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OBJECTIVES: National guidelines advise delaying initiation of solid foods until after 4-6 months of age and avoiding "high-risk" foods under the age of 4 years. However, foreign body aspiration of food remains a common preventable pediatric emergency. Our primary aim was to investigate public knowledge regarding the safe age of introduction of different foods to children and determine if demographic factors affect this knowledge. METHODS: An online survey was designed following a literature review and consultation with an expert panel. This was distributed via social media platforms. A review of our institutional data of bronchoscopy/foreign body retrievals was performed to identify trends. RESULTS: There were 1000 survey responses: 79.4% of respondents cared for children and 21.5% were medical professionals; 37.7% of respondents (n = 385) would offer high-risk foods to children <2 years of age and 56.9% (n = 582) to children <3 years. At our institution nuts (65.7%) were the most common food-related foreign body retrieved from a total of 265 over 21 years. Notably, 80% of respondents (n = 800) would offer whole nuts to children <4 years. Respondents with medical training were more likely to hold off on introducing nuts to children until a later age. CONCLUSION: Although the public has an overall appreciation of food safety, a significant proportion would feel comfortable offering high-risk foods to children under 2 and 3 years. There is a poor understanding of the danger of nuts and the appropriate age of introduction. Further research into effective public education strategies on safe food introduction in children are warranted. LEVELS OF EVIDENCE: V Laryngoscope, 2024.

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Choking susceptibility refers to the propensity of an athlete to choke under pressure. Mesagno has operationalized choking susceptibility as a combination of scores on self-consciousness, anxiety and coping. Despite the potential of Mesagno's protocol, there is currently limited support for its validity. Secondly, although mental toughness (MT) has a relationship with sport performance, there is limited research on its relationship to choking under pressure, specifically. The current study investigated the relationship between choking susceptibility and mental toughness. It was hypothesized that choking susceptible athletes will have significantly lower levels of mental toughness than those who are not choking susceptible. Data from a heterogeneous sample of athletes (N = 415) was obtained through a Qualtrics research panel. Results of a Mann-Whitney U showed that self-reported mental toughness was not significantly different in athletes categorized as choking susceptible and non-choking susceptible. Correlational analyses also highlighted differences between mental toughness and the composite scores of choking susceptibility, which provide researchers with avenues for future research in this area alongside a need for each construct to be examined in relation to choking behavior in sport.

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Aim: Recent emergence of airway clearance devices (ACDs) as a treatment alternative for foreign body airway obstructions (FBAO) lacks substantial evidence on efficacy and safety. This study aimed to assess pediatric residents' knowledge and skills in managing a simulated pediatric choking scenario, adhering to recommended protocols, and using LifeVac© and DeCHOKER© ACDs. Methods: Randomized controlled simulation trial, in which 60 pediatric residents from 3 different hospitals (median age 27 [25.0-29.9]; 76.7% female) were asked to solve an unannounced pediatric simulated choking scenario using three interventions to manage (randomized order): 1) following the recommended protocol of the European Resuscitation Council (encouraging to cough or combination of back blows and abdominal thrusts); 2) using LifeVac©; and 3) using DeCHOKER©. A Little Anne QCPR™ manikin (Laerdal Medical) was used. The variable compliance rate (%) was calculated according to the correct/incorrect execution of the steps constituting the proper actions for each test. Results: Participants demonstrated a correct compliance rate only ranging between 50-75% in following the recommended protocol for managing partial FBAO progressing to severe. Despite unfamiliarity with the ACDs, pediatric residents achieved rates between 75% and 100%, with no significant difference noted between the two devices (p = 0.173). Both scenarios were successfully resolved in under a minute, with LifeVac© demonstrating a significantly shorter response time compared to DeCHOKER© (39.2 [30.4-49.1] vs. 45.1s [33.7-59.2], p = 0.010). Conclusions: Only a minority of pediatric residents were able to adhere to the recommended FBAO protocol, whereas 70% of them were able to adequately use the ACDs. However, since a significant proportion could not, it seems that ACDs themselves do not address all issues.

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BACKGROUND: Instances of choking continue to pose a concern for the health and safety of children. This study aims to assess parents' understanding, awareness, and perspectives on child choking. METHODS: A cross-sectional study was conducted in the Al-Baha region of Saudi Arabia from September 13, 2023, to October 3, 2023. Data collection was done via an electronically validated questionnaire among parents aged 18 years and above, covering knowledge, attitudes, and practices. Statistical analysis was performed using the Mann-Whitney U test, the Kruskal-Wallis test, the Shapiro-Wilk test, and the Kolmogorov-Smirnov test. Any result below 0.05 (p < 0.05) was considered significant. RESULTS: Out of 819 participants, 705 individuals were included in the analysis. The results indicated that there was a good level of knowledge (55%) regarding handling child choking situations. Interestingly, females demonstrated higher levels of awareness compared to males (79.4% versus 20.6%). Attitudes toward managing child choking incidents were rated as overall moderate, with 66.5% showing poor practices, such as being hesitant to seek medical assistance if symptoms improved. A majority of choking cases occurred at home (85%), underscoring the importance of enhancing intervention strategies through increased knowledge dissemination. Notably, the internet and social media platforms (71.8%) emerged as primary sources of information on dealing with child choking incidents. There was significant interest in cardiopulmonary resuscitation (CPR) classes (69.2%), although many people found it hard to make time for them (45%). CONCLUSIONS: Parents in the Al-Baha area seem to have a good understanding but some concerning attitudes when it comes to child choking situations. It is important to spread awareness, correct misconceptions, and encourage CPR training.

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In Australia, strangulation has been explicitly criminalized in all states and territories. However, it continues to be a "normalized" sexual practice despite its potentially fatal consequences and associated short and long-term sequelae. This research aimed to establish the prevalence of strangulation during sex and examine predictors of positive perceptions toward sexual strangulation in Australia. Confidential, cross-sectional online surveys were conducted with 4702 Australians aged 18-35 years. Participants were 47% cis-men, 48% cis-women, and 4% trans or gender diverse. A total of 57% reported ever being sexually strangled (61% women, 43% men, 79% trans or gender diverse) and 51% reported ever strangling a partner (40% women, 59% men, 74% trans or gender diverse). Differences were found across genders on all variables of sexual strangulation, including frequency of engagement, level of pressure on the neck, consequences, wanting and enjoyment, and how consent was given/received. However, when split by gender, sexual orientation of men and women revealed further differences in behaviors, consequences, and wanting, particularly among straight and bisexual women. After accounting for exposure to strangulation in pornography and previous experience of sexual strangulation, positive perceptions of being strangled (R2 = .51) and strangling a partner (R2 = .53) were predicted by ratings that it could be done safely and social normative factors. These findings suggest strangulation is common during sex among young Australians. Non-stigmatizing education strategies are needed to engage with young people so they have a better understanding of the risks involved and how to negotiate consent and safety regarding sexual strangulation.

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AIM: To explore frontline health professionals' current understanding of non-fatal strangulation and their need for and support for a comprehensive education and screening package to support health delivery. DESIGN: A descriptive mixed-method approach was chosen to analyse responses to an anonymous, online survey consisting of ten Likert scale, open-ended and five demographic questions. 103 frontline health professionals (nurses, doctors, paramedics, midwives) participated in this study. METHODS: Content analysis of the Likert scale and open-ended questions describing the subjective experiences and perceptions of the participants was undertaken along with percentage and frequency counts of the rated Likert responses. RESULTS: The findings identified that 51.1% of health professionals do not ask about strangulation routinely and that 59% of health professionals reported receiving no formal education or professional development on NFS to enhance their knowledge or inform clinical practice. No health professionals identified mild traumatic brain injury as a consequence or sign of strangulation, nor did they identify an understanding that 50% of people may have no visible injuries after being strangled. Health professionals also do not routinely document the different agencies referred to or involved in supporting the person who experienced NFS. CONCLUSION: Findings suggest that frontline health professionals lack the confidence, skills and education needed to meet medical obligations to their patients and to fulfil their duty to 'do no harm'. Frontline health professionals would welcome a comprehensive education and screening package to guide recognition and response to non-fatal strangulation in their clinical settings. WHERE AND ON WHOM WILL THE RESEARCH HAVE AN IMPACT?: The purpose of the study was to understand and explore health professionals' knowledge about non-fatal strangulation so that improved education around better screening, and management of trauma-focused care to people who have been subjected to non-fatal strangulation could occur. NO PATIENT OR PUBLIC CONTRIBUTION: This review contains no patient or public contribution since it examines health professionals' knowledge of identifying non-fatal strangulation and the screening and assessment tools used in clinical practice.

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The risk of fatal choking for people with schizophrenia and associations with antipsychotic medication are largely unknown. Therefore, we calculated the choking-related standardized mortality ratio for schizophrenia relative to the general population (SMRchoking). We also computed adjusted hazard ratios (aHR) of choking-related mortality for antipsychotics in a nationwide cohort of patients with schizophrenia (N = 59,916). SMRchoking was 20.5 (95 % confidence interval (CI)=17.1-23.9). The aHR was 1.74 (95 %CI=1.19-2.55) for strong dopamine 2-antagonists. For other antipsychotics, CIs included 1. Importantly, aHRs were particularly high for high dose categories of strong dopamine D2 receptor (D2R) antagonists. In conclusion, a schizophrenia diagnosis is associated with a 20-fold risk of death due to choking. This risk is elevated during use of strong D2R antagonist antipsychotics, particularly when prescribed in high dosages.

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AIM: To quantify the associations of foreign body airway obstruction (FBAO) basic life support (BLS) interventions with FBAO relief and survival to discharge. METHODS: We identified prehospital FBAO patient encounters in Alberta, Canada between Jan 1, 2018 and Dec 31,2021 using the provincial emergency medical services' medical records, deterministically linked to hospital data. Two physicians reviewed encounters to determine cases and extract data. Multivariable logistic regression determined the adjusted odds ratio of FBAO relief (primary outcome) and survival to discharge for the exposure of BLS interventions (abdominal thrusts [AT], chest compressions/thrusts [CC], or combinations) relative to back blows [BB]. Intervention-associated injuries were identified using International Classification of Diseases codes, followed by health records review. RESULTS: We identified 3,677 patient encounters, including 709 FBAOs requiring intervention. Bystanders performed the initial BLS intervention in 488 cases (77.4%). Bystanders and paramedics did not relieve the FBAO in 151 (23.5%) and 11 (16.7%) cases, respectively. FBAOs not relieved before paramedic arrival had a higher proportion of deaths (n = 4[0.4%] versus n = 92[42.4%], p < 0.001). AT and CC were associated with decreased odds of FBAO relief relative to BB (adjusted odds ratio [aOR] 0.49 [95%CI 0.30-0.80] and 0.14 [95%CI 0.07-0.28], respectively). CC were associated with decreased odds of survival to discharge (aOR 0.04 [95%CI 0.01-0.32]). AT, CC, and BB were implicated in intervention-associated injuries in four, nine, and zero cases, respectively. CONCLUSIONS: Back blows are associated with improved outcomes compared to abdominal thrusts and chest compressions. These data can inform prospective studies aimed at improving response to choking emergencies.

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Oropharyngeal dysphagia, or difficulty initiating swallowing, is a frequent problem in people with Parkinson's disease (PD) and can lead to aspiration pneumonia. The efficacy of pharmacological options is limited. Postural strategies, such as a chin-down manoeuvre when drinking, have had some degree of success but may be difficult for people who have other limitations such as dementia or neck rigidity, to reproduce consistently. Using a user-centred design approach and a multidisciplinary team, we developed and tested an anti-choking mug for people with PD that helps angle the head in the optimum position for drinking. The design reflected anthropometric and ergonomic aspects of user needs with features including regulation of water flow rate and sip volume, an inner slope, a thickened handle and a wide base, which promoted a chin-down posture when used. Prototype testing using digital technology to compare neck flexion angles (the primary outcome), plus clinical outcomes assessed using standard tools (Swallowing Clinical Assessment Score in Parkinson's Disease (SCAS-PD) and Movement Disorder Society-Unified Parkinson's Disease Rating Scale (MDS-UPDRS) Parts II and III), found significant improvements in a range of parameters related to efficient swallowing and safe drinking when using the anti-choking mug versus a sham mug.

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Background and aim: Childhood choking is a global health concern that mainly affects children under the age of 5 years. The parent's and caretaker's responsibility is critical in the children's lives and can potentially influence the result of at-home injuries such as choking. We aimed to assess the knowledge, attitude, practice, and associated factors of first aid management toward choking hazards among Saudi adults from the Eastern Province. Methods: The present analytical study was carried out among 390 Saudi adults attending different primary health centers in the Eastern Province of Saudi Arabia. We used a standard and validated data research topic tool to assess knowledge, attitude, and practice. Spearman's correlation was applied to determine the correlation between each section, while binomial logistic regression analysis was applied to identify the associated factors. Results: We observed knowledge, attitude, and practice scores in 43.3, 38.9, and 36.4% of the participants, respectively. Furthermore, positive correlations between knowledge and attitude (rho = 0.42, p = 0.001), between knowledge and practice (rho = 0.57, p = 0.001), and between attitude and practice (rho = 0.41, p = 0.001) were revealed in our survey. The knowledge of the participants was significantly higher with the age group of 30-40 years [adjusted odds ratio (AOR) = 3.67 (1.94-4.65), p = 0.001] and participants who received training in first aid management [AOR = 1.64 (1.12-2.49), p = 0.037]. This study found that males [AOR = 0.36 (0.21-0.63), p = 0.001] and those working in the private sector [AOR = 0.61 (0.31-0.87), p = 0.018] had significantly lower attitudes. Conclusion: Our results underscore the importance of continuous health education initiatives and training courses at primary health care centers regarding first aid management of choking hazards to improve awareness and practices. Furthermore, we recommend prospective multicenter studies to address region-specific knowledge gaps.

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Predictive factors associated with a decline in swallowing function after 2 years were examined in 3409 Japanese older people aged ≥ 75 years who had undergone a dental checkup in Gifu Prefecture, Japan. Participants with normal swallowing function in a baseline survey in April 2018 were followed for 2 years. Swallowing function was assessed using a repetitive saliva swallowing test. In our study, 429 participants (13%) who were swallowing less than three times in 30 s based on a repetitive saliva swallowing test after 2 years were diagnosed as those with decline in swallowing function. Multivariate logistic regression analyses showed the decline in swallowing function after 2 years was associated with the male gender (odds ratio [ORs]: 0.772; 95% confidence interval [CIs]: 0.615-0.969), age ≥ 81 years (presence; ORs: 1.523; 95% CIs: 1.224-1.895), support/care-need certification (presence; ORs: 1.815; 95% CIs: 1.361-2.394), periodontal pocket depth (PPD) ≥ 4 mm (presence; ORs: 1.469; 95% CIs: 1.163-1.856), difficulty in biting hard food (yes; ORs: 1.439; 95% CIs: 1.145-1.808), choking on tea and water (yes; ORs: 2.543; 95% CIs: 2.025-3.193), and dry mouth (yes; ORs: 1.316; 95% CIs: 1.052-1.646) at baseline. Therefore, the dental checkup items associated with a decline in swallowing function after 2 years were a PPD ≥ 4 mm, difficulty in biting hard food, choking on tea and water, and dry mouth. PPD status and confirming to the self-administered questionnaire about biting, choking, and dry mouth may be useful in predicting future decline in swallowing function.

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Introduction: The tennis serve is commonly executed in high-pressure scenarios, often leading to performance decline; a condition commonly referred to as choking under pressure. One suggested effective method to avert choking involves contracting the left hand. We examined the effects of left-hand contraction on tennis serve performance using a wearable grasping material (polyurethane foam) which can be incorporated into sportswear. Materials and methods: We assigned 40 right-handed skilled tennis players to either the contraction group (n = 20) or the no-contraction group (n = 20). They were instructed to perform a second-serve task during the pre-test and pressure test. The participants in the contraction group squeezed the grasping material for 20 s before executing the task in the pressure test. We measured performance, including total scores, the number of maximum score achievements, landing positions, and kinematic indices (i.e., ball speed, racket speed, and impact height). Results: Although neither group demonstrated deteriorated performance on the pressure test, the contraction group experienced an increased number of maximum score achievements under the pressure situation compared with the pre-test (p = 0.021). Discussion: Our results suggest that when under pressure, left-hand contraction may improve performance during tennis serves.

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This study aims to determine the frequency of choking under pressure (i.e., choking) and quantify the prevalence of psychological and behavioural consequences of choking. 165 current and retired athletes (over 18 years old) from various sporting levels completed an online survey that asked about demographics, the frequency of choking, and the psychological (e.g., negative feelings toward sport, passion/enjoyment of sport negatively affected, and suicidal ideation) and behavioural (e.g., missing/skipping sport temporarily, dropping out/quitting sport, and maladaptive, risky behaviour) effects of choking. Descriptive statistics on choking frequency indicated 127 (77%) athletes in this sample experienced choking in the last year of playing their sport, and, on average, "choked" 18.25 times during that year. Of the 65 athletes currently playing sport, 36 (55.4%) experienced choking in the past month. Furthermore, 39.4% and 7.1% of athletes in this sample did not achieve higher levels of competition and had suicidal thoughts due to choking, respectively. High-performance athletes in the current sample were more likely to engage in maladaptive behaviours after choking compared to low-performance athletes. Choking more negatively affected the passion/enjoyment for sport of currently playing (i.e., excluding all retired) high-performance than currently playing low-performance athletes. This seminal study crudely quantifies the frequency of choking in athletes, but more importantly provides crucial evidence of the psychological and behavioural consequences of choking and advocates for further research into choking and athlete mental health.

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PURPOSE: Older patients with pneumonia are commonly restricted from oral intake due to concerns towards aspiration. Eating and drinking with acknowledged risks (EDAR) is a shared decision-making process emphasising patient comfort. As part of our project to find the barriers and facilitators of EDAR, we aimed for this initial study to see how frequently EDAR was selected in practice. METHODS: We performed a retrospective cohort study at an acute hospital where EDAR was initially developed, of patients aged ≥ 75 years-old admitted with pneumonia and referred to speech and language therapy. RESULTS: Out of 216 patients, EDAR decisions were made in 14.4%. The EDAR group had a higher 1-year mortality than the modified/normal diet groups (p < 0.001). Pneumonia recurrence rate did not differ significantly between the groups (p = 0.070). CONCLUSION: EDAR decisions were comparatively less common and most were associated with end-of-life care. Underlying reasons for the low EDAR application rate must be investigated to maximise patient autonomy and comfort as intended by EDAR while minimising staff burden.

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Pressure is an innate feature of competition and stimulates cognitions and emotions that can both reduce and enhance performance. Similarly, teams are ubiquitous in sport and influence their members in various ways. Yet, we know little about the ways in which teams influence their members' responses to pressure, whether they are an added demand, inducing social indispensability and exacerbating the effects of pressure, or a resource, providing shared responsibility and buffering pressure effects. We conducted a field experiment across two samples of skilled handball players (N = 189) to test how outcome interdependence vs. independence influenced athletes' appraisals of task importance and coping prospects, anxiety and excitement, and penalty shooting performance under lower vs. higher situational pressure, and to what extent performance order and teammate skill moderated these effects. We found that pressure increased task importance and emotional intensity yet being part of a team or not made little difference. Descriptively, interdependence did attenuate the increase in anxiety under higher pressure and, if paired with skilled teammates, strengthen the increase in excitement. Yet, weak pressure manipulations, insensitive samples and measures require replication and prohibit conclusive interpretations regarding the influence of teams on members' responses to pressure.

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We examined whether the alpha-band coherence between the T7-Fz (verbal analytical-motor planning) brain areas were related to superior performance in sports. We searched for related papers across eight databases: ProQuest Central, ProQuest Psychology Journals, PsycARTICLES, PsycINFO, SPORTDiscus, MEDLINE, Scopus, and Web of Science using relevant keywords (i.e., EEG AND sports AND coherence). Seven studies, with a total of 194 participants, met our inclusion criteria and were shortlisted for statistical analysis. We compared EEG coherence data for both within-subject and between-subject experimental designs. Our analysis revealed that athletes had lower coherence in the T7-Fz brain pathway for alpha- band activation (Hedges' g = - 0.54; p = 0.03) when performing better. Theoretically, these results corroborate the notion that athletes become more "neurally efficient" as the verbal and motor areas of their brains function more independently, i.e., the neural efficiency hypothesis. Accordingly, athletes who can limit verbal interference are more likely to perform a sporting task successfully.

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Introduction: In video gaming, tilt is thought to relate to poor emotional control and game performance. Despite widespread recognition of tilt in video gaming, there is a lack of research examining tilt empirically. Methods: One thousand and seven gamers took part in our online study examining gamers experience of tilt, the factors which contribute to and protect against tilt, and the emotion regulation strategies gamers employ to deal with tilt. Results: Gamers who reported playing for more competitive reasons, were at higher risk of experiencing tilt. Additional factors associated with an increased risk of experiencing tilt were increased anger and more hours spent playing. Protective factors against experiencing tilt were also identified, inclusive of a greater number of years gaming experience and engagement in adaptive emotion regulation strategies. Discussion: This study provides an important starting point for creating a better understanding of tilt in gaming, equipping us with new knowledge to better support gamers to improve their emotion regulation during game play performance.

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Background: Choking is a critical emergency that occurs when foreign objects obstruct the airways. It commonly affects young children, older people, individuals with developmental disabilities, those with acquired or lifelong disability, and those with mental health conditions. Symptoms can vary, ranging from coughing to cyanosis. Aim: Our study aims to evaluate Syrian adults' knowledge of choking and their understanding of first-aid procedures. Specifically, we will assess the prevalence of misconceptions in order to train community members and increase their level of knowledge about first aid for choking. Ultimately, our goal is to reduce deaths resulting from this critical condition. Methods: This cross-sectional study aims to assess the knowledge and attitudes regarding choking among adults in Syria. The targeted population consists of Syrians aged between 18 and 45 years who reside in Syria. Data were collected through an online survey, disseminated via social media platforms from March to July 2022. Scores were computed to quantify levels of knowledge, with participants achieving a score of 16 or higher classified as having a high level of knowledge. The collected data were analyzed using descriptive statistics, Pearson's correlation coefficient, and chi-square tests. Results: A total of 406 responded to the survey, with 246 (60.6%) scoring less than 16 points, indicating a low level of knowledge. Gender and place of residency were not correlated with knowledge level p = 0.249, p = 0.913, respectively). Participants employed in the medical field, those who had received training in first aid, and individuals with higher levels of education exhibited higher levels of knowledge. However, the level of knowledge was below expectations for these groups. Conclusion: There should be an increase in the availability of first-aid courses to the public and improvements in hands-on training for physicians and medical trainees.