OBJECTIVES:This study aims to identify factors associated with early antenatal care (ANC) initiation using a survival analysis approach applied to nationally representative data. DESIGN, SETTING AND PARTICIPANTS:This study used a cross-sectional design based on data from the nationally representative 2022 Bangladesh Demographic and Health Survey. The survey was conducted at the community level across all administrative divisions of Bangladesh. A total of 5128 ever-married women aged 15-49 years who had a live birth within 5 years prior to the survey were included in the analysis. Women with missing or incomplete information regarding the timing of their first ANC visit were excluded from the study. OUTCOME:The primary outcome was early initiation of ANC, defined as the first ANC contact within the first trimester. MATERIALS AND METHODS:The study applied survival analysis methods, including Kaplan-Meier survival curves, log-rank tests and an Accelerated Failure Time model, to assess the determinants of early ANC initiation. FINDINGS:Only 37.9% (95% CI 36.0% to 39.9%) of women in Bangladesh initiated ANC within the first trimester. Early ANC initiation was associated with higher maternal age, education, skilled employment, wealthier households, media exposure, higher decision-making autonomy, higher husband's education and urban residence. Women who reported that distance to a health facility was not a big problem had initiated ANC earlier than those who considered distance a major barrier. Regional disparities were also evident, with women from Barishal, Chattogram, Rajshahi, Khulna and Rangpur accessing ANC later than those in Dhaka. CONCLUSIONS:Persistent inequalities in early ANC initiation highlight the need for targeted policies to reduce financial barriers, improve healthcare accessibility and strengthen awareness campaigns to ensure equitable maternal healthcare in Bangladesh.
BACKGROUND:Student-athletes face unique challenges when transitioning out of collegiate sports, losing access to comprehensive athletic department healthcare services while navigating the critical developmental period of emerging adulthood. PURPOSE:Identify health and wellbeing needs among former student-athletes who have recently transitioned out of college sports to inform targeted healthcare transition strategies. STUDY DESIGN:Mixed-methods design. LEVEL OF EVIDENCE:Level 4. METHODS:A total of 35 former student-athletes (17 women, 18 men) representing diverse backgrounds who participated in their final collegiate competition between 2019 and 2023 completed surveys assessing self-reported measures of health indicators, transition healthcare resources, healthcare engagement, and sport transition planning. A total of 12 former student-athletes participated in focus groups exploring barriers and facilitators in their healthcare transition experience. RESULTS:Participants generally perceived their current health as similar to or improved compared with their collegiate athletic careers (37.1% each), whereas a smaller proportion reported worse health (25.7%). While many participants reported having a general transition plan, most (68.6%) lacked a specific healthcare management plan. Participants cited difficulties with obtaining the care or treatment they needed. Focus groups highlighted a "Performance over People" culture in elite sport in which athletic achievement was prioritized over long-term well-being. "Relational Resources" such as support from family, friends, mentors, and knowledgeable medical professionals were critical for successful sport transition. CONCLUSION:The broader culture of elite sport and the long-term consequences of participation appear to affect how student-athletes understand their health and engage with healthcare as former athletes. Former collegiate athletes experience notable gaps in healthcare support during their transition out of collegiate sports, particularly in accessing holistic care from providers who understand their health needs as former student-athletes. CLINICAL RELEVANCE:Structured healthcare transition planning, specialized provider networks that connect patients to medical professionals with sport-specific expertise, and formal mentorship programs are potential strategies for promoting the physical and mental wellbeing of former student-athletes during and after their transition out of collegiate sport.
Injury and illness burden in sports has traditionally been quantified using severity and time-loss metrics, which focus narrowly on days missed from sport. These measures fail to capture the full spectrum of health consequences, particularly those associated with non-time-loss injuries, chronic conditions, and lingering impairments following return to play. To address this gap, we propose the disability-adjusted sporting year (DASY), a novel metric adapted from the public health framework of disability-adjusted life years (DALYs). The DASY incorporates both the immediate and long-term health impact of sport-related injuries and illnesses by summing years of sport lost (YSL) and years lived with injury (YLI), weighted by condition-specific disability weights derived from broad population surveys. By anchoring assessments in athlete health rather than sport participation alone, the DASY enables a more comprehensive, equitable, and athlete-centered approach to surveillance, clinical decision making, and policy development. This manuscript outlines the theoretical foundation, calculation framework, and potential applications of the DASY metric, with the goal of advancing how health burden is evaluated in sport. By shifting the focus from return-to-play timelines to overall health loss, the DASY aligns athlete welfare more closely with broader public health standards and offers a robust tool for comparative risk assessment across sporting contexts.
Background:Shoulder and elbow injuries (SEIs) remain prevalent among high school (HS) baseball players. Pitching restriction (PR) policies were mandated by the National Federation of State High School Associations (NFHS) in 2016 as an injury prevention strategy to set workload limits and reduce overuse injuries. The effect of PR policies on HS baseball SEIs remains unknown. Hypotheses:(1) SEI rates in HS baseball players would be lower in the 3 seasons after PR policy implementation when compared with the 3 seasons before PR policy implementation and (2) specific components of PR policies would be associated with statistically significant decreases in SEI rates. Study Design:Descriptive epidemiological study. Methods:NFHS member state PR policies were obtained from publicly available websites, and components of each policy were analyzed for similarities and differences. SEI/exposure data for US HS baseball players were obtained from High School Reporting Information Online, a sports injury surveillance system. Athletic trainers reported practice and competition injury and athlete-exposure (AE) data from a national school sample during the 2013-2014 through 2018-2019 academic years. Results:During the study period, 295 (164 shoulder, 131 elbow) injuries occurred during 1,554,708 AEs. No statistically significant changes were found in SEI rates, shoulder-specific rates, or elbow-specific injury rates after PR policy mandates were implemented. When analyzing injury rates for practices and competitions collectively, consecutive pitching day rest rules (incidence rate ratio [IRR], 0.32; 95% CI, 0.22-0.46), ≤105 pitch daily maximum (IRR, 0.40; 95% CI, 0.31-0.51), different PR policy rules for regular versus postseason (IRR, 0.43; 95% CI, 0.27-0.65), varsity versus subvarsity pitch count maximums (IRR, 0.46; 95% CI, 0.35-0.59), and ≥4 days' rest if >105 pitch count (IRR, 0.53; 95% CI, 0.42-0.68) provided protective effects against SEIs compared with PR policies without these components. Conclusion:Specific components of PR policies rather than a national PR policy mandate were associated with significant reduction in SEI rates in HS baseball players. The presence of a consecutive pitching day rest rule and daily maximum pitch count of ≤105 pitches were associated with significant reductions in SEIs based on total (practice and competition) exposures, practice exposures, and competition exposures.
