Is Cumulative Load Associated with Injuries in Youth Team Sport? A Systematic Review.

BACKGROUND: High cumulative external and internal load may predispose athletes to increased risk for injury across a variety of sports, competition levels, and age groups. However, evidence of an association between cumulative load and injury in youth sport remains inconclusive. The objective of this study was to determine the current evidence for cumulative load and injury risk relationships in youth team sport through a systematic review of the existing literature. METHODS: A systematic review of the literature was performed following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. Literature searches were conducted in PubMed, Web of Science, SCOPUS, and CINAHL for relevant articles published between January 2010 and April 2021. The authors conducted independent review and quality assessment of the eligible studies. Eleven articles evaluating youth (less than 18 years old) team sport were included for qualitative synthesis. RESULTS: Fifty-nine percent (n = 39/66) of the relationships assessed revealed an association between cumulative load and injury across the team sports studied, including the presence of load-injury associations in 84% (n = 16/19) of assessments in youth soccer. Of those relationships where an association was present, 79% (n = 31/39) were positive associations between cumulative load and injury. Risk of bias assessment scores ranged from three to six out of seven possible (median = 5) for cohort studies and from four to seven out of 10 possible (median = 5.5) for cross-sectional studies. CONCLUSIONS: There is some evidence for a positive association between load and injury in youth team sport. Youth soccer was the most studied team sport, and a substantial number of positive load-injury associations were reported. Current evidence lacks consistency in the measures and metrics used in defining load-injury relationships. Trial Registration PRISMA ID - CRD42020203622.

Infant, pediatric and adult well visit trends before and during the COVID-19 pandemic: a retrospective cohort study.

BACKGROUND: Adult well visits declined during COVID-19, but literature is inconsistent in regard to whether childhood well visits declined. We determined if the COVID-19 pandemic was associated with a change in well visits among infants, children, adolescents and adults before, compared to during the COVID-19 pandemic, including through the emergence of the Delta variant. METHODS: De-identified electronic health care data came from a multi-state Midwest health care system. Eligible patients (n = 798,571) had ≥ 1 well visit between 7/1/2018 and 6/30/2021. Trends in well visits per month for children (< 1, 1-4, 5-11, 12-17 years) and adults (18-39, 40-64, ≥ 65 years) over 3-years were assessed using Joinpoint regression models and monthly percent change (MPC). RESULTS: Well visits remained stable for infants (< 1 year of age) (MPC = -0.1; 95% CI = -0.3, 0.1). For children 1-4 years and all adults, visits were stable prior to 2020, decreased from 1/2020 to 4/2020 (MPC range -20 to -40), increased from 4/2020-7/2020 (MPC range 30 to 72), and remained stable after 7/2020. Children 5-17 had seasonal variation in visits where low points occurred in Jan/Feb 2019 and high points in Aug 2019 (start of school year); however, the low point in 2020 occurred in April 2020 and the seasonal variation normalized after this. CONCLUSIONS: In a large Mid-western health care system, infant well visits did not decline at the onset (3/1/2020) of the COVID-19 pandemic. Although well visits for all other ages decreased to a low point in 4/2020, a rapid return to pre-pandemic utilization rates occurred by 7/2020. The brief decrease in preventive care may have had little impact on health.

We Asked, They Told Us: The Use of an Electronic Survey to Address Parental Health Concerns for Children.

Population health includes medical conditions and social determinants of health, and it can be measured through community health needs assessments (CHNAs). A pediatric hospital utilized a survey to ask parents to rank different health topics based on the severity they present to children in the St. Louis Metropolitan for 2 installments of a CHNA (2016 and 2019). Between November 2015 and April 2016, 1156 parents and, between May 2018 and September 2018, 1022 parents responded to the Parent Health Concerns Survey. Respondents were most likely to be 25 to 44 years old, white, educated, have an income of at least $60 000, and work-related insurance. The top needs identified in 2016 and 2018 were lack of exercise and bullying, respectively. Depression saw the largest increase. Emerging topics in 2018 include tobacco/smoking, depression, and health insurance access. Our findings suggests that pediatricians should be prepared to address concerns across a wide variety of topics.