Louise A. Kelly

Background: Obese Latino adolescents are at increased risk for stress and depressive symptomology, but interventions to target both physiological and mental health outcomes are scarce. This pilot randomized controlled trial assessed feasibility and preliminary efficacy for a home-based strength training (HBST) intervention on stress-related and mental health outcomes in obese Latino adolescent males. Methods: Fifty-two adolescents were randomized to HBST (n = 26) or control conditions (n = 26). Participants randomized to HBST completed a 16-week progressive resistance training intervention performed twice per week at home on non-consecutive days. Primary and secondary outcomes were assessed at baseline and immediately post-intervention and included measures of upper- and lower-body strength (1RM), body mass index (BMI), BMI percentile, BMI Z-score, salivary cortisol, depressive symptoms (CES-D), and perceived stress (PSS-14). Results are presented using completer-only analyses (n = 25) and mixed-design ANOVA models. An ANCOVA sensitivity analysis was conducted for depressive symptoms due to baseline imbalance, including baseline CES-D as a covariate in the model. Results: Recruitment goals were met, but retention was lower than expected (48% overall; HBST = 31%, control = 54%). Analyses revealed a significant Time × Group interaction for salivary cortisol (F(1, 20) = 5.70, p = 0.027, ηp² = 0.222), such that cortisol decreased over time in HBST participants and increased in control participants. While all strength and anthropometric outcomes improved descriptively from baseline to follow-up in the intervention condition, no significant interactions were present between groups. Depressive symptoms also decreased descriptively in HBST participants, but this effect was no longer significant after adjusting for baseline CES-D using ANCOVA (F(1, 19) = 0.002, p = 0.968). There were no significant findings for perceived stress. Conclusions: Differential effects were observed on salivary cortisol, suggesting HBST may be feasible in obese Latino adolescents. However, results should be interpreted with caution given baseline imbalance, small sample size, high attrition, and limitations with measuring cortisol at one time point without adjustment for time of day or key psychosocial and physiological confounders. All psychological and anthropometric outcomes were exploratory and non-significant after adjustment. A larger, multisite trial using baseline-adjusted analytic procedures, repeated physiological sampling, objective measures of adherence, and extended follow-up is needed to determine whether HBST produces meaningful effects that are sustained over time.

Background: Individuals with ADHD may perform poorly on tasks targeting executive functioning skills such as the ImPACT, which requires the test-taker to employ judgement in non-routine situations Objective: To determine whether ADHD serves as a mediating variable for increasing the likelihood of an invalid score. Materials and Methods: A total of 39,140 collegiate athletes and United States military cadets consented to the Concussion Assessment, Research, and Education (CARE) Consortium study. Participants completed the CARE Baseline Packet which included various sections through which study participants provide self-report data, including demographic, personal, and family history sections. The personal history portion of the CARE Baseline Packet addressed the participant’s neurological history, including self-reported diagnosis of ADHD and history of traumatic brain injury. Variables utilized for the current study included age, gender, race, ethnicity, the participant’s primary college sport, use of mouthguards for athletes competing in sports requiring them, and the presence of an ADHD diagnosis. Participants responded to a question, inquiring if they had ever been diagnosed by a medical professional with ADHD, ultimately producing a dichotomous yes/no response. Results: We found that participants with ADHD were more likely to produce invalid baseline scores (ß = −0.884; p < 0.001). Similar results were found when controlling for sex, race, age, sport played, mouthguard use, and number of previous concussions (ß = −0.786; p < 0.001). Sex, race, sport played, and mouthguard use each played a significant role in determining profile validity, independent of ADHD diagnosis. With ADHD removed from the model, age negatively affected the likelihood of a valid score (ß = −0.052; p = 0.048). Conclusions: Our study suggests that the relationship between age and ImPACT validity is explained by the presence of ADHD. Results support adjusting ImPACT’s validity thresholds for individuals with ADHD.

Objective: To describe sex differences in concussion characteristics in US Service Academy cadets. Design: Descriptive epidemiology study. Setting: Four US service academies. Participants: 2209 cadets (n = 867 females, n = 1342 males). Independent Variable: Sex. Outcome Measures: Injury proportion ratios (IPR) compared the proportion of injuries by sex (females referent) for injury situation, certainty of diagnosis, prolonged recovery, recurrent injuries, mental status alterations, loss of consciousness (LOC), posttraumatic amnesia (PTA), retrograde amnesia (RGA), motor impairments, delayed symptom presentation, and immediate reporting. Main Results: Concussions from varsity/intercollegiate sports [IPR of 1.73, 95% confidence interval (CI) 1.43–2.10] and intramurals (IPR of 1.53, 95% CI 1.02–2.32) accounted for a larger proportion in males, whereas concussions outside of sport and military activities accounted for a smaller proportion among males (IPR of 0.70, 95% CI 0.58–0.85). The proportion of concussions with prolonged recovery was lower among males (IPR of 0.69, 95% CI 0.60–0.78), while concussions with altered mental status (IPR of 1.23, 95% CI 1.09–1.38), LOC (IPR of 1.67, 95% CI 1.17–2.37), PTA (IPR of 1.94, 95% CI 1.43–2.62), and RGA (IPR of 2.14, 95% CI 1.38–3.31) accounted for a larger proportion among males. A larger proportion of concussions that were immediately reported was observed in males (IPR of 1.15, 95% CI 1.00–2.31). Proportions of other characteristics (e.g., recurrent injuries) were not different between sexes. Conclusions: A higher proportion of concussions occurred outside of sport and military training for female cadets, who also displayed proportionally longer recovery times than males, despite males demonstrating a higher proportion of LOC, PTA, and RGA. Possible factors may include different mechanisms of injury outside of sport and military training, different biopsychosocial states associated with sex or injury context, and delayed injury reporting when outside of an observed environment, possibly secondary to perceived stigma about reporting injuries.

Background: The prevalence of obesity is extremely high and increasing in elementary school children in the US, but recent systematic reviews have concluded that there are no simple, generalizable and successful obesity prevention strategies available. Objective: To assess whether an 8-week-school-based physical activity intervention would reduce BMI percentiles and improve physical fitness in both normal weight and obese children. Material and Methods: One hundred and one children were consented to the study (mean age 8.12 ± 0.10 years). BMI and BMI percentiles for age and gender were determined using EpiInfo. Participants were classified as Obese (OB) (n=48) if they had a BMI percentile of ≥ 95% for their age and gender. Normal weight (NW) was (n=53) classified as having a BMI percentile lower than 75% for age and gender. Intervention consisted of an 8-week enhanced physical activity program in school (100 minutes/week). Physical fitness was assessed using the FITNESSGRAM test battery. Repeated measures GLM was used to assess within and between subjects’ effects from pre- to post-testing. Results: GLM showed significant results within subject and between subject for BMI percentile, trunk lifts, push-ups, sit ups, sit and reach and the 1-mile run (p’s <0.01). However, our results also showed that there was a significant reduction in BMI percentile (0.001), weight (p=0.05) and waist/hip ratio (p=0.01) for the obese group. Conclusion: Our study demonstrated that an 8-week physical activity intervention was successful in improving physical fitness in NW and OB children. The 8-week program also was successful in reducing BMI percentile in the OB group. Future studies should consider increasing both the duration of the program and the sample size.

Context: Concussion research has primarily focused on sport-related mechanisms and excluded non–sport-related mechanisms. In adult populations, non–sport-related concussions (non-SRCs) demonstrated worse clinical outcomes compared with sport-related concussions (SRCs); however, investigations of non-SRCs in college-aged patients are limited. Objectives: To examine clinical outcomes in collegiate athletes with non-SRCs compared with SRCs and explore sex differences in outcomes among collegiate athletes with non-SRCs. Design: Prospective cohort study. Setting: Clinical setting. Patients or Other Participants: A total of 3500 athletes were included (n = 555 with non-SRCs, 42.5% female) from colleges or universities and service academies participating in the National Collegiate Athletic Association Department of Defense Concussion Assessment, Research and Education (CARE) Consortium. Main Outcome Measure(s): Dichotomous outcomes (yes or no) consisted of immediate reporting, mental status alterations, loss of consciousness, posttraumatic amnesia, retrograde amnesia, motor impairments, delayed symptom presentation, and required hospital transport. Continuous outcomes were symptom severity, days with concussion symptoms, and days lost to injury. Data were collected within 24 to 48 hours of injury and at return to play. Adjusted relative risks (ARRs) compared the likelihood of dichotomous outcomes by mechanism and by sex within patients with non-SRCs. Multivariate negative binomial regressions were used to assess group differences in continuous variables. Results: Athletes with non-SRCs were less likely to report immediately (ARR = 0.73, 95% CI = 0.65, 0.81) and more likely to report delayed symptom presentation (ARR = 1.17, 95% CI = 1.03, 1.32), loss of consciousness (ARR = 3.15, 95% CI = 2.32, 4.28), retrograde amnesia (ARR = 1.77, 95% CI = 1.22, 2.57), and motor impairment (ARR = 1.45, 95% CI = 1.14, 1.84). Athletes with non-SRCs described greater symptom severity, more symptomatic days, and more days lost to injury (P < .001) compared with those who had SRCs. Within the non-SRC group, female athletes indicated greater symptom severity, more symptomatic days, and more days lost to injury (P < .03) than male athletes. Conclusions: Athletes with non-SRCs had worse postinjury outcomes compared with those who had SRCs, and female athletes with non-SRCs had worse recovery metrics than male athletes. Our findings suggest that further investigation of individuals with non-SRCs is needed to improve concussion reporting and management.

Objectives The purpose of this study was to determine sex differences in recovery trajectories of assessments for sport-related concussion using Concussion Assessment, Research and Education (CARE) Consortium data. Methods National Collegiate Athletic Association athletes (N = 906; 61% female) from sex-comparable sports completed a pre-season baseline assessment and post-sport-related concussion assessments within 6 h of injury, 24–48 h, when they initiated their return to play progression, when they were cleared for unrestricted return to play, and 6 months post-injury. Assessments included the Standardized Assessment of Concussion, Balance Error Scoring System, Brief Symptom Inventory-18, Immediate Post-concussion Assessment and Cognitive Testing (ImPACT), Sport Concussion Assessment Tool-3 symptom evaluation, Clinical Reaction Time, King–Devick test, Vestibular Ocular Motor Screen, 12-item Short-Form Health Survey, Hospital Anxiety and Depression Scale, and Satisfaction with Life Scale. Results Only the Vestibular Ocular Motor Screen Total Symptom Score at the 24–48 h timepoint (p = 0.005) was statistically significantly different between sexes. Specifically, female athletes (mean = 60.2, 95% confidence interval [CI] 51.5–70.4) had higher Vestibular Ocular Motor Screen Total Symptom Scores than male athletes (mean = 36.9, 95% CI 27.6–49.3), but this difference resolved by the time of return-to-play initiation (female athletes, mean = 1.8, 95% CI 1.1–2.9; male athletes, mean = 4.1, 95% CI 1.5–10.9). Conclusions Sport-related concussion recovery trajectories for most assessments were similar for female and male National Collegiate Athletic Association athletes except for Vestibular Ocular Motor Screen symptoms within 48 h of sport-related concussion, which was greater in female athletes. Female athletes had a greater symptom burden across all timepoints, suggesting that cross-sectional observations may indicate sex differences despite similar recovery trajectories.

Objective: Investigation of fundamental movement skills (FMS) and physical fitness differences among Hispanic and Non-Hispanic White elementary school children. Materials and Methods: This study included 194 children aged between 4 and 11 in kindergarten, 2nd, and 5th grades. For evaluable participants, t-tests were used to test potential differences in fitness or fundamental movement skills. Results: There were significant group differences across the participants in terms of age, height, body mass index (BMI), BMI percentile, arm circumference, and waist circumference. In addition, there were significant differences between Hispanic and Non-Hispanic White groups in terms of catching, running, dodging, punting, and two-hand striking (p’s < 0.05). Lastly, there were significant differences between Hispanic and Non-Hispanic White in pull-ups, push-ups, and sit-ups (p’s < 0.05). Conclusions: Our study shows Hispanic children have lower fundamental movement skills and physical fitness compared to their Non-Hispanic White peers. As poor fundament movement skills and physical fitness at such a young age may lead to adverse implications for their physical fitness and health in adulthood. Future studies should focus on increasing fitness, and FMS in Hispanic elementary school children.

Introduction: Adipokines are associated with several pathological states including, metabolic syndrome, obesity, insulin resistance and type 2 diabetes. One of these adipokines, adiponectin is of particular interest as it has been shown to have numerous anti-inflammatory effects, However, the association between adiponectin and blood pressure remains inconclusive especially in the Latino adolescent with obesity. Purpose: To investigate the relationship between plasma adiponectin and blood pressure in Latino adolescents’ boys with obesity and a with a family history of Type 2 diabetes. Methods: Thirty two Latino adolescent males with obesity aged 14–17 years with a family history of type 2 diabetes underwent a frequently sampled glucose tolerance test (FSIVGTT) to measure insulin sensitivity. Body composition was assessed using dual energy x-ray absorptiometry. Obesity was defined as having a BMI percentile ≥95. Blood pressure was assessed using the Dinamap automated blood pressure monitor, and the average of three readings was used in the analysis. Fasting plasma adiponectin was determined using radioimmunoassay. Results: There were moderate positive significant correlations for adiponectin and Systolic blood pressure(SBP) (rho = 0.436, p < 0.027) and Diastolic blood pressure(DBP) (rho = 0.41,p < 0.028). A multivariate liner regression showed that plasma adiponectin could significantly detect 19% of the variance in SBP (p = 0.017, and 33% for DBP (p = 0.017). In a simple linear regression adiponectin was not related to any of our variables (p < 0.05). Conclusion: In conclusion, adiponectin was positively and significantly correlated to blood pressure in Latino adolescent with obesity. Future studies should investigate this relationship in a large sample of Latino adolescent youth.

Objective: To investigate fundamental movement skills (FMS) and physical activity differences among Hispanic and non-Hispanic White elementary school children. Materials and Methods: This study included 194 children aged between 4 and 11 in kindergarten, 2nd, and 5th grades. For evaluable participants, t-tests were used to test potential differences in fitness or movement skills. The characteristics of Hispanic and non-Hispanic White were compared using the p-value to detect statistical differences in anthropometric, FMS, and fitness characteristics. To identify any noticeable differences, the means and standard deviations of each group were compared. Results: There were significant group differences across the participants in age, height, Body Mass Index (BMI), BMI percentile, arm circumference, and waist circumference. In addition, there were significant differences between Hispanic and Non-Hispanic White in catch, run, dodge, punt, and two-hand strike (all p’s <0.05). Lastly, there were significant differences between Hispanic and Non-Hispanic White in pull-up, push-up, and sit-up (all p’s <0.05). Conclusion: Future studies should focus on decreasing obesity, increasing fitness, and FMS in elementary school children. Particularly, with Hispanic children whose FMS is negatively affected at such a young age, leading to eventual implications for their physical fitness and health in the future.

INTRODUCTION: Adipokines are associated with several pathological states including, metabolic syndrome, obesity, insulin resistance and type 2 diabetes. One of these adipokines, adiponectin is of particular interest as it has been shown to have numerous anti-inflammatory effects, However, the association between adiponectin and blood pressure remains inconclusive especially in the obese Hispanic adolescent. PURPOSE: to investigate the relationship between plasma adiponectin and blood pressure in obese Latino adolescents’ boys with a family history of Type 2 diabetes. METHODS: Thirty two obese Latino male adolescents aged 14-17 years with a family history of type 2 diabetes underwent a frequently sampled glucose tolerance test (FSIVGTT) to measure insulin sensitivity. Body composition was assessed using dual energy x-ray absorptiometry. Obesity was defined as having a BMI percentile ³95. Blood pressure was assessed using the Dinamap automated blood pressure monitor, and the average of three readings was used in the analysis. Fasting plasma adiponectin was determined using radioimmunoassay. RESULTS: There was a strong positive significant correlation for adiponectin and Systolic blood pressure(SBP) (p< 0.027) and a moderate, positive significant correction for Diastolic blood pressure(DBP) (p< 0.028). A multivariate liner regression showed that plasma adiponectin could significantly predict 19% of the variance in SBP (p=0.017, and 33% for DBP (p=0.017). CONCLUSION: In conclusion, adiponectin was positively and significantly correlated to blood pressure in obese Latino adolescent youth. Future studies should investigate this relationship in a large sample of Latino adolescent youth.