Two-and-a-Half-Year Follow-Up Study with Freedom on Water through Stand-Up Paddling: Exploring Experiences in Blue Spaces and Their Long-Term Impact on Mental Well-Being

Blue space interventions evidently have a positive impact on well-being and mental health, yet longitudinal studies on the lasting impact of such interventions are scarce. In this qualitative follow-up study with semi-structured interviews, we explored the long-term experiences over 18-42 months among six out of the initial eight women from the primary study, also including two instructors from the initial study. The participants, dealing with mental disorders, participated in the group-based intervention Freedom on Water, participating in stand-up paddling. Five main themes emerged from the empirical analysis: SUP as a catalyst for broadening horizons; learning: stepping out of the comfort zone; a break from diagnosis and rumination; connectedness to nature, specifically blue nature, and to the group; a life-changing journey; and a shift in mindset. The study revealed a long-term, life-changing impact of the program on participants' well-being and mental health. Nature and blue space activities had become a greater part of their lives, improving their mental health with feelings of calmness, positivity, healing, and freedom. Stepping out of their comfort zone facilitated experiences of success and transformed their mindsets. Moreover, they experienced a break from rumination, and they became more outwardly focused, with confidence in themselves and their abilities, while making new friendships and engaging in new and different contexts.

Local businesses' consumption and perception of Single-Use Plastics: A preliminary assessment for conservation and mitigation plans in the Egadi Islands Marine Protected Area

Modern society depends on plastic, especially through single-use plastic products (SUPs), which can affect ecological systems after use. Local policymakers can strategically adopt measures against SUPs pollution by setting effective local governance. This work was designed to evaluate SUPs consumption inside the Marine Protected Area of the Egadi Islands. A questionnaire mixed approach to understanding stakeholders' consumption, attitudes and perceptions about the uses and impacts of SUPs in the third sector was used. Results show a significant seasonal consumption of SUPs and uncertainty in the behaviour to discard them. These provide valuable insights to fill research gaps in estimating the use of SUPs and consumers' perceptions. The main aim of this work has been to understand the critical issues regarding the use of SUPs, considering the target area's patterns, in support of designing action plans for changing behaviour and the mitigation of critical issues in favour of environmental conservation.

Injuries and Use of Safety Equipment in Stand-up Paddle Boarding

Background:

Stand-up paddleboarding (SUP) is a water sport that has gained in popularity. Still, very little is known about its injury profile.

Purpose:

To analyze the incidence, mechanisms, and risk factors for SUP-related injuries in mainly calm waters and the use of safety equipment.

Study Design:

Descriptive epidemiology study.

Methods:

The authors distributed an online survey that gathered information on characteristics, injury history over the past 12 months, use of (safety) equipment, and health issues of SUP riders in German-speaking countries.

Results:

A total of 438 participants completed the survey. The mean participant age was 45 years (range, 8-82 years), 48% were female athletes, and 19.6% took part in competitions. Over the past 12 months, 72 (17%) of 431 respondents experienced a SUP-related injury, resulting in an overall incidence rate (IR) of 1.95 injuries per 1000 hours of activity. Male competitive athletes using a hardboard had the highest risk of injury. The IR for competitive riders was higher (3.21 injuries per 1000 hours) than that for recreational riders (1.41 injuries per 1000 hours). Mechanisms of injury were overuse (n = 29) and contact with the board (n = 18) or ground (n = 12). Injuries affected mainly muscles/tendons and joints of the upper arm/shoulder (n = 20), followed by wrist/hand (n = 18), knee (n = 16), elbow/forearm (n = 12), and foot (n = 11). The highest risk of injury occurred when paddling in wild water (33.3%), followed by SUP surfing (29.4%), and the lowest risk occurred while paddling on a lake (16.1%). A life vest was always used by 27, depending on the situation by 201, and never by 202 participants; a leash was always used by 161, depending on the situation by 244, and never by 26 participants. Of the 272 participants who paddled in winter, 253 wore a drysuit or wetsuit, whereas 19 paddled without any special clothing.

Conclusion:

SUP-related injuries predominantly happened in wild water or while SUP surfing, and male competitive athletes using a hardboard had the highest risk of injury. The main mechanisms of injury were overuse and hitting the board or ground. The upper extremity was more prone to injury, followed by the knee and foot. More effort should be made to educate paddlers on the necessity and correct use of the life vest, leash, and specialized outfits.

Effect of Stand-Up Paddle Boarding on Hydration Status in Recreational and Competitive Individuals

Stand up paddle (SUP) boarding is a popular water-based aquatic sport and recreational activity that continues to grow in popularity, however, little is known about its effect upon hydration status in recreational and elite level participants. The aim of this study was to examine the hydration status in SUP by investigating fluid loss through measurement of nude body mass. Thirty participants successfully completed the study. Hydration status was assessed by measurements of nude body mass taken pre and post SUP session. Intensity of the session was monitored throughout each session using a telemetry heart rate (HR) monitor; both mean and maximum HRs were assessed. Environmental conditions were recorded prior to each session and participants rated perceived hydration pre and post activity. SUP sessions average duration was 68 ± 13 mins (mean HR: 135 ± 20 bpm, peak HR: 167.1 ± 12 bpm). The average mass lost in a SUP session was 0.82 ± 0.4 kg (absolute), 0.03 ± 1 (relative BMI), 0.43 ± 0.2 (relative BSA) and the overall percentage of loss was 1.2 ± 0.6 % (p < 0.01, d = 0.47). Key predictors (p < 0.05) of fluid loss included ambient air temperature, gender (males), mean HR and SUP session duration. Results from this study suggest that SUP participants may require fluid loss monitoring to allow for effective rehydration strategies. Pre-hydration strategies are also recommended to avoid dehydration which is associated with decreased performance (aerobic and strength), increased core temperature, heart rate and may lead to detrimental health outcomes such as renal failure and heat illness in extreme circumstances.

Relationship Between Training Factors and Injuries in Stand-Up Paddleboarding Athletes

Stand-up paddleboarding (SUP) is an increasingly popular sport but, as in other sports, there is an injury ratio associated with practicing it. In other types of sport, some factors have been linked to the likelihood of suffering an injury, among which stretching, core training and resistance training may be considered the most significant. Therefore, the main aim of this study was to identify the training factors that could influence injuries suffered by participants in international SUP competitions. Ninety-seven questionnaires were collected from paddlers who participated in an international SUP circuit, with epidemiological data being gathered about injuries and different questions related to the training undertaken. A multi-factor ANOVA test was used to identify the factors which influence the state of injury. Results showed that almost 60% of injuries occurred in the arms or in the upper thoracic region, around 65% of which were in tendons or muscles and, in almost half of cases, were related to overuse. Likewise, the results showed that athletes with injury performed fewer resistance training sessions per week (p = 0.028), over fewer months per year (p = 0.001), more weekly training sessions (p = 0.004) and, lastly, a greater volume of weekly training (p = 0.003) than athletes without injury. Moreover, the most important training factors that reduce the likelihood of suffering an injury were taken into account-in. particular, resistance training alone (p = 0.011) or together with CORE training (p = 0.006) or stretching (p = 0.012), and the dominant side of paddling (p = 0.032). In conclusion, resistance training would seem to reduce the likelihood of injury among SUP practitioners, and such benefits could be obtained by resistance training alone or in combination with CORE training or stretching.

Exploring the Utilisation of Stand up Paddle Boarding in Australia

Stand Up Paddle Boarding (SUP) has grown exponentially in the last few years with unprecedented participation rates globally. Despite some scientific research on physiological and performance variables, minimal information exists regarding participation and utilisation. The purpose of this study was to discover more about how and where people participate in the relatively new sport of SUP. An open-source online survey application was administered internationally to active SUP participants to capture information relevant to both demographics and participation. Of a total of 240 responses, 154 (64.2%) were Australian. The average SUP rider was 42.9 ± 11.7 years, mass 80.4 ± 18.7 kg, 1.75 ± 0.10 m tall with a BMI of 26.1 ± 4.9. More males (69.5%) participate in SUP than females with the majority of participants from the eastern seaboard of Australia. Participants most commonly used SUP for fun and fitness, for around 3 h per week, predominantly at the beach with friends, with around half of the respondents reporting a competitive involvement. This is the first study to date to quantify participation of SUP within Australia. Results revealed SUP is a global activity with a high representation within Australia. Key findings from this study reveal the geographical and demographic distribution of SUP use. Consequently, these findings may inform the industry about its target audience. Additionally, information regarding the 'typical' SUP rider may serve to further promote and grow the sport.

Impact of A Collaborative Strategy to Reduce the Inappropriate Use of Acid Suppressive Therapy in Non-Intensive Care Unit Patients

BACKGROUND

Stress ulcer prophylaxis (SUP) is inappropriately prescribed in more than 30% of non-intensive care unit (ICU) patients, leading to unnecessary adverse events as well as increases in economic burden.

OBJECTIVE

There was an increasing trend in the prophylactic use of acid suppressive therapy (AST) in non-critically ill patients at our institution, which prompted this initiative aimed at reducing the inappropriate use of AST in non-ICU patients.

METHODS

This was a retrospective interventional study that consisted of formulation of a guideline, education to the hospitalist service, and intervention by clinical pharmacists. All adult non-ICU patients admitted to the hospitalist service who were newly initiated on AST were considered for inclusion. The primary outcome was a comparison of the proportion of inpatient days with inappropriate AST. Secondary outcomes included a comparison of patients discharged on inappropriate AST and drug acquisition costs, successful pharmacy interventions, hospitalist interventions, incidence of Clostridium difficile infection (CDI) or gastrointestinal (GI) bleeding, and drug costs averted through pharmacy intervention.

RESULTS

There were 61 patients in the historical group and 81 patients in the interventional group. This intervention resulted in a 31% absolute reduction in inappropriate patient days of AST and a 24% absolute reduction in patients discharged on inappropriate AST. There were 23 successful interventions. There were no cases of CDI and 1 GI bleed. This intervention resulted in an 87% reduction in drug acquisition costs per patient.

CONCLUSIONS

A collaboration between clinical pharmacists and a hospitalist service can significantly reduce the inappropriate use of AST in non-ICU patients.

Epidemiology of Injuries in Stand-Up Paddle Boarding

Background:

Stand-up paddle boarding (SUP) is a recreational activity and sport that has grown exponentially, with participation increasing from 1.1 million in 2010 to 2.8 million in 2014 in the United States alone. Despite this growth in participation, SUP remains underresearched with regard to injury epidemiology.

Purpose:

To investigate injury epidemiology (severity, location, type, mechanism) in SUP.

Study Design:

Descriptive epidemiology study.

Methods:

An open-source online survey was administered to active SUP participants internationally. The survey captured information relevant to demographics, participation, and injury history over the past 12 months.

Results:

Of 240 participants included in the data analysis, 67.1% were males, and 54.6% were involved in competition. Participants spent a mean 192.6 ± 179.5 hours participating in SUP per year, most commonly for fun and fitness (43.3%) at the beach or bay (63.0%). A total of 95 participants had sustained at least 1 injury. A total of 161 injuries were recorded, resulting in an injury rate of 3.63 (95% CI, 3.04-4.16) per 1000 hours of SUP. The shoulder/upper arm was the most frequently injured body location, accounting for 32.9% of all injuries, followed by the lower back (14.3%) and the elbow/forearm (11.8%). The most common injury types were to muscle/tendon (50.4%), joint/ligament (22.6%), and skin (14.2%). Endurance paddling was the most frequently reported mechanism of injury (34.5%), followed by contact with a paddler’s own board (20.1%) and sprint paddling (9.3%). Key risk factors for sustaining an injury were age >46 years, competitive status, and participating for >4.8 hours/week, as well as using SUP for racing.

Conclusion:

This is the first study to report injury epidemiology for SUP. It is evident that both sexes participate in SUP for fun, fitness, and competition. With regard to injuries, the shoulder, lower back, and elbow are the most injury prone; older age, competitive status, and longer hours of participation all influenced the chance of injury. Findings from this study provide the foundation for injury prevention strategies.

The physiological, musculoskeletal and psychological effects of stand up paddle boarding

Background

Stand up paddle boarding (SUP) is a rapidly growing sport and recreational activity where anecdotal evidence exists for its proposed health, fitness and injury rehabilitation benefits. While limited scientific evidence exists to substantiate these claims, previous studies have shown that high levels of fitness, strength and balance exists amongst participants of this sport. The purpose of this study was to conduct a training intervention on a group of previously untrained individuals to ascertain the potential of SUP on various health parameters.

Methods

An intervention study was conducted where after being tested initially, subjects were left for 6 weeks to act as their own control before the SUP intervention began. A total of 13 SUP participants completed the training study (nine males, four females) which was comprised of three 1 h sessions per week for 6 weeks.

Results

No significant changes occurred during the initial control period. Significant (P < 0.05) improvements were made in aerobic (+23.57 %) and anaerobic fitness (+41.98 %), multidirectional core strength tests (prone +19.78 %, right side +26.19 %, left side +28.31 %, Biering Sorensen +21.33 %) and self-rated quality of life questionnaires in the physical (+19.99 %) and psychological (+17.49 %) domains. No significant changes were detected in static or dynamic balance over the duration of the training intervention.

Conclusion

These results demonstrate the cardiovascular, musculoskeletal and psychological improvements achievable for the novice when utilizing SUP as a training tool. The result from this study provides some evidence to substantiate the claims of health and fitness benefits SUP.

Proton Pump Inhibitors and the Risk for Hospital-Acquired Clostridium difficile Infection

OBJECTIVE

To examine the relationship between proton pump inhibitor (PPI) usage and nosocomial Clostridium difficile infection (CDI) and determine the duration of therapy at which CDI risk increases.

PATIENTS AND METHODS

This retrospective case-control study included consecutive adult patients in whom nosocomial CDI developed after hospitalization for 3 or more days at one of 2 affiliated hospitals between June 1, 2010, and October 31, 2011. These patients were matched to patients hospitalized within 6 months who did not have CDI development in a 1:2 ratio using age, sex, and antibiotic usage. Potential risk factors for CDI, including PPI use and duration, were evaluated. Multivariate analysis was performed to control for confounding variables and identify risk factors.

RESULTS

A total of 201 patients were evaluated, 67 with CDI and 134 matched controls. Patients in whom CDI developed were more likely to have received a PPI (76% vs 39%; P<.001) and had a longer duration of PPI therapy (median [range], 5 [0-20] days vs 0 [0-11] days; P<.001) than those who did not have CDI development. After controlling for prior hospital admission, intensive care unit admission, admission from a skilled nursing facility, immunosuppression, number of antibiotics received, PPI duration, and time to event via multivariate analysis, PPI duration was found to be a risk factor for CDI (odds ratio, 1.14; 95% CI, 1.02-1.27; P=.018). The probability for CDI was higher when PPI use exceeded 2 days in patients without a prior hospital admission and 1 day in patients with a prior admission.

CONCLUSION

The duration of PPI therapy is significantly associated with CDI. Clinicians should strongly consider restricting PPI use given the short exposure time associated with this increased risk.

Impact of partial volume effect correction on cerebral β-amyloid imaging in APP-Swe mice using [(18)F]-florbetaben PET

We previously investigated the progression of β-amyloid deposition in brain of mice over-expressing amyloid-precursor protein (APP-Swe), a model of Alzheimer's disease (AD), in a longitudinal PET study with the novel β-amyloid tracer [(18)F]-florbetaben. There were certain discrepancies between PET and autoradiographic findings, which seemed to arise from partial volume effects (PVE). Since this phenomenon can lead to bias, most especially in the quantitation of brain microPET studies of mice, we aimed in the present study to investigate the magnitude of PVE on [(18)F]-florbetaben quantitation in murine brain, and to establish and validate a useful correction method (PVEC). Phantom studies with solutions of known radioactivity concentration were performed to measure the full-width-at-half-maximum (FWHM) resolution of the Siemens Inveon DPET and to validate a volume-of-interest (VOI)-based PVEC algorithm. Several VOI-brain-masks were applied to perform in vivo PVEC on [(18)F]-florbetaben data from C57BL/6(N=6) mice, while uncorrected and PVE-corrected data were cross-validated with gamma counting and autoradiography. Next, PVEC was performed on longitudinal PET data set consisting of 43 PET scans in APP-Swe (13-20months) and age-matched wild-type (WT) mice using the previously defined masks. VOI-based cortex-to-cerebellum ratios (SUVR) were compared for uncorrected and PVE-corrected results. Brains from a subset of transgenic mice were ultimately examined by autoradiography ex vivo and histochemistry in vitro as gold standard assessments, and compared to VOI-based PET results. The phantom study indicated a FWHM of 1.72mm. Applying a VOI-brain-mask including extracerebral regions gave robust PVEC, with increased precision of the SUVR results. Cortical SUVR increased with age in APP-Swe mice compared to baseline measurements (16months: +5.5%, p<0.005; 20months: +15.5%, p<0.05) with uncorrected data, and to a substantially greater extent with PVEC (16months: +12.2% p<0.005; 20months: +36.4% p<0.05). WT animals showed no binding changes, irrespective of PVEC. Relative to autoradiographic results, the error [%] for uncorrected cortical SUVR was 18.9% for native PET data, and declined to 4.8% upon PVEC, in high correlation with histochemistry results. We calculate that PVEC increases by 10% statistical power for detecting altered [(18)F]-florbetaben uptake in aging APP-Swe mice in planned studies of disease modifying treatments on amyloidogenesis.