Exercise-associated hyponatremia (EAH) is commonly observed in endurance athletes, where prolonged physical exertion combined with being unaware of personal hydration needs can lead to excessive water consumption or inadequate sodium intake. Marching band (MB) is an emerging setting for sports medicine professionals. However, there is little research on non-musculoskeletal illnesses among these performing artists. This study is part of a larger cross-sectional study and seeks to examine whether MB artists have previously experienced EAH and the presence of known EAH risk factors (e.g., pre-existing medical conditions, medication use, nutritional behaviors). Active collegiate MB members (n = 1207; mean age = 19.6 ± 1.3 years) completed an online survey that characterized demographics, medical history, and nutrition behaviors. Statistical analyses included descriptives (mean, standard deviation) and frequencies for all data. Binomial logistic regressions analyzed the relationship and determined the odds ratio (OR) between previous EAH and EAH risk factors. Participants were from 23 different states, predominately White (82.9%), female (56.7%), and at NCAA Division I institutions (92%). A total of 74 (6.1%) participants reported previously experiencing EAH, 32 (43.2%) within the past year. Previous EAH occurrence was greatest among individuals who had kidney conditions (χ2(1) = 5.920, R2 = 0.013, OR = 15.708, p = 0.015); mood/neurological conditions (χ2(1) = 7.508, R2 = 0.017, OR = 2.154, p = 0.006), particularly anxiety (χ2(1) = 7.651, R2 = 0.017, OR = 3.590, p = 0.006); used mental health medications (χ2(1) = 7.512, R2 = 0.017, OR = 2.220, p = 0.006), particularly selective serotonin reuptake inhibitors (χ2(1) = 13.502, R2 = 0.030, OR = 3.297, p < 0.001); and who dieted (χ2(1) = 6.121, R2 = 0.014, OR = 1.913, p = 0.013) or perceived they had an eating disorder (χ2(1) = 9.502, R2 = 0.021, OR = 2.729, p = 0.002). Healthcare providers should be aware that MB artists may have pre-existing medication conditions, use medication, and have inadequate nutrition. Targeted hydration and nutritional education for MB artists is essential for effective prevention and early EAH recognition, improving health and performance for MB artists within demanding environments.

Context: While increasing telehealth use throughout sports medicine has improved patients' access to health care, some communities may not have the same opportunities to connect with a provider. Barriers to telehealth implementation can be influenced by internal (eg, provider's digital health literacy and resources) and external (eg, community's social determinants of health or "SDOH") factors. This study aimed to assess the impact of internal and external factors on telehealth use by athletic trainers (ATs). Design: Crosssectional survey. Methods: In total, 767 ATs participated in the study. Participants (age = 39 [13] y) completed a survey containing the electronic health literacy scale and digital health literacy instrument, reported professional use of telehealth as a provider (yes/no), provided resources at their clinical site, and provided the zip code for the community they served. After data collection, the researchers extracted SDOH information using the zip code data from 2 US databases, including population density, median household income, poverty index, education level, and technology access. Chi -square or independent samples t tests were conducted to compare telehealth use by each SDOH factor. Results: In total, 62.3% (n = 478/767) of ATs reported using telehealth, and 81.6% of ATs (n = 626) had a dedicated facility to offer health care services. We identified a significant difference in digital health literacy scores between users and nonusers of telehealth (P=.013). We did not identify any significant differences between telehealth users by community type (P = .957), population density (P = .053), income (P = .462), poverty index (P = .073), and computer (P = .211) or broadband internet access (P = .295). Conclusions: Our data suggest that internal factors such as digital health literacy and clinical site resources may have contributed to an AT's previous telehealth use in clinical practice. However, the SDOH data extracted from the community zip code where the AT provided clinical services were similar for those with and without previous telehealth use.

Marching band (MB) artists are often part of the general student population and not required to complete a pre-participation health screening to identify predisposing medical conditions or risks for injury/illness. Anecdotally, exertional heat illnesses (EHI) are a concern for MB artists. As more athletic trainers provide MB healthcare, research is needed on EHI occurrence and MB associated EHI risk factors. We utilized an exploratory cross-sectional study design to determine EHI risk factors, including previous EHI occurrence, among collegiate MB artists. MB artists (n = 1 207; age = [19.6 ± 1.3] years) actively participating in their college/university’s MB during the 2019 football season completed an online survey to characterize demographics, medical history, medication and supplement use, and nutrition behaviors. Chi-square and binomial logistical regressions assessed associations between categorical variables. Previous EHI was reported by 50.6% of MB artists, with 466 (76.3%) experiencing exertional heat exhaustion and 31 (5.1%) exertional heat stroke. More females reported exertional heat exhaustion overall (68.2%, p < 0.001) and in the previous year (73.3%, p < 0.001). Experiencing a previous EHI was significantly associated with having a mood/neurological condition (63.5%, p < 0.001), diagnosed (74.3%, p = 0.004) or perceived eating disorder (66.7%, p < 0.001), and taking prescription medications (59.4%, p < 0.001), over-the-counter medications (58.9%, p = 0.002), and supplements (55.4%, p = 0.037). Half of collegiate MB artists reported experiencing previous EHIs and engaged in behaviors known to increase EHI risk. MB artists should complete pre-participation examinations to identify pre-existing medical conditions and risks for adverse medical events. Healthcare providers working with MB artists should develop policies and procedures to mitigate EHI risks and occurrence.

CONTEXT:For gender-diverse (GD) college marching band (MB) artists, the risks for anxiety and depression may be higher as they navigate the demands and stressors associated with MB, college, and their gender identity. OBJECTIVES:To examine the risks of anxiety and depression across GD MB artists and to explore their barriers and attitudes toward seeking mental health (MH) care. DESIGN:Cross-sectional study. SETTING:Online survey. PATIENTS OR OTHER PARTICIPANTS:Seventy-eight GD individuals (transgender = 12, nonbinary = 66, age = 19 ± 1 years). MAIN OUTCOME MEASURE(S):A survey was used to assess demographics, anxiety risk using the State-Trait Anxiety Inventory, depression risk using the Center for Epidemiologic Studies Depression Scale, and barriers and attitudes using the Barriers Towards Seeking Help Checklist, the Attitudes Toward Seeking Professional Psychological Help Scale-Short Form, and the Mental Help Seeking Attitudes Scale. We calculated descriptive statistics and univariate analyses to evaluate scores, risks, and differences between MH and receiving assistance. RESULTS:Participants had high state anxiety (mean = 52.0 ± 112.1), trait anxiety (mean = 55.2 ± 10.0), and symptoms of depression (mean = 30.4 ± 12.0) based on the State-Trait Anxiety Inventory and the Center for Epidemiologic Studies Depression Scale. Overall, 78.2% (n = 61 of 78) of GD MB artists were considered at risk for both state and trait anxiety and depression, and 18% (n = 11 of 61) did not seek help from an MH professional. These GD MB artists cited a lack of time (82.1%; n = 64 of 78) as the primary barrier to seeking professional help. The mean score on the Attitudes Toward Seeking Professional Psychological Help Scale-Short Form for all GD artists was 19.5 ± 5.0, and the total score for the Mental Help Seeking Attitudes Scale was 47.8 ± 9.2, which indicated more favorable attitudes toward seeking professional help. CONCLUSIONS:We identified high rates of clinical symptoms for depression and anxiety among GD MB artists. The data are consistent with those from other minority populations and above the normative values for cisgender students. The lack of help-seeking behaviors in nearly 15% of at-risk participants highlights the need for specialized resources for GD patients and those participating in MB.

In active populations with medial tibial stress syndrome (MTSS), is extracorporeal shockwave therapy an effective treatment to reduce pain? A computerized search was conducted in October 2021. Inclusion criteria consisted of participants 18+ years old with diagnosed MTSS for 21+ days, where pain was in the posterior medial aspect of the tibia. Exclusion criteria involved patients with tibial fractures, compartment syndrome, and prior treatment of MTSS with extracorporeal shockwave therapy. Results were measured by the number of days athletes could complete the running protocol pain-free according to the Likert scale (p = .008), visual analog scale (p = .001), and Roles and Maudsley scale (RMS; p = .002). The third study showed no statistical significance in pain reduction or self-perception of change in symptoms on the Numerical Rating Scale (NRS; p = .05). Using the Strengthening the Reporting of Observational studies in Epidemiology scale, one study received a 17/22 since no biases were addressed, lack of participant status in each stage of the study, no numbers or analysis reported in each group, and no explanation of external validity or funding. The single-blind randomized controlled trial received a 10/11 using the Physiotherapy Evidence Database scale and one level of evidence. The double-blind sham randomized controlled trial received an 11/11 and one level of evidence (LOE). The research appraised would mostly agree the use of extracorporeal shockwave therapy could reduce pain in MTSS in active populations. The strength of recommendation is B.

Relevance of Research Topic. Eating disorders can be a result of multiple factors including disordered eating, which is an array of abnormal eating behaviors including restrictive eating, fasting, frequently skipped meals, diet pills, overeating, binge-eating and then purging (vomiting). The athletic and performing art populations, specifically females, are at high risk of eating disordered compared to non-athletes and may be predisposed further depending on the nature of their sports. Purpose. The intention of this review article is to identify and review the types of feeding and eating disorders, pathogenic behaviors, prevalence of eating disorders, and risk factors for eating disorders in female athletes. Results. The review of the literature revealed that female athletes are at risk for eating disorders and pathogenic behavior engagement. Conclusions. As more information is provided to the public regarding the determinants and distribution of factors present in potentially at-risk females to developing an eating disorder, more awareness is made to continue the research and promotion of treatment. Appropriate interventions should follow best practices, incorporating a multidisciplinary care team, including a physician, dietitian, mental health professional, and athletic trainer.

CONTEXT:Marching band (MB) artists experience stressors influencing their physical, mental, and emotional health warranting medical support, and they face challenges similar to those of other college students and athletes. Mental health illnesses exist in collegiate and MB settings, but barriers affect access to treatment. OBJECTIVES:To examine MB artists' perceived barriers to and attitudes toward seeking care from mental health professionals. The secondary aim was to explore barriers to and attitudes about seeking mental health counseling between genders and history of pursuing mental health counseling. DESIGN:Cross-sectional study. SETTING:Online survey. PATIENTS OR OTHER PARTICIPANTS:A total of 534 MB artists (women = 312, men = 222; age = 19.7 ± 1.4 years). MAIN OUTCOME MEASURE(S):Participants completed surveys on demographics and past medical history along with the Barriers to Help Seeking Checklist, the Attitudes Toward Seeking Professional Psychological Help-Short Form Scale (ATSPPH-SF), and the Mental Help Seeking Attitudes Scale (MHSAS). Descriptive statistics were calculated to assess demographic data. Cross-tabulations and χ2 statistics were used to evaluate individual barriers (Barriers to Help Seeking Checklist) between genders. Scales were scored 1 to 7 and 10 to 30 on the MHSAS and ATSPPH-SF, respectively. A 1-way analysis of variance measured differences in the total mean score on the ATSPPH-SF between genders. RESULTS:The highest barrier reported was lack of time to seek services (69.1%; n = 369), followed by 47.6% (n = 254) for services not available during my free time. Average scores were 4.0 ± 0.4 on the MHSAS (indicating neutral attitudes toward seeking help) and 17.97 ± 5.48 on the ATSPPH-SF (indicating slightly positive attitudes to seeking help). No differences were seen for the total mean scores on the MHSAS and ATSPPH-SF between genders. CONCLUSIONS:Marching band artists' barriers to and attitudes toward mental health care influenced their ability to seek care in times of need and demonstrated some similarities to those of collegiate athletes. Awareness of the obstacles MB artists face in receiving mental health care will assist health care providers in advocating for improved care in this setting.

Low energy availability (LEA) is common among female student-athletes and contributes to reduced bone mineral density and hormonal dysfunction. However, limited research exists on student-athletes of color, making it difficult to generalize results across populations, particularly Historically Black Colleges and Universities (HBCUs) student-athletes. Objectives: This study examined the energy needs and LEA prevalence, with or without eating disorder (ED) risk, among HBCU female student-athletes. Methods: Twenty-seven female student-athletes (age = 19 ± 1 year; height = 166.9 ± 7.6 cm; weight = 68.8 ± 11.3 kg) completed baseline measures, including the Eating Disorder Inventory-3 (EDI-3), EDI-3 symptom checklist (EDI-SC), anthropometric measures, and resting metabolic rate (RMR). Participants maintained a dietary log to measure energy intake and wore a heart rate monitor to estimate exercise energy expenditures for 7 days. LEA was defined as <30 kcal/kg of fat-free mass (FFM)/day. Results: The mean energy availability (15.9 ± 10.1 kcal/kg FFM/day) indicated 92.6% of participants (n = 25) displayed LEA; of those, 60% (n = 15) had LEA with ED risk. ED risk was identified in 59.3% of student-athletes (n = 13; EDI-3: n = 2; SC: n = 3; Both: n = 11). Interestingly, of the two student-athletes without LEA, one was identified at risk for EDs using both the EDI-3 and SC. Conclusions: HBCU female student-athletes face high risks of LEA and EDs, with most showing signs of both. This underscores the need for culturally sensitive interventions to improve EA and support mental health in this underserved group. Clinicians should focus on nutrition education and early ED identification to enhance long-term health and athletic performance.

Clinical scenarios have risen where females with Type 1 diabetes mellitus (T1-DM), whose demographics are similar to their male counterparts, have sustained bone injuries, whereas the males with T1-DM have not. These scenarios bring into question the effect of T1-DM on various aspects of bone health and injury risk in females. The purpose of this study was to investigate the impact of T1-DM in females on their fracture risk, glycemic control abilities, and bone mineral density when compared to their male counterparts. Results were consistent across all studies, indicating that individuals with T1-DM had poor glycemic control abilities during ages within peak bone accrual, had significantly lower bone mineral density, and had a greater fracture incidence. Given these results, there is a need for future education to emphasize the importance of glycemic management, future research to investigate differences in physically active populations, and for clinicians to recognize their at-risk patients and take the necessary measures to prevent injury.

Mindful Sports Performance Enhancement (MSPE) training is a relatively new concept, which focuses on helping athletes manage a variety of stressors experienced throughout a season, including performing well academically, staying fit, having a productive season in their sport, and maintaining a healthy social life. A need for a critical appraisal is needed to assess the effectiveness of the intervention. Two cohort studies and one randomized control trial were included in the study and assessed using STROBE and PEDro Scale. Key results show, all 3 studies identified participants experiencing benefits after MSPE with aspects of awareness, acceptance, and emotion regulation. Furthermore, student-athletes who attended either all the sessions or more sessions after the 6-week course showed greater satisfaction with mental and physical health. Overall, there is level "B" evidence to support effectiveness of MSPE for college athletes in reducing sport anxiety and improving their overall well-being.

Context Screening for social determinants of health (SDOH) factors is fundamental to addressing barriers to health outcomes and identifying resources needed to provide patient-centered care. However, SDOH can be a difficult area of patient care to navigate without a screening tool. Objective To explore athletic training students’ abilities to screen for SDOH factors via standardized patient (SP) encounters and to describe the experience of screening for SDOH factors. Design Prospective, mixed-methods cohort study. Setting Simulation laboratory. Patients or Other Participants Fifty-four postbaccalaureate professional athletic training students (women = 43, men = 11; age = 23 ± 1 years). Intervention The same SP encounter was completed with 2 cohorts of athletic training students, with 1 intervention cohort (n = 29) screening for the SDOH without an aide and the control cohort (n = 25) screening with the mandatory use of a validated SDOH focused history script. Main Outcome Measures The SP encounters were evaluated using a tool containing an SDOH evaluation by domain and Athletic Training Milestone competencies. Following the SP encounter, each learner completed a postlearning survey. Data were analyzed using descriptive statistics, Mann-Whitney U tests, and thematic qualitative analysis. Results We identified a significant difference (P ≤ .001) for the overall screening for the SDOH, with the intervention cohort that was required to use the focused history script scoring significantly higher than the control cohort. The intervention cohort scored significantly higher (P ≤ .001) on the Athletic Training Milestones than the control cohort, but the intervention cohort self-rated their performance as lower during the reflection. Conclusion The use of the focused history script during the SP encounter highlighted the need for a screening tool to be present during the evaluation to facilitate a conversation about the SDOH. When health care students were not required to use the focused history script to screen for the SDOH, most failed to elicit information about the SDOH factors or performed poorly during the screening.

Context Eating disorders (EDs) are a cluster of behavioral conditions characterized by uneasy thoughts and behaviors that grow into severe or persistent eating disturbances. The demands on student-athletes may create mental and physical stressors that increase the likelihood of EDs and disordered eating. Objective To examine the ED risk through eating attitudes and behaviors in male and female student-athletes and across various sport types (endurance, aesthetic, power, ball or team, or technical sports). Design Cross-sectional study. Setting Collegiate athletics. Patients or Other Participants National Collegiate Athletic Association Division I and II student-athletes (n = 2054; males = 631; females = 1423) from 40 institutions. Main Outcome Measure(s) Participants completed a web-based demographic survey and the Eating Attitudes Test-26 (EAT-26). Multiple χ2 analyses examined participants classified as at risk for EDs. Independent-samples t tests and a 1-way analyses of variance compared sex and sport type across EAT-26 totals and subscale (Dieting, Bulimia, and Oral Control) scores. Results Overall, 25.3% (n = 520/2054) of student-athletes were classified as at risk for EDs. Differences were found between sex and ED risk (χ21,2054 = 32.9, P ≤ .01; 17.3% [n = 109/631] males, 28.9% [n = 411/1423] females) and across ED risk and sport type (χ24,2054 = 13.4, P = .01). When examining females only, we observed differences across ED risk and sport type (χ24,1423 = 13.4, P ≤ .01). No differences were evident across ED risk and sport type for males. Differences were seen between sex and binge eating (χ21,2054 = 6.8, P = .009), sex and diet pill use (χ21,2054 = 19.6, P ≤ .01), and sport type and diet pill use (χ24,2054= 12.2, P = .016), excessive exercise (χ24,2054 = 32.1, P ≤ .01), and losing more than 20 lb (9 kg) in the last 6 months (χ24,2054 = 10.2, P ≤ .037). Conclusions Student-athletes in the collegiate setting are at risk for EDs. Medical professionals, such as athletic trainers, need to be educated on the potential risk factors that may lead to EDs. Protocols for prevention, screening and recognition, and referral should be developed for student-athletes at risk for EDs.

As the number of non-native English speakers in the United States rises, the degree to which some patients understand their healthcare communication is decreasing.It is essential to recognize the areas of limited health literacy to ensure proper patient communication and education are achieved.The guiding systematic review aimed to examine different communication interventions and the reported patient experiences from those interactions.The main forms of healthcare communication interventions used in the study included inperson, telephone, and video call interpreters.Patients have been shown to respond best to in-person interpreters, but using interpreters via telephone or video call was also effective and a suitable option.Athletic trainers could use interpreters via telephone or video call to provide patients with a better understanding of their injury while improving communication between the provider and patient.The clinical bottom line of the guiding systematic review was to provide multiple forms of communication interventions to ensure the best outcome of health literacy for the patient.Athletic trainers and other healthcare providers can advocate for nonnative English speakers by creating a healthcare communication policy that includes on-demand interventions such as a translation application or a formal medical interpreter.