Initial Assessment and Management of Select Musculoskeletal Injuries: A Team Physician Consensus Statement.

ABSTRACT: Musculoskeletal injuries occur frequently in sport during practice, training, and competition. Injury assessment and management are common responsibilities for the team physician. Initial Assessment and Management of Musculoskeletal Injury-A Team Physician Consensus Statement is title 23 in a series of annual consensus documents written for the practicing team physician. This statement was developed by the Team Physician Consensus Conference, an annual project-based alliance of six major professional associations. The goal of this document is to help the team physician improve the care and treatment of the athlete by understanding the initial assessment and management of selected musculoskeletal injuries.

Nutritional Strategies for Endurance Cyclists - Periodized Nutrition, Ketogenic Diets, and Other Considerations.

ABSTRACT: Cycling is a growing sport worldwide since the COVID-19 pandemic. With the growing availability and interest in long distance events, professional and amateur cyclists are pushing themselves further and harder than ever before. Training and nutrition should be understood by the sports medicine professional in order to guide counseling toward proper fueling to avoid health consequences. This article reviews macronutrients and micronutrients, periodized training and nutrition, and the relevance of the ketogenic diet for endurance cyclists riding greater than 90 min.

PrEP Stigma and logistical barriers remain significant challenges in curtailing HIV transmission among Black and Hispanic/Latinx cisgender sexual minority men and transgender women in the US.

Despite advancements in HIV prevention, such as pre-exposure prophylaxis (PrEP), there remain inequities in accessing PrEP among Black and Hispanic/Latinx cisgender sexual minority men and transgender women (SMMTW). Researchers have documented multiple barriers to PrEP uptake, yet the relative impacts of PrEP internalized stigma and logistical barriers (e.g., Cost; time) to PrEP use are understudied. It may be meaningful to investigate potential interactions between internalized stigma and logistical barriers to PrEP use. We utilized data from 827 Black and Hispanic/Latinx SMMTW (Mage = 25.09) in the US and found that greater PrEP-related internalized stigma and greater PrEP logistical barriers were independently significantly associated with lower likelihood of current PrEP use, but PrEP-related internalized stigma became a non-significant predictor when included in a multivariable model. We found a significant interaction between PrEP-related internalized stigma and logistical barriers to PrEP use, such that the association between internalized stigma and likelihood of current PrEP use was only significant at lower levels of logistical barriers to PrEP use. Findings highlight the need to reduce logistical barriers to PrEP use, and for clinicians to acknowledge the role of stigma for individuals who otherwise do not report logistical barriers.

Willingness to Prescribe PrEP to Bisexual Men Depends on Genders of Their Past Partners: A Study of Medical Students in the USA.

Bisexual men are at increased risk for HIV compared to heterosexual men but unlikely to use pre-exposure prophylaxis (PrEP). Given that biases may influence whether bisexual men are prescribed PrEP, we examined whether medical students' decision-making was influenced by the genders of a bisexual male patient's partners. Medical students (N = 718) were randomized to one of nine conditions where they answered questions about a bisexual male patient after reviewing his electronic medical record. We manipulated the gender of his current partner (none, male, female) and the genders of his past partners (male, female, both). Current partners were described as living with HIV and not yet virally suppressed, past partners were described as being of unknown HIV-status, and condom use was described as intermittent with all partners. When the patient was not in a current relationship, perceived HIV risk and likelihood of prescribing PrEP were lowest if he only had female partners in the past. When he was in a current relationship, perceived HIV risk and likelihood of prescribing PrEP did not differ based on current or past partners' genders. In addition, identification as a PrEP candidate, perceived likelihood of adherence, and perceived likelihood of engaging in condomless sex if prescribed were lower when the patient was not in a current relationship. Medical students appropriately prioritized the status of the partner living with HIV, but their decision-making was influenced by past partner genders when the patient was not in a current relationship. Medical students may require additional education to ensure they understand PrEP eligibility criteria and make decisions based on patients' individual presentations.

ACSM-AMSSM Call to Action: Adapting Preparticipation Cardiovascular Screening to the COVID-19 Pandemic.

ABSTRACT: Preparticipation cardiovascular screening, designed to identify cardiovascular pathology responsible for sudden unexpected death, is recommended by all major professional medical organizations overseeing the clinical care of competitive athletes. Data from several large, prospective, cohort studies indicate that cardiac imaging findings consistent with inflammatory heart disease following COVID-19 infection are more common than most forms of heart disease associated with sudden death during exercise. This call-to-action document is intended to provide recommendations about how routine preparticipation cardiovascular screening for young competitive athletes - which has the capacity to detect both COVID-19 cardiovascular complications and pathology unrelated to infection - should be altered to account for recent scientific advances.

Sexual violence in sport: American Medical Society for Sports Medicine Position Statement.

The American Medical Society for Sports Medicine (AMSSM) convened a group of experts to develop a Position Statement addressing the problem of sexual violence in sport. The AMSSM Sexual Violence in Sport Task Force held a series of meetings over 7 months, beginning in July 2019. Following a literature review, the Task Force used an iterative process and expert consensus to finalise the Position Statement. The objective of this Position Statement is to raise awareness of this critical issue among sports medicine physicians and to declare a commitment to engage in collaborative, multidisciplinary solutions to reduce sexual violence in sport.

The interplay of familial warmth and LGBTQ+ specific family rejection on LGBTQ+ adolescents' self-esteem.

INTRODUCTION: Our study sought to assess the interplay of family dynamics, namely familial warmth and LGBTQ+ specific rejection, and its association to self-esteem in a non-probabilistic sample of LGBTQ+ adolescents in the United States. METHODS: Stratified by (1) cisgender and (2) transgender and non-binary LGBTQ+ adolescents (N = 8774), we tested multivariable regression analyses to assess the association between familial warmth and LGBTQ+ specific family rejection, adjusted for sociodemographic characteristics. We then conducted a sub-analysis with LGBTQ+ adolescents who reported being out to any family member about their LGBTQ+ identity; specifically, we tested a series of multivariable regression models to assess whether levels of LGBTQ+ specific family rejection attenuated the association between familial warmth and self-esteem. RESULTS: Full sample models indicated a positive association between familial warmth and self-esteem. Findings from our sub-analysis indicated that familial warmth remained positively linked to self-esteem and family rejection was negatively associated with self-esteem. Family rejection was a statistically significant moderator, attenuating the association between familial warmth and self-esteem. With respect to being out about one's sexual orientation, these findings were robust across gender stratification groups. CONCLUSIONS: Families of origin serve as sources of stress and resilience for LGBTQ+ adolescents. Our findings contribute support to arguments that familial warmth and LGBTQ+ specific rejection are not mutually-exclusive experiences among LGBTQ+ adolescents. We provide recommendations for multilevel interventions to leverage activities that support positive family dynamics and self-esteem among LGBTQ+ adolescents.

American Medical Society for Sports Medicine Position Statement: Mental Health Issues and Psychological Factors in Athletes: Detection, Management, Effect on Performance, and Prevention-Executive Summary.

The American Medical Society for Sports Medicine convened a panel of experts to provide an evidence-based, best practice document to assist sports medicine physicians and other members of the athletic care network with the detection, treatment, and prevention of mental health (MH) issues in competitive athletes. This statement discusses how members of the sports medicine team, including team physicians, athletic trainers, and MH providers, work together in providing comprehensive psychological care to athletes. It specifically addresses psychological factors in athletes including personality issues and the psychological response to injury and illness. The statement also examines the athletic culture and environmental factors that commonly impact MH, including sexuality and gender issues, hazing, bullying, sexual misconduct, and transition from sport. Specific MH disorders in athletes, such as eating disorders/disordered eating, depression and suicide, anxiety and stress, overtraining, sleep disorders and attention-deficit/hyperactivity disorder, are reviewed with a focus on detection, management, the effect on performance, and prevention. This document uses the Strength of Recommendation Taxonomy to grade level of evidence.

Mental Health Issues and Psychological Factors in Athletes: Detection, Management, Effect on Performance, and Prevention: American Medical Society for Sports Medicine Position Statement.

The American Medical Society for Sports Medicine convened a panel of experts to provide an evidence-based, best practices document to assist sports medicine physicians and other members of the athletic care network with the detection, treatment, and prevention of mental health issues in competitive athletes. This statement discusses how members of the sports medicine team, including team physicians, athletic trainers, and mental health providers, work together in providing comprehensive psychological care to athletes. It specifically addresses psychological factors in athletes including personality issues and the psychological response to injury and illness. The statement also examines the athletic culture and environmental factors that commonly impact mental health, including sexuality and gender issues, hazing, bullying, sexual misconduct, and transition from sport. Specific mental health disorders in athletes, such as eating disorders/disordered eating, depression and suicide, anxiety and stress, overtraining, sleep disorders, and attention-deficit/hyperactivity disorder, are reviewed with a focus on detection, management, the effect on performance, and prevention. This document uses the Strength of Recommendation Taxonomy (SORT) to grade level of evidence.

Sexual Violence in Sport: American Medical Society for Sports Medicine Position Statement.

The American Medical Society for Sports Medicine (AMSSM) convened a group of experts to develop a Position Statement addressing the problem of sexual violence in sport. The AMSSM Sexual Violence in Sport Task Force held a series of meetings over 7 months, beginning in July 2019. Following a literature review, the task force used an iterative process and expert consensus to finalize the Position Statement. The objective of this Position Statement is to raise awareness of this critical issue among sports medicine physicians and to declare a commitment to engage in collaborative, multidisciplinary solutions to reduce sexual violence in sport.

Sexual Violence in Sport: American Medical Society for Sports Medicine Position Statement.

The American Medical Society for Sports Medicine (AMSSM) convened a group of experts to develop a Position Statement addressing the problem of sexual violence in sport. The AMSSM Sexual Violence in Sport Task Force held a series of meetings over 7 months, beginning in July 2019. Following a literature review, the task force used an iterative process and expert consensus to finalize the position statement. The objective of this position statement is to raise awareness of this critical issue among sports medicine physicians and to declare a commitment to engage in collaborative, multidisciplinary solutions to reduce sexual violence in sport.

Cardiovascular screening of Olympic athletes reported by chief medical officers of the Rio 2016 Olympic Games.

OBJECTIVE: The IOC recommends periodic cardiovascular screening of athletes, but the adoption of these recommendations is unknown. The purpose of this investigation was to evaluate and compare cardiovascular screening practices of countries participating in the Rio 2016 Olympic Games. METHODS: A list of chief medical officers (CMOs) was compiled by the IOC during the 2016 Olympic Games. CMOs were requested to complete an online survey about cardiovascular screening of their countries' Olympic athletes. Comparisons of screening practices were made by categorising countries by continent, gross domestic product (GDP) per capita and size of athlete delegation. RESULTS: CMOs for 117/207 (56.5%) countries participating in the 2016 Olympic Games were identified. 94/117 countries (80.3%) completed the survey, representing 45.4% of all countries and 8805/11 358 (77.5%) of all 2016 Olympic athletes. Most of the countries surveyed (70.2%) perform annual cardiovascular screening. Among the survey respondents, all or most athletes from each country were screened at least once with the following components: personal history (86.2% of countries), family history (85.1%), physical examination (87.2%), resting ECG (74.5%), echocardiogram (31.9%) and stress test (30.8%). Athletes were more likely to be screened with ECG in countries with relatively larger athlete delegation (OR 2.05, 95% CI 1.10 to 3.80, p=0.023) and with higher GDP per capita (OR 1.69, 95% CI 1.11 to 2.57, p=0.014). CONCLUSION: Most of the responding countries perform annual cardiovascular screening of Olympic athletes, but there are differences in the components used. Athletes from countries with larger athlete delegations and higher GDP per capita were more likely to be screened with ECG.

Preferences of U.S. Veterans Making and Receiving Caring Cards: A Peer Approach to Recovery-Oriented Suicide Prevention.

Caring Cards is a peer-adaptation of caring contacts for suicide prevention, in which people with lived experience of suicidal thoughts and behaviors create handmade cards for peers currently experiencing suicidal thoughts and/or behaviors. The present study used data from a feasibility/acceptability study of Caring Cards at a Veterans Affairs Medical Center to explore preferences for this type of recovery-oriented suicide prevention intervention. Participants were 55 Veterans with a past (card makers, n=21) or current (card recipients, n=34) high-risk indication for suicide. Card makers participated in a 3-month weekly 60-120-minute group therapy to create cards. Card recipients received these cards monthly for six months. Survey and interview data were collected post-intervention. Pragmatic analysis of interview responses revealed preferences related to participation length, card content and frequency, group formatting, and accessibility. Among both card makers (76.2%-85.7%) and card recipients (94.1%), a majority recommended offering this intervention for Veterans who have previously or are currently struggling with mental health concerns. Over 60% of card makers wanted receive cards and 52.9% of card recipients wanted to make cards. These data further support the importance of lived experience voices in intervention development. Caring Cards, an intervention specifically focusing on improving well-being, meaning-making, and fulfillment in one's life, regards Veteran preferences as salient in the future implementation of a recovery-oriented approach to suicide prevention.

Initial Assessment and Management of Select Musculoskeletal Injuries: A Team Physician Consensus Statement.

ABSTRACT: Musculoskeletal injuries occur frequently in sport during practice, training, and competition. Injury assessment and management are common responsibilities for the team physician. Initial Assessment and Management of Musculoskeletal Injury-A Team Physician Consensus Statement is title 23 in a series of annual consensus documents written for the practicing team physician. This statement was developed by the Team Physician Consensus Conference, an annual project-based alliance of six major professional associations. The goal of this document is to help the team physician improve the care and treatment of the athlete by understanding the initial assessment and management of selected musculoskeletal injuries.

A Scoping Review of Suicide Prevention Interventions for Lesbian, Gay, Bisexual, Transgender, Queer, and Other Sexual and Gender Minority Individuals.

Purpose: This scoping review summarizes the literature on suicide-specific psychological interventions among lesbian, gay, bisexual, transgender, queer, and other sexual and gender minority (LGBTQ+) people to synthesize existing findings and support future intervention research and dissemination. Methods: Electronic databases PsycInfo and PubMed were searched for reports of psychological intervention studies with suicide-related outcome data among LGBTQ+ people. A total of 1269 articles were screened, and 19 studies met inclusion criteria (k = 3 examined suicide-specific interventions tailored to LGBTQ+ people, k = 4 examined nontailored suicide-specific interventions, k = 11 examined minority stress- or LGBTQ+ interventions that were not suicide-specific, and k = 1 examined other types of interventions). Results: Synthesis of this literature was made challenging by varied study designs, and features limit confidence in the degree of internal and external validity of the interventions evaluated. The only established suicide-specific intervention examined was Dialectical Behavior Therapy, and minority stress- and LGBTQ-specific interventions rarely targeted suicidal thoughts and behaviors (STBs). Nevertheless, most interventions reviewed demonstrated support for feasibility and/or acceptability. Only five studies tested suicide-related outcome differences between an LGBTQ+ group and a cisgender/heterosexual group. These studies did not find significant differences in STBs, but certain subgroups such as bisexual individuals may exhibit specific treatment disparities. Conclusion: Given the dearth of research, more research examining interventions that may reduce STBs among LGBTQ+ people is critically needed to address this public health issue.

Use of the Heterosexist Harassment, Rejection, and Discrimination Scale With Different Sexual Orientation, Gender, and Racial/Ethnic Groups: An Examination of Measurement Invariance.

The Heterosexist Harassment, Rejection, and Discrimination Scale (HHRDS) is one of the most commonly used measures of sexual orientation-related discrimination, but little is known about its psychometric properties across different sexual orientations, gender, and racial/ethnic groups. A three-factor model was initially obtained, but most studies treat the HHRDS unidimensionally. Therefore, we tested whether the HHRDS exhibited measurement invariance across sexual orientation, gender, and racial/ethnic groups among 792 sexual minority young adults (aged 18-29) who participated in an online study. Across models, the three-factor solution fit better than the one-factor solution. All models achieved configural invariance and most achieved metric invariance; none of the considered models achieved scalar invariance (1-3 items were not equivalent across groups, depending on the comparison). Findings suggest that the HHRDS generally functions equivalently across sexual orientation, gender, and racial/ethnic groups, but some caution in interpreting scores is warranted.

Primary Care Sports Medicine fellowship opportunities for Pediatrics-trained physicians in the United States.

OBJECTIVES: To characterize Primary Care Sports Medicine (PCSM) fellowship opportunities for Pediatrics-trained physicians across all programs in the United States. METHODS: Cross-sectional study using data from publicly-available online sources. Data were collected from the Association of American Medical Colleges (AAMC) and American Medical Society for Sports Medicine (AMSSM) online listings of PCSM programs and cross-referenced with individual program websites. Variables such as program location, departmental sponsor, and eligibility criteria specific to pediatricians were collected. RESULTS: 202 programs were identified. 196 (97.0%) were ACGME-accredited, of which 75.0% were sponsored by Family Medicine (FM), 9.7% by Physical Medicine and Rehabilitation (PMR), 9.2% by Pediatrics, and 5.1% by Emergency Medicine (EM) departments. Pediatrics-trained physicians were eligible for 133 of 196 (67.9%) programs and 241 of 350 (68.9%) total positions. Eligibility for pediatricians was highest in Pediatrics-sponsored programs (18/18, 100.0%), followed by EM (7/10, 70.0%), FM (98/147, 66.7%), and PMR (9/19, 47.4%). 49 of 133 (36.8%) programs accepting pediatricians had discrepancies regarding eligibility criteria (e.g. did not confirm eligibility criteria on their website, listed conflicting eligibility criteria within or between their website and AMSSM listing, or did not have a website available to cross-reference). CONCLUSIONS: Pediatricians are eligible for more than two-thirds of PCSM fellowship programs across the United States, including programs that are not sponsored by Pediatrics departments. Applicants may not be aware of these opportunities given discrepancies regarding eligibility in over one-third of programs. In a field underrepresented by Pediatrics-trained physicians, accurate online information and transparency of eligibility criteria are critical to raise awareness about fellowship opportunities and foster equity with regards to career opportunities for pediatricians in PCSM.

Age Differences in the Associations Between Outness and Suicidality Among LGBTQ+ Youth.

OBJECTIVE: Lesbian, gay, bisexual, transgender, and queer (LGBTQ+) youth are at increased risk for suicidality compared to their heterosexual and cisgender peers, and outness (the extent to which an individual is open about their LGBTQ+ identity to others) is an important correlate of suicidality. However, previous research has led to mixed findings regarding whether outness functions as a risk or protective factor for suicidality, and the available evidence suggests that age may play an important role. As such, the goal of the current study was to examine whether the associations between outness and suicidality differed between LGBTQ+ adolescents (ages 12-17) and emerging adults (ages 18-24). METHOD: The analytic sample included 475 LGBTQ+ youth who completed an online survey after contacting a national, LGBTQ+ crisis service provider. RESULTS: Results indicated that age significantly moderated the association between outness and suicidal ideation, such that greater outness was significantly associated with greater suicidal ideation for adolescents, but not for emerging adults. In contrast, age did not significantly moderate the associations between outness and likelihood of a past suicide attempt or perceived likelihood of a future suicide attempt. However, the main effect of outness was significant in both models, such that greater outness was significantly associated with a greater likelihood of a past suicide attempt and a greater perceived likelihood of a future suicide attempt. CONCLUSIONS: These findings suggest that the associations between outness and suicidality among LGBTQ+ youth may depend on age as well as the dimension of suicidality (ideation versus attempt). HighlightsBeing more open about one's LGBTQ+ identity may confer risk for suicidality.The influence of outness on suicidal ideation may be strongest during adolescence.There is a need for LGBTQ+ affirming policies and laws to reduce suicidality.