Through the big top: An exploratory study of circus-based artistic knowledge translation in rural healthcare services, Québec, Canada.

BACKGROUND: The conventional methods and strategies used for knowledge translation (KT) in academic research often fall short in effectively reaching stakeholders, such as citizens, practitioners, and decision makers, especially concerning complex healthcare issues. In response, a growing number of scholars have been embracing arts-based knowledge translation (ABKT) to target a more diverse audience with varying backgrounds and expectations. Despite the increased interest, utilization, and literature on arts-based knowledge translation over the past three decades, no studies have directly compared traditional knowledge translation with arts-based knowledge translation methods. Thus, our study aimed to evaluate and compare the impact of an arts-based knowledge translation intervention-a circus show-with two traditional knowledge translation interventions (webinar and research report) in terms of awareness, accessibility, engagement, advocacy/policy influence, and enjoyment. METHODS: To conduct this exploratory convergent mixed method study, we randomly assigned 162 participants to one of the three interventions. All three knowledge translation methods were used to translate the same research project: "Rural Emergency 360: Mobilization of decision-makers, healthcare professionals, patients, and citizens to improve healthcare and services in Quebec's rural emergency departments (UR360)." RESULTS: The findings revealed that the circus show outperformed the webinar and research report in terms of accessibility and enjoyment, while being equally effective in raising awareness, increasing engagement, and influencing advocacy/policy. Each intervention strategy demonstrates its unique array of strengths and weaknesses, with the circus show catering to a diverse audience, while the webinar and research report target more informed participants. These outcomes underscore the innovative and inclusive attributes of Arts-Based Knowledge translation, showcasing its capacity to facilitate researchers' engagement with a wider array of stakeholders across diverse contexts. CONCLUSION: As a relevant first step and a complementary asset, arts-based knowledge translation holds immense potential in increasing awareness and mobilization around crucial health issues.

Assessment of Professional Circus Students' Psychological Characteristics at Four Strategic Timepoints over the Scholastic Year: A Longitudinal Study Using the Stress Process Model.

OBJECTIVE: The circus professionalization process entails extensive training to mitigate the high-risk demands which increase stress in artists. In high-risk professions, everyday hassles (challenges) contribute greatly to overall stress. To capture the impact of daily challenges on student-artists, the aim of the current study was to describe the magnitude and pattern of daily challenges as well as their relationships with perceived coping, anxiety, fatigue, and psychological distress. METHODS: Ninety-two students at École Nationale de Cirque (ENC), in Montreal, Canada, completed the Circus Daily Challenges Questionnaire (CDCQ) and scales assessing perceived coping, state anxiety, and fatigue at four time points over 1 school year. The Kessler 6 Non-Specific Psychological Distress Scale (K6) was implemented at one time point. RESULTS: Findings revealed significant fluctuations in challenge level and management of challenges throughout the school year, with schedule, technical development, artistic expression, physical preparation, and sleep reported as high during the two examination periods. The lowest challenge-level scores were achieved following the extended breaks in the annual calendar. Daily challenge positively correlated to state anxiety and fatigue, and negatively correlated with perceived coping. The student-artists reported higher prevalence of moderate psychological distress to general populations. CONCLUSION: Befitting the Stress Process Model, a strong interplay between variables was observed, and the life challenges assessment provides a basis for interventions based upon commonalities across the group, as well as individually tailored.

Clinical Burden of Injuries in Students at a Professional Circus College: A 7.5-Year Longitudinal Study.

OBJECTIVE: To characterize clinical burden of injuries incurred by circus students enrolled in a 3-year college training program. METHODS: Student (n=334) injury data derived from an in situ clinic was examined over a 7.5-year time frame from August 2009 to December 2016. Injury incidence rate (per 1,000 training hours) was calculated and clinical incidence (injuries/year) was examined in relation to year in program, sex, age, and circus discipline. Weekly and monthly injury incidence were plotted with respect to milestones in the scholastic training year. Clinical burden (injury incidence and duration) was examined according to anatomic location and circus discipline. RESULTS: The overall injury incidence rate was 1.89 injuries/1,000 training hours and 0.94 injuries/1,000 training hours for injuries with a duration longer than 4 weeks. Clinical incidence decreased with year in program (p<0.05) and there were no sex or age differences. Temporal analysis demonstrated elevated weekly injury incidence for the 3 weeks following return from both summer and winter vacation (p<0.01) and for the weeks leading up to technical exams (p<0.01). According to anatomical location, shoulder injuries accounted for the greatest clinic burden followed by ankles and according to discipline, ground acrobat flyers followed by ground acrobats with equipment accounted for the greatest clinic burden. CONCLUSION: Overall injury incidence rate in the circus training program was within the range reported by other circus training programs and similar artistic and athletic training programs. Resources should be designated for enhanced rehabilitation efficacy and prevention of shoulder and ankle injuries and for ground acrobats with equipment and flyers. Preventative strategies to improve safety upon return-to-training after vacations should be examined.

Body Composition Adaptations Throughout an Elite Circus Student-Artist Training Season.

The purpose of this study was to perform a longitudinal assessment of body composition of circus student-artists in an elite 3-year college training program. Ninety-two student-artists participated (age = 20.39 ± 2.42 years; height = 170.01 ± 8.01 cm; mass = 66.48 ± 11.07 kg; 36% female and 64% male), representing 92% of the student population. Body composi- tion was assessed using multi-frequency bioelectrical impedance at four strategic time points throughout the training year to evaluate changes over the two semesters (September to December and January to April) and winter vacation (December to January). Workloads were subjectively assessed using ratings of perceived exer- tion (RPE). Averaged over the academic terms, fat mass was 11.5 ± 4.8%, muscle mass was 50.2 ± 3.4%, and body mass index was 22.9 ± 2.2. Males and females differed significantly across all absolute and relative body composition variables. Muscle mass increased (semester one, +1.0%, p < 0.001; semester two, +0.4%, p < 0.05) while fat mass decreased during each semester (semester one, -1.6%, p < 0.001; semester two, -0.6%, p < 0.05) co-varying with changes in RPE (semester one, +2.3, p < 0.05; semester two, +1.7, p < 0.05). During the winter vacation period, percent fat mass increased (males, +1.0%; females, +2.0%) and percent muscle mass decreased (males, -0.6%; females, -0.9%). Discipline-specific differences in body composition were also detected, and significant differences were observed between student-artists grouped by years in school. Over the training year, there was a positive adaptation for muscle and fat mass despite the negative adaptation experienced during the winter vacation period.

Supporting Holistic Wellbeing for Performing Artists During the COVID-19 Pandemic and Recovery: Study Protocol.

The COVID-19 pandemic resulted in the abrupt closure of circus schools, venues, and companies, introducing a myriad of novel stressors. Performers and students must now attempt to maintain their technical, physical, artistic, creative, and cognitive abilities without in-person support from their coaches and must manage the isolation from their training and performing spaces. For circus artists, the transposition of the work space to a home environment is not possible, which creates novel stressors that could lead to the exacerbation and escalation of mental health issues. The purpose of this study is to develop, implement and evaluate a holistic interventional program based on the socio-ecological model of resilience and operationalized through physical literacy. This will be a prospective longitudinal study with a retrospective comparison to data from a similar student cohort pre-pandemic. Interventions were designed using a population-specific, participant-based developmental model within a knowledge translation framework. The interventional program includes group webinars, small group information sessions, and one-on-one Zoom meetings, in addition to the distribution of electronic educational materials. The interventions will holistically provide psychological, physical, social, technical, artistic, and creative supports. Resources will be deployed throughout the closure period and through recovery, as transitions to return to training after prolonged hiatus will magnify known psychological and physical difficulties. Repeated, longitudinal assessment of students will be utilized to track changes over time at key transitions in the pandemic and school year and will be compared to a pre-pandemic school year. The framework for this program will be translatable to other performing arts and high-performance contexts. The program has implications for the mental health and overall wellbeing of artists and for cultural and economic recovery of the industry.

Physical Literacy and Resilience in Children and Youth.

Background: There is growing interest in the relationship between physical and psychosocial factors related to resilience to better understand the antecedents of health and successful adaptation to challenges in and out of school, and across the lifespan. To further this understanding, a trans-disciplinary approach was used to investigate the association between the multidimensional constructs of physical literacy and resilience in children at a key stage in their development. Methods: Cross-sectional data were collected from 227 school children aged 9-12 years old from five schools in Winnipeg, Manitoba, Canada. Resilience was measured using the Child and Youth Resilience Measure, and physical literacy through the Physical Literacy Assessment for Youth tools. Data were provided by self-report, surrogate assessors of the child (physical education teachers and parents), and trained assessors for movement skills. These data were analyzed using correlation and logistic regression. Results: Resilience was significantly correlated with numerous indicators of physical literacy, including movement capacity, confidence, and competence, environmental engagement, and overall perceptions of physical literacy. Regressions indicated that resilience could be predicted by movement confidence and competence, environmental engagement, and overall physical literacy. Conclusions: The findings of this study, using a constellation of sources, provide foundational evidence for the link between resilience and physical literacy among children, encouraging the importance of physical literacy development in schools. Longitudinal studies are required to further examine this relationship and how these previously unrelated fields may work together for a richer understanding of the interplay between the physical and psychological determinants of well-being.

Sleep and Fatigue of Elite Circus Student-Artists During One Year of Training.

AIMS: The development of elite circus artists requires extensive technical and artistic training, as well as a commensurate level of physical preparation in readiness for a demanding professional career as a performance artist. While sport research has identified the importance of monitoring sleep and fatigue in athletes to optimize performance and to prevent illness and injury, not a single study of circus artists exists. This study provides a longitudinal examination of sleep and fatigue in elite circus student-artists. METHODS: 92 student-artists (60 male, 32 female) were analyzed at 4 strategic time points over a preparatory year. At each time point, sleep parameters (duration, quality and latency), ratings of perceived exertion (RPE), wakefulness, and fatigue were obtained using questionnaires. RESULTS: Student-artists attained an average nightly sleep of 8 hours, 27 minutes, exceeding the recommended durations for general populations and those self-reported in athletes. The majority of the artists also indicated acceptable sleep latency (87%) and quality (83%) scores. Sleep parameters remained consistent throughout the year despite significant variations in training load and fatigue. Sleep parameters were not substantial predictors of overall fatigue. Fatigue covaried with yearly variation in sessional training loads. CONCLUSIONS: Although improvement in sleep could be postulated as a means to mitigate fatigue, it is likely that strategies aimed at optimizing the loading profile and additional recovery techniques be a first line approach.

Don't take down the monkey bars: Rapid systematic review of playground-related injuries.

OBJECTIVE: To synthesize the available evidence on playground-related injuries and to determine the prevalence of these injuries in pediatric populations. DATA SOURCES: A rapid systematic review was conducted using PubMed, EMBASE, and the Cochrane Library, as well as the gray literature. STUDY SELECTION: The search was limited to studies published between 2012 and 2016 and identified a total of 858 articles, of which 22 met our inclusion criteria: original quantitative studies published in peer-reviewed journals in the past 5 years, concerning unintentional injuries in playgrounds in children aged 0 to 18 years. SYNTHESIS: Information was collected on study and injury characteristics, and the proportion of pediatric injuries related to playground activity was determined. Studies were performed in various countries and most were retrospective cohort studies. The prevalence of playground-related injury ranged from 2% to 34% (median 10%). Studies varied in the types of injuries investigated, including head injuries, genitourinary injuries, ocular and dental trauma, and various types of fractures. Most injuries were low severity. CONCLUSION: Although playgrounds are a common location where pediatric injuries occur, these injuries are relatively low in frequency and severity.

Cirque du Monde as a health intervention: perceptions of medical students and social circus experts.

OBJECTIVE: To present Cirque du Soleil's social circus program, Cirque du Monde, to explore its potential as a primary health care tool for family physicians. DATA SOURCES: A review of the literature in PubMed, the Cochrane Library, PsycINFO, LaPresse, Eureka, Google Scholar, and Érudit using the key words circus, social circus, Cirque du Monde, and Cirque du Soleil; a Montreal-based initiative, Espace Transition, modeled on Cirque du Monde; and personal communication with Cirque du Soleil's Social Circus Training Advisor. STUDY SELECTION: The first 50 articles or websites identified for each key word in each of the databases were examined on the basis of their titles and abstracts in the case of articles, and on the basis of their titles and page content in the case of websites. Articles and websites that explored an aspect of social circuses or that described an intervention that involved circuses were then retained for analysis. Because all literature on social circuses was searched, no criterion for year of publication was used. SYNTHESIS: No articles on the social circus as a health intervention were found. One study on the use of the circus as an intervention in schools was identified. It demonstrated an increase in self-esteem in the children who took part. One study on the use of the circus in a First Nations community was found; it contained nonspecific, qualitative findings. The other articles identified were merely descriptions of social circuses. One website was identified on the use of the social circus to help youth who had been treated in a hospital setting for major psychiatric disorders to re-enter the community. The team in the pediatric psychiatry department at Centre Hospitalier Universitaire Sainte-Justine, the children's hospital in Montreal, Que, was contacted; they were leading this project, called Espace Transition. The unpublished preliminary findings of its pilot project demonstrate substantial improvements in overall patient functioning. According to Cirque du Soleil, there are several projects under way around the world researching the therapeutic value of social circuses. CONCLUSION: Cirque du Monde is able to reach a marginalized population that is otherwise difficult for the health system to reach. This program has therapeutic potential because of its target population, its promotion of healthy habits, and the support that it offers through the group and its workers. Cirque du Soleil is investing heavily in this project. The lack of literature yielding robust data on the social circus is therefore an important issue.