Background Although commercially developed automated insulin delivery (AID) systems have recently been approved and become available in a limited number of countries, they are not universally available, accessible, or affordable. Therefore, open-source AID systems, cocreated by an online community of people with diabetes and their families behind the hashtag #WeAreNotWaiting, have become increasingly popular. Objective This study focused on examining the lived experiences, physical and emotional health implications of people with diabetes following the initiation of open-source AID systems, their perceived challenges, and their sources of support, which have not been explored in the existing literature. Methods We collected data from 383 participants across 29 countries through 2 sets of open-ended questions in a web-based survey on their experience of building and using open-source AID systems. Narratives were thematically analyzed, and a coding framework was identified through iterative alignment. Results Participants consistently reported improvements in glycemia, physical health, sleep quality, emotional impact on everyday life, and quality of life. Knowledge of open-source AID systems was largely obtained through the #WeAreNotWaiting community, which was also the primary source of practical and emotional support. The acquisition of the components to build an open-source AID system and the technical setup were sometimes problematic. Conclusions The #WeAreNotWaiting movement represents a primary example of how informed and connected patients proactively address their unmet needs, provide peer support to each other, and obtain results through impactful, user-driven solutions. Alongside providing evidence on the safety and efficacy of open-source AID systems, this qualitative analysis helps in understanding how patients’ experiences and benefits range from psychosocial improvements to a reduction in the burden of managing diabetes. International Registered Report Identifier (IRRID) RR2-10.2196/15368

IntroductionContinue investigating Out-of-Pocket Expenses (OoPEs) and rationing of insulin and diabetes supplies, including impacts of the COVID-19 pandemic, for people with type 1 diabetes (T1D).MethodsA cross-sectional web-based survey was conducted in English and advertised by T1International’s global network of patient advocates from May through September 2022. Participants provided monthly OoPEs and rationing frequency for insulin and supplies, impacts of the COVID-19 pandemic, and open-ended comments.ResultsIn the seven most represented countries, mean monthly OoPEs were highest in the United States, followed by Panama, Canada, and India, and were much lower in the United Kingdom, Germany, and Sweden. OoPEs were highest for participants with partial healthcare coverage, followed by those with no healthcare coverage. The COVID-19 pandemic negatively impacted access and/or affordability of insulin and/or supplies for over half of participants. Globally, 19.5% reported insulin rationing and 36.6% reported rationing glucose testing supplies. Qualitative analysis of open-ended responses identified themes such as ‘mental health impacts’ and ‘limits to life choices.’DiscussionHigh OoPEs lead to rationing of insulin and supplies for many people with T1D globally. Healthcare systems improvements and price reductions of insulin and supplies are needed to ensure adequate, equitable access for all.

An investigation of Irish workplace adaptation to COVID-19 was conducted to assess impact to workers, their organisations and to develop new occupational hygiene and health adaptation mechanisms for future pandemic emergencies. As part of the study, occupational safety and health (OSH) professionals (n=60) that held responsibilities for occupational hygiene and occupational health risk management, took part in a series of semi-structured mixed-method online focus groups. Each focus group incorporated twenty quantitative questions that were answered anonymously via a poll function. 58% of workplaces began pandemic occupational hygiene and health risk management preparations prior to COVID-19s emergence in Ireland. 66% of workplaces remained open while 27% were partially closed. 34% of workplaces had over half their workforce working from home (as opposed to 5% pre-pandemic). 54% of workplaces had existing occupational hygiene and health risk assessments that incorporated infectious disease considerations prior to the pandemic. 41% of workplaces had identified a viral pandemic scenario as part of its emergency planning prior to COVID-19. The majority (63%) of workers understood the occupational hygiene and health control measures instigated as a response to COVID-19 with a greater majority (90%) more willing to accept future workplace changes if they know it is to keep them safe and healthy. Irish workplaces adapted well to the changing OSH landscape that emerged in response to COVID-19. Irish workplaces are now more likely to be able to adapt and respond well to future similar public health emergencies.

Objectives To understand how essential workers with confirmed infections responded to information on COVID-19. Design Qualitative analysis of semistructured interviews conducted in collaboration with the national contact tracing management programme in Ireland. Setting Semistructured interviews conducted via telephone and Zoom Meetings. Participants 18 people in Ireland with laboratory confirmed SARS-CoV-2 infections using real-time PCR testing of oropharyngeal and nasopharyngeal swabs. All individuals were identified as part of workplace outbreaks defined as ≥2 individuals with epidemiologically linked infections. Results A total of four high-order themes were identified: (1) accessing essential information early, (2) responses to emerging ‘infodemic’, (3) barriers to ongoing engagement and (4) communication strategies. Thirteen lower order or subthemes were identified and agreed on by the researchers. Conclusions Our findings provide insights into how people infected with COVID-19 sought and processed related health information throughout the pandemic. We describe strategies used to navigate excessive and incomplete information and how perceptions of information providers evolve overtime. These results can inform future communication strategies on COVID-19.

Introduction: Workers quickly adapted during the COVID-19 pandemic to comply with updated work arrangements, control measures and policies. Understanding adaptation difficulties/fatigue and mental health issues among workers is crucial for OSH professionals to plan for future emergencies. Materials and Methods: As part of a larger COVID-19 workplace study, 16 two-hour focus groups (4-6 participants each) were conducted with OSH professionals (n=60) in Ireland, covering four predetermined themes (organisational preparedness;organisational impacts;worker adaptation behaviour;and the future of OSH post-pandemic). Thematic analysis was conducted using Nvivo. Results: OSH professionals observed many workers rapidly adapted and became involved in organisational COVID-19 outbreak prevention and long-term adaptation, in contrast to some workers that exhibited mental health problems as they struggled to adapt. Adaptation fatigue was observed when staff were sent home to work due to a range of factors: 1) isolation at home 2) no boundary between work and life;and 3) inability to disconnect from negative media coverage. The situation can be alleviated by 1) increasing informal communication to cope with isolation;2) Employee Assistance Programmes;and 3) additional consultation regarding their COVID-19 concerns. Conclusion: Most Irish workplaces focused more on employees’ physical safety rather than their mental wellbeing. The experiences shared by OSH professionals in this study illustrate their agility and ability to apply their risk management and control skills to any unanticipated public/occupational health crisis that arises.

The intense, physical contact nature of rugby union often encourages the normalization of risk-taking behaviour resulting in a relatively high acceptance of risk. This study aims to explore safety culture in rugby union from an OSH perspective, with the purpose of assisting coaches and management in their decision-making processes to improve players' health, welfare, and long-term well-being. In terms of data collection, this study involved semi-structured interviews with senior support staff (n = 15) in elite rugby union. Interview transcripts underwent inductive analysis prior to an abductive analysis that was guided by an established occupational-safety-and-health (OSH) framework. Rugby union players' safety can be considered from two dimensions: management's commitment to safety (i.e., safety prioritization, safety empowerment, and safety justice), players' involvement in safety (i.e., safety prioritization, and trust in other players' safety competence, and players' safety concern for the opposition players). Within the themes identified, players' attitude towards their opponents' safety which has been rarely considered as a factor for injury prevention is also discussed in this study. If sport support staff (i.e., managers/coaches/medical) can become more involved in players' performance-orientated training using OSH management processes to aid in their decision-making, their exists the capacity to benefit players' safe return to play after injury rehabilitation. Meanwhile, directing the development of appropriate behavioural educational interventions to raise safety-awareness amongst players can improve their long-term health and well-being and provide them with the necessary safety and health information to support their own decision-making processes. As a multidisciplinary design, this study contributes new multidisciplinary insights that have the potential to advance managerial practices utilizing an OSH perspective, including decision-making supporting risk alleviation for safety and long-term health and wellbeing initiatives in competitive team sports.

Introduction: An investigation of Irish workplace adaptation to COVID-19 was conducted to assess impact to workers, their organisations and to develop new OSH adaptation mechanisms for future health emergencies. Materials and Methods: As part of the study, OSH professionals (n=60), each representing their workplace, took part in a series of semi-structured online focus groups. Each focus group incorporated twenty quantitative questions (covering four themes: organisational preparedness;organisational impacts;worker impacts;and the future of OSH) that were answered anonymously via a poll function. Results: 59 participants completed the questions. 58% of workplaces began pandemic preparations prior to COVID-19 emerging in Ireland. 66% of workplaces remained open while 27% were partially closed. 34% of workplaces had more than half their workforce working from home (5% pre-pandemic). 37% of workplaces had a working from home policy with 54% of workplaces having risk assessments for infectious diseases in place prior to the pandemic. 41% of workplaces had identified a viral pandemic scenario as part of its emergency planning prior to COVID-19. OSH professionals indicated that the majority (63%) of their colleagues understood the control measures instigated as a response to COVID-19 with a greater majority (90%) more willing to accept future workplace changes if they know it is to keep them safe and healthy. Conclusion: Irish workplaces adapted well to the changing OSH landscape that emerged in response to COVID-19. Irish workplaces are now more likely to be able to adapt and respond well to future public health emergencies.

Background As a treatment option for people living with diabetes, automated insulin delivery (AID) systems are becoming increasingly popular. The #WeAreNotWaiting community plays a crucial role in the provision and distribution of open-source AID technology. However, while a large percentage of children were early adopters of open-source AID, there are regional differences in adoption, which has prompted an investigation into the barriers perceived by caregivers of children with diabetes to creating open-source systems.Methods This is a retrospective, cross-sectional and multinational study conducted with caregivers of children and adolescents with diabetes, distributed across the online #WeAreNotWaiting online peer-support groups. Participants-specifically caregivers of children not using AID-responded to a web-based questionnaire concerning their perceived barriers to building and maintaining an open-source AID system.Results 56 caregivers of children with diabetes, who were not using open-source AID at the time of data collection responded to the questionnaire. Respondents indicated that their major perceived barriers to building an open-source AID system were their limited technical skills (50%), a lack of support by medical professionals (39%), and therefore the concern with not being able to maintain an AID system (43%). However, barriers relating to confidence in open-source technologies/unapproved products and fear of digital technology taking control of diabetes were not perceived as significant enough to prevent non-users from initiating the use of an open-source AID system.Conclusions The results of this study elucidate some of the perceived barriers to uptake of open-source AID experienced by caregivers of children with diabetes. Reducing these barriers may improve the uptake of open-source AID technology for children and adolescents with diabetes. With the continuous development and wider dissemination of educational resources and guidance-for both aspiring users and their healthcare professionals-the adoption of open-source AID systems could be improved.

Objectives: This study aims to understand mental health issues among Irish employees arising from COVID-19 adaptation from the perspective of Occupational Safety and Health (OSH) and/or Human Resource (HR) professionals. Methods: Fifteen focus groups including 60 OSH/HR professionals from various sectors were conducted covering four predetermined themes. The data were transcribed verbatim, with transcripts entered into Nvivo for thematic analysis incorporating intercoder reliability testing. Results: The mental health impacts among employees are identified from three stages: pre-adaptation, during adaptation, and post-adaptation. Most issues were reported during the second stage when working conditions dramatically changed to follow emerging COVID-19 policies. The identified mental health support from participating organizations included providing timely and reliable information, Employee Assistance Programme (EAP), informal communication channels, hybrid work schedules and reinforcement of control measures. Conclusion: This study explores the challenges facing employees during the different stages of COVID-19 adaptation and the associated mental health impacts. Gender’s influence on mental health consultations should be considered when planning for public health emergencies, and further research conducted in male dominated industries.

Introduction: Considerable media attention has recently focused on an increased number of professional athletes that experience forced retirement due to severe injuries. Despite the highly completive, physical nature and tolerance of risk in contact sports, no Occupational Safety and Health (OSH) awareness-related measurement instrument exists in professional sports. As part of a wider project, this study aimed to develop a survey instrument to evaluate risk and safety awareness in sports, taking elite rugby (union) as an example. Methods: Based on the identified conceptual framework incorporating theories from the OSH discipline, the survey has been updated for three rounds according to the feedback from a multidisciplinary team of experts before the pilot test. The pilot test data (n=46, response rate 76.7%) were imported to SPSS for analysis and validation. The survey's key themes included health outlook, tackle behavior, awareness of risk acceptance, reasons for risk-taking, and safety consideration for other players. Results: Overall, the survey has a high internal consistency (Cronbach's α= 0.742). Some sections of the survey require a further factor analysis, such as awareness of risk acceptance during the competition (Kaiser-Meyer-Olkin Measure of Sampling Adequacy - KMO <0.767, p<0.001) and reasons for risk-taking (KMO<0.604, p=0.003). Some sections require a larger sample size for further validation, such as safety consideration for other players (KMO<0.481, p<0.001). Conclusion: This is the first survey that evaluates players' safety and risk awareness in rugby drawing upon OSH concepts. Such a survey has the potential to improve athletes' health and wellbeing by customized educational intervention, which could point the way forward for its application in a wider range of sport settings internationally.

The emergence of COVID-19 has resulted in workplace adaptations globally. This study aims to understand the challenges faced by employees during COVID-19 workplace adaptation that could cause mental health distress. Fifteen focus groups were conducted with Occupational Safety and Health (OSH) and/or human resource professionals (n=60) from various occupational settings in Ireland between April and May 2021. The findings showed that stress arose from three primary sources: technostress, work-from-home adaptation, and COVID-19 longevity. Supports from organizations, such as providing timely information, Employee Assistance Programs, informal communication channels and the reinforcement of COVID-19 control measures, are discussed as the possible solutions to mitigate employees’ mental stress. This study contributes to the understanding of employees’ stress and the development of an intervention plan for alleviating the mental health impacts arising from occupational adaption due to COVID-19. The findings also have implications for workplace coping strategies during future global public health crises.

BACKGROUND:Given the limitations in the access and license status of commercially developed automated insulin delivery (AID) systems, open-source AID systems are becoming increasingly popular among people with diabetes, including children and adolescents.OBJECTIVE:This study aimed to investigate the lived experiences and physical and emotional health implications of children and their caregivers following the initiation of open-source AID, their perceived challenges, and sources of support, which have not been explored in the existing literature.METHODS:Data were collected through 2 sets of open-ended questions from a web-based multinational survey of 60 families from 16 countries. The narratives were thematically analyzed, and a coding framework was identified through iterative alignment.RESULTS:A range of emotions and improvements in quality of life and physical health were reported, as open-source AID enabled families to shift their focus away from diabetes therapy. Caregivers were less worried about hypoglycemia at night and outside their family homes, leading to increased autonomy for the child. Simultaneously, the glycemic outcomes and sleep quality of both the children and caregivers improved. Nonetheless, the acquisition of suitable hardware and technical setup could be challenging. The #WeAreNotWaiting community was the primary source of practical and emotional support.CONCLUSIONS:Our findings show the benefits and transformative impact of open-source AID and peer support on children with diabetes and their caregivers and families, where commercial AID systems are not available or suitable. Further efforts are required to improve the effectiveness and usability and facilitate access for children with diabetes, worldwide, to benefit from this innovative treatment.INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID):RR2-10.2196/15368.

Abstract Background Despite widespread COVID-19 vaccination programs, there is an ongoing need for targeted disease prevention and control efforts in high-risk occupational settings. This study aimed to develop, pilot, and validate an instrument for surveying occupational COVID-19 infection prevention and control (IPC) measures available to workers in diverse geographic and occupational settings. Methods A 44-item online survey was developed in English and validated for face and content validity according to literature review, expert consultation, and pre-testing. The survey was translated and piloted with 890 workers from diverse industries in Canada, Ireland, Argentina, Poland, Nigeria, China, the US, and the UK. Odds ratios generated from univariable, and multivariable logistic regression assessed differences in ‘feeling protected at work’ according to gender, age, occupation, country of residence, professional role, and vaccination status. Exploratory factor analysis (EFA) was conducted, and internal consistency reliability verified with Cronbach’s alpha. Hypothesis testing using two-sample t-tests verified construct validity (i.e., discriminant validity, known-groups technique), and criterion validity. Results After adjustment for occupational sector, characteristics associated with feeling protected at work included being male (AOR = 1.88; 95% CI = 1.18,2.99), being over 55 (AOR = 2.17; 95% CI = 1.25,3.77) and working in a managerial position (AOR = 3.1; 95% CI = 1.99,4.83). EFA revealed nine key IPC domains relating to: environmental adjustments, testing and surveillance, education, costs incurred, restricted movements, physical distancing, masking, isolation strategies, and areas for improvement. Each domain showed sufficient internal consistency reliability (Cronbach’s alpha ≥0.60). Hypothesis testing revealed differences in survey responses by country and occupational sector, confirming construct validity (p < 0.001), criterion validity (p = 0.04), and discriminant validity (p < 0.001). Conclusions The online survey, developed in English to identify the COVID-19 protective measures used in diverse workplace settings, showed strong face validity, content validity, internal consistency, criterion validity, and construct validity. Translations in Chinese, Spanish, French, Polish, and Hindi demonstrated adaptability of the survey for use in international working environments. The multi-lingual tool can be used by decision makers in the distribution of IPC resources, and to guide occupational safety and health (OSH) recommendations for preventing COVID-19 and future infectious disease outbreaks.

Background In elite rugby union, players often expose themselves to risk-taking behaviours resulting in a high risk acceptance level. The practical and theoretical occupational safety and health (OSH) have the potential to reflect health outcomes (e.g., injuries and accidents) in sports settings. Objective This study explores key indicators of injury prevention and welfare protection in rugby union from an OSH perspective. Design This study utilises semi-structured interview, the duration of which ranged from 22 to 50 minutes digitally recorded with consents. Setting Individual interviews were conducted with current rugby supporting staff involving in national, provincial and university level. Patients (or Participants) The participants (n=15) were current rugby supporting staff including coaching staff, medical staff and other management personnel. Interventions (or Assessment of Risk Factors) The interview transcripts were inductively analysed by using Nvivo software, the key risk factors were then identified using abductive analysis by adopting an existing safety climate framework. Main Outcome Measurements Factors being neglected in sports research will be discussed in this study, for example, safety justice is relating to players' risk-taking behaviours during match or training; whether opponents are 'co-workers' and players' safety attitudes towards co-workers can influence players' aggressiveness which relates to injuries and accidents. Results The framework identified for evaluating OSH awareness will be presented from two dimensions including five themes: rugby management commitment (management safety priority, management safety empowerment and management safety justice) and rugby player involvement (players' safety priority and players' trust in co-workers' safety competence). Conclusions The findings have theoretical implications for rugby organisations to design a survey to facilitate the development of appropriate behaviour interventions. Furthermore, the framework could be potentially applied in wider sports settings.

Abstract Background COVID-19 has had a significant impact on workers, arising from adaptations to control measures and consequent behaviour changes that minimise disease spread in the workplace. From an occupational safety & health (OSH) perspective, understanding how adaptations and behaviour changes have impacted workers is relevant to how organisations can preserve the health of their workers when adapting to future health emergencies. Methods Semi-structured qualitative focus groups were conducted during April/May 2021. Participants were Irish OSH practitioners. Participants volunteered from industrial sectors (public & private) as defined by the Central Statistics Office. Participants (n = 60) partook in one of sixteen, two-hour focus groups (4-6 participants per focus group) with each comprising four themes for discussion: organisational preparedness; organisational impacts; worker impacts; and the future of OSH. Thematic analyses were performed using NVivo. Results Most participants started developing adaptation measures in February/March 2020. Organisations with an international presence started developing adaptation measures earlier. As OSH professionals, most participants felt personally prepared for the challenges induced by the pandemic but did not anticipate the impact it had on their workload. Nearly all participants indicated that isolation, loneliness, fear, and anxiety had a negative impact on their co-workers' mental health. Many OSH practitioners indicated that their co-workers had responded well to the pandemic, and that positive behaviour changes and new adaptation measures had been sustained from the first wave through the third wave of the pandemic in Ireland. Conclusions Workplace mental health evaluations and worker wellbeing initiatives must be prioritised post-pandemic. OSH will need to re-evaluate its relationship with organisational human resources in the future. Key messages Irish OSH practitioners responded well to the challenge presented by COVID-19 to protect their co-workers and maintain organisational continuity. COVID-19 has had a negative impact on the mental health of Irish workers as they respond to preserve their organisation’s operations. This will need to be addressed by organisations post-pandemic.

Workplaces can be high-risk environments for SARS-CoV-2 outbreaks and subsequent community transmission. Identifying, understanding, and implementing effective workplace SARS-CoV-2 infection prevention and control (IPC) measures is critical to protect workers, their families, and communities. A rapid review and meta-analysis were conducted to synthesize evidence assessing the effectiveness of COVID-19 IPC measures implemented in global workplace settings through April 2021. Medline, Embase, PubMed, and Cochrane Library were searched for studies that quantitatively assessed the effectiveness of workplace COVID-19 IPC measures. The included studies comprised varying empirical designs and occupational settings. Measures of interest included surveillance measures, outbreak investigations, environmental adjustments, personal protective equipment (PPE), changes in work arrangements, and worker education. Sixty-one studies from healthcare, nursing home, meatpacking, manufacturing, and office settings were included, accounting for ~280,000 employees based in Europe, Asia, and North America. Meta-analyses showed that combined IPC measures resulted in lower employee COVID-19 positivity rates (0.2% positivity; 95% CI 0–0.4%) than single measures such as asymptomatic PCR testing (1.7%; 95% CI 0.9–2.9%) and universal masking (24%; 95% CI 3.4–55.5%). Modelling studies showed that combinations of (i) timely and widespread contact tracing and case isolation, (ii) facilitating smaller worker cohorts, and (iii) effective use of PPE can reduce workplace transmission. Comprehensive COVID-19 IPC measures incorporating swift contact tracing and case isolation, PPE, and facility zoning can effectively prevent workplace outbreaks. Masking alone should not be considered sufficient protection from SARS-CoV-2 outbreaks in the workplace.

Background Despite the physical, competitive nature of elite athletes and unique features of sport culture, no Occupational Safety and Health (OSH) related measurement instruments exist in sport. Objective As a part of a wider project focusing on health and safety awareness in elite sport, the purpose of this study was to develop a survey instrument for the evaluation of risk and safety awareness among elite rugby players. Design Based on an established conceptual framework incorporating OSH theories, the survey was developed by adopting questions from existing validated questionnaires through an iterative process, with the feedback from a multidisciplinary team of experts and pilot test. Setting Elite division rugby (union) team in Ireland Participants Players from an elite rugby team in Ireland (n=50) participated the advanced pilot test. Assessment of Risk Factors The key themes include current health outlook, tackle behaviour, awareness of risk acceptance, reasons for risk-taking, and safety consideration for other players. Main Outcome Measurements The data were imported to SPSS for analysis of survey reliability and validity, such as the adoption of the Kaiser-Meyer-Olkin (KMO) measure. Results Overall, the survey has a high internal consistency (Cronbach's α= 0.742). Some sections require a further factor analysis, such as current health outlook, (KMO<0.823, p<0.001) and reasons for risk-taking (KMO<0.604, p=0.003). Some sections indicate the requirement for a larger sample size for further validation, such as safety consideration for other players (KMO<0.48, p<0.001). The participants' qualitative comments on the viability of customising OSH concepts to sports context was also considered to refine the survey. Most players indicated a better understanding of risks relating to themselves than risks relating to opposition players. Conclusions Such a survey enables the measuring of athletes' safety and risk awareness level, which could possibly point the way forward for its application in a wider range of sport settings internationally for improving athletes' long-term health and wellbeing.

Background: The contact nature of rugby with its’ intensive physical interaction often exposes players to a high risk of injury and illness. Compliance with prescribed safety guidelines when returning to play during the COVID-19 pandemic is important for both rugby players and their support staff’s health and wellbeing. However, elite rugby has an inherent level of risk acceptance that has been a cultural norm in the game for decades. This paper aims to identify risk factors that influence players’ awareness and actions in relation to the highly communicable disease COVID-19, and provide rugby clubs and associations with practical return to play solutions from a health and safety perspective. Methods: This study thematically analysed interviews with 15 senior rugby support staff employed in elite rugby union that explored key factors impacting health-and-safety in elite rugby. With the emphasis on rugby players’ health-and-safety awareness (e.g. illness/injury reporting awareness) and rugby environment micromanagement (e.g. player hygiene) and rugby physical contact nature, analysing the factors that may be normalised in elite sporting settings in the context of managing return to play during the COVID-19 pandemic. Results: Due to physical contact nature of rugby, players are exposed to the risk of trauma resulting in skin abrasions and lacerations etc. which may aggregate the risk of infectious diseases. A level of micromanagement practices such as player hygiene management and health condition surveillance that builds on the current situation are effective and essential, considering rugby players in a high level of fitness condition and at a relatively young age can be overly confident with their ability to deal with the risk of illness. Furthermore, player awareness such as symptom reporting and return-to-play (RTP) after unwellness is due to improve for ensuring their health and wellbeing and of their fellow players as well as support staff during the back to field process in the context of COVID-19. Conclusions: Returning to rugby practice and competition will require a level of micromanagement and player safety awareness education in order to achieve the goal of optimally protecting the players from potential illness and / or spreading it to fellow players and support staff. Rugby rituals such as the New Zealand haka could be considered for keeping social distance between players while affirming the rugby nature of aggression exhibition.

Professional athletes involved in high-performance sport are at a high injury risk, which may lead to long-term health consequences. Professional athletes often expose themselves to risky behaviours, resulting in a higher acceptance level of occupational risk compared to other occupations. To date, many studies have focused on elite athletes' specific injury prevention techniques. The objective of this narrative review is to (1) summarise elite athletes' attitudes towards important occupational safety and health (OSH) practices, including injury reporting, medicine usage and personal protective equipment (PPE) usage, and (2) explore factors that may influence elite athletes' injury awareness. If injury awareness were given a similar weighting in elite sports as in any other highly physical occupation, the potential benefits to elite athletes and their long-term health could be highly significant. This review identifies that most elite athletes are not aware that sporting injuries are occupational injuries requiring behaviours determined by OSH rules. All the 39 studies identified met the moderate methodological quality criteria according to the Mixed Methods Appraisal Tool (MMAT). The factors impeding athletes' injury awareness from achieving occupational health standards are discussed from three safety management perspectives: organisational, societal and individual. This review contributes to a better understanding of how to build a positive safety culture, one that could reduce elite athletes' injury rate and improve their long-term wellbeing. Further research is required to develop a quantitative measurement instrument to evaluate occupational health awareness in the sport context. Based on the papers reviewed, the study population was categorised as elite, professional, high-performance amateur and student-athletes.