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Objective: To assess current concussion management practices of primary care providers. Methods: An 11 item questionnaire was mailed to primary care providers in the state of Maine, with serial mailings to non-respondents. Results: Over 50% of the questionnaires were completed, with nearly 70% of primary care providers indicating that they routinely use published guidelines as a tool in managing patients with concussion. Nearly two thirds of providers were aware that neuropsychological tests could be used, but only 16% had access to such tests within a week of injury. Conclusions: Primary care providers are using published concussion management guidelines with high frequency, but many are unable to access neuropsychological testing when it is required. R ecent estimates indicate that as many as 300 000 concussions occur each year during athletic competition. 1More than 62 000 cases of concussion are estimated to occur among high school athletes annually. 2After a concussion, the injured brain may be vulnerable to further injury if another trauma is sustained. 3 The second impact during this period of vulnerability may lead to severe cerebral oedema with potentially catastrophic neurological outcomes. 4 Evidence indicates that repeated concussive injuries to the brain may lead to long term impairment of cognitive function.5 Younger athletes may be at increased risk of complications from repetitive head trauma. 6 To reduce the risk of such adverse outcomes, numerous sets of guidelines have been established to aid the management of concussion. These guidelines suggest an appropriate time for the injured athlete to return to contact sports. 7 The most commonly used guidelines are those published by Cantu, the Colorado Medical Society, and the American Academy of Neurology.8-10 These guidelines have been widely published, but the frequency with which they are used by primary care providers remains unknown.Neuropsychological testing of athletes has been used to identify cognitive deficits after concussion. These tests may be used as an adjunct to existing management guidelines to assist doctors in determining an appropriate time for athletes to return to competition. Many investigators have examined the utility of cognitive testing regimens after concussion. [11][12][13] In this study, primary care providers (paediatricians, family doctors, family nurse practitioners, and doctor's assistants) in the state of Maine were surveyed with regard to their use of published guidelines in the management of concussion. They were also asked about their current use of neuropsychological tests to evaluate athletes with concussion. MATERIALS AND METHODSAn 11 item questionnaire was mailed to 723 primary care providers (paediatrics, family practice, nurse practitioners, and doctor's assistants) in Maine. Two subsequent mailings were made to non-respondents. Data from the survey were entered into a database, and results were analysed using standard descriptive statistics. RESULTSOf the 723 surveys sent, 367 (50.8%) were completed fully...

A consensus has yet to be established as to what an "optimal" vitamin D level is for growing children to develop strong bones for a lifetime. This study demonstrated that 14% of children living in a sunny climate had vitamin D levels below 20 ng/mL, a level universally accepted as insufficient, and 49% were below 30 ng/mL, arguably a "desired" level. A sunny climate does not assure vitamin D sufficiency. Virtually all children should be supplemented, with laboratory follow-up for those at high risk for low bone density/those with insufficiency fractures.

Individuals with seizure disorders have long been restricted from participation in certain sporting activities. Those with seizure disorders are more likely than their peers to have a sedentary lifestyle and to develop obesity. Regular participation in physical activity can improve both physical and psychosocial outcomes for persons with seizure disorders. Seizure activity often is reduced among those patients who regularly engage in aerobic activity. Recent literature indicates that the diagnosis of seizure disorders remains highly stigmatizing in the adolescent population. Persons with seizure disorders may be more accepted by peer groups if they are allowed to participate in sports and recreational activities. Persons with seizure disorders are encouraged to participate in regular aerobic activities. They may participate in team sports and contact or collision activities provided that they utilize appropriate protective equipment. There seems to be no increased risk of injury or increasing seizure activity as the result of such participation. Persons with seizure disorders still are discouraged from participating in scuba diving and skydiving. The benefits of participation in regular sporting activity far outweigh any risk to the athlete with a seizure disorder who chooses to participate in sports.