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Adequate sleep is crucial for elite athletes' recovery, performance readiness, and immune response. Establishing reference ranges for elite athletes enables appropriate contextualization for designing and targeting sleep interventions. Purpose: To establish sleep-quality reference ranges for Olympic and Paralympic cohorts using the Pittsburgh Sleep Quality Index (PSQI) and explore differences based on sex and sport types. Methods: Team USA athletes (men = 805, women = 798) completed the PSQI as part of a health-history questionnaire. Descriptive statistics were used to create reference ranges and linear models, and χ2 test of independence determined differences in PSQI global and component scores between sex, games, season, and participation. Results: Six hundred thirty-two (39.43%) athletes reported poor sleep (PSQIGlobal ≥ 5). Men displayed later bedtimes (P =.006), better global PSQI scores, shorter sleep latency, less sleep disturbance, and less use of sleep medication than women (all P <.001). Winter Games participants had later bedtime (P =.036) and sleep offset time (P =.028) compared with Summer Games athletes. Team-sport athletes woke earlier than individual-sport athletes (P <.001). Individual-sport athletes were more likely to have low (P =.005) and mild (P =.045) risk for reduced sleep duration than team-sport athletes. Conclusion: These data provide PSQI-specific reference ranges to identify groups at greatest risk for poor sleep, who may benefit most from targeted sleep interventions. [ABSTRACT FROM AUTHOR]

Purpose: Transmeridian travel is common for elite athletes participating in competitions and training. However, this travel can lead to circadian misalignment wherein the internal biological clock becomes desynchronized with the light–dark cycle of the new environment, resulting in performance decrement and potential negative health consequences. Existing literature extensively discusses recommendations for managing jet lag, predominantly emphasizing light-based interventions to synchronize the internal clock with the anticipated time at the destination. Nevertheless, visually impaired (VI) athletes may lack photoreceptiveness, diminishing or nullifying the effectiveness of this therapy. Consequently, this invited commentary explores alternative strategies for addressing jet lag in VI athletes. Conclusions: VI athletes with light perception but reduced visual acuity or visual fields may still benefit from light interventions in managing jet lag. However, VI athletes lacking a conscious perception of light should rely on gradual shifts in behavioral factors, such as meal timing and exercise, to facilitate the entrainment of circadian rhythms to the destination time. Furthermore, interventions like melatonin supplementation may prove useful during and after travel. In addition, it is recommended that athlete guides adopt phase-forward or phase-back approaches to synchronize with the athlete, aiding in jet-lag management and optimizing performance. [ABSTRACT FROM AUTHOR]

Students graduating from professional healthcare pro- grams are expected to demonstrate competence in their area of study to enter the workforce and immediately start working with people. High expectations and a fast-paced environment are typical aspects of these professional posi- tions and often result in higher rates of burnout, compas- sion fatigue, and lack of empathy leading to an overall decrease in patient satisfaction. As a result, patients who face difficult situations may often feel as though their needs are not being addressed. The purpose of thjs study was to examine the effectiveness of a shared educational module and simulated patient encounters on Improving student confidence and competence engaging in difficult conversations with patients regarding intimate partner vio- lence, substance abuse, and suicidal ideation. Students in the social work (n=14), athletic training (n=7), and physi- cian assistant degree programs (n=20) participated in a collective learning module focusing on patient-centered care (PCC) skills required for having difficult conversations with patients. After students completed the shared learn- ing module and prior to the simulated experience, students were given the Inter-professional Teams in Difficult Conver- sations Self-Assessment survey, a self-assessment tool measuring level of competence in engaging in difficult con- versations. Students were then assigned to one of three rooms at random and varied in topic from intimate partner violence, substance abuse, or suicidal ideation. After the simulation, students completed the Inter-professional Teams in Difficult Conversations Self-Assessment survey again. Standardized patients (SP) also completed the Patient-Professional Interaction Questionnaire (PPIQ) immediately after the simulated experience, As hypothe- sized, students self-reported very high confidence in their ability to engage in difficult conversations using PCC, but SPs reported feeling little empathy or understanding of their situation from the students. Findings from this research demonstrate the disconnect in transfer of knowl edge from understanding what PCC skills are to imple menting them during difficult conversations . [ABSTRACT FROM AUTHOR]

Early sport specialization is a growing concern among youth sport athletes, particularly in baseball. Motivation to participate in sports is an important factor in determining which sports youth athletes participate in and why. To qualitatively investigate the youth sport participation behaviors and motivations of collegiate baseball players. Qualitative study. Online teleconference. We conducted 25 semistructured interviews with collegiate baseball athletes who were classified as high-level (n = 8), moderate-level (n = 9), or low-level (n = 8) specialists before college. Participants completed individual semistructured interviews to allow us to develop an understanding of their youth and high school sports experiences and associated motivations to engage in those experiences. A framework analysis approach was used to analyze the transcript data and identify themes among the 3 specialization groups. From our interview analysis, 6 overall themes emerged: (1) motivation, (2) stress, (3) quitting, (4) barriers, (5) facilitators of success, and (6) future directions. Moderate- and high-level specialists described greater levels of passion, participating in deliberate practice, greater levels of performance-related stress, and more desire to quit sports than low-level specialists. None of the groups cited parents as an overbearing external motivator to participate in sport at an early age. Participants who were classified as low-, moderate-, or high-level specialists noted different experiences related to their motivation, stress level, desire to quit, barriers to participating in baseball, facilitators of success, and their overall future career goals after completing baseball. This information may be useful for parents, coaches, and health care professionals to better communicate the benefits and risks associated with sport specialization to youth athletes. Future research is needed to determine if differences in motivation levels exist in younger populations. [ABSTRACT FROM AUTHOR]

The social determinants of health (SDOH) are circumstances under which individuals are born, work, and live that influence health outcomes. Previous researchers have examined 1 determinant of economic stability and found disparities in socioeconomic status and athletic trainer (AT) availability. To examine the SDOH characteristics of Indiana secondary schools and AT availability. Cross-sectional study. Database secondary analysis. A total of 426 secondary schools. All data were collected from publicly available databases. The independent variable was AT availability, and schools were classified as having a full-time AT, a part-time AT only, or no AT. The SDOH variables were gathered for each school (at the school and county levels). Data were summarized using measures of central tendencies, 1-way analysis of variance, and Kruskal-Wallis tests. School enrollment was larger in schools with greater AT availability (P<.001). The proportion of non-White students was greater in schools with more AT availability (P=.002). Greater AT availability was present in counties with higher graduation rates (P=.03). Post hoc comparisons revealed differences in graduation rates between schools with a part-time AT and those with no AT (P=.04). Schools with less AT availability were located in counties with a slightly higher percentage of the population uninsured (P=.02). Schools with greater AT availability were located in counties with a higher ratio of population to primary care physicians (P=.03). Schools with less AT availability were located in counties with a higher population experiencing severe housing problems (P=.02). No differences were found in AT availability based on the 3 social and community context variables (P>.05). Differences were noted in AT availability and SDOH characteristics at the secondary school level. We observed less AT availability where high school graduation rates and the population of primary care providers were lower. Strategies should be implemented to improve access to athletic health care in underresourced communities. [ABSTRACT FROM AUTHOR]

Background: Early sport specialization is associated with increased risk of overuse injuries in several sports, including baseball. However, limited evidence exists evaluating how early sport specialization affects patient-reported outcome measures as they age. The purpose of this study was to determine differences in Kerlan-Jobe Orthopedic Clinic (KJOC) Shoulder and Elbow Scores among collegiate baseball players based on the grade when a participant first reported high specialization behaviors. Hypothesis: Baseball players who were highly specialized at a younger age will have worse throwing arm health while participating in college. Study Design: Cross-sectional study. Level of Evidence: Level 3. Methods: A total of 752 college baseball players was contacted through their institution's athletic trainer. We measured baseball specialization and KJOC scores using the validated Baseball and Sport Experience survey. Data were summarized using means and SDs, medians and interquartile ranges (IQRs), and frequencies and percentages. A Kruskal-Wallis test was used to determine differences in mean KJOC scale scores based on the earliest time the participant reported high-level specialization. Results: A total of 294 baseball players completed the survey (response rate: 39.1%). Of the 294 participants, 280 completed the KJOC scale questions to generate a total KJOC score (median: 90.5; IQR: 76.6-97.2). No significant differences in KJOC total scores (P = 0.78) existed based on the grade period in which the athlete was first highly specialized. Conclusion: Early baseball specialization as a youth baseball player may not impact throwing arm health in college baseball athletes. Clinical Relevance: Early specialization has been linked to increased risk for overuse injuries in certain sports, but may not lead to poorer throwing arm health in college baseball players. Sports medicine clinicians and researchers may use this information to educate various stakeholders about the benefits and risks associated with early sport specialization. [ABSTRACT FROM AUTHOR]

Context: Sport specialization among youth athletes has been associated with increased risk of overuse injuries . Previous research demonstrates that children perceive specialization to be beneficial in making their high school team and receiving athletic college scholarships. Previous research demonstrates that parents play a significant role in their child's sport experience. However, it is unknown if parents and children answer questions related to specialization factors in a similar manner . Objective: To evaluate the beliefs of youth athletes and parents on factors related to sport specialization and evaluate the level of agreement between dyads on sports specialization . Design: Cross-sectional . Setting. Online and paper surveys . Patients or Other Participants : Aim 1 : 1998 participants (993 children and 1005 parents ). Aim 2 : 77 paired parent-child dyads . Interventions : Sel f-administered survey . Main Outcome Measures : The responses were summarized via frequency and proportions (%). Chi - squares were calculated between parent and child responses. Kappa coefficients were calculated for dyads to determine level of agreement. Sport specialization was classified using a common 3-point scale. Results: The parents were more concerned about risk of injury in sports compared with children (P < .001, X2 = 231.4; parent: extremely: 7.1%; child: extremely: 3.7%). However, children were more likely to believe that specialization was associated with their chances of obtaining an athletic college scholarship compared with parents (P < .001, %2 = 201.6; parent: very/extremely likely: 13.7%; child: very/extremely likely: 15.8%). Dyad subanalysis indicated a moderate level of agreement for "quitting other sports to focus on one sport" (E= .50) and a low level of agreement for " identifying a primary sport " (x =. 30) and "training >8 months per year in primary sport" (K =. 32 ). Conclusions : Parents and youth athletes had differing beliefs on the factors related to sport specialization. Dyad analysis shows that parents and children answer sport specialization classification questions differently. Health care providers should be aware of these differences, and messaging should be individualized to the audience. [ABSTRACT FROM AUTHOR]

Sport specialization, or focused participation in a single sport, is associated with an increased rate of overuse injury and burnout. Medical associations and sport organizations have published recommendations for sport specialization aimed at reducing its negative consequences. Health care providers (HCPs) are often identified as individuals who can educate athletes and parents about these important recommendations. To compare knowledge, perceptions, awareness, confidence in knowledge, and use of sport specialization recommendations among HCPs who work with pediatric athletes. Cross-sectional study. An online web-based survey was developed to assess HCPs' knowledge, perceptions, awareness, confidence in knowledge, and clinical use of sport specialization recommendations. Participants were recruited from the research survey services of 4 professional organizations. Dependent variables were responses for awareness, perceptions, confidence in knowledge, use, and barriers sections of the survey. Data were analyzed with descriptive statistics; comparisons among HCPs were made through χ2 and Kruskal-Wallis tests. The survey was completed by 770 HCPs (completion rate = 95.1%). Respondents lacked awareness specific to recommendations surrounding the maximum number of sport participation months per year (39.5%), maximum hours per week (40.7%), and maximum number of teams on which youth athletes should participate concurrently (43.9%). Physicians were the most aware of medical organization recommendations generally (48%–68.8%) and confident in their knowledge (41.5%–75.1%). All HCPs were less aware and confident in their knowledge of sport organization recommendations, with no differences among HCPs. Physicians did not perceive many barriers to the use of the recommendations, whereas athletic trainers felt that patient (39.9%) and parent (45.3%) behaviors were the greatest barriers to usage. Awareness, perceptions, and use of sport specialization recommendations varied by discipline, but most respondents believed they were associated with a decreased risk of injury. Future researchers should focus on improved education and implementation of recommendations across all roles. [ABSTRACT FROM AUTHOR]

Girls' high school volleyball is very popular across the United States. Prospective data are limited regarding the incidence and risk factors of time-loss (TL) and non–time-loss (NTL) injuries sustained in this population. To estimate the incidence and describe the characteristics of injuries (TL and NTL) sustained in a girls' high school volleyball season. Descriptive epidemiology study. Convenience sample of 78 high school interscholastic volleyball programs. Female high school volleyball players participating during the 2018 interscholastic season. Injury rates, proportions, and rate ratios were measured for TL and NTL injuries with 95% CIs. A total of 2072 girls enrolled in the study, and 468 participants (22.5%) sustained 549 injuries (TL = 71.6%, NTL = 28.4%) for an overall injury rate of 5.31 (95% CI = 4.89, 5.79) per 1000 athlete-exposures. The competition injury rate was greater than the practice injury rate for all injuries (injury rate ratio [IRR] = 1.19; 95% CI = 1.00, 1.41) and TL injuries (IRR = 1.31; 95% CI = 1.07, 1.60). Players with a previous musculoskeletal injury had a higher rate of TL than NTL injuries (IRR = 1.36; 95% CI = 1.12, 1.65). Ankle injuries accounted for the greatest proportion of TL injuries (n = 110, 28%), while the greatest proportion of NTL injuries occurred in the hand or fingers (n = 34, 22%). Ligament sprains accounted for 40% of TL injuries (n = 156), whereas muscle or tendon strains (n = 79, 51%) accounted for more than half of all NTL injuries. Although most injuries sustained by adolescent girls' volleyball athletes were TL in nature, nearly a third of all injuries were NTL injuries. Injury characteristics differed widely between TL and NTL injuries. Understanding the most common types and characteristics of injuries among high school volleyball players is critical for the development of effective injury-prevention programs. [ABSTRACT FROM AUTHOR]

Significant health care disparities exist in the United States based on socioeconomic status (SES), but the role SES has in secondary school athletes' access to athletic training services has not been examined on a national scale. To identify differences in access to athletic training services in public secondary schools based on school SES. Cross-sectional study. Database secondary analysis. Data for 3482 public high schools. Data were gathered from the Athletic Training Locations and Services (ATLAS) database, US Census Bureau, and National Center for Education Statistics. We included schools from 5 states with the highest, middle, and lowest poverty percentages (15 states total) and collected county median household income, percentage of students eligible for free or reduced-price lunch, race and ethnicity demographics, and access to athletic training services (full-time athletic trainer [AT], part-time AT only, no AT) for each school. Data were summarized in means, SDs, medians, interquartile ranges (IQRs), frequencies and proportions, 1-way analyses of variance, and Kruskal-Wallis tests. Differences were present in school SES between schools with full-time, part-time-only, and no athletic training services. Schools with greater access to athletic training services had fewer students eligible for free or reduced-price lunch (full time: 41.1% ± 22.3%, part time only: 45.8% ± 24.3%, no AT: 52.9% ± 24.9; P <.001). Similarly, county median household income was higher in schools with increased access to athletic training services (full time median [IQR]: $56 026 [$49 085–$64 557], part time only: $52 719 [$45 355–$62 105], and no AT: $49 584 [$41 094–$57 688]; P <.001). Disparities in SES were seen in access to athletic training services among a national sample of public secondary schools. Access to ATs positively influences student-athletes' health care across several measures. Pilot programs or government funds have been used previously to fund athletic training services and should be considered to ensure equitable access, regardless of school SES. [ABSTRACT FROM AUTHOR]

Previous studies of parents of adolescent athletes identified a belief among parents of the importance of early specialization for skill development. However, it is unclear if these attitudes and beliefs are also held among parents of baseball athletes, which is the second-most popular boy's sport in the United States. The purpose of this study was to describe the knowledge, attitudes, and beliefs of parents of Little League baseball players regarding sport specialization and college scholarships. Two-hundred and forty-four parents of Little League baseball players (female parents: 60.7%, parent age: 41.1 ± 6.2 years old, male children: 98.0%, child age: 9.5 ± 1.6 years old) completed an anonymous online questionnaire regarding parent attitudes and beliefs on sport specialization and college scholarships. Most parents (72.4%) felt that specialization would increase their child's baseball ability either 'quite a bit' or 'a great deal.' Fewer than half of all parents (42.0%) reported that specialization was either 'quite a bit' or 'a great deal' of a problem. Parents underestimated the availability of Division I college baseball scholarship availability (median [IQR]: 5 [4–10]), compared to the actual value of 11.7 scholarships per Division I roster. Only 10.2% of parents (N = 25) reported that they believed it was 'somewhat' or 'very' likely that their child would receive a college baseball scholarship. Further efforts are needed to understand parent attitudes and beliefs regarding sport specialization and college scholarships in various sports to better understand current trends in youth sport participation. [ABSTRACT FROM AUTHOR]

Background: Adolescent athletes report that sports specialization improves their ability to receive a collegiate athletics scholarship, though this is not well-understood. The purpose of this study was to examine self-reported trends in high school specialization and influences for sport participation between Division I (D-I) and college-aged club (club) athletes. Hypothesis: There would be no difference in high school sport specialization or sport participation influences between D-I and club athletes. Study Design: Retrospective cross-sectional study. Level of Evidence: Level 3. Methods: A survey included specialization classification (low, moderate, and high) for 9th to 12th grade, age that the athlete started organized sport and his or her collegiate sport, and several influential factors for participation in one's primary high school sport (1 = no influence to 5 = extremely influential). Chi-square analyses were used to compare specialization classifications between groups. Nonparametric tests were used to determine significant differences in age-related variables and influential factors between D-I and club athletes. All analysis were also conducted with boys and girls separately. Results: Participants included 266 D-I (girls, 155; 58%) and 180 club (girls, 122; 68%) athletes. Club athletes were more likely to be classified as low specialization at every grade in high school, and this difference was more pronounced between D-I and club female athletes than male athletes. The number of years an athlete was classified as highly specialized in high school was not different between D-I and club athletes. Club athletes were more influenced by playing with friends than D-I athletes and D-I athletes were more influenced by pursuing a collegiate scholarship than club athletes. Conclusion: High levels of specialization in high school sport may not be necessary for playing at the collegiate level, though some level of specialization in high school might be necessary. Clinical Relevance: Clinicians should advocate for healthy long-term athlete development, which does not support high specialization in high school sports. [ABSTRACT FROM AUTHOR]