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Concussion or mild traumatic brain injury (mTBI) is a common phenomenon in the United States, with up to 3.6 million sport-related mTBIs diagnosed annually. Return to learn protocols have been developed to facilitate the reintegration of students into school after mTBI, however, the implementation of return to learn protocols varies significantly across geographic regions and school districts. An integrative review of the literature was performed using Whittemore and Knalf's methodology. A search of published literature was conducted using the PRISMA checklist. Database searches were conducted from March 2,019 to October 2,021 using the terms "mild traumatic brain injury" and "return to learn." Twenty-eight publications were included. Three themes were derived from this review: lack of policy, poor staff education on concussion symptoms and stakeholder communication breakdown. The development of communication patterns and use of a return to learn protocol could facilitate a gradual return to full academic workload after concussion.

The purposes of this study were 1) to investigate if cytokines were increased following a running road-race, and 2) to examine associations between cytokines and hyperthermia. Seventy-seven recreational runners participated in this study which occurred at the 7-mile race in the heat (ambient temperature, 25.0–26.7°C; %RH, 56.7–79.0 ± 5.0%). Before and following the race, blood draws were performed to measure circulating inflammatory cytokines. Core temperature was measured using an ingestible thermistor throughout the race. Core temperature was significantly higher at post-race (39.5 ± 0.7°C) than pre-race (36.9 ± 0.4°C, p < 0.001). IL-6, IL-8, and IL-10 significantly increased at post-race (IL-6, 48.0 ± 22.3 pg⋅ml−1; IL-8, 63.8 ± 23.9 pg⋅ml−1; IL-10, 29.2 ± 20.0 pg⋅ml−1) compared to pre-race (IL-6, 28.4 ± 13.6 pg⋅ml−1; IL-8, 53.2 ± 19.4 pg⋅ml−1; IL-10, 18.6 ± 11.9 pg⋅ml−1, p < 0.001). A greater increase in core temperature pre- to post-race was predicted by the faster finish time, a greater increase in IL-6, and greater body mass loss during the race (r2 = 0.298, p < 0.001). Small associations were found between IL-8 and core temperature at post-race (r = 0.255, p = 0.025). In conclusion, cytokines concentrations and core temperature increased following the race. Moreover, post-race hyperthermia is associated with increased IL-6, faster finish times, and higher body mass losses. [ABSTRACT FROM AUTHOR]

Background: The adoption of an emergency action plan for athletics (AEAP) minimizes the consequences of injuries. School nurses may play an important role in the adoption of an AEAP. The purpose of our study was to describe school nurse's knowledge and perceptions related to AEAP adoption. Methods: An online survey, following the Precaution-Adoption Process Model, examining respondents' readiness to act, was distributed to 1228 school nurses to evaluate their knowledge and perception of an AEAP, with N = 131 (10.6%) responding. Results: Sixty-one school nurses were unaware of AEAP adoption at their school. A lack of athletic training services at the school was associated with not adopting an AEAP. The most frequently reported barrier to adopting an AEAP related to finances. When nurses reported perceiving more barriers to adopting an AEAP, their schools were less likely to adopt one. Conclusions: A large number of nurses were unaware if their school adopted an AEAP. There is a need to improve nurses' knowledge and perceptions to promote AEAP development.

Exertional heat stroke (EHS) is a medical emergency whose likelihood in sport settings is often contingent on environmental factors, team policies, coaching strategies, and broader cultural expectations. Moreover, when it occurs, it requires immediate recognition, proper management, and care to optimize chances of survival or recovery without long-term sequelae. Max Gilpin, a secondary school American football player from Louisville, Kentucky, suffered an EHS during a football practice in August 2008, an event that resulted in his death. The purpose of this article is to use interdisciplinary methods to identify key factors that contributed to this tragedy so that similar situations do not happen again. It concludes that within a culture of inclusive gender norms and care, efforts should be made to have appropriate onsite medical expertise available to develop and implement best practices for the prevention, management, and treatment of EHS, along with coaching education specific to medical emergencies in sport and physical activity (such as EHS). This will create an environment that promotes health and safety for all student athletes participating in sport at the secondary school level.

Performing exercise in hot environmental conditions presents athletes with potential negative physiological and perceptual implications. Key constituents, such as fluid and electrolytes, are lost during sweating through the process of cooling the human body. The loss of electrolytes impairs exercise performance. Heat training is one strategy to combat sweat electrolyte loss, with decreased sweat electrolyte concentration being a main sudomotor adaptation. To measure sweat electrolyte concentration, two common assessment methods are typically utilized: whole-body washdown and regional sweat patch measurements. The effects of physiological adaptations and sweat electrolyte assessment methodology have been investigated; however, the importance of methodological differences between sweat electrolyte measurements following heat training has yet to be explored. This review explores the differences between sweat electrolyte measurement techniques following adaptations incurred with heat training. Future research directions are also provided. [ABSTRACT FROM AUTHOR]

California is the only state that does not regulate the athletic training profession, allowing unqualified personnel to be hired and call themselves athletic trainers (ATs). The benefits of employing a certified AT in the secondary school setting are numerous, but efforts to push regulation legislation continue to fail in California. To describe the availability of certified ATs in California secondary schools and explore factors influencing AT employment. Cross-sectional study. Online survey. Participants from 1538 California secondary schools. Officials from member schools completed the 2022–2023 California Interscholastic Federation Participation Census. Participants provided information specific to enrollment, sport participation, access to automated external defibrillators, and whether the school had ATs on staff. The AT's certification status was independently verified. Enrollment data specific to ethnicity, race, and percentage of students eligible for free meals were obtained through the California Department of Education Statistics. More than half (51.6%) of California secondary schools did not employ a certified AT, and 8.3% employed unqualified personnel as ATs. Nearly half (43%) of student-athlete participants were enrolled at schools with no certified AT. Schools that employed certified ATs had a lower proportion of students eligible to receive free and reduced-price meals. The average percentage of Hispanic or Latino students was greater in schools with no certified AT and schools that employed unqualified personnel as ATs than schools that employed certified ATs. Data indicate that, in a 5-year period, access to athletic training services in California secondary schools has not improved. Large gaps in access to athletic training services and clear socioeconomic and racial and ethnic disparities exist. Efforts to educate stakeholders on the importance of athletic training regulation in California should continue. [ABSTRACT FROM AUTHOR]

Little information exists regarding what exertional heatstroke (EHS) survivors know and believe about EHS best practices. Understanding this would help clinicians focus educational efforts to ensure survival and safe return-to-play following EHS. We sought to better understand what EHS survivors knew about EHS seriousness (eg, lethality and short- and long-term effects), diagnosis and treatment procedures, and recovery. Multiyear cross-sectional descriptive design. An 11.3-km road race located in the Northeastern United States in August 2022 and 2023. Forty-two of 62 runners with EHS (15 women and 27 men; age = 33 ± 15 years; pretreatment rectal temperature [TREC] = 41.5°C ± 0.9°C). Medical professionals evaluated runners requiring medical attention at the finish line. If they observed a TREC of ≥40°C with concomitant central nervous system dysfunction, EHS was diagnosed, and patients were immersed in a 189.3-L tub filled with ice water. Before medical discharge, we asked EHS survivors 15 questions about their experience and knowledge of select EHS best practices. Survey items were piloted and validated by experts and laypersons a priori (content validity index of ≥0.88 for items and scale). Survey responses. Sixty-seven percent (28/42) of patients identified EHS as potentially fatal, and 76% (32/42) indicated that it negatively affected health. Seventy-nine percent (33/42) correctly identified TREC as the best temperature site to diagnose EHS. Most patients (74%, 31/42) anticipated returning to normal exercise within 1 week after EHS; 69% (29/42) stated that EHS would not impact future race participation. Patients (69%, 29/42) indicated that it was important to tell their primary care physician about their EHS. Our patients were knowledgeable on the potential seriousness and adverse health effects of EHS and the necessity of TREC for diagnosis. However, educational efforts should be directed toward helping patients understand safe recovery and return-to-play timelines following EHS. [ABSTRACT FROM AUTHOR]

Participation in organized sport and recreational activities presents an innate risk for serious morbidity and mortality. Although death during sport or physical activity has many causes, advancements in sports medicine and evidence-based standards of care have allowed clinicians to prevent, recognize, and treat potentially fatal injuries more effectively. With the continual progress of research and technology, current standards of care are evolving to enhance patient outcomes. In this article, we provided 10 key questions related to the leading causes and treatment of sudden death in sport and physical activity, where future research will support safer participation for athletes and recreational enthusiasts. The current evidence indicates that most deaths can be avoided when proper strategies are in place to prevent occurrence or provide optimal care.