Subjective and Performance-Based Cognition and Their Associations with Head Injury History in Older Former National Football League Players

PURPOSE

Investigate the association between self-reported subjective and performance-based cognition among older (50-70 years) former professional American football players, as well as the relationship of cognitive measures with concussion history and years of football participation, as a proxy for repetitive head impact exposure.

METHODS

Among older former National Football League (NFL) players ( N = 172; mean age = 60.69 ± 5.64), associations of subjective (Patient Reported Outcome Measurement Information System Cognitive Function-Short Form) and performance-based cognitive measures (Brief Test of Adult Cognition by Telephone [BTACT] Executive Function and Episodic Memory indices) were assessed via univariable and multivariable regression models, with a priori covariates of depression and race. A similar univariate and multivariable regression approach assessed associations between concussion history and years of football participation with subjective and performance-based cognitive measures. In a sample subset ( n = 114), stability of subjective cognitive rating was assessed via partial correlation.

RESULTS

Subjective ratings of cognition were significantly associated with performance-based assessment, with moderate effect sizes (episodic memory ηp2 = 0.12; executive function ηp2 = 0.178). These associations were weakened, but remained significant ( P s < 0.05), with the inclusion of covariates. Greater concussion history was associated with lower subjective cognitive function ( ηp2 = 0.114, P < 0.001), but not performance-based cognition. The strength of association between concussion history and subjective cognition was substantially weakened with inclusion of covariates ( ηp2 = 0.057). Years of participation were not associated with measures of subjective or objective cognition ( P s > 0.05).

CONCLUSIONS

These findings reinforce the importance of comprehensive evaluation reflecting both subjective and objective measures of cognition, as well as the consideration of patient-specific factors, as part of a comprehensive neurobehavioral and health assessment of older former contact sport athletes.

Screen-Time Policies and Practices in Early Care and Education Centers in Relationship to Child Physical Activity

BACKGROUND

Few preschool children meet physical activity recommendations, whereas the majority exceeds screen-time recommendations. The purpose of this study was to examine the relationship of screen-time policies and practices with children's physical activity and sedentary time in early care and education (ECE) centers.

METHODS

We conducted a cross-sectional study of 104 children (3.3 ± 0.5 years; 50% girls) attending 10 ECE centers in the United States. Physical activity was measured by accelerometry. Screen-time practices were measured by classroom observation and director report. Mixed linear models were used to examine the relationship of screen-time practices with children's total physical activity (TPA) and moderate-to-vigorous physical activity (MVPA) and sedentary time, adjusting for child's age, sex, and BMI z-score and taking into account the clustering of children within each center. Models were repeated to include director-reported active play time as a covariate.

RESULTS

More limited/supervised screen-time (by observation) was related to higher TPA (p = 0.0003) and lower sedentary time (p = 0.0003). More limited/supervised screen-time (by director report) was related to higher TPA (p < 0.0001) and MVPA (p = 0.021) and lower sedentary time (p < 0.0001). Associations remained significant when active play time was included as a covariate. TPA was inversely related to computer access (p = 0.0015) and positively related to the use of educational screen-time compared with noneducational screen-time (p = 0.04).

CONCLUSIONS

Limiting computer usage and ensuring screen-time is educational, and integrated within the curriculum may benefit children's physical activity levels and reduce time spent sedentary.

Young Children's Screen Time and Physical Activity: Perspectives of Parents and Early Care and Education Center Providers

Early care and education (ECE) providers and parents can facilitate physical activity (PA) and reduce screen time in preschoolers. Input from caregivers on barriers and facilitators of PA and screen time is needed to comprehensively address these behaviors and promote children’s health. Four focus groups (3 parent and 1 ECE provider) were conducted. Thematic analysis was performed to identify themes and subthemes. Twenty-eight caregivers (21 parents and 7 ECE providers) participated. Caregivers reported responsibility for modeling and shaping children’s PA and screen time. Parents felt that a busy lifestyle was a PA barrier and encouraged screen time. ECE providers were concerned about certain environmental influences on PA. The groups differed in their view of screen time as either entertainment (parents) or educational (providers). Both types of caregivers were unaware of PA or screen time guidelines. Investigation into opportunities to utilize screen time to serve priorities of both caregivers and promote child PA are needed.

State Licensing Regulations on Screen Time in Childcare Centers: An Impetus for Participatory Action Research

BACKGROUND

New licensing regulations require Louisiana early care and education centers (ECEs) to limit children's screen time and increase physical activity. A community- academic partnership involving academic, community, government, and ECE stakeholders launched two initiatives: (1) an evaluation of the implementation of licensing regulations at the local level and (2) a statewide effort to develop technical assistance for ECE directors.

OBJECTIVES

To describe the methods and lessons learned and to establish recommendations based on this ongoing participatory action research.

METHODS

A case study approach was used to identify the lessons learned and recommendations thus far, based on partners' perspectives and ECE directors' participation.

LESSONS LEARNED

Recommendations include to share power and funding among stakeholders, to engage directors as partners to overcome recruitment challenges, and to start with the end in mind to ensure meaningful community engagement.

CONCLUSIONS

This participatory action approach is leading to innovative, feasible strategies to increase children's physical activity.

Clinical Herpes Zoster in Antarctica as a Model for Spaceflight

INTRODUCTION

Antarctica is a useful analog for spaceflight, as both environments are remote, isolated, and with limited resources. While previous studies have demonstrated increased asymptomatic viral shedding in both the Antarctic and spaceflight environments, clinical manifestations of reactivated viral disease have been less frequently identified. We sought to identify the incidence of clinical herpes zoster from viral reactivation in the Antarctic winter-over population.

METHODS

Medical records from the 2014 winter season were reviewed for the incidence of zoster in U.S. Antarctic personnel and then compared to the age-matched U.S.

POPULATION

RESULTS

Five cases of clinical herpes zoster occurred in the Antarctic Station population of 204 persons, for an incidence of 33.3 per 1000 person-years vs. 3.2 per 1000 person-years in the general population. Four cases were in persons under age 40, yielding an incidence of 106.7 per 1000 person-years in persons ages 30-39 compared to an incidence of 2.0 per 1000 person-years in the same U.S. age group.

DISCUSSION

Immune suppression due to the stressful Antarctic environment may have contributed to the increased incidence of herpes zoster in U.S. Antarctic personnel during the winter of 2014. Working and living in isolated, confined, and extreme environments can cause immune suppression, reactivating latent viruses and increasing viral shedding and symptomatic disease. Such changes have been observed in other austere environments, including spaceflight, suggesting that clinical manifestations of viral reactivation may be seen in future spaceflight.Reyes DP, Brinley AA, Blue RS, Gruschkus SK, Allen AT, Parazynski SE. Clinical herpes zoster in Antarctica as a model for spaceflight. Aerosp Med Hum Perform. 2017; 88(8):784-788.

Mirror Syndrome Resulting From Metastatic Congenital Neuroblastoma

Neuroblastoma is a tumor of the sympathetic ganglia and adrenal medulla that rarely metastasizes to the placenta. A 21-year-old gravida 3, para 1 at 28 weeks' gestation had an incidental finding of a 3.8-cm fetal renal mass on prenatal ultrasound. Within 1 week, the fetus developed hydrops and was delivered for nonreassuring fetal assessment. The mother developed mirror syndrome as manifested by hypertension, oliguria, and edema. The hydropic infant developed pulmonary hypertension, sepsis, and renal failure. On day of life 4, life support was discontinued. Pathological examination of the placenta revealed disseminated small round blue cells consistent with neuroblastoma. Metastasis of congenital neuroblastoma to the placenta is exceedingly rare, and cases discovered prenatally have resulted in significant maternal morbidity and 100% neonatal mortality.

The 81st Medical Group Obstetrics and Gynecology Flight's Role during Hurricane Katrina

BACKGROUND

The Obstetrics and Gynecology (OB/GYN) flight at Keesler Medical Center sheltered 36 pregnant women and their families during Hurricane Katrina to ensure that appropriate medical care would be available. Ironically, the hospital's emergency generators were destroyed during the 30-foot storm surge, while one woman with a previous cesarean section went into active labor. She ultimately underwent a cesarean delivery using battery-operated flashlights for illumination. After the storm, the damage to the hospital was so extensive as to require aeromedical evacuation of the pregnant patients and their families. In addition, two OB/GYN physicians transferred to a nearby shelter on base and provided general medical care to its occupants.

CONCLUSION

OB/GYN physicians in the military play a vital role in the care of victims of natural disasters. In addition to pregnancy-related issues, OB/GYN physicians can be expected to provide primary and emergency care to victims under austere conditions.

Safety of neck rotation for ear surgery in children with Down syndrome

OBJECTIVE

Seek information about spinal cord safety for children with Down syndrome positioned for ear surgery.

STUDY DESIGN

Prospective consecutive patients, each serving as his or her own control.

METHODS

Somatosensory evoked potentials were recorded from 17 children who were undergoing elective otolaryngological surgery. None of the patients had neurological symptoms or physical examination findings suggesting cervical spinal cord embarrassment. Specifically, muscle tone was normal or mildly reduced globally, consistent with Down syndrome, and deep tendon reflexes were normal and not appreciably different in the upper and lower extremities. On plain lateral radiographs obtained in the neutral, flexed, and extended positions, the patients' cervical spines were normal.

RESULTS

When the anesthetized children had their necks placed in either right or left 60 degrees rotation, no significant change in somatosensory latency or amplitude was found. With more than 99.999% certainty, neurologically intact children with Down syndrome with normal plain cervical spine radiographs were not exposed to extra risks by 60 degrees neck rotation during surgery.

CONCLUSION

Patients with Down syndrome who are neurologically intact and who have normal lateral neck radiographs do not appear at great risk with neck rotation.

Neck flexion and extension in children with Down syndrome: a somatosensory study

The cervical spine in Down syndrome patients is often lax, at least at radiographic imaging, and the risk of spinal cord embarrassment is increased. This study was performed to obtain information that would help identify patients at risk for this problem and reduce the risk of endotracheal intubation and other surgical procedures in patients with Down syndrome. Somatosensory evoked potential studies were performed in 15 consecutive children who were undergoing elective otolaryngic surgery. None had neurologic symptoms or the physical examination finding of cervical spinal cord embarrassment, and their cervical spines were considered normal by plain radiographs obtained in the neutral, flexed, and extended positions. No significant change in latency (P = .16) or amplitude (P = .19) was found when the anesthetized children had their necks placed in either full flexion or full extension. With more than 90% certainty, the authors believe that children with Down syndrome who have "normal" plain cervical spine radiographs are exposed to no extra risks from neck flexion or extension during surgery.

Healthy neighbors: exploring the health care systems of the United States and Canada

Millions of Americans are without insurance or access to health care. The health care industry, politicians, government, concerned groups, and individuals are struggling with proposals for a system that will ensure basic care for all our citizens. The Canadian system is often suggested as a model for the United States. Allen recently visited Canada and spoke with residents in Nova Scotia and Newfoundland about their health care. Kardos has done extensive research on various systems designed to provide universal access to health care. In the following article the authors offer information, make comparisons, and pose questions for readers.

Insect cardioactive peptides: regulation of hindgut activity by cardioacceleratory peptide 2 (CAP2) during wandering behaviour in Manduca sexta larvae

The functional relationship between cardioacceleratory peptide 2 (CAP2) and hindgut activity during wandering behaviour was investigated in fifth-instar larvae of the tobacco hawkmoth Manduca sexta. Inspection of the alimentary canal on the day prior to wandering showed that the gut, in preparation for metamorphosis, was voided of all contents by 18:00 h. Associated with this event, which we refer to as ‘gut emptying’, was an increase in the frequency of hindgut contractions measured in vivo. No change in heart activity was seen during this developmental period. Measurements of the amount of CAP2 in the central nervous system (CNS) of fifth-instar caterpillars revealed that CAP2 storage levels declined sharply on the day of gut emptying. The drop in CNS levels of CAP2 at gut emptying was temporally correlated with the appearance of CAP2 in the haemolymph. CAP2, when applied at physiological concentrations to an in vitro larval hindgut bioassay, caused changes in several parameters, including contraction frequency and amplitude, and basal tension. In vivo administration of CAP2 elicited hindgut responses that were qualitatively and quantitatively similar to those seen in vitro. Developmental studies on changes in CAP2 responsiveness during the last larval instar demonstrated that the hindgut is maximally sensitive to CAP2 on the day of gut emptying. Direct evidence in support of a role for CAP2 in fifth-instar larvae was provided by experiments in which the increase in gut activity in vivo seen at gut emptying was significantly reduced by injections of an anti-CAP antibody. Based on data from cobalt backfills and anti-CAP immunohistochemical staining, we propose that CAP2 exerts its effect on the larval hindgut at wandering via a local release from CAP-containing neurones in the terminal ganglion that project directly to the hindgut.

Cardiac rate and rhythm changes with atropine and methscopolamine

The effects of methscopolamine bromide (MSB) and atropine were compared in patients prior to elective surgery. After administration of the second dose of MSB (total dose 1.5 mug/kg) all patients exhibited at least 20% increase in heart rate. In contrast, three doses of atropine (total dose 5.3 mug/kg) were required for most patients to attain a 20% increase in heart rate while 2 patients did not attain this heart rate with a dose of 10.6 mug/kg of atropine. Comparison if single injections of MSB and atropine in normal subjects also demonstrated a more reliable dose-response relationship with MSB. Electrocardiographic changes recorded were typical of those reported with anticholinergic agents. Sinus and atrial arrhythmias were more common with atropine and nodal arrhythmias and conduction disturbances were more common with MSB. This study demonstrated that MSB can be reliably substituted for atropine when an anticholinergic drug is needed to increase heart rate. Since MSB has a limited ability to cross the blood-brain barrier, it may be the more desirable drug in patients in whom the central nervous system effects of atropine may be deleterious.