Comprehensive periodic health evaluations of 454 Norwegian Paralympic and Olympic athletes over 8 years: what did we learn?

OBJECTIVE: A periodic health evaluation (PHE) is a comprehensive and multidisciplinary investigation of athlete health widely used in elite sport, but its contents and benefits can be questioned. This study aimed to determine the prevalence of conditions identified by a PHE among Paralympic and Olympic athletes over four consecutive Games cycles from Rio de Janeiro 2016 to Beijing 2022 and to assess the benefits and potential pitfalls of a comprehensive PHE programme in detecting existing injuries, illnesses and other health issues. METHODS: We collected extensive health history and clinical examination data on elite athletes: medical history, ECG, blood pressure, blood samples, spirometry, musculoskeletal health, cognitive function, mental health and compliance with public health programmes. RESULTS: The final cohort included 87 Paralympic and 367 Olympic athletes, representing 565 PHE cycles. Musculoskeletal problems and unspecified pain, infections and allergies were the most frequent health issues. High blood pressure was the most prevalent cardiovascular finding, and vitamin D deficiency the most common laboratory abnormality. Most athletes complied with the public childhood vaccination programmes, but fewer with recommended cancer screening. Follow-up of health issues was variable. CONCLUSION: Our PHE programme identified musculoskeletal problems, infections, allergies, elevated blood pressure and vitamin D deficiency as common health conditions. Longitudinal follow-up of health conditions identified during screening and improved compliance with public health and cancer screening programmes is needed to determine the true benefits of athlete care prompted by the PHE.

Experiences of participating in individual placement and support: a meta-ethnographic review and synthesis of qualitative studies.

AIM: To provide increased understanding about how work applicants, employment specialists, social workers in the welfare service and clinicians in mental healthcare service experience participating in individual placement and support (IPS). METHODS: We searched in several databases and identified 17 studies published from 2007 to 2017 in Sweden, USA, Canada, UK, Australia and Denmark, and applied meta-ethnographic reinterpretation and synthesis. RESULTS: The employment specialists followed the core ideas of IPS, where work is seen as a way to recover. They saw the work applicants' preferences and needs as important for health and well-being, and crucial for successful work rehabilitation. In order to reach these goals, they offered a personal relationship to the work applicants. Work applicants clearly appreciated this personalised recovery-oriented mindset. Furthermore, work applicants needed the employment specialists as culture brokers between health-related questions and the expectations met in the labour market. Social workers lacked resources to such personalised support, and they were under demand of welfare regulations made for a 'train then place' model, which conflicts with the view that work leads to recovery as IPS sees it in their 'place then train' model. The scarce knowledge of the clinicians' experiences in the present study suggests that they are sceptical to work as a way to recover, which is in conflict with IPS. CONCLUSIONS: The work applicants highlighted the significance of the individualised support they received. Social workers and some clinicians found it difficult to provide this important personalised support towards work. Conflicting mindsets between the traditional gradual work rehabilitation paradigm and the IPS approach as a way of recovering might explain these frustrations and distance. Recommendations for practice. An improvement of IPS may depend on more cooperation based on an acceptance of the recovery-oriented mindset, which for some will mean an acceptance of new knowledge.

Intensive care patients' perceptions of how their dignity is maintained: A phenomenological study.

AIM: The aim of the study was to acquire knowledge of what contributes to maintaining and promoting the dignity of intensive care patients. METHOD: The study takes a phenomenological approach, and the method of data collection is qualitative research interviews. The participants consist of seven former intensive care patients. The analysis was carried out by means of Giorgi's phenomenological analysis strategy. FINDINGS: Being seen and heard and having one's wishes and needs attended to are parts of dignified care. Personal and individual nursing was essential, as well as the extra involvement beyond what was expected. Being helpless and having to be cared for was unpleasant and degrading. The experience of being unable to speak could cause demeaning situations. Being met with respect was the essence of having one's dignity maintained and promoted. The sense of being treated as an object was the essence of experiences that inhibited dignity. CONCLUSION: The findings indicate that the intensive care patients' experience of having their dignity maintained in an intensive care unit is good, despite a high-tech, busy environment. There is also potential for improvement in several areas. Awareness, moral integrity and demeanour are central to dignified patient care from the perspective of intensive care patients.