Frequency of, Confidence in, and Educational Satisfaction With Mental Illness Recognition and Referral Among Certified Athletic Trainers.

CONTEXT: Mental illness recognition and referral are required components of professional athletic training education. However, athletic trainers (ATs) often report feeling underprepared to assist patients with mental health emergencies. OBJECTIVE: To determine ATs' frequency of and confidence in psychosocial skill use and their satisfaction with education related to mental illness recognition and referral. DESIGN: Cross-sectional study. SETTING: Online survey. PATIENTS OR OTHER PARTICIPANTS: A total of 226 ATs (86 men, 140 women; age = 35.5 ± 9.9 years, years of practice = 11.9 ± 9.0). MAIN OUTCOME MEASURE(S): The independent variables were professional athletic training program, professional psychosocial courses, highest education level, psychosocial continuing education units, clinical practice setting, and years of experience. For each skill, individuals identified the average frequency with which the skill was performed each year, rated their confidence in performing the skill, and rated their satisfaction with professional education related to the skill. RESULTS: Anxiety was reported as the symptom most frequently recognized and referred. Most respondents felt moderately or extremely confident in managing patients with anxiety, panic attacks, depression, suicidal ideation, or eating disorders but less confident or unconfident in managing those with psychosis or substance use disorder. The majority of respondents felt dissatisfied or only slightly satisfied with their education related to mental health recognition and referral. Years of clinical practice and self-reported frequency of referral were significantly associated for managing patients with anxiety disorder (\(\def\upalpha{\unicode[Times]{x3B1}}\)\(\def\upbeta{\unicode[Times]{x3B2}}\)\(\def\upgamma{\unicode[Times]{x3B3}}\)\(\def\updelta{\unicode[Times]{x3B4}}\)\(\def\upvarepsilon{\unicode[Times]{x3B5}}\)\(\def\upzeta{\unicode[Times]{x3B6}}\)\(\def\upeta{\unicode[Times]{x3B7}}\)\(\def\uptheta{\unicode[Times]{x3B8}}\)\(\def\upiota{\unicode[Times]{x3B9}}\)\(\def\upkappa{\unicode[Times]{x3BA}}\)\(\def\uplambda{\unicode[Times]{x3BB}}\)\(\def\upmu{\unicode[Times]{x3BC}}\)\(\def\upnu{\unicode[Times]{x3BD}}\)\(\def\upxi{\unicode[Times]{x3BE}}\)\(\def\upomicron{\unicode[Times]{x3BF}}\)\(\def\uppi{\unicode[Times]{x3C0}}\)\(\def\uprho{\unicode[Times]{x3C1}}\)\(\def\upsigma{\unicode[Times]{x3C3}}\)\(\def\uptau{\unicode[Times]{x3C4}}\)\(\def\upupsilon{\unicode[Times]{x3C5}}\)\(\def\upphi{\unicode[Times]{x3C6}}\)\(\def\upchi{\unicode[Times]{x3C7}}\)\(\def\uppsy{\unicode[Times]{x3C8}}\)\(\def\upomega{\unicode[Times]{x3C9}}\)\(\def\bialpha{\boldsymbol{\alpha}}\)\(\def\bibeta{\boldsymbol{\beta}}\)\(\def\bigamma{\boldsymbol{\gamma}}\)\(\def\bidelta{\boldsymbol{\delta}}\)\(\def\bivarepsilon{\boldsymbol{\varepsilon}}\)\(\def\bizeta{\boldsymbol{\zeta}}\)\(\def\bieta{\boldsymbol{\eta}}\)\(\def\bitheta{\boldsymbol{\theta}}\)\(\def\biiota{\boldsymbol{\iota}}\)\(\def\bikappa{\boldsymbol{\kappa}}\)\(\def\bilambda{\boldsymbol{\lambda}}\)\(\def\bimu{\boldsymbol{\mu}}\)\(\def\binu{\boldsymbol{\nu}}\)\(\def\bixi{\boldsymbol{\xi}}\)\(\def\biomicron{\boldsymbol{\micron}}\)\(\def\bipi{\boldsymbol{\pi}}\)\(\def\birho{\boldsymbol{\rho}}\)\(\def\bisigma{\boldsymbol{\sigma}}\)\(\def\bitau{\boldsymbol{\tau}}\)\(\def\biupsilon{\boldsymbol{\upsilon}}\)\(\def\biphi{\boldsymbol{\phi}}\)\(\def\bichi{\boldsymbol{\chi}}\)\(\def\bipsy{\boldsymbol{\psy}}\)\(\def\biomega{\boldsymbol{\omega}}\)\(\def\bupalpha{\bf{\alpha}}\)\(\def\bupbeta{\bf{\beta}}\)\(\def\bupgamma{\bf{\gamma}}\)\(\def\bupdelta{\bf{\delta}}\)\(\def\bupvarepsilon{\bf{\varepsilon}}\)\(\def\bupzeta{\bf{\zeta}}\)\(\def\bupeta{\bf{\eta}}\)\(\def\buptheta{\bf{\theta}}\)\(\def\bupiota{\bf{\iota}}\)\(\def\bupkappa{\bf{\kappa}}\)\(\def\buplambda{\bf{\lambda}}\)\(\def\bupmu{\bf{\mu}}\)\(\def\bupnu{\bf{\nu}}\)\(\def\bupxi{\bf{\xi}}\)\(\def\bupomicron{\bf{\micron}}\)\(\def\buppi{\bf{\pi}}\)\(\def\buprho{\bf{\rho}}\)\(\def\bupsigma{\bf{\sigma}}\)\(\def\buptau{\bf{\tau}}\)\(\def\bupupsilon{\bf{\upsilon}}\)\(\def\bupphi{\bf{\phi}}\)\(\def\bupchi{\bf{\chi}}\)\(\def\buppsy{\bf{\psy}}\)\(\def\bupomega{\bf{\omega}}\)\(\def\bGamma{\bf{\Gamma}}\)\(\def\bDelta{\bf{\Delta}}\)\(\def\bTheta{\bf{\Theta}}\)\(\def\bLambda{\bf{\Lambda}}\)\(\def\bXi{\bf{\Xi}}\)\(\def\bPi{\bf{\Pi}}\)\(\def\bSigma{\bf{\Sigma}}\)\(\def\bPhi{\bf{\Phi}}\)\(\def\bPsi{\bf{\Psi}}\)\(\def\bOmega{\bf{\Omega}}\)\({\rm{\chi }}_{87}^2\) = 117.774, P = .016) and suicidal thoughts or actions (\({\rm{\chi }}_{87}^2\) = 179.436, P < .001). For confidence, significant positive associations were present between years of practice and self-reported recognition of patients with anxiety disorders (\({\rm{\chi }}_{145}^2\) = 195.201, P = .003) and referral for those with anxiety disorders (\({\rm{\chi }}_{145}^2\) = 15.655, P = .048) or panic attacks (\({\rm{\chi }}_{145}^2\) = 19.790, P = .011). Significant associations were also noted between the number of continuing education units and self-reported confidence in recognizing suicide (\({\rm{\chi }}_{15}^2\) = 26.650, P = .032), referring for suicidal concerns (\({\rm{\chi }}_{18}^2\) = 40.456, P = .002), recognizing substance use (\({\rm{\chi }}_{18}^2\) = 33.649, P = .014), and referring for substance use (\({\rm{\chi }}_{18}^2\) = 30.918, P = .029). No significant associations were related to satisfaction. CONCLUSIONS: The ATs with fewer years of clinical practice (ie, who had completed professional programs more recently) expressed higher confidence in mental health recognition and referral than those who had completed professional programs longer ago. We recommend that real-time interactions with individuals who have mental health concerns or emergencies be incorporated into professional education programs and that increased emphasis be placed on continuing education related to these topics.

Rural healthcare delivery and maternal and infant outcomes for diabetes in pregnancy: A systematic review.

AIM: The aim of this systematic review was to examine the literature regarding rural healthcare delivery for women with any type of diabetes in pregnancy, and subsequent maternal and infant outcomes. METHODS: Eight databases were searched in September 2020, including Medline, EMCare, CINAHL, EMBASE, Maternity and Infant Care, Cochrane, Rural and Remote Health and Aboriginal and Torres Strait Islander Health bibliography. Studies from high-income countries in rural, regional or remote areas with interventions conducted during the antenatal period were included. Intervention details were reported using the template for intervention description and replication template. Two reviewers independently assessed for risk of bias using the RoB2 and ROBINS I tools. RESULTS: Three articles met the inclusion criteria: two conducted in Australia and one in the United States. A multidisciplinary approach was reported in two of the included studies, which were modified specifically for their respective rural settings. All three studies reported rates of caesarean section, birthweight (grams) and gestational age at birth as maternal and infant outcomes. One study was considered at moderate risk of bias, and two studies were at serious risk of bias. CONCLUSION: There is a significant gap in research relating to healthcare delivery for women with diabetes in pregnancy in rural areas. This lack of research is concerning given that 19% of individuals in high-income countries reside rurally. Further research is required to understand the implications of healthcare delivery models for diabetes in pregnancy in rural areas.

Sexual conflict drives micro- and macroevolution of sexual dimorphism in immunity.

BACKGROUND: Sexual dimorphism in immunity is believed to reflect sex differences in reproductive strategies and trade-offs between competing life history demands. Sexual selection can have major effects on mating rates and sex-specific costs of mating and may thereby influence sex differences in immunity as well as associated host-pathogen dynamics. Yet, experimental evidence linking the mating system to evolved sexual dimorphism in immunity are scarce and the direct effects of mating rate on immunity are not well established. Here, we use transcriptomic analyses, experimental evolution and phylogenetic comparative methods to study the association between the mating system and sexual dimorphism in immunity in seed beetles, where mating causes internal injuries in females. RESULTS: We demonstrate that female phenoloxidase (PO) activity, involved in wound healing and defence against parasitic infections, is elevated relative to males. This difference is accompanied by concomitant sex differences in the expression of genes in the prophenoloxidase activating cascade. We document substantial phenotypic plasticity in female PO activity in response to mating and show that experimental evolution under enforced monogamy (resulting in low remating rates and reduced sexual conflict relative to natural polygamy) rapidly decreases female (but not male) PO activity. Moreover, monogamous females had evolved increased tolerance to bacterial infection unrelated to mating, implying that female responses to costly mating may trade off with other aspects of immune defence, an hypothesis which broadly accords with the documented sex differences in gene expression. Finally, female (but not male) PO activity shows correlated evolution with the perceived harmfulness of male genitalia across 12 species of seed beetles, suggesting that sexual conflict has a significant influence on sexual dimorphisms in immunity in this group of insects. CONCLUSIONS: Our study provides insights into the links between sexual conflict and sexual dimorphism in immunity and suggests that selection pressures moulded by mating interactions can lead to a sex-specific mosaic of immune responses with important implications for host-pathogen dynamics in sexually reproducing organisms.

Investigating Concussion Knowledge in US Born Versus Internationally Born Collegiate Student-Athletes in the United States.

OBJECTIVE: To compare concussion knowledge between US born and internationally born collegiate student-athletes. Furthermore, to investigate whether length of time in the United States impacted concussion knowledge. DESIGN: Survey. SETTING: Preparticipation physicals at a midwestern NAIA college. PARTICIPANTS: Three hundred one collegiate student-athletes. INTERVENTIONS: Demographic questionnaire and the Rosenbaum Concussion Knowledge and Attitudes Survey (RoCKAS). MAIN OUTCOME MEASURES: t test was used to determine whether a difference in Concussion Knowledge Index (CKI) scores exists between US born and internationally born student-athletes. A one-way analysis of variance was used to determine significance for length of time in the United States. RESULTS: A statistically significant difference was found for CKI scores between US born (19.22 ± 2.38) and internationally born student-athletes (18.01 ± 2.57) (t = 3.895, P = 0.000). Analysis of variance demonstrated statistically significant difference for CKI scores (F2,300 = 13.883, P = 0.001). Post hoc analysis found significant differences in CKI scores between US born (19.22 ± 2.38) and internationally born student-athletes in the United States less than 2 years (17.31 ± 2.52) (P = 0.000), and between internationally born student-athletes in the United States 2 or more years (19.15 ± 2.25) and internationally born student-athletes in the United States less than 2 years (17.31 ± 2.52) (P = 0.002). CONCLUSION: Among this sample, being born in the United States and length of time in the United States contribute to student-athletes' concussion knowledge. CLINICAL RELEVANCE: Standardized guidelines are needed to assist health care professionals in properly educating student-athletes about concussions as the recognition and management of concussions can be affected by a student-athlete's knowledge.

Exploring core food accessibility in Tamworth, NSW, Australia.

INTRODUCTION: A lack of core food accessibility negatively affects diet quality, potentially increasing the prevalence of health risk factors such as obesity. The purpose of this study was to investigate core food access in an Australian regional center through the use of data visualization techniques. METHODS: Supermarkets were used as a proxy for core food accessibility and were identified and mapped by town region with a combination of Google Maps and Stata/IC 15.1 software. A statistical analysis comparing the demographics of each town region was also completed using Stata. RESULTS: The maps generated suggest that there may be a disparity in core food accessibility between town regions. The analysis of demographics demonstrated that one town region had a greater proportion of disadvantaged residents, with statistically significant variation between regions. CONCLUSION: Data visualization and analysis may be a useful tool for clinicians to communicate accessibility information experienced by local residents. This need not be limited to food accessibility and extended to health services.

A randomized comparison study regarding the impact of short-duration, high-intensity exercise and traditional exercise on anthropometric and body composition measurement changes in post-menopausal women--A pilot study.

BACKGROUND: The mode and duration of exercise necessary to change body composition and reduce weight remains debatable. Menopause results in hormonal changes that preclude weight loss. This randomized pilot study compared the effects of short-duration, high-intensity interval training and traditional exercise on anthropometric and body composition measurement changes in post-menopausal women. OBJECTIVE: To compare the effects of short-duration, high-intensity interval training and traditional methods of exercise (walking) on anthropometric, body composition and body weight change over a 12-week period. MAIN OUTCOME MEASURES: Subjects (N = 18) were post-menopausal, sedentary female volunteers, randomly assigned into one of two exercise groups. Both groups exercised five out of seven days for 12 weeks. The resistance group (n = 8) (54.3 ± 7.3 years; BMI = 28.0 ± 2.1 kg/m(2); mean ± SD) exercised for 15.0 ± 3.5 min, which consisted of five different exercise routines including upper and lower extremity, a cardio segment, yoga and abdominal exercises. The walkers (n = 10) (56.6 ± 5.2 years; BMI = 29.2 ± 2.6 kg/m(2); mean ± SD) exercised for 40.0 ± 5.0 min at 65% of their age-predicted maximum heart rate. Relative (%) body fat was measured via DEXA scan, along with five anthropometric measurements, all of which were taken prior to and after 12 weeks. Independent sample t-tests were probed for differences, p ≤ 0.05. RESULTS: No statistically significant changes were determined between the groups for pre-and post-measurements. CONCLUSIONS: The outcomes of this study provide a foundation for future comparisons of short-duration high-intensity interval training exercise and traditional exercise, or walking, on anthropometric and body composition measurement changes in sedentary, overweight, post-menopausal females over a 12-week period.