Nationwide sports injury prevention strategies: A scoping review.

National strategies to prevent sports injuries can potentially improve health outcomes at a population level and reduce medical costs. To date, a compilation of the strategies that countries have attempted, and their effectiveness, does not exist. This scoping review sets out to: identify nationwide attempts at implementing sports injury prevention strategies; examine the impact of these strategies; and map them onto the Translating Research into Injury Prevention Practice (TRIPP) framework. Using Levac's scoping review method, we: (a) identified the research questions, (b) identified relevant studies, (c) identified the study selection criteria, (d) charted the data, and (e) reported the results. A search of MEDLINE, Scopus, SPORTDiscus, CINAHL, and Web of Science databases for articles published pre-June 2019 was conducted. We identified 1794 studies and included 33 studies (of 24 strategies). The USA (n = 7), New Zealand (n = 4), Canada (n = 3), the Netherlands (n = 3), Switzerland (n = 2), Belgium (n = 1), France (n = 1), Ireland (n = 1), South Africa (n = 1), and Sweden (n = 1) have implemented nationwide sports injury prevention strategies with 29 (88%) of the included studies demonstrating positive results. Mapping the strategies onto the TRIPP framework highlighted that only four (17%) of the 24 included strategies reported on the implementation context (TRIPP Stage 5), suggesting an important reporting gap. Nationwide sports injury prevention efforts are complex, requiring a multidimensional approach. Future research should report intervention implementation data; examine the implementation context early in the research process to increase the likelihood of real-world implementation success; and could benefit from incorporating qualitative or mixed research methods.

Alcohol Sponsorship and Esports: Reinforcing the Need for Legislative Restrictions on Alcohol Sponsorship.

Alcohol sponsorship in esports is on the rise. Many esports athletes and viewers are children and young people. Alcohol sponsorship of esports places millions of children and young people at risk of alcohol-related harm. Action on alcohol sponsorship in esports may provide policy makers an opportunity for greater restrictions on all alcohol sports sponsorship.

Prevalence of therapeutic use exemptions at the Olympic Games and association with medals: an analysis of data from 2010 to 2018.

OBJECTIVES: The percentage of athletes with Therapeutic Use Exemptions (TUEs) competing in elite sport and the association with winning medals has been a matter of speculation in the absence of validated competitor numbers. We used International Olympic Committee (IOC) and World Anti-Doping Agency (WADA) data to identify athletes competing with TUEs at five Olympic Games (Games) and a possible association between having a TUE and winning an Olympic medal. METHODS: We used the IOC's competition results and WADA's TUE database to identify the number of TUEs for athlete competitions (ACs, defined as one athlete competing in one event) and any associations with medals among athletes competing in individual competitions. We calculated risk ratios (RR) for the probability of winning a medal among athletes with a TUE compared with that of athletes without a TUE. We also reported adjusted RR (RRadj) controlling for country resources, which is a potential confounder. RESULTS: During the Games from 2010 to 2018, there were 20 139 ACs and 2062 medals awarded. Athletes competed with a TUE in 0.9% (181/20 139) of ACs. There were 21/2062 medals won by athletes with a TUE. The RR for winning a medal with a TUE was 1.13 (95% CI: 0.73 to 1.65; p=0.54), and the RRadj was 1.07 (95% CI: 0.69 to 1.56; p=0.73). CONCLUSION: The number of athletes competing with valid TUEs at Games is <1%. Our results suggested that there is no meaningful association between being granted a TUE and the likelihood of winning a medal.

Compliance with needle-use declarations at two Olympic Winter Games: Sochi (2014) and PyeongChang (2018).

OBJECTIVES: We describe compliance with the 'IOC Needle Policy' at two Winter Olympic Games (Sochi and PyeongChang) and compare these findings to those of the Summer Olympic Games of Rio de Janeiro. METHOD: All needle-use declaration(s) (NUD) received during the course of the 2014 and 2018 Olympic Games were reviewed. We recorded socio-demographic data, the nature and purpose of needle use, product(s) injected, and route of administration. Data were analysed descriptively. RESULTS: In total, doctors from 22 National Olympic Committees (NOCs) submitted 122 NUD involving 82 athletes in Sochi; in PyeongChang, doctors from 19 NOCs submitted 82 NUD involving 61 athletes. This represented approximately 2% of all athletes at both Games, and 25% and 20% of all NOCs participating in Sochi and PyeongChang, respectively. No marked differences in the NUD distribution patterns were apparent when comparing the two Winter Olympic Games. The most commonly administered substances were as follows: local anaesthetics, non-steroidal anti-inflammatory drug and glucocorticoids. Physicians submitted multiple NUD for 24% of all athletes who required a NUD. CONCLUSION: A limited number of NOCs submitted NUD suggesting a low incidence of needle use or limited compliance (approximately 2%). A key challenge for the future is to increase the rate of compliance in submitting NUD. More effective education of NOCs, team physicians and athletes regarding the NUD policy, its purpose, and the necessity for NUD submissions, in association with the enforcement of the appropriate sanctions following non-compliance are needed.

Outstanding performances during elite-standard short and middle-distance finals and the hyperandrogenism regulation-A detailed analysis of Caster Semenya's results.

Recently, there has been much controversy over the International Association of Athletics Federation (IAAF) regulations regarding eligibility to compete and natural testosterone levels in female athletes. Much interest lies in the analysis of Caster Semenya's extraordinary performance. The objective of this work were, a) Complete an analysis of Caster Semenya's results during the 800m finals and b) search for existing similar performances by other female athletes. We analysed the results of the finals of all IAAF World Championships and Olympic Games from 1984-2016, including the 800m results of the Diamond Leagues 2016-2018. Exponential curves were fit to the data to characterise and predict performance for each event. Caster Semenya's finishing times before her ineligibility to compete and after the suspension of the IAAF hyperandrogenism regulation were found to be 1.24% and 1.49%, respectively, faster than the characteristic performance of the elite-standard in the women's 800m final. Other female athletes, with finishing times faster than the ones predicted by the characteristic curves were also discovered. The percentage difference in performance between Caster Semenya and the other participants did not reach 3% in the 800m event. No conclusions can be drawn regarding extraordinary results ever performed during the 100m, 200m or 400m finals.

Out with the old, in with the new: how changes in cricket helmet regulations affect the vision of batters.

The International Cricket Council recently introduced new regulations for helmets in cricket. Amongst other changes, these regulations limit batters from adjusting the gap between the peak and the grille, resulting in some controversy over whether the new helmet design reduces visibility of the ball. This study compared the visual field of individuals when wearing an old helmet that does not conform to the new regulations, and the equivalent replacement which does. The visual field of 10 male participants was tested whilst wearing an old and new helmet. The new helmet resulted in a significant reduction in the visual field of the wearer (M = 66.1 out of 76 points seen in the new helmet vs. 74.8 seen with the old helmet), with the restriction predominantly confined to the superior visual field. The new regulations do appear to restrict the visual field of batters, confirming the anecdotal reports of players. However, the majority of this restriction occurs in the superior field, suggesting that the impact on batting performance may be limited. The importance of considering the impact that new helmet regulations can have on vision, batting performance, and player safety is discussed.

Transgender Policy in Sport, A Review of Current Policy and Commentary of the Challenges of Policy Creation.

This review starts with a brief history of sex policy in sport followed by an exploration of the current state of transgender sport policies. Transgender in sport, from the high school to the professional level, is a frequent news topic. Fairness in women's athletics is at the center of transgender sport policy deliberations and public debate. Despite a long history of policy attempts and revisions, the female category in sport is not precisely and universally established, complicating transgender athlete policy development. Scientific evidence is scant on fairness for transgender athletes. For a variety of social factors, many transgender athletes do not have a positive experience in sports and the younger is the athlete the more challenging it becomes to create inclusive rules. Challenges remain in making competition rules fair, but inclusive, so that transgender athletes participate in sport. The medical and scientific community will continue to provide key input.

Opinion paper: scientific, philosophical and legal consideration of doping in sports.

The term doping is generally used to indicate practices based on the use of performance-enhancing drugs (PEDs) or the abuse of medical therapies. Mostly analysed by doctors and officials, doping nevertheless also requires a philosophical consideration to avoid being simplistically portrayed as an isolated practice. To do this, we need to pay attention to the contradictions and paradoxes in the modern approach to doping in sport. In this context, doping is not only relevant to the health of an individual involved in the violation of World Anti-Doping Agency (WADA) criteria, but it actually represents a double-edged phenomenon containing ethical and legal points of view. Several philosophical items affect the ethics of doping. While, indeed, through a deontological vision it is easy to morally condemn an athlete who takes the decision to turn to doping, the same condemnation becomes difficult when the practice of doping is compared with the strong social demand of winners in every field of life. This point must be considered to prevent doping from becoming accepted as a daily practice to excel at all costs and regarded not only as normal but as a necessity for those participating in sport at both an amateur and professional level. Furthermore, a complete discussion on doping has to consider not only the philosophy of performance-enhancing drug abuse, but also the widespread practice of an inappropriate and excessive intake of certain dietary supplements with the unique and obsessive purpose (similar to doping) of increasing physical or mental performance. Based on the above, the aim of this paper is to provide a critical opinion of the doping problem and its related practices and analyze possible solutions considering issues that go beyond the impact of doping on health and reflect on whether it is right or not that an athlete does all he can to improve his performance.

Performance-Enhancing Drugs, Sport, and the Ideal of Natural Athletic Performance.

The use of certain performance-enhancing drugs (PED) is banned in sport. I discuss critically standard justifications of the ban based on arguments from two widely used criteria: fairness and harms to health. I argue that these arguments on their own are inadequate, and only make sense within a normative understanding of athletic performance and the value of sport. In the discourse over PED, the distinction between "natural" and "artificial" performance has exerted significant impact. I examine whether the distinction makes sense from a moral point of view. I propose an understanding of "natural" athletic performance by combining biological knowledge of training with an interpretation of the normative structure of sport. I conclude that this understanding can serve as moral justification of the PED ban and enable critical and analytically based line drawing between acceptable and nonacceptable performance-enhancing means in sport.

Determination and regulation of body composition in elite athletes.

In 2011, the International Association of Athletics Federations (IAAF) and IOC introduced a 'hyperandrogenism' rule that excluded women with a serum testosterone >10 nmol/L from participating in elite sport. This rule was based on the false premise that the greater lean body mass in men was a consequence of their higher serum testosterone. This rule did not have scientific backing and the Court of Arbitration for Sport subsequently rescinded the rule following an appeal from an Indian athlete barred from the Commonwealth Games. This review covers the scientific knowledge about the development and regulation of body composition in humans but also considers the lessons learnt from evolution and breeding in animals. The importance of heredity has been documented in family and twin studies. The roles of growth hormone and sex steroids are reviewed. The Androgen Insensitivity Syndrome (AIS) is considered as a model of the role of testosterone in development of body composition and also as evidence of the importance of other factors carried on the Y-chromosome that are of prime importance but have been systematically ignored. Finally the key factors determining body composition are considered and placed in a suggested order of importance.

Hyperandrogenic athletes: performance differences in elite-standard 200m and 800m finals.

The purpose of this study was to examine whether the difference in elite-standard track and field performance between women athletes with and without hyperandrogenism reaches the 10-12% difference in performance between men and women, using only results from elite-standard track and field final competitions. Officially available data from two hyperandrogenic women (Caster Semenya and Dutee Chand) were compared with the characteristic performance of 200m and 800m elite-standard finals. The finishing times of Caster Semenya, before her ineligibility to compete in 2009 and after the suspension of the 2011 IAAF Hyperandrogenism Regulations were found to be respectively 1.24% and 1.49% faster than the predicted performance in 800m finals. When compared with the result of the second classified, the difference was respectively 0.65% and 2.08%. The analysis of the finishing times of Dutee Chand did not lead to any conclusions due to the lack of available data. The present study indicates that the percentage difference in performance between women with and women without hyperandrogenism does not reach the 3% difference requested by the Court of Arbitration for Sport for the reinstatement of the Hyperandrogenism Regulations, neither does it reach the 10% accepted range of difference in performance between men and women.

Drugs in Sport - A Change is Needed, but What?

Performance enhancing drugs (PEDs) confound much of what is considered great about sport. Sport is generally associated with excellent health outcomes that can be challenged by the direct toxicities of PEDs and the indirect effects of enabling the body to push beyond normal physiological reserves, thereby potentiating the risk of some exercise-associated conditions such as atrial fibrillation. Sport should also be a source of aspirational behavioural change but this 'legacy effect' of elite sport is modest, perhaps due in part to the public disillusionment brought about by repeated drug scandals. Elite sport is an extremely lucrative industry and, whilst this money could be used to support grass roots campaigns promoting exercise, it also provides incentive for a "win at all costs" mentality that provides the substrate for drug use to enhance performance. This article discusses these issues and asserts that the destructive influence of PEDs has arguably reached a tipping point at which the reputation of professional sport is starting to become irrevocably damaged. We assert that there is a need for change, and that doctors need to be a part of this change. Repeated attempts by the anti-doping authorities to stay ahead of the PED "industry" have failed, and we argue that new approaches now need to be considered. The controversial concept of a more permissive policy in which physiological limits are set has been championed by some; whilst we propose a more restrictive process in which all drugs are banned except for a few commonly used drugs that are not associated with performance enhancement. This article is not designed to provide definitive answers but rather to promote debate and consideration of novel approaches to what may be sport's greatest challenge - the use of performance-enhancing drugs.

The Fluidity of Gender and Implications for the Biology of Inclusion for Transgender and Intersex Athletes.

One of the most contentious issues in modern day sport arises when sports are divided into male and female categories. The International Association of Athletics Federations' (IAAF) previous policy regulating intersex athletes was suspended by the Court of Arbitration for Sport (CAS), resulting in a new policy. The challenge faced by the governing body of athletics is to formulate a policy that upholds both international law and the Olympic charter that stipulates athletes compete without discrimination of any kind. Implementation of the policy has been delayed until after a verdict, expected no later than March 26, 2019, in the Semenya versus IAAF trial in the Court of Arbitration for Sport. If the policy is enacted, it will restrict athletes from competing in the female athletics category with specific differences of sex development (DSD) in races from 400 m up to the mile in international level competitions unless they lower their natural testosterone (T) levels below 5 nmol·L. To thoroughly assess this new IAAF policy, one needs to appreciate its legal, sociological, and scientific underpinnings but also the history of previous policies attempting to define precisely how athletes should be divided into male and female categories. We previously proposed a system to deal with gender variant athletes that relied on a determination of an "athlete/athletic gender." The concept of "athlete gender" was presented to multiple audiences, and the resulting survey is included. A large majority of participants (71% of 153) who answered the survey agreed with the idea of an athlete gender. This position also was accompanied by the request for more studies (20% of those who agreed) and concern over the process of hormone monitoring (32% of those who agreed) to avoid doping misuse. The primary argument of those participating in the survey that disagreed with the position (23% of 153) was that biological differences between males and females remained even after the transition (47% of opposing comments). Mixed gender/sex competitions provide unique opportunities for athletes to compete against one another outside of the traditional male/female divide and pave the way for a more flexible approach for dealing with gender variant athletes.

New and Recurrent Concussions in High-School Athletes Before and After Traumatic Brain Injury Laws, 2005-2016.

OBJECTIVES: To examine the trends of new and recurrent sports-related concussions in high-school athletes before and after youth sports traumatic brain injury laws. METHODS: We used an interrupted time-series design and analyzed the concussion data (2005-2016) from High School Reporting Injury Online. We examined the trends of new or recurrent concussion rates among US representative high-school athletes participating in 9 sports across prelaw, immediate-postlaw, and postlaw periods by using general linear models. We defined 1 athlete exposure as attending 1 competition or practice. RESULTS: We included a total of 8043 reported concussions (88.7% new, 11.3% recurrent). The average annual concussion rate was 39.8 per 100 000 athlete exposures. We observed significantly increased trends of reported new and recurrent concussions from the prelaw, through immediate-postlaw, into the postlaw period. However, the recurrent concussion rate showed a significant decline 2.6 years after the laws went into effect. Football exhibited different trends compared with other boys' sports and girls' sports. CONCLUSIONS: Observed trends of increased concussion rates are likely attributable to increased identification and reporting. Additional research is needed to evaluate intended long-term impact of traumatic brain injury laws.

How to justify a ban on doping?

BACKGROUND: This article deals with arguments that challenge the possibility of an ethical justification for a doping ban. HYPOTHESIS/PURPOSE: It shows that a justification for the doping ban is only possible if its implementation can be safeguarded. STUDY DESIGN: Systematic review. METHODS: Based on the proposition of the game theory, this article examines the scope of the arguments of naturalness, health, equal opportunity and fairness used in scientific literature. RESULTS/CONCLUSIONS: Ceteris paribus, athletes will always prefer a situation that presents no health risk to a situation in which they face a threat to their health. They will therefore consent to a doping ban on the condition that it is ensured that all parties are bound to this rule, so that anyone complying with the rules will not be afraid of losing the competition as a result. For even if we condoned self-harm, it could still be argued plausibly that the individual should not suffer more disadvantages than absolutely necessary for the sake of gaining an advantage over others. Of course, it is possible to plead for a restricted approval of doping measures with acceptable risk. But even taking minor risks would not seem sensible under the condition that all participants without exception adhere to the same conditions when there is the option to renounce the (avoidable) risks. So as far as the use of performance-enhancing substances or methods is concerned, we can maintain that even if minor health risks are to be expected, a ban on doping can be justified from an ethical point of view.

Ethics, Nanobiosensors and Elite Sport: The Need for a New Governance Framework.

Individual athletes, coaches and sports teams seek continuously for ways to improve performance and accomplishment in elite competition. New techniques of performance analysis are a crucial part of the drive for athletic perfection. This paper discusses the ethical importance of one aspect of the future potential of performance analysis in sport, combining the field of biomedicine, sports engineering and nanotechnology in the form of 'Nanobiosensors'. This innovative technology has the potential to revolutionise sport, enabling real time biological data to be collected from athletes that can be electronically distributed. Enabling precise real time performance analysis is not without ethical problems. Arguments concerning (1) data ownership and privacy; (2) data confidentiality; and (3) athlete welfare are presented alongside a discussion of the use of the Precautionary Principle in making ethical evaluations. We conclude, that although the future potential use of Nanobiosensors in sports analysis offers many potential benefits, there is also a fear that it could be abused at a sporting system level. Hence, it is essential for sporting bodies to consider the development of a robust ethically informed governance framework in advance of their proliferated use.

Sport-Related Concussion Reporting and State Legislative Effects.

OBJECTIVE: To investigate concussion rates and reporting frequencies in high school and collegiate athletes in 2013, compare results to those obtained from 1999 to 2002, and examine to what extent the 2012 Wisconsin state concussion law affected reporting in 2013. DESIGN: Retrospective 2013 survey compared with prior survey. SETTING: High schools and colleges in the Milwaukee, Wisconsin, area. PARTICIPANTS: Athletes (N = 784) from multiple sports were surveyed in 2013. Football players (N = 1532) from 1999 to 2002 completed the same measure. MAIN OUTCOME MEASURES: Both surveys assessed concussion history, concussion incidence during the current season, whether incident concussions were reported, who concussions were reported to, and reasons for not reporting. The 2013 survey also assessed awareness of the Wisconsin state law and its effect on reporting. RESULTS: Rates of concussion in the surveyed season were comparable to previous findings from 1999 to 2002 (16.6% vs 15.3%, P = 0.558). Notably, athletes were significantly more likely to report their concussions in 2013 (70.6% vs 47.3% previously, P = 0.011). Among high school athletes surveyed, 59.5% were aware of the Wisconsin state law, with 55.1% stating it would make them more likely to report a concussion. CONCLUSIONS: Rates of concussion for 1 sport season have not changed significantly over the past 14 years. The percentage of concussions that are reported to someone has increased significantly. Awareness of the Wisconsin state law does not fully account for the increase in concussion reporting. CLINICAL RELEVANCE: Given the finite amount of knowledge regarding the influence of concussion-related cultural and legal changes, these findings will help to inform clinicians of the current concussion milieu from the perspective of athletes. It will inform practitioners involved in concussion management to what extent athletes are aware of and report concussions.

Never blame the umpire - a review of Situation Awareness models and methods for examining the performance of officials in sport.

As sport becomes more complex, there is potential for ergonomics concepts to help enhance the performance of sports officials. The concept of Situation Awareness (SA) appears pertinent given the requirement for officials to understand what is going on in order to make decisions. Although numerous models exist, none have been applied to examine officials, and only several recent examples have been applied to sport. This paper examines SA models and methods to identify if any have applicability to officials in sport (OiS). Evaluation of the models and methods identified potential applications of individual, team and systems models of SA. The paper further demonstrates that the Distributed Situation Awareness model is suitable for studying officials in fastball sports. It is concluded that the study of SA represents a key area of multidisciplinary research for both ergonomics and sports science in the context of OiS. Practitioner Summary: Despite obvious synergies, applications of cognitive ergonomics concepts in sport are sparse. This is especially so for Officials in Sport (OiS). This article presents an evaluation of Situation Awareness models and methods, providing practitioners with guidance on which are the most suitable for OiS system design and evaluation.