Mindfulness Practice Is Associated With Improved Well-Being and Reduced Injury Risk in Female NCAA Division I Athletes.

BACKGROUND: Injury in sport is an inherent risk to participation, and it can have devastating consequences for the athlete, both mentally and physically. Previous research has found that impairments in well-being can increase the risk of injury, and that various forms of mindfulness training and practice can improve well-being and mental health in various populations. HYPOTHESIS: Mindfulness would be associated with greater well-being and lower risk of injury. STUDY DESIGN: Cohort study. LEVEL OF EVIDENCE: Level 3. METHODS: A total of 21 female Division I athletes underwent a formal 6-week mindfulness training program and were encouraged to continue mindfulness exercises. The athletes completed daily surveys on their smartphones in relation to mood, muscle readiness (soreness), readiness to train, energy level, daily training load, and whether they had participated in mindfulness training that day. Linear mixed effects models were used to evaluate well-being variables and mindfulness state, and separate mixed effects logistics regression models were used to evaluate injury incidence and wellness variables. RESULTS: On days with mindfulness practice, athletes reported higher mood (19.6 [18.8-20.3] vs 19.4 [18.6-20.1, P = 0.03), muscle readiness (18.9 [17.8-20.0] vs 18.6 [17.5-19.6], P = 0.03), readiness to train (78.7 [75.9-81.5] vs 77.4 [74.7-80.2], P < 0.01), and energy level (19.3 [18.6-20.1] vs 18.8 [18.1-19.5, P < 0.01) than on the days when they did not participate in mindfulness training. Mindfulness practice was associated with significantly reduced likelihood of suffering an acute injury the following day (odds ratio, 0.42; 95% CI, 0.42-0.43; P < 0.01). CONCLUSION: On an individual level, participation in mindfulness by female collegiate athletes was associated with a dramatic reduction in injury risk the following day. In addition, mindfulness was associated with significantly improved mood, muscle readiness, readiness to train, and energy level. CLINICAL RELEVANCE: These findings suggest that mindfulness training in athletes may improve well-being and reduce the risk of injury among high-level athletes.

The Influence of Race, Socioeconomic Status, and Physical Activity on the Mental Health Benefits of Sport Participation During COVID-19.

BACKGROUND: The purpose of this study was to compare the benefits of sport participation with no sport participation during the COVID-19 pandemic and determine the moderating effects of race and ethnicity, socioeconomic status (SES), and physical activity (PA) on mental health in adolescent athletes. HYPOTHESIS: Sport participation would be associated with greater improvements in mental health for athletes from racial and ethnic minority and lower SES groups compared with White and high SES groups. PA would mediate <30% of the mental health benefits of sport participation. STUDY DESIGN: Cross-sectional study. LEVEL OF EVIDENCE: Level 4. METHODS: In May 2021, adolescent athletes completed an online survey (demographics, sport participation, measures of anxiety and depression, PA). Participants were classified as those who played sports (PLY) and those who did not (DNP). Mental health symptoms for the PLY and DNP groups were compared via analysis of variance models that controlled for demographic variables. Moderating analyses assessed the interaction of sport participation status by (1) race and ethnicity (White/non-White) and (2) SES (high/low) with mental health. Mediation analyses assessed the degree that PA scores explained the differences in anxiety and depression between the 2 groups. RESULTS: Participants included 4874 adolescent athletes (52% female; age, 16.1 ± 1.3 years; PLY, 91%). Athletes who returned to sport from racial minority groups and low SES had greater decreases in anxiety (race and ethnicity: interaction estimate (b) = -1.18 ± 0.6, P = 0.04; SES, b = -1.23 ± 0.5, P = 0.02), and depression (race and ethnicity: b = -1.19 ± 0.6, P = 0.05; SES, b = -1.21 ± 0.6, P = 0.03) compared with White and high SES athletes, respectively. PA explained 24% of anxiety (P < 0.01) and 20% of depression scores (P < 0.01). CONCLUSION: Athletes who identify as a racial or ethnic minority and from areas of lower household income experienced disproportionately greater negative mental health impacts from sport restrictions during COVID-19. CLINICAL RELEVANCE: Improving access to sports in traditionally underserved areas may have significant mental health impact for adolescents.

Changes in Quality of Life Among Collegiate Athletes During COVID-19.

BACKGROUND: The COVID-19 pandemic has had a significant effect on the mental health of athletes. How this has affected quality of life (QoL), specifically in the college population, is poorly defined. HYPOTHESIS: During the COVID-19 pandemic, the mental and physical QoL will have decreased in collegiate athletes as compared with before the pandemic. STUDY DESIGN: Cross-sectional study. LEVEL OF EVIDENCE: Level 3. METHODS: Division I athletes from a total of 23 varsity teams at a single institution completed surveys between 2018 and 2022. QoL was assessed using the Veterans RAND 12-Item Health Survey (VR-12). VR-12 scores were separated into mental component scores (MCS) and physical component scores (PCS). Separate linear mixed effects models evaluated changes in MCS and PCS from pre-COVID to during COVID overall, as well as differences in changes by sex and sport type (individual, team). RESULTS: For all athletes, the PCS increased (54.6 [95% CI 54.4-54.7] vs 55.1 [54.9-55.3]; P < 0.01) and the MCS decreased (55.2 [54.9-55.5] vs 53.5 [53.1-53.8]; P < 0.01) from pre-COVID to during COVID. When evaluating for sex, women demonstrated a greater increase in PCS (0.57 ± 0.22; P = 0.01) and greater decrease in MCS (1.06 ± 0.38; P < 0.01). With respect to sport type, individual sports demonstrated a greater decrease in MCS (1.46 ± 0.39; P < 0.01), but no interaction was identified for PCS (0.42 ± 0.23; P = 0.07). CONCLUSION: Collegiate athletes demonstrated a decrease in their self-reported mental QoL during the COVID-19 pandemic, as compared with before the pandemic. This effect was most evident in women and in individual sports. Athletes also reported an increase in physical QoL during COVID that was also larger in women, but not related to sport. CLINICAL RELEVANCE: This study demonstrates the impact of the COVID-19 pandemic on collegiate athletes' QoL, including negative effects on mental health. It also identifies cohorts of athletes (women, individual) who may be more significantly affected.

The Associations Between Wellbeing and Injury Differ by Time Loss in Collegiate Athletes.

BACKGROUND: Self-reported wellbeing measures such as mood and soreness have been identified as predictors of injury risk. However, most research has focused on investigating time-loss injuries even though nontime-loss injuries are more prevalent. HYPOTHESIS: Impairments in sleep and subjective wellbeing would be associated with increased injury for both time-loss and nontime-loss injuries. STUDY DESIGN: Prospective longitudinal study. LEVEL OF EVIDENCE: Level 3. METHODS: During 2022, 127 athletes completed a daily survey that inquired about training load and sleep from the previous day along with mood, stress, and soreness on the current day. Incidence of injury was also monitored using documentation provided by athletes' respective athletic trainers. Mixed effect models were used to analyze the relationship between wellbeing and sleep measures with injury. RESULTS: Self-reported wellbeing, based most closely on soreness the day of injury, by National Collegiate Athletic Association Division 1 collegiate athletes was predictive of time-loss injuries, whereas no significant relationship was identified for nontime-loss injuries. Specifically, 1 unit increase in soreness was associated with a 39% increase in odds of sustaining a time-loss injury. CONCLUSION: This study found that subjective wellbeing and sleep have a different relationship with injury dependent upon whether the resulting injury leads to time loss. CLINICAL RELEVANCE: Self-reported wellbeing appears to be a relevant predictor of injury among collegiate athletes for time-loss injuries.

COVID-19 Planning in United States Adolescent Sports: A Survey of 1880 Organizations Representing More Than 500 000 Youth Athletes.

CONTEXT: High schools and youth sport organizations that restarted participation in the fall of 2020 during the COVID-19 pandemic relied on information sources to develop risk-mitigation procedures. OBJECTIVE: To compare the risk-mitigation procedures and information sources used by high school athletic departments and youth sport organizations. DESIGN: Cross-sectional study. SETTING: Surveys of high school and youth sport organization programs from across the United States. PATIENTS OR OTHER PARTICIPANTS: A total of 1296 high schools and 584 youth sport organizations, representing 519 241 adolescent athletes, responded to the surveys. MAIN OUTCOME MEASURE(S): Surveys regarding restarting sport, COVID-19 cases, risk-reduction procedures, and the information sources used to develop risk-reduction plans in the fall of 2020 were distributed to high school athletic directors and youth sport directors throughout the United States. The proportions of high schools and youth sport organizations using different risk-reduction procedures and information sources were compared using the χ2 test. RESULTS: High schools used more risk-reduction procedures than did youth sport organizations (high schools = 7.1 ± 2.1 versus youth sport organizations = 6.3 ± 2.4; P < .001) and were more likely than youth sport organizations to use symptom monitoring (high schools = 93% versus youth sport organizations = 85%, χ2 = 26.3; P < .001), temperature checks on site (66% versus 49%, χ2 = 53.4; P < .001), face masks for athletes during play (37% versus 23%, χ2 = 38.1; P < .001) and when off the field (81% versus 71%, χ2 = 26.1; P < .001), social distancing for staff (81% versus 68%, χ2 = 43.3; P < .001) and athletes off the field (83% versus 68%, χ2 = 57.6; P < .001), and increased facility disinfection (92% versus 70%, χ2 = 165.0; P < .001). Youth sport organizations relied more on information from sport national governing bodies than did high schools (youth sport organizations = 52% versus high schools = 10%, χ2 = 411.0; P < .001), whereas high schools were more likely to use information from sources such as the National Athletic Trainers' Association (high schools = 20% versus youth sport organizations = 6%, χ2 = 55.20; P < .001) and the National Federation of State High School Associations (high schools = 72% versus youth sport organizations = 15%, χ2 = 553.00; P < .001) for determining risk-reduction strategies. CONCLUSIONS: High schools and youth sport organizations reported using a broad range of risk-reduction procedures, but the average number was higher among high schools than youth sport organizations. Use of information from the Centers for Disease Control and Prevention and local health authorities was high overall, but use of information from professional health care organizations was low. Professional health care organizations should consider using additional measures to improve information uptake among stakeholders in youth sports.

Does Increased Physical Activity Explain the Psychosocial Benefits of Sport Participation During COVID-19?

CONTEXT: Although the return to sports during COVID-19 has been associated with improvements in mental health and quality of life (QOL), whether these benefits are primarily due to increases in physical activity (PA) is unknown. OBJECTIVE: To determine whether PA increases were responsible for the improvements in mental health and QOL among adolescents who returned to sport during the COVID-19 pandemic. DESIGN: Cross-sectional study. SETTING: Wisconsin secondary schools. PATIENTS OR OTHER PARTICIPANTS: A total of 559 adolescent athletes (age = 15.7 + 1.2 years, females = 43.6%) from 44 schools completed a survey in October 2020. MAIN OUTCOME MEASURE(S): Demographic information, whether they had returned to sport participation, school instruction type, anxiety (Generalized Anxiety Disorder-7), depression (Patient Health Questionnaire-9), QOL (Pediatric Quality of Life Inventory 4.0), and PA (Hospital for Special Surgery Pediatric Functional Activity Brief Scale). Mediation analysis was used to assess whether the relationships between sport status and anxiety, depression, and QOL were mediated by PA. RESULTS: At the time of the study, 171 (31%) had returned to play and 388 (69%) had not. Athletes who had returned to play had less anxiety (3.6 ± 0.4 versus 8.2 ± 0.6, P < .001) and depression (4.2 ± 0.4 versus 7.3 ± 0.6, P < .001) and higher QOL (88.1 ± 1.0 versus 80.2 ± 1.4, P < .001) and more PA (24.0 ± 0.5 versus 16.3 ± 0.7, P < .001). Physical activity explained a significant, but small, proportion of the difference in depression (22.1%, P = .02) and QOL (16.0%, P = .048) but not anxiety (6.6%, P = .20) between athletes who had and those who had not returned to play. CONCLUSIONS: Increased PA was responsible for only a small portion of the improvements in depression and QOL among athletes who returned to sports. This suggests that most of the mental health benefits of sport participation for adolescents during the COVID-19 pandemic were independent of the benefits of increased PA.

Impact of COVID-19 on the physical activity, quality of life and mental health of adolescent athletes: a 2-year evaluation of over 17 000 athletes.

PURPOSE: To evaluate the changes in mental health, quality of life (QOL) and physical activity (PA) among adolescent athletes during the COVID-19 pandemic as organised sports resumed. METHODS: Adolescent athletes completed surveys including demographic and sport participation information, 7-item Generalized Anxiety Disorder, 9-item Patient Health Questionnaire, Pediatric Quality of Life Inventory and the Hospital for Special Surgery Pediatric Functional Activity Brief Scale in May 2020 following COVID-19-related sport cancellations (Spring20) and after returning to sports in May 2021 (Spring21). The groups were balanced by inverse propensity score weighting and compared using analysis of variance models and ordinal regression models. RESULTS: 17 421 participants were included (Spring20=13 002; Spring21=4419; 16.2±1.2 years; 53% female). Anxiety was significantly lower (better) in Spring21 (Spring20=7.0, 95% CI 6.9 to 7.1; Spring21=4.9, 95% CI 4.8 to 5.0, p<0.001), as was the prevalence of moderate to severe anxiety (Spring20=29.4%, Spring21=17.1%, p<0.001). Depression was significantly improved in Spring21 (Spring20=7.6, 95% CI 7.5 to 7.7; Spring21=4.6, 95% CI 4.5 to 4.8, p<0.001), as was the prevalence of moderate to severe depression (Spring20=32.2%, Spring21=15.4%, p<0.001). Athletes in Spring21 reported higher QOL (Spring20=79.6, 95% CI 79.3 to 79.9; Spring21=84.7, 95% CI 84.4 to 85.0, p<0.001) and increased levels of PA (Spring20=13.8, 95% CI 13.6 to 13.9; Spring21=22.7, 95% CI 22.6 to 22.9, p<0.001). CONCLUSION: Early COVID-19 sports restrictions were associated with worsening mental health in adolescents. In 2021, after returning to sports, athletes reported significant improvements in mental health, QOL and PA, although mental health adversities remain an important priority.

[Liver surgeries in Iceland 2013-2017 - Comparison with Sweden in terms of quality registration].

INTRODUCTION: Cancers in the liver, bile duct system, gallbladder as well as metastases of the liver, have poor prognosis. Their treatment is comparable, with surgery being the most widespread, available curative treatment. Surgical treatment is anatomical or non-anatomical resection of the liver where the tumor and the adjacent liver tissue are removed. MATERIALS/METHODS: A list of patients diagnosed with cancer in the liver, bile duct system, gallbladder or metastases of the liver, during the time period 2013-2017, was obtained from the Icelandic Cancer Registry. Additional information was retrieved from medical records and entered into the electronic quality registration forms of Landspítalinn. A comparison was made between Sweden and Iceland. RESULTS: In total 108 patients were diagnosed with primary cancer of the liver, of which 24 (22%) underwent liver surgery. Of 264 diagnosed with liver metastases 38 (14%) underwent surgical treatment. A total of 63% of all reported cases were discussed at a multidisciplinary team meeting in Iceland but 93% in Sweden (p<0.0001). A sum of 29 patients (43%) developed complications within 30 days of surgery. Number of partial liver resections per 100.000 inhabitants were 2-8 in Iceland versus 4-13 in Sweden. The difference was even more apparent in patients with liver metastases. CONCLUSION: Liver surgeries performed in Iceland seem to be comparable to Sweden in terms of complications and post operative mortality. In Iceland, considerably fewer operations are performed per capita, especially on liver metastases which could be explained by the fact that fewer patients are discussed at multidisciplinary team meetings.

Contribution of Lean Mass Distribution on Aerobic Fitness and Performance in NCAA Division I Female Rowers.

ABSTRACT: Haraldsdottir, K, Sanfilippo, J, Dawes, S, and Watson, A. Contribution of lean mass distribution on aerobic fitness and performance in NCAA division I female rowers. J Strength Cond Res 36(7): 1956-1960, 2022-The purpose of this study was to determine the relative influence of total lean body mass (LBM), body fat percentage (BF%), upper extremity lean mass (ULM), lower extremity lean mass (LLM), and trunk lean mass (TLM) on maximal aerobic capacity (V̇o2max) and time to exhaustion (Tmax) in female collegiate rowers. One hundred seven female collegiate rowers (aged 18-22 years) performed maximal progressive rowing ergometer testing to determine V̇o2max and Tmax. Body mass, LBM, BF%, ULM, LLM, and TLM were determined by using dual-energy x-ray absorptiometry. Separate multivariable linear regression models were performed to predict V̇o2max and Tmax by using LBM and BF% as predictors. In addition, separate linear regression models were used to predict V̇o2max and Tmax with ULM, LLM, and TLM as covariates. Subjects were aged 20 ± 3 years. V̇o2max was significantly predicted by LBM (r2 = 0.29, p < 0.001), but not BF% (r2 = 0.002, p = 0.79). Similarly, Tmax was significantly predicted by LBM (r2 = 0.25, p < 0.001), but not BF% (r2 = 0.003, p = 0.19). V̇o2max was significantly predicted by LLM (r2 = 0.12, p < 0.01), but not ULM (r2 = 0.08, p = 0.68) or TLM (r2 = 0.09, p = 0.17), and Tmax was significantly predicted by TLM (r2 = 0.09, p = 0.02), but not ULM (r2 = 0.07, p = 0.89) or LLM (r2 = 0.08, p = 32). Among female collegiate rowers, whole body LBM is a significant predictor of both V̇o2max and Tmax. However, LLM is a stronger predictor of V̇o2max while TLM is a stronger predictor Tmax, although each of these relationships has a low coefficient of determination. These findings suggest that aerobic fitness and performance may be influenced by regions of lean mass differently.

Reported COVID-19 Incidence in Indoor Winter Sports Among US High-School Athletes.

OBJECTIVE: To evaluate the association between COVID-19 incidence among high-school athletes participating in different indoor winter sports and attending schools with in-person versus virtual instructional delivery. DESIGN: Cross-sectional survey. SETTING: US high schools. PARTICIPANTS: High-school athletic directors. INDEPENDENT VARIABLES: Indoor winter sports, school instructional delivery method, and state COVID-19 incidence. MAIN OUTCOME MEASURES: Surveys were distributed to high-school athletic directors throughout the United States regarding sport reinitiation and COVID-19 cases in winter 2020 to 2021. Separate mixed effects Poisson regression models were developed to evaluate the associations between reported COVID-19 incidence and (1) different sports and (2) school instructional delivery method, while adjusting for the background, state COVID-19 incidence. RESULTS: Four hundred thirty schools had restarted fall sports, representing 31 274 athletes on 1404 teams from 14 states. One thousand four hundred sixty cases of COVID-19 were reported, representing a case rate of 4668 cases per 100 000 athletes and an incidence rate of 58.7 cases per 100 000 player-days. Reported COVID-19 incidence was greatest among girls' hockey (82.1 cases per 100 000 player-days (95% CI, 56.8-115) and boys' hockey [76.7 (61.8-94.2)] and lowest among swimming [39.0 (31.1-48.2)] and gymnastics [28.5 (13.1-54.2)]. No difference in reported COVID-19 incidence was identified among athletes attending schools with virtual versus in-person instruction [incidence rate ratio = 0.86 (0.52-1.4)]. CONCLUSIONS: In this nationwide survey of US high-school athletic directors regarding indoor winter sports, reported COVID-19 incidence was lower in noncontact sports but unrelated to school instructional delivery method. This information may help guide decision-making regarding high-school sport participation during the COVID-19 pandemic.

The Psychosocial Benefits of Sport Participation During COVID-19 Are Only Partially Explained by Increased Physical Activity.

The purpose of this study was to determine whether physical activity (PA) increases were responsible for the improvements in mental health and quality of life (QOL) seen among adolescents who returned to sport during the COVID-19 pandemic.Adolescent athletes were asked to complete a survey in October 2020 regarding demographic information, whether they had returned to sport participation (no [DNP], yes [PLY]), school instruction type (virtual, in-person, hybrid), anxiety, depression, QOL, and PA. Anxiety, depression, QOL and PA were compared between PLY and DNP using least squares means from linear models adjusted for age, gender, and instruction type. Mediation analysis assessed whether the relationship between sport status and anxiety, depression, and QOL was mediated by PA. 171 athletes had returned to play, while 388 had not. PLY athletes had significantly lower anxiety (3.6±0.4 v 8.2±0.6, p<0.001) and depression (4.2±0.4 v 7.3±0.6, p<0.001), and significantly higher QOL (88.1±1.0 v 80.2±1.4, p<0.001) and PA (24.0±0.5 v 16.3±0.7, p<0.001). PA explained a significant, but relatively small portion of the difference in depression (22.1%, p=0.02) and QOL (16.0%, p=0.048) between PLY and DNP athletes, but did not explain the difference in anxiety (6.6%, p=0.20). Increased PA is only responsible for a small portion of the improvements in depression and QOL among athletes who returned to sports and unrelated to improvements in anxiety. This suggests that the majority of the mental health benefits of sport participation for adolescents during the COVID-19 pandemic are independent of, and in addition to, the benefits of increased PA.

Scandinavian Surgical Society: The Oldest International Surgical Society in the World.

Scandinavian Surgical Society (SSS), Nordisk Kirurgisk Förening, founded in 1893, is the oldest international surgical society in the world. The purpose of the society is to promote scientific and clinical work as well as education in the field of surgery in the Nordic countries; Denmark, Finland, Sweden, Norway and Iceland. Nordic co-operation has long traditions in the medical field. The surgical development through the surgical communities and the long-term co-operation between the Nordic surgeons have affected the patient care and development of surgery throughout the Nordic region. An overview and a historical glance of the surgical communities in the Nordic countries from the 18th century are described as well as activities in the SSS from the beginning of 1893 to these days.

Reported COVID-19 Incidence in Wisconsin High School Athletes in Fall 2020.

OBJECTIVE: To describe the incidence of COVID-19 in Wisconsin high school athletes and investigate the relationship of COVID-19 incidence with sport and face mask use. DESIGN: Retrospective survey. SETTING: High schools across Wisconsin during September 2020. PATIENTS OR OTHER PARTICIPANTS: Athletic directors representing 30 074 high school athletes with or without SARS-CoV-2. MAIN OUTCOME MEASUREMENT(S): The COVID-19 rates among athletes, counties, states, as well as school instruction type (virtual versus in person), sport type, and face mask use were assessed. Reported athlete case rates were compared with the county's general population and associations between COVID-19 incidence and sport type and face mask use, adjusting for each school's county incidence using multivariable negative binomial regression models. RESULTS: The COVID-19 incidence rates for 207 of 244 responding schools were 32.6 cases per 100 000 player-days. Reported case rates for athletes in each county were positively correlated with the county's general population case rates (ß = 1.14 ± 0.20, r = 0.60, P < .001). One case (0.5%) was attributed to sport contact by the reporting schools. No difference was identified between team and individual sports (incidence rate ratio [IRR] = 1.03 [95% CI = 0.49, 2.2], P = .93) or between noncontact and contact sports (IRR = 0.53 [0.23, 1.3], P = .14). Outdoor sports had a lower incidence rate than indoor sports, although this finding did not reach statistical significance (IRR = 0.52 [0.26, 1.1], P = .07). No significant associations were found between COVID-19 incidence and face mask use during play for those sports with greater than 50 schools reporting on face mask use (P values > .05). CONCLUSIONS: The incidence of reported COVID-19 among high school athletes was related to the county incidence, and most cases were attributed to nonsport contact. A lower COVID-19 incidence in outdoor sports approached statistical significance. The lack of a significant benefit demonstrated for face mask use may be due to relatively low rates of COVID-19 in Wisconsin during September 2020. Further research is needed to better define COVID-19 transmission risk factors during adolescent sport participation.

Mindfulness in Athletes.

ABSTRACT: Interventions to promote athlete health and performance have traditionally been focused on the physical elements of injury and training. More recently, however, increasing attention has been placed on the mental aspects of athlete health, with emerging evidence suggesting that injury risk and athletic performance are significantly affected by athlete well-being. Mindfulness meditation has been shown to have significant benefits for a number of physical and mental health outcomes in various clinical populations, and recent research has explored how mindfulness may enhance athletic performance, improve athlete mental health, reduce injury risk, and perhaps even facilitate recovery from injury. As awareness of mindfulness as a noninvasive, low-risk, and accessible intervention increases in the Western society, use among athletes has increased as well. Health care providers should be aware of this evidence in order to guide athletes regarding the use of mindfulness as an intervention to potentially improve athlete health and performance.

The Association of COVID-19 Incidence with Sport and Face Mask Use in United States High School Athletes.

CONTEXT: The relationships between different sports, face mask use and COVID-19 risk among high school athletes remains unknown. OBJECTIVE: The purpose of this study was to evaluate the influence of sport characteristics and face mask use on COVID-19 incidence among high school athletes. DESIGN: Descriptive Epidemiology Study Setting: United States High School Athletic Departments Participants: Athletic Directors Interventions: None Main Outcome Measures: Surveys were completed regarding sport re-initiation, COVID-19 cases, and risk reduction procedures in fall 2020. Separate mixed effects Poisson regression models were developed to evaluate the associations between reported COVID-19 incidence and 1) sport characteristics (contact/non-contact, individual/team, indoor/outdoor) and 2) face mask use while playing (yes/no). RESULTS: 991 schools had restarted fall sports, representing 152,484 athletes on 5,854 teams. 2,565 cases of COVID-19 were reported, representing a case rate of 1,682 cases per 100,000 athletes and an incidence rate of 24.6 cases per 100,000 player-days. COVID-19 incidence was lower among outdoor versus indoor sports (incidence rate ratio [IRR]=0.54, 95% CI=0.49-0.60, p<0.001) and non-contact versus contact sports (IRR=0.78 [0.70-0.87], p<0.001), but not team versus individual sports (IRR=0.96 [0.84-1.1], p=0.49). Face mask use was associated with a decreased incidence in girls' volleyball (IRR=0.53 [0.37-0.73], p<0.001), boys' basketball (IRR=0.53 [0.33-0.83], p=0.008) and girls' basketball (IRR=0.36 [0.19-0.63], p<0.001), and approached statistical significance in football (IRR=0.79 [0.59-1.04], p=0.10) and cheer/dance (IRR=0.75 [0.53-1.03], p=0.081). CONCLUSIONS: In this nationwide survey of high school athletes, lower COVID-19 incidence was independently associated with participation in outdoor versus indoor and non-contact versus contact sports, but not team versus individual sports. Face mask use was associated with decreased COVID-19 incidence among indoor sports, and may be protective among outdoor sports with prolonged close contact between participants.

Exercise-induced irregular right heart flow dynamics in adolescents and young adults born preterm.

BACKGROUND: Preterm birth has been linked to an elevated risk of heart failure and cardiopulmonary disease later in life. With improved neonatal care and survival, most infants born preterm are now reaching adulthood. In this study, we used 4D flow cardiovascular magnetic resonance (CMR) coupled with an exercise challenge to assess the impact of preterm birth on right heart flow dynamics in otherwise healthy adolescents and young adults who were born preterm. METHODS: Eleven young adults and 17 adolescents born preterm (< 32 weeks of gestation and < 1500 g birth weight) were compared to 11 young adult and 18 adolescent age-matched controls born at term. Stroke volume, cardiac output, and flow in the main pulmonary artery were quantified with 4D flow CMR. Kinetic energy and vorticity were measured in the right ventricle. All parameters were measured at rest and during exercise at a power corresponding to 70% VO2max for each subject. Multivariate linear regression was used to perform age-adjusted term-preterm comparisons. RESULTS: With exercise, stroke volume increased 10 ± 21% in term controls and decreased 4 ± 18% in preterm born subjects (p = 0.007). This resulted in significantly reduced capacity to increase cardiac output in response to exercise stress for the preterm group (58 ± 26% increase in controls, 36 ± 27% increase in preterm, p = 0.004). Elevated kinetic energy (KEterm = 71 ± 22 nJ, KEpreterm = 87 ± 38 nJ, p = 0.03) and vorticity (ωterm = 79 ± 16 s-1, ωpreterm = 94 ± 32 s-1, p = 0.01) during diastole in the right ventricle (RV) suggested altered RV flow dynamics in the preterm subjects. Streamline visualizations showed altered structure to the diastolic filling vortices in those born preterm. CONCLUSIONS: For the participants examined here, preterm birth appeared to result in altered right-heart flow dynamics as early as adolescence, especially during diastole. Future studies should evaluate whether the altered dynamics identified here evolves into cardiopulmonary disease later in life. Trial registration None.

Decreased Sleep and Subjective Well-Being as Independent Predictors of Injury in Female Collegiate Volleyball Players.

BACKGROUND: The relationship among sleep duration, subjective well-being, and injury risk in athletes is poorly defined. PURPOSE: To evaluate the independent effects of sleep duration, sleep quality, and subjective well-being on in-season injuries in collegiate female volleyball athletes. STUDY DESIGN: Cohort study; Level of evidence, 2. METHODS: During a 9-month competitive season, 17 female National Collegiate Athletic Association (NCAA) Division I volleyball players reported mood, fatigue, stress, soreness, sleep duration (hours), and sleep quality every morning. Well-being measures were recorded from 0 (worst) to 5 (best), and all time-loss injuries were recorded by the team athletic trainer. Separate mixed-effects logistic regression models were used to evaluate the effects of sleep and subjective well-being on in-season injury. Each well-being variable was also included in a separate mixed-effects logistic regression model with sleep duration as a covariate. RESULTS: A total of 54 injuries were recorded during the study period. Compared with days without an injury, mood, fatigue, stress, soreness, sleep quality, and sleep duration were significantly worse the day before an injury occurred. In the separate prediction models, in-season injury was significantly predicted by fatigue (odds ratio [OR], 0.56 [95% CI, 0.36-0.86]; P = .008), mood (OR, 0.52 [95% CI, 0.35-0.78]; P = .002), stress (OR, 0.63 [95% CI, 0.42-0.94]; P = .023), soreness (OR, 0.54 [95% CI, 0.38-0.79]; P = .001), sleep quality (OR, 0.49 [95% CI, 0.34-0.7]; P < .001), and sleep duration (OR, 0.69 [95% CI, 0.55-0.87]; P = .001). In the multivariable models, sleep duration remained a significant independent predictor in each of the subsequent multivariable models (OR, 0.72-0.74; P < .05 for all), as did mood (OR, 0.55 [95% CI, 0.36-0.83); P = .005) and soreness (OR, 0.57 [95% CI, 0.39-0.83]; P = .003), while fatigue (OR, 0.65 [95% CI, 0.42-1]; P = .054) and stress (OR, 0.68 [95% CI, 0.45-1]; P = .061) no longer reached statistical significance. CONCLUSION: Increased sleep duration, mood, and decreased soreness were independently associated with a reduced risk of in-season injury in this cohort of female NCAA volleyball players.

COVID-19 in US Youth Soccer Athletes During Summer 2020.

CONTEXT: As sports are reinitiated around the United States, the incidence of COVID-19 among youth soccer athletes remains unknown. OBJECTIVE: To determine the incidence of COVID-19 among youth soccer athletes and the risk-mitigation practices used by youth soccer organizations. DESIGN: Cohort study. SETTING: Survey distributed to Elite Clubs National League member clubs. PATIENTS OR OTHER PARTICIPANTS: Youth soccer club directors throughout the United States. MAIN OUTCOME MEASURE(S): Surveys were completed in late August 2020 regarding the club's current phase of return to soccer (individual only, group noncontact, group contact), date of reinitiation, number of players, cases of COVID-19, and risk-reduction procedures being implemented. Case and incidence rates were compared with national pediatric data and county data from the prior 10 weeks. A negative binomial regression model was developed to predict club COVID-19 cases using the local incidence rate and phase of return as covariates and the log of club player-days as an offset. RESULTS: A total of 124 respondents had reinitiated soccer, representing 91 007 players with a median duration of 73 days (interquartile range = 53-83 days) since restarting. Of the 119 clubs that had progressed to group activities, 218 cases of COVID-19 were reported among 85 861 players. Youth soccer players had a lower case rate and incidence rate than children in the United States (254 versus 477 cases per 100 000; incidence rate ratio = 0.511, 95% CI = 0.40, 0.57; P < .001) and the general population in the counties where data were available (268 versus 864 cases per 100 000; incidence rate ratio = 0.202, 95% CI = 0.19, 0.21; P < .001). After adjusting for the local COVID-19 incidence, we found no relationship between the club COVID-19 incidence and the phase of return (noncontact: b = 0.35 ± 0.67, P = .61; contact: b = 0.18 ± 0.67, P = .79). Soccer clubs reported using a median of 8 (interquartile range = 6-10) risk-reduction procedures. CONCLUSIONS: The incidence of COVID-19 among youth soccer athletes was relatively low when compared with the background incidence among children in the United States during the summer of 2020. No relationship was identified between the club COVID-19 incidence and the phase of return to soccer.

Decreased ventricular size and mass mediate the reduced exercise capacity in adolescents and adults born premature.

BACKGROUND: Premature birth is associated with lower levels of cardiorespiratory fitness (CRF) but the underlying mechanisms responsible remain unclear. This study assessed whether differences in cardiac morphology or function mediate differences in CRF among adolescents and young adults born preterm. METHODS: Adolescents and young adults born moderately to extremely premature (gestational age ≤ 32 weeks or birth weight < 1500 g) and age-matched term born participants underwent resting cardiac MRI and maximal exercise testing. Mediation analysis assessed whether individual cardiovascular variables accounted for a significant proportion of the difference in maximal aerobic capacity between groups. RESULTS: Individuals born preterm had lower VO2max than those born term (41.7 ±â€¯8.6 v 47.5 ±â€¯8.7, p < 0.01). Several variables differed between term and preterm born subjects, including systolic and diastolic blood pressure, mean pulmonary artery pressure, indexed left ventricular end-diastolic volume (LVEDVi), right ventricular end-diastolic volume (RVEDVi), LV mass (LVMi), LV stroke volume index (LVSVi), and LV strain (p < 0.05 for all). Of these variables, LVEDVi, RVEDVi, LVSVi, LVMi, and LV longitudinal strain were significantly related to VO2max (p < 0.05 for all). Significant portions of the difference in VO2max between term and preterm born subjects were mediated by LVEDVi (74.3%, p = 0.010), RVEDVi (50.6%, p = 0.016), and LVMi (43.0%, p = 0.036). CONCLUSIONS: Lower levels of CRF in adolescents and young adults born preterm are mediated by differences in LVEDVi, RVEDVi, and LVMi. This may represent greater risk for long-term cardiac morbidity and mortality in preterm born individuals.

COVID-19 Risk in Youth Club Sports: A nationwide sample representing over 200,000 Athletes.

CONTEXT: The COVID-19 pandemic has affected almost every aspect of life including youth sports. Little data exists on COVID-19 incidences and risk mitigation strategies in youth club sports. OBJECTIVE: To determine the reported incidence of COVID-19 cases among youth club sport athletes and the information sources used to develop COVID-19 risk mitigation procedures. DESIGN: Cross-sectional study. SETTING: Online surveys. PATIENTS: Soccer and volleyball youth club directors. INTERVENTION: A survey was completed by directors of youth volleyball and soccer clubs across the country in October 2020. Surveys included self-reported date of re-initiation, number of players, player COVID-19 cases, sources of infection, COVID-19 mitigation strategies, and information sources for the development of COVID-19 mitigation strategies. MAIN OUTCOME MEASURES: Total number of cases reported, number of players, and days since club re-initiation were used to calculate an incidence rate of cases per 100,000 player-days. To compare reported incidence rates between soccer and volleyball, a negative binomial model was developed to predict player cases with sport and state incidence as covariates and log(player-days) as an offset. Estimates were exponentiated to yield a reported incidence rate ratio (IRR) with Wald confidence intervals. RESULTS: A total of 205,136 athletes (soccer=165,580; volleyball=39,556) were represented by 437 clubs (soccer=159; volleyball=278). Club organizers reported 673 COVID-19 cases (soccer=322; volleyball=351), for a reported incidence rate of 2.8 cases per 100,000 player-days (soccer=1.7, volleyball=7.9). Volleyball had a significantly higher reported COVID-19 incidence rate compared to soccer (reported IRR = 3.06 [2.0-4.6], p<0.001). Out of 11 possible mitigation strategies, the median number of strategies used by all clubs was 7 with an interquartile range of 2. CONCLUSIONS: The incidence of self-reported cases of COVID-19 was lower in soccer clubs than volleyball clubs. Most clubs report using many COVID-19 mitigation strategies to reduce the risk of COVID-19.