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Kuenze C, Pietrosimone B, Currie KD, Walton SR, Kerr ZY, Brett BL, Chandran A, DeFreese JD, Mannix R, Echemendia RJ, McCrea M, Guskiewicz KM, Meehan WP. Joint Injury, Osteoarthritis, and Cardiovascular Disease Risk Factors in Former National Football League Athletes: An NFL-LONG Study. J Athl Train 2023; 58:528-535. [PMID: 36645831 PMCID: PMC10496448 DOI: 10.4085/1062-6050-0437.22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
CONTEXT Individuals with lower extremity osteoarthritis (OA) have a 25% greater risk of cardiovascular disease (CVD) than those without OA. The prevalence of traumatic joint injuries among National Football League (NFL) players exposes these athletes to an elevated risk for OA and potentially a greater risk of cardiovascular risk factors (CRFs) and CVD. OBJECTIVES To examine the associations between a history of lower extremity joint injury, lower extremity OA, and the prevalence of CRFs and CVD among former NFL athletes. DESIGN Cross-sectional study. PATIENTS OR OTHER PARTICIPANTS Former NFL players completed a comprehensive health questionnaire that was used in an ongoing study, the Neurologic Function Across the Lifespan: A Prospective, Longitudinal, and Translational Study for Former NFL Players (NFL-LONG). A subsample of 1738 former players reported lifetime medical diagnoses including CVD or CRFs. MAIN OUTCOME MEASURE(S) Crude and adjusted prevalence ratios (PRsadj) characterized the associations between CVD or CRFs and injury, OA diagnosis, or both among athletes who reported (1) no history of lower extremity joint injury or surgery and no diagnosed OA, (2) a history of lower extremity joint injury or surgery and no diagnosed OA, and (3) a history of lower extremity joint injury or surgery and diagnosed OA. RESULTS Neither a history of lower extremity joint injury (PRadj = 1.34; 95% CI = 0.86, 2.07) nor a history of lower extremity joint injury and diagnosed OA (PRadj = 1.41; 95% CI = 0.89, 2.25) was significantly associated with CVD. However, CRFs were 30% and 53% more prevalent in former players with lower extremity joint injury and no diagnosed OA (PRadj = 1.30; 95% CI = 1.12, 1.50) and those with lower extremity joint injury and diagnosed OA (PRadj = 1.53; 95% CI = 1.31, 1.78), respectively, versus athletes with no history of either condition. CONCLUSIONS The prevalence of CRFs was highest among former NFL athletes with a history of lower extremity joint injury and diagnosed OA. These findings provide insight regarding the potential pathways to chronic diseases that may be initiated by joint injury early in life.
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Affiliation(s)
| | - Brian Pietrosimone
- Department of Exercise & Sport Science, University of North Carolina at Chapel Hill
| | | | - Samuel R. Walton
- Department of Exercise & Sport Science, University of North Carolina at Chapel Hill
| | - Zachary Y. Kerr
- Department of Exercise & Sport Science, University of North Carolina at Chapel Hill
| | | | - Avinash Chandran
- Department of Exercise & Sport Science, University of North Carolina at Chapel Hill
- Datalys Center for Sports Injury Research and Prevention, Indianapolis, IN
| | - J. D. DeFreese
- Department of Exercise & Sport Science, University of North Carolina at Chapel Hill
| | | | - Ruben J. Echemendia
- University of Missouri–Kansas City
- University Orthopedics Center Concussion Clinic, State College, PA
| | | | - Kevin M. Guskiewicz
- Department of Exercise & Sport Science, University of North Carolina at Chapel Hill
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Kay MC, Hennink-Kaminski H, Kerr ZY, Gildner P, Ingram BM, Cameron KL, Houston MN, Linnan LA, Marshall SW, Peck KY, Register-Mihalik JK. Factors and expectations influencing concussion disclosure within NCAA Division I athletes: A mixed methodological approach. J Sport Health Sci 2023; 12:388-397. [PMID: 34547482 DOI: 10.1016/j.jshs.2021.09.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/04/2021] [Revised: 06/16/2021] [Accepted: 07/07/2021] [Indexed: 05/17/2023]
Abstract
BACKGROUND Participation in sports is associated with many benefits to all aspects of health; however, it also comes with the risk of injury, particularly concussions. Self-disclosure and care seeking following a concussion are especially important because of the lack of outwardly visible signs and/or symptoms. Although recent research has explored factors affecting concussion disclosure, use of isolated methodologies limits the ability to contextualize how disclosure or nondisclosure occurs. Therefore, the purpose of this study was to describe the factors and expectations of National Collegiate Athletic Association (NCAA) athletes that may influence concussion disclosure. METHODS This mixed-methods convergent parallel research study included 25 NCAA Division I athletes representing 13 sports, all of whom completed a concussion-education session with pre-/post-test surveys and a semistructured interview. Eligible athletes were at least 18 years old and on an NCAA roster. The surveys focused on previous concussion-related disclosure behaviors, knowledge, attitudes, beliefs, norms, and intentions about disclosing concussion. Interviews focused on the athletes' experiences related to concussion disclosure. Survey data were analyzed using descriptive statistics and Mann-Whitney U tests. Interviews were analyzed using a Consensual Qualitative Research tradition. RESULTS Participants had good concussion knowledge (median = 46.0), positive attitudes (median = 38.0), strong beliefs (median = 13.0), and strong intentions to disclose concussion symptoms (median = 7.0). None of the constructs differed by participants' gender. Although quantitative findings were mostly positive, interview data highlighted factors that may explain why some participants are successful in disclosing concussions and why others may find disclosure difficult. Educational efforts, sport culture, and medical professional presence were the primary facilitators discussed by participants. Stigma, pressure, and a lack of team support were perceived as disclosure barriers. CONCLUSION The context in which concussion disclosure occurs or does not occur is vital to the success of educational interventions. Interventions must prioritize stakeholder- and team-based perspectives on concussion to establish a network supportive to disclosure.
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Affiliation(s)
- Melissa C Kay
- School of Health Professions, College of Nursing and Health Professions, University of Southern Mississippi, Hattiesburg, MS 39406, USA
| | - Heidi Hennink-Kaminski
- School of Media and Journalism, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - Zachary Y Kerr
- Injury Prevention Research Center, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA; Department of Exercise and Sport Science, College of Arts and Sciences, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA; Matthew Gfeller Sport-Related Traumatic Brain Injury Research Center, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA; Center for the Study of Retired Athletes, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - Paula Gildner
- Injury Prevention Research Center, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - Brittany M Ingram
- Department of Exercise and Sport Science, College of Arts and Sciences, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA; Matthew Gfeller Sport-Related Traumatic Brain Injury Research Center, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - Kenneth L Cameron
- Keller Army Hospital, United States Military Academy, West Point, NY 10996, USA; Departments of Physical Medicine and Rehabilitation and Surgery, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA
| | - Megan N Houston
- Keller Army Hospital, United States Military Academy, West Point, NY 10996, USA
| | - Laura A Linnan
- Department of Health Behavior, School of Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - Stephen W Marshall
- Injury Prevention Research Center, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA; Department of Epidemiology, School of Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - Karen Y Peck
- Keller Army Hospital, United States Military Academy, West Point, NY 10996, USA
| | - Johna K Register-Mihalik
- Injury Prevention Research Center, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA; Department of Exercise and Sport Science, College of Arts and Sciences, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA; Matthew Gfeller Sport-Related Traumatic Brain Injury Research Center, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA.
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Hirschhorn RM, Huggins RA, Kerr ZY, Mensch JM, Dompier TP, Rudisill C, Yeargin SW. Access to Athletic Trainers and Emergency Medical Services Activations for Sport-Related Injuries. J Athl Train 2023; 58:387-392. [PMID: 37523419 DOI: 10.4085/234.22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/02/2023]
Abstract
CONTEXT Having athletic trainers (ATs) employed at secondary schools is associated with improved preparedness for sport-related emergencies. The use of emergency medical services (EMS) in settings with different access to athletic training services remains unknown. OBJECTIVE To compare the incidence of EMS activations for patients with sport-related injuries among zip codes with various levels of access to athletic training services. DESIGN Descriptive epidemiology study. SETTING Data were obtained from the National EMS Information System and the Athletic Training Location and Services Project. PATIENTS OR OTHER PARTICIPANTS Zip codes where 911 EMS activations for sport-related injuries among individuals 13 to 18 years old occurred. MAIN OUTCOME MEASURE(S) Incidence of EMS activations, athletic training service level (no ATs employed [NONE], less than full-time employment [PARTIAL], all ATs employed full time [FULL]), and athletic training employment model (independent contractor [IC], medical or university facility [MUF], school district [SD], mixed employment models [MIX]) for each zip code. RESULTS The EMS activations were 2.8 ± 3.6 per zip code (range = 1-81, N = 4923). Among zip codes in which at least 1 AT was employed (n = 2228), 3.73% (n = 83) were IC, 38.20% (n = 851) were MUF, 27.24% (n = 607) were SD, and 30.83% (n = 687) were MIX. Compared with SD, MUF had a 10.8% lower incidence of EMS activations (incidence rate ratio [IRR] = 0.892; 95% CI = 0.817, 0.974; P = .010). The IC (IRR = 0.920; 95% CI = 0.758, 1.118; P = .403) and MIX (IRR = 0.996; 95% CI = 0.909, 1.091; P = .932) employment models were not different from the SD model. Service level was calculated for 3834 zip codes, with 19.5% (n = 746) NONE, 46.2% (n = 1771) PARTIAL, and 34.4% (n = 1317) FULL. Compared with NONE, FULL (IRR = 1.416; 95% CI = 1.308, 1.532; P < .001) and PARTIAL (IRR = 1.368; 95% CI = 1.268, 1.476; P < .001) had higher incidences of EMS activations. CONCLUSIONS Local access to athletic training services was associated with an increased use of EMS for sport-related injuries among secondary school-aged individuals, possibly indicating improved identification and triage of sport-related emergencies in the area. The difference in EMS use among employment models may reflect different policies and procedures for sport-related emergencies.
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Affiliation(s)
| | | | - Zachary Y Kerr
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill
| | - James M Mensch
- Department of Exercise Science, Arnold School of Public Health, University of South Carolina, Columbia
| | - Thomas P Dompier
- School of Health Professions, Lebanon Valley College, Annville, PA
| | - Caroline Rudisill
- Department of Exercise Science, Arnold School of Public Health, University of South Carolina, Columbia
| | - Susan W Yeargin
- Department of Exercise Science, Arnold School of Public Health, University of South Carolina, Columbia
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Bryant AM, Kerr ZY, Walton SR, Barr WB, Guskiewicz KM, McCrea MA, Brett BL. Investigating the association between subjective and objective performance-based cognitive function among former collegiate football players. Clin Neuropsychol 2023; 37:595-616. [PMID: 35670306 PMCID: PMC9726994 DOI: 10.1080/13854046.2022.2083021] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2022] [Accepted: 05/22/2022] [Indexed: 11/03/2022]
Abstract
OBJECTIVE Studies have observed variable associations of prior contact sport participation with subjective and objective measures of cognitive function. This study directly investigated the association between subjective self-report and objective performance-based cognition among former collegiate football players, as well as its relationship to self-reported concussion history. METHODS Former collegiate football players (N = 57; mean age = 37.9 years [SD = 1.49]) retired from sport 15-years prior were enrolled. Linear regression models examined associations between subjective cognition (Quality of Life in Neurological Disorders Cognitive Functioning-Short Form), and performance on a neuropsychological battery. Domain specific (executive function) metrics of subjective (Behavior Rating Inventory of Executive Function-Adult) and objective cognition were also exclusively examined. Associations between self-reported concussion history with subjective and objective measures were tested. Potential influential factors (sleep quality and distress) were included as covariates. RESULTS Subjective cognition was not significantly associated with any objective measures of cognitive functioning (p's > .05). Greater self-reported concussion history was inversely associated with subjective cognition (B = -2.49, p = .004), but not objective performance-based cognition (p's > .05). Distress was significantly related to all metrics of subjective cognition (p's < .001) as well as performance on delayed recall and verbal fluency (p's < .05). Sleep quality was only significantly related to timed visuospatial sequencing (p = .033). CONCLUSIONS Reliance on self-reported measures of cognitive functioning alone is insufficient when assessing cognition in former contact sport athletes. Assessment of other factors known to influence subjective cognitive complaints should also be examined in determining the presence of cognitive deficits.
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Affiliation(s)
- Andrew M. Bryant
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin
- Department of Neurology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Zachary Y. Kerr
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill
| | - Samuel R. Walton
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill
| | | | - Kevin M. Guskiewicz
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill
| | - Michael A. McCrea
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin
- Department of Neurology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Benjamin L. Brett
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin
- Department of Neurology, Medical College of Wisconsin, Milwaukee, Wisconsin
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Nedimyer AK, Chandran A, Kossman MK, Gildner P, Register-Mihalik JK, Kerr ZY. Concussion knowledge, attitudes, and norms: How do they relate? PLoS One 2023; 18:e0282061. [PMID: 36812182 PMCID: PMC9946210 DOI: 10.1371/journal.pone.0282061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Accepted: 02/06/2023] [Indexed: 02/24/2023] Open
Abstract
BACKGROUND Relationships between the constructs of concussion-related knowledge, attitudes, and norms and their influence on observed care-seeking behaviors have previously been examined. Current models posit that these constructs serve as potential mediators of care-seeking behaviors; however, the dynamics between them have yet to be reconciled. METHODS A cross-sectional, online survey explored relationships among the latent constructs of concussion-related knowledge, attitudes, and norms in parents of middle school children who participate in sports in multiple settings. A just-identified and two overidentified path models were explored and compared in an effort to understand such relationships. RESULTS A total of 426 parents of United States middle school students were surveyed and included in analyses (mean age = 38.7±9.9 years; 55.6% female; 51.4% white/non-Hispanic; 56.1% with at least a bachelor's degree). All parents had middle school aged children who participated in sport in both the club and school settings. The best fitting model was a just-identified model with concussion-related norms influencing concussion-related knowledge and attitudes, and concussion-related knowledge influencing attitudes. This model accounted for 14% of the variance in attitude and 12% of the variance in knowledge. CONCLUSIONS Study findings suggest that the constructs of concussion-related knowledge, attitudes and norms are directly related to one another, yet the dynamics of such relationships may be complex. As such, a parsimonious interpretation of these constructs may not be appropriate. Future research should work to further reconcile the dynamics between these constructs, and the impact these dynamics may have in influencing care-seeking behaviors beyond serving as mediators.
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Affiliation(s)
- Aliza K. Nedimyer
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States of America
- Matthew Gfeller Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States of America
- Human Movement Science Curriculum, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States of America
- * E-mail:
| | - Avinash Chandran
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States of America
- Datalys Center for Sports Injury Research and Prevention, Indianapolis, IN, United States of America
| | - Melissa K. Kossman
- School of Health Professions, University of Southern Mississippi, Hattiesburg, MS, United States of America
| | - Paula Gildner
- Injury Prevention Research Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States of America
| | - Johna K. Register-Mihalik
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States of America
- Matthew Gfeller Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States of America
- Injury Prevention Research Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States of America
| | - Zachary Y. Kerr
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States of America
- Matthew Gfeller Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States of America
- Injury Prevention Research Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States of America
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Schmidt JD, Broglio SP, Knight K, Leeds D, Lynall RC, D'Lauro C, Register-Mihalik J, Kroshus E, McCrea M, McAllister TW, Kerr ZY, Hoy A, Kelly L, Master C, Ortega J, Port N, Campbell CD, Svoboda CSJ, Putukian M, Chrisman SPD, Langford D, McGinty G, Jackson JC, Cameron KL, James Susmarski A, DiFiori J, Goldman JT, Benjamin H, Buckley T, Kaminski T, Clugston JR, O'Donnell PG, Feigenbaum L, Eckner JT, Mihalik JP, Anderson S, Kontos A, Brooks MA, Miles C, Lintner L. Optimizing Concussion Care Seeking: A Longitudinal Analysis of Recovery. Am J Sports Med 2023; 51:214-224. [PMID: 36412549 DOI: 10.1177/03635465221135771] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Approximately half of concussions go undisclosed and therefore undiagnosed. Among diagnosed concussions, 51% to 64% receive delayed medical care. Understanding the influence of undiagnosed concussions and delayed medical care would inform medical and education practices. PURPOSE To compare postconcussion longitudinal clinical outcomes among (1) individuals with no concussion history, all previous concussions diagnosed, and ≥1 previous concussion undiagnosed, as well as (2) those who have delayed versus immediate symptom onset, symptom reporting, and removal from activity after concussion. STUDY DESIGN Cohort study; Level of evidence, 2. METHODS Participants included 2758 military academy cadets and intercollegiate athletes diagnosed with concussion in the CARE Consortium. We determined (1) each participant's previous concussion diagnosis status self-reported at baseline (no history, all diagnosed, ≥1 undiagnosed) and (2) whether the participant had delayed or immediate symptom onset, symptom reporting, and removal from activity. We compared symptom severities, cognition, balance, and recovery duration at baseline, 24 to 48 hours, date of asymptomatic status, and date of unrestricted return to activity using tests of parallel profiles. RESULTS The ≥1 undiagnosed concussion group had higher baseline symptom burdens (P < .001) than the other 2 groups and poorer baseline verbal memory performance (P = .001) than the all diagnosed group; however, they became asymptomatic and returned to activity sooner than those with no history. Cadets/athletes who delayed symptom reporting had higher symptom burdens 24 to 48 hours after injury (mean ± SE; delayed, 28.8 ± 0.8; immediate, 20.6 ± 0.7), took a median difference of 2 days longer to become asymptomatic, and took 3 days longer to return to activity than those who had immediate symptom reporting. For every 30 minutes of continued participation after injury, days to asymptomatic status increased 8.1% (95% CI, 0.3%-16.4%). CONCLUSION Clinicians should expect that cadets/athletes who delay reporting concussion symptoms will have acutely higher symptom burdens and take 2 days longer to become asymptomatic. Educational messaging should emphasize the clinical benefits of seeking immediate care for concussion-like symptoms.
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Affiliation(s)
- Julianne D Schmidt
- UGA Concussion Research Laboratory and Department of Kinesiology, University of Georgia, Athens, Georgia, USA
| | - Steven P Broglio
- Michigan Concussion Center and School of Kinesiology, University of Michigan, Ann Arbor, Michigan, USA
| | - Kristen Knight
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, California, USA
| | - Daniel Leeds
- Computer and Information Sciences, Fordham University, New York, New York, USA
| | - Robert C Lynall
- UGA Concussion Research Laboratory and Department of Kinesiology, University of Georgia, Athens, Georgia, USA
| | - Christopher D'Lauro
- Department of Behavioral Sciences and Leadership, United States Air Force Academy, Colorado Springs, Colorado, USA
| | - Johna Register-Mihalik
- Matthew Gfeller Research Center and STAR Heel Performance Laboratory, Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Emily Kroshus
- Department of Pediatrics, University of Washington, and Center for Child Health, Behavior and Development, Seattle Children's Research Institute, Seattle, Washington, USA
| | - Michael McCrea
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Tom W McAllister
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Zachary Y Kerr
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | | | - April Hoy
- School of Behavioral and Applied Sciences, Azusa Pacific University, Azusa, California, USA
| | - Louise Kelly
- Department of Exercise Science, California Lutheran University, Thousand Oaks, California, USA
| | - Christina Master
- Division of Orthopedics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Justus Ortega
- Department of Kinesiology and Recreation Administration, Humboldt State University, Humbolt, California, USA
| | - Nicholas Port
- School of Optometry, Indiana University, Bloomington, Indiana, USA
| | | | | | - Margot Putukian
- Athletic Medicine, Princeton University, Princeton, New Jersey, USA
| | - Sara P D Chrisman
- Center for Child Health, Behavior and Development, Seattle Children's Research Institute, Seattle, Washington, USA
| | - Dianne Langford
- Lewis Katz School of Medicine, Temple University, Philadelphia, Pennsylvania, USA
| | - Gerald McGinty
- United States Air Force Academy, Air Force Academy, Colorado, USA
| | | | - Kenneth L Cameron
- Keller Army Hospital, United States Military Academy, West Point, New York, USA
| | - Adam James Susmarski
- Department Head Brigade Orthopaedics and Sports Medicine, United States Naval Academy, Annapolis, Maryland, USA
| | - John DiFiori
- University of California, Los Angeles, Los Angeles, California, USA
| | - Joshua T Goldman
- Departments of Family Medicine and Orthopaedic Surgery, University of California, Los Angeles, Los Angeles, California, USA
| | - Holly Benjamin
- Department of Rehabilitation Medicine and Pediatrics, University of Chicago, Chicago, Illinois, USA
| | - Thomas Buckley
- Department of Kinesiology and Applied Physiology, University of Delaware, Newark, Delaware, USA
| | - Thomas Kaminski
- Department of Kinesiology and Applied Physiology, University of Delaware, Newark, Delaware, USA
| | - James R Clugston
- Community Health and Family Medicine, University of Florida, Gainesville, Florida, USA
| | | | - Luis Feigenbaum
- Department of Physical Therapy, Miller School of Medicine, University of Miami, Coral Gables, Florida, USA
| | - James T Eckner
- Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, Michigan, USA
| | - Jason P Mihalik
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | | | - Anthony Kontos
- Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - M Alison Brooks
- Department of Orthopedics, University of Wisconsin, Madison, Wisconsin, USA
| | - Christopher Miles
- Department of Family and Community Medicine, Wake Forest University, Winston-Salem, North Carolina, USA
| | - Laura Lintner
- Winston-Salem State University, Winston-Salem, North Carolina, USA.,Investigation performed at the University of Georgia, Athens, Georgia, USA
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Hirschhorn RM, Huggins RA, Kerr ZY, Mensch JM, Dompier TP, Rudisill C, Yeargin SW. The Association Between Access to Athletic Trainers and Emergency Medical Services Activations for Sport-Related Injuries. J Athl Train 2022:487273. [PMID: 36260700 DOI: 10.4085/1062-6050-0234.22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
CONTEXT Having athletic trainers (ATs) employed at secondary schools is associated with improved preparedness for sport-related emergencies. Utilization of emergency medical services (EMS) with different access to athletic training services remains unknown. OBJECTIVE Compare the incidence of EMS activations for sport-related injuries between zip-codes with varying access to athletic training services. DESIGN Descriptive epidemiology study. SETTING Data were obtained from the National EMS Information System and the Athletic Training Location and Services Project. PATIENTS OR OTHER PARTICIPANTS Zip-codes where 9-1-1 EMS activations for sport-related injuries among individuals 13-18 years old occurred. MAIN OUTCOME MEASURE(S) Incidence of EMS activations, athletic training service level (NONE, PART, FULL), athletic training employment model (independent contractor, IC; medical or university facility, MUF; school district, SD; mixed employment models, MIX) for each zip-code. RESULTS There were 2.8±3.5 EMS activations per zip-code (range 1-81, n=4,923). Among zip-codes where at least 1 AT was employed (n=2,228), 3.73% (n=83) were IC, 30.83% (n=687) were MIX, 27.24% (n=607) were SD, and 38.20% (n=851) were MUF. Compared to SD, MUF had a 10.8% lower incidence of EMS activations (95%CI: 0.817, 0.974, p=0.010). IC (IRR: 0.920, 95%CI: 0.758, 1.118, p=0.403) and MIX (IRR: 0.996, 95% CI: 0.909, 1.091, p=0.932) were not significantly different from SD. Service level was calculated for 3,834 zip-codes, with 19.5% (n=746) NONE, 46.2% (n=1,771) PART, and 34.4% (n=1,317) FULL. Compared to NONE, FULL (IRR: 1.416, 95%CI: 1.308, 1.532, p<0.001) and PART (IRR: 1.368, 95%CI: 1.268, 1.476, p<0.001) had higher incidences of EMS activations. CONCLUSIONS Local access to athletic training services is associated with an increased utilization of EMS for sport-related injuries among secondary school aged individuals, potentially indicative of improved identification and triage of sport-related emergencies the area. The difference in EMS utilization between employment models may represent the presence of different policies and procedures for sport-related emergencies.
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Affiliation(s)
| | | | - Zachary Y Kerr
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill,
| | - James M Mensch
- Arnold School of Public Health, Department of Exercise Science, University of South Carolina,
| | | | - Caroline Rudisill
- Arnold School of Public Health, Health Promotion, Education and Behavior, University of South Carolina,
| | - Susan W Yeargin
- Arnold School of Public Health, Department of Exercise Science, University of South Carolina,
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Salmon DM, Badenhorst M, Falvey É, Kerr ZY, Brown J, Walters S, Sole G, Sullivan SJ, Whatman C, Register-Mihalik J, Murphy I. Time to expand the circle of care - General practitioners' experiences of managing concussion in the community. J Sports Sci 2022; 40:2102-2117. [PMID: 36399490 DOI: 10.1080/02640414.2022.2130586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
New Zealand Rugby (NZR) implemented a concussion management pathway (CMP), aimed at improving management at community level. General Practitioners (GPs) played a large role in the design of this process. The objective of this study was to explore GPs' perceptions of barriers and facilitators of the CMP and rugby-related concussion management in the community. A descriptive qualitative approach using interviews and focus groups was employed. Four themes were derived: i) GPs' existing knowledge and confidence around concussion management; ii) Operational resources: time, remuneration and pathway guidance; iii) Standardising concussion care and iv) Expanding the circle of care - the need for multi-disciplinary healthcare team. These themes described how GP's concussion knowledge, and the efficiency and availability of operational resources affected their experience and ability to fulfil their tasks within the CMP. GPs found NZR's CMP especially valuable, as it provided guidance and structure. Expanding the role of other healthcare providers was seen as critical to reduce the burden on GPs, while also delivering a more holistic experience to improve clinical outcomes. Addressing the identified barriers and expanding the network of care will help to improve the ongoing development of NZR's CMP, while supporting continued engagement with all stakeholders.
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Affiliation(s)
- Danielle M Salmon
- Injury Prevention and Player Welfare, New Zealand Rugby, Wellington, New Zealand
| | - Marelise Badenhorst
- Sports Performance Research Institute New Zealand, School of Sport and Recreation, Auckland University of Technology, Auckland, New Zealand
| | - Éanna Falvey
- World Rugby House, Pembroke Street Lower, Dublin.,College of Medicine & Health, University College Cork, Cork, Ireland
| | - Zachary Y Kerr
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.,Injury Prevention Research Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - James Brown
- The Institute of Sport and Exercise Medicine, Stellenbosch University, Cape Town, South Africa
| | - Simon Walters
- Sports Performance Research Institute New Zealand, School of Sport and Recreation, Auckland University of Technology, Auckland, New Zealand
| | - Gisela Sole
- Centre of Health, Activity, Rehabilitation Research, School of Physiotherapy, University of Otago, Dunedin, Newzeland
| | - S John Sullivan
- Injury Prevention and Player Welfare, New Zealand Rugby, Wellington, New Zealand
| | - Chris Whatman
- Sports Performance Research Institute New Zealand, School of Sport and Recreation, Auckland University of Technology, Auckland, New Zealand
| | - Johna Register-Mihalik
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.,Injury Prevention Research Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Ian Murphy
- Injury Prevention and Player Welfare, New Zealand Rugby, Wellington, New Zealand
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9
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Lynall RC, D'Lauro C, Kerr ZY, Knight K, Kroshus E, Leeds DD, Register-Mihalik JK, McCrea M, Broglio SP, McAllister T, Schmidt JD, Hazzard J, Kelly L, Master C, Ortega J, Port N, Campbell D, Svoboda SJ, Putukian M, Chrisman SPD, Clugston JR, Langford D, McGinty G, Cameron KL, Houston MN, Susmarski AJ, Goldman JT, Giza C, Benjamin H, Buckley T, Kaminski T, Feigenbaum L, Eckner JT, Mihalik JP, Anderson S, McDevitt J, Kontos A, Brooks MA, Rowson S, Miles C, Lintner L, O'Donnell PG. Optimizing Concussion Care Seeking: The Influence of Previous Concussion Diagnosis Status on Baseline Assessment Outcomes. Am J Sports Med 2022; 50:3406-3416. [PMID: 35998010 DOI: 10.1177/03635465221118089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND The prevalence of unreported concussions is high, and undiagnosed concussions can lead to worse postconcussion outcomes. It is not clear how those with a history of undiagnosed concussion perform on subsequent standard concussion baseline assessments. PURPOSE To determine if previous concussion diagnosis status was associated with outcomes on the standard baseline concussion assessment battery. STUDY DESIGN Cross-sectional study; Level of evidence, 3. METHODS Concussion Assessment, Research, and Education (CARE) Consortium participants (N = 29,934) self-reported concussion history with diagnosis status and completed standard baseline concussion assessments, including assessments for symptoms, mental status, balance, and neurocognition. Multiple linear regression models were used to estimate mean differences and 95% CIs among concussion history groups (no concussion history [n = 23,037; 77.0%], all previous concussions diagnosed [n = 5315; 17.8%], ≥1 previous concussions undiagnosed [n = 1582; 5.3%]) at baseline for all outcomes except symptom severity and Brief Symptom Inventory-18 (BSI-18) score, in which negative binomial models were used to calculate incidence rate ratios (IRRs). All models were adjusted for sex, race, ethnicity, sport contact level, and concussion count. Mean differences with 95% CIs excluding 0.00 and at least a small effect size (≥0.20), and those IRRs with 95% CIs excluding 1.00 and at least a small association (IRR, ≥1.10) were considered significant. RESULTS The ≥1 previous concussions undiagnosed group reported significantly greater symptom severity scores (IRR, ≥1.38) and BSI-18 (IRR, ≥1.31) scores relative to the no concussion history and all previous concussions diagnosed groups. The ≥1 previous concussions undiagnosed group performed significantly worse on 6 neurocognitive assessments while performing better on only 2 compared with the no concussion history and all previous concussions diagnosed groups. There were no between-group differences on mental status or balance assessments. CONCLUSION An undiagnosed concussion history was associated with worse clinical indicators at future baseline assessments. Individuals reporting ≥1 previous undiagnosed concussions exhibited worse baseline clinical indicators. This may suggest that concussion-related harm may be exacerbated when injuries are not diagnosed.
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Affiliation(s)
- Robert C Lynall
- UGA Concussion Research Laboratory, Department of Kinesiology, University of Georgia, Athens, Georgia, USA.,Investigation performed at multiple sites
| | - Christopher D'Lauro
- Department of Behavioral Sciences and Leadership, United States Air Force Academy, Colorado Springs, Colorado, USA.,Investigation performed at multiple sites
| | - Zachary Y Kerr
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.,Investigation performed at multiple sites
| | - Kristen Knight
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, California, USA.,Investigation performed at multiple sites
| | - Emily Kroshus
- University of Washington, Department of Pediatrics & Seattle Children's Research Institute, Center for Child, Development and Health, Seattle, Washington, USA.,Investigation performed at multiple sites
| | - Daniel D Leeds
- Computer and Information Sciences Department, Fordham University, New York, New York, USA.,Investigation performed at multiple sites
| | - Johna K Register-Mihalik
- Matthew Gfeller Sport-Related TBI Research Center & STAR Heel Performance Laboratory, Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.,Investigation performed at multiple sites
| | - Michael McCrea
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin.,Investigation performed at multiple sites
| | - Steven P Broglio
- University of Michigan Concussion Center, University of Michigan, Ann Arbor, Michigan.,Investigation performed at multiple sites
| | - Thomas McAllister
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis, Indiana.,Investigation performed at multiple sites
| | - Julianne D Schmidt
- UGA Concussion Research Laboratory, Department of Kinesiology, University of Georgia, Athens, Georgia, USA.,Investigation performed at multiple sites
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- Investigation performed at multiple sites
| | - Joseph Hazzard
- Department of Exercise Science, Bloomsburg University.,Investigation performed at multiple sites
| | - Louise Kelly
- Department of Exercise Science, California Lutheran University.,Investigation performed at multiple sites
| | - Christina Master
- Division of Orthopedics, Children's Hospital of Philadelphia.,Investigation performed at multiple sites
| | - Justus Ortega
- Department of Kinesiology & Recreation Administration, Humboldt State University.,Investigation performed at multiple sites
| | - Nicholas Port
- School of Optometry, Indiana University.,Investigation performed at multiple sites
| | - Darren Campbell
- Intermountain Sports Medicine.,Investigation performed at multiple sites
| | - Steven J Svoboda
- MedStar Orthopaedic Institute.,Investigation performed at multiple sites
| | - Margot Putukian
- Athletic Medicine, Princeton University.,Investigation performed at multiple sites
| | - Sara P D Chrisman
- Center for Child Health, Behavior and Development, Seattle Children's Research Institute.,Investigation performed at multiple sites
| | - James R Clugston
- Department of Community Health and Family Medicine, University of Florida.,Investigation performed at multiple sites
| | - Dianne Langford
- Lewis Katz School of Medicine, Temple University.,Investigation performed at multiple sites
| | - Gerald McGinty
- United States Air Force Academy.,Investigation performed at multiple sites
| | - Kenneth L Cameron
- Keller Army Hospital, United States Military Academy.,Investigation performed at multiple sites
| | - Megan N Houston
- Keller Army Hospital, United States Military Academy.,Investigation performed at multiple sites
| | - Adam James Susmarski
- Department Head Brigade Orthopaedics and Sports Medicine, United States Naval Academy.,Investigation performed at multiple sites
| | - Joshua T Goldman
- Departments of Family Medicine & Orthopaedic Surgery, University of California, Los Angeles.,Investigation performed at multiple sites
| | - Christopher Giza
- Department of Pediatrics, University of California, Los Angeles.,Investigation performed at multiple sites
| | - Holly Benjamin
- Department of Rehabilitation Medicine and Pediatrics, University of Chicago.,Investigation performed at multiple sites
| | - Thomas Buckley
- Department of Kinesiology & Applied Physiology, University of Delaware.,Investigation performed at multiple sites
| | - Thomas Kaminski
- Department of Kinesiology & Applied Physiology, University of Delaware.,Investigation performed at multiple sites
| | - Luis Feigenbaum
- Department of Physical Therapy, Miller School of Medicine, University of Miami.,Investigation performed at multiple sites
| | - James T Eckner
- Department of PM&R, University of Michigan.,Investigation performed at multiple sites
| | - Jason P Mihalik
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill.,Investigation performed at multiple sites
| | - Scott Anderson
- University of Oklahoma.,Investigation performed at multiple sites
| | - Jane McDevitt
- Department of Health and Rehabilitation Sciences, Temple University.,Investigation performed at multiple sites
| | - Anthony Kontos
- Department of Orthopaedic Surgery, University of Pittsburgh.,Investigation performed at multiple sites
| | - M Alison Brooks
- Department of Orthopedics, University of Wisconsin, Madison.,Investigation performed at multiple sites
| | - Steve Rowson
- Department of Biomedical Engineering and Mechanics, Virginia Tech.,Investigation performed at multiple sites
| | - Christopher Miles
- Department of Family and Community Medicine, Wake Forest University.,Investigation performed at multiple sites
| | - Laura Lintner
- Wake Forest School of Medicine Family Medicine, Winston Salem State University.,Investigation performed at multiple sites
| | - Patrick G O'Donnell
- Department of Urology, UMass Memorial Health.,Investigation performed at multiple sites
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10
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Ingram BM, Kossman MK, Gildner P, Cameron KL, Houston MN, Callahan CE, Marshall SW, Kerr ZY, Register-Mihalik JK. Perceptions Of An Interactive Concussion Education Platform Among Reserve Officer Training Corps (ROTC) Cadets. Med Sci Sports Exerc 2022. [DOI: 10.1249/01.mss.0000880408.88845.c3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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11
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Nedimyer AK, Walton SR, Carneiro KA, Weight EA, Mihalik JP, Kerr ZY, DeFreese J, Chandran A. Physical Activity In Former Elite Women’s Soccer Athletes. Med Sci Sports Exerc 2022. [DOI: 10.1249/01.mss.0000877096.74849.fb] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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12
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Hirschhorn RM, Kerr ZY, Mensch JM, Huggins RA, Dompier TP, Rudisill C, Yeargin SW. Epidemiology of Emergency Medical Services Activations for Sport-Related Injuries in the United States. Cureus 2022; 14:e27403. [PMID: 36046296 PMCID: PMC9419755 DOI: 10.7759/cureus.27403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/25/2022] [Indexed: 11/29/2022] Open
Abstract
Background Literature examining emergency medical services (EMS) activations for sport-related injuries is limited to the pediatric, high school, and collegiate student-athlete populations, excluding older individuals and recreational athletes. The purpose of this study was to examine EMS activations for sport-related injuries using the National EMS Information System Database from 2017-2018. Methods Data were obtained using the National EMS Information System Database from 2017-2018. EMS activations were limited to 9-1-1 responses for individuals aged 3-99 who sustained a sports-related injury. Independent variables included patient age group: pediatric (<18 years old) vs. adult (≥18 years old). Dependent variables were patient age, gender, and chief complaint anatomic location. Frequencies and proportions were calculated for each variable. Injury proportion ratios (IPRs) with 95% confidence intervals were calculated to compare chief complaint anatomic location by age group. Results There were 71,322 sport-related injuries. Patients were 36.6±22.9 years and most (58.1%, n=41,132) were male. Adults had higher proportions of injuries affecting the abdomen (IPR: 2.05, 95%CI: 1.83, 2.31), chest (IPR: 1.90, 95%CI: 1.75, 2.05), general/global (IPR: 1.54, 95%CI: 1.50, 1.58), and genitalia (IPR: 2.40, 95%CI: 1.39, 4.15), and lower proportions of injuries affecting the back (IPR: 0.55, 95%CI: 0.50, 0.60), lower extremity (IPR: 0.63, 95%CI: 0.60, 0.65), upper extremity (IPR: 0.50, 95%CI: 0.47, 0.53), head (IPR: 0.73, 95%CI: 0.70, 0.77), and neck (IPR: 0.18, 95%CI: 0.16, 0.20) compared to pediatric patients. Conclusion Injuries sustained differed between adult and pediatric patients, indicating sport-related emergencies may change across the lifespan. General/global chief complaints likely indicate sport-related injuries affecting multiple anatomic locations and organ systems. Stakeholders planning large or high-risk athletic events should consider arranging standby or dedicated advanced life support units for their events.
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13
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Delfin D, Eke R, Gray H, Kerr ZY, Wallace JS. Associations Between Major Depressive Episodes and School- or Community-Based Activity Participation Among Adolescents Using Nationwide Representative Data. J Sch Health 2022; 92:692-701. [PMID: 35246998 DOI: 10.1111/josh.13172] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/21/2021] [Revised: 12/22/2021] [Accepted: 01/26/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND This study examined the association between participation in school-based and/or community-based activity and major depressive episodes (MDE) in adolescents using nationally representative data. METHODS This study utilized cross-sectional data from the National Survey of Drug Use and Health from 2015 to 2019. Nine screening questions determined the presence of past-year MDE in adolescents ages 12-17 (n = 67,033). Participants indicated past-year participation in school-based (eg, team sports, cheerleading, choir, band, student government, or clubs) and/or community-based activities (eg, volunteer activities, sports, clubs, or groups). Sociodemographic variables included sex, race/ethnicity, family income, and age. Descriptive statistics, univariable and multivariable regression analyses were conducted. The multivariable model included interaction terms between age and sex, and age and race/ethnicity. RESULTS Overall, 14% of the sample met the criteria for having MDE. The odds of MDE increased with age. Joint effects of age and sex, and age and race/ethnicity significantly influenced the association between MDE and school- or community-based activities. Participation in 1+ community-based activities was protective for MDE across all races/ethnicities. CONCLUSIONS Findings help illuminate the direct association of school- and community-based activity participation on MDE risk in adolescents, improving our understanding of MDE across various sociodemographic subgroups in an adolescent population. Schools should aim to facilitate equitable programming and endorse adolescent participation in multiple activities throughout the year. Schools should examine the resources available and consider partnerships that would bolster resources, access, and social capital throughout the community.
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Affiliation(s)
- Danae Delfin
- Department of Health Science, Athletic Training Program, The University of Alabama, 270 Kilgore Lane, 2121 Capital Hall, Tuscaloosa, AL, 35487, USA
| | - Ransome Eke
- Department of Health Science, The University of Alabama, 504 University Blvd, 105 Russell Hall, Tuscaloosa, AL, 35487, USA
| | - Haleigh Gray
- Department of Health Science, Athletic Training Program, The University of Alabama, 270 Kilgore Lane, 2121 Capital Hall, Tuscaloosa, AL, 35487, USA
| | - Zachary Y Kerr
- Department of Exercise and Sport Science, The University of North Carolina at Chapel Hill, 313 Woollen Gym, CB#8700, Chapel Hill, NC, 27599-8700, USA
| | - Jessica S Wallace
- Athletic Training Program, Department of Health Science, The University of Alabama, 270 Kilgore Lane, 2106 Capital Hall, Tuscaloosa, AL, 35487, USA
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14
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Wagoner CW, Lee JT, Hanson ED, Kerr ZY, Nyrop KA, Muss HB, Battaglini CL. Impact of community-based exercise on fatigue in early breast cancer survivors: identifying potential determinants of change. Breast Cancer 2022; 29:1001-1012. [PMID: 35749052 DOI: 10.1007/s12282-022-01380-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Accepted: 06/01/2022] [Indexed: 11/24/2022]
Abstract
BACKGROUND Exercise has been shown to reduce fatigue in early breast cancer survivors (EBCS), though it is unclear if these results translate to community-based exercise settings. Mechanisms that influence changes in fatigue seen after exercise are also poorly understood. This study sought to evaluate the impact of community-based exercise and identify associations of fatigue in EBCS. METHODS Twenty-nine EBCS and 13 non-cancer controls (CON) enrolled. Pre/post-intervention measurements included measures of fitness/function, balance, and adherence/compliance as well as self-reported measures of fatigue, health-related quality of life (HRQOL), well-being, self-efficacy, and physical activity. Both groups participated in a supervised 16-week aerobic + resistance exercise intervention. A mixed model ANOVA and Cohen's D effect size assessed fatigue changes, and univariable linear regressions identified fatigue associations. RESULTS Fatigue improved for EBCS (- 2.6, Cohen's D = 0.51) but not CON (0.0, Cohen's D = 0.02); no interaction effect was observed. Post-intervention fatigue in EBCS was associated with better QOL (R2 = 0.387; p < 0.01), depression (R2 = 0.251; p < 0.01), self-efficacy, (R2 = 0.453; p < 0.01), outcome expectations from exercise (R2 = 0.254; p < 0.01), balance (R2 = 0.167; p < 0.05), and the 6-minute walk test (R2 = 0.193; p < 0.05). EBCS improvements in fatigue were associated with improvements in self-reported physical health (R2 = 0.425; p < 0.01), depression (R2 = 0.233; p < 0.01), pain (R2 = 0.157; p < 0.05), outcome expectations from exercise (R2 = 0.420; p < 0.01), and the 6-minute walk test (R2 = 0.172; p < 0.05). Less fatigue in the CON group was shown be associated with better sleep quality (R2 = 0.309; p < 0.05) and pain (R2 = 0.259; p < 0.05). CONCLUSION Community-based exercise appears beneficial for alleviating fatigue in EBCS. These improvements may be driven by parallel improvements in psychosocial outcomes and objectively measured functional outcomes.
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Affiliation(s)
- Chad W Wagoner
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA. .,Human Movement Science Curriculum, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA. .,Faculty of Kinesiology, University of Calgary, 2500 University Dr NW, Calgary, AB, T2N IN4, Canada.
| | - Jordan T Lee
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.,Human Movement Science Curriculum, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Erik D Hanson
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.,Human Movement Science Curriculum, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.,Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Zachary Y Kerr
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.,Human Movement Science Curriculum, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.,Matthew Gfeller Sport-Related TBI Research Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Kirsten A Nyrop
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.,Division of Oncology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Hyman B Muss
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.,Division of Oncology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Claudio L Battaglini
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.,Human Movement Science Curriculum, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.,Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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15
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Brett BL, Kerr ZY, Walton SR, Chandran A, Defreese JD, Mannix R, Echemendia RJ, Meehan WP, Guskiewicz KM, McCrea M. Longitudinal trajectory of depression symptom severity and the influence of concussion history and physical function over a 19-year period among former National Football League (NFL) players: an NFL-LONG Study. J Neurol Neurosurg Psychiatry 2022; 93:272-279. [PMID: 34663623 PMCID: PMC8854336 DOI: 10.1136/jnnp-2021-326602] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Accepted: 10/03/2021] [Indexed: 11/03/2022]
Abstract
OBJECTIVE This study investigated the longitudinal course of depressive symptom severity over 19 years in former American football players and the influence of concussion history, contact sport participation and physical function on observed trajectories. METHODS Former American football players completed a general health questionnaire involving demographic information, medical/psychiatric history, concussion/football history and validated measures of depression and physical function at three time points (2001, 2010 and 2019). Parallel process latent growth curve modelling tested associations between concussion history, years of football participation, and overall and change in physical function on the overall level and trajectory of depressive symptoms. RESULTS Among the 333 participants (mean(SD) age, 48.95 (9.37) at enrolment), there was a statistically significant, but small increase in depressive symptom severity from 2001 (48.34 (7.75)) to 2019 (49.77 (9.52)), slope=0.079 (SE=0.11), p=0.007. Those with greater concussion history endorsed greater overall depressive symptom severity, B=1.38 (SE=0.33), p<0.001. Concussion history, B<0.001 (SE=0.02), p=0.997 and years of participation, B<0.001 (SE=0.01), p=0.980, were not associated with rate of change (slope factor) over 19 years. Greater decline in physical function, B=-0.71 (SE=0.16), p<0.001, was predictive of a faster growth rate (ie, steeper increase) of depression symptom endorsement over time. CONCLUSIONS Concussion history, not years of participation, was associated with greater depressive symptom severity. Neither factor was predictive of changes over a 19-year period. Decline in physical function was a significant predictor of a steeper trajectory of increased depressive symptoms, independent of concussion effects. This represents one viable target for preventative intervention to mitigate long-term neuropsychiatric difficulties associated with concussion across subsequent decades of life.
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Affiliation(s)
- Benjamin L Brett
- Department of Neurosurgery, Medical College of Wisconsin, Wauwatosa, WI, USA
- Department of Neurology, Medical College of Wisconsin, Wauwatosa, WI, USA
| | - Zachary Y Kerr
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Samuel R Walton
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Avinash Chandran
- Datalys Center for Sports Injury Research and Prevention, indianapolis, IN, USA
| | - J D Defreese
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Rebekah Mannix
- Division of Emergency Medicine, Boston Children's Hospital, Boston, Massachusetts, USA
- Department of Pediatrics and Emergency Medicine, Harvard Medical School, Boston, MA, USA
| | - Ruben J Echemendia
- Psychological and Neurobehavioral Associates, Inc, State College, Pennsylvania, USA
- Department of Psychology, University of Missouri-Kansas City, Kansas City, MO, USA
| | - William P Meehan
- Sports Medicine Division, Boston Children's Hospital, Boston, Massachusetts, USA
- Department of Pediatrics and Orthopedics, Harvard Medical School, Boston, MA, USA
| | - Kevin M Guskiewicz
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Michael McCrea
- Department of Neurosurgery, Medical College of Wisconsin, Wauwatosa, WI, USA
- Department of Neurology, Medical College of Wisconsin, Wauwatosa, WI, USA
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16
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Callahan CE, Kossman MK, Mihalik JP, Marshall SW, Gildner P, Kerr ZY, Cameron KL, Houston MN, Mrazik M, Register-Mihalik JK. Association between Sensation-Seeking Behaviors and Concussion-Related Knowledge, Attitudes, Perceived Norms, and Care-Seeking Behaviors among Collegiate Student-Athletes. J Sports Sci Med 2022; 21:33-42. [PMID: 35250331 PMCID: PMC8851124 DOI: 10.52082/jssm.2022.33] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Accepted: 10/27/2021] [Indexed: 06/14/2023]
Abstract
There are limited data connecting personality and behavioral tendencies and traits related to concussion care-seeking/disclosure behaviors and minimal research exists surrounding the relationship between risky behaviors, sensation-seeking, and concussion-related outcomes. This study examined the association between sensation-seeking and a student-athlete's concussion-related knowledge, attitudes, perceived social norms, and concussion care-seeking/disclosure behaviors (intention to disclose concussion symptoms, perceived control over symptom disclosure, self-removal from play due to concussion symptoms, continued play with concussion symptoms, and disclosure of all concussions at the time of injury). The current study utilized a retrospective cohort of collegiate student-athletes at a single National Collegiate Athletic Association Division I institution. Separate multivariable linear regression models estimating mean differences (MD) and 95% Confidence Intervals (CI) estimated the association between sensation-seeking and concussion knowledge, concussion attitudes, and perceived social norms. Separate multivariable binomial regression models estimating adjusted prevalence ratios (PR) and 95%CI estimated the association between sensation-seeking and intention to disclose concussion symptoms, perceived control over symptom disclosure, self-removal from play due to concussion symptoms, continued play with concussion symptoms, and disclosure of all concussions at the time of injury. All models were adjusted for sex, sport participation, and concussion history. Higher sensation-seeking was significantly associated with less favorable concussion attitudes (adjusted MD = -1.93; 95%CI = -3.04,-0.83), less favorable perceived social norms surrounding concussion (adjusted MD = -1.39; 95%CI = -2.06,-0.72), and continuing to play while experiencing concussion symptoms (adjusted PR = 1.50; 95%CI = 1.10, 2.06). Student-athletes with increased sensation-seeking could be at risk for failing to disclose a concussion, decreasing athlete safety and resulting in less optimal care post-injury. Results will inform future theory-based concussion education programs which consider behavioral tendencies and traits as well as sport culture to promote concussion care-seeking/disclosure and individualized interventions based on risky behavior engagement.
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Affiliation(s)
- Christine E Callahan
- Matthew Gfeller Center, Department of Exercise and Sport Science, The University of North Carolina, NC, USA
- Human Movement Science Curriculum, Department of Allied Health Sciences, School of Medicine, The University of North Carolina at Chapel Hill, NC, USA
| | - Melissa K Kossman
- School of Health Professions, University of Southern Mississippi, MS, USA
| | - Jason P Mihalik
- Matthew Gfeller Center, Department of Exercise and Sport Science, The University of North Carolina, NC, USA
- Human Movement Science Curriculum, Department of Allied Health Sciences, School of Medicine, The University of North Carolina at Chapel Hill, NC, USA
- Injury Prevention Research Center, The University of North Carolina at Chapel Hill NC, USA
| | - Stephen W Marshall
- Injury Prevention Research Center, The University of North Carolina at Chapel Hill NC, USA
- Department of Epidemiology, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, NC, USA
| | - Paula Gildner
- Injury Prevention Research Center, The University of North Carolina at Chapel Hill NC, USA
| | - Zachary Y Kerr
- Matthew Gfeller Center, Department of Exercise and Sport Science, The University of North Carolina, NC, USA
- Human Movement Science Curriculum, Department of Allied Health Sciences, School of Medicine, The University of North Carolina at Chapel Hill, NC, USA
- Injury Prevention Research Center, The University of North Carolina at Chapel Hill NC, USA
| | - Kenneth L Cameron
- John A. Feagin Jr. Sports Medicine Fellowship, Keller Army Hospital, United States Military Academy, NY, USA
- Departments of Physical Medicine and Rehabilitation and Surgery, Uniformed Services University of the Health Sciences, MD, USA
| | - Megan N Houston
- John A. Feagin Jr. Sports Medicine Fellowship, Keller Army Hospital, United States Military Academy, NY, USA
| | - Martin Mrazik
- Department of Educational Psychology, University of Alberta, AB, Canada
| | - Johna K Register-Mihalik
- Matthew Gfeller Center, Department of Exercise and Sport Science, The University of North Carolina, NC, USA
- Human Movement Science Curriculum, Department of Allied Health Sciences, School of Medicine, The University of North Carolina at Chapel Hill, NC, USA
- Injury Prevention Research Center, The University of North Carolina at Chapel Hill NC, USA
- STAR Heel Performance Laboratory, The University of North Carolina at Chapel Hill, NC, USA
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17
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Salmon DM, Chua J, Sullivan SJ, Whatman C, Brown J, Register-Mihalik J, Murphy I, Walters S, Clacy A, Sole G, Kerr ZY, Rasmussen K, England M. Sport concussion assessment in New Zealand high school rugby players: a collaborative approach to the challenges faced in primary care. Brain Inj 2022; 36:258-270. [PMID: 35143350 DOI: 10.1080/02699052.2022.2033839] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
PRIMARY OBJECTIVE To describe the collaborative development of a New Zealand Rugby Concussion Assessment (NZRCA) for primary care and to provide normative baseline data from a representative group of high school rugby players. METHODS This study, conducted over the 2018 and 2019 community rugby season where players were baseline tested during the pre- or start of season period. RESULTS Data were collected from 1428 players (males n = 1121, females n = 307) with a mean age of 15.9 ± 1.4 years. The mean ± SD symptom severity score was 11.3 ± 8.6, the mean number of endorsed symptoms was 8.5 ± 5.3 and the percentage feeling "normal" was 80.2 ± 15.3%. Only 5.3% of players reported no symptoms at baseline. The most common reported were: 'distracted easily' (72.5%), 'forgetful' (68.5%), and 'often tired' (62.6%). None of the participants achieved a perfect score for the SAC50. The majority of participants (89.7%) passed the tandem gait test with a time of 12.2 ± 1.7 seconds. Age, gender, and ethnicity were associated with NZRCA performance; albeit weakly. CONCLUSION This study provides normative reference values for high-school rugby players. These data will aid healthcare providers in their identification of suspected concussion in the absence of individualized baselines.
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Affiliation(s)
| | - Jason Chua
- New Zealand Rugby, Wellington, New Zealand
| | | | - Chris Whatman
- Sports Performance Research Institute New Zealand, School of Sport and Recreation, Auckland University of Technology, Auckland, New Zealand
| | - James Brown
- The Institute of Sport and Exercise Medicine, Stellenbosch University, Cape Town, South Africa
| | - Johna Register-Mihalik
- Matthew Gfeller Sport-Related Traumatic Brain Injury Research Center, Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.,Injury Prevention Research Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.,Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Ian Murphy
- New Zealand Rugby, Wellington, New Zealand
| | - Simon Walters
- Sports Performance Research Institute New Zealand, School of Sport and Recreation, Auckland University of Technology, Auckland, New Zealand
| | - Amanda Clacy
- School of Law & Society, University of the Sunshine Coast, Maroochydore, Australia
| | - Gisela Sole
- Centre of Health, Activity, Rehabilitation Research, School of Physiotherapy, University of Otago, Dunedin, New Zealand
| | - Zachary Y Kerr
- Matthew Gfeller Sport-Related Traumatic Brain Injury Research Center, Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.,Injury Prevention Research Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.,Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
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18
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Giuliani-Dewig HK, Kerr ZY, Register-Mihalik JK, Mota JA, Ryan ED. Factors Associated with the Willingness to Perform a Physical Employment Standard in Probation Officers. Med Sci Sports Exerc 2022; 54:330-336. [PMID: 34559720 DOI: 10.1249/mss.0000000000002784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
PURPOSE This study examined worker characteristics and behaviors and the perceived importance of job-related tasks associated with the willingness to perform a proposed probation officer physical ability test (PROPAT). METHODS North Carolina probation officers (N = 1213, 46.2% female, 39.8 ± 10.1 yr, 30.7 ± 6.6 kg·m-2) completed a survey including demographics, health history, and job-related tasks. A multivariable logistic regression model estimated the odds of being willing to perform the PROPAT. Adjusted odds ratios (ORadjusted) with 95% confidence intervals (CI) were calculated, with those excluding 1.00 deemed statistically significant. RESULTS The majority (72%) of probation officers were willing to perform the PROPAT. Being male (compared with female) (ORadjusted = 1.50, 95% CI = 1.12-2.02) and having moderate (ORadjusted = 1.51, 95% CI = 1.10-2.08) and high physical activity status (ORadjusted = 2.89, 95% CI = 1.97-4.28) (compared with low) increased the odds of being willing to perform the PROPAT. Additionally, reporting a greater importance of tasks, including running to pursue a suspect (TASKRUN, 1-unit increase, ORadjusted = 1.25, 95% CI = 1.10-1.43) and dragging an unresisting person (TASKDRAG, 1-unit increase, ORadjusted = 1.16, 95% CI = 1.01-1.32), increased the odds of being willing to perform the PROPAT. Increasing age (1-yr increase, ORadjusted = 0.96, 95% CI = 0.94-0.98), class II (ORadjusted = 0.45, 95% CI = 0.28-0.71) and class III obesity (compared with normal weight, ORadjusted = 0.55, 95% CI = 0.32-0.93), and a previous musculoskeletal injury (ORadjusted = 0.57, 95% CI = 0.35-0.93) all decreased the odds of being willing to perform the PROPAT. CONCLUSIONS These results suggest being older, previously injured, obese (body mass index ≥ 35 kg·m-2), and less active is associated with being less willing to participate in the PROPAT, whereas males and reporting a higher importance of the TASKRUN and TASKDRAG activities is associated with being more willing to participate in the PROPAT. Departments can use these findings to identify feasible strategies (e.g., education and physical training) to improve the implementation of physical employment standards.
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Affiliation(s)
| | | | | | - Jacob A Mota
- Department of Kinesiology, University of Alabama, Tuscaloosa, AL
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19
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Wagoner CW, Lee JT, Hanson ED, Kerr ZY, Nyrop KA, Muss HB, Battaglini CL. Baseline fatigue in early breast cancer survivors: understanding its prevalence in community-based exercise. Support Care Cancer 2022; 30:4407-4416. [DOI: 10.1007/s00520-021-06776-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Accepted: 12/20/2021] [Indexed: 11/29/2022]
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20
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Wallace J, Beidler E, Register-Mihalik JK, Hibbler T, Bretzin A, DeMedal S, Kerr ZY. Examining Concussion Nondisclosure in Collegiate Athletes Using a Health Disparities Framework and Consideration of Social Determinants of Health. J Athl Train 2022; 57:16-24. [PMID: 35040984 PMCID: PMC8775278 DOI: 10.4085/1062-6050-0054.21] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
CONTEXT Limited research exists concerning the relationship between the social determinants of health (SDOHs), including race, socioeconomic status (SES), health care access and physical environment and concussion nondisclosure in collegiate athletes. However, among high school athletes, disparities have been noted, with Black athletes who attended under-resourced schools and lacked access to an athletic trainer (AT) disclosing fewer concussions. OBJECTIVE To investigate whether concussion nondisclosure disparities existed by (1) race, (2) SES, or (3) AT health care access before college and understand the differential reasons for concussion nondisclosure between White and Black collegiate athletes. DESIGN Cross-sectional study. SETTING Collegiate athletics. PARTICIPANTS A total of 735 college athletes (84.6% White, 15.4% Black). MAIN OUTCOME MEASURE(S) Participants completed a questionnaire that directly assessed concussion nondisclosure, including reasons for not reporting a suspected concussion. With the premise of investigating SDOHs, race was the primary exposure of interest. The outcome of interest, nondisclosure, was assessed with a binary (yes or no) question, "Have you ever sustained a concussion that you did not report to your coach, AT, parent, teammate, or anyone else?" RESULTS Among the White and Black athletes, 15.6% and 17.7%, respectively, reported a history of concussion nondisclosure. No differences were found by race for distributions of history of concussion nondisclosure (P = .57). Race was not associated with concussion nondisclosure when evaluated as an effect modification measure or confounder, and no significant associations were noted by SES or high school AT access. Differences by race for reported reasons for nondisclosure were present for "At the time, I did not think it was a concussion" (P = .045) and "I thought my teammates would think I am weak" (P = .03), with Black athletes selecting these more frequently than White athletes. CONCLUSIONS These data help to contextualize race and its intersection with other SDOHs that could influence concussion nondisclosure outcomes in collegiate athletes.
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Affiliation(s)
- Jessica Wallace
- Department of Health Science, Athletic Training Program, The University of Alabama, Tuscaloosa
| | - Erica Beidler
- Department of Athletic Training, Duquesne University, Pittsburgh, PA
| | | | - Tamaria Hibbler
- Department of Athletics, Michigan State University, East Lansing
| | | | - Spencer DeMedal
- Department of Biological Sciences, Duquesne University, Pittsburgh, PA
| | - Zachary Y. Kerr
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill
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21
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Brett BL, Kerr ZY, Aggarwal NT, Chandran A, Mannix R, Walton S, DeFreese JD, Echemendia RJ, Guskiewicz KM, McCrea MA, Meehan WP. Cumulative Concussion and Odds of Stroke in Former National Football League Players. Stroke 2022; 53:e5-e8. [PMID: 34839696 PMCID: PMC8966617 DOI: 10.1161/strokeaha.121.035607] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
BACKGROUND AND PURPOSE Postmortem and experimental studies indicate a potential association between repeated concussions and stroke risk in older contact sport athletes. We examined the relationship between concussion and stroke history in former National Football League players aged ≥50 years. METHODS Former professional football players aged ≥50 years who played ≥1 year in the National Football League were enrolled in the cross-sectional study. Indirect standardization was used to calculate overall and decade-specific standardized prevalence ratios. Logistic regression using Firth's bias reduction method examined the association between lifetime concussion history 0 (n=119; 12.2%), 1 to 2 (n=152; 15.5%), 3 to 5 (n=242; 24.7%), 6 to 9 (201; 20.5%), and 10+(n=265; 27.1%) and stroke. Adjusted odds ratios for stroke were calculated for concussion history groups, age, and coronary artery disease and/or myocardial infarction. RESULTS The 979 participants who met inclusion criteria had a mean age of 65.0±9.0 years (range, 50-99). The prevalence of stroke was 3.4% (n=33), significantly lower than expected based on rates of stroke in US men aged 50 and over (standardized prevalence ratio=0.56, Z= -4.56, P<0.001). Greater odds of stroke history were associated with concussion history (10+ versus 0, adjusted odds ratio [95% CI]=5.51 [1.61-28.95]), cardiovascular disease (adjusted odds ratio [95% CI]=2.24 [1.01-4.77]), and age (1-year-increase adjusted odds ratio [95% CI]=1.07 [1.02-1.11]). CONCLUSIONS The prevalence of stroke among former National Football League players aged ≥50 years was lower than the general population, with significantly increased risk among those with 10 or more prior concussions. Findings add to the evidence suggesting that traumatic brain injuries are associated with increased risk of stroke. Clinically, management of cardio- and cerebrovascular health may be pertinent to those with a history of multiple prior concussions.
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Affiliation(s)
- Benjamin L. Brett
- Department of Neurosurgery, Medical College of Wisconsin,Correspondence: Benjamin L. Brett, 414-955-7316, , Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI 53226, Twitter: @BenjaminBrett1
| | - Zachary Y. Kerr
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill
| | | | - Avinash Chandran
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill,Datalys Center for Sports Injury Research and Prevention
| | | | - Samuel Walton
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill
| | - J. D. DeFreese
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill
| | | | - Kevin M. Guskiewicz
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill
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22
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Brett BL, Campbell H, Aggarwal NT, Kerr ZY, Chandran A, Walton S, Mannix R, DeFreese JD, Echemendia RJ, Guskiewicz KM, Meehan WP, McCrea MA. Investigating the relationships between race, cardiovascular disease, mild cognitive impairment, Alzheimer’s disease, and functional outcomes among older former National Football League players. Alzheimers Dement 2021. [DOI: 10.1002/alz.049518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
| | | | | | - Zachary Y Kerr
- University of North Carolina at Chapel Hill Chapel Hill NC USA
| | | | - Samuel Walton
- University of North Carolina at Chapel Hill Chapel Hill NC USA
| | | | - JD DeFreese
- University of North Carolina at Chapel Hill Chapel Hill NC USA
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23
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Chandran A, Kerr ZY, Roby PR, Nedimyer AK, Arakkal A, Pierpoint LA, Zuckerman SL. Concussion Symptom Characteristics and Resolution in 20 United States High School Sports, 2013/14–2017/18 Academic Years. Neurosurgery 2021. [DOI: 10.1093/neuros/nyaa091_s011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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24
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Walton SR, Kerr ZY, Mannix R, Brett BL, Chandran A, DeFreese JD, McCrea MA, Guskiewicz KM, Meehan WP, Echemendia RJ. Subjective Concerns Regarding the Effects of Sport-Related Concussion on Long-Term Brain Health among Former NFL Players: An NFL-LONG Study. Sports Med 2021; 52:1189-1203. [PMID: 34773581 DOI: 10.1007/s40279-021-01589-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/21/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND Potential links between a history of sport-related concussions and later-life neurobiological and psychological brain health have been studied in former collision-sport athletes. However, empirical studies of how former athletes perceive the future of their brain health as a result of these injuries are missing. OBJECTIVES We aimed to (1) identify the extent to which former National Football League players currently have concerns about their long-term psychological and cognitive functioning as a result of concussions sustained while playing football; (2) examine whether current concerns are different than concerns they had while playing football; (3) examine the relationship between current brain health concerns and self-reported concussion history (SR-CHx); and (4) explore other important factors associated with these concerns. METHODS In this cross-sectional study, former National Football League players with a SR-CHx of one or more concussions (n = 1514; aged mean [standard deviation] = 52.3 [15.7] years) completed a general health questionnaire. Participants reported their lifetime concussion history, as well as both their current concerns and concerns while playing football (i.e., retrospective concerns) regarding the long-term effects of concussions on their memory, thinking skills, and risk of developing chronic traumatic encephalopathy. Current and retrospective concerns were self-reported on a five-point Likert scale. Four concussion history categories were created based on SR-CHx: 1-2 (n = 309); 3-5 (n = 413); 6-9 (n = 356); and 10 + (n = 436) lifetime concussions. Proportions of participants reporting each level of current and retrospective concerns were examined to identify whether concerns presently exist in these former players, and whether their current concerns are different than retrospective concerns. Next, we explored associations between current concerns and SR-CHx. RESULTS More than one-third of participants reported being currently "extremely concerned" about memory problems (36.9%), thinking skills (37.8%), and developing chronic traumatic encephalopathy (39.5%). In contrast, when asked about concerns while playing, most reported being "not at all concerned" regarding memory = 61.2%, thinking skills = 56.1%, and developing chronic traumatic encephalopathy = 71.2%. Of those who retrospectively endorsed being "not at all" or "slightly" concerned regarding memory (n = 1159/1514), thinking skills (n = 1080/1514), and developing chronic traumatic encephalopathy (n = 1219/1514), approximately half reported being currently "moderately" or "extremely" concerned about those same issues (n = 586/1159; n = 534/1080; n = 619/1219, respectively). Current concerns regarding memory (χ216 = 316.61; p < 0.001; V = 0.264), thinking skills (χ216 = 333.17; p < 0.001; V = 0.271), and developing chronic traumatic encephalopathy (χ216 = 280.85; p < 0.001; V = 0.249) were significantly related to SR-CHx, with more concussions being associated with greater current concerns. CONCLUSIONS Former National Football League players reported significant concerns regarding the potential effects of their prior concussions on long-term brain health, and these concerns are more prevalent now than when they were playing football. Cognitive and mental health concerns are readily identifiable targets for clinical intervention. Clinicians working with former players may wish to explore the extent to which individual players experience these concerns, the nature and depth of these concerns, and the impact of these concerns on the player's functioning and well-being.
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Affiliation(s)
- Samuel R Walton
- Center for the Study of Retired Athletes, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Zachary Y Kerr
- Center for the Study of Retired Athletes, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Rebekah Mannix
- Pediatrics and Emergency Medicine, Harvard Medical School, Boston, MA, USA
| | - Benjamin L Brett
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Avinash Chandran
- Center for the Study of Retired Athletes, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Datalys Center for Sports Injury Research and Prevention, Indianapolis, IN, USA
| | - Jonathan D DeFreese
- Center for the Study of Retired Athletes, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Michael A McCrea
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Kevin M Guskiewicz
- Center for the Study of Retired Athletes, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - William P Meehan
- Micheli Center for Sports Injury Prevention and Boston Children's Hospital, Waltham, MA, USA
- Department of Pediatrics and Orthopedics, Harvard Medical School, Boston, MA, USA
| | - Ruben J Echemendia
- Department of Psychology, University of Missouri, Kansas City, Kansas City, MO, USA.
- University Orthopedics Center Concussion Clinic, 101 Regent Ct., State College, PA, 16801, USA.
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25
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Hearn DW, Kerr ZY, Wikstrom EA, Goss DL, Cameron KL, Marshall SW, Padua DA. Lower Extremity Musculoskeletal Injury in US Military Academy Cadet Basic Training: A Survival Analysis Evaluating Sex, History of Injury, and Body Mass Index. Orthop J Sports Med 2021; 9:23259671211039841. [PMID: 34660826 PMCID: PMC8511930 DOI: 10.1177/23259671211039841] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2021] [Accepted: 05/04/2021] [Indexed: 11/16/2022] Open
Abstract
Background Injury incidence for physically active populations with a high volume of physical load can exceed 79%. There is little existing research focused on timing of injury and how that timing differs based on certain risk factors. Purpose/Hypothesis The purpose of this study was to report both the incidence and timing of lower extremity injuries during cadet basic training. We hypothesized that women, those with a history of injury, and those in underweight and obese body mass index (BMI) categories would sustain lower extremity musculoskeletal injury earlier in the training period than men, those without injury history, and those in the normal-weight BMI category. Study Design Cohort study; Level of evidence, 2. Methods Cadets from the class of 2022, arriving in 2018, served as the study population. Baseline information on sex and injury history was collected via questionnaire, and BMI was calculated from height and weight taken during week 1 at the United States Military Academy. Categories were underweight (BMI <20), middleweight (20-29.99), and obese (≥30). Injury surveillance was performed over the first 60 days of training via electronic medical record review and monitoring. Kaplan-Meier survival curves were used to estimate group differences in time to the first musculoskeletal injury. Cox proportional hazard regression was used to estimate hazard ratios (HRs). Results A total of 595 cadets participated. The cohort was 76.8% male, with 29.9% reporting previous injury history and 93.3% having a BMI between 20 and 30. Overall, 16.3% of cadets (12.3% of male cadets and 29.7% of female cadets) experienced an injury during the follow-up period. Women experienced significantly greater incident injury than did men (P < .001). Separation of survival curves comparing the sexes and injury history occurred at weeks 3 and 4, respectively. Hazards for first musculoskeletal injury were significantly greater for women versus men (HR, 2.63; 95% CI, 1.76-3.94) and for those who reported a history of injury versus no injury history (HR, 1.76; 95% CI, 1.18-2.64). No differences were observed between BMI categories. Conclusion Female cadets and those reporting previous musculoskeletal injury demonstrated a greater hazard of musculoskeletal injury during cadet basic training. This study did not observe an association between BMI and injury.
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Affiliation(s)
- Darren W Hearn
- South College, Knoxville, Tennessee, USA.,Human Movement Science Curriculum, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.,United States Army, Fort Bragg, North Carolina, USA
| | - Zachary Y Kerr
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Erik A Wikstrom
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Donald L Goss
- Department of Physical Therapy, High Point University, High Point, North Carolina, USA
| | - Kenneth L Cameron
- John Feagin Jr Sports Medicine Fellowship, Keller Army Hospital, United States Military Academy, West Point, New York, USA
| | - Stephen W Marshall
- Injury Prevention Research Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Darin A Padua
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
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26
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Salmon DM, Chua J, Sullivan SJ, Whatman C, Brown J, Register-Mihalik J, Murphy I, Walters S, Clacy A, Sole G, Kerr ZY, Rasmussen K, England M. Baseline concussion assessment performance of community-based senior rugby players: a cross-sectional study. Brain Inj 2021; 35:1433-1442. [PMID: 34658272 DOI: 10.1080/02699052.2021.1972452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE To report pre-season baseline concussion assessment performance among senior rugby players and explore associations between assessment performance and player demographics. DESIGN A cross-sectional study using the New Zealand Rugby Concussion Assessments (NZRCA), comprising symptom, cognitive and dynamic coordination assessments was conducted in the 2018-2019 season. METHODS Players' baseline assessments were characterised using descriptive statistics; effect sizes (ES) and t-tests were used to explore associations between player demographic characteristics and NZRCA performance. RESULTS A total of 733 players (11.4% female) aged between 16 and 52 years completed the NZRCA. The median (range) value for symptom severity, endorsed symptoms and "percentage normal" was respectively, 5 (0-40), 5 (0-21) and 90% (30-100%). A perfect standardised assessment of concussion score was achieved by one participant; seven achieved ≥27/30 for immediate recall, and 22 achieved a perfect delayed recall score. Most participants (n = 674, 92%) passed the tandem gait test. Associations between NZRCA performance and gender, concussion history, and Pasifika ethnicity were observed with effect sizes ranging from small (0.18) to large (0.70). Six hundred and twenty-three (85%) participants reported at least one symptom. CONCLUSIONS The results from this study could help support decision-making by clinicians, improving the management of concussions in the community setting.
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Affiliation(s)
- Danielle M Salmon
- Injury Prevention and Welfare, New Zealand Rugby, Wellington, New Zealand
| | - Jason Chua
- Injury Prevention and Welfare, New Zealand Rugby, Wellington, New Zealand
| | - S John Sullivan
- Injury Prevention and Welfare, New Zealand Rugby, Wellington, New Zealand
| | - Chris Whatman
- School of Sport and Recreation, Sports Performance Research Institute New Zealand, Auckland University of Technology, Auckland, New Zealand
| | - James Brown
- The Institute of Sport and Exercise Medicine, Stellenbosch University, Cape Town, South Africa
| | - Johna Register-Mihalik
- Matthew Gfeller Sport-Related Traumatic Brain Injury Research Center, Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.,Injury Prevention Research Center and Rehab University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.,Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina U.S.A
| | - Ian Murphy
- Injury Prevention and Welfare, New Zealand Rugby, Wellington, New Zealand
| | - Simon Walters
- School of Sport and Recreation, Sports Performance Research Institute New Zealand, Auckland University of Technology, Auckland, New Zealand
| | - Amanda Clacy
- Vitality Village, Wearebe, Kensington, Queensland, Australia
| | - Gisela Sole
- Centre of Health, Activity, Rehabilitation Research, School of Physiotherapy, University of Otago, Dunedin, New Zealand
| | - Zachary Y Kerr
- Matthew Gfeller Sport-Related Traumatic Brain Injury Research Center, Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.,Injury Prevention Research Center and Rehab University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.,Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina U.S.A
| | - Karen Rasmussen
- Injury Prevention and Welfare, New Zealand Rugby, Wellington, New Zealand
| | - Mike England
- Injury Prevention and Welfare, New Zealand Rugby, Wellington, New Zealand
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27
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Scarneo-Miller SE, Lopez RM, Miller KC, Adams WM, Kerr ZY, Casa DJ. High Schools' Adoption of Evidence-Based Practices for the Management of Exertional Heat Stroke. J Athl Train 2021; 56:1142-1153. [PMID: 34662417 PMCID: PMC8530428 DOI: 10.4085/1062-6050-361-20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
CONTEXT Exertional heat stroke (EHS) deaths can be prevented by adhering to best practices. OBJECTIVE To investigate high schools' adoption of policies and procedures for recognizing and treating patients with EHS and the factors influencing the adoption of a comprehensive policy. DESIGN Cross-sectional study. SETTING Online questionnaire. PATIENTS OR OTHER PARTICIPANTS Athletic trainers (ATs) practicing in the high school (HS) setting. MAIN OUTCOME MEASURE(S) Using the National Athletic Trainers' Association position statement on exertional heat illness, we developed an online questionnaire and distributed it to ATs to ascertain their schools' current written policies for using rectal temperature and cold-water immersion. The precaution adoption process model allowed for responses to be presented across the various health behavior stages (unaware if have the policy, unaware of the need for the policy, unengaged, undecided, decided not to act, decided to act, acting, and maintaining). Additional questions addressed perceptions of facilitators and barriers. Data are presented as proportions. RESULTS A total of 531 ATs completed the questionnaire. Overall, 16.9% (n = 62) reported adoption of all components for the proper recognition and treatment of EHS. The component with the highest adoption level was "cool first, transport second"; 74.1% (n = 110) of ATs described acting on or maintaining the policy. The most variability in the precaution adoption process model responses was for a rectal temperature policy; 28.7% (n = 103) of ATs stated they decided not to act and 20.1% (n = 72) stated they maintained the policy. The most frequently cited facilitator of and barrier to obtaining rectal temperature were a mandate from the state HS athletics association (n = 274, 51.5%) and resistance to or apprehension of parents or legal guardians (n = 311, 58.5%), respectively. CONCLUSIONS Athletic trainers in the HS setting appeared to be struggling to adopt a comprehensive EHS strategy, with rectal temperature continuing as the biggest challenge. Tailored strategies based on health behavior, facilitators, and barriers may aid in changing this paradigm.
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Affiliation(s)
| | | | | | - William M. Adams
- Department of Kinesiology, University of North Carolina at Greensboro
| | | | - Douglas J. Casa
- Department of Kinesiology, University of Connecticut, Storrs
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Walton SR, Brett BL, Chandran A, DeFreese JD, Mannix R, Echemendia RJ, Meehan WP, McCrea M, Guskiewicz KM, Kerr ZY. Mild Cognitive Impairment and Dementia Reported by Former Professional Football Players over 50 Years of Age: An NFL-LONG Study. Med Sci Sports Exerc 2021; 54:424-431. [PMID: 34593716 DOI: 10.1249/mss.0000000000002802] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
PURPOSE To estimate prevalences of MCI and dementia diagnoses in former National Football League (NFL) players ≥50 years old and examine the relationships among these diagnoses and an array of predictors of long-term brain health. METHODS A cross-section of former NFL players (n = 922; aged [mean ± SD] 64.8 ± 8.9 years) completed a questionnaire. Prevalences of self-reported medical diagnoses of MCI and dementia were reported alongside U.S. population estimates across 5-year age intervals (e.g., 60-64 years). Prevalence ratios (PRs) were calculated for multiple predictors of long-term brain health. RESULTS Overall, MCI and dementia prevalences were n = 219(23.8%) and n = 82(8.9%), respectively. Each diagnosis was more prevalent in former NFL players across age groups than U.S. norms, with greater disparities at relatively younger ages (e.g., 65-69) compared with older ages. Greater prevalences of MCI and dementia were associated with: self-reported concussion history (10+ vs. 0; PRadjusted[95%CI] = 1.66[1.02-2.71] and 2.61[1.01-6.71], respectively); recent pain intensity (PRadjusted[95%CI] = 1.13[1.07-1.20] and 1.15[1.03-1.28]); and diagnoses of depression (PRadjusted[95%CI] = 2.70[1.92-3.81] and 3.22[1.69-6.14]), anxiety (PRadjusted[95%CI] = 1.96[1.26-3.07] and 3.14[1.47-6.74]), or both (PRadjusted[95%CI] = 3.11[2.38-4.08] and 4.43[2.71-7.25]). Higher MCI prevalence was related to sleep apnea (PRadjusted[95%CI] = 1.30[1.06-1.60]); higher dementia prevalence was associated with age (5-year interval, PRadjusted[95%CI] = 1.42[1.26-1.60]) and race (non-White vs. White, PRadjusted[95%CI] = 1.64[1.07-2.53]). CONCLUSIONS Self-reported MCI and dementia prevalences were higher in former NFL players than national estimates and were associated with numerous personal factors, including mood-related disorders and a high number of self-reported concussions. Predictors of higher MCI and dementia prevalence may be modifiable and warrant consideration by clinicians and researchers as potential targets to mitigate the onset of these conditions.
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Affiliation(s)
- Samuel R Walton
- Department of Exercise and Sport Science and Center for the Study of Retired Athletes, University of North Carolina at Chapel Hill, Chapel Hill, NC Department of Neurosurgery/Neurology, Medical College of Wisconsin, Milwaukee, WI Datalys Center for Sports Injury Research and Prevention, Indianapolis, IN Division of Emergency Medicine, Boston Children's Hospital, Boston, MA Department of Pediatrics and Emergency Medicine, Harvard Medical School, Boston, MA Department of Psychology, University of Missouri - Kansas City, Kansas City, MO University Orthopedics Center Concussion Care Clinic, State College, PA Sports Medicine Division, Boston Children's Hospital, Boston, MA The Micheli Center for Sports Injury Prevention, Boston, MA Department of Pediatrics and Orthopedics, Harvard Medical School, Boston, MA
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Haarbauer-Krupa JK, Register-Mihalik JK, Nedimyer AK, Chandran A, Kay MC, Gildner P, Kerr ZY. Factors associated with concussion symptom knowledge and attitudes towards concussion care-seeking among parents of children aged 5-10 years. J Safety Res 2021; 78:203-209. [PMID: 34399916 PMCID: PMC9139453 DOI: 10.1016/j.jsr.2021.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Revised: 01/26/2021] [Accepted: 05/05/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND Understanding parents' concussion-related knowledge and attitudes will contribute to the development of strategies that aim to improve concussion prevention and sport safety for elementary school children. This study investigated the association between parent- and child-related factors and concussion symptom knowledge and care-seeking attitudes among parents of elementary school children (aged 5-10 years). METHODS Four hundred parents of elementary school children completed an online questionnaire capturing parental and child characteristics; concussion symptom knowledge (25 items, range = 0-50; higher = better knowledge); and concussion care-seeking attitudes (five 7-point scale items, range = 5-35; higher = more positive attitudes). Multivariable ordinal logistic regression models identified predictors of higher score levels. Adjusted odds ratios (aOR) with 95% confidence intervals (CI) excluding 1.00 were deemed statistically significant. RESULTS Select parent and child characteristics were associated with higher score levels for both outcomes. For example, odds of better knowledge level in parents were higher with increased age (10-year increase aOR = 1.59; 95% CI = 1.10-2.28), among females (aOR = 3.90; 95% CI = 2.27-6.70), and among white/non-Hispanics (aOR = 1.79; 95%CI = 1.07-2.99). Odds of more positive concussion care-seeking attitude levels were higher among parents with a college degree (aOR = 1.98; 95%CI = 1.09-3.60). Child sports participation was not associated with higher score levels for either outcome. CONCLUSIONS Certain elementary school parent characteristics were associated with parents' concussion symptom knowledge and care-seeking attitudes. While the findings suggest providing parents with culturally and demographically relevant concussion education might be helpful, they also emphasize the importance of ensuring education/prevention regardless of their children's sports participation. Practical Applications: Pediatric healthcare providers and elementary schools offer an optimal community-centered location to reach parents with this information within various communities.
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Affiliation(s)
- Juliet K Haarbauer-Krupa
- National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA, USA.
| | - Johna K Register-Mihalik
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; Matthew Gfeller Sport-Related Traumatic Brain Injury Research Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; Injury Prevention Research Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Aliza K Nedimyer
- Matthew Gfeller Sport-Related Traumatic Brain Injury Research Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; Injury Prevention Research Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; Human Movement Science Curriculum, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Avinash Chandran
- Datalys Center for Sports Injury Research and Prevention, Indianapolis, IN, USA
| | - Melissa C Kay
- School of Health Professions, University of Southern Mississippi, Hattiesburg, MS, USA
| | - Paula Gildner
- Injury Prevention Research Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Zachary Y Kerr
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; Matthew Gfeller Sport-Related Traumatic Brain Injury Research Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; Injury Prevention Research Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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Wikstrom EA, Cain MS, Chandran A, Song K, Regan T, Migel K, Kerr ZY. Lateral Ankle Sprain and Subsequent Ankle Sprain Risk: A Systematic Review. J Athl Train 2021; 56:578-585. [PMID: 34375983 DOI: 10.4085/1062-6050-168-20] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
OBJECTIVE To evaluate the evidence regarding the association between lateral ankle sprain (LAS) history and the subsequent LAS risk, as well as sex differences in the observed associations. DATA SOURCES PubMed, CINAHL, and SPORTDiscus were searched through July 2020 for articles on LAS history and incidence during the study period. STUDY SELECTION Studies were included if they were prospective in nature and the authors reported the number of participants with and those without a history of LAS at study initiation as well as the number of participants in each group who sustained an LAS during the investigation. DATA EXTRACTION Data were study design parameters as well as the number of participants with and those without an LAS history and the number of subsequent LASs that occurred in both groups. Risk ratios (RRs) with 95% CIs compared the risk of LAS during the study period between those with and those without an LAS history for each investigation. DATA SYNTHESIS A total of 19 studies involving 6567 patients were included. The follow-up periods ranged from 14 weeks to 2 years. Assessment scores indicated the studies were of moderate to high quality. A significantly higher risk of LAS during the study period was observed among those with a history of LAS in 10 of 15 studies (RR range = 1.29-6.06). Similar associations were seen in 4 of 6 studies of all-male samples (RR range = 1.38-8.65) and 1 of 4 studies with an all-female sample (RR = 4.28). CONCLUSIONS Strong evidence indicates that a previous LAS increased the risk of a subsequent LAS injury. Men with a history of LAS appeared to be at a higher risk of sustaining a subsequent LAS, but women were not. However, further data are needed to draw definitive conclusions from the limited number of sex-specific studies.
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Affiliation(s)
| | | | - Avinash Chandran
- Datalys Center for Sports Injury Research and Prevention, Indianapolis, IN
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Kossman MK, McCrae AJ, Pryor RR, Frank SC, Hayford R, Logan PC, Moakley MG, Register-Mihalik JK, Kerr ZY. Barriers and Facilitators Faced by Athletic Trainers Implementing National Athletic Trainers' Association Inter-Association Task Force Preseason Heat-Acclimatization Guidelines in US High School Football Players. J Athl Train 2021; 56:816-828. [PMID: 33150946 DOI: 10.4085/321-20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
CONTEXT The aim of the National Athletic Trainers' Association Inter-Association Task Force (NATA-IATF) preseason heat-acclimatization guidelines was to acclimatize high school athletes to the environment during the first 2 weeks of the preseason and reduce the risk of exertional heat illness. OBJECTIVE To identify barriers and facilitators that high school athletic trainers (ATs) encountered when implementing the NATA-IATF guidelines. DESIGN Qualitative study. SETTING Individual phone interviews with all participants. PATIENTS OR OTHER PARTICIPANTS Thirty-three ATs (16 men, 17 women; age = 36.0 ± 12.0 years, athletic training experience = 12.9 ± 10.5 years) representing 19 states (4 with state mandates) were interviewed before data saturation was achieved. Participants were purposefully sampled from a larger investigation based on stratification of US Census region and preidentified high school compliance with the NATA-IATF guidelines. MAIN OUTCOME MEASURE(S) A cross-sectional, semistructured phone interview (6 steps) was conducted with each participant and then transcribed verbatim. A 7-person research team (5 coders, 2 auditors) coded the data into themes and categories, focusing on consensus of data placement to reduce bias and ensure accuracy. RESULTS Facilitators and barriers that influenced successful guideline implementation were (1) perceived stakeholder access, (2) perceived stakeholder role, (3) capability and capacity, (4) school culture, (5) logistical support, (6) resources, (7) physical environment, and (8) consistency of the guidelines. Overall, participants discussed facilitators and barriers within each category based on their experiences and circumstances. CONCLUSIONS Athletic trainers faced numerous concerns regarding compliance with the NATA-IATF preseason heat-acclimatization guidelines. Multiple levels of influence should be targeted to improve implementation. These include intrapersonal factors by giving ATs the education and self-efficacy to support advocacy for implementation, interpersonal components by establishing strong collaborative networks for change, community and environmental factors by optimizing school culture and community resources for implementation, and policy aspects by establishing consistent guidelines across all bodies.
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Affiliation(s)
- Melissa Kay Kossman
- School of Health Professions, University of Southern Mississippi, Hattiesburg
| | - Andrew J McCrae
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill
| | - Riana R Pryor
- Department of Exercise and Nutrition Sciences, Center for Research and Education in Special Environments, SUNY, University at Buffalo, NY
| | - Simone C Frank
- Department of Health Behavior, University of North Carolina at Chapel Hill
| | - Ryan Hayford
- Hussman School of Journalism and Media, University of North Carolina at Chapel Hill
| | - Paige C Logan
- Department of Health Behavior, University of North Carolina at Chapel Hill
| | - Margaret G Moakley
- Department of Health Behavior, University of North Carolina at Chapel Hill
| | | | - Zachary Y Kerr
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill
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Walton SR, Brett BL, Kerr ZY, DeFreese JD, Chandran A, Mannix R, Echemendia RJ, Meehan WP, McCrea MA, Guskiewicz KM. Changes In Health Over 18-years And In Relation To Concussion History In Former NFL Players. Med Sci Sports Exerc 2021. [DOI: 10.1249/01.mss.0000763164.55790.12] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Ingram BM, Kay MC, Callahan CE, Gildner P, Kerr ZY, Register-Mihalik JK. Effects Of An Interactive Concussion Education Platform On Concussion-related Knowledge, Attitudes, Perceived Norms, And Intention To Disclose In Collegiate Club Sport Athletes. Med Sci Sports Exerc 2021. [DOI: 10.1249/01.mss.0000763792.67503.4d] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Wagoner CW, Lee JT, Hanson ED, Kerr ZY, Nyrop KA, Muss HB, Battaglini CL. Cancer Related Fatigue And Its Associations After Community-based Exercise Participation: A Preliminary Analysis. Med Sci Sports Exerc 2021. [DOI: 10.1249/01.mss.0000764748.72674.31] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Kerr ZY, Walton SR, Brett BL, Chandran A, DeFreese JD, Mannix R, Echemendia R, Meehan WP, McCrea MW, Guskiewicz KM. Depression And Concussion History Among Former NFL Players Aged Over 50 Years: An NFL-LONG Study. Med Sci Sports Exerc 2021. [DOI: 10.1249/01.mss.0000761368.63267.bf] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Nedimyer AK, Chandran A, Robison HJ, Boltz AJ, Morris SN, Kerr ZY, Christy CL. Epidemiology Of Lower Extremity Injuries In National Collegiate Athletic Association Women’S Field Hockey: 2014/15-2018/19. Med Sci Sports Exerc 2021. [DOI: 10.1249/01.mss.0000761360.87025.64] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Adams WM, Hosokawa Y, Casa DJ, Périard JD, Racinais S, Wingo JE, Yeargin SW, Scarneo-Miller SE, Kerr ZY, Belval LN, Alosa D, Csillan D, LaBella C, Walker L. Roundtable on Preseason Heat Safety in Secondary School Athletics: Heat Acclimatization. J Athl Train 2021; 56:352-361. [PMID: 33878177 DOI: 10.4085/1062-6050-596-20] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To provide best-practice recommendations for developing and implementing heat-acclimatization strategies in secondary school athletics. DATA SOURCES An extensive literature review on topics related to heat acclimatization and heat acclimation was conducted by a group of content experts. Using the Delphi method, action-oriented recommendations were developed. CONCLUSIONS A period of heat acclimatization consisting of ≥14 consecutive days should be implemented at the start of fall preseason training or practices for all secondary school athletes to mitigate the risk of exertional heat illness. The heat-acclimatization guidelines should outline specific actions for secondary school athletics personnel to use, including the duration of training, the number of training sessions permitted per day, and adequate rest periods in a cool environment. Further, these guidelines should include sport-specific and athlete-specific recommendations, such as phasing in protective equipment and reintroducing heat acclimatization after periods of inactivity. Heat-acclimatization guidelines should be clearly detailed in the secondary school's policy and procedures manual and disseminated to all stakeholders. Heat-acclimatization guidelines, when used in conjunction with current best practices surrounding the prevention, management, and care of secondary school student-athletes with exertional heat stroke, will optimize their health and safety.
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Affiliation(s)
- William M Adams
- Hydration, Environment, and Thermal Stress Lab, Department of Kinesiology, University of North Carolina at Greensboro
| | - Yuri Hosokawa
- Faculty of Sport Sciences, Waseda University, Tokorozawa, Saitama, Japan
| | - Douglas J Casa
- Korey Stringer Institute, Department of Kinesiology, University of Connecticut, Storrs
| | - Julien D Périard
- Research Institute for Sport and Exercise, University of Canberra, Bruce, Australia
| | - Sebastien Racinais
- Research and Scientific Support Department, ASPETAR Orthopaedic and Sports Medicine Hospital, Doha, Qatar
| | | | - Susan W Yeargin
- Department of Exercise Science, University of South Carolina, Columbia
| | | | - Zachary Y Kerr
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill
| | - Luke N Belval
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas and University of Texas Southwestern Medical Center, Dallas
| | - Denise Alosa
- Athletic Medicine, South Burlington School District, Burlington, VT.,College of Nursing and Health Science, University of Vermont, Burlington
| | - David Csillan
- Department of Physical Therapy, Princeton Orthopedic Associates, NJ
| | - Cynthia LaBella
- Department of Pediatrics, Northwestern University Feinberg School of Medicine Institute for Sports Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, IL
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Abstract
CONTEXT The National Federation of State High School Associations previously implemented 2 lacrosse rule modifications: Rule 5.4 in the 2012-2013 academic year to heighten the penalty for a head or neck hit to the head, face, or neck (HFN) and Rule 5.3.5 in the 2013-2014 academic year to minimize body checking. OBJECTIVE To determine if the rates of overall injury, HFN injuries, and concussions due to intentional contact (checking) differed for boys' high school lacrosse players after Rule 5.4 and 5.3.5 modifications were enacted. DESIGN Descriptive epidemiology study. SETTING Web-based online surveillance system. PATIENTS OR OTHER PARTICIPANTS Boys' high school lacrosse players during the 2008-2009 to 2016-2017 seasons whose teams involved athletic trainers participating in the High School Reporting Information Online sports injury-surveillance system. INTERVENTION(S) Rule 5.4 in the 2012-2013 academic year increased the penalty for any intentional hits to the HFN, and Rule 5.3.5 in the 2013-2014 year eliminated body checking to a player in a defenseless position. MAIN OUTCOME MEASURE(S) Overall, HFN, and concussion injury rate ratios (IRRs) by checking mechanism; overall and checking-related injury ratios by competitions and practices. RESULTS A decrease was shown in checking-related HFN injuries (IRR = 0.29, 95% CI = 0.13, 0.65) and checking-related concussions (IRR = 0.29, 95% CI = 0.12, 0.70) during practices in the seasons after both rule modifications were imposed, but no decreases occurred in any checking-related injuries during competitions. By injury mechanism, no decreases were evident after the Rule 5.4 modification. When both rule modifications (Rules 5.4 and 5.3.5) were enacted together, concussion rates due to delivering body checks (IRR = 0.51, 95% CI = 0.29, 0.91) and overall injury risk due to being body checked (IRR = 0.72, 95% CI = 0.53, 0.97) decreased. CONCLUSIONS When both Rule 5.4 and 5.3.5 modifications were in effect, concussion and overall injury risks decreased for the body checker and the player being body checked, respectively.
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Affiliation(s)
- Stanley Guillaume
- Department of Physical Medicine & Rehabilitation, Shirley Ryan Ability Lab, Chicago, IL
| | - Andrew E Lincoln
- Sports Medicine Research Center, MedStar Sports Medicine Research Center, Baltimore, MD
| | - Lisa Hepburn
- Sports Medicine Research Center, MedStar Sports Medicine Research Center, Baltimore, MD
| | - Shane V Caswell
- School of Recreation, Health and Tourism, George Mason University, Manassas, VA
| | - Zachary Y Kerr
- Injury Prevention Research Center, University of North Carolina at Chapel Hill
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Abstract
Sedentary behavior is associated with poor physical and mental health. Targeting sedentary behavior is a simple strategy that may help counter physical and mental health concerns associated with COVID-19-related social restrictions. Of course, traditional strategies such as achieving optimal exercise and physical activity levels are also important and should be recommended. However, even under normal circumstances, the difficulty in promoting lasting exercise habits at multiple levels (e.g. individual, environment, policy) are well documented, and chances of maintaining or improving these factors is now even lower. Thus, relative to other lifestyle behaviors - sedentary behavior may be more amenable to change. Moreover, reducing sedentary behavior may be less susceptible to influence from factors associated with health disparities such as age, race, and socio-economic status compared to exercise or physical activity. Sedentary behavior is a feasible health strategy that should be targeted during COVID-19.
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Affiliation(s)
- Gabriel Zieff
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Healthy Living for Pandemic Event Protection (HL-PIVOT) Network, Chicago, IL, USA
| | - Lauren C Bates
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Healthy Living for Pandemic Event Protection (HL-PIVOT) Network, Chicago, IL, USA
| | - Zachary Y Kerr
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Justin B Moore
- Implementation Sciences, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Erik D Hanson
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Claudio Battaglini
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Lee Stoner
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Healthy Living for Pandemic Event Protection (HL-PIVOT) Network, Chicago, IL, USA
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Scarneo-Miller SE, Kerr ZY, Adams WM, Belval LN, Casa DJ. Influence of State-Level Emergency Planning Policy Requirements on Secondary School Adoption. J Athl Train 2021; 55:1062-1069. [PMID: 32818958 DOI: 10.4085/1062-6050-118-19] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
CONTEXT Emergency action plans (EAPs) are a critical component in the management of catastrophic sport-related injury. Some state high school athletics associations and state legislation have required that schools develop EAPs, but little research exists on the influence of a statewide policy requirement on local adoption of these policies. OBJECTIVE To examine the efficacy of a statewide policy requirement on local adoption of an EAP. DESIGN Cross-sectional study. SETTING Online questionnaire. PATIENTS OR OTHER PARTICIPANTS Secondary school athletic trainers were invited to complete a survey (n = 9642); 1136 completed the survey, yielding an 11.7% response rate. MAIN OUTCOME MEASURE(S) Survey responses on the adoption of EAPs along with cardiopulmonary resuscitation and automated external defibrillator (CPR/AED) requirements were cross-referenced with published statewide policies to determine the prevalence of EAP adoption. We evaluated the adoption of emergency action plan components based on the National Athletic Trainers' Association's emergency planning position statement along with CPR/AED requirements to determine component-specific prevalence. We compared the prevalence of EAP and component adoption between states that required EAPs and specific components of EAPs and states without such requirements. RESULTS Athletic trainers in states that required adoption of an EAP reported including more components of the emergency planning position statement (mean = 8 ± 4, median = 9) than in states without a requirement (mean = 7 ± 4, median = 8). The adoption of EAP components did not differ between states that required specific components of the EAP versus development of the EAP only. However, schools in states with both EAP and CPR/AED training requirements reported higher rates of CPR/AED training implementation (95.5%) than states that only required CPR/AED training (81.6%, prevalence ratio = 1.10, 95% confidence interval = 1.01, 1.20). CONCLUSIONS Based on these data, statewide policy requirements for the development of an EAP may be associated with increasing adoption of EAPs.
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Affiliation(s)
| | - Zachary Y Kerr
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill
| | - William M Adams
- Department of Kinesiology, University of North Carolina at Greensboro
| | - Luke N Belval
- Institute for Exercise and Environmental Medicine, Dallas, Texas Health Presbyterian Hospital, Dallas, TX.,University of Texas Southwestern Medical Center, Dallas, TX. Dr Scarneo-Miller is now at West Virginia University, Morgantown
| | - Douglas J Casa
- Department of Kinesiology, Korey Stringer Institute, University of Connecticut, Storrs, CT
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Nedimyer AK, Chandran A, Hirschhorn RM, Adams WM, Pryor RR, Casa DJ, Register-Mihalik JK, Kerr ZY. Exertional Heat-Stroke Management Practices and Intentions Among Secondary School Football Athletic Trainers. J Athl Train 2021; 55:1081-1088. [PMID: 32966554 DOI: 10.4085/1062-6050-474-19] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
CONTEXT Athletic trainers (ATs) are educated and trained in appropriate exertional heat-stroke (EHS) management strategies, yet disparities may exist between intended and actual uses in clinical practice. OBJECTIVE To examine the intended and actual uses of EHS management strategies among those who did and those who did not treat patients with suspected cases of EHS during the 2017 high school (HS) American football preseason. DESIGN Cross-sectional study. SETTING Online questionnaire. PATIENTS OR OTHER PARTICIPANTS A total of 1016 ATs who oversaw patient care during the 2017 HS American football preseason. MAIN OUTCOME MEASURE(S) Responding HS ATs recorded whether they had or had not managed patients with suspected EHS events during the 2017 HS American football preseason. Those who had managed patients with suspected cases of EHS reported the management strategies used; those who had not managed such patients described their intended management strategies. For each management strategy, z tests compared the proportions of actual use among ATs who managed patients with suspected EHS with the proportions of intended use among ATs who did not manage such patients. RESULTS Overall, 124 (12.2%) ATs treated patients with suspected EHS cases during the 2017 HS American football preseason. Generally, the proportions of intended use of management strategies among ATs who did not treat patients with suspected EHS were higher than the actual use of those strategies among ATs who did. For example, ATs who did treat patients with suspected EHS were more likely than those who did not treat such patients to intend to take rectal temperature (19.6% versus 3.2%, P < .001) and immerse the athlete in ice water (90.1% versus 51.6%, P < .001). CONCLUSIONS Inconsistencies occurred between intended and actual use of EHS management strategies. The standard of care for managing patients with suspected cases of EHS was not consistently used in clinical practice, although ATs who did not treat EHS stated they intended to use these management strategies more frequently. Future researchers should identify factors that preclude ATs from using the standard of care when treating patients with suspected cases of EHS.
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Affiliation(s)
- Aliza K Nedimyer
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill.,Human Movement Science Curriculum, University of North Carolina at Chapel Hill
| | - Avinash Chandran
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill.,Datalys Center for Sports Injury Research and Prevention, Inc, Indianapolis, IN
| | | | - William M Adams
- Department of Kinesiology, University of North Carolina at Greensboro
| | - Riana R Pryor
- Center for Research and Education in Special Environments, Department of Exercise and Nutrition Sciences, University at Buffalo, State University of New York
| | - Douglas J Casa
- Korey Stringer Institute, Department of Kinesiology, University of Connecticut, Storrs
| | | | - Zachary Y Kerr
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill
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Kerr ZY, Nimphius S, Stoner L, Ahmed OH, Register-Mihalik JK, Fortington LV. Strategies for engaging "multiple disciplinary" teams in sport- and exercise-related research. J Sci Med Sport 2021; 24:851-854. [PMID: 33722531 DOI: 10.1016/j.jsams.2021.03.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Revised: 02/26/2021] [Accepted: 03/03/2021] [Indexed: 11/26/2022]
Affiliation(s)
- Zachary Y Kerr
- Department of Exercise and Sport Science, University of North Carolina, USA.
| | - Sophia Nimphius
- School of Medical and Health Sciences, Edith Cowan University, Australia
| | - Lee Stoner
- Department of Exercise and Sport Science, University of North Carolina, USA
| | - Osman Hassan Ahmed
- University Hospitals Dorset NHS Foundation Trust, United Kingdom; School of Sport, Health and Exercise Science, University of Portsmouth, United Kingdom
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Giersch GEW, Charkoudian N, Pereira T, Edgell H, Freeberg KA, Craighead DH, Neill M, Allison EY, Zapcic AK, Smith KJ, Bock JM, Casey DP, Shenouda N, Ranadive SM, Tremblay JC, Williams AM, Simpson LL, Meah VL, Ruediger SL, Bailey TG, Pereira HM, Lei TH, Perry B, Mündel T, Freemas JA, Worley ML, Baranauskas MN, Carter SJ, Johnson BD, Schlader ZJ, Bates LC, Stoner L, Zieff G, Poles J, Adams N, Meyer ML, Hanson ED, Greenlund IM, Bigalke JA, Carter JR, Kerr ZY, Stanford K, Pomeroy A, Boggess K, de Souza HLR, Meireles A, Arriel RA, Leite LHR, Marocolo M, Chapman CL, Atencio JK, Kaiser BW, Comrada LN, Halliwill JR, Minson CT, Williams JS, Dunford EC, MacDonald MJ, Santisteban KJ, Larson EA, Reed E, Needham KW, Gibson BM, Gillen J, Barbosa TC, Cardoso LLY, Gliemann L, Tamariz-Ellemann A, Hellsten Y, DuBos LE, Babcock MC, Moreau KL, Wickham KA, Vagula M, Moir ME, Klassen SA, Rodrigues A. Commentaries on Point:Counterpoint: Investigators should/should not control for menstrual cycle phase when performing studies of vascular control. J Appl Physiol (1985) 2021; 129:1122-1135. [PMID: 33197376 DOI: 10.1152/japplphysiol.00809.2020] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Affiliation(s)
- Gabrielle E W Giersch
- Thermal and Mountain Medicine Division, United States Army Research Institute for Environmental Medicine, Natick, Massachusetts,Oak Ridge Institute for Science and Education, Oak Ridge, Tennnessee
| | - Nisha Charkoudian
- Thermal and Mountain Medicine Division, United States Army Research Institute for Environmental Medicine, Natick, Massachusetts
| | - T Pereira
- School of Kinesiology and Health Sciences, York University, Toronto, Ontario, Canada
| | - H Edgell
- School of Kinesiology and Health Sciences, York University, Toronto, Ontario, Canada
| | - Kaitlin A Freeberg
- Department of Integrative Physiology, University of Colorado Boulder, Boulder, Colorado
| | - Daniel H Craighead
- Department of Integrative Physiology, University of Colorado Boulder, Boulder, Colorado
| | - Matthew Neill
- Department of Kinesiology, Lakehead University, Thunder Bay, Ontario, Canada
| | - Elric Y Allison
- Department of Kinesiology, McMaster University, Hamilton, Ontario, Canada
| | - Andrea K Zapcic
- Department of Kinesiology, Lakehead University, Thunder Bay, Ontario, Canada
| | - Kurt J Smith
- Integrative Physiology Lab, Department of Kinesiology and Nutrition, University of Chicago, Chicago, Illinois
| | - Joshua M Bock
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - Darren P Casey
- Department of Physical Therapy and Rehabilitation Science, Carver College of Medicine, University of Iowa, Iowa City, Iowa,Abboud Cardiovascular Research Center, Carver College of Medicine, University of Iowa, Iowa City, Iowa,Fraternal Order of Eagles Diabetes Research Center, Carver College of Medicine, University of Iowa, Iowa City, Iowa
| | - Ninette Shenouda
- Department of Kinesiology and Applied Physiology, University of Delaware, Newark, Delaware
| | - Sushant M Ranadive
- Department of Kinesiology, University of Maryland, College Park, Maryland
| | - Joshua C Tremblay
- Centre for Heart, Lung and Vascular Health, University of British Columbia–Okanagan, Kelowna, British Columbia, Canada
| | - Alexandra M Williams
- Cellular and Physiological Sciences, Faculty of Medicine, University of British Columbia, Vancouver, Canada,International Collaboration on Repair Discoveries, University of British Columbia, Vancouver, Canada
| | - Lydia L Simpson
- Extremes Research Group, School of Sport, Health and Exercise Sciences, Bangor University, Bangor, United Kingdom
| | - Victoria L Meah
- Program for Pregnancy and Postpartum Health, Faculty of Kinesiology, Sport, and Recreation, Women and Children's Health Research Institute, Alberta Diabetes Institute, University of Alberta, Edmonton, Alberta, Canada
| | - Stefanie L Ruediger
- Physiology and Ultrasound Laboratory in Science and Exercise, Centre of Research on Exercise, Physical Activity and Health, The University of Queensland, Australia
| | - Tom G Bailey
- Physiology and Ultrasound Laboratory in Science and Exercise, Centre of Research on Exercise, Physical Activity and Health, The University of Queensland, Australia,School of Nursing, Midwifery and Social Work, The University of Queensland, Australia
| | - Hugo M Pereira
- Department of Health and Exercise Science, University of Oklahoma, Norman, Oklahoma
| | - Tze-Huan Lei
- College of Physical Education, Hubei Normal University, Huangshi, China,Laboratory for Applied Human Physiology, Graduate School of Human Development and Environment, Kobe University, Kobe, Japan
| | - Blake Perry
- School of Health Sciences, Massey University, Wellington, New Zealand
| | - Toby Mündel
- School of Sport Exercise and Nutrition, Massey University, Palmerston North, New Zealand
| | - Jessica A Freemas
- H.H. Morris Human Performance Laboratories, Dept. of Kinesiology, School of Public Health, Indiana University, Bloomington, Indiana
| | - Morgan L Worley
- H.H. Morris Human Performance Laboratories, Dept. of Kinesiology, School of Public Health, Indiana University, Bloomington, Indiana
| | - Marissa N Baranauskas
- H.H. Morris Human Performance Laboratories, Dept. of Kinesiology, School of Public Health, Indiana University, Bloomington, Indiana
| | - Stephen J Carter
- H.H. Morris Human Performance Laboratories, Dept. of Kinesiology, School of Public Health, Indiana University, Bloomington, Indiana
| | - Blair D Johnson
- H.H. Morris Human Performance Laboratories, Dept. of Kinesiology, School of Public Health, Indiana University, Bloomington, Indiana
| | - Zachary J Schlader
- H.H. Morris Human Performance Laboratories, Dept. of Kinesiology, School of Public Health, Indiana University, Bloomington, Indiana
| | - Lauren C Bates
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Lee Stoner
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Gabriel Zieff
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Jillian Poles
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Nathan Adams
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Michelle L Meyer
- Department of Emergency Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Erik D Hanson
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Ian M Greenlund
- Department of Health and Human Development, Montana State University, Bozeman, Montana,Department of Psychology, Montana State University, Bozeman, Montana
| | - Jeremy A Bigalke
- Department of Health and Human Development, Montana State University, Bozeman, Montana,Department of Psychology, Montana State University, Bozeman, Montana
| | - Jason R Carter
- Department of Health and Human Development, Montana State University, Bozeman, Montana,Department of Psychology, Montana State University, Bozeman, Montana
| | - Zachary Y Kerr
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Kathleen Stanford
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Alex Pomeroy
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Kim Boggess
- Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Hiago L R de Souza
- Physiology and Human Performance Research Group, Department of Physiology, Federal University of Juiz de Fora, Juiz de Fora, Minas Gerais, Brazil
| | - Anderson Meireles
- Physiology and Human Performance Research Group, Department of Physiology, Federal University of Juiz de Fora, Juiz de Fora, Minas Gerais, Brazil
| | - Rhai A Arriel
- Physiology and Human Performance Research Group, Department of Physiology, Federal University of Juiz de Fora, Juiz de Fora, Minas Gerais, Brazil
| | - Laura H R Leite
- Physiology and Human Performance Research Group, Department of Physiology, Federal University of Juiz de Fora, Juiz de Fora, Minas Gerais, Brazil
| | - Moacir Marocolo
- Physiology and Human Performance Research Group, Department of Physiology, Federal University of Juiz de Fora, Juiz de Fora, Minas Gerais, Brazil
| | | | - Jessica K Atencio
- Department of Human Physiology, University of Oregon, Eugene, Oregon
| | - Brendan W Kaiser
- Department of Human Physiology, University of Oregon, Eugene, Oregon
| | - Lindan N Comrada
- Department of Human Physiology, University of Oregon, Eugene, Oregon
| | - John R Halliwill
- Department of Human Physiology, University of Oregon, Eugene, Oregon
| | | | - Jennifer S Williams
- Vascular Dynamics Lab, Department of Kinesiology, McMaster University, Hamilton, Ontario, Canada
| | - Emily C Dunford
- Vascular Dynamics Lab, Department of Kinesiology, McMaster University, Hamilton, Ontario, Canada
| | - Maureen J MacDonald
- Vascular Dynamics Lab, Department of Kinesiology, McMaster University, Hamilton, Ontario, Canada
| | | | - Emily A Larson
- Department of Human Physiology, University of Oregon, Eugene, Oregon
| | - Emma Reed
- Department of Human Physiology, University of Oregon, Eugene, Oregon
| | - Karen W Needham
- Department of Human Physiology, University of Oregon, Eugene, Oregon
| | - Brandon M Gibson
- Department of Human Physiology, University of Oregon, Eugene, Oregon
| | - Jenna Gillen
- Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, Canada
| | - Thales C Barbosa
- Department of Physiology and Biophysics, University of Mississippi Medical Center, Jackson, Mississippi
| | - Licy L Yanes Cardoso
- Department of Cell and Molecular Biology, University of Mississippi Medical Center, Jackson, Mississippi
| | - Lasse Gliemann
- Department of Nutrition, Exercise and Sports, University of Copenhagen, Denmark
| | | | - Ylva Hellsten
- Department of Nutrition, Exercise and Sports, University of Copenhagen, Denmark
| | - Lyndsey E DuBos
- Division of Geriatric Medicine, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Matthew C Babcock
- Division of Geriatric Medicine, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Kerrie L Moreau
- Division of Geriatric Medicine, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado,Veterans Affairs Eastern Colorado Geriatric Research, Educational and Clinical Center, Denver, Colorado
| | - Kate A Wickham
- Environmental Ergonomics Laboratory, Department of Kinesiology, Brock University, St. Catharines, Ontario, Canada
| | | | - M Erin Moir
- School of Kinesiology, University of Western Ontario, London, Ontario, Canada
| | | | - Alex Rodrigues
- Physiology and Human Performance Research Group, Department of Physiology, Federal University of Juiz de Fora, Juiz de Fora, Minas Gerais, Brazil
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Kerr ZY, Nedimyer AK, Kay MC, Chandran A, Gildner P, Byrd KH, Haarbauer-Krupa JK, Register-Mihalik JK. Factors associated with concussion-symptom knowledge and attitudes toward concussion care seeking in a national survey of parents of middle-school children in the US. J Sport Health Sci 2021; 10:113-121. [PMID: 32919064 PMCID: PMC7987565 DOI: 10.1016/j.jshs.2020.09.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/06/2020] [Revised: 07/18/2020] [Accepted: 08/04/2020] [Indexed: 06/06/2023]
Abstract
BACKGROUND Developing appropriate concussion prevention and management paradigms in middle school (MS) settings requires understanding parents' general levels of concussion-related knowledge and attitudes. This study examined factors associated with concussion-symptom knowledge and care-seeking attitudes among parents of MS children (aged 10-15 years). METHODS A panel of 1224 randomly selected U.S. residents, aged ≥ 18 years and identifying as parents of MS children, completed an online questionnaire capturing parental and child characteristics. The parents' concussion-symptom knowledge was measured using 25 questions, with possible answers being "yes", "maybe", and "no". Correct answers earned 2 points, "maybe" answers earned 1 point, and incorrect answers earned 0 point (range: 0-50; higher scores = better knowledge). Concussion care-seeking attitudes were also collected using five 7-point scale items (range: 5-35; higher scores = more positive attitudes). Multivariable ordinal logistic regression models identified predictors of higher scores. Models met proportional odds assumptions. Adjusted odds ratios (aORs) with 95% confidence intervals (95%CIs) (excluding 1.00) were deemed statistically significant. RESULTS Median scores were 39 (interquartile range: 32-44) for symptom knowledge and 32 (interquartile range: 28-35) for care-seeking attitude. In multivariable models, odds of better symptom knowledge were higher in women vs. men (aOR = 2.28; 95%CI: 1.71-3.05), white/non-Hispanics vs. other racial or ethnic groups (aOR = 1.88; 95%CI: 1.42-2.49), higher parental age (10-year-increase aOR = 1.47; 95%CI: 1.26-1.71), and greater competitiveness (10%-scale-increase aOR = 1.24; 95%CI: 1.13-1.36). Odds of more positive care-seeking attitudes were higher in white/non-Hispanics vs. other racial or ethnic groups (aOR = 1.45; 95%CI: 1.06-1.99) and in older parental age (10-year-increase aOR = 1.24; 95%CI: 1.05-1.47). CONCLUSION Characteristics of middle school children's parents (e.g., sex, race or ethnicity, age) are associated with their concussion-symptom knowledge and care-seeking attitudes. Parents' variations in concussion knowledge and attitudes warrant tailored concussion education and prevention.
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Affiliation(s)
- Zachary Y Kerr
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599-8700, USA; Matthew Gfeller Sport-Related Traumatic Brain Injury Research Center, University of North Carolina, Chapel Hill, NC 27599-8700, USA; Injury Prevention Research Center, University of North Carolina, Chapel Hill, NC 27510, USA.
| | - Aliza K Nedimyer
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599-8700, USA; Matthew Gfeller Sport-Related Traumatic Brain Injury Research Center, University of North Carolina, Chapel Hill, NC 27599-8700, USA; Human Movement Science Curriculum, University of North Carolina, Chapel Hill, NC 27599-8700, USA
| | - Melissa C Kay
- School of Health Professions, University of Southern Mississippi, Hattiesburg, MS 39406, USA
| | - Avinash Chandran
- Datalys Center for Sports Injury Research and Prevention, Indianapolis, IN 46202, USA
| | - Paula Gildner
- Injury Prevention Research Center, University of North Carolina, Chapel Hill, NC 27510, USA
| | - K Hunter Byrd
- Injury Prevention Research Center, University of North Carolina, Chapel Hill, NC 27510, USA
| | - Juliet K Haarbauer-Krupa
- National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA 30341, USA
| | - Johna K Register-Mihalik
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599-8700, USA; Matthew Gfeller Sport-Related Traumatic Brain Injury Research Center, University of North Carolina, Chapel Hill, NC 27599-8700, USA; Injury Prevention Research Center, University of North Carolina, Chapel Hill, NC 27510, USA
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45
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Scarneo-Miller SE, Lopez RM, Miller KC, Adams WM, Kerr ZY, Casa DJ. High Schools Struggle to Adopt Evidence Based Practices for the Management of Exertional Heat Stroke. J Athl Train 2021:461689. [PMID: 33626130 DOI: 10.4085/361-20] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
CONTEXT Exertional heat stroke (EHS) deaths can be prevented by adhering to best practices. OBJECTIVE We investigated the adoption of policies and procedures for the recognition and treatment of EHS and the factors influencing the adoption of a comprehensive policy. DESIGN Cross Sectional. SETTING Online questionnaire. PATIENTS OR OTHER PARTICIPANTS Athletic trainers (ATs) practicing in the high school (HS) setting. MAIN OUTCOME MEASURE(S) Using the NATA Position Statement: Exertional Heat Illness, an online questionnaire was developed and distributed to ATs to ascertain their schools' current written policies for the use of rectal temperature and cold-water immersion (CWI). The Precaution Adoption Process Model (PAPM), allowed for responses to be presented across the various health behavior stages ("Unaware if have the policy", "Unaware for the need for the policy", "Unengaged", "Undecided", "Decided Not to Act", "Decided to Act", "Acting", and "Maintaining"). Additional questions included perceptions of facilitators and barriers. Data are presented as proportions. RESULTS A total of 531 ATs completed this questionnaire. Overall, 16.9% (n=62) report adoption of all components for proper recognition and treatment of EHS. The policy component with the highest adoption was "cool first transport second" with 74.1% (n=110) of ATs reporting "Acting" or "Maintaining." The most variability in the PAPM responses was for a rectal temperature policy, with 28.7% (n=103) of ATs reporting "Decided not to Act" and 20.1% (n=72) reporting "Maintaining." The most commonly reported facilitator and barrier for rectal temperature included state mandate from state HS athletics association (n=274,51.5%) and resistance or apprehension from parents or legal guardians (n=311,58.5%), respectively. CONCLUSIONS ATs in the HS setting appear to be struggling to adopt a comprehensive EHS strategy, with rectal temperature continuing to appear as the biggest undertaking. Tailored strategies based on health behavior, facilitators and barriers may aid in changing this paradigm.
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Affiliation(s)
- S E Scarneo-Miller
- Samantha E. Scarneo-Miller, PhD, ATC, Division of Athletic Training, School of Medicine, West Virginia University, , Twitter Handle: @SScarneoMiller
| | - R M Lopez
- Rebecca M. Lopez, PhD, ATC, Department of Orthopaedics & Sports Medicine, University of South Florida , Twitter Handle: @RLopez1010
| | - K C Miller
- Kevin C. Miller, PhD, ATC, School of Rehabilitation and Medical Sciences, Central Michigan University
| | - W M Adams
- William M. Adams, PhD, ATC, Hydration, Environment, and Thermal Stress Lab, Department of Kinesiology, University of North Carolina at Greensboro, , Twitter Handle: @william_m_adams
| | - Z Y Kerr
- Zachary Y. Kerr, PhD, Department of Exercise and Sport Science, Department of University of North Carolina-Chapel Hill,
| | - D J Casa
- Douglas J. Casa, Korey Stringer Institute, Department of Kinesiology, University of Connecticut, , Twitter Handle: @CasaDouglas
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Callahan CE, Kay MC, Kerr ZY, Hinson MT, Linnan LA, Hennink-Kaminski H, Gildner P, Marshall SW, Houston MN, Cameron KL, Register-Mihalik J. Association Between Previous Concussion Education and Concussion Care-Seeking Outcomes Among National Collegiate Athletic Association Division I Student-Athletes. J Athl Train 2021; 56:461578. [PMID: 33618368 PMCID: PMC8010936 DOI: 10.4085/1062-6050-0211.20] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
CONTEXT Limited data exist concerning differences in concussion-education exposure and how education exposures relate to care seeking and symptom disclosure, specifically by National Collegiate Athletic Association Division I student-athletes. OBJECTIVE To investigate demographic characteristics associated with concussion-education exposure and examine whether overall education exposure (yes versus no) and education-source exposure number (multiple sources versus a single source) affect concussion care-seeking and disclosure factors in Division I student-athletes. DESIGN Cross-sectional study. SETTING Classroom or online survey. PATIENTS OR OTHER PARTICIPANTS Division I student-athletes (n = 341). MAIN OUTCOME MEASURE(S) Frequencies and proportions were computed for sex, race, school year, sport, and concussion history across concussion-education groups. Prevalence ratios (PRs) and 95% CIs were calculated to quantify the associations between student-athlete characteristics and (1) overall concussion-education exposure and (2) source-exposure number. Separate multivariable linear regression models estimated adjusted mean differences (MDs) and 95% CIs, which allowed us to assess differences in concussion knowledge, attitudes, and perceived social norms relative to concussion-education exposure and exposure to multiple sources. Separate multivariable binomial regression models were performed to estimate adjusted PRs and 95% CIs in order to evaluate associations of intention, perceived control, and care-seeking or disclosure behaviors and overall concussion-education exposure and exposure to multiple sources. All models controlled for sex, sport, and concussion history. RESULTS Overall, 276 (80.9%) participants reported previous concussion education, with 179 (64.9%) being exposed to multiple sources. Student-athletes who participated in a contact sport (adjusted PR = 1.24; 95% CI = 1.06, 1.44) and those who had a concussion history (adjusted PR = 1.19; 95% CI = 1.09, 1.31) had higher prevalences of concussion-education exposure. Females had a lower prevalence of reporting multiple sources (adjusted PR = 0.82; 95% CI = 0.68, 0.99). Overall concussion-education exposure was significantly associated with more favorable perceived social norms surrounding concussion care seeking (adjusted MD = 1.37; 95% CI = 0.13, 2.61). CONCLUSIONS These findings highlighted the potential differences in overall concussion-education exposure and provide clinicians with information on groups who may benefit from additional targeted education.
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Affiliation(s)
- Christine E. Callahan
- Matthew Gfeller Sport-Related Traumatic Brain Injury Research Center, Department of Exercise and Sport Science
| | - Melissa C. Kay
- School of Health Professions, University of Southern Mississippi, Hattiesburg
| | - Zachary Y. Kerr
- Matthew Gfeller Sport-Related Traumatic Brain Injury Research Center, Department of Exercise and Sport Science
| | - Madison T. Hinson
- Matthew Gfeller Sport-Related Traumatic Brain Injury Research Center, Department of Exercise and Sport Science
| | - Laura A. Linnan
- Department of Health Behavior, Gillings School of Global Public Health
| | | | - Paula Gildner
- Injury Prevention Research Center, The University of North Carolina at Chapel Hill
| | - Stephen W. Marshall
- Injury Prevention Research Center, The University of North Carolina at Chapel Hill
| | | | | | - Johna Register-Mihalik
- Matthew Gfeller Sport-Related Traumatic Brain Injury Research Center, Department of Exercise and Sport Science
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Walton SR, Kerr ZY, Brett BL, Chandran A, DeFreese JD, Smith-Ryan AE, Stoner L, Echemendia RJ, McCrea M, Meehan Iii WP, Guskiewicz KM. Health-promoting behaviours and concussion history are associated with cognitive function, mood-related symptoms and emotional-behavioural dyscontrol in former NFL players: an NFL-LONG Study. Br J Sports Med 2021; 55:683-690. [PMID: 33397673 DOI: 10.1136/bjsports-2020-103400] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/16/2020] [Indexed: 11/03/2022]
Abstract
OBJECTIVES To examine the relationships among self-reported sport-related concussion (SRC) history and current health-promoting behaviours (exercise frequency, diet quality and sleep duration) with self-reported measures of brain health (cognitive function, symptoms of depression and anxiety and emotional-behavioural dyscontrol) in former NFL players. METHODS In this cross-sectional study, a questionnaire was sent to former NFL players. Respondents reported SRC history (categorical: 0; 1-2; 3-5; 6-9; 10+ concussions), number of moderate-to-vigorous aerobic and resistance exercise sessions per week, diet quality (Rapid Eating Assessment for Participants-Shortened) and average nightly sleep duration. Outcomes were Patient-Reported Outcomes Measurement Information System Cognitive Function, Depression, and Anxiety, and Neuro-QoL Emotional-Behavioral Dyscontrol domain T-scores. Multivariable linear regression models were fit for each outcome with SRC history, exercise frequency, diet quality and sleep duration as explanatory variables alongside select covariates. RESULTS Multivariable regression models (n=1784) explained approximately 33%-38% of the variance in each outcome. For all outcomes, SRC history (0.144≤|β|≤0.217) was associated with poorer functioning, while exercise frequency (0.064≤|β|≤0.088) and diet quality (0.057≤|β|≤0.086) were associated with better functioning. Sleeping under 6 hours per night (0.061≤|β|≤0.093) was associated with worse depressive symptoms, anxiety and emotional-behavioural dyscontrol. CONCLUSION Several variables appear to be associated with mood and perceived cognitive function in former NFL players. SRC history is non-modifiable in former athletes; however, the effects of increasing postplaying career exercise frequency, making dietary improvements, and obtaining adequate sleep represent important potential opportunities for preventative and therapeutic interventions.
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Affiliation(s)
- Samuel R Walton
- Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Zachary Y Kerr
- Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Benjamin L Brett
- Neurosurgery/Neurology, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Avinash Chandran
- Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
- NCAA Injury Surveillance Program, Datalys Center for Sports Injury Research and Prevention, Indianapolis, Indiana, USA
| | - J D DeFreese
- Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Abbie E Smith-Ryan
- Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Lee Stoner
- Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Ruben J Echemendia
- Psychology, University of Missouri Kansas City, Kansas City, Missouri, USA
- Neuropsychology, University Orthopedics Center Concussion Clinic, State College, PA, USA
| | - Michael McCrea
- Neurosurgery/Neurology, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - William P Meehan Iii
- Sports Medicine, Boston Children's Hospital, Boston, Massachusetts, USA
- Division of Emergency Medicine, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Kevin M Guskiewicz
- Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
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Abstract
OBJECTIVE This study examined the epidemiology of concussions in high school boys' ice hockey during the 2008/09 to 2016/17 school years. DESIGN Prospective cohort study. Athletic trainers from an average 33 high schools annually reported boys' ice hockey concussion and athlete-exposure (AE) data for the High School Reporting Information Online system. SETTING Convenience sample of high school boys' ice hockey programs during the 2008/09 to 2016/17 school years. PATIENTS OR OTHER PARTICIPANTS High school boys' ice hockey players (aged ∼14-18 years). INDEPENDENT VARIABLES Concussion data on event type, injury mechanism, symptom resolution time, and time loss were obtained. MAIN OUTCOME MEASURES Concussion rates with 95% confidence intervals (CIs) and distributions were calculated. RESULTS Overall, 348 concussions were reported in boys' ice hockey during the 2008/09 to 2016/17 academic years, leading to a concussion rate of 0.68/1000 AEs (95% CI, 0.61-0.75). Most occurred in competitions (85.6%), particularly after the first period (72.1% of all competition concussions). Among practice concussions, most occurred after the first hour of practice (60.0%). Most concussions were due to player contact (47.7%) and boards/glass contact (31.9%). Although 69.0% of concussed athletes had symptoms resolve in less than 7 days, only 14.1% returned to activity within a week. CONCLUSIONS Most concussions occurred within the second and third periods. Preventive strategies that counter an increased risk of concussion due to a greater intensity of gameplay coupled with increased fatigue may be warranted. Moreover, athletes may further benefit from prevention efforts that focus on anticipating impacts during gameplay.
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Affiliation(s)
- Zachary Y Kerr
- Department of Exercise and Sport Science, University of North Carolina, Chapel Hill, North Carolina
| | - Lauren A Pierpoint
- Department of Epidemiology, Colorado School of Public Health, University of Colorado Anschutz, Aurora, Colorado; and
| | - John M Rosene
- Department of Exercise and Sport Performance, University of New England, Biddeford, Maine
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Yeargin SW, Dickinson JJ, Emerson DM, Koller J, Torres-McGehee TM, Kerr ZY. Exertional heat illness risk factors and physiological responses of youth football players. J Sport Health Sci 2021; 10:91-98. [PMID: 33518018 PMCID: PMC7856561 DOI: 10.1016/j.jshs.2019.03.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/08/2018] [Revised: 09/07/2018] [Accepted: 10/09/2018] [Indexed: 06/12/2023]
Abstract
OBJECTIVE To determine which intrinsic and extrinsic exertional heat illness (EHI) risk factors exist in youth American football players and observe perceptual and physiological responses of players during events (games and practices). METHODS Cross-sectional cohort study observing 63 youth football players, varying in position. Independent variables were league (weight-restricted (WR, n = 27) and age-restricted (AR, n = 36)) and event type. Dependent variables were anthropometrics, work-to-rest ratio, and wet bulb globe temperature. Descriptive variables included preparticipation examination and uniform configuration. A subset of 16 players participated in physiological variables (heart rate and gastrointestinal temperature). Data collection occurred on 7 AR and 8 WR nonconsecutive practices and the first 3 games of the season. RESULTS Mean values for anthropometric variables were higher (p < 0.05) in the AR league than the WR league. Work time (χ2 (1,111) = 4.232; p = 0.039) and rest time (χ2 (1,111) = 43.41; p < 0.001) were significantly greater for games, but ratios were significantly higher for practices (χ2 (1,111) = 40.62; p < 0.001). The majority of events (77%) observed were in black and red flag wet bulb globe temperature risk categories. A total of 57% of the players had a preparticipation examination, and up to 82% of events observed were in full uniforms. Individual gastrointestinal temperature and heart rate responses ranged widely and no players reached critical thresholds. CONCLUSION Extrinsic (disproportionate work ratios, environmental conditions) and intrinsic (higher body mass index) EHI risk factors exist in youth football. Certain risk factors may be influenced by event and league type. National youth football organizations need to create thorough guidelines that address EHI risk factors for local leagues to adopt.
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Affiliation(s)
- Susan W Yeargin
- Department of Exercise Science, University of South Carolina, Columbia, SC 29208, USA.
| | - John J Dickinson
- Department of Exercise Science, University of South Carolina, Columbia, SC 29208, USA; Palmetto Health/USC Orthopedic Center, Keenan High School, Columbia, SC 29203, USA
| | - Dawn M Emerson
- Department of Exercise Science, University of South Carolina, Columbia, SC 29208, USA; Department of Health, Sport, and Exercise Sciences, University of Kansas, Lawrence, KS 66045, USA
| | - Jessica Koller
- Department of Exercise Science, University of South Carolina, Columbia, SC 29208, USA; Surgi-Care Inc., Boston, MA 02115, USA
| | - Toni M Torres-McGehee
- Department of Exercise Science, University of South Carolina, Columbia, SC 29208, USA
| | - Zachary Y Kerr
- Department of Exercise and Sport Science, University of North Carolina, Chapel Hill, NC 27599-8700, USA
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50
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Roby PR, Duquette P, Kerr ZY, Register-Mihalik J, Stoner L, Mihalik JP. Repetitive Head Impact Exposure and Cerebrovascular Function in Adolescent Athletes. J Neurotrauma 2020; 38:837-847. [PMID: 33081565 DOI: 10.1089/neu.2020.7350] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
The purpose of this study was to determine how subconcussive head impact exposure in high school collision sport student-athletes influenced cerebrovascular function. Transcranial Doppler was used to assess pre- to post-season changes in: (1) resting middle (MCA) and posterior cerebral arteries (PCA), (2) cerebrovascular reactivity (CVR) via breath-holding index (BHI), vasomotor reactivity response (VMRr) and overall MCA response curve, and (3) neurovascular coupling (NVC) via NVC response magnitude and overall PCA response curve. Fifty-three high school-aged athletes (age = 15.8 ± 1.2years, height = 175.8 ± 8.1cm, mass = 69.4 ± 13.5kg) were recruited into two groups (collision vs. non-collision sport). All participants completed a pre-season cerebrovascular function assessment. Following a 4- to 5-month window (118.6 ± 12.2 days), 48 athletes from the original sample (age = 16.0 ± 1.2 years, height = 175.5 ± 8.1 cm, mass = 68.6 ± 4.0 kg) repeated the cerebrovascular assessment. There were no group differences in any cerebrovascular measures at pre-season testing (p > 0.05). At post-season testing, collision sport athletes demonstrated greater positive change in BHI (t44 = -2.21, p = 0.03) while non-collision sport athletes demonstrated greater negative change in the NVC response magnitude to the reading task (t44 = 1.98, p = 0.048), and lower overall PCA response curve to the reading task (F1,2710 = 101.54, p < 0.001). All other pre- to post-season change values were non-significant (p > 0.05). Our data indicate that single-season changes in cerebrovascular outcomes may differ between collision and non-collision sport athletes. Although the clinical interpretation is still unclear, our study demonstrates that CVR and NVC assessments may be sensitive to the dynamic cerebrovascular changes occurring in adolescent athletes. Future research should continue to assess these outcomes following both subconcussive head impact exposure and throughout the recovery trajectory following concussion.
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Affiliation(s)
- Patricia R Roby
- Matthew Gfeller Sport-Related Traumatic Brain Injury Research Center, School of Medicine, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.,Curriculum in Human Movement Science, Department of Allied Health Sciences, School of Medicine, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Peter Duquette
- Matthew Gfeller Sport-Related Traumatic Brain Injury Research Center, School of Medicine, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.,Department of Physical Medicine and Rehabilitation, School of Medicine, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Zachary Y Kerr
- Matthew Gfeller Sport-Related Traumatic Brain Injury Research Center, School of Medicine, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.,Curriculum in Human Movement Science, Department of Allied Health Sciences, School of Medicine, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Johna Register-Mihalik
- Matthew Gfeller Sport-Related Traumatic Brain Injury Research Center, School of Medicine, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.,Curriculum in Human Movement Science, Department of Allied Health Sciences, School of Medicine, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Lee Stoner
- UNC Cardiometabolic Laboratory, Department of Exercise and Sport Science, School of Medicine, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.,Curriculum in Human Movement Science, Department of Allied Health Sciences, School of Medicine, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Jason P Mihalik
- Matthew Gfeller Sport-Related Traumatic Brain Injury Research Center, School of Medicine, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.,Curriculum in Human Movement Science, Department of Allied Health Sciences, School of Medicine, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
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