/adolescent practice may boost rapid junior performance, but the effects diminish or are reversed by adulthood. Moreover, expanded opportunity costs and risks (time demands, injury, burnout) imposed on young TPP participants may impair their long-term development and even prematurely terminate their career. OBJECTIVE: We aimed to provide robust and generalizable evidence on the effects of early talent promotion on junior and senior performance through a systematic review and meta-analysis. METHODS: A systematic literature search was conducted 18/03-03/04/2023 in SPORTDiscus, ProQuest, PsycINFO, PubMed, Scopus, WorldCat, and Google Scholar. We searched for original studies that compared athletes across defined higher and lower performance levels within defined types of sports, age categories, and sexes, regarding their age at commencement of TPP involvement and reported effect sizes or data needed to compute effects sizes. Mean meta-analytic Cohen's d ¯ was computed separately for junior and senior athletes. Quality of evidence was evaluated using the mixed-methods appraisal tool. RESULTS: The search yielded k = 51 effect sizes from N = 6233 athletes from a wide range of countries and sports, 82% male and 18% female, from 2009 to 2022. The central finding is that effects on short-term junior performance versus long-term senior performance are opposite, whereby higher-performing junior athletes began TPP involvement at younger ages than lower-performing junior athletes, d ¯ = - 0.53. In contrast, higher-performing senior athletes began TPP involvement at older ages than lower-performing senior athletes, d ¯ = 0.56. The findings are robust across different TPPs (federation's junior squad/selection team, youth academy), individual and team sports, and performance levels compared (international, national, regional). The quality of primary studies was high. DISCUSSION: The findings are consistent with recent meta-analytic evidence that participation patterns predicting early junior success versus long-term senior success are opposite (starting age, main-sport and other-sports practice amounts, age to reach performance 'milestones'). We discuss theoretical and practical implications of potential selection and 'treatment' effects of TPPs. CONCLUSIONS: Consistent across different populations, early TPP involvement is positively correlated with short-term junior performance but is negatively correlated with long-term senior performance.

Birth of monozygotic dichorionic twins after a single blastocyst embryo transfer: a case report of genetic determination of zygosity.

Objective: To report a case of monozygotic dichorionic (DC) twins after a single cryopreserved blastocyst embryo transfer followed by genetic determination of zygosity postpartum. Design: Case report. Setting: University hospital. Patients: A 26-year-old woman with polycystic ovary syndrome and her 36-year-old male partner with severe oligozoospermia, resulting in a 1.5-year history of primary infertility. Interventions: Controlled ovarian stimulation and intracytoplasmic sperm injection treatment with single cryopreserved embryo transfer at blastocyst stage. Main Outcome Measures: Ultrasound images of the fetuses and short tandem repeat genotyping postpartum. Results: A DC twin pregnancy following a single cryopreserved blastocyst embryo transfer was confirmed at the first trimester screening. Confirmatory testing performed postpartum included short tandem repeat analysis determining monozygosity and pathology examination reporting DC placental configuration. Conclusions: Dichorionic monozygotic twins are thought to arise from the splitting of an embryo before the blastocyst stage. This case suggests that placental configuration of monozygotic twins may not strictly depend on timing of embryo division. Genetic analysis is the only tool to confirm the zygosity.

Participation patterns in talent development in youth sports.

There has been a longstanding debate about the question: What amounts of what types of youth sport activities optimally facilitate later athletic excellence? This article provides a review of relevant research. We first evaluate popular conceptualizations of participation patterns-early specialization, deliberate practice, and deliberate play. Then, we review the available evidence on associations between performance and individual participation variables. The review reveals conceptual, definitional, and empirical flaws of the conceptions of early specialization, deliberate practice, and deliberate play. These approaches thus possess limited usefulness for empirical research. A review of studies considering individual, clearly defined participation variables provides a differentiated pattern of findings: Predictors of rapid junior performance and of long-term senior performance are opposite. Higher-performing juniors, compared to lower-performing peers, started playing their main sport, began involvement in talent promotion programs, and reached developmental performance milestones at younger ages, while accumulating larger amounts of coach-led main-sport practice, but less other-sports practice. In contrast, senior world-class athletes, compared to less-accomplished national-class peers, started playing their main sport, began involvement in talent promotion programs, and achieved performance milestones at older ages, while accumulating less coach-led main-sport practice, but more other-sports practice. We discuss implications for theory, practice, and future research.

Quantifying the Extent to Which Successful Juniors and Successful Seniors are Two Disparate Populations: A Systematic Review and Synthesis of Findings.

BACKGROUND: To what extent does the pathway to senior elite success build on junior elite success? Evidence from longitudinal studies investigating athletes' junior-to-senior performance development is mixed; prospective studies have reported percentages of juniors who achieved an equivalent competition level at senior age (e.g., international championships at both times) ranging from 0 to 68%. Likewise, retrospective studies have reported percentages of senior athletes who had achieved an equivalent competition level at junior age ranging from 2 to 100%. However, samples have been heterogeneous in terms of junior age categories, competition levels, sex, sports, and sample sizes. OBJECTIVE: This study aimed to establish more robust and generalizable findings via a systematic review and synthesis of findings. We considered three competition levels-competing at a national championship level, competing at an international championship level, and winning international medals-and addressed three questions: (1) How many junior athletes reach an equivalent competition level when they are senior athletes? (2) How many senior athletes reached an equivalent competition level when they were junior athletes? The answers to these questions provide an answer to Question (3): To what extent are successful juniors and successful seniors one identical population or two disparate populations? METHODS: We conducted a systematic literature search in SPORTDiscus, ERIC, ProQuest, PsychInfo, PubMed, Scopus, WorldCat, and Google Scholar until 15 March 2022. Percentages of juniors who achieved an equivalent competition level at senior age (prospective studies) and of senior athletes who had achieved an equivalent competition level at junior age (retrospective studies) were aggregated across studies to establish these percentages for all athletes, separately for prospective and retrospective studies, junior age categories, and competition levels. Quality of evidence was evaluated using the Mixed Methods Appraisal Tool (MMAT) version for descriptive quantitative studies. RESULTS: Prospective studies included 110 samples with 38,383 junior athletes. Retrospective studies included 79 samples with 22,961 senior athletes. The following findings emerged: (1) Few elite juniors later achieved an equivalent competition level at senior age, and few elite seniors had previously achieved an equivalent competition level at junior age. For example, 89.2% of international-level U17/18 juniors failed to reach international level as seniors and 82.0% of international-level seniors had not reached international level as U17/18 juniors. (2) Successful juniors and successful seniors are largely two disparate populations. For example, international-level U17/18 juniors and international-level seniors were 7.2% identical and 92.8% disparate. (3) Percentages of athletes achieving equivalent junior and senior competition levels were the smallest among the highest competition levels and the youngest junior age categories. (4) The quality of evidence was generally high. DISCUSSION: The findings question the tenets of traditional theories of giftedness and expertise as well as current practices of talent selection and talent promotion. A PRISMA-P protocol was registered at https://osf.io/gck4a/ .

Laboratory Findings, Medical Imaging, and Clinical Outcome in Children with Cerebral Sinus Venous Thrombosis.

INTRODUCTION: Cerebral sinus venous thrombosis (CSVT) is a rare disease, especially in children. Therefore, thrombophilia markers, risk factors, treatment strategy, and MRI, as well as clinical outcome need further investigation to support future diagnostic and therapeutic guidelines for children. METHODS: We retrospectively identified all children with CSVT treated in our center between January 1, 2000, and December 31, 2015. Risk factors and laboratory findings were investigated. Furthermore, outcome and treatment satisfaction were evaluated using magnetic resonance imaging (MRI) analyses and a modified questionnaire. RESULTS: All 43 patients, who agreed to participate, were treated with therapeutic levels of heparin; 86% of children had an increased risk for thromboembolic events upon onset of CSVT (acute disease: 58.1%, perinatal risk factors: 9.3%, medical intervention/immobility: 14%, chronic disease: 16.3%). Thrombophilia markers showed positive results (e.g., reduced values for protein C/S, factor-V-Leiden mutation) in 58% of children at the time of CSVT diagnosis but dropping to 20.9% over the course of the disease. Forty-two of 43 patients received MRI follow-ups and the outcome showed complete recanalization in 69% of the patients and partial recanalization in 31%. At the onset of CSVT, 88% of patients reported restrictions in everyday life due to CSVT; at follow-up this percentage declined to 18%. Satisfaction with the outcome among parents/patients according to the questionnaire was high with 1.7 (German school grades from 1 to 6). CONCLUSIONS: All 42 children with MRI follow-up demonstrated complete or partial recanalization under anticoagulation. This positive result underlines the need for future studies on anticoagulation to optimize therapy regimens of pediatric CSVT.

Mental health of children with and without special healthcare needs and of their caregivers during COVID-19: a cross-sectional study.

OBJECTIVE: To describe mental health outcomes and measures of pandemic burden of children with and without special healthcare needs, and their caregivers following the second wave of the COVID-19 pandemic in Germany. DESIGN: This is the second of a sequential series of cross-sectional online surveys conducted among caregivers of children ≤18 years since the onset of the COVID-19 pandemic, administrated between 2 April 2021 and 31 July 2021. MAIN OUTCOME MEASURES: Child and parental mental health were assessed using the Strengths and Difficulties Questionnaire and WHO-5 Well-being index. Children with Special Healthcare Needs (CSHCN) were identified using the CSHCN-Screener. Descriptive statistics, linear and hierarchical logistic regression modelling assessed associations between parent-reported child mental health problems and measures of pandemic burden, disease complexity, caregiver mental well-being and socioeconomic status. RESULTS: 521 participants were included in the final sample. There was a high prevalence of parent-reported mental health problems in n=302 (66.7%) children, particularly in CSHCN. Among caregivers, n=372 (72.5%) screened positive for depression. Logistic regression modelling showed a strong association of child mental health problems and disease complexity, parental mental well-being, increase in family conflict and inadequate social support. CONCLUSIONS: Our study identifies CSHCN as a particularly vulnerable group in terms of mental health outcomes. Psychosocial factors were important predictors of parent-reported child mental health problems. Policy measures should consider the importance of social support systems for vulnerable children and their families, and aim to provide accessible mental health support for caregivers.

Patientenpartizipation in der pädiatrischen Versorgungsforschung am Universitätsklinikum Freiburg: von der Projektbeteiligung zum Patientenbeirat.

Participation of patients and relatives in research means that those affected are involved in the research process in a partnership role. Despite the growing importance of participatory approaches and the large number of available concepts, many researchers and patients are faced with the question of how participatory research can be realized and organized in concrete terms. Here we report on our experiences with two different forms of patient participation in research in the context of pediatric health care research at a university hospital: (1) In a project for the development and evaluation of a case management for patients with spinal muscular atrophy, patient representatives have an consultative role. (2) In the patient advisory board, which is to accompany the research activities of the research group at the site continuously and systematically, i.e. in all phases, the participation currently corresponds to a contributory role (involvement) which, in the future, could be moved onto the collaborative stage. In both forms of participation, the essential questions include the selection of the participating patients, the type and extent of participation, and the evaluation of the effect of participation on the research that is carried out. In our experience, both forms of participation add value to research from the perspective of all participants. At the same time, they bring different opportunities and challenges. While in project-based participation the sphere of influence is already delineated by researchers, the context of the patient advisory board provides more room and openness to develop, for example, a research agenda and thus identify new research topics. In our experience, however, sufficient resources (in terms of time and money) are required from all participants, as well as good, trusting cooperation with jointly developed processes to realize both forms of participation.

Evaluation of a cross-sectoral care intervention for families with psychosocial burden: a study protocol of a controlled trial.

BACKGROUND: Family risk factors, e.g. low socioeconomic status or parental mental health disorders, can affect children's health and development. Thus, targeted preventive services for families with psychosocial burden are crucial. The German Early Childhood Intervention (ECI) program is a preventive approach that aims to strengthen parent's resources by supportive services. However, research has revealed that only a proportion of the families considered to have substantial risk factors access the ECI program. To increase pediatricians' skills in identifying risk factors, and to improve the cross-sectoral collaboration between relevant professionals and the referral of families to supportive services, the PATH-intervention (Pediatric Attention To Help) was developed. The PATH-intervention includes interprofessional quality circles and a one-day training program for the pediatricians. This study aims to evaluate this complex cross-sectoral care intervention for families with psychosocial burden. METHODS: Using a prospective quasi-experimental, controlled (matched-pair), longitudinal mixed-method design, we will compare families under treatment of pediatricians trained in the PATH-intervention with families under treatment of a control group of pediatricians. Participating families are asked to complete online-surveys. As a primary outcome, we will examine the use of supportive services of the ECI by burdened families. Secondary outcomes are the proportion of correctly identified families with psychosocial burden by the pediatricians, as well as information provision and motivation of the families to use the supportive services. Additionally, the cost-effectiveness ratio will be investigated. In the process evaluation, we will qualitatively explore the acceptance of the PATH-intervention of all involved stakeholders and the treatment fidelity of the trained pediatricians. DISCUSSION: This study will determine whether the PATH-intervention enables the pediatricians to identify and recommend supportive services to burdened families, as well as the families' use of the supportive services of the ECI. Qualitative data will give insight into the acceptance of the intervention from the perspective of all stakeholders and the treatment fidelity. Results of this study could be the starting point for the broader implementation of the PATH-intervention as standard care. TRIAL REGISTRATION: German Clinical Trials Register (DRKS): DRKS00023461 (3rd December 2020); WHO UTN: U1111- 260-6575.

Impact of the COVID-19 Pandemic on Mental Health Outcomes of Healthy Children, Children With Special Health Care Needs and Their Caregivers-Results of a Cross-Sectional Study.

BACKGROUND: Several studies have described widening inequalities as a result of the COVID-19 pandemic, mostly for adult populations. Children and adolescents are particularly impacted by the indirect effects of the pandemic and lockdown measures, such as reduced access to or delays in health care and school closures. National surveys in several countries also show a rising mental health burden in children and adolescents during the COVID-19 pandemic. Children with special health care needs are a particularly vulnerable group in this context as they rely on a wide range of services, which were mostly suspended during the first wave of the pandemic. This study aims: (1) to describe the mental health outcomes of children with and without special healthcare needs and of their caregivers following the first national lockdown in Germany; (2) to investigate variations in mental health outcomes and measures of pandemic burden according to socioeconomic status; (3) to assess the impact of socioeconomic status, disease complexity and psychosocial burden on parent-reported child mental health problems. METHODS: We conducted an online survey among 1,619 caregivers of children aged 1-18 years from August 11th until October 5th 2020. Participants were recruited both from families of children with special healthcare needs and of healthy children. Inequalities were analysed by descriptive statistics, simple and hierarchical logistic regression modelling to explore the association between socioeconomic status and psychological outcome measures, disease complexity and general burden related to COVID-19. RESULTS: There was a high prevalence of 57.4% of parent-reported mental health problems in children and of a positive screening score for depression in 30.9% of parents. Parent-reported mental health problems were more likely to affect children with low socioeconomic status, with complex chronic disease and those whose parents screened positive for depression. CONCLUSIONS: This study highlights inequalities in parent-reported child mental health outcomes by socioeconomic status and disease complexity in a large sample of German families with and without children with special health care needs. Political measures should put children at the centre and aim to mitigate the unequal impact of the COVID-19 pandemic, particularly on the mental health of vulnerable children.

In-Competition Severe Injury Events in Elite Alpine Ski Racing from 1997 to 2020: The Case of the Austrian Ski Team.

BACKGROUND: To increase safety in elite alpine ski racing Injury Surveillance Systems were implemented and preventive measures introduced. However, studies analysing the change in athletes' injury risk by controlling for their exposure are still scarce. OBJECTIVES: This study aimed to describe and analyse the risk of in-competition severe injury events (SIEcomp) in elite alpine ski racing. METHODS: Data recorded in the Austrian Ski Federation's Injury Surveillance System were used to analyse the SIEcomp incidence. Information on athletes' competition exposure was obtained from the official website of the International Ski Federation. In 23 seasons, 2333 skier seasons were recorded for the Austrian Ski Team. Within a total of 114,531 runs 169 SIEcomp occurred. Generalised Estimating Equation for Poisson Regressions were applied. RESULTS: The SIEcomp incidence per 1000 runs was 1.48 [95% confidence interval (CI) 1.26-1.73] for elite alpine ski racers and 2.21 (95% CI 1.79-2.75) for the subgroup of World Cup racers. A significant sex difference was detected for the subgroup of junior racers with a higher risk for female athletes [risk ratio (RR): 2.97, 95% CI 1.46-6.05]. Between the seasons of 1997 and 2020, the seasonal SIEcomp incidence increased by a factor of 2.67 for elite alpine ski racers and 3.53 for World Cup racers. Downhill (2.75, 95% CI 2.18-3.47) had the highest SIEcomp incidence, followed by super-G (1.94, 95% CI 1.30-2.88), giant slalom (1.40, 95% CI 1.06-1.85), and slalom (0.64, 95% CI 0.43-0.96). CONCLUSION: Although many preventive measures have been implemented in elite alpine ski racing, the risk of SIEcomp has increased over the last two decades.

Predictors of Junior Versus Senior Elite Performance are Opposite: A Systematic Review and Meta-Analysis of Participation Patterns.

BACKGROUND: Does early specialization facilitate later athletic excellence, or is early diversification better? This is a longstanding theoretical controversy in sports science and medicine. Evidence from studies investigating athletes' starting age, childhood/adolescent progress, and amounts of coach-led practice and peer-led play in their main sport and in other sports has been mixed. Each participation variable was positively correlated with performance in some studies but uncorrelated or negatively correlated with performance in others. However, samples were heterogeneous in age, sports, and performance levels. OBJECTIVE: This study aimed to establish robust, generalizable findings through a systematic review and meta-analysis. We investigated three questions: (1) did higher- and lower-performing athletes differ in childhood/adolescent progress, starting age, or amounts of main-sport or other-sports practice or play; (2) do effects differ between junior and adult athletes, compared performance levels, or types of sports; and (3) are effect sizes from different predictors associated with one another? METHODS: We conducted a systematic literature search in SPORTDiscus, ERIC, ProQuest, PsycINFO, PubMed, Scopus, WorldCat, and Google Scholar until 28 February 2021. Selection criteria included original research studies comparing higher- versus lower-performing athletes regarding one or more of our predictor variables within defined age categories, sports, and sex, and reporting effect sizes or data needed to compute effects sizes. Mean meta-analytic Cohen's d was calculated for each predictor. Quality of evidence was evaluated using GRADE. RESULTS: In total, 71 study reports met all eligibility criteria and included 262 international athlete samples, 685 effect sizes, and a total sample size of 9241 athletes from local to Olympic competition level and from diverse sports. The following findings emerged. (1) Compared with their national-class counterparts, adult world-class athletes had more childhood/adolescent multi-sport coach-led practice, a later main-sport start, less main-sport practice, and slower initial progress (|0.23|< [Formula: see text]<|0.50|; all p < 0.001). (2) The opposite was true for predictors of junior-age performance: higher-performing juniors had an earlier main-sport start, more main-sport practice, less other-sports practice, and faster initial progress (|0.23|< [Formula: see text]< |0.61|; all p < 0.001). (3) Main-sport or other-sports peer-led play had negligible effects (all p > 0.05). (4) Results were robust across types of sports. (5) Effect sizes from different predictors were associated with one another (|0.64|< r <|0.79|). A GRADE assessment revealed a low quality of evidence for peer-led play but a moderate to high quality of evidence for all other predictors. DISCUSSION: Excess childhood/adolescent specialized practice may hinder athletes' long-term development through overuse injury, burnout, suboptimal athlete-sport match, and limiting long-term learning capital. By contrast, adult world-class athletes' childhood/adolescent multi-sport practice with reduced main-sport practice implied a relatively resource-preserving, cost-reducing, and risk-buffering pattern that yielded greater long-term sustainability and practice efficiency.

Non-linear association of efficiency of practice of adult elite athletes with their youth multi-sport practice.

We explored associations of elite athletes' multi-year efficiency of practice and improvement of performance with their current and earlier participation patterns. Participants were 80 adult German track-and-field national-squad athletes. Performance improvement was measured as development of athletes' highest track-and-field championship level and placing from 19 to 25 years (t1-t2). Practice efficiency was defined as performance improvement per amount of coach-led athletics practice from t1 to t2. Participation variables included amounts of coach-led practice and peer-led play in athletics and other sports through t1 and t1-t2. Analyses involved an advanced machine learning procedure, XGBoost, allowing non-linear, multivariate exploration. We computed two models, one for performance improvement ("good" discriminative performance, AUC = 0.82) and one for practice efficiency ("fair", AUC = 0.73). Four central findings emerged: 1. Childhood/adolescent coach-led multi-sport practice was a critical discriminator of adult practice efficiency and performance improvement. 2. Associations were non-linear, displaying a saturation pattern. 3. The likelihood of achieving high adult practice efficiency was greatest when combining ~1,000-2,500 track-and-field practice hours until t1 with ~1,250 other-sports practice hours until t1. 4. Peer-led engagement in any sport had negligible effects. Childhood/adolescent multi-sport coach-led practice apparently facilitated long-term sustainability of athletes' development of adult practice efficiency and performance improvement in athletics.

Did injury incidence in alpine ski racing change after equipment regulations? An evaluation based on the injury surveillance system of the Austrian Ski Federation.

OBJECTIVES: To assess the effects of alpine competition equipment regulations from 2003, 2007 and 2012 on severe injury incidence. DESIGN: Case study METHOD: Data originated from records of the injury surveillance system of the Austrian Ski Federation. Injuries from the seasons 2001-2017 were divided in four periods between the equipment regulations. For comparison of consecutive periods, risk ratios (RR = later period / preceding period) with 95% CI were calculated. Total severe injury events, events with severe knee injuries, and events with severe ACL injuries were separately investigated. RESULTS: A significant increase of total severe injury incidence was found after the equipment regulation in 2003 (RR1.52, 95% CI 1.00-2.31). None of the other comparisons revealed significance (p<0.05) or statistical trends (p<0.1). Only the minority (40%) of the RR showed a reduction in the injury incidence of the Austrian Ski Team (lowest RR 0.78). 60% of the RR increased after the regulations (highest RR 1.63). CONCLUSIONS: Even though statistical uncertainties remain, our findings allow the conclusion, that the implemented equipment regulations did not cause a noticeable reduction of injuries. The three analysed equipment regulations were not appropriate or were counteracted by other factors.

Retirement of professional soccer players - A systematic review from social sciences perspectives.

Retiring professional athletes face multifaceted changes and potential issues of adjustment, occupational development, and well-being, which raises concerns around the world. The study systematically reviewed the available research investigating professional soccer players' sport retirement from social sciences perspectives. The literature search in electronic databases and a "snowballing" procedure yielded 17 eligible studies investigating > 2,200 retired professional soccer players. The review followed the PRISMA statement. Nine studies focused on an early transition phase to retirement period; four studies investigated later periods of ten years or longer after retirement. Around half of the players reported involuntary retirement, often associated with declining performance and/or injury. Studies suggest issues of adjustment and mental health during early years after retirement, while psychological issues had apparently declined around 1-2 decades after retirement. However, available studies had notable limitations including lack of evidenced representative samples, report of measures' reliability, and control for confounders. Furthermore, while theoretical models emphasise a holistic perspective, quantitative research often took a narrow rather than holistic perspective. In summary, available knowledge is fraught with some uncertainty regarding reliability and representativeness of the population of retired professional soccer players. We offer future directions to advance the development of a theory of sport retirement.