A National Survey on the Relationship of Youth Sport Specialization Behaviors to Self-Reported Anxiety and Depression in Youth Softball Players.

BACKGROUND: There are little to no data on whether any associations exist between sport specialization and mental health in youth softball athletes. HYPOTHESIS: Highly specialized youth softball athletes will have worse self-reported depression and anxiety symptom scores compared with low and moderate specialized athletes. STUDY DESIGN: Cross-sectional survey. LEVEL OF EVIDENCE: Level 4. METHODS: An online cross-sectional survey was distributed in the fall of 2021 to a national sample of female youth softball athletes between the ages of 12 and 18 years. Sport specialization status was determined using a 3-point specialization scale that classifies either low, moderate, or high. The patient health questionnaire-9 (PHQ-9) and the 7-item general anxiety disorder scale (GAD-7) were used to assess self-reported symptoms of depression and anxiety. Comparison also included sports participation and specialization behaviors between specialization groups. RESULTS: A total of 1283 subjects (mean age, 15.1 ± 1.7 years) fully completed the survey. After adjusting for covariates, lower scores were reported on both the PHQ-9 and GAD-7 by highly specialized athletes compared with moderate or low specialization athletes (PHQ-9, high = 8.6 ± 0.4; moderate = 11.2 ± 0.3; low = 10.9 ± 0.5; P < 0.01; GAD-7, high = 6.5 ± 0.4; moderate = 8.6 ± 0.3; low = 8.4 ± 0.4, P < 0.01). Conversely, higher scores were reported on both scales for athletes who received private softball coaching compared with those who did not (PHQ-9, 11.5 ± 0.3 vs 9.0 ± 0.3; P < 0.01; GAD-7, 8.8 ± 0.3 vs 6.9 ± 0.3, P < 0.01). Finally, athletes who reported an arm overuse injury in the previous year reported higher PHQ-9 scores (10.8 ± 0.3 vs 9.8 ± 0.3; P < 0.01). CONCLUSION: While sport specialization, as measured by the validated 3-point scale, was not associated with increased anxiety and depression symptom scores, other aspects of specialization behavior such as private coaching or overuse injury history were associated with worse scores on these scales, indicating potential concern for anxiety and depression. However, although the differences we observed were statistically significant, they did not exceed the minimal clinically important difference values that have been established for the PHQ-9 (5 points) or GAD-7 (4 points). CLINICAL RELEVANCE: This project is a first step toward understanding the sport specialization behaviors and their influence on the mental health of youth softball athletes. Focusing on investigating specialization behaviors further may reveal to be a better indicator of risk of developing anxiety and depression symptoms compared with utilizing the 3-point specialization scale.

Results of a National Survey on Sport Specialization Behavior and Throwing Arm Injury in Youth Softball Players.

BACKGROUND: There are few data on throwing arm and shoulder injury in youth softball athletes, and no data on the influence of sport specialization on injury in softball. HYPOTHESIS: We hypothesized that highly specialized athletes, and pitchers in particular, demonstrating various sport specialization behaviors would be more likely to report an upper extremity overuse injury in the previous 12 months. STUDY DESIGN: Cross-sectional survey. LEVEL OF EVIDENCE: Level 4. METHODS: An online, anonymous, cross-sectional survey was distributed to a national sample of female youth softball players between the ages of 12 and 18 years in fall 2021. Topics included were indicators of sport specialization and self-reported injuries to the throwing arm. RESULTS: A total of 1309 participants (mean age, 15.1 ± 1.7 years) completed the survey; 19.4% (N = 254) scored as highly specialized, 69.7% (N = 912) as moderately specialized, and 10.9% (N = 143) with low specialization. Of all participants, 27.3% (N = 357) pitched in the previous year. A minority of all players (43.7%; N = 572) reported arm injury in the previous 12 months, with 45.9% of pitchers (N = 164) reporting the same. Multivariate regression showed increased adjusted odds ratio (aOR) of injury history for athletes playing >30 games per year (aOR, 1.74; 95% CI, 1.26-2.40), participating on a club team (aOR, 3.36; 95% CI,1.85-6.07), and in pitchers participating on club teams (aOR, 2.97; 95% CI, 1.18-7.45). Decreased aOR of injury was noted in those participating in >8 months of softball per year (aOR, 0.25; 95% CI, 0.12-0.51) and in pitchers who were moderately specialized (aOR, 0.39; 95% CI, 0.17-0.92) and playing >8 months per year (aOR, 0.33; 95% CI, 0.11-0.96). CONCLUSION: This sample provides a large proportion of athletes classified as high or moderately specialized in youth softball (89%). A large proportion (43.7%) of subjects reported arm injury in the past year, and insight into injury risk is provided. The results present conflicting data on the risk versus protective effect of specialization in youth softball athletes. CLINICAL RELEVANCE: This project is a first step toward understanding sport specialization behavior and its influence on injury in youth softball.

Food as medicine: a quasi-randomized control trial of two healthy food interventions for chronic disease management among ambulatory patients at an urban academic center.

BACKGROUND: Globally, poor nutrition is a driver of many chronic diseases and is responsible for more deaths than any other risk factor. Accordingly, there is growing interest in the direct provision of healthy foods to patients to tackle diet-linked chronic diseases and mortality. AIM: To assess the effect of two healthy food interventions in conjunction with nutrition counseling and education on select chronic disease markers, food insecurity, diet quality, depression, and on self-efficacy for healthy eating, healthy weight, and chronic disease management. METHODS: This parallel-arm quasi-randomized control trial will be conducted between January 2022 and December 2023. Seventy adult patients recruited from a single academic medical center will be randomly assigned to receive either: i) daily ready-made frozen healthy meals or ii) a weekly produce box and recipes for 15 weeks. Participants will, additionally, take part in one individual nutrition therapy session and watch videos on healthy eating, weight loss, type 2 diabetes, and hypertension. Data on weight, height, glycated hemoglobin, blood pressure, and diabetes and blood pressure medications will be collected in-person at the baseline visit and at 16 weeks from baseline and via medical chart review at six months and 12 months from enrollment. The primary outcome of the study is weight loss at 16 weeks from baseline. Pre- and post-intervention survey data will be analyzed for changes in food insecurity, diet quality, depression, as well as self-efficacy for health eating, healthy weight, and chronic disease management. Through retrospective chart review, patients who received standard of care will be matched to intervention group participants as controls based on body mass index, type 2 diabetes, and/or hypertension. FINDINGS: By elucidating the healthy food intervention with better health outcomes, this study aims to offer evidence that can guide providers in their recommendations for healthy eating options to patients.

52-year-old man • intermittent fevers • recently received second dose of COVID-19 vaccine • tremors in all 4 extremities • Dx?

► intermittent fevers ► recently received second dose of COVID-19 vaccine ► tremors in all 4 extremities.

Incidence of Sudden Cardiac Arrest and Death in Young Athletes and Military Members: A Systematic Review and Meta-Analysis.

OBJECTIVE: To evaluate the quality of the evidence on the incidence of sudden cardiac arrest (SCA) and sudden cardiac death (SCD) in athletes and military members and estimate the annual incidence of SCA and SCD. DATA SOURCES: We searched MEDLINE, Embase, Cochrane CENTRAL, Web of Science, BIOSIS, Scopus, SPORTDiscus, PEDro, and ClinicalTrials.gov from inception to dates between February 21 and July 29, 2019. STUDY SELECTION: Studies in which the incidence of SCA, SCD, or both in athletes or military members aged <40 years was reported were eligible for inclusion. We identified 40 studies for inclusion. DATA EXTRACTION: Risk of bias (ROB) was assessed using a validated, customized tool for prevalence studies. Twelve had a low ROB, while the remaining 28 had a moderate or high ROB. Data were extracted for narrative review and meta-analysis. DATA SYNTHESIS: Random-effects meta-analysis was performed in studies judged to have a low ROB in 2 categories: (1) 5 studies of regional- or national-level data, including athletes at all levels and both sexes, demonstrated 130 SCD events with a total of 11 272 560 athlete-years, showing a cumulative incidence rate of 0.98 (95% CI = 0.62, 1.53) per 100 000 athlete-years and high heterogeneity (I2 = 78%) and (2) 3 studies of competitive athletes aged 14 to 25 years were combined for a total of 183 events and 17 798 758 athlete-years, showing an incidence rate of 1.91 (95% CI = 0.71, 5.14) per 100 000 athlete-years and high heterogeneity (I2 = 97%). The remaining low-ROB studies involved military members and were not synthesized. CONCLUSIONS: The worldwide incidence of SCD is rare. Low-ROB studies indicated the incidence was <2 per 100 000 athlete-years. Overall, the quality of the available evidence was low, but high-quality individual studies inform the question of incidence levels. PROSPERO REGISTRATION: CRD42019125560.

Screening Electrocardiogram in Young Athletes and Military Members: A Systematic Review and Meta-Analysis.

OBJECTIVE: To determine the effect of electrocardiogram (ECG) screening on the prevention of sudden cardiac arrest and death in young athletes and military members. DATA SOURCES: MEDLINE, Embase, CENTRAL, Web of Science, BIOSIS, Scopus, SPORTDiscus, PEDro, and ClinicalTrials.gov were searched from inception to dates between February 21 and July 29, 2019. STUDY SELECTION: Randomized and nonrandomized controlled trials in which preparticipation examination including ECG was the primary intervention used to screen athletes or military members aged ≤40 years. Acceptable control groups were those receiving no screening, usual care, or preparticipation examination without ECG. Three published studies and 1 conference abstract were identified for inclusion. DATA EXTRACTION: In all 4 studies, risk of bias was assessed using the Cochrane risk-of-bias tool and was found to be generally high. Two studies had data extracted for random effects meta-analysis, and the remaining study and conference abstract were included in the narrative review. The overall quality of evidence was assessed using the Grading of Recommendations, Assessment, Development and Evaluation approach. DATA SYNTHESIS: We included 4 nonrandomized studies (11 689 172 participants), of which all had a high risk of bias. Pooled data from 2 studies (n = 3 869 274; very low-quality evidence) showed an inconclusive 42% relative decrease in risk of sudden cardiac death (relative risk = 0.58; 95% CI = 0.23, 1.45), equating to an absolute risk reduction of 0.0016%. The findings were consistent with a potential 77% relative decreased risk to a 45% relative increased risk in participants screened using ECG. Heterogeneity was found to be high, as measured using I2 statistic (71%). Data from the remaining study and abstract were similarly inconclusive. CONCLUSIONS: Existing evidence for the effect of ECG screening is inconclusive and of very low quality. In our meta-analysis, we observed that screening ECG may result in a considerable benefit or harm to participants. Higher-quality studies are needed to reduce this uncertainty.

Professional Women's Softball Injuries: An Epidemiological Cohort Study.

OBJECTIVE: To report the epidemiology of Women's National Professional Fast-Pitch (NPF) softball injuries during the 2017 season. The secondary objective was to evaluate risk factors for pitching injuries. DESIGN/SETTING: Prospective injury data were collected from the primary clinical care of 6 professional softball teams. PARTICIPANTS: The NPF study population consisted of 153 players. INDEPENDENT VARIABLES: Data collection included the following: number of practices each week, diagnosis of the injury, game or practice injury, position played when sustaining the injury, treatment for the injury, number of missed practices and/or games as a result of the injury, and total days until return to play. MAIN OUTCOME MEASURES: Injury rate (IR) overall, IR in position players, and IR in pitchers. Secondary outcomes included risk assessment for injury in pitchers; descriptive statistics on the injuries recorded in all players. RESULTS: Pitchers reported both upper extremity and lower extremity injuries equally, whereas positional players reported more lower extremity injuries. Pitchers were also most likely to be injured during a practice than a game. Overall, there were 3.26 reported game injuries per 1000 athlete exposures (AE) and 4.79 practice injuries per 1000 AE. Pitchers specifically had 1.88 reported game injuries per 1000 AE and 5.66 practice injuries per 1000 AE. CONCLUSIONS: In contrast to previous data, our study showed an increased IR in practice as compared to games in both position players and pitchers. Significant injuries were relatively rare, and most injuries seemed minor, usually with less than 7 days missed, suggesting a relative safety associated with this sport.

Retrospective Comparison of Cardiac Testing and Results on Inpatients with Low Pretest Probability Compared with Moderate/High Pretest Probability for Coronary Artery Disease.

OBJECTIVE: To determine whether admission, and provocative stress testing of patients who have ruled out for acute coronary syndrome put patients with low-risk category for coronary artery disease (CAD) at risk for false-positive provocative stress testing and unnecessary coronary angiogram/imaging. METHODS: A retrospective chart review was performed on patients between 30 and 70 years old, with no pre-existing diagnosis of CAD, admitted to observation or inpatient status chest pain or related complaints. Included patients were categorized based on Duke Clinical Score for pretest probability for CAD into either low-risk group, or moderate/high-risk group. The inpatient course was compared including whether provocative stress testing was performed; results of stress testing; whether patients underwent further coronary imaging; and what the results of the further imaging showed. RESULTS: 543 patients were eligible: 305 low pretest probability, and 238 moderate/high pretest probability. No difference was found in rate of stress testing relative risk (RR) = 1.01 (95% CI, 0.852 to 1.192; P = 0); rate of positive or equivocal stress tests between the 2 groups: RR = 0.653 (95% CI, 0.415 to 1.028; P = .07,). Low-pretest-probability patients had a lower likelihood of positive coronary imaging after stress test, RR = 0.061 (95% CI, 0.004 to 0.957; P = .001). CONCLUSION: Follow-up provocative testing of all patients admitted/observed after emergency department presentation with chest pain is unlikely to find CAD in patients with low pretest probability. Testing all low-probability patients puts them at increased risk for unnecessary invasive confirmatory testing. Further prospective testing is needed to confirm these retrospective results.

Softball Pitching and Injury.

The windmill softball pitch generates considerable forces about the athlete's shoulder and elbow. The injury pattern of softball pitchers seems to be primarily overuse injury, and they seem not to suffer the same volume of injury that baseball pitchers do. This article will explore softball pitching techniques, kinetics and kinematics of the windmill pitch, epidemiology of softball pitchers, and discuss possible etiologies of softball pitching injuries.

Preventing Sudden Cardiac Death: Automated External Defibrillators in Ohio High Schools.

CONTEXT: Ohio passed legislation in 2004 for optional public funding of automated external defibrillators (AEDs) in all Ohio high schools. OBJECTIVE: To report occurrences of sudden cardiac arrest in which AEDs were used in Ohio high schools and to evaluate the adherence of Ohio high schools with AEDs to state law and published guidelines on AEDs and emergency action plans (EAPs) in schools. DESIGN: Cross-sectional survey. SETTING: Web-based survey. PATIENTS OR OTHER PARTICIPANTS: A total of 264 of 827 schools that were members of the Ohio High School Athletic Association. MAIN OUTCOME MEASURE(S): We surveyed schools on AED use, AED maintenance, and EAPs. RESULTS: Twenty-five episodes of AED deployment at 22 schools over an 11-year period were reported; 8 (32%) involved students and 17 (68%) involved adults. The reported survival rate was 60% (n = 15). Most events (n = 20, 80%) in both students and adults occurred at or near athletic facilities. The annual use rate of AEDs was 0.7%. Fifty-three percent (n = 140) of schools reported having an EAP in place for episodes of cardiac arrest. Of the schools with EAPs, 57% (n = 80) reported having rehearsed them. CONCLUSIONS: Our data supported the placement of AEDs in high schools given the frequency of use for sudden cardiac arrest and the survival rate reported. They also suggested the need for increased awareness of recommendations for EAPs and the need to formulate and practice EAPs. School EAPs should emphasize planning for events in the vicinity of athletic facilities.

Incidence of Staphylococcus aureus nasal colonization and soft tissue infection among high school football players.

BACKGROUND: Methicillin-resistant Staphylococcus aureus (MRSA) skin and soft tissue infections have been documented with increasing frequency in both team and individual sports in recent years. It also seems that the level of MRSA skin and soft tissue infections in the general population has increased. METHODS: One hundred ninety athletes from 6 local high school football teams were recruited for this prospective observational study to document nasal colonization and the potential role this plays in skin and soft tissue infections in football players and, in particular, MRSA infections. Athletes had nasal swabs done before their season started, and they filled out questionnaires regarding potential risk factors for skin and soft tissue infections. Those enrolled in the study were then observed over the course of the season for skin and soft tissue infections. Those infected had data about their infections collected. RESULTS: One hundred ninety of 386 available student athletes enrolled in the study. Forty-four of the subjects had nasal colonization with methicillin-susceptible S. aureus, and none were colonized with MRSA. There were 10 skin and soft tissue infections (8 bacterial and 2 fungal) documented over the course of the season. All were treated as outpatients with oral or topical antibiotics, and none were considered serious. Survey data from the preseason questionnaire showed 21% with skin infection, 11% with methicillin-susceptible S. aureus, and none with MRSA infection during the past year. Three reported a remote history of MRSA infection. CONCLUSIONS: We documented an overall skin infection rate of 5.3% among high school football players over a single season. Our results suggest that skin and soft tissue infection may not be widespread among high school athletes in northeast Ohio.