'The Fittest on Earth': Performance and Image Enhancing Drugs Use Within UK CrossFit Communities

While there are different harms that are related to sport/exercise (hooliganism, gambling, drug use, violence, etc.), in this chapter we are particularly interested in exploring the ‘subjective harms’ and ‘embedded harms’ associated with the exercise regime known as CrossFit, with specific attention to the use of performance and image enhancing drugs (PIEDs) and dietary supplements within this milieu. Drawing on the deviant leisure perspective, the chapter explores the possible ways in which CrossFitters may ‘self-harm’ in their conformity to social norms and values and specifically the cultural injunction to either perform or be aesthetically appealing and, more importantly, how these harms may be mitigated, meditated or exacerbated by a CrossFit leisure identity. The main purpose of this chapter is to (1) empirically investigate the reported prevalence of supplements and PIEDs in CrossFit within the UK, (2) examine the relationship between CrossFit and (un)healthy behaviours and practices more generally and (3) situate our findings within the broader theoretical lens of deviant leisure

Global overview of the management of acute cholecystitis during the COVID-19 pandemic (CHOLECOVID study)

Abstract Background This study provides a global overview of the management of patients with acute cholecystitis during the initial phase of the COVID-19 pandemic. Methods CHOLECOVID is an international, multicentre, observational comparative study of patients admitted to hospital with acute cholecystitis during the COVID-19 pandemic. Data on management were collected for a 2-month study interval coincident with the WHO declaration of the SARS-CoV-2 pandemic and compared with an equivalent pre-pandemic time interval. Mediation analysis examined the influence of SARS-COV-2 infection on 30-day mortality. Results This study collected data on 9783 patients with acute cholecystitis admitted to 247 hospitals across the world. The pandemic was associated with reduced availability of surgical workforce and operating facilities globally, a significant shift to worse severity of disease, and increased use of conservative management. There was a reduction (both absolute and proportionate) in the number of patients undergoing cholecystectomy from 3095 patients (56.2 per cent) pre-pandemic to 1998 patients (46.2 per cent) during the pandemic but there was no difference in 30-day all-cause mortality after cholecystectomy comparing the pre-pandemic interval with the pandemic (13 patients (0.4 per cent) pre-pandemic to 13 patients (0.6 per cent) pandemic; P = 0.355). In mediation analysis, an admission with acute cholecystitis during the pandemic was associated with a non-significant increased risk of death (OR 1.29, 95 per cent c.i. 0.93 to 1.79, P = 0.121). Conclusion CHOLECOVID provides a unique overview of the treatment of patients with cholecystitis across the globe during the first months of the SARS-CoV-2 pandemic. The study highlights the need for system resilience in retention of elective surgical activity. Cholecystectomy was associated with a low risk of mortality and deferral of treatment results in an increase in avoidable morbidity that represents the non-COVID cost of this pandemic. </jats:sec