Abstract Purpose To identify barriers to concussive symptom reporting in high school athletics. Methods We conducted a qualitative focus group study with varsity high school athletes from three ...football, two boys' soccer, and four girls' soccer teams in the Seattle, WA, area (50 participants). Professional moderators led the groups with a standardized script that discussed concussion knowledge as well as hypothetical concussion scenarios. Focus groups were recorded and transcribed, and transcripts were analyzed by two investigators using thematic analysis with Atlas.ti. Results Athletes could describe multiple signs and symptoms of concussion. Athletes also understood the dangers of concussions, and all groups mentioned the possibility of death or long-term disability. However, when confronted with scenarios involving concussive symptoms, athletes reported they would not stop playing. They would either continue to play (6/9 groups) or would take a brief break and then return to play (3/9 groups). Several barriers seemed to explain athletes' responses. Athletes wanted to keep playing and knew that reporting symptoms might result in being removed from the game. In addition, concussive symptoms were nonspecific, and thus could be mistaken for another etiology. Finally, athletes were hesitant to report symptoms to coaches if they did not result in significant pain or disability. Conclusions There are several barriers to concussive symptom reporting in high school athletics. Athlete concussion knowledge does not seem to be a barrier, but coach approachability may be an issue. Interventions that seek to improve coach communication with athletes regarding concussion management might increase symptom reporting.
...investigators should review press releases from their institution, funder, and the publishing journal. ...when investigators present the results of their studies at meetings, or in other venues, ...they should use language similar to that used in the article if it has already been published or is in preparation. ...the conclusions of their studies and what they say to the media are their responsibility. Since communication is fundamental to public health it is crucial that investigators avoid hype and spin, acknowledge limitations, and be circumspect, perhaps even understating the impact their study will have on individual clinical care or public health recommendations.
Despite supportive evidence for an association between safe firearm storage and lower risk of firearm injury, the effectiveness of interventions that promote such practices remains unclear. Guided by ...the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist, we conducted a systematic review of randomized and quasi-experimental controlled studies of safe firearm storage interventions using a prespecified search of 9 electronic databases with no restrictions on language, year, or location from inception through May 27, 2015. Study selection and data extraction were independently performed by 2 investigators. The Cochrane Collaboration's domain-specific tool for assessing risk of bias was used to evaluate the quality of included studies. Seven clinic- and community-based studies published in 2000-2012 using counseling with or without safety device provision met the inclusion criteria. All 3 studies that provided a safety device significantly improved firearm storage practices, while 3 of 4 studies that provided no safety device failed to show an effect. Heterogeneity of studies precluded conducting a meta-analysis. We discuss methodological considerations, gaps in the literature, and recommendations for conducting future studies. Although additional studies are needed, the totality of evidence suggests that counseling augmented by device provision can effectively encourage individuals to store their firearms safely.
Silencing the science on gun research Kellermann, Arthur L; Rivara, Frederick P
JAMA : the journal of the American Medical Association,
2013-Feb-13, Letnik:
309, Številka:
6
Journal Article
Hospitals have difficulty justifying the expense of maintaining trauma centers without strong evidence of their effectiveness. To address this gap, we examined differences in mortality between level ...1 trauma centers and hospitals without a trauma center (non-trauma centers).
Mortality outcomes were compared among patients treated in 18 hospitals with a level 1 trauma center and 51 hospitals non-trauma centers located in 14 states. Patients 18 to 84 years old with a moderate-to-severe injury were eligible. Complete data were obtained for 1104 patients who died in the hospital and 4087 patients who were discharged alive. We used propensity-score weighting to adjust for observable differences between patients treated at trauma centers and those treated at non-trauma centers.
After adjustment for differences in the case mix, the in-hospital mortality rate was significantly lower at trauma centers than at non-trauma centers (7.6 percent vs. 9.5 percent; relative risk, 0.80; 95 percent confidence interval, 0.66 to 0.98), as was the one-year mortality rate (10.4 percent vs. 13.8 percent; relative risk, 0.75; 95 percent confidence interval, 0.60 to 0.95). The effects of treatment at a trauma center varied according to the severity of injury, with evidence to suggest that differences in mortality rates were primarily confined to patients with more severe injuries.
Our findings show that the risk of death is significantly lower when care is provided in a trauma center than in a non-trauma center and argue for continued efforts at regionalization.
Postconcussive and co-occurring psychological symptoms are not uncommon after sports-related concussion and are associated with functional impairment and societal costs. There is no evidence-based ...treatment targeting postconcussive symptoms in children and adolescents. The goal of this study was to test a collaborative care intervention model with embedded cognitive-behavioral therapy, care management, and psychopharmacological consultation. We hypothesized that patients in collaborative care would demonstrate greater reductions in postconcussive, depressive, and anxiety symptoms and improvement in functioning over the course of 6 months, compared with usual care control.
Patients aged 11 to 17 years with persistent symptoms ≥1 month after sports-related concussion were randomly assigned to receive collaborative care (n = 25) or care as usual (n = 24). Patients were assessed before randomization and after 1, 3, and 6 months. Groups were compared over time via linear mixed effects regression models.
Adolescents assigned to collaborative care experienced clinically and statistically significant improvements in postconcussive symptoms in addition to functional gains at 6 months compared with controls. Six months after the baseline assessment, 13.0% of intervention patients and 41.7% of control patients reported high levels of postconcussive symptoms (P = .03), and 78% of intervention patients and 45.8% of control patients reported ≥50% reduction in depression symptoms (P = .02). No changes between groups were demonstrated in anxiety symptoms.
Orchestrated efforts to systematically implement collaborative care treatment approaches for slow-to-recover adolescents may be useful given the reductions in postconcussive and co-occurring psychological symptoms in addition to improved quality of life.
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