scholarly journals Concussion related deficits in the general population predict impairments in varsity footballers

2019 ◽  
Author(s):  
Clara Alexandra Stafford ◽  
Bobby Stojanoski ◽  
Conor Wild ◽  
Danielle Brewer-Deluce ◽  
Timothy D. Wilson ◽  
...  
Keyword(s):  
General Population ◽  
Inhibitory Control ◽  
Population Level ◽  
American Football ◽  
Cognitive Tasks ◽  
Football Players ◽  
Head Impacts ◽  
Demographic Questionnaire ◽  
History Of

ObjectiveWe investigated the long-term cognitive effects of concussion in 19,261 members of the general population and a cohort of varsity American football players with a history of frequent head impacts, using tests that are known to be sensitive to small changes in performance. MethodsWe asked 19,261 participants to complete a demographic questionnaire and 12 cognitive tests measuring aspects of executive function, including inhibitory control. We compared the performance of those reporting a history of concussion (post-concussion) to those reporting no history of concussion (non-concussed) on the cognitive battery and four non-cognitive variables. We used the results of this population-level study to predict the profile of cognitive performance in varsity American football players, who completed the same cognitive tasks. ResultsPost-concussion and non-concussed participants did not differ on 11 of the 12 cognitive tasks employed. However, on a test of inhibitory control based on the classic Stroop paradigm, post-concussion participants showed accuracy-related impairments specific to the incongruent conditions of the task. Post-concussion participants reported higher levels of anxiety, depression, and trouble concentrating. An entirely independent sample of 74 varsity American football players demonstrated the same pattern of impairment: compared to healthy controls, they scored significantly lower on the test of inhibitory control but were indistinguishable from controls on the 11 other tasks.InterpretationSelf-reported concussion is not associated with long-term general effects on cognitive function. Nevertheless, those who report at least one concussion and those who expose themselves to long-term frequent sport-related head impacts, do have a modest, but statistically robust, deficit of inhibitory control.

scholarly journals Defining Exposures in Professional Football: Professional American-Style Football Players as an Occupational Cohort

2019 ◽  
Vol 7 (2) ◽  
pp. 232596711982921 ◽  
Author(s):  
Rachel G. Grashow ◽  
Andrea L. Roberts ◽  
Ross Zafonte ◽  
Alvaro Pascual-Leone ◽  
Herman Taylor ◽  
...  
Keyword(s):  
American Football ◽  
Epidemiological Methods ◽  
Football Players ◽  
Professional Football ◽  
Head Impacts ◽  
Adverse Health Outcomes ◽  
Acute Injuries ◽  
Full Complement ◽  
Occupational Cohort

Studies of professional American football players have shown that football-related activities lead to acute injuries and may have long-term adverse health outcomes including osteoarthritis, neurocognitive impairment, and cardiovascular disease. However, the full complement of what constitutes professional football exposure has yet to be effectively articulated. Most likely, professional football exposure encompasses a multifaceted array of experiences including head impacts and joint stresses, long-term pain medication use, dietary restrictions, and strenuous training regimens. To study the health of professional American football players, characterizing the group as an occupational cohort and taking advantage of methods established within the discipline of occupational epidemiology may be beneficial. We conducted a narrative review of existing football research, occupational epidemiological methods papers, and occupational medicine studies. Here we describe the traditional occupational epidemiological approach to assessing exposure in a novel cohort and show how this framework could be implemented in studies of professional football players. In addition, we identify the specific challenges associated with studying an elite athletic occupational group, including the healthy worker effect and other types of selection and information biases, and explore these in the context of existing studies of football-related health. The application of well-established occupational epidemiological methods to professional football players may yield new insights into the effects of playing exposure and may provide opportunities for interventions to reduce harm.

History of Chronic Traumatic Encephalopathy

2020 ◽  
Vol 40 (04) ◽  
pp. 353-358
Author(s):  
Robert C. Cantu ◽  
Charles Bernick
Keyword(s):  
Chronic Traumatic Encephalopathy ◽  
Neurological Impairment ◽  
American Football ◽  
Football Players ◽  
Long Term Effects ◽  
Public Attention ◽  
Head Impacts ◽  
Repetitive Head Impacts ◽  
History Of ◽  
Initial Description

AbstractThe long-term effects of repetitive head impacts have been recognized for close to a century. What is now referred to as chronic traumatic encephalopathy (CTE) was first described by Martland in 1928 in a series of boxers. Over the years, several important articles were published, including Critchley's 1957 report where he introduced the term “chronic traumatic encephalopathy,” Robert's study in 1969 which provided evidence of the prevalence of neurological impairment in retired fighters, and Corsellis' initial description of the pathology of CTE. However, what brought public attention to the issue of CTE in sports were the postmortem findings of CTE pathology in professional American football players, initially reported by Omalu and subsequently in a large series by McKee. There is now standardization of pathological criteria for CTE and recognition that it can be seen across all activities that involve repetitive head impacts.

Effect of Turf Toe on Foot Contact Pressures in Professional American Football Players

2009 ◽  
Vol 30 (5) ◽  
pp. 405-409 ◽  
Author(s):  
Robert H. Brophy ◽  
Seth C. Gamradt ◽  
Scott J. Ellis ◽  
Ronnie P. Barnes ◽  
Scott A. Rodeo ◽  
...  
Keyword(s):  
Body Mass Index ◽  
National Football League ◽  
Peak Pressure ◽  
American Football ◽  
Football Players ◽  
Plantar Pressures ◽  
History Of ◽  
Turf Toe ◽  
The Relationship ◽  
Contact Pressures

Background: The relationship between turf toe and plantar foot pressures has not been extensively studied. Two hypotheses were tested in a cohort of professional American football players: first, that a history of turf toe is associated with increased peak hallucal and first metatarsophalangeal (MTP) plantar pressures; second, that decreased range of motion (ROM) of the first MTP correlates with increased peak hallucal and first MTP plantar pressures. Materials and Methods: Forty-four athletes from one National Football League (NFL) team were screened for a history of turf toe during preseason training. Dorsal passive MTP ROM and dynamic plantar pressures were measured in both feet of each player. Anatomical masking was used to assess peak pressure at the first MTP and hallux. Results: First MTP dorsiflexion was significantly lower in halluces with a history of turf toe (40.6 ± 15.1 degrees versus 48.4 ± 12.8 degrees, p = 0.04). Peak hallucal pressures were higher in athletes with turf toe (535 ± 288 kPa versus 414 ± 202 kPa, p = 0.05) even after normalizing for athlete body mass index ( p = 0.0003). Peak MTP pressure was not significantly different between the two groups tested. First MTP dorsiflexion did not correlate with peak hallucal or first MTP pressures. Conclusion: This study showed that turf toe is associated with decreased MTP motion. In addition, increased peak hallucal pressures were found. Further study is warranted to determine whether these pressures correlate with the severity of symptoms or progression of turf toe to first MTP arthritis.

Association Between Antemortem FLAIR White Matter Hyperintensities and Neuropathology in Brain Donors Exposed to Repetitive Head Impacts

Neurology ◽  
2021 ◽  
pp. 10.1212/WNL.0000000000013012
Author(s):  
Madeline Uretsky ◽  
Sylvain Bouix ◽  
Ronald J. Killiany ◽  
Yorghos Tripodis ◽  
Brett Martin ◽  
...  
Keyword(s):  
White Matter ◽  
White Matter Hyperintensities ◽  
Microvascular Disease ◽  
Head Impact ◽  
American Football ◽  
Football Players ◽  
Head Impacts ◽  
Repetitive Head Impacts ◽  
Pathological Correlation ◽  
Daily Function

Background and Objectives:Late neuropathologies of repetitive head impacts from contact sports can include chronic traumatic encephalopathy (CTE) and white matter degeneration. White matter hyperintensities (WMH) on fluid attenuated inversion recovery (FLAIR) MRI scans are often viewed as microvascular disease from vascular risk, but might have unique underlying pathologies and risk factors in the setting of repetitive head impacts. We investigated the neuropathological correlates of antemortem WMH in brain donors exposed to repetitive head impacts. The association between WMH, and repetitive head impact exposure and informant-reported cognitive and daily function were tested.Methods:This imaging-pathological correlation study included symptomatic deceased men exposed to repetitive head impacts. Donors had antemortem FLAIR scans from medical records and were without evidence of CNS neoplasm, large vessel infarcts, hemorrhage, and/or encephalomalacia. WMH were quantified using log-transformed values for total lesion volume (TLV), calculated using the lesion prediction algorithm from the Lesion Segmentation Toolbox. Neuropathological assessments included semi-quantitative ratings of white matter rarefaction, cerebrovascular disease, p-tau severity (CTE stage, dorsolateral frontal cortex), and Aβ. Among football players, years of play was a proxy for repetitive head impact exposure. Retrospective informant-reported cognitive and daily function were assessed using the Cognitive Difficulties Scale (CDS) and Functional Activities Questionnaire (FAQ). Regression models controlled for demographics, diabetes, hypertension, and MRI resolution. Statistical significance was defined as p<0.05.Results:The sample included 75 donors: 67 football players and 8 non-football contact sport athletes and/or military veterans. Dementia was the most common MRI indication (64%). Fifty-three (70.7%) had CTE at autopsy. Log-TLV was associated with white matter rarefaction (OR=2.32, 95% CI=1.03,5.24, p=0.04), arteriolosclerosis (OR=2.38, 95% CI=1.02,5.52, p=0.04), CTE stage (OR=2.58, 95% CI=1.17,5.71, p=0.02), and dorsolateral frontal p-tau severity (OR=3.03, 95% CI=1.32,6.97, p=0.01). There was no association with Aβ. More years of football play was associated with log-TLV (b=0.04, 95% CI=0.01,0.06, p=0.01). Greater log-TLV correlated with higher FAQ (unstandardized beta=4.94, 95% CI=0.42,8.57, p=0.03) and CDS scores (unstandardized beta=15.35, 95% CI=-0.27,30.97, p=0.05).Discussion:WMH might capture long-term white matter pathologies from repetitive head impacts, including those from white matter rarefaction and p-tau, in addition to microvascular disease. Prospective imaging-pathological correlation studies are needed.Classification of Evidence:This study provides Class IV evidence of associations between FLAIR white matter hyperintensities, and neuropathological changes (white matter rarefaction, arteriolosclerosis, p-tau accumulation), years of American football play, and reported cognitive symptoms in symptomatic brain donors exposed to repetitive head impacts.

scholarly journals Similar head impact acceleration measured using instrumented ear patches in a junior rugby union team during matches in comparison with other sports

2016 ◽  
Vol 18 (1) ◽  
pp. 65-72 ◽  
Author(s):  
Doug A. King ◽  
Patria A. Hume ◽  
Conor Gissane ◽  
Trevor N. Clark
Keyword(s):  
Injury Risk ◽  
Linear Acceleration ◽  
Rugby Union ◽  
Head Impact ◽  
American Football ◽  
Football Players ◽  
Head Impacts ◽  
Impact Acceleration ◽  
The Impact ◽  
Rugby Players

OBJECTIVE Direct impact with the head and the inertial loading of the head have been postulated as major mechanisms of head-related injuries, such as concussion. METHODS This descriptive observational study was conducted to quantify the head impact acceleration characteristics in under-9-year-old junior rugby union players in New Zealand. The impact magnitude, frequency, and location were collected with a wireless head impact sensor that was worn by 14 junior rugby players who participated in 4 matches. RESULTS A total of 721 impacts > 10g were recorded. The median (interquartile range [IQR]) number of impacts per player was 46 (IQR 37–58), resulting in 10 (IQR 4–18) impacts to the head per player per match. The median impact magnitudes recorded were 15g (IQR 12g–21g) for linear acceleration and 2296 rad/sec2 (IQR 1352–4152 rad/sec2) for rotational acceleration. CONCLUSIONS There were 121 impacts (16.8%) above the rotational injury risk limit and 1 (0.1%) impact above the linear injury risk limit. The acceleration magnitude and number of head impacts in junior rugby union players were higher than those previously reported in similar age-group sports participants. The median linear acceleration for the under-9-year-old rugby players were similar to 7- to 8-year-old American football players, but lower than 9- to 12-year-old youth American football players. The median rotational accelerations measured were higher than the median and 95th percentiles in youth, high school, and collegiate American football players.

scholarly journals Feasibility of evaluation of the natural history of kidney disease in the general population using electronic healthcare records

2020 ◽  
Author(s):  
Faye Cleary ◽  
David Prieto-Merino ◽  
Sally Hull ◽  
Ben Caplin ◽  
Dorothea Nitsch
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
General Population ◽  
Natural History ◽  
Sufficient Information ◽  
Long Term Changes ◽  
History Of ◽  
Method Of Evaluation ◽  
Changes Over Time

Abstract Background Knowledge about the nature of long-term changes in kidney function in the general population is sparse. We aim to identify whether primary care electronic healthcare records capture sufficient information to study the natural history of kidney disease. Methods The National Chronic Kidney Disease Audit database covers ∼14% of the population of England and Wales. Availability of repeat serum creatinine tests was evaluated by risk factors for chronic kidney disease (CKD) and individual changes over time in estimated glomerular filtration rate (eGFR) were estimated using linear regression. Sensitivity of estimation to method of evaluation of eGFR compared laboratory-reported eGFR and recalculated eGFR (using laboratory-reported creatinine), to uncover any impact of historical creatinine calibration issues on slope estimation. Results Twenty-five per cent of all adults, 92% of diabetics and 96% of those with confirmed CKD had at least three creatinine tests, spanning a median of 5.7 years, 6.2 years and 6.1 years, respectively. Median changes in laboratory-reported eGFR (mL/min/1.73 m2/year) were −1.32 (CKD) and −0.60 (diabetes). Median changes in recalculated eGFR were −0.98 (CKD) and −0.11 (diabetes), underestimating decline. Magnitude of underestimation (and between-patient variation in magnitude) decreased with deteriorating eGFR. For CKD Stages 3, 4 and 5 (at latest eGFR), median slopes were −1.27, −2.49 and -3.87 for laboratory-reported eGFR and −0.89, −2.26 and −3.75 for recalculated eGFR. Conclusions Evaluation of long-term changes in renal function will be possible in those at greatest risk if methods are identified to overcome creatinine calibration problems. Bias will be reduced by focussing on patients with confirmed CKD.

scholarly journals Surveillance of COVID-19 in the General Population Using an Online Questionnaire: Report From 18,161 Respondents in China

10.2196/18576 ◽  
2020 ◽  
Vol 6 (2) ◽  
pp. e18576 ◽  
Author(s):  
Hongxing Luo ◽  
Yongchan Lie ◽  
Frits W Prinzen
Keyword(s):  
Risk Factors ◽  
General Population ◽  
Potential Risk ◽  
Online Survey ◽  
Population Level ◽  
Online Questionnaire ◽  
Wuhan City ◽  
Level Information ◽  
Potential Risk Factors ◽  
History Of

Background The recent outbreak of the coronavirus disease (COVID-19) has become an international pandemic. So far, little is known about the role of an internet approach in COVID-19 participatory surveillance. Objective The aim of this study is to investigate whether an online survey can provide population-level information for observing prevalence trends during the early phase of an outbreak and identifying potential risk factors of COVID-19 infection. Methods A 10-item online questionnaire was developed according to medical guidelines and relevant publications. It was distributed between January 24 and February 17, 2020. The characteristics of respondents and temporal changes of various questionnaire-derived indicators were analyzed. Results A total of 18,161 questionnaires were returned, including 6.45% (n=1171) from Wuhan City. Geographical distributions of the respondents were consistent with the population per province (R2=0.61, P<.001). History of contact significantly decreased with time, both outside Wuhan City (R2=0.35, P=.002) and outside Hubei Province (R2=0.42, P<.001). The percentage of respondents reporting a fever peaked around February 8 (R2=0.57, P<.001) and increased with a history of contact in the areas outside Wuhan City (risk ratio 1.31, 95% CI 1.13-1.52, P<.001). Male sex, advanced age, and lung diseases were associated with a higher risk of fever in the general population with a history of contact. Conclusions This study shows the usefulness of an online questionnaire for the surveillance of outbreaks like COVID-19 by providing information about trends of the disease and aiding the identification of potential risk factors.

scholarly journals How to lift a model for individual behaviour to the population level?

2010 ◽  
Vol 365 (1557) ◽  
pp. 3523-3530 ◽  
Author(s):  
O. Diekmann ◽  
J. A. J. Metz
Keyword(s):  
Environmental Variables ◽  
Mathematical Theory ◽  
Birth Rate ◽  
Population Level ◽  
Dynamic Energy Budget ◽  
Mathematical Exploration ◽  
History Of ◽  
State Changes ◽  
Numerical Bifurcation

The quick answer to the title question is: by bookkeeping; introduce as p(opulation)-state a measure telling how the individuals are distributed over their common i(ndividual)-state space, and track how the various i-processes change this measure. Unfortunately, this answer leads to a mathematical theory that is technically complicated as well as immature. Alternatively, one may describe a population in terms of the history of the population birth rate together with the history of any environmental variables affecting i-state changes, reproduction and survival. Thus, a population model leads to delay equations. This delay formulation corresponds to a restriction of the p-dynamics to a forward invariant attracting set, so that no information is lost that is relevant for long-term dynamics. For such equations there exists a well-developed theory. In particular, numerical bifurcation tools work essentially the same as for ordinary differential equations. However, the available tools still need considerable adaptation before they can be practically applied to the dynamic energy budget (DEB) model. For the time being we recommend simplifying the i-dynamics before embarking on a systematic mathematical exploration of the associated p-behaviour. The long-term aim is to extend the tools, with the DEB model as a relevant goal post.

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