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To describe athletes' coverage by national medical teams, and injuries and illnesses occurring during the four weeks before and during the 2023 African Youth Under 18/20 Athletics Championships. Cross-sectional and prospective cohort study design. We conducted a study with data collection of: 1) national medical teams, 2) injury and illness complaints during the four weeks preceding the championships using an online pre-participation health questionnaire, and 3) newly incurred in-championship injuries and illnesses collected by national medical teams and the local organising committee using daily standardised online report forms, for all registered athletes at the championships. Among the 43 countries participating at the championships, 15 (34.9 %) countries had a medical team with at least one medical personnel. Of the 15 countries, 6 (40.0 %) countries had at least one physiotherapist and one physician, 4 (26.7 %) countries had only physiotherapist(s), and 5 (33.3 %) countries had only physician(s). Nine (60 %) countries participated in the injury surveillance study, including 397 athletes: 61 (15.4 %) completed the pre-participation health questionnaire and 11 athletes (18.0 %) reported an injury complaint and 6 (9.8 %) an illness complaint during the four weeks before the championships. During the championships, there were 52.9 injuries and 50.4 illnesses per 1000 registered athletes. The main injury location was the thigh (33.3 %), and the main injury type was the muscle (47.6 %). The most common system affected by illness was the upper respiratory tract (55.0 %), and the main illness cause was idiopathic (50.0 %). This preliminary study provides foundational information to improve medical coverage and services during international championships, and orient injury/illness prevention in youth athletics across Africa. [ABSTRACT FROM AUTHOR]

Following sport-related concussion (SRC), early studies have demonstrated racial differences in time to clinical recovery; however, these differences have not been fully explained. We sought to further explore these associations by considering possible mediating/moderating factors. Data from patients aged 12–18 years diagnosed with SRC from November 2017 to October 2020 were analyzed. Those missing key data, lost to follow-up, or missing race were excluded. The exposure of interest was race, dichotomized as Black/White. The primary outcome was time to clinical recovery (days from injury until the patient was either deemed recovered by an SRC provider or symptom score returned to baseline or zero.) A total of 389 (82%) White and 87 (18%) Black athletes with SRC were included. Black athletes more frequently reported no SRC history (83% vs. 67%, P = 0.006) and lower symptom burden at presentation (median total Post-Concussion Symptom Scale 11 vs. 23, P < 0.001) than White athletes. Black athletes achieved earlier clinical recovery (hazard ratio [HR] = 1.35, 95% CI 1.03–1.77, P = 0.030), which remained significant (HR = 1.32, 95% CI 1.002–1.73, P = 0.048) after adjusting for confounders associated with recovery but not race. A third model adding the initial Post-Concussion Symptom Scale score nullified the association between race/recovery (HR = 1.12, 95% CI 0.85–1.48, P = 0.410). Adding prior concussion history further reduced the association between race/recovery (HR = 1.01, 95% CI 0.77–1.34, P = 0.925). Overall, Black athletes initially presented with fewer concussion symptoms than White athletes, despite no difference in time to clinic. Black athletes achieved earlier clinical recovery following SRC, a difference explained by differences in initial symptom burden and self-reported concussion history. These crucial differences may stem from cultural/psychologic/organic factors. [ABSTRACT FROM AUTHOR]

Objectives: The primary objective was to evaluate chronic obstructive pulmonary disease (COPD) interventions in a pharmacist-led telemedicine clinic. Secondary objectives were to quantify emergency department (ED) visits and hospitalizations for COPD exacerbations.Setting: A single-center, outpatient telemedicine clinic within the Veterans Affairs (VA) Tennessee Valley Healthcare System from January 2021 to June 2021.Practice Description: Patients with an active COPD diagnosis and assigned to a primary care team within the local VA were reviewed for enrollment. Visits were conducted through VA video connect or telephone. During these appointments, pertinent information was collected and pharmacotherapy and nonpharmacotherapy interventions were implemented to optimize COPD management.Practice Innovation: Visits were conducted by a postgraduate year 2 ambulatory care pharmacy resident under supervision of a clinical pharmacy specialist with a scope of practice. Appointments were virtual to reduce coronavirus disease 2019 exposure and increase access to care. Patients were identified through a COPD patient report and provider referral to target high-risk patients.Evaluation: Interventions made were documented at each visit. Chart review and patient interview were used to quantify ED visits or hospitalizations for COPD exacerbations occurring the year before or during clinic enrollment.Results: Of 82 charts reviewed, 18 patients were eligible for enrollment. Eleven were followed as 7 patients did not show for initial visits. A total of 31 COPD interventions occurred including 13 nonpharmacotherapy (i.e., inhaler education, smoking cessation) and 18 pharmacotherapy (i.e., optimization of COPD regimens). An average of 3 COPD interventions were completed per patient followed. No ED visits and 2 hospitalizations for a COPD exacerbation occurred during the study period. This cohort had 1 ED visit and 10 hospitalizations the year before enrollment.Conclusion: This telemedicine clinic experience, albeit a small study population, suggests an opportunity for pharmacists to provide pharmacotherapy and nonpharmacotherapy interventions, which may improve COPD-related outcomes and access to care. [ABSTRACT FROM AUTHOR]

Although methamphetamine use has been increasing in recent years and occurring within new populations and in broader geographical areas, there is limited research on its use and effect in pregnancy. This study aimed to examine the association between prenatal methamphetamine use and maternal and neonatal outcomes in a large, contemporary birth cohort. This was a retrospective cohort study using California-linked vital statistics and hospital discharge data from 2008 to 2019. Methamphetamine use was identified using the International Classification of Disease, Ninth Revision and Tenth Revision, codes. Chi-square tests and multivariable Poisson regression models were used to evaluate the associations between methamphetamine use and maternal and neonatal outcomes. A total of 4,775,463 pregnancies met the inclusion criteria, of which 18,473 (0.39%) had methamphetamine use. Compared with individuals without methamphetamine use, individuals with methamphetamine use had an increased risk of nonsevere hypertensive disorders (adjusted risk ratio, 1.81; 95% confidence interval, 1.71–1.90), preeclampsia with severe features (adjusted risk ratio, 3.38; 95% confidence interval, 3.14–3.63), placental abruption (adjusted risk ratio, 3.77; 95% confidence interval, 3.51–4.05), cardiovascular morbidity (adjusted risk ratio, 4.30; 95% confidence interval, 3.79-4.88), and severe maternal morbidity (adjusted risk ratio, 3.53; 95% confidence interval, 3.29–3.77). In addition, adverse neonatal outcomes were increased, including preterm birth at <37 weeks of gestation (adjusted risk ratio, 2.85; 95% confidence interval, 2.77–2.94), neonatal intensive care unit admission (adjusted risk ratio, 2.46; 95% confidence interval, 2.39–2.53), and infant death (adjusted risk ratio, 2.73; 95% confidence interval, 2.35–3.16). Methamphetamine use in pregnancy is associated with an increased risk of adverse maternal and neonatal outcomes that persists after adjustment for confounding variables and sociodemographic factors. Our results can inform prenatal and postpartum care for this high-risk, socioeconomically vulnerable population. [Display omitted] [ABSTRACT FROM AUTHOR]

Objectives: The purpose of this study was to identify collegiate athletes' anxiety-related concussion perceptions and examine factors that may be related to increased anxiety injury beliefs.Design: Cross-sectional study.Methods: Male and female Division I, II and III NCAA collegiate athletes (n = 482) completed a 10- to 15-minute survey examining their demographics, diagnosed concussion history, concussion knowledge, and public media sources they have previously acquired concussion information from. The survey also included the Perceptions of Concussion Inventory for Athletes (PCI-A) which results in six outcome variables (anxiety, effects, control, clarity, treatment, and symptom variability). Univariable and a backward stepwise multivariable logistic regression model were utilized to identify variables that were associated with greater (above median) negative anxiety-related concussion perception scores.Results: Collegiate athletes displayed moderate anxiety-related concussion perceptions (12.8 ± 3.2; scores ranged from 4 - low anxiety to 20 - high anxiety). The majority of participants reported that concussions are upsetting to them (60.7%), with a sizable proportion being worried (46.7%), fearful (40.7%), or anxious (25.0%) about sustaining a concussion. In the multivariable regression, higher perception that concussions have long-term effects (OR = 2.72; 95% CI: 1.79-4.12), greater beliefs of internal control to influence concussion outcomes (OR = 1.78; 95% CI: 1.15-2.75), and female sex (OR = 1.77; 95% CI: 1.15-2.71) were associated with higher anxiety beliefs.Conclusions: This study for the first time establishes that negative, anxiety-related perceptions about concussions are prevalent in a collegiate athlete population. Addressing these perceptions through evidence-based, educational and management initiatives, such as highlighting that concussions are treatable and most do not result in long-term negative consequences with early diagnosis and proper management, are critical to improve emotions surrounding concussion. This may be particularly important for female athletes in this population. [ABSTRACT FROM AUTHOR]

The Mind, Exercise, Nutrition, Do It! 7–13 (MEND 7–13) program was adapted in 2016 by 5 Denver Health federally qualified health centers (DH FQHC) into MEND+, integrating clinician medical visits into the curriculum and tracking health measures within an electronic health record (EHR). We examined trajectories of body mass index (BMI, kg/m2) percentile, and systolic and diastolic blood pressures (SBP and DBP) among MEND+ attendees in an expanded age range of 4 to 17 years, and comparable nonattendees. Data from April 2015 to May 2018 were extracted from DH FQHC EHR for children eligible for MEND+ referral (BMI ≥85th percentile). The sample included 347 MEND+ attendees and 21,061 nonattendees. Mixed-effects models examined average rate of change for BMI percent of the 95th percentile (%BMIp95), SBP and DBP (mm Hg), after completion of the study period. Most children were ages 7 to 13 years, half were male, and most were Hispanic. An average of 4.2 MEND+ clinical sessions were attended. Before MEND+, %BMIp95 increased by 0.247 units/month among MEND+ attendees. After attending, %BMIp95 decreased by 0.087 units/month (P <.001). Eligible nonattendees had an increase of 0.084/month in %BMIp95. Before MEND+ attendance, SBP and DBP increased by 0.041 and 0.022/month, respectively. After MEND+ attendance, SBP and DBP decreased by 0.254/month (P <.001) and 0.114/month (P <.01), respectively. SBP and DBP increased by 0.033 and 0.032/month in eligible nonattendees, respectively. %BMIp95, SBP, and DBP significantly decreased among MEND+ attendees when implemented in community-based clinical practice settings at DH FQHC. [ABSTRACT FROM AUTHOR]

Background: Given the frequency, severity, and attention of traumatic brain injury in children, benchmarking disparities and injury characteristics for adolescent patients is pivotal in understanding and enhancing both clinical care and outcomes.Objectives: The purpose of this study was to investigate racial disparities on mechanism of injury, clinical outcomes, and social-health factors among adolescents treated in the emergency department (ED) for a head, neck, or brain injury.Methods: This study is the result of a retrospective chart review of head-, neck-, and brain-injured adolescent patients (n = 2857) treated at three community hospital EDs and one stand-alone ED. Outcome measures included patient demographics (gender, race/ethnicity, age), Glasgow Coma Scale score, hospital length of stay, intensive care unit length of stay, mechanism of injury, primary diagnosis, secondary diagnosis of a concussion, ventilation days, discharge disposition, and primary insurance.Results: There were racial differences in primary diagnosis, mechanism of injury, and insurance status. Results indicated that a higher proportion of white patients were diagnosed with a concussion compared with black patients (p < 0.001). Moreover, a higher proportion of white patients were seen in the ED for head, neck, or brain injury as a result of a sports or motor vehicle incident, whereas a leading mechanism among black patients was assault (p = 0.01). More white patients had private insurance, whereas more black patients had Medicaid (p < 0.001).Conclusion: The disparities in mechanisms for which black and white adolescent patients are seeking care at the ED for head, neck, or brain injury help to identify social-health risks of sustaining a head, neck, or brain injury. These racial disparities between black and white adolescents seen at the ED for head, neck, or brain injury suggest the need for further research to better understand the national representation of these disparities. [ABSTRACT FROM AUTHOR]

• This study provides quantitative differences in concussion knowledge between White and African American parents of high school athletes. • This highlights an evident disparity in concussion-health resources likely provided to parents or accessible to parents of different demographics. • Further, these racial differences underline community-level and 'place-based' concussion education and intervention inequities that warrant further exploration. Introduction: Concussion is a type of traumatic brain injury that can be sustained through participation in different sports. It is important that a parent be able to identify common and uncommon symptoms of a concussion to ensure the safety and good health of their child. The purpose of this study was to compare knowledge of concussion scores among White and African American parents and guardians. Methodology: This cross-sectional study consisted of a single survey of 53 questions that was given to parents/guardians of high school athletes at a preseason parent meeting. Parent and guardian knowledge of concussion was assessed through a series of 45 questions. Participants were asked to correctly identify signs and symptoms of concussion, answer questions regarding the anatomy of a concussion (i.e. a concussion is an injury to the brain), answer true/false questions about general concussion knowledge, select from a list the consequences of multiple concussions and select from a list the consequences of returning to play too soon from a concussion. Knowledge of concussion was calculated by summing correct responses for the 45 knowledge questions. Racial differences were calculated using an ANCOVA, controlling for socioeconomic school type. The statistical significance level was set a priori p ≤ 0.05 for all analyses. Results: Participants of this study consisted of 176 [115 (65.3%) White, 61 (34.7%) African American] parents/guardians of high school athletes. Significant differences in knowledge of concussion scores between White parents/guardians [38.50 ± 4.55 (85.6% correct)], and African American parents/guardians [35.15 ± 4.97, 78.1% correct)] were identified (F (1,172) = 4.82, p = 0.03). Conclusion: Knowledge of concussion disparities exist between African American and White parents/guardians. This disparity could cause complications from concussion to surface among children and adolescents participating in sport as their parents/guardians may not be able to correctly identify the signs and symptoms in order to seek proper medical care. Practical Application: Findings from this study highlight quantitative differences in concussion knowledge of parents from different demographics. These findings underline disparities and inequities in access to concussion-health resources that need to be addressed. [ABSTRACT FROM AUTHOR]

The article discusses some of the psychosocial aspects of sports rehabilitation. Topics covered include the negative impact of fear of re-injury on the rehabilitation process, effective communication skills in the athletic training setting as a key component to patient care, and the need for clinicians to focus on the injured individual rather than the physical injury.

Obesity and diabetes increase circulating levels of microbial components derived from the gut microbiota. Individual bacterial factors (i.e., postbiotics) can have opposing effects on blood glucose. We tested the net effect of gut bacterial extracts on blood glucose in mice using a microbiota-based vaccination strategy. Male and female mice had improved glucose and insulin tolerance five weeks after a single subcutaneous injection of a specific dose of a bacterial extract obtained from the luminal contents of the upper small intestine (SI), lower SI, or cecum. Injection of mice with intestinal extracts from germ-free mice revealed that bacteria were required for a microbiota-based vaccination to improve blood glucose control. Vaccination of Nod1 −/− , Nod2 −/− , and Ripk2 −/− mice showed that each of these innate immune proteins was required for bacterial extract injection to improve blood glucose control. A microbiota-based vaccination promoted an immunoglobulin-G (IgG) response directed against bacterial extract antigens, where subcutaneous injection of mice with the luminal contents of the lower SI elicited a bacterial extract-specific IgG response that is compartmentalized to the lower SI of vaccinated mice. A microbiota-based vaccination was associated with an altered microbiota composition in the lower SI and colon of mice. Lean mice only required a single injection of small intestinal-derived bacterial extract, but high fat diet (HFD)-fed, obese mice required prime-boost bacterial extract injections for improvements in blood glucose control. Subversion of the gut barrier by vaccination with a microbiota-based extract engages innate immunity to promote long-lasting improvements in blood glucose control in a dose-dependent manner. [Display omitted] • Subcutaneous injection of gut bacterial extracts improved blood glucose control in mice. • Microbiota-based vaccination engaged NOD1-NOD2-RIPK2 to alter blood glucose. • Microbiota-based vaccination promoted a proximal gut IgG response. • Microbiota-based vaccination altered the composition of the gut microbiome. • Obese mice required prime-boost injections to improve blood glucose control. [ABSTRACT FROM AUTHOR]

Objective: To determine if racial/ethnic differences exist in the diagnosis and mechanism of injury among children and adolescents visiting the emergency department (ED) for concussion and minor head trauma (MHT).Study Design: A retrospective, cross-sectional study of patient (age ≤19 years) visits to the ED for concussion between 2010-2015, using the National Hospital Ambulatory Medical Care Survey, was completed. The primary study exposure was race/ethnicity. Outcome measures included ED visits that resulted in a concussion/MHT diagnosis and mechanism of injury. Mechanism categories included sport, motor vehicle collision, fall, assault, and other mechanism. A multivariable logistic regression and multinomial logistic regression were conducted to assess relationships between race/ethnicity and outcomes. Findings were weighted to reflect population estimates.Results: In total, 1263 child/adolescent visits for concussion/MHT were identified, representing an estimated 6.6 million child/adolescent visits nationwide. Compared with non-Hispanic White pediatric patients, non-Hispanic Black patients were least likely to have an ED visit for a concussion/MHT (P < .001; OR, 0.66; 95% CI, 0.52-0.83) The odds of non-Hispanic Black children/adolescents (OR, 3.80; 95% CI, 1.68-8.55) and children/adolescents of other race/ethnicity (OR, 4.93; 95% CI, 1.09-22.23) sustaining a concussion/MHT resulting from assault vs sport was higher.Conclusions: Amid the emerging focus on sport-related concussion, these ethnic/racial differences in ED diagnosis of concussion/MHT demonstrate sociodemographic differences that warrant further attention. Assault may be a more common mechanism of concussion among children/adolescents of a racial minority. [ABSTRACT FROM AUTHOR]

• From 2010 to 2018, over 7 million visits to Emergency Departments (EDs) were due to concussion. • The vast majority of concussions diagnosed in EDs were not sport-related. • Most concussions were diagnosed in the South, followed by West, Midwest, and Northeast. • The Midwest and Northeast regions of the US had lower odds of concussion diagnoses in EDs. • Geographic region and mechanism of injury patterns inform future concussion efforts. Background : Concussion is a type of traumatic brain injury (TBI) that can be sustained through sport-related and non-sport-related (e.g., motor vehicle accidents, falls, assaults) mechanisms of injury (MOI). Variations in concussion incidence and MOI may be present throughout the four geographic regions (Midwest, Northeast, South, West) of the United States. However, there is limited evidence exploring concussion cause and diagnosis patterns based on geographic region and MOI. These factors have implications for better understanding the burden of concussion and necessary efforts that can translate to the mitigation of safety concerns. Purpose: The purpose of this study was to identify patterns of sport-related concussion (SRC) and non-sport-related concussion (NSRC) across the four geographic regions of the United States. Methods: A descriptive epidemiology study of patient visits to the emergency department (ED) for concussion between 2010 and 2018, using publicly available data from the National Hospital Ambulatory Medical Care Survey (NHAMCS) was conducted. The exposure of interest was geographic region while the main outcome measures were concussion diagnosis and MOI. Descriptive statistics were calculated using population-weighted frequencies and percentages. The association between geographic region and MOI (SRC vs. NSRC) was analyzed using logistic regression models. Odds ratios (OR) presented with 95% confidence intervals (CI) were included. Univariate analyses were conducted followed by multivariable analyses adjusting for sex, age, race/ethnicity, and primary source of payment. Statistical significance was set a priori at p < 0.05 for all analyses. Results: From 2010 to 2018, 1,161 visits resulted in a concussion diagnosis, representing an estimated 7,111,856 visits nationwide. A greater proportion of concussion diagnoses occurred within EDs in the South (38.2%) followed by the West (25.8%), Midwest (21.4%), and Northeast (14.6%). Compared to the West region, patients visiting the ED in the Midwest (OR = 0.75, 95% CI = 0.57–0.98) and Northeast (OR = 0.71, 95% CI = 0.51–0.98) had a lower odds of being diagnosed with a concussion. More patients sustained a NSRC MOI (94.3%) compared to SRC MOI (5.7%). For both mechanisms, the South region had the highest population-weighted frequency of SRC (n = 219,994) and NSRC diagnoses (n = 2,495,753). Univariate and multivariable logistic regression analyses did not reveal statistically significant associations for geographic region and MOI (p > 0.05). Conclusion: Our findings showed that the Midwest and Northeast regions had a lower odds of concussion diagnoses in EDs. Overall, the vast majority of concussions were not sport-related, which has public health implications. These findings improve our understanding of how concussion injuries are being sustained geographically nationwide and help to explain care-seeking patterns for concussion in the ED setting. [ABSTRACT FROM AUTHOR]

Background: Women with at least 1 prior occurrence of premature birth often have demographic and medical risk factors that are not modifiable. However, smoking cessation could be a targeted intervention in which a woman with a history of premature birth may be able to reduce her future risk of recurrence.Objective: This study aims to assess how trimester-specific smoking patterns influence the risk of recurrent premature birth.Study Design: This was a population-based retrospective cohort study of singleton nonanomalous live births in Ohio, 2006-2012 using vital statistics birth records. This analysis was limited to women with at least 1 prior premature birth. Rates of birth <37 weeks were compared among nonsmokers, women who smoked in the 3 months prior to pregnancy and quit in the first vs quit in the second vs quit in the third trimester. Multivariate logistic regression analyses assessed the association between smoking cessation at various time points in pregnancy and recurrent premature birth while adjusting for maternal race, education, Medicaid enrollment, and marital status.Results: We analyzed the outcomes of 36,432 women with a prior premature birth who subsequently delivered at 20-42 weeks. One third of women with a prior premature birth smoked during pregnancy. Of smokers, 16% quit early in the first trimester, 7% quit in the second, 5% quit in the third trimester, and 72% smoked throughout pregnancy. The rate of recurrent premature birth in nonsmokers was high 28% in this cohort. Smoking in pregnancy with cessation in the first or second trimester was not significantly associated with an increase in recurrent premature birth rates (first trimester, 29% adjusted odds ratio, 0.97 [95% confidence interval, 0.9-1.1], and second trimester, 31% adjusted odds ratio, 1.10 [95% confidence interval, 0.9-1.3], respectively). However, quitting late in pregnancy (third trimester) was associated with a high rate (43%) of delivery <37 weeks, adjusted odds ratio, 1.81 (95% confidence interval, 1.48-2.21). Continued smoking throughout pregnancy was also associated with an increased recurrent premature birth (32%), adjusted odds ratio, 1.14 (95% confidence interval, 1.07-1.22), despite adjustment for concomitant premature birth risk factors.Conclusion: Smoking cessation in pregnancy and its relationship to preterm birth has been studied extensively, and it is widely accepted that smoking in pregnancy increases preterm birth rates. However, this study provides novel information quantifying the risk of recurrent preterm birth and stratifies the increased risk of recurrent preterm birth by trimester-specific smoking behavior. Although women with even 1 prior premature birth are at an inherently high risk of recurrence, women who stopped smoking early in the first 2 trimesters experienced similar preterm birth rates compared with nonsmokers. However, delayed smoking cessation or smoking throughout pregnancy significantly increased recurrent premature birth risk. Smoking cessation is a potential modifiable risk factor for recurrent preterm birth in high-risk pregnancies. This study highlights the importance of early pregnancy smoking cessation in those at especially high risk, women with a prior preterm birth. [ABSTRACT FROM AUTHOR]