Primary Care Sports Medicine fellowship opportunities for Pediatrics-trained physicians in the United States.

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

Common Ultrasound Applications for Pediatric Musculoskeletal Conditions.

PURPOSE OF REVIEW: To discuss the use of ultrasound for diagnosis and management of common pediatric musculoskeletal conditions through a case-based approach. RECENT FINDINGS: Ultrasound is an essential diagnostic modality in the early detection of developmental dysplasia of the hips and can be used as early as 6 weeks of age when the ossific nucleus has not developed yet. Ultrasound is helpful in diagnosing traumatic injuries such as fractures and intramuscular hematomas, can visualize fracture healing at early stages, and can also be used to guide aspiration of hematomas that can help with decreasing pain and faster recovery. Ultrasound is superior to radiographs in evaluating joint effusions and soft tissue infections or masses and is better tolerated by children compared to other imaging modalities such as magnetic resonance imaging (MRI). Ultrasound is an easily accessible, affordable, non-invasive, and radiation-free imaging modality that is well tolerated by children and their families. It can aid in the diagnosis and management of a wide variety of musculoskeletal conditions including developmental, traumatic, and infectious etiologies, as well as in the evaluation of superficial soft tissue masses.

Common Upper Extremity Injuries in Pediatric Athletes.

PURPOSE OF REVIEW: The aim of this study is to review the most recent literature on common upper extremity injuries in pediatric athletes and discuss their diagnosis, management, and outcomes. We also highlight ultrasound as a tool in their evaluation. RECENT FINDINGS: Shoulder conditions presented include little league shoulder, glenohumeral rotation deficit, acute traumatic shoulder dislocation, and multidirectional shoulder instability. Elbow conditions include capitellar OCD, medial epicondyle avulsion fracture, and medial epicondylitis. We also review scaphoid fractures and gymnast wrist. Not all physeal injuries lead to long-term growth disruption. Ultrasound has been shown to be useful in the diagnosis of scaphoid fracture, medial epicondyle avulsion fractures, and capitellar OCD. It can also be helpful in assessing risk for shoulder and elbow injuries in overhead athletes. There is a rising burden of upper extremity injuries among pediatric athletes. Knowledge of their sport specific mechanics can be helpful in diagnosis. As long-term outcome data become available for these conditions, it is clear, proper diagnosis and management are critical to preventing adverse outcomes. We highlight many of these injuries, best practice in care, and controversies in care in hopes of improving outcomes and preventing injury for pediatric athletes.

Optimizing Health and Athletic Performance for Women.

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

Specific dietary practices in female athletes and their association with positive screening for disordered eating.

BACKGROUND: To determine if following specific diets was associated with reporting behaviors that are consistent with disordered eating compared to non-diet-adherent athletes. We hypothesized that athletes adhering to specific diets were more likely to report disordered eating than those not following a diet. METHODS: One thousand female athletes (15-30 years) completed a comprehensive survey about athletic health and wellness. Athletes were asked to specify their diet and completed 3 eating disorder screening tools: the Brief Eating Disorder in Athletes Questionnaire, the Eating Disorder Screen for Primary Care, and self-reported current or past history of eating disorder or disordered eating. Descriptive statistics were calculated for all study measures and chi-squared tests assessed relationships between athletes' dietary practices and their responses to eating disorder screening tools. Statistical significance was defined as p < 0.05. RESULTS: Two hundred thirty-four of 1000 female athletes reported adherence to specific diets. 69 of the 234 diet-adhering athletes (29.5%) were excluded due to medically-indicated dietary practices or vague dietary descriptions. Of the 165 diet-adherent athletes, 113 (68.5%) screened positively to ≥1 of the 3 eating disorder screening tools. Specifically, athletes practicing a low-carbohydrate diet were more likely to report disordered eating vs. athletes without dietary restrictions (80% vs. 41.8%; p < 0.0001). CONCLUSION: Specific diet adherence in female athletes may be associated with reporting behaviors that are consistent with disordered eating. Health practitioners should consider further questioning of athletes reporting specific diet adherence in order to enhance nutritional knowledge and help treat and prevent eating disorders or disordered eating.

Female athletes may follow special diets for various reasons including sociocultural practices, environmental concerns, or health and weight-management benefits. These practices may put them at risk for developing eating disorders, which peak during adolescence, and are more common among athletes. Eating disorders or disordered eating in athletes may lead to inadequate fueling or low energy availability and its subsequent health and performance-related complications, also known as Relative Energy Deficiency in Sport (RED-S). It may be difficult to detect eating disorders among athletes due to the secretive nature behind these behaviors. In addition, objective information such as low weight or body mass index (BMI) may not be reliable due to their increased muscle mass. The results of this study revealed that female athletes who reported practicing special diets, especially those who follow a low-carbohydrate diet may be associated with developing eating disorders compared to female athletes who did not report any dietary restrictions. These findings should prompt healthcare providers to evaluate these individuals further in order to enhance their nutritional knowledge and help treat and prevent consequences linked to eating disorders or disordered eating.