搜索结果：International journal of sports medicine

The 2023 iteration of the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) estimated prevalence, incidence, and health burden for 375 diseases and injuries, including 12 mental disorders. We assess past, current, and emerging trends in the prevalence and burden of mental disorders across sexes and age groups, for 21 regions, 204 countries and territories, and by Socio-demographic Index (SDI) quintile, from 1990 to 2023. Mental disorders included in GBD 2023 were anxiety disorders, major depressive disorder, dysthymia, bipolar disorder, schizophrenia, autism spectrum disorders, conduct disorder, attention-deficit hyperactivity disorder, anorexia nervosa, bulimia nervosa, idiopathic developmental intellectual disability, and a residual category of other mental disorders. A literature review identified epidemiological data for each disorder. These were analysed via a Bayesian meta-regression to estimate prevalence by disorder, sex, age, location, and year. Disorder-specific prevalence was multiplied by disability weights representing the severity of health loss associated with each disorder to estimate years lived with disability (YLDs). Deaths due to anorexia nervosa were assessed with a Cause of Death Ensemble modelling strategy to estimate deaths by sex, age, location, and year, and then multiplied by the standard life expectancy at age of death to estimate years of life lost (YLLs). YLDs equalled disability-adjusted life-years (DALYs) for all mental disorders except anorexia nervosa (the only mental disorder considered as an underlying cause of death in GBD), for which DALYs represented the sum of YLDs and YLLs. We presented prevalence, deaths, YLDs, YLLs, and DALYs as counts, age-specific rates per 100 000 population, and age-standardised rates per 100 000 population. We estimated 1·17 billion (95% uncertainty interval 1·06-1·31) prevalent cases of mental disorders globally in 2023, equivalent to an age-standardised prevalence rate of 14 210·7 cases (12 849·5-15 940·1) per 100 000 population. These estimates represented a 95·5% (75·0-121·2) increase in prevalent cases and 24·2% (11·4-41·4) increase in age-standardised prevalence rate between 1990 and 2023. All mental disorders showed increases in prevalent cases between 1990 and 2023, while notable increases were seen in age-standardised prevalence rates for anxiety disorders, major depressive disorder, dysthymia, anorexia nervosa, bulimia nervosa, schizophrenia, and conduct disorder. There were an estimated 171 million (127-228) DALYs due to mental disorders globally across sex and age in 2023, equivalent to an age-standardised DALY rate of 2070·5 DALYs (1519·1-2750·5) per 100 000 population. Mental disorders contributed to 6·1% (4·8-7·6) of all-cause DALYs in 2023, making them the fifth leading cause of global DALYs (up from 12th in 1990). DALYs were almost entirely composed of YLDs. Mental disorders were the leading cause of YLDs in 2023 (up from second in 1990), explaining 17·3% (14·8-20·6) of all-cause global YLDs. Leading causes of mental disorder DALYs were anxiety disorders (ranked 11th among the 304 diseases and injuries at Level 4 of the GBD cause hierarchy), major depressive disorder (15th), and schizophrenia (41st). Globally in 2023, mental disorder age-standardised DALY rates were higher among females (2239·6 [1643·7-3014·1] per 100 000) than among males (1900·2 [1399·8-2510·8] per 100 000), and peaked in the 15-19 years age group (2617·3 [1850·6-3696·8] per 100 000). All locations showed increased mental disorder DALY rates in 2023 compared with 1990, ranging across countries and territories from 1302·4 (952·7-1683·7) per 100 000 in Viet Nam to 3555·8 (2661·9-4715·0) per 100 000 in the Netherlands. Across SDI quintiles, DALY rates ranged from 1853·0 (1352·1-2469·3) per 100 000 for middle SDI to 2184·1 (1606·1-2890·3) per 100 000 for high SDI. A significant health burden was imposed by mental disorders in all countries and territories in 2023, irrespective of the health resources available. In some instances, this burden has increased over time and is unevenly distributed across populations. Stronger surveillance systems, particularly in low-income and middle-income countries, are required. Additionally, we need more coordinated and inclusive policies to reduce the burden through early treatment and prevention, tailored to sex and age differences across locations. Responding to the mental health needs of our global population, especially those most vulnerable, is an obligation, not a choice. Gates Foundation, Queensland Health, and University of Queensland.

The aim of this study was to analyze, among lean adolescents, the changes in lipids associated with sports participation and the role of time spent in vigorous sports participation. Lean adolescents of both sexes were followed for 12 months (121 boys and 51 girls [aged 11-17 y]). Lipids were the dependent variables (total cholesterol, low density lipoprotein-cholesterol, high density lipoprotein-cholesterol, triacylglycerol and the atherogenic index of plasma). Adolescents were divided according to sports participation (engaged and not engaged), with sports participation intensity assessed by heart rate during sports. Multivariate models were adjusted by ethnicity, biological maturation, body fat, lean soft tissue, insulin resistance, and inflammation. The atherogenic index of plasma changed in favor of boys (engaged: -0.021 [95% confidence interval: -0.060 to 0.019] versus not engaged: 0.117 [95% confidence interval: 0.028 to 0.207]) and girls engaged in sports (engaged: -0.062 [95% confidence interval: -0.102 to -0.022] versus not engaged: 0.098 [95% confidence interval: -0.018 to 0.214]). The main determinants of changes in the atherogenic index of plasma among boys were changes in lean soft tissue (r=-0.415 and p=0.050) and vigorous physical activity among girls (r=-0.291 and p=0.012). In summary, sports participation was associated with improvements in lipid profile among lean adolescents.

Developmental delay affects daily living, social functioning, and mental health. Maternal cardiovascular health (CVH) during pregnancy may indicate an adverse intrauterine environment, but its association with developmental delay is unclear. To examine the association between maternal CVH during pregnancy and developmental delay in offspring at 4 years of age. This cohort study enrolled patients between July 19, 2013, and March 31, 2017, with 5 years of follow-up, at obstetric hospitals and clinics in Miyagi Prefecture, Japan. Participants included eligible mother and offspring pairs enrolled in the Tohoku Medical Megabank Project Birth and Three-Generation Cohort Study. Offspring were followed up until age 4 years. Data analyses were conducted from November 12, 2024, to March 24, 2026. Maternal CVH during pregnancy, which was assessed using Life's Essential 8 metrics (diet, physical activity, nicotine exposure, sleep health, body mass index, blood lipids, blood glucose, and blood pressure). Each metric was scored on a scale of 0 (least favorable) to 100 (most favorable), and these scores were used to categorize mothers as having high (80-100), moderate (50-79), or low (0-49) CVH. Developmental delay at age 4 years, which was evaluated by the mother using the validated Japanese version of Ages and Stages Questionnaire, Third Edition. This instrument has 5 domains: communication, gross motor, fine motor, problem solving, and personal-social skills. Domain-specific delay was defined as 2 or more SDs below the mean score, and developmental delay in total was defined as delay in 1 or more of the 5 domains. Among 19 160 eligible mother and offspring pairs, 8238 (43.0%) were analyzed. Offspring were assessed at a mean (SD) age of 4.1 (0.2) years and included 4299 males (52.2%). Among mothers with high, moderate, and low CVH, 154 (8.8%), 763 (12.1%), and 33 (16.8%), respectively, had offspring with developmental delay in total. Compared with high CVH, moderate (risk ratio [RR], 1.30; 95% CI, 1.09-1.54) and low (RR, 1.62; 95% CI, 1.11-2.36) CVH during pregnancy were associated with developmental delay in total. Low CVH was associated with higher prevalence of developmental delay across all 5 domains, with personal-social domain having the largest effect size (RR, 2.23; 95% CI, 1.23-4.07; P for trend = .002) and communication domain having the smallest effect size (RR, 1.40; 95% CI, 0.69-2.85; P for trend = .03). In this cohort study of mother and offspring pairs in Japan, better maternal CVH during pregnancy was associated with a lower risk of offspring developmental delay at age 4 years.

The rates of hip arthroscopy are increasing worldwide for femoroacetabular impingement syndrome (FAIS). There is a lack of literature examining outcomes of modern nonoperative treatment of patients with FAIS. To develop and assess the effectiveness of a pelvic tilt-focused exercise program for nonoperative management for patients with FAIS. Cohort study; Level of evidence, 2. Eligible patients included those aged 16 to 55 years who met radiographic and clinical criteria for FAIS. Enrolled patients participated in a 10-minute standardized pelvic tilt-focused home exercise program (HipFit10) at least 4 times per week over 6 months. Self-reported adherence was tracked weekly. Patient-reported outcomes were collected at baseline and 3 and 6 months. The International Hip Outcome Tool-33 (iHOT-33) score was measured at baseline and 3 and 6 months, with the primary outcome being the iHOT-33 change score between baseline and 6 months. Secondary outcomes included the Hip Outcome Score-Activities of Daily Living (HOS-ADL), pain visual analog scale (pain VAS) score, crossover to surgical management, and complications. A total of 214 patients were enrolled between August 2020 and October 2021. The mean age was 34.2 &#xb1; 10.2 years, and 121 (57%) patients were female. Within the study period, 19 of 214 (9%) patients dropped out or were lost to follow-up. By 6 months, 153 of 195 (78%) patients completed the intervention and elected to avoid surgery, and 42 of 195 (22%) patients signed up for or underwent surgery. The final iHOT-33 score was completed by 192 of 195 (98%) participants with mean improvement from baseline to 6 months of 11.7 (95% CI, 9.2 to 14.1; P < .001). By 6 months, 103 of 192 (54%) participants achieved the iHOT-33 minimal clinically important difference of 6.8. Significant improvements also were seen in the iHOT-33 score from baseline to 3 months (mean difference [MD], 7.6; 95% CI, 5.7 to 9.6) and from 3 months to 6 months (MD, 3.7; 95% CI, 1.8 to 5.6), as well as in the HOS-ADL (0-3 months: MD, 2.65; 95% CI, 0.8 to 4.4) and pain VAS score (0-3 months: MD, -7.7 [95% CI, -4.8 to -10.5]; 3-6 months: MD, -3.5 [95% CI, -0.6 to -6.3]). No adverse events were reported. In this study of patients with FAIS, pelvic tilt-focused physical therapy was utilized to improve patient function with 78% avoiding surgery. These results suggest the HipFit10 program is a safe and effective nonoperative option for patients with FAIS.

The Anterior Cruciate Ligament Injury Severity Scale (ACLISS) was developed to classify the magnitude of damage to knee structures beyond the anterior cruciate ligament (ACL) (meniscus, cartilage, collateral ligaments, etc) at the time of ACL rupture. However, its validity in predicting clinical outcomes after ACL reconstruction (ACLR) has never been assessed. To determine whether ACLISS correlates with reoperation and patient-reported functional outcomes after ACLR. Cohort study; Level of evidence, 3. The records of all patients who underwent primary ACLR at a single institution between 2019 and 2022 with minimum follow-up of 2 years were reviewed. Patients were excluded if they had concomitant collateral ligament or posterior cruciate ligament repair/reconstruction or prior ipsilateral ACLR. ACLISS scores (0-12) and grades (grade 1: scores 0-3; grade 2: scores 4-7; grade 3: scores 8-12) were determined using preoperative magnetic resonance imaging and intraoperative arthroscopic findings based on the original published technique. The primary outcome was reoperation after ACLR. Secondary outcomes included International Knee Documentation Committee (IKDC) subjective scores and Marx activity scores. Bivariable and multivariable logistic regression analyses were performed to identify predictors of reoperation. Cox proportional hazards modeling and Kaplan-Meier survival analysis were used to evaluate time to reoperation. Statistical significance was defined as a P value <.05. A total of 324 patients met the inclusion criteria. The mean age was 29.3 &#xb1; 13.6 years, and 50.9% of the patients were male. The mean follow-up was 5.1 &#xb1; 0.8 years. Of the patients, 177 (54.6%) were classified as ACLISS grade 1 damage, with a mean score of 2.3 &#xb1; 0.9; 141 (43.5%) as grade 2, with mean score of 4.8 &#xb1; 0.9, and 6 (1.9%) as grade 3, with mean score of 8.2 &#xb1; 0.4. Overall, 87 (26.9%) patients required medial meniscus repair, and 82 (25.3%) patients required lateral meniscus repair. The overall ACL revision rate was 4.0%. A total of 34 (10.5%) patients had reoperation for any reason. The mean IKDC score was 84.4 &#xb1; 14.2, and the mean Marx score was 8.6 &#xb1; 5.4. There was no significant association between ACLISS grade and reoperation rate (grade 1: 10.2%; grades 2 and 3: 10.9%; P = .832). In multivariable analysis, hybrid autograft with allograft augmentation was significantly associated with increased reoperation risk (OR, 7.68; 95% CI, 1.82-32.4; P = .006). Survival analysis revealed that patients with grades 2 and 3 experienced earlier reoperations, with 69% occurring between 5 and 15 months compared to 22% for grade 1 (P = .0086). IKDC and Marx scores did not differ significantly by ACLISS score. While ACLISS grade does not predict overall reoperation rates or functional outcomes when concomitant injuries are appropriately managed, patients with higher grades experienced earlier reoperation.

As survival improves globally, the central public health challenge increasingly shifts from extending life to extending healthy lifespan. The compression of morbidity hypothesis proposes that effective prevention and care will delay disability more than death, reducing the morbidity gap-ie, the duration or proportion of life spent in poor health. We aimed to comprehensively estimate changes in the morbidity gap globally, regionally, and nationally from 1990 to 2023, by sociodemographic development levels and sex, and analysed leading diseases and injuries and their underlying risk factors contributing to years lived in poor health. Using Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2023 estimates of life expectancy and healthy life expectancy (HALE) at birth for 204 countries and territories from 1990 to 2023, we calculated the morbidity gap as life expectancy minus HALE, and the proportional morbidity gap as this difference divided by life expectancy. Results are presented globally, by GBD super-region and country, Socio-demographic Index (SDI) quintile, and sex. We decomposed the morbidity gap into cause-specific and risk-specific contributions, assigning to each cause group its proportional share of years lived with disability (YLD), adjusted for comorbidity to avoid double counting disability for co-occurring conditions. We report mean estimates and 95% uncertainty intervals (UIs) derived from 250 or more draws from posterior distributions. From 1990 to 2023, the global morbidity gap increased from 8&#xb7;8 years (95% UI 6&#xb7;7-11&#xb7;2) to 10&#xb7;7 (8&#xb7;2-13&#xb7;7), an increase of 1&#xb7;9 years (1&#xb7;3-2&#xb7;6), or 21&#xb7;9% (16&#xb7;0-27&#xb7;9), with point estimates suggesting widening morbidity gaps in 203 of 204 countries and territories. Globally in 2023, an average of 14&#xb7;5% of life was spent in poor health, compared to 13&#xb7;6% in 1990. From 1990 to 2023, across locations, age-specific morbidity gaps widened across the adult life course, rather than concentrating in the final years of life. In 2023, morbidity gaps were largest in the high SDI quintile and smallest in the low SDI quintile. Countries with longer life expectancies had larger morbidity gaps and both had a positive relationship with SDI; however, the relationship between life expectancy and the proportional morbidity gap was less clear. A small number of chronic, largely non-fatal causes were the primary contributors to the morbidity gap, with musculoskeletal disorders (especially low back pain), mental disorders (depressive and anxiety disorders), sense organ diseases (age-related hearing loss), unintentional injuries (falls), and other non-communicable diseases together accounting for 57&#xb7;4% of unhealthy years in 2023, globally. High fasting plasma glucose, high body-mass index, and child and maternal malnutrition were the leading risk factors contributing to the global morbidity gap. The expansion of the morbidity gap across nearly all locations indicates that improvements in survival have consistently outpaced reductions in non-fatal health loss across geographies, SDI levels, and sexes, with most populations now spending a decade or more of life in poor health across the lifespan. Progress towards healthy ageing should therefore be assessed not only by reduced mortality, but also by declines in years lived in poor health, with emphasis placed on extending healthspan. The Gates Foundation.

Approximately 40% of women stop endocrine therapy for hormone-receptor-positive breast cancer within the first 5 years of prescribed treatment because of side effects. Musculoskeletal complaints are among the most frequently reported side effects. The Cancer Of the BReast Asanas (COBRA) study examines the effect of an 18-week yoga programme on endocrine therapy-associated musculoskeletal complaints in women with breast cancer. In total, 140&#x2009;women will be randomised in a 1:1 ratio to the intervention or waitlist control group. The intervention programme consists of two times a week 1-hour supervised Hatha or (easy) Vinyasa yoga classes at a yoga or sports centre for 18&#x2009;weeks and once per week a half-hour at home using videos. The waitlist control group is asked to maintain their habitual lifestyle during the first 18&#x2009;weeks and will participate in a similar yoga programme to the intervention group for the following 18&#x2009;weeks. The control group yoga programme is offered live-remote. The primary outcome (musculoskeletal complaints) is assessed with the Brief Pain Inventory questionnaire at baseline and 18&#x2009;weeks (primary comparison) and additionally at 36&#x2009;weeks. Secondary outcomes include lower and upper extremity joint complaints, menopausal symptoms, fatigue, sleep, quality of life, anxiety and depression, cognitive complaints and habitual physical activity (all patient-reported), vital signs and anthropometrics, physical fitness, blood biomarkers, medication use, safety data and patient and teacher experiences. At baseline and 18&#x2009;weeks, cognitive complaints are also assessed with an online neuropsychological test battery. The COBRA study was approved by the Medical Ethical Committee of the University Medical Center Utrecht. The study started on 8 October 2024, and 65 participants have been included (20 January 2026). Results will be submitted to an international peer-reviewed journal. NCT06480513.

The aim of this study was to achieve consensus on important topics related to tenosynovial giant cell tumour (TGCT) and giant cell tumour of bone (GCTB), and to identify areas for future research. In January 2026, a consensus meeting, The Birmingham Orthopaedic Oncology Meeting (BOOM), held in Cape Town, South Africa, gathered 314 delegates from 59 countries to debate 21 consensus statements on tenosynovial giant cell tumour (TGCT) and giant cell tumour of bone (GCTB) through a modified Delphi process. Of the 21 statements, two achieved unanimous consensus, 18 strong consensus, and one moderate consensus. Unanimous consensus was reached for prioritizing joint-preserving intralesional curettage in GCTB when feasible, and for supporting non-surgical approaches in anatomically challenging cases, particularly sacral lesions. The statement addressing the role of denosumab in GCTB achieved only moderate consensus. The use of adjuvants in GCTB, as well as the management of recurrent and systemic GCTB, including long-term use of denosumab, reached strong consensus. Strong consensus was achieved in the surgical and non-surgical management for both primary and recurrent TGCT. Surveillance strategies for both TGCT and GCTB generated substantial discussion despite strong consensus, reflecting ongoing uncertainty and lack in evidence. This international consensus provides practical guidance for the management of TGCT and GCTB while identifying important gaps in evidence. Joint-preserving surgery remains central to the treatment of GCTB, with selective integration of systemic therapies and individualized surveillance. The consensus framework highlights priorities for future collaborative research in orthopaedic oncology.

Participation is a key rehabilitation outcome. However, there is limited evidence on the measurement properties of patient-reported outcome measures (PROMs) that assess participation in rehabilitation settings. Therefore, this study evaluated the test-retest reliability and responsiveness of two widely used PROMs: the Utrecht Scale for Evaluation of Rehabilitation - Participation (USER-P) Restriction subscale and the Patient-Reported Outcomes Measurement Information System Ability to Participate in Social Roles and Activities 4-item short form (PROMIS-APS-SF) in inpatient and outpatient settings. In this multicentre prospective cohort study, inpatients and outpatients completed PROMs at the start of rehabilitation (T0), after six months (T1), and two weeks thereafter (T2). Test-retest reliability (T1-T2) was evaluated using intraclass correlation coefficients (ICCs), Bland-Altman plots, and the smallest detectable change (SDC). Responsiveness (T0-T1) was examined using effect sizes, area under the curve (AUC), and the minimal important change (MIC) based on the Global Rating of Change scale. A total of 553 patients completed PROMs at T0-T1, of whom 168 also completed them at T2. Scores on both PROMs demonstrated sufficient test-retest reliability (ICC&#x2009;>&#x2009;0.70) across both rehabilitation settings. Moderate to large effect sizes were found, except for the PROMIS-APS-SF scores in inpatients, which showed a small effect size. The USER-P Restriction scores achieved sufficient AUC values for inpatients (0.71) and outpatients (0.72). At group level, MIC values exceeded the SDC for both PROMs, but only few did at individual level. Scores on both PROMs appeared appropriate for evaluating participation outcomes at group level within rehabilitation settings, with the USER-P Restriction scores showing better responsiveness among inpatients. However, the use of these scores for evaluating individual participation goals seems limited. Participation is often an important goal in rehabilitation for patients, but there is limited evidence how well different patient-reported outcome measures (PROMs) capture changes in participation during inpatient and outpatient treatment. This study used two commonly participation PROMs in rehabilitation: the USER-P Restriction subscale and the PROMIS-APS short form. Researchers examined whether the PROMs were consistent in stable participants (test-retest reliability), and whether they could detect meaningful changes in participation over time (responsiveness). In rehabilitation patients, scores on both PROMs showed sufficient reliability and adequate responsiveness across inpatient and outpatient settings. Changes in USER-P Restriction scores were larger among inpatients, likely reflecting changes in activity-based participation, while changes in PROMIS-APS-SF scores were lower, possibly capturing changes in broader social participation. At group level, meaningful change could be reliably detected, but at individual level, measurement error was too high to reliably detect these changes in individual patients. Overall, these findings suggest that both PROMs are suitable for evaluating participation outcomes in rehabilitation settings on group level and that the choice of PROM should match the specific aspect of participation that needs to be measured and evaluated.

Breast cancer survivors frequently experience adverse changes in body composition, cardiometabolic biomarkers, functional capacity and quality of life that may worsen long-term prognosis, yet the comparative effectiveness of lifestyle interventions across delivery formats and supervision levels remains unclear. Background/Objectives: This systematic review assessed the effects of structured diet and exercise interventions on body composition, metabolic and inflammatory biomarkers, functional capacity, dietary habits and quality of life in breast cancer survivors. Methods: Following PRISMA guidelines, Cochrane, PubMed, Scopus and Web of Science were searched for randomized controlled trials and quasi-experimental studies published in English between 2016 and 2026. Risk of bias was assessed with RoB 2 and ROBINS-I and certainty of evidence with GRADE. Results: Of 1413 records, 15 studies (11 RCTs; mean age 46-60 years; mostly overweight or obese post-treatment women) met the inclusion criteria; twelve interventions were supervised and three home-based or web-based. Within the assessed domains, many studies reported significant improvements in body composition, quality of life and metabolic or inflammatory biomarkers. Effects were larger in multimodal supervised programs combining caloric restriction with moderate-to-vigorous aerobic plus resistance training (5-8% weight loss; 19-29% visceral fat reduction; improved insulin, IGF-1, leptin, adiponectin and EORTC QLQ-C30 scores), whereas digital or low-intensity interventions produced smaller, less uniform objective effects despite improving dietary behaviors. GRADE certainty ranged from very low to moderate-high. Conclusions: Multimodal supervised programs offer the most robust benefits; digital formats require additional supervision. Standardized protocols and longer follow-up are needed.

Adherence to physical activity (PA) during hospitalization remains low in patients with oral cancer, despite the benefits of early mobilization emphasized in oncological rehabilitation protocols. Insight into how patients perceive PA in the immediate postoperative period is crucial for designing effective, patient-centered interventions. This qualitative study explored patients' experiences of PA during hospitalization following oral cancer surgery. A qualitative study was conducted using semistructured interviews guided by the behavior change wheel (BCW) framework. Dutch-speaking patients treated for oral cancer at the oral and maxillofacial department of University Hospitals Leuven (Belgium) and head and neck surgical oncology department of University Medical Center Utrecht (The Netherlands) were purposively sampled. Interviews were conducted at discharge, transcribed verbatim, and thematically analyzed in NVivo (QSR International, version 12, Burlington, MA, USA). Fifteen patients were included until saturation occurred. Seven overarching themes were identified: (A) barriers to PA, (B) activities of daily living (ADL), (C) support, (D) emotional state, (E) perceptions of PA, (F) PA patterns, and (G) recovery expectations. Walking was the most common activity, but participation was restricted by fatigue, medical devices, and a predominantly passive hospital culture. PA was strongly linked to regaining autonomy, coping with confinement, and preparing for discharge. Despite substantial barriers, patients with oral cancer demonstrate intrinsic motivation to remain active. However, this motivation often remains unmet due to insufficient personalized support and limited integration of PA into routine care. Perioperative physiotherapeutic interventions may help to overcome barriers and promote sustainable engagement in recovery-oriented activity.

The Australian Institute of Sport Sports Supplement Program, launched in 2000, promotes evidence-based, safe, and legal supplement use in Australian high-performance sports. It has evolved into a comprehensive framework in response to regulatory changes, rapid growth in supplement products, and widespread access to both information and misinformation. Founded on a "food first" philosophy, it recognises circumstances where supplements may offer unique advantages, including addressing nutrient deficiencies, providing support pre-, during and post-exercise, and supporting performance. Its principles were shaped to counter fragmented regulation, aggressive marketing, and athletes' reliance on non-expert information sources. Central to the framework is a dynamic ABCD classification system, categorising supplements according to the strength of scientific evidence for their effectiveness, safety, and anti-doping risk. Key initiatives include web-based education resources, strategic supplement provision, applied research, and robust governance-especially batch testing and integrity processes-to reduce anti-doping rule violations. The framework now serves as a benchmark for national and international sporting bodies and has driven a cultural shift that places sports dietitians at the forefront of supplement guidance and enhances collaboration across performance support and medicine staff. Future priorities include deeper digital integration, adequate resourcing to remain contemporary, and broader athlete and stakeholder engagement to maintain rigorous, evidence-informed standards.

Major sporting tournaments (MSTs) are complex mass-gathering events that place demands on local medical services. Although single-sport (SS-MSTs) and multi-sport tournaments (MS-MSTs) share core planning principles, differences in event structure may influence medical service utilization. This study compared on-site medical utilization, and hospital transport rates across SS-MSTs and MS-MSTs, emphasizing evidence-based insights to guide scalable and effective medical staffing. A prospective analysis was performed using daily reported medical data from four MSTs: UEFA EURO 2012, EHF EURO 2016 (SS-MSTs), The World Games 2017 and the European Games 2023 (MS-MSTs). Patient presentations (PPs), transports to hospital (TTHs), and medical-event-to-transport-to-hospital rates (METH) were analyzed. PP-rates (PPRs) and TTH-rates (TTHRs) were calculated per 10,000 attendees. Comparisons were conducted between tournaments and tournament types. Across 2,188,497 spectators, 1,539 PPs and 135 TTHs were recorded. Spectator PPRs were higher at SS-MSTs than at MS-MSTs (5.71 vs. 3.97), while TTHRs (0.42 vs. 0.48) and METH (6.09 vs. 10.08) were similar. Fewer than 10% of on-site presentations required hospital transport. SS-MSTs exhibited higher spectator medical demand per event, whereas MS-MSTs showed more distributed demand across multiple venues. This comparative, multi-event analysis provides evidence-based insights to inform scalable and effective medical staffing at major sporting tournaments. The findings demonstrate higher per-event utillization at SS-MSTs and distributed service requirements at MS-MSTs, offering practical guidance for optimizing resource allocation and medical planning strategies.

This study described the epidemiology of elbow medial ulnar collateral ligament injuries in collegiate baseball players between the 2014 to 2015 and 2018 to 2019 academic years using National Collegiate Athletic Association Injury Surveillance Program data. Injury rate ratios and descriptive statistics were used to characterize the epidemiology of these injuries. The overall medial ulnar collateral ligament injury rate in National Collegiate Athletic Association baseball players between 2015 and 2019 was 0.95/10,000 athletic exposures. Medial ulnar collateral ligament injury rates rose annually from 2015 to 2019. The medial ulnar collateral ligament injury rate was statistically significantly higher in competition (1.36/10,000 athletic exposures) than practice (0.61/10,000 athletic exposures; injury rate ratio: 2.22; confidence interval: 1.27-3.88). Pitchers accounted for 83.3% of injured players. Forty-three percent of medial ulnar collateral ligament injuries required athletes to miss the remainder of the season, and 18.5% of medial ulnar collateral ligament injuries required surgical intervention. In conclusion, the rate of medial ulnar collateral ligament injuries in collegiate baseball players increased steadily each year from 2015 to 2019. Medial ulnar collateral ligament injuries occur at a significantly higher rate during competition compared to practice, and pitchers account for the greatest number of medial ulnar collateral ligament injuries among college baseball players.

Workers' compensation (WC) patients often experience inferior outcomes compared with non-workers' compensation (non-WC) patients after orthopaedic procedures. Long-term outcomes for contemporary hip arthroscopy in this group remain unclear. To compare patient-reported outcomes (PROs), achievement of clinically significant outcomes, and reoperation-free survival between WC and non-WC patients undergoing hip arthroscopy for labral tear/femoroacetabular impingement syndrome at a minimum 10-year follow-up. Cohort study; Level of evidence, 3. Patients who underwent hip arthroscopy between January 2012 and February 2015 with &#x2265;10-year follow-up were included. WC patients were propensity-score matched with non-WC patients on age, sex, and body mass index. PROs were assessed preoperatively and at 2-, 5-, and 10-year postoperatively, including Hip Outcome Score-Activities of Daily Living (HOS-ADL), Hip Outcome Score-Sport-specific (HOS-SS), Modified Harris Hip Score (mHHS), 12-item International Hip Outcome Tool (iHOT-12), and visual analog scale (VAS) for pain and satisfaction. Achievement of minimal clinically important difference (MCID), patient acceptable symptom state (PASS), and reoperation rates were compared. A total of 37 WC hips were matched with 108 non-WC hips. Both cohorts demonstrated significant improvements in all PROs from baseline (P < .001). Preoperatively, WC patients had lower HOS-ADL (46.9 vs 63.5; P < .001) and mHHS scores (47.4 vs 57.3; P = .004), but similar HOS-SS and VAS-Pain scores (P&#x2265; .076). At 2 years, WC patients reported lower HOS-ADL, HOS-SS, mHHS, and iHOT-12 scores (P&#x2264; .047). At 5 years, HOS-ADL and HOS-SS remained lower in WC patients (P&#x2264; .004), whereas other PROs were comparable (P&#x2265; .160). At 10 years, no significant between-group differences persisted (P&#x2265; .057). WC patients achieved higher MCID rates for HOS-ADL (94.7% vs 68.8%; P = .021) and mHHS (87% vs 62%; P = .038), with comparable MCID and PASS rates for other PROs. Both cohorts demonstrated similar reoperation-free survivorship (P = .383). Overall, 33 WC patients (91.7%) returned to work at a mean time of 8.7 &#xb1; 5.2 months postoperatively. At a minimum 10-year follow-up, WC patients demonstrated sustained improvement and outcomes comparable to non-WC patients after primary hip arthroscopy. Although WC status is associated with inferior preoperative and early postoperative outcomes, long-term symptom resolution, functional improvement, and joint preservation can be expected in appropriately selected patients treated with contemporary hip arthroscopy techniques.

The critical power (CP) model offers a physiologically grounded mathematical framework for understanding the limits of human exercise performance. Despite its strong empirical foundation and broad application in both research and practice, the CP concept remains frequently misunderstood. Misconceptions about its physiological foundations, mathematical structure, and practical application, along with the emergence of other performance models have contributed to inappropriate use, scepticism, and confusion-both in the literature and in the field. In this article, we identify and critically evaluate ten of the most pervasive critiques of the CP model. These include: CP being a purely mathematical construct without physiological basis; CP representing an indefinitely sustainable power output; and claims that other models have rendered CP obsolete. For each critique, we examine the underlying assumptions and available evidence, with the aim of clarifying how the model can be most appropriately applied and interpreted. Overall, the CP model is congruent with current understanding of exercise physiology, while its limitations highlight the complexity and manifestation of fatigue dynamics across different exercise intensity domains. When applied within an appropriate context, CP remains a useful and informative tool for characterising exercise tolerance and understanding the complex interplay between exercise intensity, exercise duration, and fatigue.

The best treatment for acute anterior cruciate ligament (ACL) injuries (surgical or nonsurgical) remains uncertain, particularly regarding return to sport (RTS) and knee function. To compare patient-reported knee function (International Knee Documentation Committee Subjective Knee Form [IKDC-SKF]) and RTS between non-ACL reconstruction (ACLR) and ACLR treatment strategies 24 months after ACL injury or reconstruction and identify predictors of these outcomes. Cohort study; Level of evidence, 2. From the NACOX multicenter cohort, 272 patients (mean age, 25.5 years; 95% CI, 24.6-26.3 years; 52% females) with acute ACL injuries were followed for 24 months after ACL injury or ACLR. Treatment (non-ACLR vs ACLR) was determined via shared decision-making in routine practice. IKDC-SKF scores were collected at 3, 6, 12, and 24 months and analyzed using a linear mixed-effects model adjusted for age, sex, preinjury activity level, and new serious knee injury. RTS was defined as return to preinjury Tegner level or higher. Risk factors for not returning to sport were evaluated using log-binomial regression. The ACLR group had higher preinjury Tegner levels (8 vs 6.5; P < .001) and was younger (24.2 vs 27.6 years; P < .001). No differences in IKDC-SKF scores were observed between non-ACLR and ACLR groups. IKDC-SKF scores improved over time for both groups (P < .001) but were negatively affected by new serious knee injury (P < .001), older age (P = .003), and female sex (P = .004). Overall, 75% of patients achieved RTS within 24 months (mean, 6.3 months; 95% CI, 5.6-7.0 months), with no difference between groups (72% non-ACLR vs 77% ACLR; P = .286). Patients without ACLR returned to sport earlier (3.5 months [95% CI, 2.8-4.2 months] vs 8.1 months [95% CI, 7.2-9.0 months]; P < .001). In patients aged 26 to 40 years, ACLR was associated with a 3.15-fold higher risk of not returning to sport at 24 months compared to the non-ACLR group (P = .015). In this cohort of patients with ACL injury, both nonsurgical management and ACLR, determined through shared decision-making, resulted in comparable patient-reported knee function and RTS rates at 24 months, although the ACLR group was younger and had higher activity level. Non-ACLR treatment may therefore be a viable option for selected patients, particularly those who are older or have lower activity demands, to achieve satisfactory RTS outcomes. Older age (26-40 years) was associated with a higher risk of not returning to sport after ACLR, highlighting the importance of individualized treatment decisions.

This systematic review and network meta-analysis compared the effectiveness of five flexibility-enhancing interventions-static stretching, dynamic stretching, ballistic stretching, proprioceptive neuromuscular facilitation, and foam rolling-on ankle dorsiflexion range of motion in physically active healthy adults. A comprehensive search of multiple databases was conducted up to August 4, 2025. This review followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 guidelines and was registered in prospectively registered in the International Prospective Register of Systematic Reviews. Effect sizes were synthesized using a random-effects network meta-analysis, and intervention rankings were based on the surface under the cumulative ranking curve. Forty-one randomized controlled trials (n=1,670) were included. For the passive range of motion, proprioceptive neuromuscular facilitation (surface under the cumulative ranking curve: 76.8%) and foam rolling (67.8%) were the most effective overall. In long-term protocols (>1 mo), both proprioceptive neuromuscular facilitation (standardized mean difference 1.04 [0.64-1.44]) and foam rolling (standardized mean difference 1.03 [0.53-1.53]) remained superior to controls. For active range of motion, foam rolling ranked the highest (surface under the cumulative ranking curve: 87.2%) and demonstrated the largest short-term improvement, while static stretching showed the most favorable long-term maintenance (surface under the cumulative ranking curve: 72.4%). No intervention-related adverse events were reported. Proprioceptive neuromuscular facilitation and foam rolling are optimal for long-term flexibility enhancement, whereas foam rolling is recommended for short-term, pre-exercise movement preparation. Static stretching may support sustained active range of motion across extended training periods. Intervention selection should align with specific performance goals and training timelines.

High sodium intake is a leading dietary risk factor for stomach cancer, particularly in East Asia. In Japan, traditional dietary patterns contribute to elevated sodium consumption and a high burden of stomach cancer. This study aims to forecast disability-adjusted life years (DALYs) for stomach cancer attributable to high sodium intake in Japan from 2022 to 2050, and to assess the impact of multiple sodium reduction policy scenarios. We conducted a longitudinal forecasting study using autoregressive integrated moving average with exogenous variables (ARIMAX) models based on Global Burden of Disease 2021 data (1990-2021). The Japanese population was stratified by sex and age groups (15-49, 50-69, and &#x2265;70). Five future exposure scenarios were modelled: (1) reference (current trends), (2) best-case (50% reduction in sodium exposure by 2050), (3) optimal (30% reduction by 2032), (4) moderate (30% reduction by 2050), and (5) worst-case (highest exposure levels from recent years maintained). These scenarios were aligned with national and international sodium reduction targets, including the revised "Health Japan 21" (third term; 7 g/day by 2032) and the World Health Organisation (WHO) 5 g/day/30% reduction goals. Under the reference scenario, age-standardised DALY rates are projected to decline by 31.4% (to 15.4 per 100,000) by 2050. The best-case scenario projects a 54.7% decline (to 10.1 per 100,000). Substantial demographic disparities persist: males and those aged &#x2265;70 consistently show higher burdens. Notably, the 50-69 age group shows the greatest variation in 2050 projections across scenarios (17.1 to 73.5 per 100,000), indicating high policy sensitivity. Meanwhile, in the &#x2265;70 group, DALY rates remain high regardless of scenario, especially among males (199.4 vs. 57.8 per 100,000 for females), reflecting cumulative lifetime exposure. Under modelled assumptions, sustained achievement of national sodium reduction targets could meaningfully reduce future stomach cancer DALYs in Japan, with the largest absolute gains in older adults but the largest relative gains in younger and middle-aged groups. Because stomach cancer aetiology is multifactorial and the projections rest on modelled associations and a continuity-of-trend assumption, these findings support strengthened, demographically targeted sodium reduction interventions as one complementary component of a broader, multi-risk factor approach to stomach cancer prevention.