Menstrual Cycle Patterns After Concussion in Adolescent Patients

Progesterone and Estradiol Levels Associated with Concussion and Clinical Outcomes and Recovery in Female Athletes and Cadets

INTRODUCTION

Female athletes are underrepresented in concussion research, and few studies have investigated associations of ovarian hormones with concussion outcomes. This study explored associations of concussion with levels and variability of progesterone, estradiol, and their ratio (P/E) and examined relationships of hormone levels with clinical measures and recovery after concussion in CARE Consortium female athletes and cadets.

METHODS

Female participants enrolled ( n = 749) at pre-injury baseline. Participants with concussion (mean age, 19.34 yr; n = 130, 90 athletes, 40 nonathlete cadets) completed one or more visits at nonstandardized times of day: immediately post-injury, 24 h post-injury, upon initiating the return-to-play protocol (Init RTP), and 7 d following unrestricted return-to-play (PRTP). Controls (mean age, 19.85 yr; n = 67, 61 athletes, 6 nonathlete cadets) completed similar visits. Linear mixed models and general linear models tested associations of hormone levels and/or variation with concussion status, symptoms, and recovery, controlling for self-reported birth control use at pre-injury baseline.

RESULTS

Female participants with concussion had higher progesterone levels relative to controls on average across all visits (mean difference (MD; ln ng·mL -1 ) (standard error) = 0.26 (0.08), t (193) = 3.03, P = 0.003). Those with concussion had elevated estradiol at 24 h (MD = 0.27 (0.09), t (506) = 3.04, P = 0.02), Init RTP (MD = 0.38 (0.09), t (508) = 4.29, P < 0.001), and PRTP (MD = 0.30 (0.09), t (515) = 3.25, P = 0.01) relative to pre-injury baseline and compared with controls at Init RTP (MD = 0.35 (0.12), t (429) = 2.78, P = 0.006). Concussed participants had a lower range of estradiol over 7-28 d than controls ( B (SE) = -0.24 (0.09), F (1,145) = 6.43, P = 0.01). Acutely after concussion, estradiol was positively associated with Brief Symptom Inventory Global Severity Index scores ( B (SE) = 0.29 (0.12), F (1,102) = 5.60, P = 0.02). No significant relationships were found between hormones and recovery.

CONCLUSIONS

These results, which warrant further research, suggest that ovarian hormones may be associated with concussion and psychological symptom severity post-concussion.

Hybrid Greylag Goose deep learning with layered sparse network for women nutrition recommendation during menstrual cycle

A complex biological process involves physical changes and hormonal fluctuation in the menstrual cycle. The traditional nutrition recommendation models often offer general guidelines but fail to address the specific requirements of women during various menstrual cycle stages. This paper proposes a novel Optimization Hybrid Deep Learning (OdriHDL) model to provide a personalized health nutrition recommendation for women during their menstrual cycle. It involves pre-processing the data through Missing Value Imputation, Z-score Normalization, and One-hot encoding. Next, feature extraction is accomplished using the Layered Sparse Autoencoder Network. Then, the extracted features are utilized by the Hybrid Attention-based Bidirectional Convolutional Greylag Goose Gated Recurrent Network (HABi-ConGRNet) for nutrient recommendation. The hyper-parameter tuning of HABi-ConGRNet is carried out using Greylag Goose Optimization Algorithm to enhance the model performance. The Python platform is used for the simulation of collected data, and several performance metrics are employed to analyze the performance. The OdriHDL model demonstrates superior performance, achieving a maximum accuracy of 97.52% and enhanced precision rate in contrast to the existing methods, like RNN, CNN-LSTM, and attention GRU. The findings suggest that OdriHDL captures complex patterns between nutritional needs and menstrual symptoms and provides robust solutions to unique physiological changes experienced by women.

Is your system fit for purpose? Female athlete health considerations for rugby injury and illness surveillance systems

This review discusses female-specific health considerations in injury and illness surveillance and provides rugby-specific recommendations for future surveillance. Identifying priority injury and illness problems by determining those problems with the highest rates within women's rugby may highlight different priorities than sex comparisons between men's and women's rugby. Whilst sports exposure is the primary risk for health problems in sports injury and illness surveillance, female athletes have health domains that should also be considered. Alongside female athlete health domains, studies investigating rugby injuries and illnesses highlight the need to broaden the health problem definition typically used in rugby injury and illness surveillance. Using a non-time-loss health problem definition, recording female-specific population characteristics, embedding female athlete health domains and having up-to-date injury and illness coding systems should be prioritized within surveillance systems to begin to shed light on potential interactions between sports exposure, health domains and, injuries and illnesses. We call for a collaborative approach across women's rugby to facilitate large injury and illness datasets to be generated and enable granular level categorization and analysis, which may be necessary for certain female athlete health domains. Applying these recommendations will ensure injury and illness surveillance systems improve risk identification and better inform injury and illness prevention strategies in women's rugby.

Community and Patient Features and Health Care Point of Entry for Pediatric Concussion

Importance

Many recent advances in pediatric concussion care are implemented by specialists; however, children with concussion receive care across varied locations. Thus, it is critical to identify which children have access to the most up-to-date treatment strategies.

Objective

To evaluate differences in the sociodemographic and community characteristics of pediatric patients who sought care for concussion across various points of entry into a regional health care network.

Design, Setting, and Participants

This cross-sectional study included children seen for concussions across a regional US health care network from January 1, 2017, to August 4, 2023. Pediatric patients aged 0 to 18 years who received an International Statistical Classification of Diseases and Related Health Problems, Tenth Revision, Clinical Modification code for concussion were included. The study took place at emergency department (ED) and outpatient (primary care [PC] and specialty care [SC]) settings.

Exposures

Age at visit, biological sex, parent-identified race and ethnicity, payer type, median income and percentage of adults with a bachelor's degree for home zip code, and overall and subdomain Child Opportunity Index (COI) score based on patient address.

Main Outcomes and Measures

The association of exposures with point of entry of ED, PC, and SC were examined in both bivariate analysis and a multinomial logistic regression.

Results

Overall, 15 631 patients were included in the study (median [IQR] age, 13 [11-15] years; 7879 [50.4%] male; 1055 [6.7%] Hispanic, 2865 [18.3%] non-Hispanic Black, and 9887 [63.7%] non-Hispanic White individuals). Race and ethnicity were significantly different across settings (1485 patients [50.0%] seen in the ED were non-Hispanic Black vs 1012 [12.0%] in PC and 368 [8.7%] in SC; P < .001) as was insurance status (1562 patients [52.6%] seen in the ED possessed public insurance vs 1624 [19.3%] in PC and 683 [16.1%] in SC; P < .001). Overall and individual COI subdomain scores were also significantly different between settings (overall COI median [IQR]: ED, 30 [9-71]; PC, 87 [68-95]; SC, 87 [69-95]; P < .001). Race, insurance status, and overall COI had the strongest associations with point of entry in the multivariable model (eg, non-Hispanic Black patients seen in the ED compared with non-Hispanic White patients: odds ratio, 2.03; 95% CI, 1.69-2.45).

Conclusions and Relevance

In this cross-sectional study, children with concussion seen in the ED setting were more likely to be non-Hispanic Black, have public insurance, and have a lower Child Opportunity Index compared with children cared for in the PC or SC setting. This highlights the importance of providing education and training for ED clinicians as well as establishing up-to-date community-level resources to optimize care delivery for pediatric patients with concussion at high risk of care inequities.

Age-Related Variations in Clinical Profiles for Children with Sports- and Recreation-Related Concussions

OBJECTIVE

The purpose was to examine clinical profiles in concussed children aged 5-9 and 10-12 years and compare them with those of adolescents >12 years.

METHODS

This study included patients aged 5-18 years presenting to a specialty care concussion program with a sports- and recreation-related (SRR) concussion ≤28 days postinjury. Demographics, injury mechanisms, symptoms, and clinical features were assessed. Chi-squared tests, one-way ANOVA, and Kruskal-Wallis were used for comparisons across age groups.

RESULTS

A total of 3280 patients with SRR concussion were included: 5.0% were 5-9 years, 18.4% were 10-12 years, and 76.6% were 13-18 years. Younger age groups had more males than females (5-9 years: 70.7% vs. 29.3%) and more commonly sustained their injury during limited- (28.7%), and non-contact (7.9%) activities compared to other age groups (p < 0.01). Younger children presented less symptoms frequently (p ≤ 0.042), but higher symptom severity in somatic and emotional domains (p ≤ 0.016). Fewer 5-9-year-olds reported changes in school (25.6%), sleep (46.3%), and daily habits (40.9%) than adolescents (p < 0.001).

CONCLUSIONS

Among SRR-concussed children and adolescents, we found significant age-related variations in demographics, injury mechanism, symptoms, and clinical features. Recognizing these unique features in younger children may facilitate targeted management and treatment.

Using mobile health to expedite access to specialty care for youth presenting to the emergency department with concussion at highest risk of developing persisting symptoms: a protocol paper for a non-randomised hybrid implementation-effectiveness trial

INTRODUCTION

Paediatric concussion is a common injury. Approximately 30% of youth with concussion will experience persisting postconcussion symptoms (PPCS) extending at least 1 month following injury. Recently, studies have shown the benefit of early, active, targeted therapeutic strategies. However, these are primarily prescribed from the specialty setting. Early access to concussion specialty care has been shown to improve recovery times for those at risk for persisting symptoms, but there are disparities in which youth are able to access such care. Mobile health (mHealth) technology has the potential to improve access to concussion specialists. This trial will evaluate the feasibility of a mHealth remote patient monitoring (RPM)-based care handoff model to facilitate access to specialty care, and the effectiveness of the handoff model in reducing the incidence of PPCS.

METHODS AND ANALYSIS

This study is a non-randomised type I, hybrid implementation-effectiveness trial. Youth with concussion ages 13-18 will be enrolled from the emergency department of a large paediatric healthcare network. Patients deemed a moderate-to-high risk for PPCS using the predicting and preventing postconcussive problems in paediatrics (5P) stratification tool will be registered for a web-based chat platform that uses RPM to collect information on symptoms and activity. Those patients with escalating or plateauing symptoms will be contacted for a specialty visit using data collected from RPM to guide management. The primary effectiveness outcome will be the incidence of PPCS, defined as at least three concussion-related symptoms above baseline at 28 days following injury. Secondary effectiveness outcomes will include the number of days until return to preinjury symptom score, clearance for full activity and return to school without accommodations. The primary implementation outcome will be fidelity, defined as the per cent of patients meeting specialty care referral criteria who are ultimately seen in concussion specialty care. Secondary implementation outcomes will include patient-defined and clinician-defined appropriateness and acceptability.

ETHICS AND DISSEMINATION

This study was approved by the Institutional Review Board of the Children's Hospital of Philadelphia (IRB 22-019755). Study findings will be published in peer-reviewed journals and disseminated at national and international meetings.

TRIAL REGISTRATION NUMBER

NCT05741411.

Progesterone Levels in Adolescent Female Athletes May Contribute to Decreased Cognitive Performance During Acute Phase of Sports-Related Concussion

Although many outcome studies pertaining to sports-related concussion exist, female athletes with concussion remain an understudied group. We examined whether neurocognitive performance in adolescent females with sports-related concussion (SRC) is related to menstrual cycle-related hormone levels measured at one-week post-concussion, one-month post-concussion, or both. Thirty-eight female athletes, ages 14-18, were matched into two groups: SRC or healthy control. Self-reported symptom scores were higher among concussed females in the luteal phase, when progesterone levels are highest. Results suggest that progesterone levels may contribute to a heightened experience of symptoms during the acute phase of SRC, providing further evidence of a possible link between progesterone and symptom scores following concussion.

Exploring the relationship between contraceptive medication use and concussion recovery in female collegiate athletes: a LIMBIC MATARS consortium investigation

OBJECTIVE

While recovery from concussion is variable, women are more likely to report symptoms, experience worse outcomes, and have longer recovery trajectories following concussion than men. Preliminary data suggest that hormonal fluctuations, specifically progesterone, may be associated with this variability. This study aimed to understand the effect of contraceptive medication on concussion recovery.

METHODS

A retrospective chart review using consensus-based common data elements was conducted at 11 NCAA institutions as part of the LIMBIC MATARS consortium. Participants included female collegiate athletes diagnosed with a concussion who did (n = 117) or did not report (n = 339) contraceptive medication use. Number of days between diagnosis and symptom resolution were compared using Mann-Whitney U tests. Self-reported diagnosis of attention deficit hyperactivity disorder, concussion history, anxiety, and depression was compared using Chi-squared tests.

RESULTS

The proportions of participants who did or did not take contraceptive medication were similar across covariates. Female athletes regardless of contraceptive medication use recovered similarly following a concussion.

CONCLUSIONS

Our findings suggest that contraceptive medication use did not significantly impact concussion recovery. Future prospective investigations should examine documentation practices and operationalize terminology for hormonal contraceptive medication to better understand their role on recovery from sport-related concussion in female collegiate athletes.