bluuebunny/crossref_metadata_2025_split huggingface dataset:
Outcomes after sport-related concussion: does socioeconomic status matter?
Authors: Zuckerman Scott L , Kuhn Andrew W , Yengo-Kahn Aaron M , Zalneraitis Brian Holt , Solomon Gary S , Sills Allen K 
Published: November 2017

ObjectiveTo determine the impact of socioeconomic status (SES) on outcomes after sport-related concussion (SRC) in a regional sports concussion centre.DesignRetrospective cohort study.SettingComprehensive sports concussion centre.Participants282 youth, high school, and collegiate student-athletes.InterventionAll patients seen at a comprehensive sports concussion centre were contacted after their injury for in-depth telephone interviews. Subsequent demographic data was also collected.Outcome measuresSES was defined based on six variables: cost of living percentile, median income percentile, % college graduates, % homeowners, county type, and insurance. Outcomes after SRC were defined as the following three variables: days of symptom duration, days of missed school, and days of missed practice.Main resultsA total of 282 student-athletes were studied. The median age was 15.8 years (range 11.6–22.2). American football was the most common sport (32.2%). After multivariate cox-regression analysis, no relationship between SES and symptom duration or missed practice was seen. For the outcome of missed school, insurance status had a significant relationship, where those with private insurance had fewer missed days of school than those with public insurance (HR 0.46, 95% CI: 0.26–0.83, p=0.009).ConclusionsIn a regional cohort of youth, high school and collegiate student-athletes, SES had largely no impact on the outcomes of symptom duration, missed school, and missed practice. The only significant relationship was that those with private insurance returned to school quicker than those with public insurance, which may represent increased access to rehabilitation resources after SRC.Competing interestsNone.GS Solomon receives consulting fees from the Tennessee Titans (NFL), the Nashville Predators (NHL), and the athletic departments of several universities, all fees paid to institution. In addition he is a member of the ImPACT Scientific Advisory Board and receives reimbursement for expenses to board meetings.AK Sills is a consulting physician to the Nashville Predators (uncompensated) and also serves as an unaffiliated neurotrauma consultant for the NFL.
The prevalence of concussion within the military academies: findings from the concussion assessment, research, and education (care) consortium
Authors: O’Connor Kathryn L , Dain Allred C , Cameron Kenneth L , Campbell Darren E , Houston Megan N , Johnson Brian R , D’Lauro Chris , McGinty Gerald , O’Donnell Patrick G , Peck Karen Y , Svoboda Steven J , McCrea Michael , McAllister Thomas , Broglio Steven P 
Published: November 2017

ObjectiveDescribe prevalence and risk factors for concussion among USA Service Academy cadets.DesignProspective.SettingThree USA Service Academies.ParticipantsNCAA and non-NCAA athlete cadets (n=7636, 22% female) enrolled in the CARE Consortium (2014–2015).Assessment of risk factorsNCAA status, contact-sport, gender, and brief sensation seeking scale (BSSS) were examined as risk factors for previous concussion.Outcome measuresNumber of previous concussions.Main results21% of cadets reported a previous concussion with median time from injury being 2.5 years (IQR 0.99–4.57). At least one previous concussion occurred in 18% of freshman prior to Service Academy enrollment and 12% of sophomore through senior cadets sustained a concussion during their time at the academy. Cadets who are NCAA athletes had a 1.57 (95% CI: 1.12–2.19) greater odds of sustaining a concussion at the academy than non-NCAA cadets. Poisson regression modelling the number of previous concussions revealed significant main effects for contact-sport and BSSS. Controlling for BSSS, contact-sport cadets had 1.82 (95% CI: 1.69–1.95) times the prevalence rate of previous concussion compared to non-contact sport athletes. Additionally, controlling for contact-sport, higher BSSS scores increased prevalence of previous concussions by 1.17 (95% CI: 1.10–1.24) times.ConclusionsOverall concussion prevalence among all service academy cadets is similar to prevalence of concussion previously reported for NCAA athletes. Within the academies, cadets who are also NCAA athletes have greater odds of concussion, likely due to increased risk exposure. Contact-sport status and increased sensation seeking is associated with increased number of previous concussions.Competing Interests/ AcknowledgementsThis project was supported, in part, with support from the Grand Alliance Concussion Assessment, Research, and Education (CARE) Consortium, funded, in part by the National Collegiate Athletic Association (NCAA) and the Department of Defense (DOD).The U.S. Army Medical Research Acquisition Activity, 820 Chandler Street, Ford Detrick MD 21702–5014 is the awarding and administering acquisition office.This work was supported by the Office of the Assistant Secretary of Defense for Health Affairs through the Psychological Health and Traumatic Brain Injury Program under Award NO W81XWH-14-2-0151. Opinions, interpretations, conclusions and recommendations are those of the author and are not necessarily endorsed by the Department of Defense (DHP funds.)
Eye movement and white matter integrity in patients with post-concussion syndrome
Authors: Taghdiri Foad , Irwin Samantha , Multani Namita , Tarazi Apameh , Ebraheem Ahmed , Chung Jonathan , Khodadadi Mozghan , Goswami Ruma , Wennberg Richard , Green Robin , Mikulis Dave , Tator Charles , Eizenman Moshe , Tartaglia Maria Carmela 
Published: November 2017

ObjectiveTo assess eye movements in patients with post-concussion syndrome (PCS) and use diffusion tensor imaging (DTI) to determine relationship between eye movements and white matter integrity.Designcross-sectional study.InterventionAttention and executive function were tested using Visual Attention Scanning Technology (VAST) [EL-MAR Inc., Toronto, Ontario, Canada]. In a matching task, the normalised number of transitions (NNT) to a master image before making the first selection was used as a surrogate of working memory. During this task, subjects view a set of slides, each slide includes a master image and six variants, and they have to select a variant that is similar to the master (only one variant is an exact replica of the master).Outcome measuresWe related performance on VAST to white matter integrity using Tract-Based Spatial Statistics of DTI metrics such as fractional anisotropy (FA) for whole brain analyses as well as seed-based probabilistic tractography analysis of the superior longitudinal fasciculus (SLF), Cingulum tract, and Uncinate fasciculus (UF).Main results60 participants (mean age 34.3 years, SD 13.8) had a mean of 4 concussions. There were negative correlations between whole brain FA and NNT (r=−0.501, p<0.001). In addition, when we performed probabilistic tractography analyses, we found a negative correlation between the FA of right SLF and NNT (r=−0.332, p=0.009).ConclusionsImpaired performance on eye tracking measures of attention and executive function may reflect alterations in white matter tracts.Competing interestsNone.Moshe Eizenman is a director in EL-MAR Inc.
Prevalence of knee pain, radiographic osteoarthritis and arthroplasty in retired professional footballers compared with men in the general population: a cross-sectional study
Authors: Fernandes Gwen Sascha , Parekh Sanjay Mukund , Moses Jonathan , Fuller Colin , Scammell Brigitte , Batt Mark Edward , Zhang Weiya , Doherty Michael 
Published: November 2017

ObjectivesTo determine the prevalence of knee pain, radiographic knee osteoarthritis (RKOA), total knee replacement (TKR) and associated risk factors in male ex-professional footballers compared with men in the general population (comparison group).Methods1207 male ex-footballers and 4085 men in the general population in the UK were assessed by postal questionnaire. Current knee pain was defined as pain in or around the knees on most days of the previous month. Presence and severity of RKOA were assessed on standardised radiographs using the Nottingham Line Drawing Atlas (NLDA) in a subsample of 470 ex-footballers and 491 men in the comparison group. The adjusted risk ratio (aRR) and adjusted risk difference (aRD) with 95% CI in ex-footballers compared with the general population were calculated using the marginal model in Stata.ResultsEx-footballers were more likely than the comparison group to have current knee pain (aRR 1.91, 95% CI 1.77 to 2.06), RKOA (aRR 2.21, 95% CI 1.92 to 2.54) and TKR (aRR 3.61, 95% CI 2.90 to 4.50). Ex-footballers were also more likely to present with chondrocalcinosis (aRR 3.41, 95% CI 2.44 to 4.77). Prevalence of knee pain and RKOA were higher in ex-footballers at all ages. However, even after adjustment for significant knee injury and other risk factors, there was more than a doubling of risk of these outcomes in footballers.ConclusionsThe prevalence of all knee osteoarthritis outcomes (knee pain, RKOA and TKR) were two to three times higher in male ex-footballers compared with men in the general population group. Knee injury is the main attributable risk factor. Even after adjustment for recognised risk factors, knee osteoarthritis appear to be an occupational hazard of professional football.
Examining the effects of enhanced provider–patient communication on postoperative tonsillectomy pain: protocol of a randomised controlled trial performed by nurses in daily clinical care
Authors: van Vliet Liesbeth M , van Dulmen Sandra , Thiel Bram , van Deelen Gerard W , Immerzeel Stephanie , Godfried Marc B , Bensing Jozien M 
Published: November 2017

IntroductionPlacebo effects (true biopsychological effects not attributable to the active ingredients of medical technical interventions) can be attributed to several mechanisms, such as expectancy manipulation and empathy manipulation elicited by a provider’s communication. So far, effects have primarily been shown in laboratory settings. The aim of this study is to determine the separate and combined effects of expectancy manipulation and empathy manipulation during preoperative and postoperative tonsillectomy analgesia care on clinical adult patients’ outcomes.Methods and analysisUsing a two-by-two randomised controlled trial, 128 adult tonsillectomy patients will be randomly assigned to one out of four conditions differing in the level of expectancy manipulation (standard vs enhanced) and empathy manipulation (standard vs enhanced). Day care ward nurses are trained to deliver the intervention, while patients are treated via the standard analgesia protocol and hospital routines. The primary outcome, perceived pain, is measured via hospital routine by a Numeric Rating Scale, and additional prehospitalisation, perihospitalisation and posthospitalisation questionnaires are completed (until day 3, ie, 2 days after the operation). The manipulation is checked using audio recordings of nurse–patient interactions.Ethics and disseminationAlthough communication is manipulated, the manipulations do not cross norms or values of acceptable behaviour. Standard medical care is provided. The ethical committee of the UMC Utrecht and the local OLVG hospital committee approved the study. Results will be published via (inter)national peer-reviewed journals and a lay publication.Trial registration numberNTR5994; Pre-results.
Progression of disease preceding lower extremity amputation in Denmark: a longitudinal registry study of diagnoses, use of medication and healthcare services 14 years prior to amputation
Authors: Jensen Pia Søe , Petersen Janne , Kirketerp-Møller Klaus , Poulsen Ingrid , Andersen Ove 
Published: November 2017

ObjectivesPatients with non-traumatic lower extremity amputation are characterised by high age, multi-morbidity and polypharmacy and long-term complications of atherosclerosis and diabetes. To ensure early identification of patients at risk of amputation, we need to gain knowledge about the progression of diseases related to lower extremity amputations during the years preceding the amputation.DesignA retrospective population-based national registry study.SettingThe study includes data on demographics, diagnoses, surgery, medications and healthcare services from five national registries. Data were retrieved from 14 years before until 1 year after the amputation. Descriptive statistics were used to describe the progression of diseases and use of medication and healthcare services.ParticipantsAn unselected cohort of patients (≥50 years; n=2883) subjected to a primary non-traumatic lower extremity amputation in 2010 or 2011 in Denmark.ResultsThe prevalence of atherosclerosis, hypertension and diabetes was 70%, 53% and 49%, respectively. Among patients with atherosclerosis, 42% had not received cholesterol-lowering treatment even though 87% had visited their general practitioner within the last year prior to amputation. Further, 16% were diagnosed with diabetes at the time of the amputation. The prevalence of cardiovascular diseases increased from 22% to 70%, atherosclerosis from 5% to 53% and diabetes from 17% to 35% over the 14 years preceding major amputation. Of all patients, 64% had been in contact with the hospital or outpatient clinics within the last 3 years, and 29% received a prescription of opioids 3 years prior to the amputation.ConclusionAmong patients with non-traumatic lower extremity amputation, one-third live with undiagnosed and untreated atherosclerosis and one-sixth suffer from undiagnosed diabetes despite continuous contacts to general practitioner and the hospital. This study emphasises a need for enhanced focus, among both hospital clinicians and general practitioners, on the early identification of atherosclerosis and diabetes.
Preschool children’s context-specific sedentary behaviours and parental socioeconomic status in Finland: a cross-sectional study
Authors: Määttä Suvi , Konttinen Hanna , Haukkala Ari , Erkkola Maijaliisa , Roos Eva 
Published: November 2017

ObjectivesThis study examined the associations of parental socioeconomic status (SES) with preschoolers’ objectively measured sedentary time (SED) over the course of a week and with parent-reported children’s screen and reading times at home as indicators of sedentary behaviours (SB).DesignCross-sectional.SettingIn years 2015 and 2016 in Finland.Participants864 children, aged 3–6 years, with their parents.Outcome measuresChildren’s accelerometer data were transformed into average SED minutes per hour in different contexts (preschool, home during preschool days, weekend and total). Parent-reported children’s screen and reading times were expressed as average daily minutes. The SES indicators (maternal and paternal education and relative household income) were grouped into three categories. Linear or logistic regression analyses were used, with municipality, season, and children’s gender and age as covariates. CIs were adjusted for clustering at the preschool group level.ResultsChildren with low maternal (β=17.21, 95% CI: 8.71 to 25.71) and paternal (β=10.54, 95% CI: 0.77 to 20.30) education had more overall screen time at home than their more advantaged counterparts. SES differences in overall screen time were mostly explained by TV viewing. Children with low as opposed to high maternal education (β=−2.66, 95% CI: −4.95 to –0.38) had less reading time at home. Children whose fathers were on the middle (β=−1.15, 95% CI: −2.01 to –0.29) educational level had less weekend SED than those with high paternal education. Otherwise, parental SES was not related to objectively measured SED.ConclusionsThe results of this study highlight the fact that the associations between parental SES and preschoolers’ SB are dependent on the indicators of SES and SBs, and vary between different contexts. Generally, parental SES was not associated with SED, whereas some SES differences existed in screen time and reading time at home. Interventions aiming to diminish SES differences in children’s SB should focus on home hours.Trial registration numberISRCTN57165350.
Retrospective interrupted time series examining hypertension and diabetes medicines usage following changes in patient cost sharing in the ‘Farmácia Popular’ programme in Brazil
Authors: Emmerick Isabel Cristina Martins , Campos Monica Rodrigues , Luiza Vera Lucia , Chaves Luisa Arueira , Bertoldi Andrea Dâmaso , Ross-Degnan Dennis 
Published: November 2017

Objectives‘Farmácia Popular’ (FP) programme was launched in 2004, expanded in 2006 and changed the cost sharing for oral hypoglycaemic (OH) and antihypertensive (AH) medicines in 2009 and in 2011. This paper describes patterns of usage and continuity of coverage for OH and AH medicines following changes in patient cost sharing in the FP.Study designInterrupted time series study using retrospective administrative data.MethodsMonthly programme participation (PP) and proportion of days covered (PDC) were the two outcome measures. The open cohort included all patients with two or more dispensings for a given study medicine in 2008–2012. The interventions were an increase in patient cost sharing in 2009 and zero patient cost sharing for key medicines in 2011.ResultsA total of 3.6 and 9.5 million patients receiving treatment for diabetes and hypertension, respectively, qualified for the study. Before the interventions, PP was growing by 7.3% per month; median PDC varied by medicine from 50% to 75%. After patient cost sharing increased in 2009, PP reduced by 56.5% and PDC decreased for most medicines (median 60.3%). After the 2011 free medicine programme, PP surged by 121 000 new dispensings per month and PDC increased for all covered medicines (80.7%).ConclusionCost sharing was found to be a barrier to continuity of treatment in Brazil’s private sector FP programme. Making essential medicines free to patients appear to increase participation and continuity of treatment to clinically beneficial levels (PDC >80%).
Do digital innovations for HIV and sexually transmitted infections work? Results from a systematic review (1996-2017)
Authors: Daher Jana , Vijh Rohit , Linthwaite Blake , Dave Sailly , Kim John , Dheda Keertan , Peter Trevor , Pai Nitika Pant 
Published: November 2017

ObjectiveDigital innovations with internet/mobile phones offer a potential cost-saving solution for overburdened health systems with high service delivery costs to improve efficiency of HIV/STI (sexually transmitted infections) control initiatives. However, their overall evidence has not yet been appraised. We evaluated the feasibility and impact of all digital innovations for all HIV/STIs.DesignSystematic review.Setting/participantsAll settings/all participants.InterventionWe classified digital innovations into (1) mobile health-based (mHealth: SMS (short message service)/phone calls), (2) internet-based mobile and/or electronic health (mHealth/eHealth: social media, avatar-guided computer programs, websites, mobile applications, streamed soap opera videos) and (3) combined innovations (included both SMS/phone calls and internet-based mHealth/eHealth).Primary and secondary outcome measuresFeasibility, acceptability, impact.MethodsWe searched databases MEDLINE via PubMed, Embase, Cochrane CENTRAL and Web of Science, abstracted data, explored heterogeneity, performed a random effects subgroup analysis.ResultsWe reviewed 99 studies, 63 (64%) were from America/Europe, 36 (36%) from Africa/Asia; 79% (79/99) were clinical trials; 84% (83/99) evaluated impact. Of innovations, mHealth based: 70% (69/99); internet based: 21% (21/99); combined: 9% (9/99).All digital innovations were highly accepted (26/31; 84%), and feasible (20/31; 65%). Regarding impacted measures, mHealth-based innovations (SMS) significantly improved antiretroviral therapy (ART) adherence (pooled OR=2.15(95%CI: 1.18 to 3.91)) and clinic attendance rates (pooled OR=1.76(95%CI: 1.28, 2.42)); internet-based innovations improved clinic attendance (6/6), ART adherence (4/4), self-care (1/1), while reducing risk (5/5); combined innovations increased clinic attendance, ART adherence, partner notifications and self-care. Confounding (68%) and selection bias (66%) were observed in observational studies and attrition bias in 31% of clinical trials.ConclusionDigital innovations were acceptable, feasible and generated impact. A trend towards the use of internet-based and combined (internet and mobile) innovations was noted. Large scale-up studies of high quality, with new integrated impact metrics, and cost-effectiveness are needed. Findings will appeal to all stakeholders in the HIV/STI global initiatives space.
Mental health of South Asian youth in Peel Region, Toronto, Canada: a qualitative study of determinants, coping strategies and service access
Authors: Islam Farah , Multani Amanpreet , Hynie Michaela , Shakya Yogendra , McKenzie Kwame 
Published: November 2017

ObjectivesThis qualitative study set out to understand the mental health challenges and service access barriers experienced by South Asian youth populations in the Peel Region of Toronto, Canada.SettingIn-depth semistructured interviews were carried out with South Asian youth living in Peel Region (Mississauga, Brampton and Caledon), a suburb of Toronto, Canada, home to over 50% of Ontario’s South Asian population.ParticipantsSouth Asian youth (n=10) engaged in thoughtful, candid dialogue about their mental health and service access barriers.Primary and secondary outcome measuresQualitative interview themes related to mental health stressors and mental health service access barriers experienced by youth living in Peel Region were assessed using thematic analysis.ResultsSouth Asian youth face many mental health stressors, from intergenerational and cultural conflict, academic pressure, relationship stress, financial stress and family difficulties. These stressors can contribute to mental health challenges, such as depression and anxiety and drug use, with marijuana, alcohol and cigarettes cited as the most popular substances. South Asian youth were only able to identify about a third (36%) of the mental health resources presented to them and did not feel well informed about mental health resources available in their neighbourhood.ConclusionsThey offered recommendations for improved youth support directed at parents, education system, South Asian community and mental health system. Institutions and bodies at all levels of the society have a role to play in ensuring the mental health of South Asian youth.