Animating Embodied Memories: An Inquiry into Medium-Specificity of Animation in Greatness Code (2020)

The long-term outcome of athletes with frequent ventricular premature complexes (VPCs) and apparently normal heart has not been fully clarified. To evaluate the clinical and prognostic significance of VPCs and the influence of continuing sports activity during follow-up, we studied 120 healthy athletes (96 men; median age 16 years) in whom frequent VPCs (>100 VPCs/24 hours) were discovered by chance during preparticipation screening. All athletes were followed up for a median of 84 months. During follow-up, 96 underwent serial 24-hour Holter recording and 62 underwent serial echocardiography. The median number of VPCs/24 hours on basal Holter was 3,760. During follow-up, 81 athletes continued sports activity, whereas 39 did not. No athlete died or developed overt heart disease. The median number of VPCs/24 hours decreased in both athletes who continued sports activity and those who did not (from 3,805 to 1,124, p <0.0001 and from 5,787 to 1,298, p <0.0001, respectively). During follow-up, left ventricular ejection fraction slightly decreased to <55% in 9 of 62 athletes who, in respect to the remaining 53, had more VPCs/24 hours both in the basal state (12,000 vs 3,880) and during follow-up (10,702 vs 1,368), and a longer follow-up (95 vs 36 months). In conclusion, (1) frequent VPCs in athletes without heart disease have a long-term benign prognostic significance, (2) sporting activity does not modify this benign outcome, (3) during follow-up, the burden of VPCs decreases whether or not subjects continue sports activity, and (4) in 14.5% of athletes, ejection fraction slightly decreases over time.

Background: Femoroacetabular impingement syndrome (FAIS) is a common cause of hip pain and disability in athletes. Arthroscopic treatment for FAIS is well-established; however, the long-term results in elite athletes are limited. Purpose: To evaluate outcomes 5 years after arthroscopic treatment for FAIS in elite athletes. Study Design: Case series; Level of evidence, 4. Methods: Elite athletes undergoing arthroscopic treatment for FAIS with a minimum 5-year follow-up were included. They were prospectively followed up with patient-reported outcome measures. An elite athlete was defined as having a Hip Sports Activity Scale (HSAS) level of 7 or 8 before the onset of symptoms. Preoperatively and 5 years after surgery, all athletes completed a web-based questionnaire, including the Copenhagen Hip and Groin Outcome Score (comprising 6 subscales), the EQ-5D and EQ-VAS (European Quality of Life–5 Dimensions Questionnaire and European Quality of Life–Visual Analog Scale), iHOT-12 (International Hip Outcome Tool), a visual analog scale for hip function, and the HSAS. Moreover, patients reported their overall satisfaction with their hip function. Preoperative measurements were compared with the 5-year follow-up. Results: A total of 64 elite athletes (52 men, 12 women) with a mean ± SD age of 24 ± 6 years were included. On average, patients reported a statistically significant and clinically relevant improvement from preoperative patient-reported outcome measures to the 5-year follow-up (P < .0003), Copenhagen Hip and Groin Outcome Score subscales (symptoms, 51.7 vs 71.9; pain, 61.0 vs 81.1; function of daily living, 67.1 vs 83.6; function in sports and recreation, 40.0 vs 71.5; participation in physical activity, 25.0 vs 67.4; hip and groin–related quality of life, 34.4 vs 68.0), EQ-5D (0.60 vs 0.83), EQ-VAS (66.1 vs 76.7), and iHOT-12 (40.0 vs 68.8). At the 5-year follow-up, 90.5% reported satisfaction with their overall hip function. In total, 54% still participated in competitive sports (HSAS, 5-8) at follow-up, while 77% had decreased their level. Older patients and patients with longer duration of symptoms reported a significantly lower level of sports activity (HSAS, 0-4; P < .009). Conclusion: Arthroscopic treatment for FAIS in elite athletes results in a statistically significant and clinically relevant improvement regarding symptoms, hip function, quality of life, and pain 5 years after surgery. Approximately half of the cohort was still in competitive sports at follow-up, yet 77% had decreased their level of sports. Nine of 10 patients were satisfied with their surgery.

This article discusses the current literature on the definition, prevalence, and consequences of dissociation in competitive sports. In light of the available evidence, it is argued that there are four reasons why dissociation deserves particular attention in this context: (i) Dissociation seems to be more prevalent among athletes when compared with the general population; (ii) potentially performance-enhancing aspects of dissociation may contribute to its chronic use; (iii) dysfunctional aspects of dissociation may entail underperformance; (iv) chronic use of dissociation may mask and exacerbate mental disorders, such as Post-traumatic Stress Disorder, and delay recovery from injury. In conclusion, it is advocated that standardized measures of dissociation be included in medical sports examinations.

Due to the developments in international junior competitive and top-class sports, young athletes are exposed to increasing levels of stress. Chronic stress in youth elite athletes can result from different sources, including general life stress, major life events, and time demands associated with training and competitive activities that have been steadily increasing for years. Therefore, effective preventative strategies are needed, and one possible avenue can be seen in facilitating the coexistence of school and competitive sport. In Switzerland, such educational structures only developed gradually after the turn of the millennium. Current evidence suggests that such educational opportunities are well received by adolescent elite athletes. Since still a considerable percentage of students report mental health issues, additional action is needed to support youth athletic development. Nevertheless, a significant improvement of the services cannot be achieved in the long term without additional financial resources. In view of the scarce resources, it is crucial that the institutions involved cooperate optimally to use synergies. Finally, efforts are required to more systematically monitor the mental health state of young elite athletes and to evaluate whether the introduction of new structures has the desired effects.

The purpose of this systematic review was to evaluate fetal and maternal pregnancy outcomes of elite athletes who had participated in competitive sport immediately before conception. Online databases were searched up to March 24, 2020. Studies of any design and language were eligible if they contained information on the relevant population (pregnant women), exposure (engaged in elite sport immediately before pregnancy), and outcomes (birth weight, low birth weight, macrosomia, preterm birth, fetal heart rate and pulse index, cesarean sections, instrumental deliveries, episiotomies, duration of labor, perineal tears, pregnancy-induced low back pain, pelvic girdle pain, urinary incontinence, miscarriages, prenatal weight gain, inadequate/excess prenatal weight gain, maternal depression or anxiety). Eleven unique studies (n = 2256 women) were included. We identified "low" certainty evidence demonstrating lower rates of low back pain in elite athletes compared with active/sedentary controls (n = 248; odds ratio, 0.38; 95% confidence interval, 0.20-0.73; I2 = 0%) and "very low" certainty evidence indicating an increased odds of excessive prenatal weight gain in elite athletes versus active/sedentary controls (n = 1763; odds ratio, 2.47; 95% confidence interval, 1.26-4.85; I2 = 0%). Low certainty evidence from two studies (n = 7) indicated three episodes of fetal bradycardia after high-intensity exercise that resolved within 10 min of cessation of activity. No studies reported inadequate gestational weight gain or maternal depression or anxiety. There were no differences between elite athletes and controls for all other outcomes. There is "low" certainty of evidence that elite athletes have reduced odds of experiencing pregnancy-related low back pain and "very low"certainty of evidence that elite athletes have increased the odds of excessive weight gain compared with active/sedentary controls. More research is needed to provide strong evidence of how elite competitive sport before pregnancy affects maternal and fetal outcomes.PROSPERO Registration: CRD42020167382.

Back to table of contents Previous article Next article On Mental Health, People, and PlacesFull AccessStress in Athletes’ LivesEzra E. H. Griffith, M.D.Ezra E. H. GriffithSearch for more papers by this author, M.D.Published Online:28 Sep 2021https://doi.org/10.1176/appi.pn.2021.10.34In recent months, there has been intense discussion about the connection between competitive sport and mental health. The commentary, focused in large part on the stress endured by elite athletes, has coincided with major international sports events. We have had, almost in back-to-back fashion, the French Open tennis tournament, the Tour de France cycling event, the European 2020 soccer championship, and the Olympics in Japan. Naomi Osaka, a world-famous tennis champion, made the news because of her unwillingness to face the pressure of yet another news conference at the French Open. Some bystanders thought she should respect her obligation to face the public because she had committed to doing so. Others agreed the journalists were offensive. At the Tokyo Olympics, Simone Biles, the American star gymnast, evoked similar conflicting responses when she withdrew from events, citing health matters.At the European soccer championship, France was eliminated by Switzerland. The match went into overtime and then to a penalty shootout. Kylian Mbappe, a superstar for France, missed his penalty. That outcome sent France’s players to the showers and home in disgrace. Mbappe apparently apologized to his fans for what sports writers called a failure. More sympathetic supporters urged him to keep his head up, as the day after the match would mark the debut of a new season. The three athletes I have mentioned illustrate well the stress of competitive athletics.We follow elite athletes and how they fare on the different terrains of performance. Their annual income and lifestyle, especially in major sports, always attract our attention. Their bodies and minds serve as models of biomedical wonderment for physicians like us. Their capacity for concentration, the sacrifices they make, and their commitment teach us much about what they endure daily.There are other features of sports that put excitement in our lives. Some years ago, my hospital organized a tournament of bed racing. We closed a street. Different divisions in the facility took a bed, decorated it, named it, and oiled its wheels. An employee, not weighing too much, volunteered to ride in the bed. A team of amateur athletic runners pushed each bed. We all spread the word about the event. The bed-race tournament was on. Every bed had its supporters. I was amazed at how much organized effort was put into this event. We had so much fun that I forgot to ask where the idea had originated. Athletics, competition, and team spirit came together and reawakened the slumbering youth in all of us, even in the bystanders.With these wonderfully positive notions about competitive sports so present in our culture, how did the idea take root that elite athletes are the very incarnation of perfection and are obliged to meet public expectations? We must know that they make mistakes from time to time in what they do, and anxiety haunts the best of them. While performances may be breathtaking, consistently flawless performance is hard to sustain. So, why this mourning and weeping over the mistakes of our athletes and their inability to cope well with stress at every event? Why not just console and encourage them when they are facing loss, injury, and disappointing performances?I still recall the early years in elementary school running after a soccer ball on the playground without quite knowing what to do with it. Eventually, the running was accompanied by thoughtful preparation and strategy. I remember the contentment of belonging to a group, the sense of accomplishment, learning about leadership when I captained the team, feeling the admiration of bystanders when I scored a goal. I also learned about losing in the context of competition and about the pain of a torn muscle during excessive effort.We should urge sports enthusiasts to stop pretending that the elite athlete owes them continual brilliant performances. We should remonstrate with coaches who never prepare a substitute for the day that the star center forward on the soccer team will be unable to play. We know that sports can be pleasurable enough to evoke a kind of loyalty from fans that borders on spiritual commitment. We recognize sports’ service as antidote to the drudgery of daily life. Still, creating an idealistic vision of athletics misleads us all. There is risk in the act of living, and that includes sports. ■Ezra E. H. Griffith, M.D., is professor emeritus of psychiatry and African American Studies at Yale University. ISSUES NewArchived

Return-to-Play for Elite Athletes With Genetic Heart Diseases Predisposing to Sudden Cardiac Death

Representation of the body is a nuclear aspect of self-image. Body representation includes both subjective and intersubjective experiences. The importance of visual body representation in our social life is demonstrated by the time we spend to take care of our physical appearance, including use of plastic surgery, as well as by the severe mental disorders associated to its alteration, including eating disorders (EDs) and body dysmorphic disorders. In spite of these issues, (neuro)psychological research on body representation has so far mainly focused on the body as a motor device, devoted to the perception of and interaction with objects. The complexity of factors involved in the development, maintenance, and plasticity of body image representations requires an integrated approach that facilitates the evaluation and treatment of EDs with novel, evidence-based, and more efficacious protocols. This special issue of European Psychologist aims to advance such an integrative approach, with a collection of papers that gather different perspectives on the phenomenological, cognitive, (neuro)psychological, and cultural aspects of body representation disorders.

Background: Few studies have published the results of hip arthroscopic surgery in elite athletes and none studying a significant number of elite female athletes. Purpose: (1) To compare sex-based differences in the ability to return to prior competitive sports activity after arthroscopic hip surgery. (2) To compare sex-based differences in the type of sports activity, diagnosis, and treatment in athletes requiring hip arthroscopic surgery. Study Design: Cohort study; Level of evidence, 3. Methods: Data on all elite athletes who underwent primary hip arthroscopic surgery between 2007 and 2014 were included. Athletes with a Hip Sports Activity Scale (HSAS) score of over 6 were identified. The preoperative evaluation included a medical history, history of sports activity, and hip-specific outcome scores (Modified Harris Hip Score [MHHS] and International Hip Outcome Tool–33 [iHOT-33]). Surgical findings and time to return to competitive sports were documented. Results: Of 547 hips in 484 consecutive patients, 98 elite athletes (49 female) with a mean follow-up of 18.9 ± 12.8 months were identified. Eighty patients desired to return to their original competitive activity: 38 were female (42 hips; mean age, 21.5 ± 3.9 years), and 42 were male (54 hips; mean age, 20.5 ± 1.9 years). Moreover, 84.2% of female athletes and 83.3% of male athletes were able to return to the same level of competition at a mean of 8.3 ± 3.0 and 8.8 ± 2.9 months, respectively. Significant improvements between preoperative and postoperative outcome scores were seen in both groups (all P < .0001). Female athletes had more pincer femoroacetabular impingement (FAI) (P = .0004) and instability (P < .0001). Conversely, male athletes were diagnosed more commonly with combined FAI (P < .0001), demonstrated greater acetabular cartilage damage (P = .0004), and required microfracture more often (P = .0014). Female athletes competed more frequently in flexibility (4/38, 11%; P = .047) and endurance (9/38, 24%) sports, while male athletes participated in cutting (14/42, 33%), contact (6/42, 14%), and asymmetric (13/42, 31%) sports more often. Patients who returned to their baseline level of competition had a shorter duration of symptoms preoperatively (P = .001). Microfracture status did not affect the ability to return to sports. Conclusion: Female and male elite athletes were able to return to competitive sports activity at the same or higher level after hip arthroscopic surgery at a similar rate, although their performance in sports was not measured. Distinct differences in the diagnosis, treatment, and type of sports activity between sexes were seen. The duration of symptoms negatively correlated with outcomes. Microfracture did not affect the return to sports.

Background: The impact of the corona pandemic on competitive sports has not yet been studied in a larger group of athletes. Methods: Using an online questionnaire, junior and adult elite athletes from Germany and Austria were asked about their infection status, potential symptoms of COVID-19, and the impact of the pandemic on their athletic activity. Results: Between April 21, 2020 and February 16, 2021, a total of 2981 questionnaires were recorded (50.3% female, 25.7% professional athletes, 37.9% national team members). 78 athletes (2.6%) reported a positive PCR test result for SARS-CoV-2. In addition, 67 (2.3%) athletes reported that they had experienced the disease but were self-diagnosed. In 19 athletes (0.6%), infection was suspected by a physician but without testing. 841 (28.2%) athletes stated that they were in quarantine at least once. At least one symptom that might be associated with COVID-19 was observed in 38.7% of all athletes. Cardiac symptoms were reported significantly more often in PCR-positive athletes than in the group of athletes without confirmed infection or no infection. 15 athletes (0.5%) were admitted to hospital due to COVID-19, 8 of them were hospitalized for more than 1 week. Conclusion: The corona pandemic has a massive impact on competitive sports. In addition to indirect consequences due to quarantine measures or cancellation of competitions, infections with SARS-CoV-2 occurred in a significant proportion of athletes. Severe courses with hospitalization were also recorded among competitive athletes.

Comparison of Frequency of Significant Electrocardiographic Abnormalities in Endurance Versus Nonendurance Athletes

Intensive physical training and participation in competitive sports during childhood and early adolescence may affect athletes' pubertal development. On the other hand, pubertal timing, early or late, may impact on an athlete selection for a particular sport. Genetic predisposition, training load, nutritional status and psychological stress determine athletes' pubertal timing. Athletes that practice esthetic sports, especially gymnasts, are predisposed to a delay in pubertal development. The growing evidence indicates that energy deficiency, not a systemic training per se, plays a crucial role in the pathogenesis of functional hypothalamic hypogonadism in female athletes. Metabolic and psychologic stress activate hypothalamic-pituitary-adrenal axis and suppress hypothalamic-pituitary-ovarian axis. Female athletes who do not begin secondary sexual development by the age of 14 or menstruation by the age of 16 warrant a comprehensive evaluation and a targeted treatment. Somatic growth and sexual maturation of elite female athletes are largely sport-specific since each sport favors a particular somatotype and requires a specific training. Chronic negative energy balance resulting from a systemic physical training and inadequate energy intake may delay pubertal development in elite athletes. Youth athletes, especially those engaged in competitive sports that emphasize prepubertal or lean appearance, are at risk of developing relative energy deficiency in sport associated with disordered eating or eating disorders. Management strategies should address the complex conditions underlying functional hypothalamic hypogonadism.

During the COVID-19 pandemic, many athletes from several sporting disciplines were infected with the SARS-CoV-2. The aim of this systematic review is to summarize the current scientific evidence on the psychological sequelae and mental health of elite athletes who have been infected by the virus. The review was performed following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Statement; three databases were searched: PubMed, ISI Web of Knowledge, and Scopus. The initial search resulted in 2420 studies; after duplicate removal and screening by title and abstract, 41 articles were screened by full-text. A total of four eligible articles were included in the review. All included articles measured depression and anxiety in athletes who had suffered from COVID-19, while in three papers levels of stress were measured. Overall, the only two questionnaires used in more than one study were the DASS-21 and the APSQ. In our systematic review, we highlighted that mental and psychological health in elite athletes has the same importance as physical health. This statement suggests that these examinations should be introduced and performed during the competitive sports' medical examinations conducted at the start of the sporting season, which currently consists only of the examination of physical parameters. Due to lack of studies on the topic, the results of our review show that mental health in athletes with a history of SARS-CoV-2 infection is an issue that requires more investigation, considering the evidence of clinical consequences. The importance of post-infection psychological sequelae is significant in assessing possible repercussions on the athletes' sporting performance.

Sport neuroscience revisited (?): a commentary.

Cognitive Development and Cognitive Neuroscience: The Learning Brain is a thoroughly revised edition of the bestselling Cognitive Development. The new edition of this full-colour textbook has been updated with the latest research in cognitive neuroscience, going beyond Piaget and traditional theories to demonstrate how emerging data from the brain sciences require a new theoretical framework for teaching cognitive development, based on learning. Building on the framework for teaching cognitive development presented in the first edition, Goswami shows how different cognitive domains such as language, causal reasoning and theory of mind may emerge from automatic neural perceptual processes. Cognitive Neuroscience and Cognitive Development integrates principles and data from cognitive science, neuroscience, computer modelling and studies of non-human animals into a model that transforms the study of cognitive development to produce both a key introductory text and a book which encourages the reader to move beyond the superficial and gain a deeper understanding of the subject matter. Cognitive Development and Cognitive Neuroscience is essential for students of developmental and cognitive psychology, education, language and the learning sciences. It will also be of interest to anyone training to work with children.