A Win-Win for Sport and Exercise Medicine and Primary Care: A Qualitative Case Study of the Added Competence Model in Canada.

OBJECTIVE: To understand the unique impacts of the College of Family Physicians of Canada's (CFPC) Certificate of Added Competence (CAC) in Sport and Exercise Medicine (SEM) on the delivery of comprehensive care in Canada. DESIGN: Secondary analysis of qualitative interview data collected during a multiple case study of the impacts of the CAC program in Canada. SETTING: Six cases purposively sampled from across Canada. Each case was bound by a collective of healthcare providers who work with a defined group of patients. PARTICIPANTS: Across the cases, 48 individuals participated, including SEM and other enhanced skill family physicians, generalist family physicians, residents, specialists, and administrative staff. MAIN OUTCOME MEASURES: Qualitative descriptions of the impacts of the SEM certificate on comprehensive care provision in Canada. RESULTS: SEM certificate holders experience enhanced well-being and professional satisfaction while also benefitting comprehensive care in communities in numerous ways. That SEM certificate holders may prioritize professional interests over community healthcare needs was identified as a potential drawback. Athletes and physically active individuals have specific healthcare needs, and may constitute a significant critical mass to be considered a community unto themselves. CONCLUSIONS: The SEM certificates impact healthcare positively when holders work in collaborative models that are well aligned with local community needs. Expanding the awareness of the scope of SEM and advocacy for adequate remuneration for these services have the potential to enhance SEM contributions to comprehensive family medicine in Canada.

Consensus statement on the methodology of injury and illness surveillance in FINA (aquatic sports).

BACKGROUND: Injury and illness surveillance in the aquatic disciplines has been conducted during the FINA World Championships and Olympic Games. The development of an aquatic-specific injury and illness surveillance system will improve the quality of the data collected and the development of preventive measures. Our ultimate objective is to enhance aquatic athlete health and performance. OBJECTIVE: The objective was to refine the injury and illness surveillance protocols to develop aquatic-specific definitions of injury and illness; define aquatic-specific injury location and causation; better describe overuse injuries; regard pre-existing and recurrent injuries; more accurately define aquatic athlete exposures and develop a protocol to capture out-of-competition aquatic athlete health parameters. METHODS: FINA compiled an Injury and Illness Surveillance Expert Working Group comprised of international experts to review the scientific literature in the field. A consensus meeting was convened to provide an opportunity for debate, following which recommendations were collated. RESULTS: Aquatic-specific injury and illness surveillance protocols covering both the in-competition and out-of-competition time periods were developed. Definitions for all relevant variables were outlined, and documentation forms for athletes and for clinicians were proposed. Recommendations for the implementation of an injury and illness surveillance system for FINA are presented. CONCLUSION: The FINA consensus authors recommend ongoing in-competition and out-of-competition surveillance to determine injury and illness trends over time. The implementation of the definitions and methodology outlined in this paper will improve the accuracy and value of injury and illness surveillance, and provide important information for injury prevention.

Safeguarding the child athlete in sport: a review, a framework and recommendations for the IOC youth athlete development model.

Participation in sport has many physical, psychological and social benefits for the child athlete. A growing body of evidence indicates, however, that sport participation may have inherent threats for the child's well-being. The subject of safeguarding children in sport has seen an increase in scientific study in recent years. In particular, there is increasing emphasis on identifying who is involved in abuse, the context of where it occurs and the identification of the various forms of abuse that take place in the sporting domain. Safeguarding principles developed by the International Safeguarding Children in Sport Founders Group are presented along with 8 underlying pillars which underpin the successful adoption and implementation of safeguarding strategies. This safeguarding model is designed to assist sport organisations in the creation of a safe sporting environment to ensure that the child athlete can flourish and reach their athletic potential through an enjoyable experience. The aim of this narrative review is to (1) present a summary of the scientific literature on the threats to children in sport; (2) introduce a framework to categorise these threats; (3) identify research gaps in the field and (4) provide safeguarding recommendations for sport organisations.

International Olympic Committee consensus statement on thermoregulatory and altitude challenges for high-level athletes.

Challenging environmental conditions, including heat and humidity, cold, and altitude, pose particular risks to the health of Olympic and other high-level athletes. As a further commitment to athlete safety, the International Olympic Committee (IOC) Medical Commission convened a panel of experts to review the scientific evidence base, reach consensus, and underscore practical safety guidelines and new research priorities regarding the unique environmental challenges Olympic and other international-level athletes face. For non-aquatic events, external thermal load is dependent on ambient temperature, humidity, wind speed and solar radiation, while clothing and protective gear can measurably increase thermal strain and prompt premature fatigue. In swimmers, body heat loss is the direct result of convection at a rate that is proportional to the effective water velocity around the swimmer and the temperature difference between the skin and the water. Other cold exposure and conditions, such as during Alpine skiing, biathlon and other sliding sports, facilitate body heat transfer to the environment, potentially leading to hypothermia and/or frostbite; although metabolic heat production during these activities usually increases well above the rate of body heat loss, and protective clothing and limited exposure time in certain events reduces these clinical risks as well. Most athletic events are held at altitudes that pose little to no health risks; and training exposures are typically brief and well-tolerated. While these and other environment-related threats to performance and safety can be lessened or averted by implementing a variety of individual and event preventative measures, more research and evidence-based guidelines and recommendations are needed. In the mean time, the IOC Medical Commission and International Sport Federations have implemented new guidelines and taken additional steps to mitigate risk even further.

Medical complications of an aquatic innovation.

The sport of swimming has been affected by the innovations of technology with the evolution of the swimsuit. The health benefits of swimming are numerous and are well documented in the scientific literature. As swimming is a low-impact sport, injuries are relatively uncommon. As a direct result of the new swimsuits, team physicians have identified the emergence of a new trend in injury in the aquatic athlete. Extensive blistering and ulceration of the finger tips and distal interphalangeal joints in addition to ecchymoses of the lower limb are now common in the aquatic athlete wearing the new swimsuits. Team physicians working with elite swimmers should be aware of this phenomenon and institute preventive measures.

Injury surveillance in multi-sport events: the International Olympic Committee approach.

BACKGROUND: The protection of athletes' health by preventing injuries is an important task for international sports federations. Standardised injury surveillance provides not only important epidemiological information, but also directions for injury prevention, and the opportunity for monitoring long-term changes in the frequency and circumstances of injury. Numerous studies have evaluated sports injuries during the season, but few have focused on injuries during major sport events such as World Championships, World Cups or the Olympic Games. OBJECTIVES: To provide an injury surveillance system for multi-sports tournaments, using the 2008 Olympic Games in Beijing as an example. METHODS: A group of experienced researchers reviewed existing injury report systems and developed a scientific sound and concise injury surveillance system for large multi-sport events. RESULTS: The injury report system for multi-sport events is based on an established system for team sports tournaments and has proved feasible for individual sports during the International Association of Athletics Federations World Championships in Athletics 2007. The most important principles and advantages of the system are comprehensive definition of injury, injury report by the physician responsible for the athlete, a single-page report of all injuries, and daily report irrespective of whether or not an injury occurred. Implementation of the injury surveillance system, all definitions, the report form, and the analysis of data are described in detail to enable other researchers to implement the injury surveillance system in any sports tournament. CONCLUSION: The injury surveillance system has been accepted by experienced team physicians and shown to be feasible for single-sport and multi-sport events. It can be modified depending on the specific objectives of a certain sport or research question; however, a standardised use of injury definition, report forms and methodology will ensure the comparability of results.

The basics of synchronized swimming and its injuries.

Synchronized swimming is a complex, physically demanding sport. It is a challenging and interesting sport for the sports medicine clinician. There is opportunity for involvement in program development and in the treatment of medical illness and injury. There is also great potential for clinical research in synchronized swimming because of the paucity of published literature. Greater understanding of the competitive structure, training requirements, and common medical presentations facilitate the management of synchronized swimmers.