MEASUREMENT OF HEAD IMPACTS IN COLLEGIATE FOOTBALL PLAYERS: RELATIONSHIP BETWEEN HEAD IMPACT BIOMECHANICS AND ACUTE CLINICAL OUTCOME AFTER CONCUSSION Prevalence of neurocognitive and balance deficits in collegiate aged football players without clinically diagnosed concussion. Mild head injury in sports. Does Visual Performance Influence Head Impact Severity Among High School Football Athletes? Physiological and performance responses to the “FIFA 11+” (part 1): is it an appropriate warm-up? Football injuries in Australia at the élite level. Examining Concussion Rates and Return to Play in High School Football Players Wearing Newer Helmet Technology: A Three-Year Prospective Cohort Study Three distinct mechanisms predominate in non-contact anterior cruciate ligament injuries in male professional football players: a systematic video analysis of 39 cases Sugammadex: when should we be giving it? A Prospective Video-Based Analysis of Injury Situations in Elite Male Football Relationship of soccer heading to computerized neurocognitive performance and symptoms among female and male youth soccer players The Nature and Duration of Acute Concussive Symptoms in Australian Football Injury risk of playing football in Futsal World Cups Neuropsychological functioning and recovery after mild head injury in collegiate athletes. Evaluation of the King–Devick test as a concussion screening tool in high school football players Psychophysiologic Treatment of Chronic Tinnitus: A Randomized Clinical Trial Baseline Neurocognitive Deficits in the CATIE Schizophrenia Trial Immediate Neurocognitive Effects of Concussion Systemic therapy in the curative treatment of head-and-neck squamous cell cancer: Cancer Care Ontario clinical practice guideline. Cognitive effects of one season of head impacts in a cohort of collegiate contact sport athletes Injuries in female football players in top-level international tournaments Are skilled players at greater risk of injury in female youth football? Cumulative effects associated with recurrent concussion in collegiate football players: the NCAA Concussion Study.
OBJECTIVE To determine the relationship between recorded head accelerations and impact locations and acute clinical outcome of symptomatology , neuropsychological , and postural stability tests after cerebral concussion in Division I collegiate football players . METHODS A prospect i ve field study was used in which accelerometers were embedded in the football helmets of 88 collegiate football players .  Linear and rotational accelerations of all head impacts sustained over the course of 2004 to 2006 National Collegiate Athletic Association football seasons were collected in real-time . Change scores were calculated on clinical measures from the players ' preseason baseline to postinjury ( within 48 h ) and regressed against the recorded linear and rotational accelerations of the head at the time of the concussion . RESULTS Thirteen concussions were recorded ranging in impact magnitudes of 60.51 to 168.71 g. Linear regression showed no significant relationships between impact magnitude ( linear or rotational acceleration ) or impact location and change scores for symptom severity , postural stability , or neurocognitive function ( P > 0.05 ) . CONCLUSION Our findings suggest that football players are concussed by impacts to the head that occur at a wide range of magnitudes and that clinical measures of acute symptom severity , postural stability , and neuropsychological function all appear to be largely independent of impact magnitude and location . Because of the varying magnitudes and locations of impacts result ing in concussion as well as other factors such as the frequency of subconcussive impacts and number of previous concussions , it may be difficult to establish a threshold for concussive injury that can be applied to all football players STUDY DESIGN Prospect i ve cohort . OBJECTIVES To identify the prevalence of neurocognitive and balance deficits in collegiate football players 48 hours following competition . BACKGROUND Neurocognitive testing , balance assessment s , and subjective report of symptoms are a commonly used test battery in examining athletes when concussion is suspected . Previous literature suggests many concussions go unreported . Little research exists examining the prevalence of neurocognitive or balance deficits in athletes who do not report concussion-like symptoms to a health care provider . METHODS Forty-five Division IA collegiate football players participated in this study . Preseason baseline scores using the  Balance Error Scoring System , the Immediate Post-Concussion Assessment and Cognitive Testing , and the Postconcussion Symptom Scale  were compared to posttest results obtained 48 hours following a game . Prevalence of symptoms was analyzed and reported . RESULTS Thirty-two ( 71 % ) of the 45 athletes tested demonstrated at least 1 deficit in either the Postconcussion Symptom Scale , Balance Error Scoring System , or at least 1 composite score of the Immediate Post-Concussion Assessment and Cognitive Testing . Nineteen of the 32 subjects demonstrated a change in 2 or more categories of neurocognitive and balance function . CONCLUSION In a cohort of football players tested 48 hours following their last game of the season , who did not seek medical attention related to a concussion , a significant number demonstrated limitations in neurocognitive and balance performance , suggesting that further research may need to be performed to improve recognition of an athlete 's deficits and to improve the ability to assess concussion . LEVEL OF EVIDENCE Differential diagnosis/symptom prevalence , level 3b Mild head injury has been recognized as producing numerous " postconcussive " symptoms that temporarily reduce an individual 's ability to function . Controversy exists over the short- and long-term effects of mild head injuries , and the effects of repeated concussive blows to the head have not been sufficiently studied . Amateur and professional athletes provide an excellent population for the examination of many aspects of postconcussive syndrome . The nature , incidence , and cognitive and emotional symptoms of mild head injury , are review ed within , the framework of professional and amateur sports . Particular attention is paid to the few available prospect i ve studies of amateur boxers and collegiate football players Objective : To compare the odds of sustaining moderate and severe head impacts , rather than mild , between high school football players with high and low visual performance . Design : Prospect i ve quasi-experimental . Setting : Clinical Research Center/On-field . Participants : Thirty-seven high school varsity football players . Interventions : Athletes completed the Nike SPARQ Sensory Station visual assessment before the season . Head impact biomechanics were captured at all practice s and games using the Head Impact Telemetry System . Main Outcome Measures : Each player was classified as either a high or low performer using a median split for each of the following visual performance measures : visual clarity , contrast sensitivity , depth perception , near – far quickness , target capture , perception span , eye – h and coordination , go/no go , and reaction time . We computed the odds of sustaining moderate and severe head impacts against the reference odds of sustaining mild head impacts across groups of high and low performers for each of the visual performance measures . Results : Players with better near – far quickness had increased odds of sustaining moderate [ odds ratios ( ORs ) , 1.27 ; 95 % confidence intervals ( CIs ) , 1.04 - 1.56 ] and severe head impacts ( OR , 1.45 ; 95 % CI , 1.05 - 2.01 ) as measured by Head Impact Technology severity profile . High and low performers were at equal odds on all other measures . Conclusions : Better visual performance did not reduce the odds of sustaining higher magnitude head impacts . Visual performance may play less of a role than expected for protecting against higher magnitude head impacts among high school football players . Further research is needed to determine whether visual performance influences concussion risk . Clinical Relevance : Based on our results , we do not recommend using visual training programs at the high school level for the purpose of reducing the odds of sustaining higher magnitude head impacts Abstract The aim of the study was to examine the post-exercise effects of the “ FIFA 11 + ” on various physical performance and physiological variables , to underst and whether this programme is an appropriate warm-up for football players . Results were compared with the literature using a meta-analytical approach . Twenty amateur male football players [ mean age 25.5 ( s ± 5.1 ) years , body mass 75(8 ) kg , height 181(6 ) cm ] participated in the study . They were tested twice before ( control period ) and once after the “ FIFA 11 + ” for : 20-m sprints , agility , vertical jump , stiffness , isometric maximal voluntary contraction ( MVC ) , rate of force development ( RFD ) , and star excursion balance test . Oxygen uptake , lactate and core temperature were also measured . Pre-post warm-up differences were found for all the performance variables ( from 1.0 to 6.2 % ; 0.015 < P < 0.001 ) with the exclusion of MVC ( −13 % ; P = 0.426 ) and RFD ( −10 % ; P = 0.205 ) . After the warm-up there was an increase ( 0.004 < P < 0.001 ) in resting oxygen uptake from 325(87 ) to 379(142 ) mL · min−1 , in core temperature from 37.3(0.3 ) to 37.7(0.3 ) ° C , and in lactate from 1.0(0.2 ) to 2.6(1.1 ) mmol · L−1 . In conclusion , the “ FIFA 11 + ” prevention programme can be considered an appropriate warm-up , inducing improvements in football players comparable with those obtained with other warm-up routines reported in the literature OBJECTIVE To determine injury profiles for the élite level competitions of football played in Australia . DESIGN Over the 1992 seasons , all injuries were prospect ively recorded from 26 clubs in football competitions which included the Australian Football League ( AFL ) , New South Wales Rugby League ( NSWRL ) and New South Wales Rugby Union ( NSWRU ) . RESULTS Some 2398 injuries were reported . In Australian Rules football , the most common injury was the hamstring tear ( 13 % ) ; this also accounted for the most time missed due to injury ( 16 % ) . In rugby league and union , the most common injuries were head and facial lacerations ( 11 % and 20 % ) followed by concussion ( 8 % and 5 % ) . The injuries accounting for most time missed were fractures and knee ligament injuries in the rugby codes . In Australian Rules football there were more lower limb muscle strain injuries , a high proportion of which were recurrences , with a significant incidence during training sessions . In the rugby codes , minor injuries to the head and neck were more common , particularly in forwards . While rugby league players suffered the most injuries , AFL injuries were on average more severe and consequently the total time missed through injury by players in these two codes was very similar . Rugby union had a significantly lower injury prevalence at the élite club competition level than rugby league or Australian Rules football . CONCLUSION Injury rates in the élite football competitions are high , warranting ongoing analysis and further study in particular areas OBJECTIVE : The purpose of this study was to compare concussion rates and recovery times for athletes wearing newer helmet technology compared to traditional helmet design . METHODS : This was a three-year , prospect i ve , naturalistic , cohort study . Participants were 2,141 high school athletes from Western Pennsylvania . Approximately half of the sample wore the Revolution helmet manufactured by Riddell , Inc.  ( n = 1,173 ) and the remainder of the sample used  st and ard helmets ( n = 968 ) . Athletes underwent computerized neurocognitive testing through the use of ImPACT at the beginning of the study . Following a concussion , players were reevaluated at various time intervals until recovery was complete . RESULTS : In the total sample , the concussion rate in athletes wearing the Revolution was 5.3 % and in athletes wearing st and ard helmets was 7.6 % [ & khgr;2 ( 1 , 2 , 141 ) = 4.96 , P < 0.027 ] . The relative risk estimate was 0.69 ( 95 % confidence interval = 0.499– 0.958 ) . Wearing the Revolution helmet was associated with approximately a 31 % decreased relative risk and 2.3 % decreased absolute risk for sustaining a concussion in this cohort study . The athletes wearing the Revolution did not differ from athletes wearing st and ard helmets on the mechanism of injury ( e.g. , head-to-head strike ) , on-field concussion markers ( e.g. , amnesia or loss of consciousness ) , or on-field presentation of symptoms ( e.g. , headaches , dizziness , or balance problems ) . CONCLUSION : Recent sophisticated laboratory research has better eluci date d injury biomechanics associated with concussion in professional football players . This data has led to changes in helmet design and new helmet technology , which appears to have beneficial effects in reducing the incidence of cerebral concussion in high school football players Background Current knowledge on anterior cruciate ligament ( ACL ) injury mechanisms in male football players is limited . Aim To describe ACL injury mechanisms in male professional football players using systematic video analysis . Methods We assessed  videos from 39 complete ACL tears recorded via prospect i ve professional football injury surveillance between 2001 and 2011 . Five analysts independently review ed all videos to estimate the time of initial foot contact with the ground and the time of ACL tear . We then analysed all videos according to a structured format describing the injury circumstances and lower limb joint biomechanics . Results Twenty-five injuries were non-contact , eight indirect contact and six direct contact injuries . We identified three main categories of non-contact and indirect contact injury situations : ( 1 ) pressing ( n=11 ) , ( 2 ) re-gaining balance after kicking ( n=5 ) and ( 3 ) l and ing after heading ( n=5 ) . The fourth main injury situation was direct contact with the injured leg or knee ( n=6 ) . Knee valgus was frequently seen in the main categories of non-contact and indirect contact playing situations ( n=11 ) , but a dynamic valgus collapse was infrequent ( n=3 ) . This was in contrast to the tackling-induced direct contact situations where a knee valgus collapse occurred in all cases ( n=3 ) . Conclusions Eighty-five per cent of the ACL injuries in male professional football players result ed from non-contact or indirect contact mechanisms . The most common playing situation leading to injury was pressing followed by kicking and heading . Knee valgus was frequently seen regardless of the playing situation , but a dynamic valgus collapse was rare 2011 ; 14 : 371–380 . 6 . Senn S , Gavini F , Magrez D , Scheen A. Issues in performing a network meta analysis . Statistical Methods in Medical Research 2013 ; 22 : 169–89 . 7 . Salanti G , Higgins JP , Ades A , Ioannidis JP . Evaluation of networks of r and omized trials . Statistical Methods in Medical Research 2008 ; 17 : 279– 301 . 8 . Song F , Clark A , Bachmann MO , Maas J. Simulation evaluation of statistical properties  of methods for indirect and mixed treatment comparisons . BMC Medical Research Methodology 2012 ; 12 : 1–14 . 9 . Jansen JP , Naci H. Is network meta- analysis as valid as st and ard pairwise meta- analysis ? It all depends on the distribution of effect modifers . BMC Medicine 2013 ; 11 : 1 . 10 . The Guidelines Manual . London : National Institute for Health and Clinical Excellence . 2012 . https://www . nice.org.uk/process/pmg6/chapter/6 review ing-the- evidence ( accessed 27/ 05/2017 ) . 11 . Kanters S , Ford N , Druyts E , et al. Use of network meta- analysis  in clinical guidelines . Bulletin of the World Health Organization 2016 ; 94 : 782–4 . 12 . Kiefer C , Sturtz S , Bender R. Indirect comparisons and network meta-analyses : estimation of effects in the absence of head-to-head trials . Deutsches € Arzteblatt International 2015 ; 112 : 803–8 . 13 . Imberger G , Gluud C , Boylan J , Wetterslev J. Systematic review s of anesthesiologic interventions reported as statistically significant : problems with power , precision , and type 1 error protection . Anesthesia and Analgesia 2015 ; 121 : 1611–22 . 14 . Afshari A , Wetterslev J , Smith AF . Can systematic review s with sparse data be trusted ? Anaesthesia 2017 ; 72 : 12–6 . 15 . Jakobsen JC , Wetterslev J , Lange T , Gluud C. Viewpoint : taking into account risks of r and om errors when analysing multiple outcomes in systematic review s. Cochrane Data base of Systematic Review s 2016 ; 3 : ED000111 . 16 . Jakobsen JC , Wetterslev J , Winkel P , Lange T , Gluud C. Thresholds for statistical and clinical significance in systematic review s with meta-analytic methods . BMC Medical Research Methodology 2014 ; 14 : 120 . 17 . Wetterslev J , Jakobsen JC , Gluud C. Trial Sequential Analysis in systematic review s with meta- analysis . BMC Medical Research Methodology 2017 ; 17 : 39 . 18 . Smith AF , Carlisle JC . Review s , systematic review s and Anaesthesia . Anaesthesia 2015 ; 70 : 644–70 . 19 . Cook TM , Kelly FE . The Difficult Airway Society 2015 guidelines and the sacred cows of routine airway management . Anaesthesia 2016 ; 71 : 466–7 . 20 . Schmitz S , Adams R , Walsh C. Incorporating data from various trial design s into a mixed treatment comparison model . Statistics in Medicine 2013 ; 32 : 2935–49 . 21 . Marshall SD , P and it JJ . Radical evolution : the 2015 Difficult Airway Society guidelines for managing unanticipated difficult or failed tracheal intubation . Anaesthesia 2016 ; 71 : 131–7 . 22 . Black AE , Flynn PE , Smith HL , Thomas ML , Wilkinson KA . Association of Pediatric Anaesthetists of Great Britain and Irel and . Development of a guideline for the management of the unanticipated difficult airway in pediatric practice . Pediatric Anaesthesia 2015 ; 25 : 346–62 . 23 . Hagberg CA , Gabel JC , Connis RT . Difficult Airway Society 2015 guidelines for the management of unanticipated difficult intubation in adults : not just another algorithm . British Journal of Anaesthesia 2015 ; 115 : 812–4 . 24 . Martin-Castro C , Montero A.  Flexible laryngeal mask as an alternative to reinforced tracheal tube for upper chest , head and neck oncoplastic surgery . European Journal of Anaesthesiology 2008 ; 25 : 261–6 . 25 . Maclennan A , Smith AF . An analysis of critical incidents relevant to paediatric anaesthesia reported to the UK National Reporting and Learning System , 2006 - 2008 . Pediatric Anesthesia 2011 ; 21 : 841–7 . 26 . P and it JJ , Popat MT , Cook TM , et al. The Difficult Airway Society ‘ ADEPT ’ Guidance on selecting airway devices : the basis of a strategy for equipment evaluation . Anaesthesia 2011 ; 66 : 726–37 Background The mechanisms for football injuries are largely unknown . Aim To describe the characteristics of injury situations in elite male football using a video-based method called football incident analysis . Study Design Prospect i ve cohort study . Methods During the 1999 season ,  videotapes  from 52 matches in the Icel and ic elite football league were review ed . Incidents ( N = 95 ) were recorded when the match was interrupted by the referee because of a suspected injury . Team physical therapists recorded injuries prospect ively ( N = 28 time-loss injuries ) . Results Duels caused 84 of the incidents , mostly  tackling duels ( n = 54 ) . The exposed player 's attention appeared to be focused away from the opponent in 93 % of the cases . The 3 main mechanisms observed were ( 1 ) breakdown attacks , tackling from the side or the front , attention focused on the ball ( 24 % ) ; ( 2 ) defensive tackling duels  , attention focused on the ball or low ball control ( 20 % ) ; and ( 3 ) heading duels  , attention focused on the ball in the air ( 13 % ) . Conclusion Most incidents and injuries occurred during breakdown attacks and when a player was involved in tackling duels . Player attention appeared to be focused mainly on the ball , not on the opponent challenging him to gain ball possession Primary objective : The purpose of this study was to investigate the relationship between soccer heading and computerized neurocognitive performance and symptoms in female and male youth soccer players . Research design : Cross-sectional and prospect i ve design . Methods and procedures : A total of 63 ( 27 females , 36 males ) youth soccer players aged 13–18 years ( M = 15.89 , SD = 1.17 ) participated in the study . Participants completed the Immediate Post-concussion Assessment and Cognitive Test ( ImPACT ) and symptom report . Main outcomes : Computerized neurocognitive performance ( e.g. , verbal and visual memory , motor processing , and reaction time ) and symptoms . Results : There were no differences in neurocognitive performance or symptoms among low- , moderate- , and high-exposure header groups . The current sample outperformed the 10th percentile norms for neurocognitive and symptom scores . Males headed the ball more frequently and reported lower verbal and visual memory and motor processing speed scores than females . Conclusion : The current findings did not support a relationship between soccer heading and computerized neurocognitive performance and symptoms . The research ers suggest that any purported effects of soccer heading in youth are subtle and may affect only a small number of athletes . The reported sex differences in heading exposure warrant further attention Objective The purpose of this pilot study was to document the nature and temporal profile of the clinical symptoms of acute sport-related concussion . Design Prospect i ve cohort study Patient Population A total of 303 elite Australian football players participating in a national competition during a single season . Outcome Measures Number and duration of symptoms , digit symbol substitution test ( DSST ) scores , time of return to play post injury . Results A total of 23 concussions were recorded over the course of the 20-week football season . No catastrophic head injuries occurred . Headache was the most common symptom and the most persistent , with 40 % of players reporting headache symptoms lasting more than 15 minutes . Ten of the players ( 43 % ) returned to sport on the day of the injury with the remainder resuming play within 2 weeks . A low likelihood of return to play on the day of injury was found where 3 or more symptoms were present or where the symptoms lasted more than 15 minutes . These findings were significantly correlated with poor DSST performance . Conclusions This pilot study suggests that both the number of postconcussive symptoms and their duration may be used as a measure of injury severity and a guide for return to play Background While injuries in football ( soccer ) have been the subject of numerous publications , little information is available about the injury risk in futsal . Objective Analysis of the incidence and characteristics of injury in  futsal players during top-level international tournaments . Design Prospect i ve survey . Methods Player injuries during three consecutive Futsal World Cups  were analysed using an established injury report system . The physicians of all participating teams reported all injuries after each match on a st and ardised injury report form . The average response rate was 93 % . Results A total of 165 injuries were reported from 127 matches , which is equivalent to an incidence of 195.6 injuries per 1000 player hours ( 95 % CI 165.8 to 225.6 ) or 130.4 injuries per 1000 player matches ( 95 % CI 110.5 to 150.3 ) . The majority of injuries were caused by contact with another player , and 36 % of the injuries occurred during non-contact activities . Most injuries affected the lower extremity ( 70 % ) , followed by head and neck ( 13 % ) , upper extremity ( 10 % ) and trunk ( 7 % ) . The most frequent diagnoses were contusion of the lower leg ( 11 % ) , ankle sprain ( 10 % ) and groin strain ( 8 % ) . On average , one time-loss injury in every two matches was reported . Conclusion While the location and diagnosis of injuries were similar in the two types of football , fewer injuries in futsal than in football were caused by contact with another player and by foul play . More information on injury mechanisms in futsal is needed to develop specific injury preventive interventions OBJECTIVE This study prospect ively examined neuropsychological functioning in 2300 collegiate football players from 10 National Collegiate Athletic Association Division A universities . The study was design ed to determine the presence and duration of neuropsychological symptoms after mild head injury . METHODS A nonequivalent repeated measures control group design was used to compare the neuropsychological test scores and symptoms of injured players ( n = 183 ) with those of gender , age , and education matched controls . A number of neuropsychological tests , including the Paced Auditory Serial Addition Test , the Digit Symbol Test , and the Trail Making Test , as well as a symptom checklist  were used . TECHNIQUE Players and controls were assessed before engaging in game activity and 24 hours , 5 days , and 10 days after injury , using the st and ardized test battery and symptom checklist . RESULTS Players with head injuries displayed impaired performance and increased symptoms in comparison to controls , but this impairment resolved within 5 days in most players . Players with head injuries showed significant improvement between 24 hours and 5 days , as well as between 5 and 10 days . CONCLUSION Although single , uncomplicated mild head injuries do cause limited neuropsychological impairment , injured players generally experience rapid resolution of symptoms with minimal prolonged sequelae OBJECTIVE Concussion is the most common type of traumatic brain injury , and results from impact or impulsive forces to the head , neck or face . Due to the variability and subtlety of symptoms , concussions may go unrecognized or be ignored , especially with the pressure placed on athletes to return to competition . The King-Devick ( KD ) test , an oculomotor test originally design ed for reading evaluation , was recently vali date d as a concussion screening tool in collegiate athletes . A prospect i ve study was performed using high school football players in an attempt to study the KD as a concussion screening tool in this younger population . METHODS 343 athletes from four local high school football teams were recruited to participate . These athletes were given baseline KD tests prior to competition . Individual demographic information was collected on the subjects . St and ard team protocol was employed to determine if a concussion had occurred during competition . Immediately after diagnosis , the KD test was re-administered to the concussed athlete for comparison to baseline . Post-season testing was also performed in non-concussed individuals . RESULTS Of the 343 athletes , nine were diagnosed with concussions . In all concussed players , cumulative read times for the KD test were significantly increased ( p<0.001 ) . Post-season testing of non-concussed athletes revealed minimal change in read times relative to baseline . Univariate analysis revealed that history of concussion was the only demographic factor predictive of concussion in this cohort . CONCLUSION The KD test is an accurate and easily administered sideline screening tool for concussion in adolescent football players Background : Tinnitus seems to be associated with psychophysiological over-activation ( e.g. , of head and shoulder muscles ) . Therefore we aim ed to develop and evaluate a new intervention program including a psychophysiological approach . Methods : Forty-three tinnitus sufferers were r and omized to 2 groups , one receiving a psychophysiologically oriented intervention lasting 7 intervention sessions ( plus 2 assessment sessions ) , whereas the other group waited for a comparable time period . Afterward , patients on the waiting list also received the intervention . Physiological variables were muscle activity of head and shoulders and electrodermal activity . Psychological assessment  s took place at pretreatment , post-treatment , and 6 months later . Follow-up data were available from 95 % of participants . Major outcome variables were self-rating scales ( e.g. , tinnitus annoyance assessed by the Tinnitus Question naire ) , and diary data ( self-control , daily time of perceiving the tinnitus ) . Results : On most tinnitus specific variables , patients in the treatment group improved significantly more than patients on the waiting list . Main effect sizes for tinnitus-specific variables were up to 0.89 . Muscle reactivity of head muscles at the beginning predicted significant treatment effects . Conclusion : Compared with meta-analytical review s of psychological interventions for tinnitus sufferers , the presented treatment is brief and in the upper range of effectiveness . ES = effect size ; GSI = General Symptomatic Index ( mean score of Brief Symptom Inventory ) ; IG = intervention group ; MG = merged group ; SCL-90R = symptom check list ; TQ = Tinnitus Question naire ; WLG = waiting list group Neurocognition is moderately to severely impaired in patients with schizophrenia . However , the factor structure of the various neurocognitive deficits , the relationship with symptoms and other variables , and the minimum amount of testing required to determine an adequate composite score has not been determined in typical patients with schizophrenia . An ‘ all-comer ’ approach to cognition is needed , as provided by the baseline assessment of an unprecedented number of patients in the CATIE ( Clinical Antipsychotic Trials of Intervention Effectiveness ) schizophrenia trial . From academic sites and treatment providers representative of the community , 1493 patients with chronic schizophrenia were entered into the study , including those with medical comorbidity and substance abuse .  Eleven neurocognitive tests were administered , result ing in 24 individual scores reduced to nine neurocognitive outcome measures , five domain scores and a composite score . Despite minimal screening procedures , 91.2 % of patients provided meaningful neurocognitive data . Exploratory principal components analysis yielded one factor accounting for 45 % of the test variance . Confirmatory factor analysis showed that a single-factor model comprised of five domain scores was the best fit . The correlations among the factors were medium to high , and scores on individual factors were very highly correlated with the single composite score . Neurocognitive deficits were modestly correlated with negative symptom severity ( r=0.13–0.27 ) , but correlations with positive symptom severity were near zero ( r<0.08 ) . Even in an ‘ all-comer ’ clinical trial , neurocognitive deficits can be assessed in the overwhelming majority of patients , and the severity of impairment is similar to meta-analytic estimates . Multiple analyses suggested that a broad cognitive deficit characterizes this sample . These deficits are modestly related to negative symptoms and essentially independent of positive symptom severity OBJECTIVE To prospect ively measure the immediate neurocognitive effects and early course of recovery from concussion and to examine the effects of loss of consciousness ( LOC ) and posttraumatic amnesia ( PTA ) on the severity of neurocognitive impairment immediately after concussion . METHODS A sports-related concussion research model was used to allow prospect i ve immediate evaluation of concussion . A total of 2385 high school and college football players were studied . Ninety-one players ( 3.8 % ) sustained concussions during the study . A brief neurocognitive and neurological screening measure , the St and ardized Assessment of Concussion  , was used to assess cognitive functioning before the football season , immediately after injury , and 15 minutes , 48 hours , and 90 days after injury . RESULTS St and ardized Assessment of Concussion scores immediately after concussion were significantly lower than the preseason baseline score and the noninjured population baseline mean , even for injured subjects without LOC or PTA . Subjects with LOC were most severely impaired immediately after injury , whereas those without LOC or PTA were least impaired . Significant impairment was also detected 15 minutes after injury , but all three groups returned to baseline levels of cognitive functioning within 48 hours . CONCLUSION These findings are the first to demonstrate not only that a gradient of increasing concussion severity is represented by PTA and LOC but also that measurable neurocognitive abnormalities are evident immediately after injury without PTA or LOC OBJECTIVE The aim of the present work was to make recommendations about the use of systemically administered drugs in combination or in sequence with radiation ( rt ) or surgery , or both , for cure or organ preservation , or both , in patients with locally advanced nonmetastatic ( stages iii-ivb ) squamous cell carcinoma of the head and neck ( lascchn ) . METHODS The Meta- analysis of Chemotherapy in Head and Neck Cancer ( mach-nc ) reports have , de facto , guided practice since 2000 , and so we search ed the literature for systematic review s published from January 2000 to February 2015 in reference to five research questions . A search was also conducted up to February 2015 for r and omized trials ( rcts ) not included in the meta-analyses . Recommendations were constructed using the Cancer Care Ontario Program in Evidence -Based Care practice guidelines development cycle . RESULTS In addition to up date d mach-nc reports , five additional meta-analyses and thirty rcts were identified . Five recommendations for lascchn treatment were generated based on those data . Concurrent chemoradiation ( ccrt ) is recommended to maximize the chance of cure in patients less than 71 years of age when rt is used as definitive treatment . The same recommendation also applies to patients with resected lascchn considered to be at high risk for locoregional recurrence . For lascchn patients who are c and i date s for organ preservation strategies and would otherwise require total laryngectomy , either ccrt or induction chemotherapy , followed by rt or surgery based on tumour response is recommended . The addition of cetuximab to intensified rt ( concomitant boost or hyperfractionated schedule ) is an alternative to ccrt . Routine use of induction chemotherapy to improve overall survival is not recommended . CONCLUSIONS We were able to use high-level evidence from patients receiving rt as definitive or postoperative treatment to generate recommendations for the use of systemic therapy in the treatment of lascchn . A limitation is a lack of stratification for human papillomavirus-related cancers of the oropharynx . One rct provided evidence for the use of cetuximab as an alternative to chemotherapy in the definitive rt setting . Concurrent chemoradiation provides one strategy for larynx preservation , but the best strategy is unclear . Use of induction chemotherapy does not improve overall survival , and its use should be limited to patients requiring immediate tumour downsizing before local therapy Objective : To determine whether exposure to repetitive head impacts over a single season negatively affects cognitive performance in collegiate contact sport athletes . Methods : This is a prospect i ve cohort study at 3 Division I National Collegiate Athletic Association athletic programs . Participants were 214 Division I college varsity football and ice hockey players who wore instrumented helmets that recorded the acceleration-time history of the head following impact , and 45 noncontact sport athletes . All athletes were assessed prior to and shortly after the season with a  cognitive screening battery ( ImPACT ) and a subgroup of athletes also were assessed with 7 measures from a neuropsychological test battery . Results : Few cognitive differences were found between the athlete groups at the preseason or postseason assessment s. However , a higher percentage of the contact sport athletes performed more poorly than predicted postseason on a measure of new learning ( California Verbal Learning Test ) compared to the noncontact athletes ( 24 % vs 3.6 % ; p < 0.006 ) . On 2 postseason cognitive measures ( ImPACT Reaction Time and Trails 4/B ) , poorer performance was significantly associated with higher scores on several head impact exposure metrics . Conclusion : Repetitive head impacts over the course of a single season may negatively impact learning in some collegiate athletes . Further work is needed to assess whether such effects are short term or persistent Background : Despite the growing popularity of women ’s football and the increasing number of female players , there has been little research on injuries sustained by female football players . Purpose : Analysis of the incidence , characteristics and circumstances of injury in elite female football players in top-level international tournaments . Study design : Prospect i ve survey . Methods : Injuries incurred in seven international football tournaments  were analysed using an established injury report system .  Doctors of all participating teams reported all injuries after each match on a st and ardised injury reporting form . The mean response rate was 95 % . Results : 387 injuries were reported from 174 matches , equivalent to an incidence of 67.4 injuries/1000 player hours ( 95 % CI 60.7 to 74.1 ) or 2.2 injuries/match ( 95 % CI 2.0 to 2.4 ) . Most injuries ( 84 % ; 317/378 ) were caused by contact with another player . The injuries most commonly involved the lower extremity ( n = 248 ; 65 % ) , followed by injuries of the head and neck ( n = 67 , 18 % ) , trunk ( n = 33 , 9 % ) and upper extremity ( n = 32 , 8 % ) . Contusions ( n = 166 ; 45 % ) were the most frequent type of injury , followed by sprains or ligament rupture ( n = 96 ; 26 % ) and strains or muscle fibre ruptures ( n = 31 ; 8 % ) . The most common diagnosis was an ankle sprain . There were 7 ligament ruptures and 15 sprains of the knee . On average 1 injury/match ( 95 % CI 0.8 to 1.2 ) was expected to result in absence from a match or training . Conclusion : The injury rate in women ’s top-level tournaments was within the range reported previously for match injuries in elite male and female players . However , the diagnoses and mechanisms of injury among the female players differed substantially from those previously reported in male football players Background Knowledge of skill-related risk factors for injury in football is limited . Objective To investigate whether there is an association between football skills and risk of injury in football . Study Design Prospect i ve cohort study of the incidence of injuries and a retrospective evaluation of the players ' skill-level . Methods Exposure and injuries were registered prospect ively in 82 of 125 football teams ( 1665 of 2540 female Norwegian amateur players aged 13–17 years ) throughout one football season ( March – October 2007 ) . A st and ardised question naire design ed to assess the football skills of each player was completed by the coaches after the season . Results Across the different skill attributes , the injury incidence in the high-skilled players varied from 4.4 to 4.9 injuries per 1000 player hours , compared to 2.8 to 4.0 injuries per 1000 player hours in the low-skilled players . Players skilled at ball receiving , passing and shooting , heading , tackling , decision-making when in ball possession or in defence and physically strong players were at significantly greater risk of sustaining any injury , an acute injury and a contact injury than their less skilled teammates ( rate ratio : 1.50–3.19 , all p<0.05 ) . Conclusions Players with high levels of football skill were at greater risk of sustaining injuries than their less skilled teammates CONTEXT Approximately 300 000 sport-related concussions occur annually in the United States , and the likelihood of serious sequelae may increase with repeated head injury . OBJECTIVE To estimate the incidence of concussion and time to recovery after concussion in collegiate football players . DESIGN , SETTING , AND PARTICIPANTS Prospect i ve cohort study of 2905 football players from 25 US colleges were tested at preseason baseline in 1999 , 2000 , and 2001 on a variety of measures and followed up prospect ively to ascertain concussion occurrence . Players injured with a concussion were monitored until their concussion symptoms resolved and were followed up for repeat concussions until completion of their collegiate football career or until the end of the 2001 football season . MAIN OUTCOME MEASURES Incidence of concussion and repeat concussion ; type and duration of symptoms and course of recovery among players who were injured with a concussion during the seasons . RESULTS During follow-up of 4251 player-seasons , 184 players ( 6.3 % ) had a concussion , and 12 ( 6.5 % ) of these players had a repeat concussion within the same season . There was an association between reported number of previous concussions and likelihood of incident concussion .  Players reporting a history of 3 or more previous concussions were 3.0 ( 95 % confidence interval , 1.6 - 5.6 ) times more likely to have an incident concussion than players with no concussion history . Headache was the most commonly reported symptom at the time of injury ( 85.2 % ) , and mean overall symptom duration was 82 hours . Slowed recovery was associated with a history of multiple previous concussions ( 30.0 % of those with > or =3 previous concussions had symptoms lasting > 1 week compared with 14.6 % of those with 1 previous concussion ) . Of the 12 incident within-season repeat concussions , 11 ( 91.7 % ) occurred within 10 days of the first injury , and 9 ( 75.0 % ) occurred within 7 days of the first injury . CONCLUSIONS Our study suggests that players with a history of previous concussions are more likely to have future concussive injuries than those with no history ; 1 in 15 players with a concussion may have additional concussions in the same playing season ; and previous concussions may be associated with slower recovery of neurological function
The overall results of r and om effects modelling of football heading were found to be inconclusive across all outcomes , groups and time points .
No moderating variables related to method ological , sample or study characteristics were supported in the analysis ; age was a potential moderating variable .
Summary / conclusions We provide the first meta-analytical review of football heading effects aggregated from multiple studies and extended findings from a recent systematic review of the effects of football heading .
Our analysis indicates no overall effect for heading a football on adverse outcomes
Aim / objective The objective of this study was to provide a meta- analysis examining the effects of football heading .
Design Meta-analytical review on football heading effects on neurocognitive performance , cognition and symptom reports .