A Scoping Review of Concussion Guidelines in Amateur Sports in the United Kingdom
Abstract
:- What is already known?
- A recent report by the Digital, Culture, Media and Sports Committee criticised the UK Government and sporting governing bodies for their failure to reduce the risk of SRC, particularly within the amateur athlete population.
- The Berlin statement published by the Concussion in Sport Group (CISG) should act as a framework for the development of SRC guidelines.
- Whilst previous studies have looked at concussion guidelines within elite and professional sport, no research has been conducted focusing on SRC guidelines in amateur sport in the UK.
- What are the new findings?
- The vast majority of UK amateur sporting organisations have published SRC guidelines following the recommendations outlined by the Berlin statement; however, there is a large discrepancy between the contents of each sport-specific guide.
- We recommend that the UK government publish standardised concussion guidelines for the use of all amateur sporting organisations within the UK.
1. Introduction
2. Methods
2.1. Stage 1: Identify the Research Question(s)
- Which sporting governing bodies have published concussion guidelines appropriate for use in amateur sport in the UK?
- Do these concussion guidelines follow the recommendations outlined in the Berlin statement?
- What improvements can be made to future concussion guidelines?
2.2. Stage 2: Identifying Relevant Studies
2.3. Stage 3: Study Selection
2.4. Stage 4 and 5: Charting the Data and Collating, Summarizing, and Reporting Results
3. Results
3.1. Sporting Organisation Guidelines
3.2. Compliance with the Berlin Statement
4. Discussion
4.1. Accessibility
4.2. Recognise, Remove and Re-Evaluate
4.3. Rest
4.4. Refer and Recover
4.5. Return to Sport and Reconsider
4.6. Paediatric SRC
4.7. Gender and SRC
4.8. Return to School/Work
4.9. Residual Effects and Sequelae
4.10. Future Recommendations
4.11. Limitations
5. Conclusions
Author Contributions
Funding
Data Availability Statement
Conflicts of Interest
References
- Herring, S.; Kibler, W.B.; Putukian, M.; Solomon, G.S.; Boyajian-O’Neill, L.; Dec, E.L.; Franks, R.R.; Indelicato, P.A.; Labella, C.R.; Leddy, J.J.; et al. Selected issues in sport-related concussion (SRC|mild traumatic brain injury) for the team physician: A consensus statement. Br. J. Sports Med. 2021, 55, 1251–1261. [Google Scholar] [CrossRef] [PubMed]
- Moreland, G.; Barkley, L.C. Concussion in Sport. Curr. Sports Med. Rep. 2021, 20, 181–182. [Google Scholar] [CrossRef] [PubMed]
- McCrory, P.; Feddermann-Demont, N.; Dvoøák, J.; Cassidy, J.D.; Mclntosh, A.; Vos, P.E.; Echemendia, R.J.; Meeuwisse, W.; Tarnutzer, A.A. What is the definition of sports-related concussion: A systematic review. Br. J. Sports Med. 2017, 51, 877–887. [Google Scholar] [CrossRef] [PubMed]
- McCrory, P.; Johnston, K.; Meeuwisse, W.; Aubry, M.; Cantu, R.; Dvorak, J.; Graf-Baumann, T.; Kelly, J.; Lovell, M.; Schamash, P. Summary and agreement statement of the 2nd International Conference on Concussion in Sport, Prague 2004. Br. J. Sports Med. 2005, 39, 196–204. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- McCrory, P.; Meeuwisse, W.; Johnston, K.; Dvorak, J.; Aubry, M.; Molloy, M.; Cantu, R. Consensus Statement on Concussion in Sport—The 3rd International Conference on Concussion in Sport Held in Zurich, November 2008. S. Afr. J. Sports Med. 2009, 1, 406–420. [Google Scholar] [CrossRef] [Green Version]
- McCrory, P.; Meeuwisse, W.H.; Aubry, M.; Cantu, R.C.; Dvorak, J.; Echemendia, R.J.; Engebretsen, L.; Johnston, K.M.; Kutcher, J.S.; Raftery, M.; et al. Consensus Statement on Concussion in Sport—The 4th International Conference on Concussion in Sport Held in Zurich, November 2012. PM R 2013, 5, 255–279. [Google Scholar] [CrossRef]
- Aubry, M.; Cantu, R.; Dvorak, J.; Graf-Baumann, T.; Johnston, K.; Kelly, J.; Lovell, M.; McCrory, P.; Meeuwisse, W.; Schamasch, P. Summary and agreement statement of the First International Conference on Concussion in Sport, Vienna 2001. Phys. Sportsmed. 2002, 30, 57–63. [Google Scholar] [CrossRef]
- McCrory, P.; Meeuwisse, W.; Dvořák, J.; Aubry, M.; Bailes, J.; Broglio, S.; Cantu, R.C.; Cassidy, D.; Echemendia, R.J.; Castellani, R.J.; et al. Consensus statement on concussion in sport—The 5th international conference on concussion in sport held in Berlin, October 2016. Br. J. Sports Med. 2017, 51, 838–847. [Google Scholar] [CrossRef] [Green Version]
- Davis, G.A.; Makdissi, M.; Bloomfield, P.; Clifton, P.; Cowie, C.; Echemendia, R.; Falvey, E.C.; Fuller, G.W.; Green, G.A.; Harcourt, P.; et al. Concussion guidelines in national and international professional and elite sports. Neurosurgery 2020, 87, 418–425. [Google Scholar] [CrossRef]
- Beakey, M.; Blake, C.; Tiernan, S.; Collins, K. Are Irish Sporting Organisations Review article. Eur. J. Sport Med. 2016, 3, 41–54. [Google Scholar]
- Arksey, H.; O’Malley, L. Scoping studies: Towards a methodological framework. Int. J. Soc. Res. Methodol. Theory Pract. 2005, 8, 19–32. [Google Scholar] [CrossRef] [Green Version]
- Levac, D.; Colquhoun, H.; O’Brien, K.K. Scoping studies: Advancing the methodology. Implement. Sci. 2010, 5, 69. [Google Scholar] [CrossRef] [Green Version]
- Tricco, A.; Zarin, L.E.; O’Brien, K.; Colquhoun, H.; Levac, D. Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) Checklist SECTION. Ann. Intern. Med. 2018, 169, 11–12. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Sport England. Active Lives Adult November 2019–20 Report. 2019, pp. 1–57. Available online: https://sportengland-production-files.s3.eu-west-2.amazonaws.com/s3fs-public/2021-12/Active%20Lives%20Children%20and%20Young%20People%20Survey%20Academic%20Year%202020-21%20Report.pdf?VersionId=3jpdwfbsWB4PNtKJGxwbyu5Y2nuRFMBV (accessed on 10 July 2021).
- British American Football Association. British American Football Association Concussion Guidelines. 2017, Volume 1, pp. 1–10. Available online: https://rules.bafra.info/docs/2017/BAFA/Concussion%20Protocol%20FINAL.pdf (accessed on 10 July 2021).
- British Basketball. Concussion Guidelines for Basketball in Great Britain 2016-KEY POINTS SUMMARY. 2016, pp. 1–15. Available online: https://www.basketballengland.co.uk/media/12000/concussion-guidelines-2016.pdf (accessed on 11 July 2021).
- England Boxing. England Boxing Rule Book. 2020, p. 59. Available online: https://www.englandboxing.org/wp-content/uploads/2020/07/England-Boxing-Rule-Book-2020.pdf (accessed on 12 July 2021).
- England Cricket Board. New Some of the Key Developments Since the Last Ecb Concussion Guidelines. 2018, pp. 1–37. Available online: https://platform-static-files.s3.amazonaws.com/ecb/document/2018/03/20/1af72872-6efe-4cc9-8d47-9c9493bd46cd/ECB_Head_Injury_Concussion_Guidelines_2018.pdf (accessed on 10 July 2021).
- Gaelic Athletic Association. Concussion Management Guidelines for Gaelic Games. 2018, pp. 1–14. Available online: https://learning.gaa.ie/sites/default/files/ConcussionManagementGuidelinesforGaelicGamesNovember2018_0.pdf (accessed on 13 July 2021).
- Fédération Internationale de Gymnastique. Fig—Concussion Guidelines. 2020. Available online: https://a.storyblok.com/f/83342/x/bdad669133/medical_fig_concussion-overview.pdf (accessed on 27 July 2021).
- Moghal, M.; Rossiter, M. GB & England Hockey Concussion Policy Guideline Summary. 2018, pp. 1–12. Available online: https://www.cuhc.org.uk/wp-content/uploads/2020/10/CUHC-Concussion-Policy-2020-21.pdf (accessed on 11 July 2021).
- Eventing, B. British Eventing Rules & Member’s Handbook. 2021. Available online: https://www.britisheventing.com/news/2020-rules (accessed on 10 July 2021).
- International Ice Hockey Federation. International Ice Hockey Federation Concussion Protocol. 2017. Available online: https://blob.iihf.com/iihf-media/iihfmvc/media/downloads/medical/medical-care-guide/2021-iihf-concussion-protocol.pdf (accessed on 13 July 2021).
- British Judo. British Judo Association Minor Head Injury Policy. 2020, pp. 3–5. Available online: https://www.britishjudo.org.uk/wp-content/uploads/2020/02/Minor-Head-Injury-Policy-Valid-5th-February-2020-v1.1.pdf (accessed on 12 July 2021).
- England Netball. England Netball Concussion Policy. 2018. Available online: https://www.netballsouth.co.uk/userfiles/file/docs/competitions/EN-branded-concussion-policy.pdf (accessed on 12 July 2021).
- Rugby Football League. Concussion. Available online: https://www.rugby-league.com/governance/medical/concussion (accessed on 19 July 2021).
- England Rugby. HEADCASE- Extended Guidelines. Published Online First: 2021. Available online: https://www.englandrugby.com/dxdam/fc/fc36ddd4-fa06-413e-865a-3fb1d7c15926/HEADCASEEXTENDED.pdf (accessed on 14 July 2021).
- The Football Association. The FA’s Concussion Guidelines. 2019. Available online: https://www.thefa.com/get-involved/fa-concussion-guidelines-if-in-doubt-sit-them-outold (accessed on 10 July 2021).
- Swart, J.; Bigard, X.; Fladischer, T.; Palfreeman, R.; Riepenhof, H.; Jones, N.; Heron, N. Cycling-Specific Sport Related Concussion. Published Online First: 2020. Available online: https://www.uci.org/docs/default-source/medical/2020-uci-cycling-specific-sport-related-concussion-protocol.pdf (accessed on 14 July 2021).
- Echemendia, R.J.; Meeuwisse, W.; McCrory, P.; Davis, G.A.; Putukian, M.; Leddy, J.; Makdissi, M.; Sullivan, S.J.; Broglio, S.P.; Raftery, M.; et al. The Sport Concussion Assessment Tool 5th Edition (SCAT5): Background and rationale. Br. J. Sports Med. 2017, 51, 848–850. [Google Scholar] [CrossRef] [PubMed]
- Davis, G.A.; Purcell, L.; Schneider, K.J.; Yeates, K.O.; Gioia, G.A.; Anderson, V.; Ellenbogen, R.G.; Echemendia, R.J.; Makdissi, M.; Sills, A.; et al. The Child Sport Concussion Assessment Tool 5th Edition (Child SCAT5): Background and rationale. Br. J. Sports Med. 2017, 51, 859–861. [Google Scholar] [CrossRef]
- Echemendia, R.J.; Meeuwisse, W.; McCrory, P.; Davis, G.A.; Putukian, M.; Leddy, J.; Makdissi, M.; Sullivan, S.J.; Broglio, S.P.; Raftery, M.; et al. The Concussion Recognition Tool 5th Edition (CRT5): Background and rationale. Br. J. Sports Med. 2017, 51, 870–871. [Google Scholar] [CrossRef] [Green Version]
- Majerske, C.W.; Mihalik, J.P.; Ren, D.; Collins, M.W.; Reddy, C.C.; Lovell, M.R.; Wagner, A.K. Concussion in Sports: Postconcussive Activity Levels, Symptoms, and Neurocognitive Performance. J. Athl. Train. 2008, 43, 265–274. [Google Scholar] [CrossRef] [Green Version]
- Makdissi, M.; Schneider, K.J.; Feddermann-Demont, N.; Guskiewicz, K.M.; Hinds, S.; Leddy, J.J.; McCrea, M.; Turner, M.; Johnston, K.M. Approach to investigation and treatment of persistent symptoms following sport-related concussion: A systematic review. Br. J. Sports Med. 2017, 51, 958–968. [Google Scholar] [CrossRef]
- Makdissi, M.; Cantu, R.C.; Johnston, K.M.; McCrory, P.; Meeuwisse, W.H. The difficult concussion patient: What is the best approach to investigation and management of persistent (>10 days) postconcussive symptoms? Br. J. Sports Med. 2013, 47, 308–313. [Google Scholar] [CrossRef]
- Carson, J.D.; Lawrence, D.W.; Kraft, S.A.; Garel, A.; Snow, C.L.; Chatterjee, A.; Libfeld, P.; MacKenzie, H.M.; Thornton, J.S.; Moineddin, R.; et al. Premature return to play and return to learn after a sport-related concussion. Can. Fam. Phys. 2014, 60, e310–e315. Available online: http://www.cfp.ca/content/60/6/e310.abstract (accessed on 30 July 2021).
- Ellemberg, D.; Henry, L.C.; Macciocchi, S.N.; Guskiewicz, K.M.; Broglio, S.P. Advances in sport concussion assessment: From behavioral to brain imaging measures. J. Neurotrauma 2009, 26, 2365–2382. [Google Scholar] [CrossRef] [PubMed]
- Halstead, M.E.; Walter, K.D.; McCambridge, T.M. Clinical report—Sport-related concussion in children and adolescents. Pediatrics 2010, 126, 597–615. [Google Scholar] [CrossRef] [Green Version]
- Gessel, L.M.; Fields, S.K.; Collins, C.L.; Dick, R.W.; Comstock, R.D. Concussions among United States high school and collegiate athletes. J. Athl. Train. 2007, 42, 495–503. [Google Scholar] [PubMed]
- Field, M.; Collins, M.W.; Lovell, M.R.; Maroon, J. Does age play a role in recovery from sports-related concussion? A comparison of high school and collegiate athletes. J. Pediatr. 2003, 142, 546–553. [Google Scholar] [CrossRef] [Green Version]
- Lovell, M.R.; Collins, M.W.; Iverson, G.L.; Field, M.; Maroon, J.C.; Cantu, R.; Podell, K.; Powell, J.W.; Belza, M.; Fu, F.H. Recovery from mild concussion in high school athletes. J. Neurosurg. 2003, 98, 296–301. [Google Scholar] [CrossRef] [PubMed]
- McClincy, M.P.; Lovell, M.R.; Pardini, J.; Collins, M.W.; Spore, M.K. Recovery from sports concussion in high school and collegiate athletes. Brain. Inj. 2006, 20, 33–39. [Google Scholar] [CrossRef]
- Dick, R.W. Is there a gender difference in concussion incidence and outcomes? Br. J. Sports Med. 2009, 43, 46–50. [Google Scholar] [CrossRef]
- Collins, M.W.; Kontos, A.P.; Okonkwo, D.O.; Almquist, J.; Bailes, J.; Barisa, M.; Bazarian, J.; Bloom, O.J.; Brody, D.L.; Cantu, R.; et al. Statements of Agreement From the Targeted Evaluation and Active Management (TEAM) Approaches to Treating Concussion Meeting Held in Pittsburgh, October 15–16, 2015. Neurosurgery 2016, 79, 912–929. [Google Scholar] [CrossRef] [Green Version]
- Granito, V.; Carroll, J. Psychological response to athletic injury: Sex differences. J. Sport Behav. 2002, 25, 243–259. [Google Scholar]
- DeMatteo, C.; McCauley, D.; Stazyk, K.; Harper, J.; Adamich, J.; Randall, S.; Missiuna, C. Post-concussion return to play and return to school guidelines for children and youth: A scoping methodology. Disabil. Rehabil. 2015, 37, 1107–1112. [Google Scholar] [CrossRef]
- Covassin, T.; Moran, R.; Wilhelm, K. Concussion Symptoms and Neurocognitive Performance of High School and College Athletes Who Incur Multiple Concussions. Am. J. Sports Med. 2013, 41, 2885–2889. [Google Scholar] [CrossRef] [PubMed]
- Guskiewicz, K.M.; McCrea, M.; Marshall, S.W.; Cantu, R.C.; Randolph, C.; Barr, W.; Onate, J.A.; Kelly, J.P. Cumulative Effects Associated With Recurrent Concussion in Collegiate Football PlayersThe NCAA Concussion Study. JAMA 2003, 290, 2549–2555. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Zemper, E.D. Two-Year Prospective Study of Relative Risk of a Second Cerebral Concussion. Am. J. Phys. Med. Rehabil. 2003, 82, 653–659. Available online: https://journals.lww.com/ajpmr/Fulltext/2003/09000/Two_Year_Prospective_Study_of_Relative_Risk_of_a.1.aspx (accessed on 10 August 2021). [CrossRef] [PubMed]
- McCrory, P.; Davis, G.; Makdissi, M. Second Impact Syndrome or Cerebral Swelling after Sporting Head Injury. Curr. Sports Med. Rep. 2012, 11, 21–23. Available online: https://journals.lww.com/acsm-csmr/Fulltext/2012/01000/Second_Impact_Syndrome_or_Cerebral_Swelling_after.8.aspx (accessed on 10 August 2021). [CrossRef] [PubMed]
- Sport Scotland. If in Doubt, Sit Them Out. 2015, pp. 1–8. Available online: http://www.sportscotland.org.uk/media/1534421/Scottish-Sports-Concussion-Guidance.pdf (accessed on 16 August 2021).
Sport | Sporting Organisation Concussion Guidelines | Sport(s) Played within Organisation |
---|---|---|
American Football | British American Football Associatio [15] | American Football |
Basketball | British Basketball [16] | Basketball and Wheelchair Basketball |
Boxing | England Boxing [17] | Boxing |
Cricket | England and Wales Cricket Board [18] | Cricket |
Cycling | British Cycling | Road, Off road (MTB), Track, Paracycling, Amateur BMX, Leisure/Sportive & Cyclo-cross |
Gaelic | Gaelic Athletic Association [19] | Gaelic, Hurling, Camogie and Handball |
Gymnastics | British Gymnastics [20] | Acrobatic Gymnastics, Aerobic Gymnastics, Disability Gymnastics, Men’s Artistic Gymnastics, Rhythmic Gymnastics, TeamGym, Trampoline, Double Mini Tramp, Tumbling and Women’s Artistic Gymnastics |
Hockey | GB and England Hockey [21] | Field Hockey |
Equestrian | British Eventing [22] | Dressage, show jumping and cross country |
Ice Hockey | England Ice Hockey Association [23] | Ice Hockey |
Judo | British Judo [24] | Judo |
Netball | England Netball [25] | Netball |
Rugby League | England Rugby League [26] | Rugby League |
Rugby Union | England Rugby Union [27] | Rugby Union, Sevens Rugby, Tag and Touch Rugby |
Soccer | Football Association [28] | Soccer/Football |
Sporting Organisation | Assessment Tools | Initial Complete Rest (Hours) | GRTP Protocol | Return to Play | Notes | ||
---|---|---|---|---|---|---|---|
Child | Adult | Child | Adult | ||||
BAFA | SCAT3 PCRT | 48 | 24 | Yes | 23 | 19 | Athletes should not be left alone, consume alcohol or drive until all symptoms have gone |
BB | SCAT3 PCRT | NA | NA | Yes | 23 | 19 | NA |
EB | NA | 24–48 | 24–48 | Yes | 39 | 35 | Do not stay alone for the first 24 h post- injury Minimise use of mobile phones, TV, reading and all forms of training and exercise |
ECB | SCAT5 PCRT | NA | 24 | Yes | 23 | 7 | No alcohol, prescription or non- prescription drugs |
GAA | SCAT5 VOMS CRT5 | 48 | Male- 24–48 Female- 48 | Yes | 15 | Male- 7 Female- 15 | Should not be left alone for first 24 h. Minimise exposure to TV, PC, laptops, smartphones, tablets, video games etc |
BG | SCAT5 PCRT | NA | 48 | Yes | 28 | 14 | NA |
GBH | SCAT5 PCRT | NA | 24 | Yes | 23 | 6 | Must be off all medications that modify symptoms of the concussion e.g., painkillers |
EIHA | SCAT5 PCRT | NA | 24–48 | Yes | NA | 6 | NA |
BJ | NA | 7–10 days | 7–10 days | Yes | 28 | 14 | If unconsciousness results from shime waza (strangulation technique) the player may be allowed to return following three days of rest |
EN | SCAT5 PCRT | NA | NA | Yes | 23 | 6 | If no doctor present is suitably trained and experienced in the management of SRC a mandatory two week rest period must occur before commencing GRTP for all ages |
ERL | SCAT5 PCRT | 48 | 24 | Yes | 23 | 19 | Individuals should avoid initially then gradually reintroduce; reading, TV, computer games and driving |
ERU | SCAT5 PCRT | 24–48 | 24–48 | Yes | 23 | 19 | No driving, exercise, minimise screen time No cognitive (brain) activities e.g., reading, television, computer, video games and smart phones. |
FA | SCAT5 PCRT | 24–48 | 24–48 | Yes | 23 | 19 | Should not be left alone within the first 24 h, consume alcohol or drive a motor vehicle |
Sporting Organisation | Prolonged Recovery | Return to Work/Education | Record Concussion | Multiple Concussions | Medical Clearance |
---|---|---|---|---|---|
BAFA | NA | A player may need a day or two off work/study to rest and reasonable adjustments made to the player’s normal work/study | NA | NA | No |
BB | Concussion lasting longer than 10 days needs specialist assessment | NA | NA | A second concussion within 12 months should be assessed and managed by HCPs | Yes |
EB | If symptoms >four weeks post injury for children or >two weeks for adults contact your GP | When going back to school, you may need to go back gradually and have some changes to your schedule so that symptoms do not worsen. You should not return to sport until you have returned to full school/learning without symptoms | Yes | Two knockouts in 90 days = 90- day suspension Three knockouts in 12 months = 1-year suspension Loss of Consciousness (LOC):
| Yes |
ECB | Urgent neurological or neurosurgical consultancy before continuing GRTP | Return-to-school guidelines, which include extra-time for assignments/exams, quiet study areas, increased breaks and rest | Yes | Player needs a prolonged recovery period (i.e., three weeks) and/or onward referral. | Yes |
GAA | Symptoms lasting > 10–14 days should be referred to an appropriate specialist | A graduated return to school/education strategy is necessary. | NA | NA | Yes |
BG | Individuals with symptoms >4 weeks for children and >2 weeks for adults may benefit from a supervised multidisciplinary approach | NA | NA | NA | Yes |
GBH | Should be assessed and managed by experienced HCP | Athletes should partake in a graduated return to school programme. | NA | Should be assessed and managed by an experienced HCP | Yes |
EIHA | NA | NA | NA | Yes | |
BJ | NA | NA | Yes | NA | Yes |
EN | Recovery >10 days need referred to an experienced HCP | Academic and non- academic work should cease until stage two of the GRTP and that workload is reduced until completion of GRTP | NA | If second concussion within a 12-month period or history of multiple concussions (>3) referral to experienced HCP should take place | Yes |
ERL | NA | It is reasonable for a student to miss a day or two of studies but extended absence is uncommon and the young person’s academic teacher(s) or tutor should be consulted | Yes | NA | Yes |
ERU | Athletes who fail to progress through GRTP should return to their GP for review | In some cases, it may be appropriate for the player to miss a day or two of work/study | NA | Anyone who sustains >2 concussions in a 12-month period should seek advice from their GP | No |
FA | NA | Students may need to have allowances made for impaired cognition during recovery e.g., extra time | NA | Any player with a second concussion within 12 months should be assessed and managed by an experienced HCP | Yes |
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Scullion, E.; Heron, N. A Scoping Review of Concussion Guidelines in Amateur Sports in the United Kingdom. Int. J. Environ. Res. Public Health 2022, 19, 1072. https://doi.org/10.3390/ijerph19031072
Scullion E, Heron N. A Scoping Review of Concussion Guidelines in Amateur Sports in the United Kingdom. International Journal of Environmental Research and Public Health. 2022; 19(3):1072. https://doi.org/10.3390/ijerph19031072
Chicago/Turabian StyleScullion, Emer, and Neil Heron. 2022. "A Scoping Review of Concussion Guidelines in Amateur Sports in the United Kingdom" International Journal of Environmental Research and Public Health 19, no. 3: 1072. https://doi.org/10.3390/ijerph19031072