Medical care and first aid: an interassociation consensus framework for organised non-elite sport during the COVID-19 pandemic.

The cessation of amateur and recreational sport has had significant implications globally, impacting economic, social and health facets of population well-being. As a result, there is pressure to resume sport at all levels. The ongoing prevalence of SARS-CoV-2 and subsequent 'second waves' require urgent best practice guidelines to be developed to return recreational (non-elite) sports as quickly as possible while prioritising the well-being of the participants and support staff.This guidance document describes the need for such advice and the process of collating available evidence. Expert opinion is integrated into this document to provide uniform and pragmatic recommendations, thereby optimising on-field and field-side safety for all involved persons, including coaches, first responders and participants.The nature of SARS-CoV-2 transmission means that the use of some procedures performed during emergency care and resuscitation could potentially be hazardous, necessitating the need for guidance on the use of personal protective equipment, the allocation of predetermined areas to manage potentially infective cases and the governance and audit of the process.

The "price-tag" of foot health in infancy and early childhood: a cross sectional survey of UK parents.

Children's feet are complex structures and strategies for supporting good foot health throughout childhood can be challenging. Greater awareness of the contemporary factors influencing decisions, such as footwear purchases, is needed to inform health narratives which are more closely aligned to parents' attitude and behaviours. The aim of this study was to explore parent's knowledge of children's foot health, understand the common foot health concerns and experiences with footcare services. A purposeful sampling approach was used to recruit parents of children aged 5 years and under. Participants completed a self-administered, online survey which consisted of 39 questions across six sections: (1) Participant demographics; (2) Developmental events (milestones such as crawling and walking); (3) Foot health concerns; (4) Developmental aids (products such as baby bouncers and baby walkers); (5) Footwear; and (6) Foot health information. Both adaptive and mandatory questions were used. Descriptive statistics were used to summarise closed-ended questions, and a summative content analysis was adopted to draw inferences from the text data. Two-hundred thirty-nine parents completed the survey, and this represented female participants (n = 213) aged between the ages 34-42 (n = 126) or 25-34 (n = 83) years of age. The survey generated responses from a wide geographical spread across the UK, but the majority of these were from the North West of England (n = 75) and South East of England (n = 46). Four main themes were drawn from the content analysis: (1) foot health concerns and seeking advice; (2) information and advice; (3) how parents support infant milestone events; and (4) footwear.Conclusion: This work provides insight into parents' perspective on the broad topics of children's foot health, identifying common experiences and concerns about their children's foot health and the factors which influence decision making. Understanding more about these issues will help health professionals support parents during infancy and early years. What is Known: • Maintaining good foot health throughout childhood is important and many factors influence decision making. • There is little understanding about how parents care for their children feet and their understanding of good foot health practices and services. What is New: • Insight into the common factors which influence parents' approaches to supporting early development and the typical concerns that parents encountered about their children's overall foot health and footwear. • Identifies areas of children's foot health for health professionals to target when developing information sources for parents.

Interassociation consensus recommendations for pitch-side emergency care and personal protective equipment for elite sport during the COVID-19 pandemic.

The COVID-19 pandemic has necessitated many novel responses in healthcare including sport and exercise medicine. The cessation of elite sport almost globally has had significant economic implications and resulted in pressure to resume sport in very controlled conditions. This includes protecting pitch-side medical staff and players from infection. The ongoing prevalence of SARS-CoV-2 and the desire to resume professional sport required urgent best practice guidelines to be developed so that sport could be resumed as safely as possible. This set of best practice recommendations assembles early evidence for managing SARS-CoV-2 and integrates expert opinion to provide a uniform and pragmatic approach to enhance on-field and pitch-side safety for the clinician and player. The nature of SARS-CoV-2 transmission creates new hazards during resuscitation and emergency care and procedures. Recommendations for the use and type of personal protective equipment during on-field or pitch-side emergency medical care is provided based on the clinical scenario and projected risk of viral transmission.

Understanding conversations about alcohol between parents and their 15-17 year olds: a qualitative study.

BACKGROUND: There is an increasing awareness that parents can play an important role in shaping their children's attitudes towards alcohol and use of alcohol. However, there has been little research exploring the conversations parents have with their children about alcohol. The present study aims to address this gap by exploring conversations between parents and their 15-17 year old children. METHODS: Using a cross-sectional qualitative design, recruitment took place over two phases to allow a purposive maximum variation sample of parents and young people. Sixty-four participants (n = 48 parents; n = 16 young people aged 15-17 years) took part in semi-structured interviews. The sample was diverse and included participants from throughout the United Kingdom. Thematic analysis was used to analyse the data separately for all parents and 16 matched parent-child pairs. RESULTS: The parents' findings were summarised within the following thematic areas: 1) style of conversation; 2) triggers to conversations; 3) topics conveyed during conversations; and 4) supervision of child's alcohol consumption. Most parents were comfortable talking to their children about alcohol. It was considered that open and honest conversations helped demystify alcohol for young people. Most conversations that parents had with their children were brief and informal and a wide range of triggers to these conversations were reported. There was some indication that as children got older conversations became more frequent and more focused on safety. Overall, the matched parent-child interviews were very consistent regarding levels of child drinking, conversation starters, and topics discussed. However, in some cases parents underestimated their child's need and desire for further conversations about alcohol. CONCLUSIONS: Most parents felt comfortable having conversations with their older children about alcohol. However, parents also wanted more support with having these conversations, particularly about how to start a conversation and what to talk about. This study provides several recommendations to help parents have an open conversation about alcohol with their children. For example, brief, informal chats seem to be the most appropriate way of speaking to children about alcohol compared to a more formal, "sit-down" style of conversation.

Time-loss injuries versus non-time-loss injuries in the first team rugby league football: a pooled data analysis.

OBJECTIVE: To describe the injury rates in first team rugby league in terms of those injuries that require missed playing time and those that do not. DESIGN: A pooled data analysis from 2 independent databases. SETTING: Rugby league match and training environment over several seasons from 1990 to 2003. MAIN OUTCOME MEASURES: Injuries were reported as rates per 1000 hours of participation and as percentages with their associated 95% confidence intervals (CIs). RESULTS: A total of 1707 match injuries were recorded. Of these injuries, 257 required players to miss the subsequent match. The remaining 1450 injuries did not require players to miss the next game. They represented 85% (95% CI, 83-87) of all injuries received and recorded. The ratio of non-time-loss (NTL) to time-loss (TL) injuries was 5.64 (95% CI, 4.96-6.42). There were 450 training injuries, of which 81 were TL injuries and 369 NTL injuries. The NTL training injury rate was 4.56 (95% CI, 3.58-5.79) times higher than TL injury rate. CONCLUSIONS: Non-time-loss injuries represent the largest proportion of injuries in rugby league. If NTL injuries are not recorded, the workload of practitioners is likely to be severely underestimated.

'This Adds Another Perspective': Qualitative Descriptive Study Evaluating Simulation-Based Training for Health Care Assistants, to Enhance the Quality of Care in Nursing Homes.

Much of the UK's ageing population lives in care homes, often with complex care needs including dementia. Optimal care requires strong clinical leadership, but opportunities for staff development in these settings are limited. Training using simulation can enable experiential learning in situ. In two nursing homes, Health Care Assistants (HCAs) received training in clinical communication skills (Situation-Background-Assessment-Recommendation Education through Technology and Simulation, SETS: group training with an actor simulating scenarios); and dementia (A Walk Through Dementia, AWTD: digital simulation, delivered one-to-one). In this qualitative descriptive study, we evaluated the potential of this training to enhance HCAs' clinical leadership skills, through thematic analysis of 24 semi-structured interviews with HCAs (before/after training) and their managers and mentors. Themes were checked by both interviewers. HCAs benefitted from watching colleagues respond to SETS scenarios and reported greater confidence in communicating with registered healthcare professionals. Some found role-play participation challenging. AWTD sensitised HCAs to the experiences of residents with dementia, and those with limited dementia experience gained a fuller understanding of the disease's effects. Staffing constraints affected participation in group training. Training using simulation is valuable in this setting, particularly when delivered flexibly. Further work is needed to explore its potential on a larger scale.

Steps towards evidence-based foot-care for children: Behaviour and opinions of health professionals.

Allied health professionals (AHPs) working with children need the appropriate knowledge, skills and experiences to provide high-quality care. This includes using research to drive improvements in care and ensuring that knowledge and practices are consistent and build upon the best available evidence. The aim of this work was to understand more about the shared behaviours and opinions of health professionals supporting children's foot health care; how they find information that is both relevant to their clinical practice as well as informing the advice they share. A qualitative design using semi-structured, one-to-one, telephone interviews with AHPs was adopted. Thematic analysis was used to generate meaning, identify patterns and develop themes from the data. Eight interviews were conducted with physiotherapists, podiatrists and orthotists. Five themes were identified relating to health professionals: (a) Engaging with research; (b) Power of experience; (c) Influence of children's footwear companies; (d). Dr Google - the new expert and (e) Referral pathways for children's foot care. The findings indicate that the AHPs adopted a number of strategies to develop and inform their own professional knowledge and clinical practice. There could be barriers to accessing information, particularly in areas where there is limited understanding or gaps in research. The availability of online foot health information was inconsistent and could impact on how AHPs were able to engage with parents during consultations.

In-Person and Technology-Mediated Peer Support in Diabetes Care: A Systematic Review of Reviews and Gap Analysis.

PURPOSE: The purpose of this study is to report a systematic review of reviews of evidence and gaps focused on in-person and technology-mediated diabetes peer support and its impact on clinical, behavioral, and psychosocial outcomes. METHODS: We conducted a systematic review of reviews in accordance with the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines. Reviews published in English from December 1978 through December 2018 examining clinical, behavioral, and psychosocial outcomes were included. The search yielded 167 reviews that were examined for inclusion/exclusion criteria. RESULTS: Nine systematic reviews and meta-analyses meeting criteria were included. Findings suggest peer support interventions can have a positive impact on clinical (A1C, blood pressure, cholesterol, weight), behavioral (diabetes knowledge, being active, healthy eating, medication management, self-management, self-efficacy, empowerment), and psychosocial (social support, health and diabetes distress, depression, quality of life) outcomes. Research gaps exist related to understanding the effects of emerging technology-mediated peer support modalities and the effects of peer support on gestational diabetes. CONCLUSION: Many clinical, behavioral, and psychosocial benefits related to in-person and technology-mediated peer support exist. Diabetes care and education specialists should incorporate and recommend peer support resources for people with diabetes.

The Role and Value of Ongoing and Peer Support in Diabetes Care and Education.

PURPOSE: Increasing attention is being given to the challenges and emotional toll of managing diabetes. This Perspectives in Practice details the specialty's guiding documents for initial and ongoing support. It also defines various types of social support, including peer support, for optimal diabetes care. Focusing on peer support, this paper provides a review of the body of evidence demonstrating the value of peer support to improve clinical and behavioral outcomes. To achieve positive outcomes, it is optimal for people with diabetes to have access to ongoing support from their health care provider, including diabetes care and education specialists. They should also be made aware of, and given referral to options and opportunities for peer support. This Perspectives in Practice concludes with a call to action for diabetes care and education specialists to deliver to integrate and promote the value of peer support in the care they provide. CONCLUSION: Managing diabetes during the stages and ages of life is chronically challenging and complex. Various types of support offered by health care providers, including diabetes care and education specialists and others in the person's social support milieu, can positively affect emotional well-being. Health care providers should routinely assess their client's social supports and refer the person with diabetes and/or their caregivers to evidence-based types of peer support mutually determined to be of most value. Diabetes care and education specialists should increase their awareness of opportunities to integrate the value of and referral to peer support in their counseling and to gain greater insight into the diabetes-lived experience.

Pitch-side management of acute shoulder dislocations: a conceptual review.

The shoulder, specifically the glenohumeral joint, by virtue of its anatomical characteristics and biomechanics confers a large range of movement, which ultimately results in a joint that is inherently prone to becoming unstable. The incidence of acute traumatic shoulder dislocation varies within the sporting environment, commonly occurring following direct trauma. Anterior dislocations account for nearly 90% of all dislocations. While most are referred and managed in the emergency department, pitch-side relocation by experienced clinicians does occur prior to referral. The aim of this study was to delineate a guideline specifically for the pitch-side management of this common injury. A literature search of PubMed and Medline using the keywords 'prehospital', 'pitch-side', 'shoulder dislocation' and 'reduction' or 'relocation technique' was performed, and the available literature was reviewed and collated. Articles focusing on reduction techniques were then reviewed, with particular consideration on their applicability to a pitch-side setting. While studies exist that compare and contrast examination and reduction techniques, most are based in a hospital setting. To date, there is no standardised management protocol published for the initial management of an anterior dislocated shoulder in a pitch-side setting. This article addresses this discrepancy and proposes a structured, algorithmic approach to the pitch-side management of a shoulder dislocation. The article addresses factors to consider in a pitch-side setting, suitable techniques and postreduction care. While a systematic approach has been delineated in this article, we recommend those pitch-side medical practitioners who provide this form of support should have attended appropriate training and ensure adequate malpractice cover.

Normative adductor squeeze tests scores in rugby.

BACKGROUND: Groin pain is a common problem. Adductor squeeze tests are used to diagnose, monitor and prophylactically determine the risk of developing groin pain. This study defines normative adductor squeeze scores in professional rugby that will facilitate strength monitoring during screening. METHODS: Using a sphygnamometer, squeeze scores were collected, at one professional rugby club as part of the pre-season screening for two seasons. Scores were collected in four positions. For all positions mean strength and 95% confidence intervals were calculated. RESULTS: Data were collected for 81 athletes. Mean strength for adduction at 60° was 220.1 (212.2-228.1); 0° 211.1 (201.7-220.5); 90°90° 198.8 (190.0-207.7); 90°90° supported 224.9 (214.9-234.9). Backs had lower squeeze scores than forwards for 0°, 90°:90° and 90°:90° supported (p > 0.05 for all four tests); older players had lower scores, as did shorter and lighter players (p > 0.05 except for height with test 60° p = 0.048 and test 90°:90° supported p = 0.035). CONCLUSION: This study establishes references ranges for adductor squeeze tests for normative pre-season data in non-injured rugby players. This information will enable evaluation and inform return to play judgements following adductor related injury.

Leptin and energy metabolism in pulmonary tuberculosis.

BACKGROUND: Pulmonary tuberculosis is the classic cause of "consumption," but the pathogenesis of such wasting is largely unknown. Animal studies in other conditions suggest that leptin may be a mediator between proinflammatory cytokine activity and wasting. OBJECTIVE: We tested whether the leptin concentration, after control for body fat mass, is higher during active pulmonary tuberculosis than after recovery and whether it correlates with energy metabolism and proinflammatory cytokine activity. DESIGN: Nondiabetic adults with pulmonary tuberculosis (n = 32) were recruited into a prospective observational study. Patients found to be antibody positive for human immunodeficiency virus were excluded from the study. Dual-energy X-ray absorptiometry, indirect calorimetry, and food intake protocols were performed at baseline and after 1 and 6 mo of tuberculosis treatment. Fasting plasma leptin, tumor necrosis factor alpha and its soluble receptor, and interleukin 6 were measured by enzyme-linked immunosorbent assay. RESULTS: Resting energy expenditure was close to Harris-Benedict predictions and did not change significantly during treatment, but energy intake increased. Leptin concentration was correlated in a log-linear fashion with percentage body fat but was independent of cytokines and energy intake. There was no significant difference in leptin, corrected for energy balance and fat mass, at baseline and after 1 and 6 mo of treatment. CONCLUSIONS: These data are compatible with recovery from anorexia or starvation without discernible hyper- or hypometabolism. The close correlation of leptin with body fat mass is similar to observations in healthy subjects. No additional influence of disease state or proinflammatory cytokine activity was found. Leptin does not appear to be a component of the immune response to human pulmonary tuberculosis, and thus it cannot account for the weight loss and anorexia associated with tuberculosis.

Nutrient partitioning during treatment of tuberculosis: gain in body fat mass but not in protein mass.

BACKGROUND: Tuberculosis is an important cause of wasting. The functional consequences of wasting and recovery may depend on the distribution of lost and gained nutrient stores between protein and fat masses. OBJECTIVE: The goal was to study nutrient partitioning, ie, the proportion of weight change attributable to changes in fat mass (FM) versus protein mass (PM), during antimycobacterial treatment. DESIGN: Body-composition measures were made of 21 men and 9 women with pulmonary tuberculosis at baseline and after 1 and 6 mo of treatment. All subjects underwent dual-energy X-ray absorptiometry and deuterium bromide dilution tests, and a four-compartment model of FM, total body water (TBW), bone minerals (BM), and PM was derived. The ratio of PM to FM at any time was expressed as the energy content (p-ratio). Changes in the p-ratio were related to disease severity as measured by radiologic criteria. RESULTS: Patients gained 10% in body weight (P < 0.001) from baseline to month 6. This was mainly due to a 44% gain in FM (P < 0.001); PM, BM, and TBW did not change significantly. Results were similar in men and women. The p-ratio decreased from baseline to month 1 and then fell further by month 6. Radiologic disease severity was not correlated with changes in the p-ratio. CONCLUSIONS: Microbiological cure of tuberculosis does not restore PM within 6 mo, despite a strong anabolic response. Change in the p-ratio is a suitable parameter for use in studying the effect of disease on body composition because it allows transformation of such effects into a normal distribution across a wide range of baseline proportion between fat and protein mass.

Changes in auditory cortex and the development of mismatch negativity between 2 and 6 months of age.

Evoked responses to stimulus deviance were compared in infants between 2 and 6 months of age. A deviant stimulus containing a short silent gap occasionally replaced a repeating standard stimulus matched in duration, intensity and approximate spectral content. At two months, the standard stimuli evoked only a positive slow wave, and its amplitude was increased in response to the deviant stimuli. By 6 months, the deviant stimuli evoked an increased negativity at approximately 200 ms, similar to the mismatch negativity (MMN) response in adults. The results are considered with respect to layer-specific cortical maturation during this period.

For debate: consensus injury definitions in team sports should focus on encompassing all injuries.

OBJECTIVE: The purpose of this paper is to highlight the most effective method of collecting injury data by using a definition that encompasses all injuries into the data collection system. The definition provides an accurate picture of injury incidence and also allows filtering of records so that data can be reported in a variety of comparable ways. DATA SOURCES/SYNTHESIS: A qualitative review of literature in team sports, plus expert opinion, served as the basis for data collection strategies. Articles were retrieved from SportsDiscus and PubMed using the terms "sports injury definition" and "injury definition." These terms were searched for the period 1966 to November 2006. RESULTS: One of the major results (from this paper) that supports the use of an all-encompassing injury definition is that 70% to 92% of all injuries sustained fall into the transient category--that is, by only recording injuries that result in missed matches, the majority of injuries are missed and therefore injury rates are underreported. CONCLUSION: An injury definition should be the most encompassing definition that enables a true, global picture of injury incidence to be seen in participation in any team sport.

An analysis of injury rates after the seasonal change in rugby league.

OBJECTIVES: To determine whether the increase in the incidence of injury found for the first summer season in which rugby league (RL) was played in the UK was repeated in subsequent summer seasons. DESIGN: A retrospective and prospective cohort study design. SETTING AND PARTICIPANTS: Injuries were recorded from all players who took part in 141 games over 3 summer seasons (1997 to 1999) for 1 professional team. These were compared against rates from previously collected data for 3 earlier winter and 1 summer season. ASSESSMENT OF RISK FACTORS: For each injury it was recorded in which season it occurred; how many games or training sessions, if any, were subsequently missed; the type, site and severity of injury. MAIN OUTCOME MEASURES: Injuries were reported as rate per 1000 hours, also broken down into severity according to the number of games missed and whether subsequent training sessions were missed. RESULTS: A sustained increase in injury incidence has been found comparing summer RL over RL played in the winter. There was an increase in injury rates for all sites and types, but not all reached significance. CONCLUSIONS: Data collected over 6 seasons indicate a higher risk of sustaining an injury playing summer RL, but the cause may be related to a combination of factors. These may include the ground or weather conditions associated with summer rugby, player characteristics or changes in the game itself and future research needs to investigate these further.