Menstrual cycle characteristics, perceived impact on performance, and barriers to communication: Perspectives of high-performance adolescent athletes in Singapore.

The purpose of this study was to examine the menstrual cycle (MC) characteristics, explore the impact on performance, and identify barriers to and facilitators of MC-related communication among high-performance female adolescent athletes in Singapore. Ninety athletes (15.4 ± 1.8 years) from multiple sports completed an online questionnaire. Eighty-four athletes were postmenarcheal (menarcheal age 11.9 ± 1.3 years), including two who were using an oral contraceptive pill (OCP). Secondary amenorrhea, current or history of, was self-reported in 16% of athletes. Sixty-two percent and 67% of non-OCP athletes perceived that the MC affected their ability to train and compete, respectively. Athletes preferred speaking to a parent (85%) and a female figure (67%) about MC-related concerns. Through thematic analysis, three barriers to communication were constructed: (1) pervasive menstrual stigma, (2) constraints of the training environment, and (3) the low value placed on MC-related conversations. Two facilitators of communication were constructed: (1) respect athletes' individual experiences as menstruating girls and (2) foster a safe space for MC-related conversations. Findings demonstrated that menstrual irregularities are common in adolescent athletes and screening for MC disorders, particularly primary amenorrhea should be undertaken in this population, with clear support pathways for management including symptom mitigation. To support athletes in raising MC-related concerns when needed, structured communication pathways that consider individual preferences and involve a (female) point of contact should be established within the training environment. Improving menstrual health literacy among adolescent athletes before any misinformation or negative perceptions are firmly established may contribute to longevity in their athletic careers.

Influence of the Intention to Lean the Body Forward on Kinematics and Kinetics of Sprinting for Active Adults.

This study investigated the influence of the intention to lean the body forward on spatiotemporal and ground reaction force variables during the acceleration phase of a sprint. Fourteen active adults performed two 50 m sprints (with and without the intention to lean), during which spatiotemporal variables and impulses were obtained using a long force platform system. Effect size (Cohen's d) was used to examine the differences between the two trials. We found that running speed and net anteroposterior impulse did not change by the intention for all steps. However, step frequency increased in the initial two steps through decreases in support time and flight time by the intention. Moreover, these shorter support and flight times were caused by a decrease in the vertical impulse. The propulsive impulse did not change during the initial part of acceleration phase, but the braking impulse decreased at the first step. This study demonstrates that an intention to lean the body forward leads to a smaller braking impulse and a higher step frequency through shorter support and flight times and a smaller vertical impulse during the initial part of the acceleration phase of a sprint.

Improving the performance of nutrition screening through a series of quality improvement initiatives.

BACKGROUND: Nutrition screening identifies patients at risk of malnutrition to facilitate early nutritional intervention, yet incompletion and error rates of 30%-90% have been reported for commonly used screening tools. The effect of a series of quality improvement initiatives in improving the referral process and the overall performance of the 3-Minute Nutrition Screening (3-MinNS) tool was assessed for patients at National University Hospital (Singapore) at risk for malnutrition. METHODS: Annual audits were carried out from 2008 through 2013 on 4,467 patients. Performance gaps were identified and addressed through interventions, including (1) implementing a nutrition screening protocol, (2) nutrition screening training, (3) nurse empowerment for online dietetics referral of at-risk cases, (4) a closed-loop feedback system, and (5) removing a component of 3-MinNS that caused the most errors without compromising its sensitivity and specificity. RESULTS: Nutrition screening error rates were 33% and 31%, with 5% and 8% blank or missing forms, in 2008 and 2009, respectively. For patients at risk of malnutrition, referral to dietetics took up to 7.5 days, with 10% not referred at all. After the interventions, nonreferrals decreased to 7% (2010), 4% (2011), and 3% (2012 and 2013), and the mean turnaround time from screening to referral was reduced significantly from 4.3 +/- 1.8 days to 0.3 +/- 0.4 days (p < .001). Error rates were reduced to 25% (2010), 15% (2011), 7% (2012), and 5% (2013), and the percentage of blank or missing forms was reduced to and remained at 1%. CONCLUSION: Quality improvement initiatives were effective in reducing the incompletion and error rates of nutrition screening and led to sustainable improvements in the referral process of patients at nutritional risk.

Nutritional Intervention Incorporating Expedited 10 g Protein Counter (EP-10) to Improve the Albumin and Transferrin of Chronic Hemodialysis Patients.

Objective. The expedited 10 g protein counter (EP-10) is a quick and valid clinical tool for dietary protein quantification. This study aims to assess the clinical effectiveness of the EP-10 in improving serum albumin and transferrin in chronic hemodialysis patients. Methods. Forty-five patients with low serum albumin (<38 g/L) were enrolled in this study. Parameters measured included dry weight, height, dietary intake, and levels of serum albumin, transferrin, potassium, phosphate, and kinetic modeling (Kt/V). The nutritional intervention incorporated the EP-10 in two ways (1) to quantify protein intake of patients and (2) to educate patients to meet their protein requirements. Mean values of the nutritional parameters before and after intervention were compared using paired t-test. Results. Three months after nutritional intervention, mean albumin levels increased significantly from 32.2 ± 4.8 g/L to 37.0 ± 3.2 g/L (P < 0.001). Thirty-eight (84%) patients showed an increase in albumin levels, while two (4%) maintained their levels. Of the thirty-six (80%) patients with low transferrin levels (<200 mg/dL), 28 (78%) had an increase and two maintained their levels after intervention. Mean transferrin levels increased significantly from 169.4 ± 39.9 mg/dL to 180.9 ± 38.1 mg/dL (P < 0.05). Conclusion. Nutritional intervention incorporating the EP-10 method is able to make significant improvements to albumin and transferrin levels of chronic hemodialysis patients.

Development and validation of an expedited 10 g protein counter (EP-10) for dietary protein intake quantification.

OBJECTIVE: Precise protein quantification is essential in clinical dietetics, particularly in the management of renal, burn, and malnourished patients. The expedited 10 g protein counter (EP-10) was developed to expedite the estimation of dietary protein for nutritional assessment and recommendation. The main objective of this study was to compare the validity and efficacy of the EP-10 with the American Dietetic Association's "Exchange List for Meal Planning" (ADA-7 g) in quantifying dietary protein intake, against computerized nutrient analysis (CNA). DESIGN: Protein intake of 197 food records kept by healthy adult subjects in Singapore was determined thrice using 3 different methods: (1) EP-10, (2) ADA-7 g, and (3) CNA using SERVE program (Version 4.0). Assessments using the EP-10 and ADA-7 g were performed by 2 assessors in a blind crossover manner while a third assessor performed the CNA. All assessors were blind to each other's results. Time taken to assess a subsample (n = 165) using the EP-10 and ADA-7 g was also recorded. RESULTS: Mean difference in protein intake quantification when compared with the CNA was statistically nonsignificant for the EP-10 (1.4 ± 16.3 g, P = .239) and statistically significant for the ADA-7 g (-2.2 ± 15.6 g, P = .046). Both the EP-10 and ADA-7 g had clinically acceptable agreement with the CNA, as determined via Bland-Altman plots, although it was found that EP-10 had a tendency to overestimate with protein intakes above 150 g. The EP-10 required significantly less time for protein intake quantification than the ADA-7 g (mean time of 65 ± 36 seconds vs. 111 ± 40 seconds, P < .001). CONCLUSION: The EP-10 and ADA-7 g are valid clinical tools for protein intake quantification in an Asian context, with EP-10 being more time efficient. However, a dietician's discretion is needed when the EP-10 is used on protein intakes above 150 g.