American Academy of Pediatrics Recommended Cardiac Screening Questions in Preparticipation Physical Evaluation Forms.

To evaluate the utilization of the American Academy of Pediatrics' (AAP) cardiovascular screening questions within preparticipation physical evaluation forms from the 50 state high school athletic associations. We found that fewer than one-half of state forms incorporated all 10 AAP questions; moreover, a subset failed to adhere to criteria recommended by either the AAP or American Heart Association.

Knowledge and practice of preparticipation physical evaluation of Saudi primary care physicians in the Eastern Province of Saudi Arabia.

BACKGROUND: The preparticipation physical evaluation (PPE) monograph is a vital resource for medical providers aimed at ensuring the safety and well-being of athletes during sports participation by screening for injuries and disease risk factors. However, the concept of PPE is relatively new in Saudi Arabia, where primary care physicians (PCPs) often lack the proper training for it. This study's aim was to assess PCPs' knowledge and practice of PPE and identify associated factors. MATERIALS AND METHODS: A self-administrated web-based questionnaire was distributed to PCPs in the Eastern Province of Saudi Arabia. The questionnaire covered the various aspects of PPE knowledge (including general principles, components, contraindications of sports participation, concerning history and physical findings, electrocardiography interpretations, and ethical considerations) as well as PPE practice. Initial treatment of data included descriptive statistics.; Chi-square tes or Fisher's exact test as, as appropriate, were used to determine association of knowledge and practices with various independent variables. RESULTS: Of the 240 contacted PCPs, 192 responded yielding a response rate of 80%; 50.5% had no prior PPE training. About 43% of the PCPs had not encountered PPE during their examination, but the remainder performed monthly PPE. Notably, 82.8% demonstrated a poor level of knowledge regarding PPE and only 43% had a satisfactory level of practice. CONCLUSION: This study revealed that a significant proportion of PCPs displayed poor knowledge of PPE and <½ of our sample showed satisfactory practice levels. Recommendations to establish the local guidelines regarding PPE for PCPs to follow should be emphasized and PPE training integrated into both undergraduate and postgraduate family medicine curricula. These measures are crucial for the enhancement of the safety of athletes in Saudi Arabia.

Physical Evaluation of Beef Bulls.

Physical evaluation of beef bulls is important in determining their ability to be long-lived useful breeding animals. A basic examination should include an assessment of the bull's conformation, gait, and overall appearance. Skeletal soundness can be easily evaluated with well-formed feet and legs. Muscularity and reproductive soundness can be verified visually as should the head and mouth. Finally, attention should be paid to breed characteristics if it is a purebred bull. A bull must be able to walk, eat, and see to effectively function as a natural service sire in pasture, pens, or especially extensive range environments.

Effect of drying temperature and storage time on the crispiness of homemade apple snacks.

BACKGROUND: The apple (Malus domestica Borkh.) plays an important role in the trendy market of dried snacks because of its exceptional flavor and texture. In addition to the health benefits, there is also a general disposition to consume organic and do-it-yourself products. RESULTS: Three different drying temperatures, 65, 75, and 85 °C, were tested using a commercial ventilated drying oven in 'Royal Gala' and 'Golden Delicious' cultivars. Physical changes, including texture, color, shrinkage ratio, and microstructure, were evaluated for the temperatures and cultivars considered. Based on the results, particularly in terms of shrinkage, hardness, and crispiness, a drying temperature of 75 °C was selected to perform texture profile analyses throughout the drying period. Storability conditions were evaluated to determine the best moment to maintain the physical properties of the dried snacks during storage. Considered the more important property related to consumer preferences, crispiness was followed with puncture tests. CONCLUSION: The storage of apple chips, dried at the various temperatures, that must be performed in 5-10 min after removing from the drying oven, was assessed over the course of a month. Both the drying process and the subsequent storage proved effective in preserving the desired texture of the apple snacks, regardless of the specific cultivar or drying temperature used. Through this study, with a refined understanding of the changes occurring during the drying process and the optimization of storage conditions, we can confidently offer consumers the best combination of crispy and healthy snacks that meet their expectations. © 2023 Society of Chemical Industry.

Lower rates of return to sport in patients with generalised joint hypermobility two years after ACL reconstruction: a prospective cohort study.

BACKGROUND: Generalised joint hypermobility (GJH) has been associated with an increased risk of suffering an anterior cruciate ligament (ACL) injury. Patients with GJH exhibit lower muscle strength and poorer scores for patient-reported outcomes after ACL reconstruction, compared with patients without GJH. The aim of this study was to examine differences in the percentages of patients who return to sport (RTS) or pre-injury level of activity (RTP), muscle function and patient-reported outcomes at the time of RTS or RTP, as well as the time of RTS or RTP in patients with GJH compared with patients without GJH in the first two years after ACL reconstruction. METHODS: This prospective study used data from an ACL- and rehabilitation-specific register located in Gothenburg, Sweden. Patients aged between 16 and 50, who had a primary ACL injury treated with reconstruction, were included. Data up to two years after ACL reconstruction were used and consisted of achieving RTS and RTP, results from isokinetic muscle function tests for knee extension and flexion and patient-reported outcomes (Knee Self-Efficacy Scale, Knee injury and Osteoarthritis Outcome Score and ACL-Return to Sport after Injury scale) at the time of RTS, as well as the time of RTP. A Beighton Score of ≥ 5/9 was used to define GJH. A Tegner Activity Scale of ≥ 6 was used to define RTS, while a Tegner equal to or above pre-injury level was used to define RTP. RESULTS: A total of 1,198 patients (54.7% women) with a mean age of 28.5 ± 8.6 years were included. A smaller proportion of patients with GJH achieved RTS compared with patients without GJH (49.2% vs. 57.3%, Odds ratio: 0.720, p = 0.041). Furthermore, patients with GJH were marginally less symmetrical on the knee extension strength test, expressed as a Limb Symmetry Index, at the time of RTP compared with patients without GJH (87.3 ± 13.5 vs. 91.7 ± 14.3, Cohen's d = 0.142, p = 0.022). No further differences were found between groups regarding any muscle function tests or patient-reported outcomes. CONCLUSION: A smaller proportion of patients with GJH achieved RTS compared with patients without GJH. Patients with GJH displayed less symmetrical knee extension strength at the time of RTP compared with patients without GJH.

Beautiful Strangers: Physical Evaluation of Strangers Is Influenced by Friendship Expectation.

People tend to evaluate themselves as better than they actually are. Such enhanced positive evaluation occurs not only for the self but also for close others. We extend the exploration of enhanced evaluation of close others to that of strangers. We predict that when individuals consider becoming friends with a stranger, their preference for a pleasant physical experience will drive an enhanced evaluation of that person. In two experiments, participants who considered friendship with a stranger evaluated the stranger as looking, sounding, and smelling better than how control participants evaluated them. The amount of time participants expected to spend with the stranger predicted their evaluation (Studies 1-2). In a large-scale third study, using various target stimuli, we found that when participants have an interest in a friendship but then are unable to physically spend time together, the enhanced-evaluation effect is weaker compared with when they could spend time together.

Sport activities for children and adolescents: the Position of the European Academy of Paediatrics and the European Confederation of Primary Care Paediatricians 2023-Part 1. Pre-participation physical evaluation in young athletes.

The European Academy of Paediatrics (EAP) and the European Confederation of Primary Care Paediatricians (ECPCP) emphasize the importance of promoting healthy lifestyles within the pediatric population. Many health professionals have questions concerning adequate levels of physical activity for both the healthy pediatric population and for those who may have specific complications. Unfortunately, the academic literature that provides recommendations for participation in sport activities within the pediatric population that have been published during the last decade in Europe is limited and is mainly dedicated to specific illnesses or advanced athletes and not toward the general population. The aim of part 1 of the EAP and ECPCP position statement is to assist healthcare professionals in implementing the best management strategies for a pre-participation evaluation (PPE) for participation in sports for individual children and adolescents. In the absence of a uniform protocol, it is necessary to respect physician autonomy for choosing and implementing the most appropriate and familiar PPE screening strategy and to discuss the decisions made with young athletes and their families. This first part of the Position Statement concerning Sport Activities for Children and Adolescents is dedicated to healthy young athletes.

Are sit-to-stand and isometric handgrip tests comparable assessment tools to identify dynapenia in sarcopenic people?

Sarcopenia is a neuromuscular disease characterized by the simultaneous existence of reduced muscle strength and muscle atrophy. The current recommendations for the diagnosis of sarcopenia suggest dynapenia be operationalized using either isometric handgrip strength (IHG) or sit-to-stand (STS) tests. However, specific associations between each of these assessment tools and sarcopenia-related parameters have been observed. In addition, important neuromuscular and biomechanical aspects differ between IHG and STS. This scenario has important clinical implications and calls for detailed studies to refine the current recommendations for sarcopenia identification. The present communication presents evidence to foster a constructive debate on the matter.

Spasticity Management Teams, Evaluations, and Tools: A Canadian Cross-Sectional Survey.

OBJECTIVE: The objective of this study is to determine the physical evaluations and assessment tools used by a group of Canadian healthcare professionals treating adults with spasticity. METHODS: A cross-sectional web-based 19-question survey was developed to determine the types of physical evaluations, tone-related impairment measurements, and assessment tools used in the management of adults with spasticity. The survey was distributed to healthcare professionals from the Canadian Advances in Neuro-Orthopedics for Spasticity Congress database. RESULTS: Eighty study participants (61 physiatrists and 19 other healthcare professionals) completed the survey and were included. Nearly half (46.3%, 37/80) of the participants reported having an inter- or trans-disciplinary team managing individuals with spasticity. Visual observation of movement, available range of motion determination, tone during velocity-dependent passive range of motion looking for a spastic catch, spasticity, and clonus, and evaluation of gait were the most frequently used physical evaluations. The most frequently used spasticity tools were the Modified Ashworth Scale, goniometer, and Goal Attainment Scale. Results were similar in brain- and spinal cord-predominant etiologies. To evaluate goals, qualitative description was used most (37.5%). CONCLUSION: Our findings provide a better understanding of the spasticity management landscape in Canada with respect to staffing, physical evaluations, and outcome measurements used in clinical practice. For all etiologies of spasticity, visual observation of patient movement, Modified Ashworth Scale, and qualitative goal outcomes descriptions were most commonly used to guide treatment and optimize outcomes. Understanding the current practice of spasticity assessment will help provide guidance for clinical evaluation and management of spasticity.

The Body Adiposity Index is not applicable to the Brazilian adult population.

Background: Obesity is a serious disease that burdens public health systems around the world. It is a risk factor for the development of several non-communicable chronic diseases that are related to the amount and distribution of body fat. Body composition assessment using simple and low-cost techniques can help in the early detection of excess fat, allowing for the prevention and treatment of both obesity and associated diseases. Thus, identifying and proposing valid anthropometric indices for this purpose can be a great ally of health programs. Objective: To verify the validity of the Body Adiposity Index (BAI) in relation to Dual Energy X-Ray Absorptiometry (DXA) for estimating body fat percentage in Brazilian adults, as well as to propose a new mathematical model to estimate the fat-free mass of this population. Methods: In a cross-sectional study, 424 subjects (of which 220 were women), aged between 20 and 59 years, were evaluated by BAI and DXA, then randomly divided into two groups stratified by sex: the development group (n = 283) and the cross-validation group (n = 141). Statistical analyses to test the validity of BAI as a predictor of fat mass, in addition to proposing a new mathematical model for estimating fat-free mass, using DXA as a reference method. The analysis included paired t-test, stepwise multiple regression, coefficient of concordance correlation, and Bland-Altman plots. Results: The BAI validity analysis showed a low correlation coefficient of agreement [CCC = 0.626; ρ (precision) = 0.795; Cb(accuracy) = 0.787]; in addition, the mean difference in the Bland-Altman plot was different from zero in the cross-validation group (p < 0.01) and limits of agreement (LOA) ranged between-8.0 and 14.4 kg, indicating a poor agreement between the BAI and the reference method. The new mathematical model for estimating FFM showed a high correlation coefficient of agreement (CCC = 0.952; ρ = 0.953; Cb = 0.999), in addition to acceptable LOA in the Bland-Altman plot (-6.7 and 6.7). Conclusion: In the studied sample, the BAI showed low validity for estimating body fat, while the new proposed model was found to be a good option to assess the body composition of Brazilian adults.

Primary Site Identification of Soft-Tissue Mass: Things to Know in MRI Assessment.

The spectrum of soft-tissue mass is varied, including neoplastic and nonneoplastic/inflammatory lesions. However, soft-tissue tumors have similar imaging findings and, therefore, the diagnosis of soft-tissue mass is challenging. Although careful assessment of the internal characteristics on imaging can often narrow the differential diagnoses, the differential diagnosis may be out of the question if identification of the soft-tissue mass origin is missed. The purpose of this article is to review the imaging findings and the essential anatomy to identify the primary site of the soft-tissue mass, and discuss the associated potential pitfalls. In order not to fall into a pitfall, recognition of characteristic imaging findings indicating the origin of the soft-tissue mass and anatomical knowledge of the normal tissue distribution are necessary. LEVEL OF EVIDENCE: 5 TECHNICAL EFFICACY STAGE: 3.

Reproducibility of an endurance test for master swimmers

Abstract Aim: This study aimed to verify the reproducibility of an endurance test for master swimmers. Methods: Seventeen male swimmers, aged from 30 to 50 years (35.06 ± 5.36), weight (78.71 ± 13.06 kg), height (174.35 ± 0.07 cm), participated in this study. The participants underwent the Progressive Swim Test (PSwT), which corresponds to swimming progressively to exhaustion in a 25-meter pool, guided by the recording of sound signals indicating the swimming rhythm. We verified the following variables: heart rate before the test (BHR) and right after the end of the test (AHR), followed by the rate of perceived exertion (RPE) and a total of laps performed (SN - swimming number). For comparison between the three days of tests, the one-way repeated measures ANOVA with Tukey's Post-Hoc was performed. Relative reproducibility was performed by the r test and the intraclass correlation coefficient (ICC). Absolute reproducibility was determined using the coefficient of variation (CV) and the confidence interval (CI). Results: The results showed high reproducibility in (PSwT) in master swimmers in the analyzed variables of intergroup and intragroup with relative reproducibility of r > 0.60 and ICC > 0.70 and absolute reproducibility with CI 95% (lower −1.10 and upper 0.99) and CV < 10%. Most of the cases were within the limits of agreement of the Bland-Altman tests, all variables were considered a level of significance with (p <0.05). Conclusion: The Progressive Swim Test (PSwT) is a reproducible instrument in the assessment of endurance in master swimmers.

MBboard: Validity and Reliability of a New Tool Developed to Evaluate Specific Strength in Rock Climbers.

In the present study, we analysed the validity and reliability of a new tool designed to assist the measurement of maximal upper-limb strength in rock climbers in a specific way, named MBboard. The MBboard consists of an artificial small climbing hold affixed to a wooden board, which is connected to any cable-motion strength equipment to determine the maximum dynamic strength (MBboard-1RM). Ten male rock climbers (Rock Climbing Group, RCG = 10) and ten physically active men (Control Group, CG = 10) performed, on three separate occasions, a familiarization session with procedures adopted during MBboard-1RM testing and two experimental trials (i.e., test and retest) to determine the construct validity and reliability of the MBboard during unilateral seated cable row exercise. In the first trial, the electromyographic activity (EMG) was recorded from the flexor digitorum superficialis. The self-reported climbing ability was also recorded. The RCG had superior performance (i.e. 37.5%) and EMG activity (i.e. 51%) in MBboard-1RM testing when compared with the CG (p < 0.05). There was a significant correlation between the MBboard-1RM results and climbing ability (r > 0.72, p < 0.05). Intraclass correlation coefficient analysis revealed good reliability within trials (ICC > 0.79, p < 0.05). These findings suggest that the MBboard is a valid and reliable tool to assess rock climbing-specific maximal strength. The validity of MBboard-1RM appears to be related to the finger flexor muscles activation, probably reflecting the specific adaptations resulting from long-term practice of this sport discipline.

Enfrentamiento del paciente con dolor abdominal / Approach to the patient with abdominal pain

El dolor abdominal es una causa frecuente de consulta ambulatoria, sus causas son múltiples e incluyen patologías de riesgo vital u otras de bajo riesgo que requieren principalmente tratamiento y no requieren mayores estudios. La historia clínica y el examen físico son las herramientas principales para poder sospechar la etiología de la enfermedad que está causando el dolor abdominal. Es por esto que realizar una historia completa, haciendo preguntas dirigidas a confirmar o descartar sospechas diagnósticas, asociado a un examen físico completo y sistemático, es la principal forma de orientar el diagnóstico y estudio posterior del paciente. Conocer el cuadro clínico de las enfermedades que dentro de sus síntomas pueden presentar dolor abdominal, especialmente aquellas que son de riesgo vital permite poder diagnosticarlas con la rapidez que se requiere. Así mismo, es necesario reconocer aquellas enfermedades que son más frecuentes y que no requieren mayores estudios sino tratamiento básico, habitualmente ambulatorio. Existen personas que, por sus condiciones de salud o edad, pueden tener presentaciones atípicas de cuadros habituales o mayores riesgos de tener enfermedades infrecuentes o de mayor riesgo vital, que es importante reconocer al momento de la evaluación.

Abdominal pain is a common complaint in ambulatory medicine. It has multiples causes,including lifethreatening pathologies and other benign in which the need in treatment and no other tests. The clinical history and physical examination are the key to suspect the etiology of the underlying disease. A complete history includes make direct questions to confirm or discard the diagnostic suspects and with a complete and systematic physical examination are the main way to get the diagnosis and treatment of the patient. The clinician must know the syndromes which includes abdominal pain, especially those life-threatening which requires urgent treatment or surgery. Also needs to know the frequent benign syndromes that can be safely treated symptomatically with no further investigation. Older adults or patients with comorbidities may present with unusual causes of abdominal pain or may have an atypical presentation of common disorders. Also, may present more frequent serious etiologies that may require urgent interventions.

A comprehensive interdisciplinary view at the Return to Sport after COVID-19 infection.

The COVID-19 pandemic has affected the whole world. It applies to all age and social groups. It is no different with athletes. So far, we cannot say for sure what the long-term consequences of SARS-CoV-2 infection are. Recent evidence, however, suggests that we should be very careful when returning to sports. After self-isolation, the athlete should undergo a Preparticipation Physical Examination and then pay attention to the gradual dosing of the load to prevent complications. Lifestyle changes and care for the mental health of athletes are also necessary during the illness. In this work, we present a comprehensive methodology for returning to sports after COVID-19 for medical and coaching teams caring for athletes divided according to the course of the disease. In scientific literature, similar algorithms are called "Return to Play" or "Return to Sport". Creating an exact algorithm can make the Return to Play process more efficient and safer. However, increased attention still needs to be paid to certain organ systems and specific symptoms that could indicate long-term consequences to the new type of coronavirus.

Efectividad del cuestionario global e internacional de actividad física comparado con evaluaciones prácticas / Effectiveness of the global and international physical activity questionnaire compared to practice evaluations

El objetivo de esta revisión fue examinar la efectividad del cuestionario Global de actividad física y el Cuestionario Internacional de actividad física forma corta, en relación con las evaluaciones prácticas que valoran la condición física saludable como instrumento de valoración del sedentarismo. Se realizó una búsqueda digital en bases de datos científicas de alto factor de impacto según referencia electrónica de Scimagojr, Scopus, Pubmed y Ebsco. La efectividad del cuestionario internacional y global de actividad física, en la valoración del sedentarismo y prescripción del ejercicio físico parecen condicionados en comparación con las evaluaciones prácticas, que valoran factores similares, sin embargo, proveen indicadores básicos que debe tomarse en cuenta al inicio de prescribir actividad física, se evidencia la necesidad de aplicar parámetros de nivel sedentario y aptitud física en población adulta establecidos por evaluaciones prácticas(AU)

The objective of this review was to examine the effectiveness of the Global Physical Activity Questionnaire and the International Short Form Physical Activity Questionnaire, in relation to practical evaluations that assess healthy physical condition as an instrument for assessing sedentary lifestyle A digital search was conducted in scientific databases of high impact factor according to electronic reference of Scimagojr, Scopus, Pubmed, and Ebsco. The effectiveness of the international and global physical activity questionnaire, in assessing sedentary lifestyle and prescribing physical exercise seem conditioned, compared to practical evaluations, which assess similar factors, however they provide basic indicators that should be taken into account at the beginning of prescribing physical activity, the need to apply sedentary level and physical fitness parameters in the adult population established by practical evaluations is evident(AU)

Detection and Management of Heart Disease in Athletes.

Primary care clinicians fulfill critical roles of screening for, diagnosing, and managing cardiovascular disease. In young athletes, primary structural and electrical diseases are the focus. Coronary artery disease is the chief concern in older athletes. Sudden cardiac arrest may be the initial presentation of disease and is more common in young athletes than historically appreciated. The traditional preparticipation evaluation, or sports physical, is limited in its ability to accurately raise suspicion of underlying disease. The 12-lead electrocardiogram is a more accurate screening tool. Contemporary risk stratification and treatment protocols may allow for safe return to sport on a case-by-case basis.

Quality of life and cognitive and functional performance of octogenarians and nonagenarians undergoing hemodialysis.

OBJECTIVE: To evaluate the quality of life, cognitive and functional capacity of older adult patients undergoing hemodialysis who are 80 years of age or older and compare them to older adults without chronic kidney disease (CKD) treated at a geriatrics outpatient clinic. METHOD: First, 103 older adult patients undergoing hemodialysis and 103 older adults without CKD matched by gender and age were evaluated. Cognitive aspects as evaluated by the mini mental state examination, the Boston Naming Test and verbal fluency were analyzed; comorbidities according to the Charlson's comorbidity index; social support through the Medical Outcomes Study scale; functional ability through the chair sit-to-stand and gait speed tests, as well as the basic activities of daily living (BADL) and instrumental activities of daily living (IADL) and quality of life according to the Kidney Disease Quality of Life Short Form (KDQOL SF-36) questionnaires. RESULTS: The hemodialysis group had a higher rate of comorbidities (7.8 ± 2.4 vs. 5.8 ± 2.3, p < 0.001). In the multiple logistic regression analysis, the group undergoing hemodialysis presented a ninefold greater chance of dependence for IADL than controls, a 4.3 and 3.2 times greater chances for inadequacy on the gait speed and chair sit-to-stand tests, respectively, as well as a 4.4-fold higher risk of cognitive decline on the verbal fluency test. CONCLUSION: Long-lived patients undergoing hemodialysis presented worse quality of life and functional and cognitive performance compared to long-term patients attended at the outpatient clinic, indicating that preventive and protective measures should be considered and implemented.