Healthy High School Research Articles

A - 54 Changes in the Blink Reflex after a Sport-Related Concussion: Test–Retest Reliability of a Blink Reflexometer

Abstract Purpose The blink reflex may be affected by concussion, but psychometric analyses examining devices that measure the blink reflex are limited. This study assessed the test–retest reliability of the Blinkcns EyeStatTM device at two pre-season baseline time points in a cohort of healthy high school athletes. Method During pre-season, high school athletes completed the EyeStatTM scanning twice, 15-minutes apart. Pearson/Spearman correlations and Intraclass Correlation Coefficients (ICC, i.e., the measure of test re-test reliability) were calculated across 10 different parameters (e.g., latency, total blink time, oscillations, time to open/close). Additionally, t-tests examined if these parameters differed based on biological sex, sleep status (i.e., <8 vs. ≥8 hours the night before), and prior concussion history (i.e., 0 vs. ≥1 prior concussions). Results Of the 48 athletes (age, M = 16.0¬ ± 1.2 years), 35.4% were female. Correlations ranged from 0.45–0.82 (all p-values<0.001) between the two assessments, and ICCs were 0.46–0.87 (all p-values<0.02). Additionally, none of the Eyestat parameters were significantly associated with biological sex, sleep status, or prior concussion history (all p-values>0.05). Conclusions This study suggests substantial test–retest reliability of the EyeStatTM device across 10 parameters in a cohort of healthy high school athletes. The findings support the potential utility of the EyeStatTM device as a reliable baseline measure for assessing the blink reflex among young athletes.

The effect of brain-derived neurotrophic factor Val66Met polymorphism on adolescent activity and rest rhythms, circadian preferences and attentional performance

BackgroundVariations in circadian regulating mechanisms generate different individual preferences in respect of sleep and activity timing, which are known as chronotypes. In this sense, specifically during adolescence, there is a greater tendency for an eveningness chronotype. One factor that has been shown to have an impact on circadian rhythm patterns, as well as on some aspects of cognitive function, is the relatively common Val66Met (rs6265) polymorphism in the human brain-derived neurotrophic factor gene. ObjectiveThis study aimed to evaluate the effect of the BDNF Val66Met polymorphism on the performance of adolescents in attentional tests, circadian preferences and activity-rest rhythm. Methods85 healthy high school students completed the Morningness-Eveningness Questionnaire to assess their circadian preferences; were evaluated using the Psychological Battery for Attention Assessment; and were categorized as carriers and non-carriers of the rs6265 polymorphism using the TaqMan rt-PCR technique. A subsample of 42 students had their activity/rest rhythm recorded by actigraphy for nine days from which sleep parameters were estimated. ResultsCircadian preference did not affect attentional performance (p > 0.1), but the time that the students attended school had an impact on all types of attention with morning shift students scoring higher, regardless of chronotype (p < 0.05). The presence of the BDNF Val66Met polymorphism was associated only with alternate attention performance (p < 0.05). Regarding actigraphy evaluation, the carriers of the polymorphism demonstrated significantly higher total time in bed, total sleep time, social jetlag, and earlier sleep onset. ConclusionsThe results indicate some degree of adaptation in the students' attentional performance, according to their school schedules. The presence of BDNF polymorphism demonstrated a counterintuitive impact on attentional performance, comparing to previous findings. The findings reinforce the effect of genetic traits on sleep-wake rhythm parameters, when objectively evaluated.

Preventing Stress among High School Students in Denmark through the Multicomponent Healthy High School Intervention-The Effectiveness at First Follow-Up.

Stress is a widespread phenomenon and young people especially are experiencing high levels of stress. School-related factors are the most frequently self-reported stressors among adolescents, but few interventions have targeted the school environment. This study evaluated the effectiveness of the Healthy High School (HHS) intervention on stress at a 9-month follow-up. The study included 5201 first-year high school students (~16 years) in Denmark. Participating schools were randomized into the HHS intervention (N = 15) or control group (N = 15). Baseline measurements were conducted in August 2016 and the follow-up was conducted in May 2017. The intervention was designed to promote well-being (primary outcome) by focusing on physical activity, meals, sleep, sense of security, and stress (secondary outcomes). The intervention comprised: structural initiatives at the school level; a teaching material; peer-led innovation workshops; and a smartphone app. The 10-item Perceived Stress Scale was used to measure stress. Intervention effects on perceived stress were estimated using an intention-to-treat approach with multiple imputations of missing data and multilevel general linear regression modelling. A total of 4577 students answered the baseline questionnaire. No statistically significant difference was found in stress between students at intervention and control schools at the follow-up (mean score: 16.7 versus 16.7, adjusted b = 0.42, 95% CI: -0.16;1.00). The HHS Study is one of the first large randomized controlled trials targeting school environmental stressors. Potential implementation failures and the failures of the program theory are discussed.

Effect of the multicomponent healthy high school intervention on meal frequency and eating habits among high school students in Denmark: a cluster randomized controlled trial

BackgroundPrevious studies have shown that multicomponent interventions may improve meal frequency and eating habits in children, but evidence among young people is limited. This study evaluated the effect of the Healthy High School (HHS) intervention on daily intake of breakfast, lunch, water, fruit, and vegetables at 9-month follow-up.MethodsThe study included first-year students (≈16 years) attending high school in Denmark. Participating schools were randomized into the HHS intervention (N = 15) or control group (operating as usual) (N = 15). The intervention was designed to promote well-being (primary outcome) by focusing on healthy habits including meals, stress prevention, and strong peer relations. It included a curriculum, structural and organisational initiatives, a workshop, and a smartphone application. Students completed self-administered online questionnaires at the beginning of the school year and nine months later. To account for clustering of data, we used multilevel logistic regression analyses to estimate odds ratios (OR). We applied an intention-to-treat approach with multiple imputations of missing data.ResultsAt baseline 4577 of 5201 students answered the questionnaire and 4512 at follow-up. In both groups the proportion of students eating breakfast decreased from approximately 50% to 40% from baseline to follow-up, and lunch frequency decreased from approximately 50% to 47%. Daily water intake, intake of fresh fruit and intake of vegetables remained unchanged from baseline to follow-up. There were no significant between group differences on any of the outcomes at first follow-up: breakfast: OR = 0.85 (95% CI: 0.65;1.10), lunch: OR = 0.96 (95% CI: 0.75;1.22), water intake: OR = 1.14 (95% CI: 0.92;1.40), intake of fresh fruit: (OR = 1.07, 95% CI: 0.84;1.37), vegetables: (OR = 1.01, 95% CI: 0.77;1.33).ConclusionNo evidence of an effect of the HHS intervention was found for any of the outcomes. Future studies are warranted to explore how health promoting interventions can be integrated in further education to support educational goals. Moreover, how to fit interventions to the lives and wishes of young people, by also including systems outside of the school setting.Trial registrationISRCTN, ISRCTN43284296. Registered 28 April 2017 - retrospectively registered.

Association Between Passive Hip Range of Motion and Pitching Kinematics in High School Baseball Pitchers.

BackgroundLimitations in passive hip range of motion (PROM) may negatively affect pitching mechanics in baseball pitchers. Understanding the relationships between PROM and mechanics can assist in the development of injury prevention protocols.PurposeThe purpose of this study was to examine the association of hip rotational PROM with pelvis and trunk rotation during pitching in high school baseball pitchers. Study Design: Cross-sectional.MethodsTwenty-five healthy high school baseball pitchers volunteered (15.9 ± 1.1 years; 180.4 ± 5.5 cm; 75.4 ± 9.3 kg). Seated passive hip internal rotation (IR) and external rotation (ER) PROM were measured using a digital inclinometer. Total PROM was calculated (IR+ER). Pitching biomechanical data were collected with a 3-dimensional electromagnetic tracking system while pitchers threw fastballs. Simple linear regressions were performed to examine the association between hip IR, ER, and total PROM with pitching kinematics at foot contact including stride length, pelvis rotation, and trunk rotation.ResultsOnly one significant association in PROM and kinematics was observed. Drive leg hip IR PROM was associated with trunk rotation angle [F(1,24) = 4.936, p = 0.036], with an R2 = 0.177. Drive leg total PROM was not associated trunk rotation angle [F(1,24) = 4.144, p = 0.053] with an R2 = 0.153.ConclusionsIncreased drive leg hip IR PROM was associated with decreased trunk rotation towards home plate. Hip total PROM and ER were not related to pitching mechanics.Level of Evidence2

Харчова поведінка та якість життя школярів старших класів м. Львова

Актуальність. Негативна динаміка захворюваності дитячого населення та щорічне її збільшення свідчать про необхідність посилення уваги до проблеми, передусім до забезпечення дієвого профілактичного компонента. Аналізуючи причини негативної динаміки показників стану здоров’я дітей та молоді в Україні, не можна ігнорувати спосіб життя, що в структурі чинників впливу на формування стану здоров’я займає провідні позиції. Мета дослідження — вивчення особливостей способу життя, харчової поведінки школярів старших класів та їх впливу на основні показники якості життя. Матеріали та методи. Спосіб життя та харчову поведінку 80 здорових дітей віком 14–17 років було вивчено за допомогою анкети, що містила питання про сімейний анамнез, житлово-побутові умови, харчування та режим дня. Для оцінки основних параметрів якості життя було використано опитувальник MOS SF-36. Результати. Аналіз опитування показав, що 45 % дітей щоденно вживають м’ясні продукти промислового виробництва. Страви з риби в щоденному раціоні дітей наявні лише в 13,8 % випадків. Молоко і молочні продукти відзначені в щоденному раціоні менше ніж у половини опитаних дітей (35 %). Виявлено високий відсоток вживання підлітками слабоалкогольних напоїв (15 %). З’ясовано, що 45 % дітей проводять більше 3 годин на день за комп’ютером або біля телевізора, лише 22,5 % гуляють на свіжому повітрі більше 2 годин на добу. Показники якості життя були вірогідно вищі за шкалою життєздатності в дітей при тривалості прогулянок більше 2 годин на день. У дітей, які повноцінно обідають щодня, вірогідно вищі показники соціальної активності, значення за шкалою психологічного здоров’я і шкалою життєздатності. Відзначено вірогідне зниження показника життєздатності в групі дітей із тривалим перебуванням біля комп’ютера (3 години і більше). У школярів, які займаються в спортивних секціях, вірогідно вищі показники якості життя за шкалою психологічного здоров’я і шкалою загального здоров’я. У дітей із тривалістю нічного сну 8 годин відзначена вірогідно вища емоційна стабільність за шкалою емоційного функціонування (р &lt; 0,05). Висновки. Раціон харчування сучасних школярів не відповідає встановленим нормативам. Це може бути фактором ризику гастродуоденальної патології в майбутньому, тому потребує систематичної корекції. Крім раціонального харчування, чинниками, що впливають на самопочуття та психоемоційний статус школярів, є дозовані фізичні навантаження, регулярні прогулянки на свіжому повітрі та обмежене користування комп’ютером. Оцінка якості життя є простим та інформативним методом комплексного вивчення стану здоров’я школярів і може бути рекомендована до широкого застосування в педіатрії.

Remote Implementation of a Health Promotion Program in an Underserved High School during COVID-19: Lessons Learned

Background: This study examined the impact of remote implementation of a school-based health promotion program on health beliefs and behaviors of adolescent participants from an underserved high school during the COVID-19 pandemic. Methods: As part of the program, Family Medicine residents trained healthy 10th grade high school students from a vulnerable community in California to become health coaches for family members with diabetes. Five of eight onehour weekly sessions were delivered remotely after shelter in place was mandated. Students completed online pre and post-participation surveys including questions on health beliefs and behaviors and experience with remote learning. We explored factors associated with the likelihood of attending the remote classes, and we used paired T-tests to compare pre-and post-scores of health beliefs and behaviors, and qualitative analysis of open-ended questions to assess differences between those who completed in person sessions only and those who attended remote sessions. Results: 45 participants completed pre-surveys and 26 of those completed postsurveys. 14 of those 26 attended remote program sessions. The 14 who attended the additional remote sessions demonstrated significant improvements in health mindsets (belief that body has self-healing properties p=.045; belief that illness is an opportunity p=.028); consumption of fruits and vegetables (p=.054); consumption of sugary drinks (p=.047); understanding of how to improve their health (p=.055); and frequency of talking about health with their families (p=.057). Participants who did not attend remote sessions did not show significant improvements in these areas. Non-attendees were more likely to be Hispanic and male. Conclusions: These findings suggest that remote health promotion programs could support the health and well-being of adolescents in underserved communities. Yet, more research is essential to ensure all adolescents can participate.

Peer mentors' role in school-based health promotion: qualitative findings from the Young & Active study.

SummaryPeer-led interventions are highlighted as promising strategies to promote health among adolescents, but little is known about the mechanisms underlying this approach. To better understand the role of peer mentors (PMs) as implementers in school-based health promotion, we combined participant observations, focus group interviews and video recordings to explore high school students’ reception of a peer-led intervention component (Young & Active). Young & Active aimed to increase well-being among first-year high school students (∼16 years of age) through the promotion of movement and sense of community and was implemented during the school year 2016–2017 in a larger school-based intervention study, the Healthy High School study in Denmark. The Healthy High School study was designed as a cluster-randomized controlled trial with 15 intervention schools and 15 control schools. At each intervention school, university students in Sports Science and Health (members of the research group) facilitated an innovation workshop aiming at inspiring all first-year students to initiate movement activities at schools. The findings illustrate potentials and challenges implied in the PM role. The peer mentors’ profound commitment, as well as their response and sensibility to situational contingencies, were found to be significant for the students’ reception and experience of the intervention. In conclusion, the specific job of PMs as implementers seems to consist of simultaneously following a manual and situationally adjusting in an emerging context balancing commitment and identification to the target group and the intervention project.

What characterizes schools and students participating in health promoting school-based intervention studies? Findings from the healthy high school study

The Healthy High School (HHS) intervention was developed to promote well-being among first-year high school students (~16 years of age) in Denmark by targeting stress, physical activity, meal habits, sleep, and sense of community. Thirty-one schools were randomly allocated to intervention (16 schools) or control (15 schools) groups in a cluster-randomized controlled trial. The purpose of this short communication was to compare characteristics of students and schools between 1) schools accepting to participate in the HHS study and non-participating schools using national survey data and 2) intervention and control schools using HHS baseline data. We included cross-sectional data from the Danish National Youth Study 2014 on 119 schools and 22,935 first-year students to characterize participating schools and students. At baseline (August 2016), students (n = 4577; 88.0%) and principals (n = 29; 96.7%) completed online questionnaires. Compared to non-participating schools, fewer HHS schools perceived their school as being popular and offered weekly sport activities outside school hours. More HHS schools had teachers engaged in health promotion activities and focused on stress prevention. The characteristics of HHS students did not differ markedly from non-participating high school students. There were no socio-demographic, outcome or contextual differences between the study arms. To ensure successful recruitment of schools it is important that the intervention meets the need of the schools and that the advantages of participation are explicit. This underlines the need for a thorough needs assessment prior to intervention development, co-creation of intervention activities with school staff, and a well-planned recruitment strategy.

An analysis of pre-season risk factors for low back injury in high-school baseball pitchers: a prospective study

Pitching motion requires whole-body coordination; therefore, poor control of the lower extremities, pelvis and trunk may cause shoulder and elbow injuries. However, few studies have described the relationship between the shoulder joint function and low back injury in high-school baseball pitchers. A total of 128 healthy high school pitchers underwent pre-season medical checkups, where their shoulder range of motion and shoulder strength were measured. The participants completed a self-recorded daily questionnaire regarding the presence of low back pain. Pitchers were divided into injured and non-injured groups. Low back injury was observed in 13 participants (13.4%). In the injured group, horizontal adduction on the dominant shoulder was significantly less than in the non-injured group. A logistic regression analysis showed that horizontal adduction on the dominant side was a significant independent risk factor for low back injury during the season. It is important to recognize that restriction of the shoulder function not only causes shoulder and elbow injuries but can also risk low back injury.

Retinal vessel shift and its association with axial length elongation in a prospective observation in Japanese junior high school students.

PurposeTo investigate retinal vessel shift (RVS) and its association with axial length (AL) elongation in junior high school students.MethodsTotal 161 eyes of 161 healthy junior high school students were prospectively studied. Optical AL and anterior chamber depth (ACD) measurements, and fundus photography were performed in the first and third grades. Eyes of subjects in the first and third grade that had perfect matching among all the retinal vessels were allocated to the RVS(−) group, otherwise allocated to the RVS(+) group. In the RVS(+) group, the peripapillary retinal arteries angle (PRAA) was measured for quantitative analysis of RVS; the angle between the major retinal arteries. The variables related to PRAA were identified using model selection with the corrected Akaike information criterion.ResultsForty-two eyes (26.1%) were allocated to the RVS(+) group. There were seven patterns in the RVS of those in the RVS(+) group, including clockwise shift in the supra temporal area (5 eyes), infra temporal area (7 eyes), and nasal area (9 eyes); anticlockwise shift in the supra temporal area (7 eyes), infra temporal area (5 eyes), and nasal area (2 eyes); and distal shift in the temporal area (7 eyes). The optimal model for the PRAA narrowing included larger AL and body weight in the first grade, and greater AL elongation.ConclusionVarious (seven) RVS patterns were observed in about 25% of the junior high school students within two years. RVS was associated with AL elongation, and useful to reveal the mechanism of myopic retinal stretch.

Thermal Comfort in School Classes in the Era of Global Warming: A Prospective Multicenter Study.

We investigated adolescents' feelings of thermal comfort during the educational process in various geographical locations far apart and present recommendations for the adjustment of the thermal environment in schools. The prospective international multicenter study took place in 8 locations on different continents. The survey in the form of a questionnaire was carried out among 2800 healthy high school students. The study was divided into "cold season survey," "warm-season survey," and heat wave survey. The statistically significant difference between the "cold season survey" score of 4.04 (discomfort) and "warm-season survey" score of 3.47 (slight discomfort) (p=.04) indicates that students feel more thermal discomfort during winter months in all 8 locations. The heat wave survey score was 4.53 (discomfort). During the cold season, 29.24% of high school students felt themselves in full thermal comfort and 76.48% of the students felt themselves relatively comfortable (slightly cool-comfortable-slightly warm). Even during the ongoing process of climate change, the cold season discomfort remains the main problem for students in classes. This tendency is present in different continents as a universal problem. We recommend keeping an entrance hall and classroom temperatures at different levels and to advise students about proper clothing.

The Effect of the Crow Hop on Elbow Stress During an Interval Throwing Program

Background: Postoperative rehabilitation protocols after ulnar collateral ligament (UCL) reconstruction typically involve a structured interval throwing program. In an effort to minimize torque placed on the UCL, athletes are often instructed to throw with a crow hop, even at short throwing distances. However, the effect of the crow hop on medial elbow stress is unknown. Purpose/Hypothesis: The purpose was to determine whether elbow stress differs with and without a crow hop across the throwing distances of a typical interval throwing program. We hypothesized that crow hop throws would generate lower torque on the elbow than standing throws at each distance of the interval throwing program. Study Design: Controlled laboratory study. Methods: Healthy high school and collegiate pitchers and position players were recruited from the surrounding area. Each player was outfitted with a wearable athletic sleeve and device that recorded elbow torque (Newton-meters), arm slot (degrees), arm speed (revolutions per minute), and shoulder rotation (degrees). Ball velocity (miles per hour) was measured using a radar gun. Players were instructed to perform 3 crow hop throws and 3 standing throws at distances of 30, 45, 60, 90, 120, 150, and 180 feet. A repeated measures analysis of variance was used to compare ball velocity, elbow torque, arm slot, arm speed, and shoulder rotation between crow hop and standing throws at each throwing distance. Results: Twenty athletes participated in this study (average age, 17.8 years; range, 15-25 years). The average medial elbow torque increased at each distance for both crow hop and standing throws at distances of 30, 45, 60, and 90 feet (P < .05), after which there were no significant increases in elbow torque (P > .05). The average torque was higher for crow hop throws than standing throws at distances of 30 feet (13.9 N·m vs 12.0 N·m; P = .002), 45 feet (21.8 N·m vs 19.3 N·m; P = .005), and 60 feet (28.0 N·m vs 24.5 N·m; P = .02). Conclusion: Crow hop throws generated greater medial elbow torque than standing throws at distances up to 60 feet; however, there were no differences in elbow torque at distances greater than 60 feet between the 2 throw types. For both crow hop and standing throws, elbow stress increased at each distance interval up to 90 feet before plateauing at distances greater than 90 feet. The crow hop throwing technique does not reduce medial elbow stress during a simulated interval throwing program, and it may actually increase torque at shorter throwing distances. Clinical Relevance: The results of our study indicate that it would be prudent for players to initially perform standing throws at shorter distances and only later be allowed to employ a natural crow hop at greater distances to minimize torque placed on the medial elbow during UCL rehabilitation protocols.

Effects of Mound Versus Flat-Ground Pitching and Distance on Arm Mechanics and Elbow Torque in High School Pitchers.

Background:Although the monitoring of a pitcher’s throwing arm workload has become a hot topic in both research and the pitching world, the impact of mound height and distance still remains unclear.Purpose:To compare the kinetics and kinematics between pitches from a mound and flat ground at 2 different distances.Study Design:Descriptive laboratory study.Methods:A total of 21 healthy high school varsity baseball pitchers (age, 16.2 ± 1.3 years; weight, 73.6 ± 11.0 kg; height, 181.3 ± 6.4 cm) participated in this study. Players were fitted with a motusBASEBALL sensor and sleeve. Each pitcher was instructed to pitch 5 fastballs under 4 conditions: mound at 60.5 ft (regulation distance), flat ground at 60.5 ft, mound at 50.5 ft, and flat ground at 50.5 ft. Linear mixed-effects models were used to account for both intra- and interplayer variability. A multivariable model was used to evaluate the association of mound pitching, flat-ground pitching, and their distances (50.5 ft and 60.5 ft), and their interaction to arm speed, arm slot, arm rotation, elbow varus torque, and ball velocity.Results:There were no statistically significant effects of mound, flat-ground, or distance variation on arm speed or shoulder rotation. Arm slot was significantly higher (+3.0°; P = .02) on pitches from the mound at 60.5 ft compared with 50.5 ft. Elbow varus torque was lower (–1.5 N·m; P = .02) on mound pitches at 60.5 ft compared with 50.5 ft. Pitches thrown from the mound displayed significantly faster ball velocity compared with flat-ground pitches at both distances (P < .01 for both), with pitches at 60.5 ft having higher velocity (+0.7 m/s; P < .01).Conclusion:Contrary to long-standing notions, the study results suggest that pitching from the mound does not significantly increase stress on the elbow compared with flat-ground pitching. Lower elbow varus torque and faster ball velocity at the regulation distance compared with the reduced distance indicate that elbow stress and ball velocity may not correlate perfectly, and radar guns may not be an appropriate surrogate measure of elbow varus torque.Clinical Relevance:A better understanding of the kinetic and kinematic implications of various throwing programs will allow for the designing of programs that are driven by objective data with aims directed toward injury prevention and rehabilitation in baseball pitchers.

Implementation of initiatives to prevent student stress: process evaluation findings from the Healthy High School study.

Process evaluation of public health interventions is important for understanding intervention results and can help explain why interventions succeed or fail. This study evaluated implementation of a school-based intervention combining educational and environmental strategies to prevent stress among Danish high school students. We investigated dose delivered, dose received, fidelity, appreciation, barriers and facilitators at the 15 intervention schools using mixed methods and multiple data sources: questionnaires among students, teachers and school coordinators; semi-structured interviews with school coordinators; telephone interviews with student counsellors; and focus group interviews with students and teachers. Implementation varied by schools and classes. Half of the intervention schools delivered the environmental strategies. For the educational strategies, dose delivered differed according to intervention provider. Students reported a lower dose received compared with dose delivered reported by school staff. Overall, student counsellors, school coordinators and students—especially those with low perceived stress—were satisfied with the stress preventive initiatives while teacher satisfaction varied. Five main barriers and three facilitators for implementation were identified. The use of multiple data sources and data methods created new knowledge of the implementation process which is important for the interpretation of effect evaluation and development of future interventions.

Severe and persistent nerve palsy after ultrasound-guided continuous interscalene brachial plexus block in a teenager undergoing shoulder surgery: a case report

BackgroundAlthough neurologic sequela is a recognized complication after interscalene brachial plexus block (ISB), there is a paucity of information on how severe and persistent neuropathy occurs and develops.Case presentationA healthy high school soccer goalkeeper was scheduled for an arthroscopic Bankart repair. After continuous ISB for 2 days, sensation in the C5 and C6 areas and motor function did not return. With symptomatic drug treatment for neuropathic pain and rigorous rehabilitation, recovery of sensory loss and muscle weakness were gradually observed around 1 to 2 months after surgery. He returned to sport 1 year after surgery.ConclusionThis report is the first detailed description of a case who incurred severe and persistent nerve injury after continuous ISB yet recovered nearly fully to return to being an athlete. The present case should also underscore the importance of close observation after surgery in cases where a patient receives continuous ISB.

Study protocol of the Healthy High School study: a school-based intervention to improve well-being among high school students in Denmark

BackgroundThe prevalence of low well-being, perceived stress and unhealthy behaviours is high among high school students, but few interventions have addressed these problems. The aim of this paper is to present a study protocol of a cluster randomised controlled trial evaluating the Healthy High School (HHS) intervention programme. The intervention programme is designed to improve well-being (primary outcome) by preventing 1) stress and promoting 2) sleep, 3) sense of community, 4) physical activity (PA) and 5) regular and healthy meals among high school students in Denmark.MethodsThe development of the HHS study was guided by the Intervention Mapping protocol. The intervention comprises four components: 1) a teaching material, 2) a smartphone app, 3) a catalogue focusing on environmental changes, and 4) a peer-led innovation workshop aiming at inspiring students to initiate and participate in various movement activities. The HHS study employs a cluster-randomised controlled trial design. Thirty-one high schools across Denmark were randomly allocated to intervention (16 schools) or control (15 schools) groups. The study included all first-year students (~ 16 years of age) (n = 5976 students). Timeline: Intervention: August 2016 – June 2017. Collection of questionnaire data: Baseline (August 2016), 1st follow-up (May 2017) and 2nd follow-up (April 2018). All students were invited to participate in a monthly sub-study about perceived stress using text messages for data collection (September 2016 – June 2017). PA was objectively assessed among a sub-sample of students using accelerometers (Axivity, AX3) in August 2016 and May 2017. Primary outcome measures: Student well-being measured by the Cantril Ladder and the five item World Health Organisation Well-being Index (individual level outcomes). Secondary outcome measures: Stress (10-item Perceived Stress Scale), sleep (quantity and quality), PA (hours of moderate-to-vigorous PA per week, hours of daily sedentary time and average daily PA), meal habits (daily intake of breakfast, lunch, snacks and water), and strong sense of community in class and at school, respectively (individual level outcomes). The study encompasses process and effect evaluation as well as health economic analyses.Trial registrationISRCTN ISRCTN43284296, 28 April 2017, retrospectively registered.

Sports participation volume and psychosocial outcomes among healthy high school athletes

We assessed the association between hours/week of sports participation and psychosocial outcomes among high school athletes. We hypothesized that more hours of participation would be associated with the lower levels of anxiety and depressive symptoms. Participants completed the Patient-reported Outcomes Measurement Information System (PROMIS) Pediatric Profile 25 quality of life and other questionnaires to assess sports participation, socioeconomic status, and health history. We evaluated the multivariable relationship between hours/week in sport and PROMIS scores while adjusting for the independent effect of age and varsity team status. A total of 230 high school athletes participated in this study (mean=15.4±1.2 years of age). More hours/week playing sports were significantly associated with the lower levels of depressive symptoms (coefficient=-0.073, 95% CI=-0.137, -0.010; P=0.02). Sports participation was not significantly associated with any other psychosocial domain scores on the PROMIS questionnaire. More hours of sports participation were significantly associated with the lower depressive symptoms, but no other psychosocial domain. While our findings are cross-sectional, sport participation may play a role in attenuating symptoms of depression in high school athletes. Sports participation may play a beneficial role in lessening depressive symptoms among healthy high school students.

Importance of radar gun inclusion during return-to-throwing rehabilitation following ulnar collateral ligament reconstruction in baseball pitchers: a simulation study

Rehabilitation following elbow ulnar collateral ligament reconstructionin baseball pitchers relies on a progression of pitching activities to ensure protection and gradual strengthening of the reconstructed ligament. The purpose of this study was to determine the medial elbow torque associated with pitches at various effort levels and determine whether radar gun assistance improves players' abilities to accurately match partial-effort pitches with true references based on maximum pitch velocity. Thirty-seven healthy high school and collegiate baseball pitchers were included in this study. Participants were excluded if they were injured, recovering from injury, or otherwise not currently pitching at full effort. Pitch parameters were collected using a validated wearable sensor. Participants threw 5 pitches at 50%, 75%, and 100% subjective effort. Pitchers then threw 5 pitches at 50% maximum velocity and 75% maximum velocity, as measured by a radar gun. Thirty-seven pitchers completed this study. Pitches thrown at 50% and 75% partial effort were significantly faster and generated higher elbow torque than did pitches thrown at 50% and 75% velocity, respectively (P < .001). A 10% decrease in percentage of maximum velocity was associated with a 13% decrease in percentage of maximum elbow torque (β coefficient = 1.3, R2 = 0.81, P < .001). Pitchers generate higher-than-intended forces when throwing at 50% and 75% effort during a subjective partial-effort throwing protocol. Use of a radar gun to guide partial-effort throwing during throwing rehabilitation programs may protect the reconstructed elbow from excess medial torque.

Neurostructural correlates of optimism: Gray matter density in the putamen predicts dispositional optimism in late adolescence.

Dispositional optimism reflects one's generalized positive expectancies for future outcomes and plays a crucial role in personal developmental outcomes and health (e.g., counteracting related mental disorders such as depression and anxiety). Increasing evidence has suggested that extraversion is an important personality factor contributing to dispositional optimism. However, less is known about the association between dispositional optimism and brain structure and the role of extraversion in this association. Here, we examined these issues in 231 healthy high school students aged 16 to 20 years (110 males, mean age = 18.48 years, SD = 0.54) by estimating regional gray matter density (rGMD) using a voxel‐based morphometry method via structural magnetic resonance imaging. Whole‐brain regression analyses revealed a significant positive correlation between dispositional optimism and the rGMD of the bilateral putamen after adjusting for age, sex, family socioeconomic status (SES), general intelligence, and total gray matter volume (TGMV). Moreover, prediction analyses using fourfold balanced cross‐validation combined with linear regression confirmed a significant connection between dispositional optimism and putamen density after adjusting for age, sex, and family SES. More importantly, subsequent mediation analysis showed that extraversion may account for the association between putamen density and dispositional optimism after adjusting for age, sex, family SES, general intelligence, TGMV, and the other four Big Five personality traits. Taken together, the current study provides new evidence regarding the neurostructural basis underlying dispositional optimism in adolescents and underscores the importance of extraversion as an essential personality factor for dispositional optimism acquisition.