Background:
Previous research has examined associations between concussion history and adverse health outcomes among former professional football players. Less is known about the potential effects of ...concussion among former college football players without additional exposure at the professional level.
Purpose:
To examine the association between concussion and adverse health outcomes in a cohort of former college football players without exposure to professional football, 15 years after their playing careers ended.
Study Design:
Cross-sectional study; Level of evidence, 3.
Methods:
A sample of 204 former collegiate football players (23.4% of eligible athletes with available contact information)—all of whom played at least 1 season of football from 1999 to 2001 in the National Collegiate Athletic Association (NCAA) and had no professional football exposure—completed a general health survey that assessed lifetime concussion history and included the following: the Veterans RAND 36 Item Health Survey, containing a physical composite score (PCS) and mental composite score (MCS); the depression module of the Patient Health Questionnaire; and the 4-item CAGE alcohol dependence questionnaire (for “cutting down, annoyance by criticism, guilty feeling, and eye-openers”). Multivariable binomial regression models estimated adjusted prevalence ratios (PRs) with 95% CIs while controlling for demographics and playing history covariates through forward selection model building.
Results:
Most participants reported a concussion history (84.3%). Overall, 22.1% and 39.2% of participants reported a PCS and an MCS <50, respectively (indicating worse health than the US national average); 19.1% reported Patient Health Questionnaire scores ≥10 (indicating moderate/severe depression); and 24.8% reported CAGE scores ≥2 (indicating alcohol dependence). The prevalence of having an MCS <50 was higher among those reporting ≥3 versus 0 concussions (PR, 2.5; 95% CI, 1.3-4.9). Controlling for body mass index (BMI), the prevalence of moderate/severe depression was higher among those reporting ≥3 versus 0 concussions (PR, 4.2; 95% CI, 1.0-16.3). Controlling for BMI, the prevalence of having a PCS <50 was higher among those reporting ≥3 versus 1 or 2 concussions (PR, 2.6; 95% CI, 1.3-5.0) but not 0 concussions (PR, 1.5; 95% CI, 0.6-3.6). No associations were found for alcohol dependence.
Conclusion:
Associations between a history of multiple concussions and adverse health outcomes were found among former collegiate football players without professional football exposure but were limited to those reporting ≥3 prior concussions. Because only 23.4% of eligible athletes responded to the survey, the possibility of ascertainment bias exists, and our findings should thus be interpreted with some caution. Continued examination within nonprofessional football populations is needed, but findings highlight the need for prevention efforts to reduce concussion incidence.
Empirical evidence supports the idea that previous severe injuries in former collegiate athletes may adversely affect their ability to participate in daily activities later in life, which may then ...decrease their health-related quality of life (HRQOL).
To assess the influences of previous severe injuries on the HRQOL of former National Collegiate Athletic Association (NCAA) athletes.
Cross-sectional study.
Online survey.
A total of 171 former NCAA collegiate athletes (69 men, 102 women; age = 29.7 ± 3.9 years, height = 171.5 ± 10.4 cm, mass = 76.4 ± 12.9 kg) participated. All individuals completed a demographics questionnaire and the Short Form-36 version 2 (SF-36v2) Health Survey via Qualtrics.
The dependent variables were the physical composite and mental composite summary scores and the 8 subscales of the SF-36v2. The independent variable was the presence of previous severe injury (history of a severe injury or no history of a severe injury during collegiate athletics). Two multivariate analyses of variance were conducted. The first multivariate analysis of variance was conducted for the 8 SF-36v2 subscales and the second for the 2 summary scores.
For the summary scores and all 8 SF-36v2 subscales, the responses were worse for the 103 former collegiate athletes who sustained a previous severe injury compared with the 68 who did not sustain a severe injury. The largest difference between groups was for the physical composite score, with a mean difference of 15.8 points (1.5 standard deviations worse than the US population); the physical functioning subscale demonstrated a mean difference of 12.9 points (1.3 standard deviations worse than the US population).
A majority of the athletes in our sample had experienced a severe injury. Based on these data, previous severe injuries had a negative influence on the HRQOL of former NCAA collegiate athletes.
Background:
College athletes participate in physical activity that may increase chronic stress and injury and induce overtraining. However, there is little known about how previous injuries that have ...occurred during college may limit current physical activity and/or decrease their subsequent health-related quality of life (HRQoL).
Purpose:
To evaluate HRQoL in former United States National Collegiate Athletic Association Division I athletes and nonathletes with the Patient-Reported Outcomes Measurement Information System (PROMIS) and a demographics questionnaire.
Study Design:
Cohort study (prognosis); Level of evidence, 2.
Methods:
The study sample was recruited through alumni databases at a large Midwestern university and consisted of 2 cohorts: (1) former Division I athletes and (2) nonathletes who participated in recreational activity, club sports, or intramurals while attending college. Participants answered a survey constructed with a web-based system. All individuals contacted were between the ages of 40 and 65 years. Study participants responded to the questions on the PROMIS scales for sleep, anxiety, depression, fatigue, pain interference, physical function, and satisfaction with participation in social roles. The PROMIS was developed to fill the void of HRQoL being evaluated by multiple instruments. An additional questionnaire was constructed to record demographic and exercise information.
Results:
Initially, 1280 former Division I athletes and nonathletes were contacted; 638 surveys were returned (49.8%). Surveys eligible for analyses (71.6%) were completed by 232 former Division I athletes (mean age ± SD, 53.36 ± 7.11 years) and 225 nonathletes (mean age ± SD, 53.60 ± 6.79 years). Univariate analyses for the effect of group was significantly related to PROMIS scales for physical function, depression, fatigue, sleep disturbances, and pain interference (P < .05). The overall scores were significantly worse for the former Division I athletes than for the nonathletes on 5 of the 7 scales. In addition, the former Division I athletes reported significantly more limitations in daily activities and more major and chronic injuries than did the nonathlete controls.
Conclusion:
According to these data, former Division I athletes have decreased HRQoL compared with nonathletes.
Clinical Relevance:
Sports encourage physical activity, which help promote a healthy lifestyle. Moderate activity and exercise should be encouraged. However, the demands of Division I athletics may result in injuries that linger into adulthood and possibly make participants incapable of staying active as they age, thereby lowering their HRQoL.
To develop standards and recommendations for transitional care for young people (YP) with juvenile-onset rheumatic and musculoskeletal diseases (jRMD). The consensus process involved the following: ...(1) establishing an international expert panel to include patients and representatives from multidisciplinary teams in adult and paediatric rheumatology; (2) a systematic review of published models of transitional care in jRMDs, potential standards and recommendations, strategies for implementation and tools to evaluate services and outcomes; (3) setting the framework, developing the process map and generating a first draft of standards and recommendations; (4) further iteration of recommendations; (5) establishing consensus recommendations with Delphi methodology and (6) establishing standards and quality indicators. The final consensus derived 12 specific recommendations for YP with jRMD focused on transitional care. These included: high-quality, multidisciplinary care starting in early adolescence; the integral role of a transition co-ordinator; transition policies and protocols; efficient communications; transfer documentation; an open electronic-based platform to access resources; appropriate training for paediatric and adult healthcare teams; secure funding to continue treatments and services into adult rheumatology and the need for increased evidence to inform best practice. These consensus-based recommendations inform strategies to reach optimal outcomes in transitional care for YP with jRMD based on available evidence and expert opinion. They need to be implemented in the context of individual countries, healthcare systems and regulatory frameworks.
A report by the Institute of Medicine called for comprehensive nationwide concussion incidence data across the spectrum of athletes aged 5 to 23 years.
To describe the incidence of concussion in ...athletes participating in youth, high school, and collegiate American football.
Data were collected by athletic trainers at youth, high school, and collegiate football practices and games to create multiple prospective observational cohorts during the 2012 and 2013 football seasons. Data were collected from July 1, 2012, through January 31, 2013, for the 2012 season and from July 1, 2013, through January 31, 2014, for the 2013 season. The Youth Football Surveillance System included 118 youth football teams, providing 4092 athlete-seasons. The National Athletic Treatment, Injury and Outcomes Network program included 96 secondary school football programs, providing 11 957 athlete-seasons. The National Collegiate Athletic Association Injury Surveillance Program included 24 member institutions, providing 4305 athlete-seasons.
All injuries regardless of severity, including concussions, and athlete exposure information were documented by athletic trainers during practices and games.
Injury rates, injury rate ratios, risks, risk ratios, and 95% CIs were calculated.
Concussions comprised 9.6%, 4.0%, and 8.0% of all injuries reported in the Youth Football Surveillance System; National Athletic Treatment, Injury and Outcomes Network; and National Collegiate Athletic Association Injury Surveillance Program, respectively. The game concussion rate was higher than the practice concussion rate across all 3 competitive levels. The game concussion rate for college athletes (3.74 per 1000 athlete exposures) was higher than those for high school athletes (injury rate ratio, 1.86; 95% CI, 1.50-2.31) and youth athletes (injury rate ratio, 1.57; 95% CI, 1.17-2.10). The practice concussion rate in college (0.53 per 1000 athlete exposures) was lower than that in high school (injury rate ratio, 0.80; 95% CI, 0.67-0.96). Youth football had the lowest 1-season concussion risks in 2012 (3.53%) and 2013 (3.13%). The 1-season concussion risk was highest in high school (9.98%) and college (5.54%) in 2012.
Football practices were a major source of concussion at all 3 levels of competition. Concussions during practice might be mitigated and should prompt an evaluation of technique and head impact exposure. Although it is more difficult to change the intensity or conditions of a game, many strategies can be used during practice to limit player-to-player contact and other potentially injurious behaviors.
Recent advances in DNA sequencing have led to the development of breast cancer susceptibility gene panels for germline genetic testing of patients. We assessed the frequency of mutations in 17 ...predisposition genes, including BRCA1 and BRCA2, in a large cohort of patients with triple-negative breast cancer (TNBC) unselected for family history of breast or ovarian cancer to determine the utility of germline genetic testing for those with TNBC.
Patients with TNBC (N = 1,824) unselected for family history of breast or ovarian cancer were recruited through 12 studies, and germline DNA was sequenced to identify mutations.
Deleterious mutations were identified in 14.6% of all patients. Of these, 11.2% had mutations in the BRCA1 (8.5%) and BRCA2 (2.7%) genes. Deleterious mutations in 15 other predisposition genes were detected in 3.7% of patients, with the majority observed in genes involved in homologous recombination, including PALB2 (1.2%) and BARD1, RAD51D, RAD51C, and BRIP1 (0.3% to 0.5%). Patients with TNBC with mutations were diagnosed at an earlier age (P < .001) and had higher-grade tumors (P = .01) than those without mutations.
Deleterious mutations in predisposition genes are present at high frequency in patients with TNBC unselected for family history of cancer. Mutation prevalence estimates suggest that patients with TNBC, regardless of age at diagnosis or family history of cancer, should be considered for germline genetic testing of BRCA1 and BRCA2. Although mutations in other predisposition genes are observed among patients with TNBC, better cancer risk estimates are needed before these mutations are used for clinical risk assessment in relatives.
Idiopathic hypogonadotropic hypogonadism (IHH) with anosmia (Kallmann syndrome; KS) or with a normal sense of smell (normosmic IHH; nIHH) are heterogeneous genetic disorders associated with ...deficiency of gonadotropin-releasing hormone (GnRH). While loss-of-function mutations in FGF receptor 1 (FGFR1) cause human GnRH deficiency, to date no specific ligand for FGFR1 has been identified in GnRH neuron ontogeny. Using a candidate gene approach, we identified 6 missense mutations in FGF8 in IHH probands with variable olfactory phenotypes. These patients exhibited varied degrees of GnRH deficiency, including the rare adult-onset form of hypogonadotropic hypogonadism. Four mutations affected all 4 FGF8 splice isoforms (FGF8a, FGF8b, FGF8e, and FGF8f), while 2 mutations affected FGF8e and FGF8f isoforms only. The mutant FGF8b and FGF8f ligands exhibited decreased biological activity in vitro. Furthermore, mice homozygous for a hypomorphic Fgf8 allele lacked GnRH neurons in the hypothalamus, while heterozygous mice showed substantial decreases in the number of GnRH neurons and hypothalamic GnRH peptide concentration. In conclusion, we identified FGF8 as a gene implicated in GnRH deficiency in both humans and mice and demonstrated an exquisite sensitivity of GnRH neuron development to reductions in FGF8 signaling.
Introduction Many studies have explored patients' experiences of dialysis and other treatments for kidney failure. This is the first qualitative multi-site international study of how staff perceive ...the process of a patient's transition from peritoneal dialysis to in-centre haemodialysis. Current literature suggests that transitions are poorly coordinated and may result in increased patient morbidity and mortality. This study aimed to understand staff perspectives of transition and to identify areas where clinical practice could be improved. Methods Sixty-one participants (24 UK and 37 Australia), representing a cross-section of kidney care staff, took part in seven focus groups and sixteen interviews. Data were analysed inductively and findings were synthesised across the two countries. Results For staff, good clinical practice included: effective communication with patients, well planned care pathways and continuity of care. However, staff felt that how they communicated with patients about the treatment journey could be improved. Staff worried they inadvertently made patients fear haemodialysis when trying to explain to them why going onto peritoneal dialysis first is a good option. Despite staff efforts to make transitions smooth, good continuity of care between modalities was only reported in some of the Australian hospitals where, unlike the UK, patients kept the same consultant. Timely access to an appropriate service, such as a psychologist or social worker, was not always available when staff felt it would be beneficial for the patient. Staff were aware of a disparity in access to kidney care and other healthcare professional services between some patient groups, especially those living in remote areas. This was often put down to the lack of funding and capacity within each hospital. Conclusions This research found that continuity of care between modalities was valued by staff but did not always happen. It also highlighted a number of areas for consideration when developing ways to improve care and provide appropriate support to patients as they transition from peritoneal dialysis to in-centre haemodialysis.
The prevalence of physical chronic or long-term conditions in adolescents aged 10-24 years is rising. Mobile phone and tablet mobile technologies featuring software program apps are widely used by ...these adolescents and their healthy peers for social networking or gaming. Apps are also used in health care to support personal condition management and they have considerable potential in this context. There is a growing body of literature on app use in health contexts, thereby making a systematic review of their effectiveness very timely.
To systematically review the literature on the effectiveness of mobile apps designed to support adolescents' management of their physical chronic or long-term conditions.
We conducted a review of the English-language literature published since 2003 in five relevant bibliographical databases using key search terms. Two independent reviewers screened titles and abstracts using data extraction and quality assessment tools.
The search returned 1120 hits. Of the 19 eligible full-text papers, four met our review criteria, reporting one pilot randomized controlled trial and three pretest/post-test studies. Samples ranged from 4 to 18 participants, with a combined sample of 46 participants. The apps reported were targeted at type 1 diabetes, asthma, and cancer. Two papers provided data for calculating effect size. Heterogeneity in terms of study design, reported outcomes, follow-up times, participants' ages, and health conditions prevented meta-analyses. There was variation in whether adolescents received guidance in using the app or were solely responsible for navigating the app. Three studies reported some level of patient involvement in app design, development, and/or evaluation. Health professional involvement in the modelling stages of apps was reported in all studies, although it was not always clear whether specific clinical (as opposed to academic) expertise in working with adolescents was represented. The dearth of studies and the small overall sample size emphasizes the need for future studies of the development, evaluation, use, and effectiveness of mobile apps to support adolescents' personal management of their conditions.
A key finding of the review is the paucity of evidence-based apps that exist, in contrast to the thousands of apps available on the app market that are not evidence-based or user or professional informed. Although we aimed to assess the effectiveness of apps, the dearth of studies meeting our criteria meant that we were unable to be conclusive in this regard. Based on the available evidence, apps may be considered feasible health interventions, but more studies involving larger sample sizes, and with patient and health professional input at all stages, are needed to determine apps' acceptability and effectiveness. This review provides valuable findings and paves the way for future rigorous development and evaluation of health apps for adolescents with chronic or long-term conditions.
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