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Lesbian, gay, bisexual, transgender, and queer (LGBTQ+) youth are at increased risk for suicidality compared to their heterosexual and cisgender peers, and outness (the extent to which an individual is open about their LGBTQ+ identity to others) is an important correlate of suicidality. However, previous research has led to mixed findings regarding whether outness functions as a risk or protective factor for suicidality, and the available evidence suggests that age may play an important role. As such, the goal of the current study was to examine whether the associations between outness and suicidality differed between LGBTQ+ adolescents (ages 12-17) and emerging adults (ages 18-24).The analytic sample included 475 LGBTQ+ youth who completed an online survey after contacting a national, LGBTQ+ crisis service provider.Results indicated that age significantly moderated the association between outness and suicidal ideation, such that greater outness was significantly associated with greater suicidal ideation for adolescents, but not for emerging adults. In contrast, age did not significantly moderate the associations between outness and likelihood of a past suicide attempt or perceived likelihood of a future suicide attempt. However, the main effect of outness was significant in both models, such that greater outness was significantly associated with a greater likelihood of a past suicide attempt and a greater perceived likelihood of a future suicide attempt.These findings suggest that the associations between outness and suicidality among LGBTQ+ youth may depend on age as well as the dimension of suicidality (ideation versus attempt). HighlightsBeing more open about one's LGBTQ+ identity may confer risk for suicidality.The influence of outness on suicidal ideation may be strongest during adolescence.There is a need for LGBTQ+ affirming policies and laws to reduce suicidality.

Sexual minority young adults are at increased risk for suicidal ideation (SI) compared with heterosexual young adults. Though several frameworks exist to explain the development of suicide risk, including the Interpersonal Theory of Suicide (IPTS) and the Minority Stress Model, few studies have examined these frameworks simultaneously. This study examines these frameworks longitudinally among sexual minority young adults.A total of 792 sexual minority young adults (50% bisexual+, 50% gay/lesbian) completed an online survey at baseline, one-month follow-up, and two-month follow-up assessing constructs related to IPTS, the minority stress model, and SI.Over half of our sample (52.9%) reported any SI at baseline. In the full sample, all types of minority stress at baseline were significantly associated with SI at two-month follow-up via perceived burdensomeness (PB) and thwarted belongingness (TB) at one-month follow-up. In the bisexual+ subsample, all bisexual-specific minority stressors at baseline were significantly associated with SI at two-month follow-up via PB at one-month follow-up; internalized binegativity was also associated with SI via TB. However, effects became non-significant when controlling for previous levels of the mediators and outcome variables.Both minority stress and IPTS are relevant for understanding suicide risk among sexual minority young adults.

Introduction Our study sought to assess the interplay of family dynamics, namely familial warmth and LGBTQ+ specific rejection, and its association to self-esteem in a non-probabilistic sample of LGBTQ+ adolescents in the United States. Methods Stratified by (1) cisgender and (2) transgender and non-binary LGBTQ+ adolescents (N = 8774), we tested multivariable regression analyses to assess the association between familial warmth and LGBTQ+ specific family rejection, adjusted for sociodemographic characteristics. We then conducted a sub-analysis with LGBTQ+ adolescents who reported being out to any family member about their LGBTQ+ identity; specifically, we tested a series of multivariable regression models to assess whether levels of LGBTQ+ specific family rejection attenuated the association between familial warmth and self-esteem. Results Full sample models indicated a positive association between familial warmth and self-esteem. Findings from our sub-analysis indicated that familial warmth remained positively linked to self-esteem and family rejection was negatively associated with self-esteem. Family rejection was a statistically significant moderator, attenuating the association between familial warmth and self-esteem. With respect to being out about one's sexual orientation, these findings were robust across gender stratification groups. Conclusions Families of origin serve as sources of stress and resilience for LGBTQ+ adolescents. Our findings contribute support to arguments that familial warmth and LGBTQ+ specific rejection are not mutually-exclusive experiences among LGBTQ+ adolescents. We provide recommendations for multilevel interventions to leverage activities that support positive family dynamics and self-esteem among LGBTQ+ adolescents.

OBJECTIVES To characterize Primary Care Sports Medicine (PCSM) fellowship opportunities for Pediatrics-trained physicians across all programs in the United States. METHODS Cross-sectional study using data from publicly-available online sources. Data were collected from the Association of American Medical Colleges (AAMC) and American Medical Society for Sports Medicine (AMSSM) online listings of PCSM programs and cross-referenced with individual program websites. Variables such as program location, departmental sponsor, and eligibility criteria specific to pediatricians were collected. RESULTS 202 programs were identified. 196 (97.0%) were ACGME-accredited, of which 75.0% were sponsored by Family Medicine (FM), 9.7% by Physical Medicine and Rehabilitation (PMR), 9.2% by Pediatrics, and 5.1% by Emergency Medicine (EM) departments. Pediatrics-trained physicians were eligible for 133 of 196 (67.9%) programs and 241 of 350 (68.9%) total positions. Eligibility for pediatricians was highest in Pediatrics-sponsored programs (18/18, 100.0%), followed by EM (7/10, 70.0%), FM (98/147, 66.7%), and PMR (9/19, 47.4%). 49 of 133 (36.8%) programs accepting pediatricians had discrepancies regarding eligibility criteria (e.g. did not confirm eligibility criteria on their website, listed conflicting eligibility criteria within or between their website and AMSSM listing, or did not have a website available to cross-reference). CONCLUSIONS Pediatricians are eligible for more than two-thirds of PCSM fellowship programs across the United States, including programs that are not sponsored by Pediatrics departments. Applicants may not be aware of these opportunities given discrepancies regarding eligibility in over one-third of programs. In a field underrepresented by Pediatrics-trained physicians, accurate online information and transparency of eligibility criteria are critical to raise awareness about fellowship opportunities and foster equity with regards to career opportunities for pediatricians in PCSM.

The current study examined the role of LGBTQ identity pride in the associations among discrimination, social support, and depressive symptoms in a sample of LGBTQ youth. As part of a larger study, 13,440 LGBTQ youth completed a survey assessing depressive symptoms, past-year bullying, family rejection, general and LGBTQ-specific teacher support, general and LGBTQ-specific family support, and LGBTQ identity pride. Findings showed that greater bullying and family rejection were associated with lower LGBTQ identity pride and, in turn, greater depression. Conversely, greater general and LGBTQ-specific teacher support and greater general and LGBTQ-specific family support were associated with greater LGBTQ identity pride and, in turn, lower depression. All of the indirect effects were significant when the predictors were examined in separate models and most remained significant when the predictors were examined simultaneously. LGBTQ identity pride may be a mechanism linking discrimination and social support to depression among LGBTQ youth.

Recent studies have demonstrated that the COVID-19 pandemic has contributed to increases in depression for sexual minority people. However, there has been limited attention to whether its negative impact differs across subgroups of sexual minority people or to whether its negative impact is prospectively associated with increases in depressive symptoms. To address these gaps, the present study examined demographic differences in the negative impact of COVID-19 on sexual minority people and whether the negative impact of COVID-19 was associated with increases in depressive symptoms one- and two-months later. A total of 695 sexual minority young adults completed surveys at three time points (baseline, one-month follow-up, and two-month follow-up). Results indicated that younger age, identifying as transgender/gender diverse or as a cisgender woman, and being a full-time student were associated with being more negatively impacted by the pandemic. Furthermore, the negative impact of COVID-19 was associated with higher levels of depressive symptoms at the two-month follow-up. However, this became nonsignificant after adjusting for baseline levels of depressive symptoms, likely due to its strong association with subsequent levels. Findings provide preliminary support for within-group heterogeneity in the negative impact of COVID-19 on sexual minority people and for the negative impact of COVID-19 on mental health in this population. (PsycInfo Database Record (c) 2021 APA, all rights reserved) Impact Statement Public Significance Statement-Among sexual minority people, certain groups (e.g., transgender/gender diverse, cisgender women, full-time students) have experienced a greater negative impact of the COVID-19 pandemic than others, and being negatively impacted by the pandemic is associated with worse mental health. Policies and interventions should prioritize minimizing the negative effects of the pandemic on the groups that are most negatively affected. (PsycInfo Database Record (c) 2021 APA, all rights reserved)

Sexual minority (e.g., gay, lesbian, bisexual) people are at increased risk for suicidal thoughts and behaviors compared to their heterosexual peers. The interpersonal theory of suicide proposes that perceived burdensomeness and thwarted belongingness are central to the desire to die, and both are associated with suicidal ideation in sexual minority samples. The Interpersonal Needs Questionnaire (INQ) was developed to measure these risk factors and has become the most commonly used measure. However, it is unknown whether the INQ demonstrates similar measurement properties across subgroups of sexual minority people. Therefore, the goal of this study was to examine whether the 15-item version of the INQ exhibited measurement invariance (MI) across sexual orientation (gay/lesbian vs. bi +), gender identity (cisgender men vs. cisgender women vs. transgender/gender diverse individuals), and race/ethnicity (non-Latinx White individuals vs. people of color) in a sample of 792 sexual minority young adults (ages 18-29). A series of multigroup measurement invariance models indicated that the INQ-15 met strict invariance (i.e., equal factor loadings, item intercepts, and residual variances) across all three dimensions of identity. This indicates that it can be used and compared across diverse samples of sexual minority young adults. Results also indicated that perceived burdensomeness was greater for transgender/gender diverse individuals than for cisgender men and women, and that perceived burdensomeness and thwarted belongingness were greater for people of color than for non-Latinx White individuals. In contrast, gay/lesbian and bi + individuals did not differ. Additional research is needed to understand the factors that account for these group differences. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

The American Medical Society for Sports Medicine convened a panel of experts to provide an evidence-based, best practice document to assist sports medicine physicians and other members of the athletic care network with the detection, treatment, and prevention of mental health (MH) issues in competitive athletes. This statement discusses how members of the sports medicine team, including team physicians, athletic trainers, and MH providers, work together in providing comprehensive psychological care to athletes. It specifically addresses psychological factors in athletes including personality issues and the psychological response to injury and illness. The statement also examines the athletic culture and environmental factors that commonly impact MH, including sexuality and gender issues, hazing, bullying, sexual misconduct, and transition from sport. Specific MH disorders in athletes, such as eating disorders/disordered eating, depression and suicide, anxiety and stress, overtraining, sleep disorders and attention-deficit/hyperactivity disorder, are reviewed with a focus on detection, management, the effect on performance, and prevention. This document uses the Strength of Recommendation Taxonomy to grade level of evidence.

The American Medical Society for Sports Medicine convened a panel of experts to provide an evidence-based, best practices document to assist sports medicine physicians and other members of the athletic care network with the detection, treatment, and prevention of mental health issues in competitive athletes. This statement discusses how members of the sports medicine team, including team physicians, athletic trainers, and mental health providers, work together in providing comprehensive psychological care to athletes. It specifically addresses psychological factors in athletes including personality issues and the psychological response to injury and illness. The statement also examines the athletic culture and environmental factors that commonly impact mental health, including sexuality and gender issues, hazing, bullying, sexual misconduct, and transition from sport. Specific mental health disorders in athletes, such as eating disorders/disordered eating, depression and suicide, anxiety and stress, overtraining, sleep disorders, and attention-deficit/hyperactivity disorder, are reviewed with a focus on detection, management, the effect on performance, and prevention. This document uses the Strength of Recommendation Taxonomy (SORT) to grade level of evidence.

Bisexual men are at increased risk for HIV compared to heterosexual men but unlikely to use pre-exposure prophylaxis (PrEP). Given that biases may influence whether bisexual men are prescribed PrEP, we examined whether medical students' decision-making was influenced by the genders of a bisexual male patient's partners. Medical students (N = 718) were randomized to one of nine conditions where they answered questions about a bisexual male patient after reviewing his electronic medical record. We manipulated the gender of his current partner (none, male, female) and the genders of his past partners (male, female, both). Current partners were described as living with HIV and not yet virally suppressed, past partners were described as being of unknown HIV-status, and condom use was described as intermittent with all partners. When the patient was not in a current relationship, perceived HIV risk and likelihood of prescribing PrEP were lowest if he only had female partners in the past. When he was in a current relationship, perceived HIV risk and likelihood of prescribing PrEP did not differ based on current or past partners' genders. In addition, identification as a PrEP candidate, perceived likelihood of adherence, and perceived likelihood of engaging in condomless sex if prescribed were lower when the patient was not in a current relationship. Medical students appropriately prioritized the status of the partner living with HIV, but their decision-making was influenced by past partner genders when the patient was not in a current relationship. Medical students may require additional education to ensure they understand PrEP eligibility criteria and make decisions based on patients' individual presentations.

Purpose of Review The exponential growth of women participating in competitive sports throughout the years was made possible through several initiatives by the International Olympic Committee and the passage and implementation of Title IX as a federal law in the United States. However, this positive trend towards gender equity in sports has not transpired for women in medicine, especially in fields that care for elite athletes. This current review will discuss specific areas that can be tailored to help female athletes prevent injuries and optimize their athletic performance. We will also highlight how increased female team physician representation in sports may help optimize care for female athletes. Recent Findings Female athletes are considered high risk for certain conditions such as ACL tears, patellofemoral pain syndrome, bone stress injuries, sport-related concussions, and sexual violence in sport. Addressing factors specific to female athletes has been found to be valuable in preventing injuries. Strength and conditioning can optimize athletic performance but remains underutilized among female athletes. Although diversity in healthcare workforce has been found to be beneficial for multiple reasons, women remain underrepresented in sports medicine. Increasing female team physician representation may positively impact care for female athletes. Summary Team physicians must understand the physiologic, biomechanical, and anatomic factors that are unique to female athletes in order to tailor injury prevention programs and optimize their athletic performance. Advocating for gender equity in sports medicine to advance representation of women in the field will increase workforce diversity and promote excellence in sports medicine care.

INTRODUCTION Despite high rates of suicide among LGBTQ+ youth, the interpersonal theory of suicide (IPTS) has rarely been examined in this population. The current study utilized a longitudinal design to examine whether perceived burdensomeness and thwarted belongingness independently and simultaneously predicted higher levels of suicidal ideation over time in a sample of LGBTQ+ youth who utilized crisis services. We also investigated whether gender identity moderated these associations. METHODS A total of 592 youth (12-24 years old) who had contacted a national crisis hotline for LGBTQ+ youth completed two assessments 1-month apart. RESULTS Perceived burdensomeness and thwarted belongingness independently predicted greater suicidal ideation 1 month later; however, only perceived burdensomeness remained prospectively associated with suicidal ideation when both factors were tested in the same model. Gender identity moderated the associations between IPTS factors and suicidal ideation, such that both perceived burdensomeness and thwarted belongingness were associated with greater suicidal ideation 1 month later for sexual minority cisgender young women and transgender/genderqueer individuals, but not for sexual minority cisgender young men. CONCLUSION The IPTS helps explain increases in suicidal ideation over time among LGBTQ+ youth and therefore can be used to inform suicide prevention and intervention approaches for this population.

Compared to heterosexual individuals, sexual minorities exhibit elevated risk for depression and borderline personality disorder (BPD). One psychosocial factor relevant to sexual minority mental health is outness, or the degree to which an individual discloses or conceals their sexual orientation. Previous findings are mixed regarding whether outness is associated with better or worse mental health, likely because outness can have positive consequences (e.g., social support) and negative consequences (e.g., discrimination). Support exists for both mechanisms, but previous studies have not simultaneously considered how outness may be related to mental health outcomes in different ways through social support versus discrimination. The present study examined: (a) the association between outness and depressive symptoms, (b) the association between outness and BPD symptoms, and (c) the indirect effects of outness on depressive/BPD symptoms through social support and discrimination. A total of 256 sexual minority participants completed an online or in-person survey. Greater outness was associated with lower depressive symptoms and BPD symptoms. There was an indirect effect of outness on depressive symptoms through social support, with greater outness being associated with greater social support and, in turn, lower depressive symptoms. Outness had an indirect effect on BPD symptoms through both social support and discrimination. Greater outness was associated with both greater social support and discrimination, with greater social support being associated with lower BPD symptoms, and greater discrimination with greater BPD symptoms. Outness may contribute to mental health through multiple mechanisms, serving as either a risk or protective factor. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

The current study examined parent-adolescent discrepancies in reports of family functioning and their relation to attachment styles, depressive symptomatology, and suicidal ideation in a diverse sample of adolescents (49.7% African American, 15.5% Hispanic/Latino, 28.7% White, 81.9% female). Participants were 129 adolescents (ages 12–18) and one caregiver (79% mothers). Adolescents had met inclusion criteria in a Randomized Clinical Trial for depressed and suicidal adolescents. Measures of family functioning, symptoms, and attachment styles were assessed at baseline prior to treatment. On average, adolescents reported less family cohesion compared to caregivers (t (127) = −3.01, p = 0.003) but similar levels of family conflict (p> 0.05). Polynomial regression models demonstrated that avoidant attachment styles with mother figures were associated with adolescent-reported family conflict when parents reported low family conflict (b = 0.79, SE = 0.24, p

The current study examined suicide-related disclosure intentions in LGBTQ + youth, and the associations between reporting of lifetime experiences of minority stress and intentions to disclose suicidal thoughts.A sample of 592 LGBTQ + youth ages 12-24 (22.3% cisgender men, 33.1% cisgender women, 44.6% gender diverse, 75.3% white) who contacted an LGBTQ-specific crisis service, completed a survey.Youth reported highest intentions to disclose future suicidal ideation to LGBTQ-specific crisis services, a mental health professional, and someone they know who also identifies as LGBTQ. They reported lowest suicide-related disclosure intentions to family, spiritual counselors, and emergency room personnel. Greater lifetime minority stress was significantly associated with lower suicide-related disclosure intentions. When specific domains of minority stress were examined separately, five domains were significantly associated with lower suicide-related disclosure intentions: identity management, family rejection, homonegative communication, negative expectancies, and internalized homonegativity. However, only internalized homonegativity remained significant when they were examined simultaneously. In addition, greater lifetime minority stress was significantly associated with lower suicide-related disclosure intentions to some groups (e.g., family, friends), but not others (e.g., others who have thought about or attempted suicide, others who identify as LGBT).Minority stress may play an important role in LGBTQ + youth's suicide-related disclosure intentions. As such, reducing minority stress and its effects may be an important target to promote disclosure of suicidal thoughts and access to treatment among LGBTQ + youth.HIGHLIGHTSMinority stress was associated with lower suicide-related disclosure intentions.Internalized homonegativity was uniquely associated with disclosure intentions.Reducing minority stress may promote disclosure of suicidal thoughts.

Background: Slipping rib syndrome (SRS) is an often unrecognized cause of lower chest and upper abdominal pain in children and adolescents. Surgical resection of the cartilaginous portions of the slipping rib often provides permanent pain relief, with the standard surgical approach being an open resection. A minimally invasive approach has not been reported previously; we report a novel laparoscopic technique for the treatment of SRS with satisfactory results. Materials and Methods: A retrospective review of all consecutive pediatric patients who underwent laparoscopic cartilage resection during the year 2019 and open cartilage resection during the year 2018 was included. Following data were recorded: age of patients, length of symptoms, length of procedure, length of cartilage resection, length of stay, resolution of pain, cosmetic acceptability, and postoperative complications. Results: Four patients underwent laparoscopic slipping rib resection without complication during the year 2019. The mean age of symptom onset was 15 (range 14-16) years old, mean length of symptoms was 1.4 (0.5-2.0) years, and mean age at operation was 16.5 (16-18) years old. The average length of the procedure was 72.8 (55-102) minutes, and mean length of cartilage removed was 2.3 (1.9-3.0) cm. Three patients underwent standard open operation during the year 2018. All patients reported complete resolution of their chronic pain at their 6-month follow-up visit. Conclusions: Laparoscopic technique can be used to treat SRS. All patients reported high satisfaction from resolution of chronic pain and the cosmetic appearance of their surgical scars.

The American Medical Society for Sports Medicine (AMSSM) convened a group of experts to develop a position statement addressing the problem of sexual violence in sport. The AMSSM Sexual Violence in Sport Task Force held a series of meetings over 7 months, beginning in July 2019. Following a literature review, the task force used an iterative process and expert consensus to finalize the position statement. The objective of this position statement is to raise awareness of this critical issue among sports medicine physicians and to declare a commitment to engage in collaborative, multidisciplinary solutions to reduce sexual violence in sport.

The current study examined the relation between sexual minority status, social support, emotion dysregulation, and suicide attempt in a community sample. A total of 388 community and college adults completed a one-time survey examining self-injury and suicidality. Findings demonstrated that that social support and emotion regulation, independently and in sequence, mediated the relation between sexual minority status and suicide attempt. The reverse mediation model with emotion regulation as the first mediator and social support as the second mediator was also significant. Social support and emotion regulation may both be related and may explain the relation between sexual minority status and suicide attempt. If replicated longitudinally, these findings shed light on specific risk factors and their interrelations, which may have important implications for preventing suicide in sexual minorities.

The American Medical Society for Sports Medicine convened a panel of experts to provide an evidence-based, best practice document to assist sports medicine physicians and other members of the athletic care network with the detection, treatment, and prevention of mental health (MH) issues in competitive athletes. This statement discusses how members of the sports medicine team, including team physicians, athletic trainers, and MH providers, work together in providing comprehensive psychological care to athletes. It specifically addresses psychological factors in athletes including personality issues and the psychological response to injury and illness. The statement also examines the athletic culture and environmental factors that commonly impact MH, including sexuality and gender issues, hazing, bullying, sexual misconduct, and transition from sport. Specific MH disorders in athletes, such as eating disorders/disordered eating, depression and suicide, anxiety and stress, overtraining, sleep disorders and attention-deficit/hyperactivity disorder, are reviewed with a focus on detection, management, the effect on performance, and prevention. This document uses the Strength of Recommendation Taxonomy to grade level of evidence.

Sleep is an important factor that can directly influence the mental well-being of athletes. There exists a number of theories regarding the purpose of sleep, though data and consensus opinion supporting these theories remain limited. Sleep consists of a number of different phases, and a disruption of the sleep cycle can impact sleep quality and function in athletes and active people. Sleep can be both a precipitant and a consequence of mental health disorders, and there are a number of sleep-specific disorders that can impact athletic performance. Sleep optimization begins with understanding the problem at hand, conducting appropriate studies if needed, and providing education and treatments to reduce or eliminate risk factors and maladaptive behaviors. A number of medications may impact sleep type and sleep quality and, in some instances, may be used to promote sleep onset and treat insomnia.

Context: The advent of Web-based sports injury surveillance via programs such as the High School Reporting Information Online system and the National Collegiate Athletic Association Injury Surveillance Program has aided the acquisition of boys' and men's soccer injury data. Objective: To describe the epidemiology of injuries sustained in high school boys' soccer in the 2005–2006 through 2013–2014 academic years and collegiate men's soccer in the 2004–2005 through 2013–2014 academic years using Web-based sports injury surveillance. Design: Descriptive epidemiology study. Setting: Online injury surveillance from soccer teams of high school boys (annual average = 100) and collegiate men (annual average = 41). Patients or Other Participants: Boys' or men's soccer players who participated in practices and competitions during the 2005–2006 through 2013–2014 academic years in high school and the 2004–2005 through 2013–2014 academic years in college, respectively. Main Outcome Measure(s): Athletic trainers collected time-loss (≥24 hours) injury and exposure data. Injury rates per 1000 athlete-exposures (AEs), injury rate ratios (IRRs) with 95% confidence intervals (CIs), and injury proportions by body site and diagnosis were calculated. Results: High School Reporting Information Online documented 2912 time-loss injuries during 1 592 238 AEs; the National Collegiate Athletic Association Injury Surveillance Program documented 4765 time-loss injuries during 686 918 AEs. The injury rate was higher in college than in high school (6.94 versus 1.83/1000 AEs; IRR = 3.79; 95% CI = 3.62, 3.97). Injury rates increased with smaller school size for high schools and were higher in Division I than in Divisions II and III. The injury rate was higher during competitions than during practices in both high school (IRR = 3.55; 95% CI = 3.30, 3.83) and college (IRR = 3.45; 95% CI = 3.26, 3.65). Most injuries were to the lower extremity. However, concussion was a common injury, particularly in collegiate goalkeepers and at all positions for high school players. Concussions accounted for more than one-fifth of injuries in high school games. Conclusions: Injury-prevention interventions should be tailored to reflect variations in the incidence and type of injury by level of competition, event type, and position.

Context: The advent of Web-based sports injury surveillance via programs such as the High School Reporting Information Online system and the National Collegiate Athletic Association Injury Surveillance Program has aided the acquisition of girls' and women's soccer injury data. Objective: To describe the epidemiology of injuries sustained in high school girls' soccer in the 2005–2006 through 2013–2014 academic years and collegiate women's soccer in the 2004–2005 through 2013–2014 academic years using Web-based sports injury surveillance. Design: Descriptive epidemiology study. Setting: Online injury surveillance from soccer teams in high school girls (annual average = 100) and collegiate women (annual average = 52). Patients or Other Participants: Female high school and collegiate soccer players who participated in practices or competitions during the 2004–2005 through 2013–2014 academic years. Main Outcome Measure(s): Athletic trainers collected time-loss (≥24 hours) injury and exposure data. Injury rates per 1000 athlete-exposures (AEs), injury rate ratios (IRRs) with 95% confidence intervals (CIs), injury proportions by body site, and diagnoses were calculated. Results: The High School Reporting Information Online system documented 3242 time-loss injuries during 1 393 753 AEs; the National Collegiate Athletic Association Injury Surveillance Program documented 5092 time-loss injuries during 772 048 AEs. Injury rates were higher in college than in high school (6.60 versus 2.33/1000 AEs; IRR = 2.84; 95% CI = 2.71, 2.96), and during competitions than during practices in high school (IRR = 4.88; 95% CI = 4.54, 5.26) and college (IRR = 2.93; 95% CI = 2.77, 3.10). Most injuries at both levels affected the lower extremity and were ligament sprains or muscle/tendon strains. Concussions accounted for 24.5% of competition injuries in high school but 14.6% of competition injuries in college. More than one-third of competition injuries to high school goalkeepers were concussions. Conclusions: Injury rates were higher in college versus high school and during competitions versus practices. These differences may be attributable to differences in reporting, activity intensity, and game-play skill level. The high incidence of lower extremity injuries and concussions in girls' and women's soccer, particularly concussions in high school goalkeepers, merits further exploration and identification of prevention strategies.

ObjectiveThe IOC recommends periodic cardiovascular screening of athletes, but the adoption of these recommendations is unknown. The purpose of this investigation was to evaluate and compare cardiovascular screening practices of countries participating in the Rio 2016 Olympic Games.MethodsA list of chief medical officers (CMOs) was compiled by the IOC during the 2016 Olympic Games. CMOs were requested to complete an online survey about cardiovascular screening of their countries’ Olympic athletes. Comparisons of screening practices were made by categorising countries by continent, gross domestic product (GDP) per capita and size of athlete delegation.ResultsCMOs for 117/207 (56.5%) countries participating in the 2016 Olympic Games were identified. 94/117 countries (80.3%) completed the survey, representing 45.4% of all countries and 8805/11 358 (77.5%) of all 2016 Olympic athletes. Most of the countries surveyed (70.2%) perform annual cardiovascular screening. Among the survey respondents, all or most athletes from each country were screened at least once with the following components: personal history (86.2% of countries), family history (85.1%), physical examination (87.2%), resting ECG (74.5%), echocardiogram (31.9%) and stress test (30.8%). Athletes were more likely to be screened with ECG in countries with relatively larger athlete delegation (OR 2.05, 95% CI 1.10 to 3.80, p=0.023) and with higher GDP per capita (OR 1.69, 95% CI 1.11 to 2.57, p=0.014).ConclusionMost of the responding countries perform annual cardiovascular screening of Olympic athletes, but there are differences in the components used. Athletes from countries with larger athlete delegations and higher GDP per capita were more likely to be screened with ECG.

The American Medical Society for Sports Medicine convened a panel of experts to provide an evidence-based, best practices document to assist sports medicine physicians and other members of the athletic care network with the detection, treatment and prevention of mental health issues in competitive athletes. This statement discusses how members of the sports medicine team, including team physicians, athletic trainers and mental health providers, work together in providing comprehensive psychological care to athletes. It specifically addresses psychological factors in athletes including personality issues and the psychological response to injury and illness. The statement also examines the athletic culture and environmental factors that commonly impact mental health, including sexuality and gender issues, hazing, bullying, sexual misconduct and transition from sport. Specific mental health disorders in athletes, such as eating disorders/disordered eating, depression and suicide, anxiety and stress, overtraining, sleep disorders and attention-deficit/hyperactivity disorder, are reviewed with a focus on detection, management, the effect on performance and prevention. This document uses the Strength of Recommendation Taxonomy to grade level of evidence.

The 2009 IOC Consensus Statement on Periodic Health Evaluation (PHE) of Elite Athletes recommends a 12-lead ECG, but the frequency of the PHE elements is not defined.1 In 2011, the International Paralympic Committee (IPC) approved the IPC Medical Code, which describes the need for routine PHE based on the latest medical knowledge.2 However, the components and frequency of screening are also not delineated. Recent research has evaluated the cardiovascular (CV) screening practices of Olympic athletes, but there are limited data regarding CV screening of Paralympic athletes.3 4 This study aimed to investigate current practices for CV screening of Paralympic athletes. Chief medical officers (CMOs) for National Paralympic Committees of the PyeongChang 2018 Paralympic Winter Games were identified by the IPC and surveyed regarding the CV screening practices of their respective teams. The primary outcome was the utilisation of CV screening components as part of the PHE. The secondary outcomes were the frequency of performing the CV screening components. A total of 35 of the 49 (71.4%) countries …

Cardiovascular screening in athletes has been a source of controversy within the sports medicine community. Annual screening inclusive of ECG is currently required by all major professional sports leagues in the USA and recommended by the IOC.1 In 2016, the American Medical Society for Sports Medicine (AMSSM) published a statement on cardiovascular screening, recognising knowledge gaps and advocating for medical providers caring for competitive athletes to consider important factors when determining an individualised cardiovascular screening strategy. These include the risk of sudden cardiac arrest (SCA) in the specific athlete population, the available resources and cardiology infrastructure for screening and secondary evaluations.2 The purpose of this investigation was to determine the cardiovascular screening practices of the US National Governing Bodies (NGBs) and National Paralympic Committees (NPCs). This study was approved by the Institutional Review Board from the …

Introduction Wolff-Parkinson-White (WPW) syndrome is a congenital abnormality that involves an accessory pathway between the atria and the ventricles in addition to the normal atrioventricular node-His pathway. This extra pathway can conduct electrical impulses to the ventricles more quickly and can cause pre-excitation arrhythmias to occur [1]. Three percent to 4% of WPW cases are familial and inherited as an autosomal dominant trait. WPW syndrome has a frequency of 1.5 to 3.1 per 1000 persons in Western countries [2]. The incidence of WPW is higher in men than in women, and it can occur at any age [3]. Therefore, it is inevitable that WPW syndrome can pose a major risk to the small fraction of athletes that have inherited the condition. The following two case reports describe the evaluation of possible WPW syndrome in two Division I collegiate athletes, a female softball player and a female water polo player. Quick detection of the syndrome is vital, and this should be followed by risk stratification and treatment according to the guidelines established by the 36th Bethesda Conference.

The two most troublesome skin infections in wrestlers are herpes gladiatorum and tinea gladiatorum. Determining whether athletes should or should not be disqualified from practice or competition because of these infections requires some expertise. Recommendations are presented to assist the practitioner in the care of these conditions in wrestlers and other athletes who have frequent skin-to-skin contact.

Background Cardiac screening in athletes has recently been a focus of investigation and debate among the sports medicine community. Athletic associations and organizations, including the International Olympic Committee, have issued recommendations regarding screening practices in an effort to prevent sudden cardiac death in sport. Objective To examine cardiovascular screening strategies among Olympic-level athletic teams. Design Cross-sectional survey. Setting United States National Governing Bodies (NGBs) and National Paralympic Committees (NPCs). Participants Medical team members for US NGBs and NPCs. Interventions Medical team members were surveyed regarding the cardiovascular screening practices of their respective teams. Main Outcome Measurements The screening components and screening frequency performed by US NGBs and NPCs. Results Medical team members for 49/72 (68%) of the US NGBs and NPCs were identified and contact information was obtained through various sources. 42/49 teams (86%) completed the assessment (34 from NGBs and 8 from NPCs). Twenty-one of 42 teams (50%) reported that there was a periodic health evaluation requirement that directed the cardiovascular screening components, frequency, and/or provider. The following screening components were reported as being performed at least once in all or most athletes: personal history (91% of teams), family history (86%), physical exam (81%), electrocardiogram (33%), echocardiogram (5%), and stress test (2%). For teams who did not screen athletes with ECG, the most frequently cited reasons were lack of ECG equipment (40%), lack of evidence (33%), and lack of consensus regarding follow-up testing (20%). Conclusion The US NGBs and NPCs are a heterogeneous collection of athletic teams that have varying approaches to cardiovascular screening. Lack of infrastructure appears to be the biggest barrier to implementing advanced screening protocols. Results from this investigation can be used to support efforts to provide consistent cardiovascular screening practices to NGB and NPC athletes with the goal of preventing tragedy from sudden cardiac death.

> “…we rejoice in our sufferings, knowing that suffering produces endurance, and endurance produces character…” Romans 5: 3–4 Promoting fitness and keeping people active is a major focus of sports medicine professionals. Regular exercise reduces the incidence of, and prevents, many diseases and improves quality of life across the lifespan.1,–,3 The American Medical Society for Sports Medicine (AMSSM) is an organisation of primary care sports medicine physicians that is dedicated to promoting safe participation in regular exercise for all people. Phiddipides may have been the first true endurance athlete, running several hundred miles to relay news during the Persian/Greek War 2500 years ago. Following the Athenian victory at the Battle of Marathon, he ran 26 miles to announce the victory and upon completion of his run, died. From this tragedy, the marathon running event was born. As more and more people complete marathons, the public mystique of the marathon as a way to differentiate oneself from ‘normal’ athletes is wearing off, and endurance athletes are pushing the envelope farther and longer in a quest for greatness. …

Sports that require skin-to-skin contact between competitors, such as wrestling, create environments where infections can spread. Skin screening checks are made before any wrestling competition, but this usually doesn't happen with other sports. Two of the most common skin infections are herpes gladiatorum (caused by the same virus that causes cold sores) and tinea gladiatorum, also known as ringworm (caused by a fungus). These skin infections can spread rapidly among teammates, coaches, and opponents, so it is very important to treat the infection as soon as it is discovered. Athletes who have active skin infections can be disqualified from competition and withheld from practice.