An examination of the role of the sports and exercise medicine specialist in Ireland- from epidemiology to treatment

The expansion of the specialty of sports and exercise medicine (SEM) is a relatively recent development in the medical community and the role of the SEM specialist continues to evolve and develop. The SEM specialist is ideally placed to care for all aspects of physical activity not only in athletes but also in the general population. As an advocate for physical activity the SEM specialist plays a broad role in advising safe effective sports and recreation participation; screening for disease related to sports participation; examining and contributing to the evidence behind treatment strategies and evaluating any potential negative impact of sports injury prevention measures. In this thesis I will demonstrate the breadth of the role the Sports and Exercise Medicine Specialist from epidemiology to in-depth examination of treatment strategies. In Chapter 2, I examined the epidemiology of sports and recreation related injury (SRI) in Ireland, an area that has previously been poorly studied. We report on 3,172 SRI (14% of total presentations) presentations to the ED over 6 months. Paediatric patients (4-16 yrs) were over represented comprising 39.9% of all SRI presentation compared to 16% of total ED presentations and 18% of the general population. These injuries were serious (32% fractures) and though 49% of injuries occurred during organised competition/practice, 41.5% occurred during recreation-most often at home. In Chapter 3, I examined risk factors associated with hand injury in hurling. The previous chapter highlighted the importance of a firm evidence base underpinning treatment strategies. When measures to improve welfare are introduced not only must potential benefits be measured, so too must potential unwanted adverse outcomes. In this study I examined a cohort of adult hurlers who had presented to the ED with a hurling related injury in order to highlight the variables associated with hand injury in this population. I found the athletes who wore a helmet were far more likely (OR 3.15 95% CI (1.51-6.56) p= 0.002) to suffer a hand injury than athletes who did not. Very few of those interviewed (4.9%) used hand protection compared to 65% who used helmet and faceguard. The introduction of the helmet and faceguard in hurling has undeniably decreased the incidence of head and face injury in hurling. However in tandem with this intervention several observational studies have demonstrated an increase in the occurrence of hurling related hand injuries. This study highlights the importance of being cognisant of unanticipated or unintended consequences when implementing a new treatment or intervention. In Chapter 4, I examined the role of population screening as applied to sport and exercise. This is a controversial area –cardiac screening in the exercising population has been the subject of much debate. Specifically I define the prevalence of exercise induced bronchoconstriction (EIB) using a specifically designed sports specific field-testing protocol. In this study I found almost a third (29%) of a full international professional rugby squad had confirmed asthma or EIB, as compared with 12-15% of the general population. Despite regular medical screening, 5 ‘new’ untreated cases (12%) were elicited by the challenge test and in the group already on treatment for asthma/EIB; over 50% still displayed EIB. In Chapter 5, I examined the evidence supporting current treatment options for iliotibial band friction syndrome (ITBFS). The practice of sports medicine has traditionally been ‘eminence based’ rather than ‘evidence based’. This may be problematic as some of these practices are based upon flawed principles- for example the treatment of iliotibial band friction syndrome (ITBFS). In this chapter, using cadaveric and biomechanical studies I expand upon the growing base of evidence clarifying the anatomy and biomechanics of the area-thereby re-examining the principles on which current treatments are based. The role of the SEM specialist is broad; we chose to examine specific examples of some of the roles that they execute. An understanding of the epidemiology of SRI presenting to the ED has implications for individual patients, sports governing bodies and health resource utilisation. Population screening is an important tool in health promotion and disease prevention in the general population. Screening in SEM may have similar less well-recognised benefits. The SEM specialist needs to be conversant in screening for medical conditions concerning physical activity. A comprehensive understanding of the pathophysiology of a disease is required for its diagnosis and treatment. Due to the ongoing evolution of SEM many treatments are eminence-based rather than evidence‐based practice. Continued re-examination of the fundamentals of current practice is essential. An awareness of potential unwanted side effects is essential prior to the introduction of any new treatment or intervention. The SEM specialist is ideally placed to advise sports governing bodies on these issues prior to and during their implementation.

The geographies of encounter: investigating the spatiality and construction of 'meaningful' encounters with difference through the experiences of international students at University College Cork, Ireland

The purpose of this research is to investigate how international students negotiate encounters with Irish students and construct ‘meaning’ from those encounters in the spaces of the university and city. As cities are increasingly characterised by a multiplexity of diversity, the issue of living with difference is becoming more and more pertinent. In the wake of escalating socio-spatial polarisation, inter-cultural tension, racism, and xenophobia, the geographies of encounter seek to untangle the interactions that occur in the quotidian activities and spaces of everyday life to determine whether such encounters might reduce prejudice, antipathy and indifference and establish common social bonds (Amin 2002; Valentine 2008). Thus far, the literature has investigated a number of sites of encounter; public space, the home, neighbourhoods, schools, sports clubs, public transport, cafes and libraries (Wilson 2011; Schuermans 2013; Hemming 2011; Neal and Vincent 2011; Mayblin, Valentine and Anderrson 2015; Laurier and Philo 2006; Valentine and Sadgrove 2013; Harris, Valentine and Piekut 2014; Fincher and Iveson 2008). While these spaces produce a range of outcomes, the literature remains frustrated by a lack of clarity of what constitutes a ‘meaningful’ encounter and how such encounters might be planned for. Drawing on survey and interview data with full-time international students at University College Cork, Ireland, this study contributes to understanding how encounters are shaped by the construction and reproduction of particular identities in particular spaces, imbuing spaces with uneven power frameworks that produce diverse outcomes. Rather than identifying a singular ‘meaningful’ outcome of encounter as a potential panacea to the issues of exclusion and oppression, the contention here is to recognise a range of outcomes that are created by individuals in a range of ways. To define one outcome of encounter as ‘meaningful’ is to overlook the scale of intensity of diverse interactions and the multiplicity of ways in which people learn to live with difference.

Wearable wireless inertial measurement for sports applications

A wearable WIMU (Wireless Inertial Measurement Unit) [1] system for sports applications based on Tyndall's 25mm mote technology [2] has been developed to identify tennis performance determining factors, giving coaches & players improved feedback [3, 4]. Multiple WIMUs transmit player motion data to a PC/laptop via a receiver unit. Internally the WIMUs consist of: an IMU layer with MEMS based sensors; a microcontroller/transceiver layer; and an interconnect layer with supplemental 70g accelerometers and a lithium-ion battery. Packaging consists of a robust ABS plastic case with internal padding, a power switch, battery charging port and status LED with Velcro-elastic straps that are used to attach the device to the player. This offers protection from impact, sweat, and movement of sensors which could cause degradation in device performance. In addition, an important requirement for this device is that it needs to be lightweight and comfortable to wear. Calibration ensures that misalignment of the accelerometer and magnetometer axes are accounted for, allowing more accurate measurements to be made.

An automated calibration tool for high performance wireless inertial measurement in professional sports

Traditional motion capture techniques, for instance, those employing optical technology, have long been used in the area of rehabilitation, sports medicine and performance analysis, where accurately capturing bio-mechanical data is of crucial importance. However their size, cost, complexity and lack of portability mean that their use is often impractical. Low cost MEMS inertial sensors when combined and assembled into a Wireless Inertial Measurement Unit (WIMU) present a possible solution for low cost and highly portable motion capture. However due to the large variability inherent to MEMS sensors, such a system would need extensive characterization to calibrate each sensor and ensure good quality data capture. A completely calibrated WIMU system would allow for motion capture in a wider range of real-world, non-laboratory based applications. Calibration can be a complex task, particularly for newer, multi-sensing range capable inertial sensors. As such we present an automated system for quickly and easily calibrating inertial sensors in a packaged WIMU, demonstrating some of the improvements in accuracy attainable.

Deer forests, game shooting and landed estates in the South West of Ireland, 1840 - 1970

This thesis is concentrated on the historical aspects of the elitist field sports of deer stalking and game shooting, as practiced by four Irish landed ascendancy families in the south west of Ireland. Four great estates were selected for study. Two of these were, by Irish standards, very large: the Kenmare estate of over 136,000 acres in the ownership of the Roman Catholic Earls of Kenmare, and the Herbert estate of over 44,000 acres in the ownership of the Protestant Herbert family. The other two were, in relative terms, small: the Grehan estate of c.7,500 acres in the ownership of the Roman Catholic Grehan family, and the Godfrey estate of c.5,000 acres, in the ownership of the Protestant Barons Godfrey. This mixture of contrasting estate size, owner's religions, nobleman, minor aristocrat and untitled gentry should, it is argued, yield a diversity of the field sports and lifestyles of their owners, and go some way to assess the contributions, good or bad, they have bequeathed to modern Ireland. Equally, it should help in assessing what importance, if any, applied to hunting. In this context, hunting is here used in its broadest meaning, and includes deer stalking and game shooting, as well as hunting with dogs and hounds on foot and horseback. Where a specific type of hunting is involved, it is so described; for example, fox hunting, stag hunting, hare hunting. Similarly, the term game is sometimes used in sporting literature to encompass all species of quarry killed, and can include deer, ground game (hares and rabbits), waterfowl, and various species of game birds. Where it refers to specific species, these are so described; for example grouse, pheasants, woodcork, wild duck, etc. Since two of these estates - the Kenmare and Herbert - each created a deer forest, unique in mid-19th century Ireland, they form the core study estates; the two smaller estates serve as comparative studies. And, equally unique, as these two larger estates held the only remnant population of native Irish red deer, the survival of that herd itself forms a concomitant core area of analysis. The numerary descriptions applied to these animals in popular literature are critically reassessed against prime source historical evidence, as are the so-called deer forest 'clearances'. The core period, 1840 to 1970, is selected as the seminal period, spanning 130 years, from the creation of the deer forests to when a fundamental change in policy and administration was introduced by the state. Comparison is made with similar estates elsewhere, in Britain and especially in Scotland. Their influence on the Irish methods and style of hunting is historically examined.

The Queen's College, Cork: its origins and early history, 1803-1858

This work examines the origins and early history of the Queen's College, Cork. Designedly there is as much stress on the origins as on the early history, for it is the contention of the work that the College was something more than a legislative mushroom. It was very much in the tradition of the civic universities which added an exciting new dimension to academic life in these islands in the nineteenth century. The first chapter surveys university practice and thinking at the opening of the century, relying exclusively on published sources. The second chapter is devoted specifically to the state of learning in Cork during the period, and makes extensive use of hitherto unpublished manuscript material in relation to the Royal Cork Institution. The third chapter deals with the highly significant evidence on education embodied in the Report of the Select Committee on Irish Education of 1838. This material has not previously been published. In chapter four an extended study is made of relevant letters in the manuscript correspondence of Sir Robert Peel - even the most recent authoritative biography has ignored this material. The remaining three chapters are devoted more specifically to the College, both in the formulation or policy and in its practical working. In chapter six there is an extended survey of early College life based exclusively on hitherto unpublished manuscript material in the College Archives. All of these sources, together with incidental published material, are set out at the end of each chapter.

Urbanisation and sport participation in townships in China

Urbanisation as a phenomenon is a complex social process which can be quite difficult to define and understand. In recent years, urbanisation in China has developed at an ever increasing rate. Urban population rates have now surpassed 50% (figure from 2011). Based on the growing importance placed on the increasing number of urbanised/urbanising townships, the issue of people’s lives within the townships has also become an important feature in regard to the impact that urbanisation is having upon China. Clearly this links China’s urban development to the transformation of sport participation in China. This research aims to examine what the reality of the sport participation on-the-ground is within six selective townships in China and examine the reasons for the reality through the lens of figurational theory. In order to do so, some features of Norbert Elias’s figurational theory (involvement and detachment, power) are employed as the theoretical framework. Two townships in Lüliang of Shanxi province, two townships in Jincheng of Shanxi Province and two townships in Huizhou of Guangdong province were selected in order to answer these key questions. The three cities which the townships are located are in different stages of urbanisation. Semi-structured interview were conducted. The current situation were described from the aspects of age, gender, occupation and income aspects and the transformation of sport participation. This research concludes that the current sport participation situation within these six townships is due to the influences stemming from several aspects: sport policy and sport organisation; economy condition, culture, urbanisation, and self-requirement and individual interest towards sport. This power forms a network of interdependency which also aids our understanding of the current sport participation within these six selected Chinese townships.

Globalization and basketball in China: governance, market and culture

Chinese sports are developing under very complex and unique political, economic, and cultural circumstances in the global age. This study aims to investigate the process of globalization in basketball through an examination of its multidimensional manifestations. The study aligns itself with Ritzer’s (2003, 2007b) conceptualization of dichotomizing the process of globalization into grobalization and glocalization. On that basis, the trajectory of basketball globalization in China is identified as the result of a contextual and competing interplay between the penetration of the NBA and the consequent engagement of Chinese basketball. A qualitative methodological approach was conducted to achieve the research aim. Data were collected from a number of sources, including official documents and semi-structured interviews with relevant basketball participants. The study reveals that globalization and basketball in China, in the political and institutional dimension, is a conflicting process. The universalization of the NBA’s governance model could not be fully assimilated due to the centralization of power in the Chinese government, which is hindering the further professionalization and marketization of basketball. In the economic dimension, the globalization process is seen to interplay with the local basketball market, which is growing thanks to the adaption of the NBA’s marketing strategies. In the cultural dimension, the study demonstrates that the NBA has to some extent cosmopolitanized and consumerized Chinese basketball culture, while resistance from both the state and the Chinese people has risen, creolizing the globalization of basketball culture in China.

A social history of sport in Cork, Tipperary and Waterford, c. 1880-1930

This thesis seeks to explore the development of sport in Munster in the late nineteenth and early twentieth centuries by comparing developments in three counties: Cork, Tipperary and Waterford. In particular this thesis considers the development of rugby and soccer in comparative perspective across these three counties, asking what local factors impacted on their uneven development in the region and considering the extent to which the traditional model of diffusion applies to the reception of these sports in the three counties. By giving consideration to these two particular non-indigenous sports, the thesis will, through answering that question, explore ideas of cultural reception, national identity and class as expressed at local level. These themes will be explored by placing the comparative analysis of these two sports into a wider context of sporting development regionally and nationally in the period, in particular the emerging commercialisation of sport, and also the diverse sporting culture of which these two sports were a part. Utilising a wide range of archival sources from local, national and sporting newspapers, to club records, official publications and ephemera this thesis builds a picture of sport in Munster that is deeply rooted in the community, and that forms an important facet of the social world of Cork, Tipperary and Waterford from 1880-1930.

College adjustment, depressive symptoms and peer support among undergraduate university students

Background: College adjustment is a developmental milestone that can be stressful and may lead to mental health problems such as depression. Support during this adjustment period is seen as essential, however it is unknown if informal peer support from fellow students has any impact on either college adjustment or depressive symptoms. Aim: To identify levels of social and personal college adjustment, depressive symptoms and peer support among students, and to examine the relationship between the variables. Design: A quantitative correlational design was used Instruments: Data were collected using two subscales of the Student Adaptation to College Questionnaire; the Centre for Epidemiology Depressive Symptoms Scale and a subscale of the Peer Support Evaluation Inventory. Sample: The sample consisted of 417, first (n=188), second (n=134) and fourth (n=94) year nursing and midwifery students from one University in Ireland. Findings: The findings indicated that 20% of participants were poorly personally adjusted and 9% poorly socially adjusted. Furthermore, 34% of participants experienced significant depressive symptoms. Most students had good levels of peer support. Statistically significant relationships were found between all key variables, the strongest of which were between personal adjustment and depressive symptoms and social adjustment and depressive symptoms. Differences in adjustment and depressive symptom scores were found based on year of study, with second year students experiencing more depressive symptoms and having poorer personal adjustment scores. Participants who had poor relationships with their father’s experienced greater depressive symptoms and had more difficulties personally and socially adjusting to college. The alcohol consumption of participants had a statistically significant correlation with college adjustment, depressive symptoms and peer support, with higher consumption having a positive impact on the variables.

Childhood obesity in Ireland: recent trends and modifiable determinants

Background: Childhood obesity is a global epidemic posing a significant threat to the health and wellbeing of children. To reverse this epidemic, it is essential that we gain a deeper understanding of the complex array of driving factors at an individual, family and wider ecological level. Using a social-ecological framework, this thesis investigates the direction, magnitude and contribution of risk factors for childhood overweight and obesity at multiple levels of influence, with a particular focus on diet and physical activity. Methods: A systematic review was conducted to describe recent trends (from 2002-2012) in childhood overweight and obesity prevalence in Irish school children from the Republic of Ireland. Two datasets (Cork Children’s Lifestyle [CCLaS] Study and the Growing Up in Ireland [GUI] Study) were used to explore determinants of childhood overweight and obesity. Individual lifestyle factors examined were diet, physical activity and sedentary behaviour. The determinants of physical activity were also explored. Family factors examined were parental weight status and household socio-economic status. The impact of food access in the local area on diet quality and body mass index (BMI) was investigated as an environmental level risk factor. Results: Between 2002 and 2012, the prevalence of childhood overweight and obesity in Ireland remained stable. There was some evidence to suggest that childhood obesity rates may have decreased slightly though one in four Irish children remained either overweight or obese. In the CCLaS study, overweight and obese children consumed more unhealthy foods than normal weight children. A diet quality score was constructed based on a previously validated adult diet score. Each one unit increase in diet quality was significantly associated with a decreased risk of childhood overweight and obesity. Individual level factors (including gender, being a member of a sports team, weight status) were more strongly associated with physical activity levels than family or environmental factors. Overweight and obese children were more sedentary and less active than normal weight children. There was a dose response relationship between time spent at moderate to vigorous physical activity (MVPA) and the risk of childhood obesity independent of sedentary time. In contrast, total sedentary time was not associated with the risk of childhood obesity independent of MVPA though screen time was associated with childhood overweight and obesity. In the GUI Study, only one in five children had 2 normal weight parents (or one normal weight parent in the case of single parent families). Having overweight and obese parents was a significant risk factor for overweight and obesity regardless of socio-economic characteristics of the household. Family income was not associated with the odds of childhood obesity but social class and parental education were important risk factors for childhood obesity. Access to food stores in the local environment did not impact dietary quality or the BMI of Irish children. However, there was some evidence to suggest that the economic resources of the family influenced diet and BMI. Discussion: Though childhood overweight and obesity rates appear to have stabilised over the previous decade, prevalence rates are unacceptably high. As expected, overweight and obesity were associated with a high energy intake and poor dietary quality. The findings also highlight strong associations between physical inactivity and the risk of overweight and obesity, with effect sizes greater than what have been typically found in adults. Important family level determinants of childhood overweight and obesity were also identified. The findings highlight the need for a multifaceted approach, targeting a range of modifiable determinants to tackle the problem. In particular, policies and interventions at the shared family environment or community level may be an effective mean of tackling this current epidemic.

The human papillomavirus and cancer: a multiphase study investigating preventative behaviours in young males

Background: The Human Papillomavirus (HPV) is one of the world’s most common sexually transmitted infections, and a causative factor of oropharyngeal, anal and penile cancers in males. Worldwide, an estimated 39,000 HPV-associated cancers occur each year in men. The highest rates of HPV infection are found in adults aged 18 to 28 years. Clinical evidence indicates that use of a condom in addition to obtaining the HPV vaccine provides the greatest protection from HPV infections. Aim: To explore young men’s attitudes, beliefs, and behavioural intention in relation to receiving the HPV vaccine and using a condom correctly and consistently. Collectively, both behaviours are linked to the prevention of HPV transmission and associated infections with HPV. Method: A multi- phase study, underpinned by the Theory of Planned Behaviour, involving a qualitative belief elicitation, pilot, and quantitative cross-sectional study was conducted. A belief elicitation (n=12) phase was used to generate items to include in a newly developed research instrument. Post pilot the research instrument was utilised in a cross sectional online survey to explore the attitudes, beliefs, and behavioural intention of young men (n= 359) with regard to receiving the HPV vaccine, and using a condom correctly and consistently. Data Collection: Data collection took place over a three month time frame. Male participants were recruited from a university in Southern Ireland via a student email system, as well as posting advertisements on numerous health, social and sports websites. Sample: Three hundred and fifty nine male participants aged 18- 28 years completed the online questionnaire. Data Analysis: Data were analysed using SPSS. Descriptive, correlational, multiple and hierarchical regression analysis were performed on the indirect and direct variables of the Theory of Planned Behaviour i.e. attitude, subjective norm, perceived behavioural control, and intention. Status variables were also included in descriptive analysis and hierarchical regressions. Findings are presented through text and graphical representation. Results: Alarming sexual health statistics identified that only 44.3% of participants always used a condom, and 78.6% never used a condom for oral sex. Furthermore, findings reveal that the constructs of the Theory of Planned Behaviour adequately measure male’s attitudes, beliefs and behavioural intention with regard to both behaviours. The Theory of Planned Behaviour has assisted in identifying how social pressures play an influential role in relation to males receiving the HPV vaccine. Attitudes presented as the most significant predictor of male’s intentions to use a condom correctly and consistently. Intention to perform both behaviours was identified as moderate to high. Conclusion: This study has contributed to the field of HPV research, as it is the first piece of research to explore preventative HPV behaviours i.e. receiving the HPV vaccine, and condom use, amongst young males, utilising the Theory of Planned Behaviour. A deeper understanding of young male’s attitudes, beliefs, and behavioural intention on this topic has been achieved. Additionally, a new robust research instrument has been constructed. Findings from this study will undoubtedly help in the implementation of the HPV vaccine in Ireland, as well as influence health promotion campaigns aimed at young males, addressing the topic of condom use.