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Although sport is promoted as a means of improving health for persons with disabilities, empirical evidence from the Global South remains limited. This study addressed this gap by examining how sport participation and athletic identity relate to mental and physical health among persons with disabilities in the Lao People's Democratic Republic. A cross-sectional survey was conducted with 106 adults (55 males and 51 females), and data were analyzed using quantitative group comparisons and mediation and moderation analyses. Sport participation showed minimal direct associations with health outcomes, whereas athletic identity demonstrated significant positive relationships with life satisfaction and physical health. Mediation analysis indicated that athletic identity indirectly linked sport participation with physical health, and moderation analysis showed that athletic identity strengthened the positive association between sport participation and mental health. These findings suggest that sport-related health benefits depend not only on participation but also on the internalization of an athletic identity.

In this hypothesis and theory paper, we propose a conceptual framework for identifying sports whose characteristics align with traits commonly associated with autism spectrum disorder (ASD). Inspired by reports in sports media about neurodiverse athletes who have excelled in various athletic activities, we hypothesized that some sports may especially suit individuals with ASD because they trigger fewer symptoms while also allowing them to play to their strengths. This article is not a review aimed at testing a hypothesis but instead presents our hypothesis, organizes relevant concepts, and discusses which sports may be best suited for athletes with ASD. To explore our hypothesis, we examined two recent reviews on sports-based interventions for individuals with ASD. Our examination revealed that most published studies have investigated symptom relief or the management of challenging behaviors, not participating in sports for enjoyment, to develop skills, or as a means of performance. Because few such studies have measured performance or the suitability of specific sports for individuals with ASD, we particularly considered whether some sports are especially suited for individuals with ASD for the purpose of not only competition but also performance. Following an overview of four sports categories, this article discusses how those categories are compatible with some common symptoms and features of ASD. Emphasizing the variability between and within the categories, we showcase certain sports in order to provide guidance for athletes and children with ASD, as well as their parents and therapists, in identifying appropriate sports for their particular forms of ASD.

Maternal nutrition is an important factor influencing maternal health and foetal development. Community health workers (CHWs) and mother mentors (MMs) play a critical role in assisting pregnant women, particularly in low-resource rural settings; however, their knowledge on maternal nutrition remains untapped. This study investigated the attitudes and experiences of CHWs and MMs regarding optimal maternal nutrition among pregnant women in Limpopo Province, South Africa. A qualitative exploratory descriptive design was adopted. Purposive sampling was used to recruit participants. Data were collected through in-depth interviews with 11 MMs and five focus group discussions with 34 CHWs. Data were analysed using Braun and Clarke's thematic analysis framework, supported by NVivo and manual coding. Three themes emerged. The first theme focused on participants' knowledge and beliefs about maternal nutrition, including food types, dietary behaviours, and the significance of nutrition for maternal and foetal health. The second theme identified barriers to adequate maternal nutrition, such as cultural norms and beliefs, socio-economic constraints, limited resources, misconceptions about pregnancy supplements, and trust concerns. The third theme emphasised the roles of CHWs and MMs, including health education, health literacy promotion, and liaison with healthcare services and community support systems. The findings demonstrate that maternal nutrition habits are influenced by a complex interaction of social, cultural, and economic factors, as well as individual expertise. These findings also highlighted the importance of context-specific and culturally responsive maternal nutrition interventions. Strengthening the competence of CHWs and MMs through standardised training and increased community engagement may contribute to improved maternal nutrition outcomes in disadvantaged settings.

In the fear-avoidance model, kinesiophobia is a critical affective barrier that is associated with persistent activity avoidance and psychological distress among people with disabilities. While sport-technology use correlates with lower levels of kinesiophobia, the indirect pathways that may explain this relationship remain underexplored, especially in individuals who are already physically active and engaged with technology. This study examined how sport-technology use relates to kinesiophobia in a specific subpopulation of adults with sensory or physical disabilities, and explored the independent and serial associative roles of health locus of control and self-efficacy in this relationship. A cross-sectional survey was conducted with 901 adults from China who had physical, visual, or hearing impairments, were current sport-technology users (cumulative use ≥1 month, ≥1 time/month), and had participated in physical activity within the past 6 months. Individuals with intellectual or multiple disabilities were excluded. Bootstrap analyses were used to estimate the total, direct, and indirect associations, including independent indirect associations via health locus of control and self-efficacy, as well as their serial indirect association. Greater sport-technology use was associated with lower kinesiophobia (β = -0.268, 95% CI [-0.326, -0.209]). The total indirect association represented 33.58% of the total association. Significant indirect pathways were identified through health locus of control alone, through self-efficacy alone, and through the serial route from health locus of control to self-efficacy. In this group of physically active sport-technology users with sensory or physical disabilities, Greater sport-technology use predicted lower levels of kinesiophobia. This relationship was statistically mediated by independent and serial indirect effects through health locus of control and self-efficacy.

LLM-based exercise and health guidance creates a distinctive risk-management challenge: seemingly modest changes in product claims, target users, data inputs, personalization, automation, human oversight, or updates may move a tool from general wellness support toward higher-risk medical use. In exercise prescription and rehabilitation, an unsafe recommendation can affect physical load, recognition of warning symptoms, and timely referral. We conducted a structured narrative review and doctrinal/comparative legal analysis, anchored in China's National Medical Products Administration (NMPA) framework and informed by the European Union Medical Device Regulation (MDR), the EU Artificial Intelligence Act, and US Food and Drug Administration (FDA) and International Medical Device Regulators Forum (IMDRF) materials. Peer-reviewed literature was primarily searched for 2019-2026, with foundational regulatory, legal, and technical guidance included where directly relevant. We propose a six-dimensional trigger matrix covering intended use and claims, user context, depth of personalization, data and sensor sources, automation, human oversight and closed-loop control, and upgrade and change pathways. The framework includes anchored Green/Yellow/Red coding rules, non-compensatory aggregation rules, a structured governance checklist, and a lifecycle pathway for evidence generation, risk management, and change control. In a preliminary application exercise, three independent raters applied the coding rules to seven standardized hypothetical scenarios and achieved complete agreement on all dimension-level and overall designations (Fleiss' kappa = 1.00). This small exercise supports initial reproducibility of the rubric but does not establish legal classification accuracy, clinical validity, or real-world effectiveness. The proposed framework is intended to support earlier risk identification, evidence planning, procurement review, and dialogue among developers, healthcare institutions, and regulators; it does not replace product-specific legal analysis or regulatory determination. Large language models can give advice about exercise, weight management, rehabilitation, and healthy living. A tool may begin as general fitness coaching but become riskier when it starts to use medical records or medical-device data, gives advice for people with a disease, changes plans automatically, or claims to treat or monitor a health condition. In these situations, an unsafe recommendation could ask a person to exercise too hard, fail to respond appropriately to warning symptoms, or delay professional care. This study offers a practical way to identify these changes early. We reviewed Chinese medical-device rules and compared them with European and US approaches. We propose six questions about a tool’s purpose, users, tailoring, data, automation, professional review, and updates. Three independent raters used the draft questions on seven example tools and reached the same overall judgments. This early test does not prove that the framework can determine a product’s legal status or clinical safety. It can help developers, health services, and regulators ask the right safety questions before a tool is widely used.

This study explored the associations between health-related quality of life (HRQoL) factors on happiness and self-rated health (SRH). It also identified HRQoL factors and the extent of their association, while providing implications for the direction of physical education. This study used the 2022 Korea Community Health Survey conducted by the Korea Disease Control and Prevention Agency. The HRQoL factors examined were athletic ability, self-management, daily activities, pain/discomfort, and anxiety/depression. The dependent variables were happiness and SRH. Correlation and standard multiple regression analysis to analyze the relationship between happiness, health-related quality of life, and self-subjective health. HRQoL factors demonstrating a significant association with happiness, in descending order, were lower levels of anxiety/depression, lower levels of pain/discomfort, daily activities, and athletic ability. Lower levels of pain/discomfort, athletic ability, daily activities, lower levels of anxiety/depression, and self-management were significantly associated with SRH, in descending order of impact.

This study investigated the association between ankle injury and the subsequent onset of non-specific low back pain (LBP), and identified the potential contributions of age, sex, body mass index (BMI), and physical activity (PA) to LBP development. This retrospective cohort study used data from the Korean National Health Insurance Sharing Service (2002-2021). Kaplan-Meier analyses estimated cumulative incidence and mean survival time to LBP onset. Cox proportional hazards models were employed to calculate adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) for LBP onset, adjusting for age, sex, BMI, and PA. LBP occurred in 118,086 of 218,683 individuals (54.0%) with ankle injury and 246,425 of 2,582,974 healthy controls (9.54%). After adjusting for covariates, the ankle-injury group was associated with a higher incidence of LBP than the control group (HR=19.021; 95% CI=18.877-19.167). These findings warrant future biomechanical studies to clarify the mechanisms that associate ankle injury with LBP.

Despite the growing popularity of co-creation to develop complex interventions, there is limited guidance on planning and implementing a co-creation process in public health. This study aims to critically review and update one such guidance, the PRODUCES framework, to develop a more comprehensive, user-friendly guide for public health researchers and practitioners. Evidence- and user-informed guideline development. A multi-method, evidence-informed approach was used to identify strengths, gaps, and areas for improvement. This included a snowballing review of peer-reviewed articles citing the PRODUCES framework, followed by in-depth interviews and a mixed-methods survey with lead authors identified through the review. Data from included studies, interviews, and survey responses were analysed thematically. The search identified 96 studies, of which 21 were included. Four interviews and nine survey responses were obtained. Strengths included flexibility, clear foundational guidance, and practical applicability, while limitations related to clarity, overlapping stages, and terminology. Participants suggested strengthening implementation guidance and methods and highlighted the value of complementary frameworks. These findings informed the development of the PRODUCES+ guideline. Building on user input, the original framework, and contemporary co-creation literature, the PRODUCES+ Guideline provides an expanded, step-by-step resource for planning co-creation in public health.

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Global policy discourse increasingly frames sport, leisure, and recreation as tools for advancing climate justice alongside education, health, and social cohesion. While initiatives such as the United Nations Sports for Climate Action Framework highlight sport's potential to address the climate crisis, little is known about how SDP can foster meaningful climate action - defined as actions that contribute to transformative and equitable climate solutions that produce measurable greenhouse gas emissions reductions and support systemic change, especially in the face of climate vulnerabilities structured by intersecting inequalities of class, race, gender, and postcoloniality (IPCC, 2023). Indeed, research on the knowledge-to-action gap in climate change education underscores the importance of affective experiences and existential reflection as mediators between environmental learning and action. In this paper, we argue that physical culture - especially the use of outdoor adventure sports and recreation (OASR) - when deployed in the context of SDP, is potentially uniquely positioned to cultivate environmental identity through embodied, emotional engagement with nature. We further contend that - because SDP initiatives operate in social domains directly impacted by climate change - they are well positioned to advance climate justice. In this perspectives piece, we look across disciplines to explore the role of affective engagement and existential experience in sport as a pedagogical entry point for climate action, climate activism and climate justice. We conclude that SDP offers an unrealized space for socioemotional and behavioural learning - often neglected in climate change education - that can strengthen pathways from climate knowledge to climate action for climate justice.

Physical activity is essential for healthy ageing, yet older adults with disabilities show lower participation than those without disabilities. This study examined barriers, participation intention, and preferred participation modes among non-participating older adults with disabilities, focusing on heterogeneity across disability types. This cross-sectional study used nationally representative data from the 2024 National Survey on Sports Participation for Persons with Disabilities in South Korea. The sample included 1,865 adults aged ≥60 years who reported no exercise participation during the previous year under the survey-based definition. Weighted descriptive analyses, Rao-Scott tests, and survey-weighted logistic regression were performed. The most common primary barriers were lack of motivation (27.1%), poor health condition (23.9%), and lack of time to exercise (11.5%), with significant variation in several barriers across disability types. Severe disability was associated with lower odds of participation intention (OR=0.62, 95% CI: 0.46-0.85), whereas employment was associated with higher odds (OR=1.44, 95% CI: 1.09-1.91). Compared with physical disabilities, hearing and speech disabilities were associated with higher odds of participation intention (OR=1.43, 95% CI: 1.08-1.89). Among respondents with participation intention, outdoor walking was the most preferred mode (57.5%); preferred modes did not differ significantly across disability types. Non-participation in exercise was heterogeneous across disability types, particularly in primary reported barriers, while participation intention differed by disability severity, employment status, and disability type. Outdoor walking was the predominant preference among those reporting intention, highlighting the importance of considering both disability-specific heterogeneity and overall preferences when planning exercise-support strategies.

Cognitive fatigue (CF), characterized by decrements in executive function and heightened subjective exhaustion resulting from prolonged cognitive exertion, has emerged as a critical determinant of athletic performance and psychophysiological wellbeing. Despite the exponential growth in research output, systematic quantitative analyses of the intellectual structure, evolutionary trajectory, and emerging frontiers within this domain remain scarce. Drawing upon the Web of Science Core Collection and Scopus databases, this study retrieved publications addressing exercise and cognitive fatigue from 1998 to 2025 using the search strategy: TS = ("physical activity" OR exercise OR sport*) AND TS = ("mental fatigue" OR "cognitive fatigue" OR "mental fog" OR "cognitive weariness*" OR "cognitive exhaustion*"). Following systematic screening, 820 articles were included for bibliometric analysis utilizing Bibliometrix and VOSviewer. Publication output rose modestly (1.84% annually), peaking in 2025 (n = 106), likely reflecting post-pandemic mental health research expansion and portable neurotechnology adoption. The US and China led productivity; the UK showed highest citation impact (48.16/article), suggesting influential contributions, though this may reflect publication timing and foundational works. Vrije Universiteit Brussel and University of Birmingham topped institutional output, reflecting sustained contributions within the Marcora, Meeusen, and Roelands traditions. Frontiers in Psychology was most influential. Keywords shifted from laboratory tasks to ecologically valid sport contexts ("football," "team sports"). Thematic evolution moved from "chronic fatigue syndrome" to "perceived exertion" and "depression," then to "executive function" and "combat sports"-indicating a gradual shift from descriptive symptoms to integrated cognitive-affective-physiological mechanisms. "Cognitive effort," "physical fatigue," and "executive function" occupied the motor themes quadrant in 2024-2025, signaling mature, structurally central topics. Findings suggest emerging brain-body-performance integration. This study traces an evolution from pathological fatigue measurement to executive function precision assessment. Bibliometric indicators reveal growing emphasis on cognitive effort as a motor modulator, with co-occurrence patterns identifying dual clusters around subjective perception and performance parameters. Whether this bibliographic convergence reflects validated physiological mechanisms or emerging theoretical hypotheses requires further primary experimental investigation. This analysis provides a complementary, field-level perspective that complements, rather than replaces, primary experimental research.

Time in moderate-to-vigorous intensity activity (MVPA), light intensity activity (LPA), and sleep are critical for bone health in older adults but are often considered separately despite being inherently co-dependent. We examined cross-sectional associations between compositions of accelerometry-derived MVPA, LPA, inactivity, and sleep with bone microarchitecture and strength (High-Resolution Peripheral Quantitative Computed Tomography; HR-pQCT) in community-dwelling older men (n=119) and women (n=177), mean age 76.3±4.6 yrs. Participants wore an ActiGraph GT9X on their non-dominant wrist for 7 consecutive 24hr periods during the Study of Muscle, Mobility and Aging (SOMMA) baseline visit. The primary outcomes were distal radius (DR) and tibia (DT) estimated failure load, and secondarily, total volumetric bone mineral density (vBMD), and cortical (Ct) and trabecular (Tb) vBMD, area (Ar), and thickness (Th) from HR-pQCT. Compositional data analysis methods evaluated proportions of time in one behavior relative to the remaining behaviors. Sex-stratified multiple linear regression estimated associations between 24hr composition with sex-specific standardized HR-pQCT parameters. Compositional isotemporal substitution methods estimated hypothetical changes in continuous HR-pQCT measures if 10-60 min in one behavior was displaced by another. On average, women spent 90.2 min/day (6.3%) in MVPA, 346.1 min/day (24.0%) in LPA, 556.4 min/day (38.6%) in inactivity, and 447.4 min/day (31.1%) in sleep; men spent 93.6 min/day (6.5%) in MVPA, 309.5 min/day (21.5%) in LPA, 596.7 min/day (41.4%) in inactivity, and 440.2 min/day (30.6%) in sleep. Compared to the average sex-specific 24hr composition, higher proportions of MVPA were associated with higher DR and DT failure load in women; higher DR Tb.vBMD and Tb.Th in men; and higher DR Tt.vBMD, Ct.Ar, and Ct.Th, and DT Ct.vBMD, Ct.Ar, and Ct.Th in women. Hypothetically displacing 10-60 min in inactivity for MVPA resulted in more favorable HR-pQCT parameters. These data support the importance of MVPA for a healthy skeleton in older men and women. Time spent in all 24hr activities impacts bone strength. We evaluated associations between moderate-to-vigorous intensity physical activity, light intensity physical activity, inactivity, and sleep together with measures of bone strength. In women, 10 minutes of moderate-to-vigorous intensity physical activity instead of inactivity may increase bone strength. In men, higher amounts of time in any activity beyond the average were not associated with bone strength. These results support the importance of moderate-to-vigorous intensity physical activity for a healthy skeleton.

This narrative review examines post-traumatic stress disorder (PTSD) and other trauma- and stressor-related mental health disorders in elite athletes. Elite athletes may experience these disorders at higher rates than the general population owing to disproportionate exposure to traumas and stressors, which can be experienced at individual and collective levels. These disorders can be difficult to detect due to complex symptom presentations and coping strategies that may mask symptoms. They can have both psychological and somatic components, and this dual nature has significant relevance for elite athletes given sport demands. Early identification of elite athletes suffering from trauma- and stressor-related symptoms may prevent progression to PTSD and other chronic mental health disorders. Cultural considerations specific to trauma require attention, as athletes' diverse cultural backgrounds shape help-seeking behaviours, symptom expression, stigma and access to care. Within a framework of trauma-informed care, first-line psychotherapies are generally cognitive-behavioural therapy-based, and first-line pharmacological treatments are generally serotonergic antidepressants. Team-based interventions may be necessary if there is a vicarious aspect to traumas or stressors. Future needs for the field include study and implementation of coordinated approaches to trauma screening and trauma- and stressor-related symptom screening for elite athletes. Healthcare providers and other entourage members for elite athletes should receive education on trauma-informed approaches. Organisational supports should facilitate implementation of trauma-informed care. Further research is needed on all types of traumas and stressors and particularly on institutional and systemic maltreatment as well as on established and emerging therapies as uniquely applied to elite athletes.

Aerobic exercise, defined as rhythmic and continuous physical activity performed at moderate intensity to improve cardiorespiratory fitness, is widely recognised as an effective non-pharmacological intervention for improving the mental health of adolescents with subthreshold depression. However, whether the environment in which exercise is performed-such as indoor versus outdoor settings-modulates its psychological benefits remains insufficiently understood, as empirical evidence is still scarce. This study aims to compare the psychological effects of aerobic exercise conducted in different environmental contexts among adolescents with subthreshold depression and to identify which exercise setting may provide greater therapeutic advantages. This assessor-blinded, two-arm, parallel-group randomised controlled trial will recruit adolescents who meet standardised subthreshold depression screening criteria. Participants will be randomly assigned to the indoor aerobic exercise group or outdoor aerobic exercise group using sex-stratified block randomisation to ensure balanced allocation between male and female participants. Both groups will participate in an 8-week moderate-intensity aerobic exercise programme (2-3 sessions per week, 40 min per session), with heart rate monitoring employed to ensure consistency of exercise intensity across conditions. Depressive symptoms, anxiety and sleep quality will be assessed at baseline (week 0), mid-intervention (week 4) and post-intervention (week 8). Data analysis will be conducted according to the intention-to-treat principle. Ethical approval has been obtained from the Ethics Committee of Capital University of Physical Education and Sports (Approval No. 2025A139). The findings of this study will be disseminated through peer-reviewed publications and academic conferences. ChiCTR2500112215.

To identify and synthesize return-to-sport (RTS) criteria reported after the Bristow-Latarjet procedure for anterior glenohumeral instability in athletes, and to evaluate the associated time to RTS, RTS rate, and instability recurrence, with the aim of informing an evidence-based combination of RTS criteria that may optimize earlier RTS while minimizing recurrence. This protocol follows the guidelines of the Preferred Reporting Items for Systematic review and Meta-Analysis-Protocols (PRISMA-P) statement and it has been registered in the International Prospective Register of Systematic Reviews (PROSPERO; CRD42024563618). We will include randomized and non-randomized comparative studies, cohort and case-control studies, and case series reporting explicit RTS criteria after Bristow-Latarjet in athletes, with a minimum follow-up of 12 months. Searches will be conducted in the PubMed, Web of Science, Embase, SciELO, CENTRAL and SPORTDiscus databases, as well as Google Scholar for grey literature, without restrictions on date, geography, or language. Two reviewers will independently screen and extract data using the Covidence (Veritas Health Innovation Ltd) software. The primary outcomes are time to RTS, RTS rate, and recurrence (using the time point closest to 12 months, when multiple assessments are available). The risk of bias will be assessed using the Risk of Bias 2 (RoB 2; the Cochrane Collaboration) for randomized clinical trials (RCTs), the Newcastle-Ottawa Scale (NOS) for non-randomized comparative studies, and the Joanna Briggs Institute (JBI) Critical Appraisal Checklist for Case Series, and the certainty of the evidence will be rated according to the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach. When appropriate, random-effects meta-analysis and exploratory meta-regression will be performed; subgroup and sensitivity analyses are planned. The systematic review will provide a criterion-centered synthesis of RTS definitions and clearance strategies after Bristow-Latarjet, linking each criterion to clinically-relevant outcomes (time to RTS, RTS rate, and recurrence). The findings are expected to support more consistent, evidence-informed RTS decision-making and guide future prospective validation of optimized RTS criteria combinations. Identificar e sintetizar os critérios de retorno ao esporte relatados após o procedimento de Bristow-Latarjet para instabilidade glenoumeral anterior em atletas, e avaliar o tempo associado e a taxa de retorno ao esporte e a recorrência de instabilidade, com o objetivo de informar uma combinação baseada em evidências de critérios de retorno ao esporte que possa otimizar o retorno antecipado, para minimizar a recorrência. Este protocolo segue as diretrizes da declaração Preferred Reporting Items for Systematic review and Meta-Analysis-Protocols (PRISMA-P) e está registrado no International Prospective Register of Systematic Reviews (PROSPERO; CRD42024563618). Incluiremos estudos comparativos randomizados e não randomizados, estudos de coorte e de caso-controle, e séries de casos que relatem critérios explícitos de retorno ao esporte após Bristow-Latarjet em atletas, com seguimento mínimo de 12 meses. As buscas serão realizadas nas bases de dados PubMed, Web of Science, Embase, SciELO, CENTRAL e SPORTDiscus, além do Google Acadêmico para a literatura cinzenta, sem restrições de data, geografia ou idioma. Dois revisores farão a triagem e a extração de dados de forma independente, usando o programa Covidence (Veritas Health Innovation Ltd). Os resultados primários são o tempo até o retorno ao esporte, a taxa de retorno ao esporte e a recorrência (usando o ponto de tempo mais próximo de 12 meses, quando várias avaliações estão disponíveis). O risco de viés será avaliado utilizando a ferramenta Risk of Bias 2 (RoB 2; the Cochrane Collaboration) para ensaios clínicos randomizados (ECRs), a Newcastle-Ottawa Scale (NOS) para estudos comparativos não randomizados, e a Lista de Verificação de Avaliação Crítica para Séries de Casos do Joanna Briggs Institute (JBI) para séries de casos, e a certeza da evidência será classificada por meio da abordagem Grading of Recommendations Assessment, Development, and Evaluation (GRADE). Quando apropriado, metanálise de efeitos aleatórios e metarregressão exploratória serão realizadas; análises de subgrupo e de sensibilidade estão planejadas. Esta revisão sistemática fornecerá uma síntese centrada nos critérios das definições de retorno ao esporte e das estratégias de liberação após Bristow-Latarjet relacionando cada critério a desfechos clinicamente relevantes (tempo até o retorno ao esporte taxa de retorno ao esporte e recorrência). Espera-se que os resultados apoiem a tomada de decisão de retorno ao esporte de forma mais consistente e baseada em evidências e orientem a futura validação prospectiva de combinações otimizadas de critérios de retorno ao esporte.

Existing UE return-to-sport (RTS) decision-making criteria do not assess neurocognitive (NC) deficits, increasing the risk of reinjury. This study aimed to establish the test-retest reliability of two NC reactive (NCR) variations of an upper extremity (UE) functional performance test (FPT). Forty-two healthy adults completed two trials each of the Closed Kinetic Chain (CKC) UE Stability Test and two NCR variations, the UE Reactive CKC Test-Single Light (UERCKCT-SL) and UE Reactive CKC Test-Multi-Light (UERCKCT-ML), on two separate days. The average number of touches and reaction time were recorded. Reliability was assessed using systematic bias, total error, intraclass correlation coefficients (ICC), and 90% minimal detectable change. ICC results for each test ranged from .669 to .816 for females and .676 to .872 for males. A significant difference in the average number of touches performed between the test variations was observed for both females (F 2,38&#x2009;=&#x2009;7.6, p&#x2009;=&#x2009;.002, &#x3b7; p 2 &#x2009;=&#x2009;.29) and males (F 2,42&#x2009;=&#x2009;13.5, p&#x2009;<&#x2009;.001, &#x3b7; p 2 &#x2009;=&#x2009;.39). Test reaction time differences between the UERCKCT-SL and UERCKCT-ML were not significant for females (t 19&#x2009;=&#x2009;1.20, d&#x2009;=&#x2009;0.21, P&#x2009;=&#x2009;.245, CIdiff = -56.78 to 15.43) and males (t 21&#x2009;=&#x2009;0.40, d&#x2009;=&#x2009;0.05, p&#x2009;=&#x2009;.692, CIdiff = -59.65 to 40.33). Adding NCR multitask UE testing may improve RTS decision-making guidelines by better mimicking sporting demands. However, further research is needed to identify clinically suitable and ecologically valid NCR UE CKC FPT.

This study investigates the challenges faced by university academics (lecturing staff) in supporting student-athletes, with particular attention to the context of small island nations where sporting pathways are still evolving. It also explores their views and awareness of existing support structures, as well as their recommendations for improving institutional support. Semi-structured interviews were conducted with 12 university academics across 11 faculties in Malta. Participants were selected using purposive, convenience, and snowball sampling. Data were analysed using reflexive thematic analysis to explore the range of perceived challenges and support needs. The study revealed that academics faced multiple challenges in supporting student-athletes, including unawareness of student-athletes in their classes, difficulty balancing academic requirements with student-athletes' needs, mental health concerns, and cultural and generational differences. Academics recommended enhancing support systems through increased inter-faculty dialogue, targeted training, incentives for sport mentors, greater university support, a balance of student-athletes' rights and obligations, and the promotion of the student-athlete support programme. Findings underscore the necessity of culturally sensitive, adaptable, and integrated frameworks to accommodate both athletic and academic demands. The research highlights the importance of enhanced support for academics and student-athletes in psychologically informed environments, particularly in small nations such as Malta, where unique cultural and sporting constraints exist. These insights offer valuable contributions to both theory and practice in the development of sport and education policy and support.

Adolescent athletes with attention-deficit hyperactivity disorder (ADHD) have a higher prevalence of concussion history, and ADHD symptoms may complicate post-concussion neurocognitive test interpretation. This study compared post-concussion testing results in adolescents with and without ADHD. Athletes (10-18 years) from the North Texas Concussion Registry (2015-2024) were categorized as ADHD-only or No-ADHD (no learning disorders or ADHD). Post-concussion testing included ImPACT and King-Devick at initial visit, and Generalized Anxiety Disorder-7 (GAD-7), Patient Health Questionnaire-8 (PHQ-8), and Pittsburgh Sleep Quality Index (PSQI) at initial visit and 3-month follow-up. Groups were compared using Mann-Whitney U tests and longitudinal data were compared using paired Student t tests (P&#x2009;<&#x2009;.05). A total of 1518 athletes were included (155 ADHD; 46.6% female). No differences were found in primary ImPACT cognitive domains or King Devick testing scores between groups. ADHD-only athletes had higher GAD-7 and PHQ-8 scores (&#x3bc;&#x2009;=&#x2009;4.24, &#x3bc;&#x2009;=&#x2009;5.46) than no-ADHD athletes (&#x3bc;&#x2009;=&#x2009;3.37, &#x3bc;&#x2009;=&#x2009;4.36) (P&#x2009;<&#x2009;.05) at initial visit, but no differences were observed at 3 months. Recognizing affective symptoms after concussion in athletes with ADHD is important for clinical intervention.