An examination of changes in psychological status across four phases of injury recovery and return to sport: A prospective weekly study of competitive athletes from acute care to return to sport.

While ample research has shown that sport injuries are associated with poor psychological status, scant attention has been given to changes in injured athletes' psychological status over the full course of recovery and return to sport. The aim of the present study was to prospectively investigate potential changes in injured athletes' psychological status across four phases of recovery and return to sport. A total of 38 severely injured adult competitive athletes (58% female; mean age 24.1 ± 7.18 years) participated in this prospective weekly investigation (n = 319 observations). Athletes' were asked to indicate their current phase of recovery or return to sport (acute care, rehabilitation, adapted training, or full return to sport) after which they responded to visual analog scales assessing post-injury psychological status, including: perceived pain (frequency and intensity), emotions (positive and negative), anxiety (cognitive and physiological), motivation, self-efficacy, and satisfaction. During the acute care phase, participants showed higher scores of perceived pain, and physiological anxiety compared to the other phases. During the adapted training phase, amotivation was higher than in the acute care phase, and self-efficacy was lower than in other phases. At full return to sport, athletes showed less perceived pain, cognitive anxiety, and more satisfaction than during other phases. The present study provides a deeper prospective understanding of changes in athlete's psychological status over the course of injury recovery and return to sport and highlight the importance of monitoring psychological status.

Using a socioecological approach to explore healthy lifestyle in elite sport: a qualitative study of French athletes', coaches', and managers' perspectives.

Elite athletes are continually subjected to a range of constraints specific to high performance, and these can have a negative impact on their health. Although many studies have explored the individual factors related to risky behaviours and disorders in elite sport contexts, few have focused on health promotion. Consequently, the interpersonal, institutional, and policy factors of the health-related behaviours of elite athletes are still poorly explored. Based on the socioecological model, this study aimed to identify the factors involved in the health-related lifestyle of elite athletes. Semi-structured interviews were conducted with 45 participants: athletes (N = 32), their coaches (N = 6) and the managers of elite sport centres (N = 7). Both deductive and inductive thematic analyses were performed. Our results highlight the views of the actors. Regarding intrapersonal factors, resilience qualities and health literacy appeared as key factors in influencing the health-related lifestyle of elite athletes. At the interpersonal level, parents and coaches emerged as the main sources of educational support. Regarding institutional factors, the health policies of the elite sport centres were key factors in supporting the athletes' healthy lifestyle. These results encourage the development of health promotion programs at different levels of intervention.

Visual Search Strategies of Elite Fencers: An Exploratory Study in Ecological Competitive Situation.

This study investigates the visual activity of fencers in conditions resembling official competitions. Previous research in experimental conditions has shown that experts focus on specific areas of the torso and the armed arm to control movement initiation. Eight right-handed fencers (epee: two males, one female; foil: one male; sabre: two males, two females) participated in a simulated competition, wearing an eye tracker during one bout. The findings showed that the main fixation in foil and sabre is the upper torso, while in epee, it is the lower torso. In epee and sabre, the upper torso is viewed about 50% of the time, with three other areas also observed, while in foil, the fixation is totally directed to the upper torso. Additionally, two new areas of interest were identified: the score machine and an area involving fixations other than the opponent. The study found no direct link between visual activity and performance. The visual search strategy varies among weapons, with foil using a gaze anchor or foveal spot and epee and sabre utilizing a visual pivot due to the discipline's inherent rules. The study also emphasizes that competition-like conditions can disrupt visual activity with external stimuli, possibly affecting performance.

Effects of Mindfulness for Performance Programme on Actual Performance in Ecological Sport Context: Two Studies in Basketball and Table Tennis.

Mindfulness For Performance is a programme that has been developed over 15 years. It aims to help athletes maintain effective attentional focus regardless of the disruptive sensations and thoughts induced by the performance situation. It is inspired by Mindfulness Based Stress Reduction and Acceptance Commitment Therapy programmes and has been adapted to the specificities of sport. It is composed of three steps: (a) psychoeducation and identification of the focus of attention, (b) mindfulness and acceptance training, and (c) integrating skills acquired into training and competition. This article reports the effects of MFP in two studies in national basketball players and in young table tennis players. The first study showed that mindfulness skills and free-throw accuracy during basketball games increased more in the experimental group than in the control group. Table tennis results revealed that participants who showed the highest percentage of adherence to the programme benefited more from MFP training in terms of performance outcome (i.e., accumulated points collected from published results compared with the baseline phase) than participants who showed weaker percentages of adherence to the programme. Both studies provided some evidence on the effects of MFP on specific performance indicators (i.e., free-throw accuracy in basketball and ranking points in table tennis), but this needs to be confirmed by further research measuring other relevant performance indicators. The impact and conditions of adherence also deserve more consideration.

Therapeutic Drug Monitoring of Direct Oral Anticoagulants May Increase Their Benefit-Risk Ratio.

The attractiveness of direct oral anticoagulants (DOACs) over vitamin K antagonists, in addition to a better benefit-risk ratio, stems from the fact that no therapeutic drug monitoring is deemed necessary. This has been recently mitigated by the fact that increased dabigatran (D) plasma levels have been associated with hemorrhages, and is currently under scrutiny of the European Medicines Agency. We aimed to evaluate, in real conditions of use, whether patients with out-of-range DOAC blood concentrations (too high or too low) were associated with bleeding or thrombosis. Patients treated with D or rivaroxaban (R) were prospectively included in a hospital cohort. D and R plasma levels were measured by high-pressure liquid chromatography-tandem mass spectrometry-at the physician's demand. We defined concentration range as "expected" within the 95% confidence interval of the mean concentration obtained from pivotal trials, and "out of range" when concentrations were outside of that interval. A blind assessment of concentrations versus occurrence of bleeding or thrombosis was performed by means of univariate and multivariate analysis. Three hundred and twenty-two patients (mean age 78.5 years ± 13.1), treated with D or R were included consecutively. They had a mean CHA2DS2-VASc at 4.4 ± 1.7 and a mean HAS-BLED score at 1.7 ± 0.9. Irrespective of the DOAC prescribed, patients presenting with out-of-range concentrations had significantly more bleeding or thrombosis than patients with expected concentrations (P < 0.001). Patients with bleeding were more prone to have concentrations beyond the 95 percentile (N = 62, P < 0.001), whereas patients with thrombosis were more likely to have concentrations below the fifth percentile (N = 26, P < 0.05). The main risks associated with hemorrhages were abnormal concentrations, a high HAS-BLED score, the patient's age, and the creatinine blood level. For thrombosis, a concentration below the fifth percentile was the only risk factor that was significant in our cohort. While D and R under current recommendation have a better benefit-risk ratio than warfarin, their safe usage could be further optimized by some degree of therapeutic monitoring.

Anxiety and Motivation to Return to Sport During the French COVID-19 Lockdown.

Feeling anxious and presenting self-determined motivations about returning to sport after a break may impair sport performance and increase the risk of sustaining an injury. Hence, the aim of this study is to explore differences in anxiety and motivation to return to sport according to gender, expertise, training status before and during the lockdown, and athletes' availability (i.e., injury status) at the time of the lockdown. A total of 759 competitive athletes (49% female; mean age: 27 ± 10 years old) completed the cross-sectional study. Participants were invited to state their expertise, training status before and during the lockdown (did they have a training program), and whether they were injured at the start of the lockdown. Additionally, participants filled out psychometric self-report measures of anxiety (TFAI-return) and motivation (SMS-return) to return to sport. Due to non-normal distributions in the TFAI and SMS scores, non-parametric group comparisons were performed to compare participants for each categorical variable: non-parametric correlation tests were also performed to test the associations between continuous variables. Group comparisons showed higher scores of anxiety for females, younger athletes, athletes practicing and competing at the highest level, and athletes without a training program during the lockdown. Moreover, results suggested lower motivation scores (i.e., autonomous and controlled) for older athletes, experts (practicing for more than 10 years), athletes practicing and competing at a lower level, and athletes without a training program during the lockdown. Additionally, participants who were injured at the start of the lockdown reported higher scores of cognitive anxiety to return to sport than non-injured participants. The results of this study suggest that elite athletes may have suffered from external pressures to return to sport during the lockdown. Additionally, participants with a training program during the lockdown seemed to be less anxious and more self-determined to return to sport after the lockdown. Future studies may focus on the impact of cognitive behavioral interventions on anxiety and motivation to return to sport.

Major bleeding events in octagenarians associated with drug interactions between dabigatran and P-gp inhibitors.

BACKGROUND: The direct oral anticoagulant dabigatran does not require any routine therapeutic drug monitoring. Yet, concerns about possible drug interactions susceptible to increase its inherent bleeding risk, especially in very elderly patients, have been raised recently. The aim of our study was to evaluate to what extent the co-prescription of P-gp inhibitors with dabigatran may increase its plasma levels and lead to bleeding complications, in usual conditions of care of the very elderly. METHODS: Fifty-eight patients over 85 years old with non valvular atrial fibrillation receiving dabigatran were included in a prospective cohort. Prescriptions were screened for the presence of P-gp inhibitors (Group A) or not (Group B). RESULTS: Patients from Group A had increased dabigatran mean plasma concentrations as compared with patients from Group B (A vs. B: 182.2 ± 147.3 vs. 93.7 ± 64.9 ng/mL). One third of the patients from Group A had dabigatran concentrations that were deemed "out of range" versus none in Group B (P = 0.05). This was associated with more frequent bleeding complications in Group A (A: 30.4%, B: 8.6%, P = 0.04). CONCLUSION: In our cohort of very elderly patients, at least, the co-prescription of dabigatran with P-gp inhibitors in usual conditions of care resulted in higher dabigatran plasma concentrations and more frequent bleeding occurrences.

Nivolumab Causing a Polymyalgia Rheumatica in a Patient With a Squamous Non-Small Cell Lung Cancer.

The anti-programmed cell-death-1 antibody, nivolumab, has been recently approved for the treatment of advanced non-small cell lung cancer. Although, today, immune-related adverse effects such as dermatologic, digestive, hepatic, and endocrine toxicities are well-known with immune checkpoint inhibitors, rheumatic diseases are less well described. Herein, we report the case of a patient without a history of arthritis who developed polymyalgia rheumatica after 13 cycles of nivolumab used for the treatment of advanced non-small cell lung cancer. Laboratory evidence of inflammatory syndrome, articular echography, and clinical presentation with classical symptoms and also distal manifestations were suggestive of this chronic inflammatory disorder. Because of a relevant pain, clinicians were forced to suspend immunotherapy. Nevertheless, due to glucocorticoid therapy, the patient's symptoms have decreased progressively. Moreover, nivolumab was reintroduced 8 weeks later, whereas prednisone (10 mg) was continued, without any recurrence symptoms. To conclude, our case suggests that polymyalgia rheumatica might be a very disabling anti-programmed cell-death-1 immune-related adverse effect.

Athletes' expectations with regard to officiating competence.

This study aimed to identify the cues upon which athletes rely when developing their expectations with regard to the competence of sports officials and to examine the sources of information, which are given priority in different kinds of sport (i.e. team, racquet and fighting sports). A questionnaire - the Athlete Perception of Sports Officials Questionnaire (APSO-Q) - was developed in which athletes (N=472) were asked to indicate the influence of 32 cues on their impressions of sports officials. Exploratory factor analysis (EFA) yielded a four-factor model (i.e. static cues, psychological, communicational and performance cues). Athletes mostly rely on psychological and personal communication attributes when evaluating officiating competence. Moreover, team players perceived that static cues were more influential when forming their expectations of sports officials than racquet players and fighting contestants. Such findings may have implications for athlete-official relationships and training of sports officials.