Sport and leisure activities in the heat: What safety resources exist?

OBJECTIVES: To conduct a document analysis of sports and leisure activity heat-related injury prevention resources in Australia and develop an understanding of the content within those resources. DESIGN & METHODS: Heat resources were included if they dealt specifically with, or could be extrapolated to, prevention of heat-related injuries. Collating strategies for the catalogue included: (1) a detailed search of the organisation's website and (2) an online search for sport specific heat resources. A content analysis of each resource was first performed, and descriptive codes were assigned to the data using qualitative data analysis software. Every coded text was recorded as an individual data point (n). Common sub-categories were identified by thematic analysis and collated under three broader categories. RESULTS: A total of 468 data points were identified within the 64 heat resources found. Guidelines (n = 20) and policies (n = 18) were the most common type of resources followed by factsheets (n = 9), webpages (n = 8), laws and by-laws (n = 2). Three overarching categories emerged through the data analysis process: preventive strategies (n = 299, 63.9%), risk factors (n = 94, 20.1%), treatment (n = 75, 16.0%). Activity modification, which included information on rescheduling games and extra breaks, was the most common intervention. Cricket, soccer, swimming and triathlon had the most complete set of heat resources. CONCLUSIONS: The findings of this study provide an insight into the composition of heat-related sports injury prevention resources within Australia and identify areas for development. As the resources were incomplete for many sports, the development of more comprehensive heat safety resources is required to ensure the safety of participants.

Protecting the world's finest athletes: periodic health evaluation practices of the top performing National Olympic Committees from the 2016 Rio or 2018 PyeongChang Olympic Games.

AIM: To describe the periodic health evaluation (PHE) practices of the top performing National Olympic Committees (NOCs). METHODS: We sent a survey to NOCs finishing in the top 8 for medal count at the 2016 Rio Olympic Games or 2018 PyeongChang Olympic Games. The survey included four sections: (1) PHE staff composition and roles, (2) beliefs regarding the PHE, (3) a ranking of risk factors for future injury and (4) details on the elements of the PHE. RESULTS: All 14 NOCs with top 8 finishes at the 2016 Rio Olympic Games or 2018 PyeongChang Olympic Games completed the survey. NOCs included a median of seven staff specialties in the PHE, with physicians and physiotherapists having the highest level of involvement. There was agreement that PHEs are effective in identifying current health conditions (13/14) and that athletes should receive individualised action plans after their PHE (14/14), but less agreement (6/14) that PHEs can predict future injury. The practices of NOCs were diverse and often specific to the athlete population being tested, but always included the patient's health history, laboratory studies, cardiovascular screening and assessments of movement capacity. The top three risk factors for future injury were thought to be previous injury, age and training experience. CONCLUSIONS: Among the top performing NOCs, the PHE is a comprehensive, multidisciplinary process aimed to identify existing conditions and provide baseline health and performance profiles in the event of future injury. Research linking PHEs to injury prevention is needed.

Long-Term Assessment of Rehabilitation Treatment of Sports through Artificial Intelligence Research.

BACKGROUND: Artificial intelligence (AI) technology has been incorporated into all walks of life, especially the integration of machine learning and health management has achieved very significant progress and results. It is very necessary to analyze personalized sports health management services and long-term assessment of health issues in the era of AI. METHODS: This paper explores AI + personalized sports management service system design ideas, system operation process, management stage design, taking common chronic diseases, and diabetes as examples. 150 patients were divided into an observation group and a control group, and the blood glucose, blood pressure, blood lipid, and knowledge awareness rate were compared. RESULTS: The blood glucose, blood pressure, and blood lipid levels of the observation group all reduced, and the awareness rate of diabetes knowledge increased, which proved that the AI research has great value in sports rehabilitation research coupled with long term health assessment and is worth further research. CONCLUSION: The AI research proposed in this paper is of far-reaching practical significance in helping the transformation and upgrading of the sports health management service industry, promoting the innovative development of sports health management service supply, and promoting national fitness and national health.

From theory to practice: operationalizing a climate vulnerability for sport organizations framework for heat hazards among US High schools.

BACKGROUND: Sport organizations must comprehensively assess the degree to which their athletes are susceptible to exertional heat illnesses (i.e. vulnerable) to appropriately plan and adapt for heat-related hazards. Yet, no heat vulnerability framework has been applied in practice to guide decision making. OBJECTIVES: We quantify heat vulnerability of state-level requirements for health and safety standards affecting United States (US) high school athletes as a case study. DESIGN: Observational. METHODS: We utilize a newly developed climate vulnerability to sports organizations framework (CVSO), which considers the heat hazard of each state using summer maximum wet bulb globe temperature (WBGT) in combination with an 18-point heat safety scoring system (18 = best policy). Heat vulnerability is categorized as "problem" [higher heat (>27.9°C) and lower policy score (≤9)], "fortified" [higher heat (>27.9°C) and higher policy score (>9)], "responsive" [lower heat (<27.9°C) and lower policy score (≤9)], and "proactive" [lower heat (<27.9°C) and higher policy score (>9)]. RESULTS: Across the US, the mean WBGT was 28.4±2.4°C and policy score was 6.9±4.7. In combination, we observed organizations within each of the four vulnerability categories with 16% (n=8) in fortified, 16% (n=8) in proactive, 29% (n=15) in problem, and 39% (n=20) in responsive. CONCLUSIONS: The CSVO framework allowed us to identify different degrees of vulnerability among the state's and to highlight the 29% (n=15) of states with immediate needs for policy revisions. We found the CSVO framework to be highly adaptable in our application, suggesting feasibility for use with other sports governing bodies.

The Resumption of Sports Medicine During the COVID-19 Post-Epidemic Period: Experiences from Wuhan, People's Republic of China.

ABSTRACT: Coronavirus disease 2019 (COVID-19) is spreading worldwide, with its outlook not looking optimistic. Simultaneously, the epidemic is currently under control in many areas. The resumption of work and production in areas that have achieved control of outbreaks is a problem. Considering the extremely transmissible nature of COVID-19, and the presence of asymptomatic infected people, avoiding nosocomial infection and protecting medical staff and patients during the post-epidemic period remain difficult problems that need to be solved. At present, few articles have examined relevant experiences in the field of sports medicine. Wuhan, the People's Republic of China, was the original epicenter of COVID-19, with physicians as the initial frontline workers. Wuhan is now gradually returning to a more normal state after a series of urgent, strict, and effective measures were utilized to combat the epidemic. During this time, we collected first-hand experiences of sports medicine work resumption in the initial 2-month period, including preparations before resuming work, outpatient management methods, online outpatient services, inpatient ward management, principles for determination of the examination results, and preparations for operations. The strict and feasible management strategies that we conducted were useful in avoiding hospital-based infections. We intend to share our own experiences and thoughts in this area. We hope that this will be helpful and inspiring to our sports medicine colleagues around the world.

Prevention of Sport-Related Concussion.

Concussion remains a common injury among sports participants. Implementing risk-reduction strategies for sport-related concussion (SRC) should be a priority of medical professionals involved in the care of athletes. Over the past few decades, a multifaceted approach to reducing SRC risk has been developed. Protective equipment, rule and policy change/enforcement, educational programs, behavioral modifications, legislation, physiologic modifications, and sport culture change are a few of the programs implemented to mitigate SRC risk. In this article, the authors critically review current SRC risk-reduction strategies and offer insight into future directions of injury prevention for SRC.

Clinician Well-being during a Pandemic: Practices to Boost Resilience and Life Satisfaction.

The role of the sports medicine physician has been challenged in several ways during the COVID-19 pandemic, potentially eroding a sense of well-being. Four universal human needs related to flourishing and a sense of life satisfaction are the framework we use to examine the effects of a pandemic on sports medicine clinicians. We offer two evidence-based practices to promote well-being and resilience within each of the four universal needs.

Improving concussion education: consensus from the NCAA-Department of Defense Mind Matters Research & Education Grand Challenge.

Early disclosure of possible concussive symptoms has the potential to improve concussion-related clinical outcomes. The objective of the present consensus process was to provide useful and feasible recommendations for collegiate athletic departments and military service academy leaders about how to increase concussion symptom disclosure in their setting. Consensus was obtained using a modified Delphi process. Participants in the consensus process were grant awardees from the National Collegiate Athletic Association and Department of Defense Mind Matters Research & Education Grand Challenge and a multidisciplinary group of stakeholders from collegiate athletics and military service academies. The process included a combination of in-person meetings and anonymous online voting on iteratively modified recommendations for approaches to improve concussion symptom disclosure. Recommendations were rated in terms of their utility and feasibility in collegiate athletic and military service academy settings with a priori thresholds for retaining, discarding and revising statements. A total of 17 recommendations met thresholds for utility and feasibility and are grouped for discussion in five domains: (1) content of concussion education for athletes and military service academy cadets, (2) dissemination and implementation of concussion education for athletes and military service academy cadets, (3) other stakeholder concussion education, (4) team and unit-level processes and (5) organisational processes. Collectively, these recommendations provide a path forward for athletics departments and military service academies in terms of the behavioural health supports and institutional processes that are needed to increase early and honest disclosure of concussion symptoms and ultimately to improve clinical care outcomes.

Remote assessment in sport and exercise medicine (SEM): a narrative review and teleSEM solutions for and beyond the COVID-19 pandemic.

BACKGROUND: The COVID-19 pandemic forces sport and exercise medicine (SEM) physicians to think differently about the clinical care of patients. Many rapidly implement eHealth and telemedicine solutions specific to SEM without guidance on how best to provide these services. AIM: The aim of this paper is to present some guiding principles on how to plan for and perform an SEM consultation remotely (teleSEM) based on a narrative review of the literature. A secondary aim is to develop a generic teleSEM injury template. RESULTS: eHealth and telemedicine are essential solutions to effective remote patient care, also in SEM. This paper provides guidance for wise planning and delivery of teleSEM. It is crucial for SEM physicians, technology providers and organisations to codesign teleSEM services, ideally involving athletes, coaches and other clinicians involved in the clinical care of athletes, and to gradually implement these services with appropriate support and education. CONCLUSION: teleSEM provides solutions for remote athlete clinical care during and after the COVID-19 pandemic. We define two new terms-eSEM and teleSEM and discuss guiding principles on how to plan for and perform SEM consultations remotely (teleSEM). We provide an example of a generic teleSEM injury assessment guide.

The eSports conundrum: is the sports sciences community ready to face them? A perspective.

The reality of eSports is something much more complex than individual users playing video games. There are several characteristics that eSports have in common with traditional sports: from the spirit of competition to the structural composition of the teams, including the increase in performance with training and practice, up to the injuries and physical and psychological stress of the athlete. The number of scientific papers interested in this reality is still relatively low, although in recent years there has been a significant increase in this regard. Probably the lack of knowledge of the world of eSports by inexperts can represent an initial obstacle in the approach to this environment. Therefore, an all-round analysis of the eSports industry is fundamental: including the figures that characterize them, the different eSports disciplines, the possible physical and mental consequences for athletes. Emphasizing the similarities between electronic and non-electronic sports is essential in order to make people, and the scientific community in particular, understand how they should be considered equal to the "traditional" vision of sports especially in the need for professional medical support. The number of professional and amateur eSports players increase every day as well as the birth of professional organizations and national teams while medical monitoring seems to have fallen behind. In the near future, we hope that the scientific community and in particular the medical disciplines will be able to closely support the world of eSports to guarantee the correct assistance to all professional and non-professional athletes. An increase in the number of scientific work and specific studies will certainly bring benefits in countering physical attrition, reducing the risk of injury, in psychological support to athletes and in the fight against doping reality.

Returning to Sport during the Covid-19 pandemic: The sports physicians' role

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Sports Medicine Staffing Across National Collegiate Athletic Association Division I, II, and III Schools: Evidence for the Medical Model.

CONTEXT: The ratio of clinicians to patients has been associated with health outcomes in many medical contexts but has not been explored in collegiate sports medicine. The relationship between administrative and financial oversight models and staffing is also unknown. OBJECTIVE: To (1) evaluate staffing patterns in National Collegiate Athletic Association sports medicine programs and (2) investigate whether staffing was associated with the division of competition, Power 5 conference status, administrative reporting structure (medical or athletic department), or financial structure (medical or athletic department). DESIGN: Cross-sectional study. SETTING: Collegiate sports medicine programs. PATIENTS OR OTHER PARTICIPANTS: Representatives of 325 universities. MAIN OUTCOME MEASURE(S): A telephone survey was conducted during June and July 2015. Participants were asked questions regarding the presence and full-time equivalence of the health care providers on their sports medicine staff. The number of athletes per athletic trainer was determined. RESULTS: Responding sports medicine programs had 0.5 to 20 full-time equivalent staff athletic trainers (median = 4). Staff athletic trainers at participating schools cared for 21 to 525 athletes per clinician (median = 100). Both administrative and financial oversight from a medical department versus the athletics department was associated with improved staffing across multiple metrics. Staffing levels were associated with the division of competition; athletic trainers at Division I schools cared for fewer athletes than athletic trainers at Division II or III schools, on average. The support of graduate assistant and certified intern athletic trainers varied across the sample as did the contributions of nonphysician, nonathletic trainer health care providers. CONCLUSIONS: In many health care settings, clinician : patient ratios are associated with patient health outcomes. We found systematic variations in clinician : patient ratios across National Collegiate Athletic Association divisions of competition and across medical versus athletics organizational models, raising the possibility that athletes' health outcomes vary across these contexts. Future researchers should evaluate the relationships between clinician : patient ratios and athletes' access to care, care provision, health care costs, health outcomes, and clinician job satisfaction.

Sports Medicine Staffing Patterns and Incidence of Injury in Collegiate Men's Ice Hockey.

CONTEXT: The relative availability of clinicians as well as the types and training of health care providers have been associated with morbidity and mortality in non-athletic health care settings. Whether staffing variations are associated with injury incidence in collegiate athletes is unknown. OBJECTIVE: To evaluate whether the institutional ratio of athletes to athletic trainers (patient load) or the ratio of staff to nonstaff (graduate assistant and certified intern) athletic trainers or both is associated with the incidence of injuries sustained by male ice hockey athletes at the school. DESIGN: Descriptive epidemiology study. SETTING: National Collegiate Athletic Association (NCAA) men's ice hockey teams. PATIENTS OR OTHER PARTICIPANTS: Collegiate men's ice hockey athletes. MAIN OUTCOME MEASURE(S): The NCAA Injury Surveillance Program collected data from collegiate men's ice hockey athletes. Staffing patterns were obtained through telephone interviews. Injury counts, injury rates per 1000 athlete-exposures, and injury rate ratios with 95% confidence intervals were calculated and compared between the following groups: (1) schools with high (versus low) patient load and (2) schools with high (versus low) ratio of staff to nonstaff (graduate assistant and certified intern) athletic trainers. RESULTS: Both the patient load and relative number of staff athletic trainers were associated with variations in the incidences and types of diagnosed injuries in male ice hockey players. Specifically, fewer injuries were diagnosed by clinicians at institutions with high patient loads. The rates of injury overall and non-time-loss injuries were lower in the high patient-load group. Time-loss injury rates, severe injury rates, concussion rates, and overall rates of injury during competition were greater in the group with a higher proportion of staff athletic trainers, whereas non-time-loss injury rates were lower. CONCLUSIONS: In this study of collegiate men's ice hockey players, athlete health outcomes were directly related to the number and types of clinicians available. Future researchers should evaluate whether this finding extends beyond men's ice hockey.

Staffing, Financial, and Administrative Oversight Models and Rates of Injury in Collegiate Athletes.

CONTEXT: Structural features of health care environments are associated with patient health outcomes, but these relationships are not well understood in sports medicine. OBJECTIVE: To evaluate the association between athlete injury outcomes and structural measures of health care at universities: (1) clinicians per athlete, (2) financial model of the sports medicine department, and (3) administrative reporting structure of the sports medicine department. DESIGN: Descriptive epidemiology study. SETTING: Collegiate sports medicine programs. PATIENTS OR OTHER PARTICIPANTS: Colleges that contribute data to the National Collegiate Athletic Association (NCAA) Injury Surveillance Program. MAIN OUTCOME MEASURE(S): We combined injury data from the NCAA Injury Surveillance Program, sports medicine staffing data from NCAA Research, athletic department characteristics from the United States Department of Education, and financial and administrative oversight model data from a previous survey. Rates of injury, reinjury, concussion, and time loss (days) in NCAA athletes. RESULTS: Compared with schools that had an average number of clinicians per athlete, schools 1 standard deviation above average had a 9.5% lower injury incidence (103.6 versus 93.7 per 10000 athlete-exposures [AEs]; incidence rate ratio [IRR] = 0.905, P < .001), 2.7% lower incidence of reinjury (10.6 versus 10.3 per 10000 AEs; IRR = 0.973, P = .004), and 6.7% lower incidence of concussion (6.1 versus 5.7 per 10000 AEs; IRR = 0.933, P < .001). Compared with the average, schools that had 1 standard deviation more clinicians per athlete had 16% greater injury time loss (5.0 days versus 4.2 days; IRR = 1.16, P < .001). At schools with sports medicine departments financed by or reporting to the athletics department (or both), athletes had higher injury incidences (31% and 9%, respectively). CONCLUSIONS: The financial and reporting structures of collegiate sports medicine departments as well as the number of clinicians per athlete were associated with injury risk. Increasing the number of sports medicine clinicians on staff and structuring sports medicine departments such that they are financed by and report to a medical institution may reduce athlete injury incidence.

Collegiate Athletic Trainers' Experiences With External Pressures Faced During Decision Making.

CONTEXT: Conflict is prevalent between sports medicine professionals and coaching staffs regarding return-to-play decisions for athletes after injury in the National Collegiate Athletic Association (NCAA) Division I setting. The firsthand experiences of athletic trainers (ATs) regarding such conflict have not been fully investigated. OBJECTIVE: To better understand the outside pressures ATs face when making medical decisions regarding patient care and return to play after injury in the NCAA Division I Football Bowl Subdivision (FBS) setting. DESIGN: Qualitative study. SETTING: Semistructured one-on-one telephone interviews. PATIENTS OR OTHER PARTICIPANTS: Nine ATs (4 men, 5 women; age = 31 ± 8 years [range = 24-48 years]; years certified = 9 ± 8). DATA COLLECTION AND ANALYSIS: Interviews were audio recorded and later transcribed. Thematic analysis was completed phenomenologically. Researcher triangulation, peer review, and member checks were used to establish trustworthiness. RESULTS: Two major themes emerged from the qualitative analysis: (1) pressure is an expected component of the Division I FBS AT role, and (2) strategies can be implemented to mitigate the negative effects of pressure. Three subthemes supported the second major theme: (1) ensuring ongoing and frequent communication with stakeholders about an injured athlete's status and anticipated timeline for return to play, (2) providing a rationale to coaches or administrations to foster an understanding of why specific medical decisions are being made, and (3) establishing positive relationships with coaches, athletes, and administrations. CONCLUSIONS: External pressure regarding medical decisions was an anticipated occurrence for our sample. Such pressure was described as a natural part of the position, not negative but rather a product of the culture and environment of the Division I FBS setting. Athletic trainers who frequently face pressure from coaches and administration should use the aforementioned strategies to improve the workplace dynamic and foster an environment that focuses on patient-centered care.