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

The International Olympic Committee's (IOC) consensus statement on 'methods for recording and reporting of epidemiological data on injury and illness in sport' recommended standardising methods to advance data collection and reporting consistency. However, additional aspects need to be considered when these methods are applied to specific sports settings. Therefore, we have developed a snow sports-specific extension of the IOC statement to promote the harmonisation of injury and illness registration methods among athletes of all levels and categories in the different disciplines governed by the International Ski and Snowboard Federation (FIS), which is also applicable to other related snow sports such as biathlon, ski mountaineering, and to some extent, para snow sports. The panel was selected with the aim of representing as many different areas of expertise/backgrounds, perspectives and diversity as possible, and all members were assigned to thematic subgroups based on their profiles. After panel formation, all members were provided with an initial draft of this extension, which was used as a basis for discussion of aspects specific to the discipline, application context, level and sex within their snow sports subgroup topic. The outcomes were then aligned with the IOC's existing consensus recommendations and incorporated into a preliminary manuscript draft. The final version of this snow sports-specific extension was developed and approved in two iterative rounds of manuscript revisions by all consensus panel members and a final meeting to clarify open discussion points. This snow sports-specific extension of the IOC statement is intended to guide researchers, international and national sports governing bodies, and other entities recording and reporting epidemiological data in snow sports to help standardise data from different sources for comparison and future research., Competing Interests: Competing interests: MM is a deputy editor, LE is an IPHP editor and BC and EV are associate editors at BJSM., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Objectives: Our aims were (a) to describe the prevalence and incidence of self-reported injuries and illnesses of amateur golfers over a 5-month period and (b) to investigate potential risk factors for injury., Methods: We recruited 910 amateur golfers (733 males [81%] and 177 females [19%]) from golf clubs in the USA and Switzerland. The median age was 60 (IQR: 47-67) and the median golfing handicap was 12 (IQR: 6-18). Participants' health was monitored weekly for 5 months using the Oslo Sports Trauma Research Centre Questionnaire on Health Problems. Players also completed a baseline questionnaire on personal and golf-specific characteristics and their medical history., Results: We distributed 19 406 questionnaires and received 11 180 responses (57.6%). The prevalence of injuries was 11.3% (95% CI: 9.8 to 12.8) and of illnesses was 2% (95% CI 1.7 to 2.2). The incidence of injuries and illnesses was 3.79 (95% CI 3.54 to 4.06) and 0.94 (95% CI 0.81 to 1.07) per golfer per year, respectively. The injury regions with the highest burden of injury (time-loss days per player per year) were lumbosacral spine (5.93), shoulder (3.47) and knee (2.08). Injury risk was higher with increased age, osteoarthritis and previous injury., Conclusion: The prevalence and incidence of injury and illness in amateur golf were low compared with many other sports. To further reduce the burden of injury, future research attention should be directed towards the lumbosacral spine, knee and shoulder., Competing Interests: Dr AM receives remuneration from clinical and research services to professional golf organisations. Dr MLM is a deputy editor of BJSM and Dr BC is an associate editor for BJSM., (Copyright © Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Objective: A periodic health evaluation (PHE) is a comprehensive and multidisciplinary investigation of athlete health widely used in elite sport, but its contents and benefits can be questioned. This study aimed to determine the prevalence of conditions identified by a PHE among Paralympic and Olympic athletes over four consecutive Games cycles from Rio de Janeiro 2016 to Beijing 2022 and to assess the benefits and potential pitfalls of a comprehensive PHE programme in detecting existing injuries, illnesses and other health issues., Methods: We collected extensive health history and clinical examination data on elite athletes: medical history, ECG, blood pressure, blood samples, spirometry, musculoskeletal health, cognitive function, mental health and compliance with public health programmes., Results: The final cohort included 87 Paralympic and 367 Olympic athletes, representing 565 PHE cycles. Musculoskeletal problems and unspecified pain, infections and allergies were the most frequent health issues. High blood pressure was the most prevalent cardiovascular finding, and vitamin D deficiency the most common laboratory abnormality. Most athletes complied with the public childhood vaccination programmes, but fewer with recommended cancer screening. Follow-up of health issues was variable., Conclusion: Our PHE programme identified musculoskeletal problems, infections, allergies, elevated blood pressure and vitamin D deficiency as common health conditions. Longitudinal follow-up of health conditions identified during screening and improved compliance with public health and cancer screening programmes is needed to determine the true benefits of athlete care prompted by the PHE., Competing Interests: Competing interests: KS is the coeditor of the British Journal of Sports Medicine-Injury Prevention and Health Protection. In the period, these data were collected, the Oslo Sports Trauma Research Center has had a non-financial research partnership with FitStats Technologies (2017 to present)., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

The study aimed to analyse incidence and characteristics of time-loss injuries and illnesses during the FIFA World Cup Qatar 2022. Of 838 male football players, 705 consented to participate. Team medical staff reported 82 time-loss injuries, corresponding to an injury event incidence of 5.6 injuries/1000 h of total exposure (95%CI 4.5 to 7.0 injuries/1000 h), with a median of 2 time-loss injury events per team (IQR, 1 to 4.5, range 0-7). The total injury burden was 103 (95% CI 61 to 152) days per 1000 h. Muscle/tendon injuries had the highest incidence of tissue types (48 cases, 3.3/1000 h (95% CI 2.5 to 4.4), and hamstring muscle injuries were the most frequent diagnosis (16 cases, incidence 1.1/1000 h, 95% CI 0.6 to 1.8). Match injury event incidence was 20.6/1000 h (15.0 to 27.7) and training injury event incidence was 2.1/1000 h (1.4 to 3.1). The majority (52%) of sudden-onset injuries were non-contact injuries, 40% direct contact and 8% indirect contact. We recorded 15 time-loss illnesses, corresponding to an illness event incidence of 1.1 per 1000 competition days, (95% CI: 0.6 to 1.8), and illness burden of 2.1 (1.0 to 3.4) days lost per 1000 competition days. The most common illness was respiratory infection (12 cases, 80%). Match injury event incidence was the lowest in any FIFA World Cup since injuries have been monitored.

Introduction: Most epidemiological studies in the field of military medicine have been based on data from medical records and registries. The aims of this study were to test a self-reporting injury surveillance system commonly used in sports medicine in a military setting, and to describe the injury pattern among Norwegian army conscripts during a period of military training., Method: A total of 296 conscripts in His Majesty the King's Guard were asked to report all injuries each week for 12 weeks, using a modification of the Oslo Sports Trauma Research Center Questionnaire on Health Problems (OSTRC-H2). We recorded all injuries irrespective of their need for medical attention or consequences for military participation. In addition, we retrieved data on injuries recorded by military physicians in the medical record from the Norwegian Armed Forces Health Register., Results: The mean weekly response rate was 74%. A total of 357 injuries were recorded, of which 82% were only captured through the OSTRC-H2 and 3% only in the medical records. The average weekly prevalence of injury was 28% (95% CI: 25% to 31%), and 10% (95% CI: 8% to 12%) experienced injuries with a substantial negative impact on training and performance. The greatest injury burden was caused by lower limb injuries, with knee and foot injuries as the predominant injury locations., Conclusion: The OSTRC-H2 is suitable for use in a military setting and records substantially more injuries than the standard medical record. The prevalence of injuries among conscripts is high and comparable with many elite sports., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. No commercial re-use. See rights and permissions. Published by BMJ.)

The relationship between recent (acute) training load relative to long-term (chronic) training load may be associated with sports injury risk. We explored the potential for modelling acute and chronic loads separately to address current statistical methodology limitations. We also determined whether there was any evidence of an interaction in the association between acute and chronic training loads and injury risk in football. A men's Qatar Stars League football cohort (1 465 players, 1 977 injuries), where training load was defined as the number of minutes of activity, and a Norwegian elite U-19 football cohort (81 players, 60 injuries), where training load was defined as the session rating of perceived exertion (sRPE). Mixed logistic regression was run with training load on the current day (acute load) and cumulative past training load estimated by distributed lag non-linear models (chronic load) as independent variables. Injury was the outcome. An interaction between acute and chronic training load was modelled. In both football populations, we observed that the risk of injury on the current day for different values of acute training load was highest for players with low chronic load, followed by high and then medium chronic load. The slopes varied substantially between different levels of chronic training load, indicating an interaction. Modelling acute and chronic loads separately in regression models is a suitable statistical approach for analysing the association between relative training load and injury risk in injury prevention research. Sports scientists should also consider the potential for interactions between acute and chronic load., Competing Interests: The authors declare no conflict of interest., (Copyright © Biology of Sport 2024.)

Objective: To describe the patterns of health problems among Norwegian Olympic candidates during their preparations for five consecutive Olympic Games (London 2012, Sochi 2014, Rio de Janeiro 2016, PyeongChang 2018 and Tokyo 2020)., Methods: This was a descriptive epidemiological study using the Oslo Sports Trauma Research Center Questionnaire on Health Problems to collect data on all self-reported health problems from Norwegian Olympic candidate athletes for 12-18 months prior to each Olympic Games. Team physicians and physiotherapists followed up the athlete reports, providing clinical care and classifying reported problems according to the International Olympic Committee 2020 consensus statement on methods for recording and reporting of epidemiological data on injury and illness in sport., Results: Between 2011 and 2020, 533 athletes were included in the Norwegian Olympic team monitoring programme, with a 78% response to the weekly questionnaire. During this time, athletes reported 2922 health problems, including 1409 illnesses (48%), 886 overuse injuries (repetitive mechanism, 30%) and 627 acute injuries (traumatic mechanism, 21%). Diagnostic codes were recorded for 2829 (97%) of health problems. Athletes reported, on average, 5.9 new health problems per year (95% CI: 5.6 to 6.1), including 1.3 acute injuries (CI: 1.2 to 1.4), 1.7 overuse injuries (CI: 1.6 to 1.9) and 2.9 illnesses (CI: 2.7 to 3.0). Each year, female and male athletes lost an average of 40 and 26 days of training and competition due to health problems, respectively. The diagnoses with the highest health burden were anterior cruciate ligament rupture, respiratory infection, lumbar pain and patellar tendinopathy., Conclusion: The injury burden was particularly high among female athletes and in team sports, whereas endurance sports had the greatest burden of illness. Our data provide a compelling argument for prioritising medical care and investing in prevention programmes not just during the Olympic Games, but also the preparation period., Competing Interests: Competing interests: KS is the coeditor of the British Journal of Sports Medicine-Injury Prevention and Health Protection. In the period these data were collected, the Oslo Sports Trauma Research Center has had non-financial research partnerships with SpartaNova (2013–2016) and FitStats Technologies (2017–present)., (© Author(s) (or their employer(s)) 2023. No commercial re-use. See rights and permissions. Published by BMJ.)

Objectives: To describe the prevalence, incidence and burden of all health problems in the Norwegian women's premier league., Methods: During the 2020 and 2021 seasons, players in the Norwegian women's premier league reported all health problems (sudden-onset injuries, gradual-onset injuries and illnesses) weekly, using the Oslo Sports Trauma Research Centre Questionnaire on Health Problems. Team medical staff diagnosed reported problems using the Sport Medicine Diagnostic Coding System. We calculated average weekly prevalence, incidence and burden of all health problems reported., Results: We included 294 players (age: 22±4 years) from 11 teams. Response rate to the weekly questionnaire was 79%. On average, 32% (95% CI: 31% to 33%) of the players reported at least one health problem at any time and 22% (95% CI: 21% to 23%) reported a substantial health problem negatively affecting their training volume or performance. The overall incidence was 10.7 health problems per 1000 hours of football exposure. Sudden-onset injuries were most severe (68% of the total time loss), followed by gradual-onset injuries (25%) and illnesses (8%). Thigh was the most common injury location (26%), while knee injuries were most severe, causing 42% of the total injury time loss. Anterior cruciate ligament (ACL) injuries alone caused 30% of the total injury time loss., Conclusion: One in five players had a health problem negatively affecting their training volume or performance at any time. Sudden-onset injuries represented the most burdensome health problem. Thigh injuries were most frequent, while knee injuries, ACL injuries especially, were most severe., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2023. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: Studies examining associations between injuries and outcomes like quality of life and psychological distress are important to understand a broader range of possible consequences of injuries for population health., Aims: The aim of this study was to examine associations between self-reported injury and quality of life, psychological distress, sleeping problems, and global subjective health., Methods: The sample was drawn from the Norwegian National Population Register. Data were collected among the general adult populations in three Norwegian counties in 2019-2020 (response rate 45.3%, n = 74,030). Exposure variables were being injured during the last 12 months, cause of injury (if more than one, the most serious one), and functional impairment due to injuries. Outcome variables included measures of total quality of life, global quality of life, positive affect, negative affect, positive social relations, social capital (trust, belongingness, feeling safe), psychological distress, sleep problems, loneliness, and global subjective health. Data were analysed with General Linear Modelling in SPSS Complex., Results: Reporting to have been injured once during the last 12 months was associated with slightly elevated levels of psychological distress, sleeping problems, and loneliness, and lower mean scores on quality-of-life indicators and global subjective health. Reporting being injured twice or more showed more pronounced contrasts to the reference group on the same outcomes, with Cohen's d-values (absolute numbers) ranging from 0.17 to 0.54. For having been victim to violence, d-values ranged from 0.30 to 1.01. Moderate functional impairment due to injuries was associated with less favourable scores on all outcomes (d ranging from 0.15 to 0.71). For strong functional impairment d-values ranged from 0.35 to 1.17., Conclusions: Elevated levels of distress and reduced levels of quality of life are particularly associated with multiple injuries, being victim to violence, and functional impairment due to injuries. Prospective, longitudinal studies with high quality instruments and large samples, allowing adjustment for baseline values of outcome variables, and utilization of state-of-the-art statistical techniques, would bring this research closer to examining causality., (© 2023. The Author(s).)

The IOC made recommendations for recording and reporting epidemiological data on injuries and illness in sports in 2020, but with little, if any, focus on female athletes. Therefore, the aims of this supplement to the IOC consensus statement are to (i) propose a taxonomy for categorisation of female athlete health problems across the lifespan; (ii) make recommendations for data capture to inform consistent recording and reporting of symptoms, injuries, illnesses and other health outcomes in sports injury epidemiology and (iii) make recommendations for specifications when applying the Strengthening the Reporting of Observational Studies in Epidemiology-Sport Injury and Illness Surveillance (STROBE-SIIS) to female athlete health data.In May 2021, five researchers and clinicians with expertise in sports medicine, epidemiology and female athlete health convened to form a consensus working group, which identified key themes. Twenty additional experts were invited and an iterative process involving all authors was then used to extend the IOC consensus statement, to include issues which affect female athletes.Ten domains of female health for categorising health problems according to biological, life stage or environmental factors that affect females in sport were identified: menstrual and gynaecological health; preconception and assisted reproduction; pregnancy; postpartum; menopause; breast health; pelvic floor health; breast feeding, parenting and caregiving; mental health and sport environments.This paper extends the IOC consensus statement to include 10 domains of female health, which may affect female athletes across the lifespan, from adolescence through young adulthood, to mid-age and older age. Our recommendations for data capture relating to female athlete population characteristics, and injuries, illnesses and other health consequences, will improve the quality of epidemiological studies, to inform better injury and illness prevention strategies., Competing Interests: Competing interests: ISM and HPD are an Associate Editor of BJSM. JST and NSM are Editors of BJSM. KEA, PCZ and MM are Deputy Editors of BJSM. EV is the Editor in Chief of BMJ Open Sports and Exercise Medicine., (© Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: Top-level football referees take decisions during strenuous physical activity, and often under great mental pressure. Despite their central role in a football match, little is known about referees' health problems, particularly in female referees., Aim: To investigate the prevalence and burden of health problems in female and male top-level referees., Study Design: Prospective cohort study., Method: Fifty-five Norwegian male and female top-level referees reported health problems (injuries and illnesses) in pre-season and during the 2020 competitive season, using the Oslo Sports Trauma Research Center Questionnaire on Health Problems (OSTRC-H2)., Results: We recorded data for 49 weeks with a compliance of 98%. On average, 34% (95% CI 31-36%) of referees reported at least one health problem each week, and 20% (95% CI 19-22%) reported substantial health problems. Female referees reported more health problems than male referees, and on-field referees reported more health problems than assistant referees. Gradual-onset injuries were most prevalent and caused the greatest absence from training and matches, whereas illnesses represented only a small portion to the overall burden of health problems. The injury incidence was three injuries per athlete-year (95% CI 2.5-3.5) and 11 injuries per 1000 match hours (95% CI 7-18). The illness incidence was 1.4 illnesses per athlete-year (95% CI 1.1-1.8). Injuries to the lower legs and feet represented the highest burden of health problems., Conclusion: Top-level referees, especially females, reported a high prevalence of health problems. Gradual-onset injuries to the lower leg and foot represented the highest injury burden.

Objectives: The primary aim was to describe the characteristics and prevalence of musculoskeletal complaints of a large group of non-professional golfers. Secondary aims were to compare golfers different in (A) skill-level, (B) presence of low back pain (LBP) and (C) performance of prevention exercises., Methods: A sample of 1170 male golfers (mean age 54.98, SD=13.3) were surveyed online on personal and golf-specific characteristics, medical history and complaints in the preceding 7 days. Subgroups (A) with different golfing handicap (0 to 5, >5 to 10, >10), (B) with and without LBP and (C) who performed versus did not perform injury prevention exercises were compared using analysis of variance and χ 2 test., Results: The prevalence and severity of musculoskeletal complaints was similar in everyday life and when playing golf. More than one-third of the golfers (n=436; 37.3%) reported LBP in the preceding 7 days, while other frequently affected body parts were the shoulder and knee. Golfers with different skill level differed in age and most golf-related characteristics but not in prevalence and severity of musculoskeletal complaints. Golfers with and without LBP were similar in almost all variables. Golfers who performed prevention exercises (n=371; 27.1%) were older and had a higher prevalence of complaints., Conclusion: The prevalence and severity of musculoskeletal complaints in golfers were similar to the wider population. It seems that injury prevention exercises were implemented after injury, rather than as primary prevention. Prospective studies looking at the epidemiology of injury, risk factors and interventions are required., Competing Interests: Competing interests: AM receives remuneration from clinical and research services to professional golf organisations., (© Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Purpose: To map the current practice of handling missing data in the field of training load and injury risk and to determine how missing data in training load should be handled., Methods: A systematic review of the training load and injury risk literature was performed to determine how missing data are reported and handled. We ran simulations to compare the accuracy of modelling a predetermined relationship between training load and injury risk following handling missing data with different methods. The simulations were based on a Norwegian Premier League men's football dataset (n = 39). Internal training load was measured with the session Rating of Perceived Exertion (sRPE). External training load was the total distance covered measured by a global positioning systems (GPS) device., Results: Only 37 (34%) of 108 studies reported whether training load had any missing observations. Multiple Imputation using Predicted Mean Matching was the best method of handling missing data across multiple scenarios., Conclusion: Studies of training load and injury risk should report the extent of missing data, and how they are handled. Multiple Imputation with Predicted Mean Matching should be used when imputing sRPE and GPS variables.

Background: Training and game loads are potential risk factors of injury in junior elite ice hockey, but the association of training and game loads to injuries is unknown., Purpose: To investigate the association of chronic training and game loads to injury risk in junior male elite ice hockey players., Study Design: Cohort study; Level of evidence, 2., Methods: In this prospective cohort study, we monitored all health problems among 159 male junior ice hockey players (mean age, 16 years; range, 15-19 years) at sports-specific high schools during the 2018-2019 school year. Players reported their health problems every week using the Oslo Sports Trauma Research Center Overuse Questionnaire on Health Problems (OSTRC-H2). The number of training sessions and games was reported for 33 weeks. We calculated the previous 2-week difference in training/game loads as well as the cumulative training/game loads of the previous 2, 3, 4, and 6 weeks and explored potential associations between training/game loads and injury risk using mixed-effects logistic regression., Results: The players reported 133 acute injuries, 75 overuse injuries, and 162 illnesses in total, and an average of 8.8 (SD ±3.9) training sessions and 0.9 (SD ± 1.1) games per week. We found no association between the difference of the two previous weeks or the previous 2- 3- and 4-week cumulative, training or game load and acute injuries, nor the difference of the two previous weeks, or the previous 4- and 6-week cumulative, training or game load and overuse injuries (OR, ∼1.0; P > .05 in all models)., Conclusion: In the current study of junior elite ice hockey players, there was no evidence of an association between cumulative exposure to training/game loads and injury risk., Competing Interests: One or more of the authors has declared the following potential conflict of interest or source of funding: Financial support was received from the Innlandet Hospital Trust (salary support for A.N.) and the Stiftelsen fondet til fremme av idrettsmedisin og idrettsfysioterapi. AOSSM checks author disclosures against the Open Payments Database (OPD). AOSSM has not conducted an independent investigation on the OPD and disclaims any liability or responsibility relating thereto., (© The Author(s) 2022.)

The Coronavirus Disease-19 (COVID-19) pandemic forced the Norwegian male premier league football season to reschedule, reducing the fixture calendar substantially. Previous research has shown that a congested match schedule can affect injury rates in professional football. Therefore, we aimed to investigate whether the Norwegian premier league teams suffered more injuries in the more match congested 2020 season than in the regular 2019-season. We invited all teams having participated in both seasons to export their injury data. Only teams that used the same medical staff to register injuries in both seasons were included, and to maximize data comparability between seasons, we applied a time-loss injury definition only. Seven of 13 teams agreed to participate and exported their injury data. Both seasons had 30 game weeks, but the 2020 season was 57 days shorter than the 2019 season. The match injury incidence did not differ significantly [incidence rate ratio 0.76 (0.48-1.20; p = 0.24) in the 2020 season compared to the 2019 season. Furthermore, we found no differences in the number of injuries, days lost to injury, matches missed to injury, or injury severity. We could not detect any differences between the two seasons, suggesting the congested match calendar combined with the safety measures in the 2020 season can be a safe alternative in future seasons., Competing Interests: Author CT was employed by the company Rosenborg Ballklubb. Author MB was employed by the company Bodø Glimt FK. Author DT was employed by the company Brann Sportsklubb. Author AB was employed by the company Odds Ballklubb. Author CW was employed by the company Kristiansund Ballklubb. Author EM was employed by the company Stabæk Fotball. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Dalen-Lorentsen, Andersen, Thorbjørnsen, Brown, Tovi, Braastad, Lindinger, Williams, Moen, Clarsen and Bjørneboe.)

Background: Calculating the disease burden due to injury is complex, as it requires many methodological choices. Until now, an overview of the methodological design choices that have been made in burden of disease (BoD) studies in injury populations is not available. The aim of this systematic literature review was to identify existing injury BoD studies undertaken across Europe and to comprehensively review the methodological design choices and assumption parameters that have been made to calculate years of life lost (YLL) and years lived with disability (YLD) in these studies., Methods: We searched EMBASE, MEDLINE, Cochrane Central, Google Scholar, and Web of Science, and the grey literature supplemented by handsearching, for BoD studies. We included injury BoD studies that quantified the BoD expressed in YLL, YLD, and disability-adjusted life years (DALY) in countries within the European Region between early-1990 and mid-2021., Results: We retrieved 2,914 results of which 48 performed an injury-specific BoD assessment. Single-country independent and Global Burden of Disease (GBD)-linked injury BoD studies were performed in 11 European countries. Approximately 79% of injury BoD studies reported the BoD by external cause-of-injury. Most independent studies used the incidence-based approach to calculate YLDs. About half of the injury disease burden studies applied disability weights (DWs) developed by the GBD study. Almost all independent injury studies have determined YLL using national life tables., Conclusions: Considerable methodological variation across independent injury BoD assessments was observed; differences were mainly apparent in the design choices and assumption parameters towards injury YLD calculations, implementation of DWs, and the choice of life table for YLL calculations. Development and use of guidelines for performing and reporting of injury BoD studies is crucial to enhance transparency and comparability of injury BoD estimates across Europe and beyond., (© 2022. The Author(s).)

Background: Geographical differences in health outcomes are reported in many countries. Norway has led an active policy aiming for regional balance since the 1970s. Using data from the Global Burden of Disease Study (GBD) 2019, we examined regional differences in development and current state of health across Norwegian counties., Methods: Data for life expectancy, healthy life expectancy (HALE), years of life lost (YLLs), years lived with disability (YLDs), and disability-adjusted life-years (DALYs) in Norway and its 11 counties from 1990 to 2019 were extracted from GBD 2019. County-specific contributors to changes in life expectancy were compared. Inequality in disease burden was examined by use of the Gini coefficient., Findings: Life expectancy and HALE improved in all Norwegian counties from 1990 to 2019. Improvements in life expectancy and HALE were greatest in the two counties with the lowest values in 1990: Oslo, in which life expectancy and HALE increased from 71·9 years (95% uncertainty interval 71·4-72·4) and 63·0 years (60·5-65·4) in 1990 to 81·3 years (80·0-82·7) and 70·6 years (67·4-73·6) in 2019, respectively; and Troms og Finnmark, in which life expectancy and HALE increased from 71·9 years (71·5-72·4) and 63·5 years (60·9-65·6) in 1990 to 80·3 years (79·4-81·2) and 70·0 years (66·8-72·2) in 2019, respectively. Increased life expectancy was mainly due to reductions in cardiovascular disease, neoplasms, and respiratory infections. No significant differences between the national YLD or DALY rates and the corresponding age-standardised rates were reported in any of the counties in 2019; however, Troms og Finnmark had a higher age-standardised YLL rate than the national rate (8394 per 100 000 [95% UI 7801-8944] vs 7536 per 100 000 [7391-7691]). Low inequality between counties was shown for life expectancy, HALE, all level-1 causes of DALYs, and exposure to level-1 risk factors., Interpretation: Over the past 30 years, Norway has reduced inequality in disease burden between counties. However, inequalities still exist at a within-county level and along other sociodemographic gradients. Because of insufficient Norwegian primary data, there remains substantial uncertainty associated with regional estimates for non-fatal disease burden and exposure to risk factors., Funding: Bill & Melinda Gates Foundation, Research Council of Norway, and Norwegian Institute of Public Health., Competing Interests: Declaration of interests We declare no competing interests., (Copyright © 2022 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license. Published by Elsevier Ltd.. All rights reserved.)

Objectives: Determine how to assess the cumulative effect of training load on the risk of injury or health problems in team sports., Methods: First, we performed a simulation based on a Norwegian Premier League male football dataset (n players=36). Training load was sampled from daily session rating of perceived exertion (sRPE). Different scenarios of the effect of sRPE on injury risk and the effect of relative sRPE on injury risk were simulated. These scenarios assumed that the probability of injury was the result of training load exposures over the previous 4 weeks. We compared seven different methods of modelling training load in their ability to model the simulated relationship. We then used the most accurate method, the distributed lag non-linear model (DLNM), to analyse data from Norwegian youth elite handball players (no. of players=205, no. of health problems=471) to illustrate how assessing the cumulative effect of training load can be done in practice., Results: DLNM was the only method that accurately modelled the simulated relationships between training load and injury risk. In the handball example, DLNM could show the cumulative effect of training load and how much training load affected health problem risk depending on the distance in time since the training load exposure., Conclusion: DLNM can be used to assess the cumulative effect of training load on injury risk., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: Athletics (also known as track and field) is one of the most popular sports in the world and is the centrepiece of the Summer Olympic Games. Participation in athletics training and competition involves a risk of illness and injury., Purpose: To describe injury and illness in British Olympic track and field athletes over three full training and competition seasons., Study Design: Descriptive Epidemiology Study., Methods: A total of 111 athletes on the British national program were followed prospectively for three consecutive seasons between 2015-2018. Team medical personnel recorded all injuries and illnesses during this time, following current consensus-based methods. All data pertaining to these records were reviewed and analyzed for sports injury and illness epidemiological descriptive statistics., Results: The average age of the athletes was 24 years for both males and females (24 years, +/- 4). Total exposure for the three seasons was 79 205 athlete days (217 athlete years). Overuse injuries (56.4%) were more frequent than acute injuries (43.6%). The thigh was the most common injury location (0.6 per athlete year), followed by the lower leg (0.4 per athlete year) and foot (0.3 per athlete year). Muscle and tendon were the most commonly injured tissues, while strains and tears were the most common pathology type. Hamstring muscle strain was the most common diagnosis causing time loss, followed by Achilles tendinopathy and soleus muscle strain. Respiratory illness was the most common illness type (0.3 per athlete year)., Conclusion: Hamstring strains, Achilles tendinopathy, and soleus strains are the most common injuries in athletics and have highest burden. Respiratory illness is the most common illness and has the highest burden. Knowledge of this injury and illness profile within athletics could be utilised for the development of targeted prevention measures within the sport at the elite level., Level of Evidence: 3., Competing Interests: The authors declare no conflicts of interest

Background: Little is known about the association between physical fitness and the risk of injury or illness in ice hockey. The least-fit players may be more prone to injury and illness., Purpose: To examine the association between preseason fitness level and injury or illness risk among elite ice hockey players during the regular season., Study Design: Cohort study; Level of evidence, 2., Methods: A total of 133 male ice hockey players in the GET League (the premier professional league in Norway) completed 8 different exercises (40-m sprint, countermovement jump, 3000-m run, squat, bench press, chin-ups, brutal bench, and box jump) at the annual 1-day preseason testing combine. During the 2017-2018 competitive season, the players reported all health problems (acute injuries, overuse injuries, and illnesses) weekly (31 weeks) using the Oslo Sports Trauma Research Center Questionnaire on Health Problems., Results: Overall, the players reported 191 acute injuries, 82 overuse injuries, and 132 illnesses. The least-fit tercile of players did not report more health problems (mean, 3.0; 95% CI, 2.2-3.8) compared with the most-fit (mean, 3.4; 95% CI, 2.6-4.2) or the medium-fit (mean, 2.7; 95% CI, 1.9-3.5) players. The most-fit players reported more substantial health problems (mean, 2.0; 95% CI, 1.6-2.5) compared with the medium-fit (mean, 1.3; 95% CI, 0.8 -1.8) and least-fit (mean, 1.8; 95% CI, 1.3-2.3) ( P = .02) players. There was no association between low physical fitness and number of health problems when comparing the least-fit tercile of the players with the rest of the cohort ( P > .05); however, there was an association between low physical fitness and greater severity of all health problems when comparing the least-fit tercile of players to the rest of the cohort after adjusting for time on ice per game, playing position, and age ( P = .02)., Conclusion: Low physical fitness was not associated with increased rate of injury or illness but was associated with greater severity of all health problems after adjusting for time on ice per game, playing position, and age., Competing Interests: One or more of the authors has declared the following potential conflict of interest or source of funding: Financial support was received from the Sykehuset Innlandet Hospital Trust and Stiftelsen fondet til fremme av idrettsmedisin og idrettsfysioterapi. AOSSM checks author disclosures against the Open Payments Database (OPD). AOSSM has not conducted an independent investigation on the OPD and disclaims any liability or responsibility relating thereto., (© The Author(s) 2022.)

Objectives: To examine mental health problems among elite athletes in a student population, compared to the general student population, and to explore the association between weekly hours of training across mental health indicators., Methods: Data are from a national study from 2018 of all college and university students in Norway. Participants indicated if they considered themselves to be an elite athlete, and how many hours per week they trained. Mental health problems were assessed using several well-validated questionnaires., Results: Among 50,054 students, 1.3% identified themselves as elite athletes. Both male and female elite athletes had generally better mental health across most health outcomes, reporting fewer mental health problems, less loneliness, higher satisfaction with life, more positive affect, and fewer alcohol problems. Elite athletes in team sports had slightly better mental health compared to athletes of individual sports. Increased hours of weekly exercise was associated with better mental health. However, there was generally little to be gained from increasing the amount of training from 7-10 hours/week to 14+ hours per week. Female athletes who trained 14 or more hours per week reported poorer mental health across most outcome measures., Conclusion: This study showed that both male and female elite athletes generally had better mental health across a range of health outcomes, when compared to the general student population. The study also found a positive dose-response relationship between weekly hours of training and mental health, but also a worsening of mental health for females at the extreme end of exercise continuum. The self-report nature of this student sample means that care should be taken when generalizing to other studies of elite athletes., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Grasdalsmoen, Clarsen and Sivertsen.)

Objective: To describe the illness and injury pattern of Norwegian Para athletes over five consecutive Paralympic Summer and Winter Games cycles and to identify which health problems should be targeted in risk management plans with respect to impairment types., Methods: We monitored athletes from 12 to 18 months prior to each Game using a weekly online questionnaire (Oslo Sports Trauma Research Center-H2 (OSTRC-H2)). We asked them to report all health problems they had experienced in the preceding 7 days, irrespective of their consequences on their sports participation or performance and whether they had sought medical attention., Results: Between 2011 and 2020, 94 candidate athletes were included in this monitoring programme and prepared to represent Norway; of these, 66 (71%) were finally selected for multiple Paralympic Games. The overall response rate to the weekly questionnaires was 87%. At any given time during the five observation cycles, 37% of the athletes (95% CI 36% to 38%) reported having at least one health problem. Athletes with neurological impairments (n=51) lost 10 days per year due to respiratory problems (95% CI 9 to 11) compared with 9 days (8-10) among those with musculoskeletal impairments (n=37). Gastrointestinal problems caused a time loss of on average 4 days per year in athletes with neurological impairments versus 1 day in athletes with musculoskeletal impairments (mean difference 2.7 days, 2.1-3.3). Musculoskeletal injuries generated a high burden for both athlete groups, in particular, to the elbow, shoulder and lumbosacral regions., Conclusion: At any given time, nearly two out of five elite Norwegian Para athletes reported at least one health problem. Respiratory tract and other infections; gastrointestinal problems, injuries to the shoulder, elbow and lumbosacral regions represented the greatest health burden. Our findings can help guide the allocation of clinical resources, which should include a broad network of medical specialists, together with dieticians and physiotherapists, to meet the health challenges in Para athletes., Competing Interests: Competing interests: KS is the co-editor of the British Journal of Sports Medicine—Injury Prevention and Health Protection. In the period these data were collected, the Oslo Sports Trauma Research Center has had non-financial research partnerships with SpartaNova (2013–2016) and FitStats Technologies Inc. (2017–present)., (© Author(s) (or their employer(s)) 2022. No commercial re-use. See rights and permissions. Published by BMJ.)

Context: The epidemiologic focus on time loss may underestimate the true magnitude of hip and groin problems in male ice hockey players., Objective: To describe the prevalence, incidence, and severity of hip and groin problems (time loss and non-time loss) in Swedish ice hockey players over the course of a season and explore potential preseason risk factors for these conditions., Design: Prospective 1-season cohort study., Setting: Professional and semiprofessional Swedish ice hockey players., Patients or Other Participants: A total of 12 professional and semiprofessional male ice hockey teams were invited to participate. Of those, 9 teams agreed, and 163 players were included in the analyses., Main Outcome Measure(s): Hip and groin problems in the previous season (time loss, non-time loss), isometric adduction and abduction strength, and 5-second squeeze test results were recorded before the season and served as independent variables in the risk factor analysis. Main outcome measures were cumulative incidence of hip and groin problems, average prevalence, and odds ratios (ORs) for groin problems in season., Results: Cumulative incidence was 45.4% (95% CI = 37.6%, 53.4%) for all problems and 19% (95% CI = 13.3%, 25.9%) for substantial problems. Average prevalence was 14.1% (95% CI = 10.8%, 17.5%) for all and 5.7% (95% CI = 4.3%, 7.2%) for substantial problems. Among reported problems, 69.2% had a gradual onset, and only 17% led to time loss. Players with non-time-loss problems in the previous season had higher odds for new problems (all: OR = 3.3 [95% CI = 1.7, 6.3]; substantial: OR = 3.6 [95% CI = 1.8, 8.4]). Preseason strength was not significantly associated with the odds for subsequent problems., Conclusion: Hip and groin problems are common in ice hockey players and may lead to substantial impairments in performance. Only 1 in 5 problems led to time loss, and 7 in 10 had a gradual onset. Non-time-loss problems in the previous season were a significant risk factor for new problems, whereas decreased preseason hip-adduction and -abduction strength was not., (© by the National Athletic Trainers' Association, Inc.)

Objective: To describe the implementation of a health monitoring programme for Norwegian Paralympic and Olympic candidates over five consecutive Olympic and Paralympic Games cycles (London 2012, Sochi 2014, Rio de Janeiro 2016, PyeongChang 2018 and Tokyo 2020)., Methods: Athletes were monitored for 12-18 months preparing for the games using a weekly online questionnaire (OSTRC-H2) with follow-up by physicians and physiotherapists, who provided clinical care and classified reported problems., Results: Between 2011 and 2020, 533 Olympic and 95 Paralympic athletes were included in the monitoring programme, with an overall response of 79% to the weekly questionnaire and a total observation period of 30 826 athlete weeks. During this time, 3770 health problems were reported, with a diagnosis rate of 97%. The average prevalence of health problems at any given time was 32% among Olympic athletes and 37% among Paralympic athletes. Acute traumatic injuries represented the greatest burden for Olympic team sport athletes, and illnesses represented the greatest burden for Olympic endurance and Paralympic athletes. On average, Olympic athletes lost 27 days and Paralympic athletes lost 33 days of training per year due to health problems., Conclusion: Conducting long-term health monitoring of Olympic and Paralympic athletes is challenging, particularly because athletes travel frequently and often relate to many medical providers. This programme has been implemented and improved within Team Norway for five Olympic and Paralympic cycles and during this time we believe it has helped protect our athletes' health., Competing Interests: Competing interests: KS is the coeditor of the British Journal of Sports Medicine-Injury Prevention and Health Protection. In the period these data were collected, the Oslo Sports Trauma Research Center has had non-financial research partnerships with SpartaNova (2013–2016) and FitStats Technologies (2017 to present)., (© Author(s) (or their employer(s)) 2021. No commercial re-use. See rights and permissions. Published by BMJ.)