Publications by authors named "Jessica Wallace"

60 Publications

Tumor Extracellular Vesicles Regulate Macrophage-Driven Metastasis through CCL5.

Cancers (Basel) 2021 Jul 10;13(14). Epub 2021 Jul 10.

Ben May Department for Cancer Research, University of Chicago, Chicago, IL 60615, USA.

Purpose: To understand how tumor cells alter macrophage biology once they are recruited to triple-negative breast cancer (TNBC) tumors by CCL5.

Method: Mouse bone marrow derived macrophage (BMDMs) were isolated and treated with recombinant CCL5 protein alone, with tumor cell conditioned media, or with tumor extracellular vesicles (EVs). Media from these tumor EV-educated macrophages (TEMs) was then used to determine how these macrophages affect TNBC invasion. To understand the mechanism, we assayed the cytokine secretion from these macrophages to determine how they impact tumor cell invasion. Tumor CCL5 expression was varied in tumors to determine its role in regulating macrophage biology through EVs.

Results: Tumor EVs are a necessary component for programming naïve macrophages toward a pro-metastatic phenotype. CCL5 expression in the tumor cells regulates both EV biogenesis/secretion/cargo and macrophage EV-education toward a pro-metastatic phenotype. Analysis of the tumor EV-educated macrophages (TEMs) showed secretion of a variety of factors including CXCL1, CTLA-4, IFNG, OPN, HGF, TGFB, and CCL19 capable of remodeling the surrounding tumor stroma and immune infiltrate. Injection of tumor cells with macrophages educated by metastatic tumor cell EVs into mice increased tumor metastasis to the lung.

Conclusion: These results demonstrate that tumor-derived EVs are key mediators of macrophage education and likely play a more complex role in modulating tumor therapeutic response by regulating the tumor immune infiltrate.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.3390/cancers13143459DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8303898PMC
July 2021

Anxiety-related concussion perceptions of collegiate athletes.

J Sci Med Sport 2021 Jun 25. Epub 2021 Jun 25.

Department of Orthopaedic Surgery, University of Pittsburgh, USA; UPMC Sports Medicine Concussion Program, University of Pittsburgh, USA.

Objectives: The purpose of this study was to identify collegiate athletes' anxiety-related concussion perceptions and examine factors that may be related to increased anxiety injury beliefs.

Design: Cross-sectional study.

Methods: Male and female Division I, II and III NCAA collegiate athletes (n = 482) completed a 10- to 15-minute survey examining their demographics, diagnosed concussion history, concussion knowledge, and public media sources they have previously acquired concussion information from. The survey also included the Perceptions of Concussion Inventory for Athletes (PCI-A) which results in six outcome variables (anxiety, effects, control, clarity, treatment, and symptom variability). Univariable and a backward stepwise multivariable logistic regression model were utilized to identify variables that were associated with greater (above median) negative anxiety-related concussion perception scores.

Results: Collegiate athletes displayed moderate anxiety-related concussion perceptions (12.8 ± 3.2; scores ranged from 4 - low anxiety to 20 - high anxiety). The majority of participants reported that concussions are upsetting to them (60.7%), with a sizable proportion being worried (46.7%), fearful (40.7%), or anxious (25.0%) about sustaining a concussion. In the multivariable regression, higher perception that concussions have long-term effects (OR = 2.72; 95% CI: 1.79-4.12), greater beliefs of internal control to influence concussion outcomes (OR = 1.78; 95% CI: 1.15-2.75), and female sex (OR = 1.77; 95% CI: 1.15-2.71) were associated with higher anxiety beliefs.

Conclusions: This study for the first time establishes that negative, anxiety-related perceptions about concussions are prevalent in a collegiate athlete population. Addressing these perceptions through evidence-based, educational and management initiatives, such as highlighting that concussions are treatable and most do not result in long-term negative consequences with early diagnosis and proper management, are critical to improve emotions surrounding concussion. This may be particularly important for female athletes in this population.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.jsams.2021.06.011DOI Listing
June 2021

Evaluating Concussion Nondisclosure in College Athletes using a Health Disparities Framework and Appreciation for Social Determinants of Health.

J Athl Train 2021 Jun 15. Epub 2021 Jun 15.

The University of North Carolina at Chapel Hill, Department of Exercise and Sport Science, Assistant Professor, 313 Woollen Gym, CB#8700, Chapel Hill, NC 27599-8700.

Context: There is limited research concerning the relationship between social determinants of health, including race, healthcare access, socioeconomic status (SES), and physical environment; and, concussion nondisclosure in college-athletes. However, in high school athletes, disparities have been noted, with Black athletes attending under-resourced schools and lacking access to an athletic trainer (AT) disclosing fewer concussions.

Objective: To investigate whether concussion nondisclosure disparities exist by 1) race, 2) SES, and 3) AT healthcare access prior to college; and to understand the differential reasons for concussion nondisclosure between Black and White college-athletes.

Design: Cross-sectional Setting: College athletics Participants: 735 college-athletes (84.6% White, 15.4% Black) Main Outcome Measures: Participants completed a questionnaire that directly assessed concussion nondisclosure, including reasons for not reporting a suspected concussion. With the premise of investigating social determinants of health, race was the primary exposure of interest. The outcome of interest, nondisclosure, was assessed with a binary (yes/no) question, "Have you ever sustained a concussion that you did not report to your coach, athletic trainer, parent, teammate, or anyone else?"

Results: Overall, among White and Black athletes 15.6% and 17.7% respectively reported a history of concussion nondisclosure. No significant differences were found by race for distributions of history of concussion nondisclosure (p=0.57). Race was not associated with concussion nondisclosure when evaluated as an effect modification measure or confounder; and, no significant associations were noted by SES or high school AT access. Differences by race for reported reasons for nondisclosure were found for: "At the time I did not think it was a concussion" (p=0.045) and "I thought my teammates would think I am weak" (p=0.03) with Black athletes reporting these more frequently than White athletes.

Conclusions: These data help to contextualize race and its intersection with other social determinants of health that could influence concussion nondisclosure outcomes in college-athletes.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.4085/1062-6050-0054.21DOI Listing
June 2021

Understanding racial differences in computerized neurocognitive test performance and symptom-reporting to deliver culturally competent patient-centered care for sport-related concussion.

Appl Neuropsychol Adult 2021 May 12:1-10. Epub 2021 May 12.

Department of Psychology, Saint Joseph's University, Philadelphia, Pennsylvania, USA.

Objective: This study examined neurocognitive performance and symptoms between concussed Black and White collegiate athletes at baseline, post-injury, and change from baseline to post-injury.

Method: The Immediate Post-Concussion Assessment and Cognitive Test (ImPACT) was used to measure neurocognitive performance and four concussion symptom clusters for 235 concussed collegiate athletes. Between-groups differences were documented at baseline and post-injury, along with change in scores for sex/race, and sport/race groups, using ANOVAs. Baseline scores, and days-to-post-test were covariates in post-injury comparisons. Symptom endorsement by race was evaluated using chi-square analyses.

Results: At baseline, group comparisons by race and sex showed that Black male/female athletes scored lower on reaction time (RT; = .008), White females scored higher on verbal memory (VerbMem; = .001), Black females scored lower on visual motor processing speed (VMS; = .001), and Black football athletes scored slower/poorer on RT ( = .001) and VMS ( = .006). Post-injury, Black males scored lower on visual memory (VisMem; .005) and VMS ( = .002), and Black football athletes scored slower on VMS ( = .005), whereas White non-football athletes scored higher on VerbMem ( = .002) and reported fewer symptoms. Significant time-by-sport/race interactions were found for VerbMem ( < .001), VisMem ( < .001) and reported symptoms. With respect to post-injury symptom scores/endorsement, Black athletes scored significantly higher for physical ( = .01) and sleep ( = .01) symptoms.

Conclusion: These findings drive the conversation of how subjective measures of symptoms, and objective clinical concussion measures, may relate to the concussion recovery process and providing a culturally competent clinical management approach for diverse patients.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1080/23279095.2021.1912047DOI Listing
May 2021

Assessing Differences in Concussion Symptom Knowledge and Sources of Information Among Black and White Collegiate-Athletes.

J Head Trauma Rehabil 2021 May-Jun 01;36(3):139-148

Department of Health Science, University of Alabama, Tuscaloosa; Department of Athletic Training, Duquesne University, Pittsburgh, Pennsylvania (Dr Beidler); Department of Exercise and Sport Science, University of North Carolina at Chapel Hill (Drs Kerr and Register-Mihalik); and Department of Kinesiology, Michigan State University, East Lansing (Mss Hibbler and Anderson).

Objective: Basic concussion symptom knowledge is fundamental to concussion identification; however, racial disparities in concussion knowledge exist in high school and youth sports. It is unknown whether similar differences exist in collegiate-athletes. Identifying racial disparities in concussion knowledge and sources of concussion information is essential to inform equitable approaches to knowledge translation and educational interventions. This study examined how Black and White collegiate-athletes differed in their knowledge of concussion symptoms and use of concussion information sources.

Setting: National Collegiate Athletic Association (NCAA) institutions.

Participants: Collegiate-athletes.

Design: Cross-sectional.

Main Measures: Collegiate-athletes completed a questionnaire that assessed personal and sports demographics, concussion symptom knowledge, and use of concussion information sources. Fisher's exact tests and Wilcoxon rank-sum tests examined differences in outcome measures between Black and White collegiate-athletes. A multivariable Poisson regression model examined the association between race and concussion symptom knowledge scores while accounting for sex, sports contact level, NCAA division, concussion history, and specific concussion information sources. Incidence rate ratios (IRRs) with 95% CIs excluding 1.00 were deemed significant.

Results: A total of 768 (82.6% White, 17.4% Black) collegiate-athletes completed the questionnaire. Black athletes were more likely to have lower concussion symptom knowledge scores than White athletes (P < .001). In the multivariable Poisson regression model controlling for covariates, this finding was retained (IRR = 0.97; 95% CI, 0.94-0.997). White athletes were more likely to report school-based professional (P < .001), online medical sources (P = .02), and the NCAA (P = .008) as sources of concussion information. Black athletes were more likely to report referees (P = .03) as a source of concussion knowledge.

Conclusion: Despite NCAA concussion education requirements for athletes, Black collegiate-athletes were found to have lower concussion knowledge than White collegiate-athletes. The findings highlight the need for equitable strategies to disseminate concussion information to diverse populations by improving the physician-patient relationship and investing in culturally appropriate educational materials.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1097/HTR.0000000000000672DOI Listing
May 2021

Concussion Knowledge and Reporting Behaviors Among Collegiate Athletes.

Clin J Sport Med 2020 Mar 11. Epub 2020 Mar 11.

*Department of Kinesiology, Coastal Carolina University, Conway, South Carolina; †Department of Athletic Training, Duquesne University, Pittsburgh, Pennsylvania; ‡Department of Health Science and Athletic Training, University of Alabama, Tuscaloosa, Alabama; and §Department of Kinesiology, Michigan State University, East Lansing, Michigan.

Objective: The purpose of the current study was to explore knowledge surrounding sport-related concussions (SRCs) and the impact on reporting behaviors in collegiate athletes, including sex differences.

Design: Cross-sectional.

Setting: Institutional.

Participants: Participants were 986 collegiate athletes (607 men), aged 19.7 years (SD = 1.4) from 6 institutions, who completed a survey, including items on personal/sport demographics and SRC knowledge and reporting behaviors.

Interventions: Athletes were given a short (15-minute) survey to complete during team meetings and preparticipation physicals.

Main Outcome Measures: Athletes' scores on the survey, and reporting behaviors (ie, whether or not they failed to report a suspected SRC and reasons for not reporting SRCs), were examined.

Results: Independent samples t tests revealed female athletes scored significantly higher than male athletes on total SRC knowledge [t (926.6) = -10.6, P < 0.01] and symptom knowledge (t (859) = -7.0, P < 0.01). Approximately one-quarter of athletes reported continuing to play after sustaining a suspected SRC. Chi-square analyses exposed significant differences between male and female athletes failing to report a suspected SRC (χ = 7.69, P < 0.01).

Conclusions: Given the current findings, educational efforts aimed at collegiate athletes may not be enough. Furthermore, it is apparent that sex differences exist in SRC knowledge and reporting behaviors among collegiate athletes.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1097/JSM.0000000000000833DOI Listing
March 2020

Time-to-Event Analyses: Return to Unrestricted Participation After Sport-Related Concussion in a Cohort of High School Athletes.

J Athl Train 2021 Feb 22. Epub 2021 Feb 22.

Department of Health Science, University of Alabama, Tuscaloosa.

Context: Understanding time loss resulting from sport-related concussion (SRC) within individual sports allows high school athletic trainers to provide accurate and evidence-based clinical information. Currently, research regarding patterns of clinical recovery outcomes in high school student-athletes across sports is lacking.

Objective: To describe the time to authorized unrestricted return to participation (RTP) after SRC in a large cohort of high school student-athletes in a variety of sports using a time-to-event analysis.

Design: Descriptive epidemiology study.

Setting: Aggregate injury and player exposure data from the Michigan High School Athletic Association Head Injury Reporting System.

Patients Or Other Participants: High school student-athletes.

Main Outcome Measure(s): Dates for SRC injury events and authorized unrestricted RTP were entered into the Head Injury Reporting System for each case and were used to calculate time to unrestricted RTP. Survival analysis indicated the time to authorized RTP for males and females in weekly increments across sports and academic years. Separate Kaplan-Meier analyses adjusted for SRC cases with a history of concussion also identified the proportions of student-athletes who obtained authorized medical clearance in weekly increments.

Results: A total of 15 821 SRCs, 10 375 (65.6%) in males and 5446 (34.4%) in females, were reported during the 2015-2016 through 2018-2019 academic years. The median time to authorized unrestricted RTP was 11 days for all patients. Approximately 30% of concussed student-athletes were not cleared for unrestricted RTP by 14 days after their SRC diagnosis, with 13% taking longer than 21 days to return to unrestricted RTP after SRC.

Conclusions: The results from this multisite, state-based injury surveillance system indicated that it is not abnormal for high school student-athletes to take longer than 14 days to fully recover from an SRC. This information may be useful for educating high school student-athletes and sport stakeholders, normalizing SRC recovery trajectory perceptions, and establishing realistic RTP timeline expectations.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.4085/1062-6050-0150-20DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8010927PMC
February 2021

Factors Associated With Concussion Nondisclosure in Collegiate Student-Athletes.

J Athl Train 2021 Feb;56(2):157-163

Duquesne University, Pittsburgh, PA.

Context: Mandated concussion education has aimed to improve student-athlete knowledge; however, some collegiate student-athletes continue to not disclose concussion. Concussion knowledge may not be the only factor influencing reporting, as student-athlete sex, sport, and pressure from external stakeholders (eg, coaches, teammates, fans, parents or family) have all been documented as influencing collegiate concussion-reporting behavior.

Objective: To examine factors associated with concussion nondisclosure in collegiate student-athletes.

Design: Cross-sectional study.

Setting: Four National Collegiate Athletic Association Division I and two Division II universities.

Patients Or Other Participants: A total of 1125 collegiate student-athletes completed the survey, and 741 provided viable responses and were included for data analysis.

Main Outcome Measure(s): We used a 10- to 15-minute electronic or paper-and-pencil survey that asked about personal and sport demographics, diagnosed concussions and nondisclosed concussion history, concussion knowledge, and level of agreement regarding pressure to play after a head impact experienced during collegiate sport participation. Significant univariable factors were entered into a multivariable logistic regression analysis.

Results: Sex (P = .005), sport-risk type (P < .001), diagnosed concussion history (P < .001), concussion knowledge (P = .017), and pressure from coaches (P < .001), teammates (P < .001), fans (P = .024), and parents or family (P = .003) were factors associated with concussion nondisclosure in individual univariable logistic regressions. After we conducted multivariable analyses, male sex (P = .001), high concussion-risk sport participation (P = .048), diagnosed concussion history (P < .001), increased concussion knowledge (P = .013), and experiencing pressure from coaches to continue playing after sustaining a hit to the head (P = .002) were factors associated with concussion nondisclosure in collegiate student-athletes.

Conclusions: Our results suggest that concussion-education programs should go beyond the identification of signs and symptoms to include the dangers of continuing to play, long-term consequences, and transparency about concussion protocols. Comprehensive concussion-education programs should involve coaches and athletes to improve the reporting culture.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.4085/1062-6050-0102-20DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7901587PMC
February 2021

Racial Disparities in Diagnosis of Concussion and Minor Head Trauma and Mechanism of Injury in Pediatric Patients Visiting the Emergency Department.

J Pediatr 2021 Jun 29;233:249-254.e1. Epub 2021 Jan 29.

Departments of Pediatrics & Emergency Medicine, Harvard Medical School, Boston, MA; Division of Emergency Medicine, Boston Children's Hospital, Boston, MA.

Objective: To determine if racial/ethnic differences exist in the diagnosis and mechanism of injury among children and adolescents visiting the emergency department (ED) for concussion and minor head trauma (MHT).

Study Design: A retrospective, cross-sectional study of patient (age ≤19 years) visits to the ED for concussion between 2010-2015, using the National Hospital Ambulatory Medical Care Survey, was completed. The primary study exposure was race/ethnicity. Outcome measures included ED visits that resulted in a concussion/MHT diagnosis and mechanism of injury. Mechanism categories included sport, motor vehicle collision, fall, assault, and other mechanism. A multivariable logistic regression and multinomial logistic regression were conducted to assess relationships between race/ethnicity and outcomes. Findings were weighted to reflect population estimates.

Results: In total, 1263 child/adolescent visits for concussion/MHT were identified, representing an estimated 6.6 million child/adolescent visits nationwide. Compared with non-Hispanic White pediatric patients, non-Hispanic Black patients were least likely to have an ED visit for a concussion/MHT (P < .001; OR, 0.66; 95% CI, 0.52-0.83) The odds of non-Hispanic Black children/adolescents (OR, 3.80; 95% CI, 1.68-8.55) and children/adolescents of other race/ethnicity (OR, 4.93; 95% CI, 1.09-22.23) sustaining a concussion/MHT resulting from assault vs sport was higher.

Conclusions: Amid the emerging focus on sport-related concussion, these ethnic/racial differences in ED diagnosis of concussion/MHT demonstrate sociodemographic differences that warrant further attention. Assault may be a more common mechanism of concussion among children/adolescents of a racial minority.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.jpeds.2021.01.057DOI Listing
June 2021

Socioeconomic status and race as social determinants of health to be considered in clinical use of pre-season vestibular and oculomotor tests for concussion.

J Clin Transl Res 2020 Nov 7;6(4):168-178. Epub 2020 Oct 7.

School of Community Health Sciences, University of Nevada, 1664 N. Virginia Street m/s 0274, Reno, NV 89557, United States.

Background: Aside from racial and socioeconomic disparities in computerized neurocognitive testing and symptomology, there is a scarcity of research representing more diverse populations on other widely used tests for concussion, including vestibular and visual assessment.

Aim: The aim of the study was to investigate if racial and socioeconomic differences exist on baseline vestibular/ocular motor screening (VOMS) and King-Devick (K-D) test performance in high school student-athletes.

Methods: A total of 670 participants (66.1% White, 33.9% Black) with a mean age of 15.43±1.2 years were administered a baseline VOMS, average Near Point of Convergence (NPC) distance, and K-D test. The exposure variables included race (White or Black) and socioeconomic status (SES), defined as free and reduced lunch status (FRL or No-FRL). FRL status was determined by each participant's school SES. The outcome variables consisted of baseline VOMS item symptom provocation scores, average NPC distance, and K-D baseline time. A series of Mann-Whitney tests were performed for K-D baseline time, NPC distance, and VOMS items with FRL status or race as a between-subject factor. Two multivariable linear regressions were run to assess the association of (1) K-D baseline times using FRL, race, sex, and corrected vision as variables in the model and (2) average NPC distance using FRL, race, sex, and corrected vision as variables in the model.

Results: When adjusting for multiple comparisons, FRL athletes had slower (worse) K-D times (<0.001) than non-FRL athletes. Black athletes had significantly lower mean NPC distance compared to White athletes at baseline (=0.02) and FRL status athletes reported a significantly greater (worse) mean symptom provocation following the visual motion sensitivity item on the VOMS (=0.02); however, these findings were no longer significant following adjustments for multiple comparisons. No differences were noted for any remaining VOMS items. The first model explained 3.9% of the total variance of K-D baseline times, whereas the second model was not significant.

Conclusions: Racial and SES differences existed on average NPC distance and the K-D test at baseline. Possible explanations for group differences may be neurobiological, anatomical, and/or disparity in nature. With a higher probability of undiagnosed and uncorrected vision impairment, vestibular dysfunction, and saccadic eye tracking deficits likely to be more apparent as a consequence of poverty or health inequities, it is important that healthcare providers, especially those that diagnose and treat concussions, understand that performance on the VOMS and K-D tests at baseline may be subject to sociodemographic factors of SES and race.

Relevance For Patients: To provide the most culturally competent care, clinicians should consider sociodemographic variables of race and SES as social determinants of health worthy of attention on objective and subjective measures of baseline concussion assessment.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7821747PMC
November 2020

Predictors of Concussion Nondisclosure in Collegiate Student-Athletes.

J Athl Train 2021 Jan 15. Epub 2021 Jan 15.

Duquesne University, Pittsburgh, PA.

Context: Mandated concussion education has aimed to improve student-athlete knowledge; however, some collegiate student-athletes continue to not disclose concussion. Concussion knowledge may not be the only factor influencing reporting, as student-athlete sex, sport, and pressure from external stakeholders (eg, coaches, teammates, fans, parents or family) have all been documented as influencing collegiate concussion-reporting behavior.

Objective: To examine predictors of concussion nondisclosure in collegiate student-athletes.

Design: Cross-sectional study.

Setting: Four National Collegiate Athletic Association Division I and two Division II universities.

Patients Or Other Participants: A total of 1125 collegiate student-athletes completed the survey, and 741 provided viable responses and were included for data analysis.

Main Outcome Measure(s): We used a 10- to 15-minute electronic or paper-and-pencil survey that asked about personal and sport demographics, diagnosed concussions and nondisclosed concussion history, concussion knowledge, and level of agreement regarding pressure to play after a head impact experienced during collegiate sport participation. Significant univariable predictor variables were entered into a multivariable logistic regression analysis.

Results: Sex (P = .005), sport-risk type (P < .001), diagnosed concussion history (P < .001), concussion knowledge (P = .017), and pressure from coaches (P < .001), teammates (P < .001), fans (P = .024), and parents or family (P = .003) were predictors of concussion nondisclosure in individual univariable logistic regressions. After we conducted multivariable analyses, male sex (P = .001), high concussion-risk sport participation (P = .048), diagnosed concussion history (P < .001), increased concussion knowledge (P = .013), and experiencing pressure from coaches to continue playing after sustaining a hit to the head (P = .002) were predictors of concussion nondisclosure in collegiate student-athletes.

Conclusions: Our results suggest that concussion-education programs should go beyond the identification of signs and symptoms to include the dangers of continuing to play, long-term consequences, and transparency about concussion protocols. Comprehensive concussion-education programs should involve coaches and athletes to improve the reporting culture.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.4085/1062-6050-0102.20DOI Listing
January 2021

Development and factor structure of the perceptions of concussion inventory for athletes (PCI-A).

Brain Inj 2021 Feb 28;35(3):292-298. Epub 2020 Dec 28.

Department of Orthopaedic Surgery, University of Pittsburgh, PA, USA.

: This study evaluated the factor structure of the Perceptions of Concussion Inventory for Athletes (PCI-A) using exploratory factor analytic (EFA) techniques in a sample of collegiate student-athletes. Perception differences by sex and sport-related concussion (SRC) risk level were explored.: This cross-sectional-design study included 298 male and 183 female collegiate student-athletes from 18 sports at six institutions. Participants completed a demographic and concussion history survey, and the PCI-A.: The EFA revealed a 6-factor solution (Anxiety, Effects, Clarity, Treatment, Control, and Symptom Variability) that accounted for 56.1% of the variance in responses. Female collegiate student-athletes displayed statistically higher levels of Anxiety, Clarity, Symptom Variability, and Control than males. Lower concussion risk sport athletes reported statistically higher levels of anxiety surrounding SRC and concerns relating to the long-term and major effects of an SRC.: This study provides evidence that the PCI-A is an acceptable measure to examine the perceptions of collegiate student-athletes regarding SRC. The findings supported a six-factor structure of the PCI-A in the current study for collegiate student-athletes compared to the seven-factor structure indicated in previous research. The findings reveal sex and concussion risk sport differences in PCI-A responses.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1080/02699052.2020.1861655DOI Listing
February 2021

Racial disparities in parent knowledge of concussion and recognition of signs and symptoms.

J Safety Res 2020 12 8;75:166-172. Epub 2020 Oct 8.

Athletic Training Program, Michigan State University, 105 IM Circle, East Lansing, MI 48840, United States. Electronic address:

Introduction: Concussion is a type of traumatic brain injury that can be sustained through participation in different sports. It is important that a parent be able to identify common and uncommon symptoms of a concussion to ensure the safety and good health of their child. The purpose of this study was to compare knowledge of concussion scores among White and African American parents and guardians.

Methodology: This cross-sectional study consisted of a single survey of 53 questions that was given to parents/guardians of high school athletes at a preseason parent meeting. Parent and guardian knowledge of concussion was assessed through a series of 45 questions. Participants were asked to correctly identify signs and symptoms of concussion, answer questions regarding the anatomy of a concussion (i.e. a concussion is an injury to the brain), answer true/false questions about general concussion knowledge, select from a list the consequences of multiple concussions and select from a list the consequences of returning to play too soon from a concussion. Knowledge of concussion was calculated by summing correct responses for the 45 knowledge questions. Racial differences were calculated using an ANCOVA, controlling for socioeconomic school type. The statistical significance level was set a priori p ≤ 0.05 for all analyses.

Results: Participants of this study consisted of 176 [115 (65.3%) White, 61 (34.7%) African American] parents/guardians of high school athletes. Significant differences in knowledge of concussion scores between White parents/guardians [38.50 ± 4.55 (85.6% correct)], and African American parents/guardians [35.15 ± 4.97, 78.1% correct)] were identified (F = 4.82, p = 0.03).

Conclusion: Knowledge of concussion disparities exist between African American and White parents/guardians. This disparity could cause complications from concussion to surface among children and adolescents participating in sport as their parents/guardians may not be able to correctly identify the signs and symptoms in order to seek proper medical care. Practical Application: Findings from this study highlight quantitative differences in concussion knowledge of parents from different demographics. These findings underline disparities and inequities in access to concussion-health resources that need to be addressed.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.jsr.2020.09.007DOI Listing
December 2020

Body Mass Index and Blood Pressure Improvements With a Pediatric Weight Management Intervention at Federally Qualified Health Centers.

Acad Pediatr 2021 03 3;21(2):312-320. Epub 2020 Dec 3.

Obesity Prevention and Control Branch, Division of Nutrition, Physical Activity, and Obesity (OE Imoisili, EA Lundeen, DS Freedman, L Kompaniyets, C Dooyema, S Park, HM Blanck, and AB Goodman), National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Ga; United States Public Health Service (OE Imoisili, LS Womack, HM Blanck, and AB Goodman), Rockville, Md.

Objective: The Mind, Exercise, Nutrition, Do It! 7-13 (MEND 7-13) program was adapted in 2016 by 5 Denver Health federally qualified health centers (DH FQHC) into MEND+, integrating clinician medical visits into the curriculum and tracking health measures within an electronic health record (EHR). We examined trajectories of body mass index (BMI, kg/m) percentile, and systolic and diastolic blood pressures (SBP and DBP) among MEND+ attendees in an expanded age range of 4 to 17 years, and comparable nonattendees.

Methods: Data from April 2015 to May 2018 were extracted from DH FQHC EHR for children eligible for MEND+ referral (BMI ≥85th percentile). The sample included 347 MEND+ attendees and 21,061 nonattendees. Mixed-effects models examined average rate of change for BMI percent of the 95th percentile (%BMIp95), SBP and DBP (mm Hg), after completion of the study period.

Results: Most children were ages 7 to 13 years, half were male, and most were Hispanic. An average of 4.2 MEND+ clinical sessions were attended. Before MEND+, %BMIp95 increased by 0.247 units/month among MEND+ attendees. After attending, %BMIp95 decreased by 0.087 units/month (P < .001). Eligible nonattendees had an increase of 0.084/month in %BMIp95. Before MEND+ attendance, SBP and DBP increased by 0.041 and 0.022/month, respectively. After MEND+ attendance, SBP and DBP decreased by 0.254/month (P < .001) and 0.114/month (P < .01), respectively. SBP and DBP increased by 0.033 and 0.032/month in eligible nonattendees, respectively.

Conclusions: %BMIp95, SBP, and DBP significantly decreased among MEND+ attendees when implemented in community-based clinical practice settings at DH FQHC.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.acap.2020.11.026DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8091487PMC
March 2021

Collegiate Athletes' Concussion Awareness, Understanding, and -Reporting Behaviors in Different Countries With Varying Concussion Publicity.

J Athl Train 2020 Dec 1. Epub 2020 Dec 1.

Department of Health and Human Performance, Dublin City University, Ireland.

Context: Concussions are a global public health concern, and education on the importance of self-reporting may not reach all athletes to the same degree around the world.

Objective: To determine if differences were present in the concussion awareness, understanding, and -reporting behaviors of collegiate athletes' in 3 countries with varied degrees of concussion publicity.

Design: Cross-sectional survey.

Setting: Collegiate sports medicine clinics.

Patients Or Other Participants: Collegiate athletes in the United States (n = 964; high publicity), Ireland (n = 302; moderate publicity), and Jordan (n = 129; low publicity). The degree of concussion publicity was categorized based on the extent of national public health awareness initiatives, care guidelines, research publications, and mass media coverage.

Main Outcome Measure(s): Participants completed a 10- to 15-minute survey on concussion awareness, understanding, and -reporting behaviors. The main outcome measures were concussion education (awareness; 21 options; select all sources of concussion information), concussion knowledge (understanding; maximum score of 49), and diagnosed/nondisclosed concussion history (reporting behaviors; self-report yes/no items).

Results: A higher proportion of Jordanian athletes reported never having received concussion information previously (73.6%) than Irish (24.2%) or US athletes (9.4%). Knowledge differed among countries (P < .0001, η2 = .28), with US athletes displaying higher total knowledge scores (40.9 ± 4.5) than Jordanian (35.1 ± 5.6) and Irish (32.1 ± 3.5) athletes. A greater percentage of Irish and US athletes reported a history of a diagnosed concussion (31.8% and 29.6%, respectively) and history of concussion nondisclosure (25.2% and 15.5%, respectively) than Jordanian athletes (2.3% and 0.0% for history of a diagnosed concussion and history of concussion nondisclosure, respectively).

Conclusions: In the United States, where concussion publicity is high, formal legislation exists, and sports medicine resources, concussion awareness and understanding were increased. More culturally appropriate concussion initiatives are needed globally to ensure that athletes around the world can identify concussive injuries and understand the dangers of continued sport participation while concussed.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.4085/1062-6050-0575.19DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7863604PMC
December 2020

Time-to-Event Analyses: Return to Unrestricted Participation Following Sport-Related Concussion in a Cohort of High School Athletes.

J Athl Train 2020 Nov 5. Epub 2020 Nov 5.

Jessica Wallace, PhD, LAT, ATC, Assistant Professor, Department of Health Science, University of Alabama, Phone: 205-348-4577, Email:

Context: Understanding time-loss resulting from sport-related concussion (SRC) within individual sports allows high school athletic trainers to provide accurate and clinically evidence-based information. Currently there is a lack of research regarding patterns of clinical recovery outcomes in high school student-athletes across sports.

Objective: To describe the time to authorized unrestricted RTP following SRC in a large cohort of high school student-athletes in variety of sports using a time-to-event analysis.

Design: Descriptive Epidemiology Study.

Setting: Aggregate injury and player exposure data from the STATE-XXX High School Athletic Association (XHSAA) Head Injury Reporting System (HIRS).

Patients Or Other Participants: High school student-athletes.

Main Outcome Measure(s): Dates for SRC injury events and authorized unrestricted RTP were entered into the HIRS for each case, and were used to calculate time to unrestricted RTP. Survival analysis determined time to authorized RTP for males and females in weekly increments across sports and academic years. Separate Kaplan-Meier analyses adjusted for SRC cases with a history of concussion also identified the proportions of student-athletes that obtained authorized medical clearance in weekly increments.

Results: There was a total of 15,821 SRC cases, 10,375 (65.6%) male and 5,446 (34.4%) female, reported during the 2015-16 through 2018-19 academic years. The median time to authorized unrestricted RTP was 11 days for all cases. Approximately, 30% of concussed student-athletes were not cleared for unrestricted RTP by 14 days following their SRC diagnosis, with 13% taking longer than 21 days to unrestricted RTP after SRC.

Conclusions: The results from this multi-site, State-based injury surveillance system indicate that it is not abnormal for high school student-athletes to take longer than 14 days to fully recovery from a SRC. This information may be useful for educating high school student-athletes and sport stakeholders, normalizing SRC recovery trajectory perceptions, and establishing realistic RTP timeline expectations.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.4085/150-20DOI Listing
November 2020

Brief iPad-Based Assessment of Cognitive Functioning with ImPACT® Quick Test: Prevalence of Low Scores Using Multivariate Base Rates.

Arch Clin Neuropsychol 2020 Nov;35(8):1276-1282

Harvard Medical School; Spaulding Rehabilitation Hospital and Spaulding Research Institute; MassGeneral Hospital for Children Sports Concussion Program; & Home Base, A Red Sox Foundation and Massachusetts General Hospital Program, Charlestown, MA, USA.

Objective: The ImPACT® Quick Test is a brief iPad-based battery of neurocognitive tests that has been standardized on a sample of children, adolescents, and adults (ages 12-70). This study provides information on the prevalence of ImPACT® Quick Test scores falling below specific percentiles in the normative sample to aid in clinical interpretation and reduce the risk of over-interpreting, or misinterpreting, a single low score.

Method: Participants were 683 individuals ranging in age from 12 to 70, who were assessed individually. The ImPACT® Quick Test includes five subtests, contributing to three factor scores: motor speed, memory, and attention tracker. The prevalence of low factor scores, stratified by age and sex, were calculated using multivariate base rates.

Results: In the total sample, obtaining 1 or more scores below the 25th percentile was common (base rate, BR = 47.2%), but obtaining 2 or more scores in this range was uncommon (BR = 15.3%). Similarly, obtaining 1 or more scores below the 16th percentile was common (BR = 31.4%), but obtaining two or more scores in this range was uncommon (BR = 6.9%). There were small differences in BRs between sexes and the number of low scores was fairly similar across the age groups.

Conclusion: Results from this study parallel previous work illustrating that a substantial percentage of healthy individuals will obtain one or more low test scores when administered a brief battery of cognitive tests. Given that some healthy individuals will obtain a single score below expected cut-offs, clinicians should caution against overinterpreting a single low test score.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1093/arclin/acaa078DOI Listing
November 2020

The Underreporting of Concussion: Differences Between Black and White High School Athletes Likely Stemming from Inequities.

J Racial Ethn Health Disparities 2021 Aug 14;8(4):1079-1088. Epub 2020 Sep 14.

Department of Kinesiology, Athletic Training, Michigan State University, East Lansing, MI, 48840, USA.

Previous studies have found that Black high school athletes have poorer knowledge about concussions and have fewer sports medicine healthcare resources than White athletes, but research on concussion disclosure by race is still needed. Therefore, the purpose of this study was to examine racial differences in concussion reporting behaviors between Black and White high school athletes. This cross-sectional study administered surveys to 577 high school athletes (64.5% Black; 72.3% males; 16.02 ± 1.2 years) from 14 schools (title I, n = 9; non-title I, n = 5). The survey included self-reported items on concussions and bell-ringers experienced during games and practices and the number of these episodes that were reported to an authoritative figure. Reasons for reporting and not reporting were also assessed. Results found that White athletes were more likely to recall experiencing a bell-ringer in games compared with Black athletes. They were also more likely to report a bell-ringer or concussion that occurred in a game. There was a significantly higher proportion of Black athletes compared with White athletes that did not report their bell-ringer experienced in games and concussions experienced in practices. White athletes were more likely than Black athletes to disclose a concussion because they thought they had a concussion, while there were no racial differences in the reasons for not reporting. The findings of this study highlight the critical role that race, as a social determinant of health, may play in concussion reporting in high school athletes. Future public health efforts should seek to further understand and overcome inequities in healthcare resources for concussion education and management.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s40615-020-00864-xDOI Listing
August 2021

Examination of Racial Disparities in Adolescents Seen in the Emergency Department for Head, Neck, or Brain Injury.

J Emerg Med 2020 Dec 4;59(6):783-794. Epub 2020 Sep 4.

Department of Trauma, Mercy Health, St. Elizabeth Youngstown Hospital, Youngstown, Ohio.

Background: Given the frequency, severity, and attention of traumatic brain injury in children, benchmarking disparities and injury characteristics for adolescent patients is pivotal in understanding and enhancing both clinical care and outcomes.

Objectives: The purpose of this study was to investigate racial disparities on mechanism of injury, clinical outcomes, and social-health factors among adolescents treated in the emergency department (ED) for a head, neck, or brain injury.

Methods: This study is the result of a retrospective chart review of head-, neck-, and brain-injured adolescent patients (n = 2857) treated at three community hospital EDs and one stand-alone ED. Outcome measures included patient demographics (gender, race/ethnicity, age), Glasgow Coma Scale score, hospital length of stay, intensive care unit length of stay, mechanism of injury, primary diagnosis, secondary diagnosis of a concussion, ventilation days, discharge disposition, and primary insurance.

Results: There were racial differences in primary diagnosis, mechanism of injury, and insurance status. Results indicated that a higher proportion of white patients were diagnosed with a concussion compared with black patients (p < 0.001). Moreover, a higher proportion of white patients were seen in the ED for head, neck, or brain injury as a result of a sports or motor vehicle incident, whereas a leading mechanism among black patients was assault (p = 0.01). More white patients had private insurance, whereas more black patients had Medicaid (p < 0.001).

Conclusion: The disparities in mechanisms for which black and white adolescent patients are seeking care at the ED for head, neck, or brain injury help to identify social-health risks of sustaining a head, neck, or brain injury. These racial disparities between black and white adolescents seen at the ED for head, neck, or brain injury suggest the need for further research to better understand the national representation of these disparities.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.jemermed.2020.07.002DOI Listing
December 2020

Engaging stakeholders in the adaptation of the pediatric weight management program for national implementation.

Implement Sci Commun 2020 17;1:55. Epub 2020 Jun 17.

Division of General Academic Pediatrics, MassGeneral Hospital for Children, 125 Nashua Street, Suite 860, Boston, MA 02114 USA.

Background: is an evidence-based weight management program with clinical- and family-facing components for delivery in pediatric primary care for families of children ages 2 to 12 years. We used the Consolidated Framework for Implementation Research (CFIR) to guide formative work prior to national implementation. The purpose of this study was to describe the process and results of stakeholder engagement and program adaptation.

Methods: We used mixed qualitative and quantitative methods to iteratively adapt and optimize the program by assessing needs and perspectives of clinicians and parents, as well as contextual barriers, facilitators, and organizational readiness for the uptake of the proposed program tools and implementation strategies. We conducted interviews with primary care clinicians from four health care organizations in Boston, MA; Denver, CO; and Greenville, SC, and used principles of immersion-crystallization for qualitative analyses. We also conducted surveys of parents of children with a body mass index ≥ 85th percentile.

Results: We reached thematic saturation after 52 clinician interviews. Emergent themes representing the CFIR domains of intervention characteristics, outer and inner setting, and process included (1) importance of evidence-based clinical decision support tools that integrate into the workflow and do not extend visit time, (2) developing resources that respond to family's needs, (3) using multimodal delivery options for family resources, (4) addressing childhood obesity while balancing competing demands, (5) emphasizing patient care rather than documentation and establishing sustainability plans, and (6) offering multiple training methods that incorporate performance feedback. Of the parents surveyed ( = 400), approximately 50% were Spanish-speaking and over 75% reported an annual income < $50,000. Parents affirmed the importance of addressing weight management during well-child visits, being provided with referrals and resources, and offering multiple methods for resource delivery. Decisions about program modifications were made at the program and healthcare-system level and based on stakeholder engagement findings. Modifications included cultural, geographic, and target audience adaptations, as well as varied resource delivery options.

Conclusions: To ensure the fit between the program and national implementation settings, adaptations were systematically made through engagement of clinician and parent stakeholders to support adoption, sustainability, and health outcomes.

Trial Registration: NCT04042493.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1186/s43058-020-00047-zDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7427919PMC
June 2020

Premorbid anxiety and depression and baseline neurocognitive, ocular-motor and vestibular performance: A retrospective cohort study.

J Neurol Sci 2020 Nov 26;418:117110. Epub 2020 Aug 26.

Kinesiology & Sport Science Department, Youngstown State University, 1 University Plaza, 307 Beeghly Center, Youngstown, OH 44555, United States of America.

Concussion has become a growing concern among sport and healthcare practitioners. Experts continue to investigate ways to advance the quality of concussion evaluation, diagnosis and management. Psychological conditions have been reported to influence concussion assessment outcomes at baseline and post-concussion; however, little evidence has examined psychological conditions and their effect on multifaceted measures of concussion. A retrospective cohort design was employed to examine differences between those with and without a premorbid psychological condition for high school and collegiate athletes who completed a preseason baseline battery, consisting of symptom reporting, computerized neurocognitive assessment, Vestibular-Ocular Motor Screening (VOMS), and the King-Devick (KD) test. Forty athletes within the sample self-reported a diagnosed psychological risk factor, consisting of depression and/or anxiety, and each were matched with a discordant control. Controls were matched on sex, age, sport, concussion history and ocular history. Athletes with psychological conditions reported higher symptom severity and had worse visual motor speed than controls. There were no differences between groups on other neurocognitive domains, VOMS, or KD. These results suggest that vestibular-ocular tools may be more consistent or less likely to vary between those with and without a premorbid psychological diagnosis, adding value to tools such as the KD and VOMS.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.jns.2020.117110DOI Listing
November 2020

Diversifying sport-related concussion measures with baseline balance and ocular-motor scores in professional Zambian football athletes.

Phys Sportsmed 2020 Sep 14:1-8. Epub 2020 Sep 14.

Football Association of Zambia, Lusaka, Zambia.

Purpose: Normative values of common sport-related concussion assessment tools may assist clinical diagnosis and management. However, current baseline normative values are not representative of athletic participants across international domains. This study develops healthy baseline norms on the Balance Error Scoring System (BESS), and King-Devick (K-D), providing baseline reference values for professional Zambian football athletes.

Methods: Of the 125 male participants (aged 24.48 ± 5.41 years) screened for this study, 9 (7.2%) reported a previous history of concussion, 98 (78.4%) completed the Balance Error Scoring System and 88 (70.4%) completed the King-Devick. Descriptive statistics calculated for the BESS and the K-D test included mean, standard deviation, median, interquartile range (IQR), and percentiles ranks.

Main Findings: Participants scored a mean ± standard deviation of 10.15 ± 5.6 and a median [IQR] of 9 [6-12.25] errors on the total BESS and completed the K-D test in a mean ± standard deviation 56.85 ± 10.55 seconds and a median [IQR] 55.28 [48.7-64.8] seconds.

Conclusions: Cross-cultural awareness and management of sport-related concussion are continuously improving the safety and well-being of athletic participants around the world. The diverse representation in these data may aid in interpretation of post-injury performance during sport-related concussion management in Zambia. This study develops baseline reference values currently lacking within African cultures and demonstrates the feasibility and global clinical utility of two sport-related concussion assessment resources.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1080/00913847.2020.1819149DOI Listing
September 2020

Disparities on Baseline Performance Using Neurocognitive and Oculomotor Clinical Measures of Concussion.

Am J Sports Med 2020 09 17;48(11):2774-2782. Epub 2020 Aug 17.

Department of Kinesiology, Michigan State University, East Lansing, Michigan, USA.

Background: Given the high participation of Black/African American individuals in high school sports, especially high-risk sports for concussion, it is important to note if racial and socioeconomic status (SES) differences exist in baseline performance on clinical measures of concussion.

Purpose: To explore the association between race and SES on baseline concussion assessments of neurocognitive performance and oculomotor function in adolescent athletes.

Study Design: Cohort study (Diagnosis); Level of evidence, 3.

Methods: A total of 564 high school athletes (mean ± SD age, 15.33 ± 1.1 years) completed the baseline Immediate Post-Concussion Assessment and Cognitive Test and King-Devick (KD) battery before the start of their competitive season. Race was defined as either White/non-Hispanic or Black/African American. SES status was determined by whether the individual's participating high school was a Title I or non-Title I school. A series of multivariable linear regression analyses were conducted to evaluate the association of computerized neurocognitive test scores (verbal memory, visual memory, motor processing speed, and reaction time), symptom severity scores, and KD scores by race and SES.

Results: White/non-Hispanic individuals performed significantly better than Black/African American individuals on verbal memory ( < .01), visual memory ( < .01), visual motor processing speed ( < .01), and reaction time ( < .01) and had a lower symptom score ( < .01). Regarding SES, individuals from non-Title I schools performed better on visual memory ( = .05) and reaction time ( = .02) than individuals from Title I schools. Examination of cumulative KD test reading time revealed that there was no association between race on baseline reading times ( = .12). There was a significant association between cumulative reading time and SES ( = .02). Individuals from non-Title I schools performed significantly faster than individuals from Title I schools on KD test time.

Conclusion: Overall, race and SES influence neurocognitive and oculomotor concussion baseline performance in high school athletes. These findings add to the growing literature on the influence of race and SES on neurocognitive and oculomotor function baseline concussion assessments; they highlight the necessity for individualized concussion baseline measurements or race-specific normative reference values.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1177/0363546520946753DOI Listing
September 2020

Cross-cultural exploration of baseline ImPACT Quick Test performance among football athletes in Zambia.

Phys Sportsmed 2021 May 13;49(2):165-170. Epub 2020 Jul 13.

Department of Kinesiology, Michigan State University, East Lansing, MI, USA.

Objective: Concussion is a global sport injury; however, this public health issue has yet to be studied across Africa. It is unknown if tests such as the Immediate Post-Concussion Assessment and Cognitive Test (ImPACT) Quick Test (QT) are culturally appropriate for implementation as part of a concussion screening protocol in Zambia or other African nations. Study objectives included: 1) establish that Zambian athletes are able to complete the iPad-based ImPACT QT with respect to language or cultural barriers that may exist, and 2) document baseline neurocognitive percentile ranks among Zambian football athletes on the ImPACT QT.

Methods: This study was completed with adult premiere league football athletes in Zambia (n = 125) aged 24.48 ± 5.41. Participants completed the ImPACT QT neurocognitive assessment prior to a preseason practice. Outcome measures were average performance on 3 factor scores: Motor Speed, Memory, and Attention Tracker, presented as percentile ranks using normative data built-into the ImPACT QT.

Results: Zambian athletes scored nearly two standard deviations below the mean on Motor Speed (7 percentile), using North American normative data. However, performance on Attention Tracker (44 percentile) and Memory (56 percentile) was within the average range.

Conclusion: Results of the current study show that Zambian athletes are able to complete the ImPACT QT, despite any language or cultural differences that may exist. In addition, preliminary percentile ranks suggest Zambian football athletes have average scores on Attention and Memory and below average scores on Motor Speed. These data are the first to explore Zambian athletes' performance on a cognitive concussion measure.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1080/00913847.2020.1790983DOI Listing
May 2021

Rapid Capture and Extraction of Sweat for Regional Rate and Cytokine Composition Analysis Using a Wearable Soft Microfluidic System.

J Invest Dermatol 2021 Feb 17;141(2):433-437.e3. Epub 2020 Jun 17.

Epicore Biosystems, Cambridge, Massachusetts, USA; Querrey Simpson Institute for Bioelectronics, Northwestern University, Evanston, Illinois, USA; Center for Bio-Integrated Electronics, Northwestern University, Evanston, Illinois, USA; Department of Biomedical Engineering, Northwestern University, Evanston, Illinois, USA; Institute for Innovations in Development Science, Northwestern University, Evanston, Illinois, USA. Electronic address:

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.jid.2020.05.107DOI Listing
February 2021

Obesity during pregnancy results in maternal intestinal inflammation, placental hypoxia, and alters fetal glucose metabolism at mid-gestation.

Sci Rep 2019 11 26;9(1):17621. Epub 2019 Nov 26.

Department of Biochemistry and Biomedical Sciences, McMaster University, Hamilton, Canada.

We investigated whether diet-induced changes in the maternal intestinal microbiota were associated with changes in bacterial metabolites and their receptors, intestinal inflammation, and placental inflammation at mid-gestation (E14.5) in female mice fed a control (17% kcal fat, n = 7) or a high-fat diet (HFD 60% kcal fat, n = 9; ad libitum) before and during pregnancy. Maternal diet-induced obesity (mDIO) resulted in a reduction in maternal fecal short-chain fatty acid producing Lachnospiraceae, lower cecal butyrate, intestinal antimicrobial peptide levels, and intestinal SCFA receptor Ffar3, Ffar2 and Hcar2 transcript levels. mDIO increased maternal intestinal pro-inflammatory NFκB activity, colonic CD3 T cell number, and placental inflammation. Maternal obesity was associated with placental hypoxia, increased angiogenesis, and increased transcript levels of glucose and amino acid transporters. Maternal and fetal markers of gluconeogenic capacity were decreased in pregnancies complicated by obesity. We show that mDIO impairs bacterial metabolite signaling pathways in the mother at mid-gestation, which was associated with significant structural changes in placental blood vessels, likely as a result of placental hypoxia. It is likely that maternal intestinal changes contribute to adverse maternal and placental adaptations that, via alterations in fetal hepatic glucose handling, may impart increased risk of metabolic dysfunction in offspring.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1038/s41598-019-54098-xDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6879619PMC
November 2019

Effects of attention deficit hyperactivity disorder and learning disability on vestibular and ocular baseline concussion assessment in pediatric athletes.

Appl Neuropsychol Child 2019 Oct 25:1-7. Epub 2019 Oct 25.

Sport Injury Research Laboratory, Department of Kinesiology, Michigan State University , East Lansing , MI , USA.

Vestibular and ocular motor assessment has gained popularity as a tool for sport-related concussion among healthcare professionals. With awareness of premorbid risk factors, such as attentional problems, it is imperative to understand their effects at baseline. The purpose of this study was to examine the effects of attention deficit/hyperactivity disorder (ADHD) and diagnosed learning disability (LD) on vestibular and oculomotor baseline concussion assessment in pediatrics. Pediatric athletes between the ages of 8 and 14 years with ADHD/LD ( = 30) and match controls without ADHD/LD ( = 30) completed baseline concussion testing, consisting of symptom provocation on the Vestibular/Ocular Motor Screening (VOMS) and oculomotor performance on near point of convergence (NPC) and King-Devick (K-D) tools. Those diagnosed with ADHD/LD performed worse on baseline saccades ( range = .02-.10), convergence ( = .04), vestibular ocular reflex (VOR) ( = .03) and visual motion sensitivity (VMS) ( = .04) of the VOMS. Base rate analyses revealed that 26% of athletes in the ADHD/LD group had ≥1 and 13.3% had ≥2 VOMS domains over clinical cutoff levels, compared to 3.3% (≥1 domain) and 0 (≥2 domains) of controls. Individuals with ADHD/LD also performed worse on K-D assessment ( = .005). However, no differences were reported on NPC distance ( = .19). These findings suggest worse baseline concussion assessment scores on vestibular/ocular motor assessment domains in pediatric athletes diagnosed with ADHD/LD. Additional research is needed on assessment outcomes to determine if special consideration to those diagnosed with ADHD/LD is warranted.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1080/21622965.2019.1683453DOI Listing
October 2019

Examining the Impact of Antimicrobial Fluoroquinolones on Human DNA Topoisomerase IIα and IIβ.

ACS Omega 2019 Feb 22;4(2):4049-4055. Epub 2019 Feb 22.

Department of Pharmaceutical Sciences and Department of Pharmacy Practice, Lipscomb University College of Pharmacy and Health Sciences, One University Park Drive, Nashville, Tennessee 37204-3951, United States.

Fluoroquinolones are a class of widely prescribed antibiotics with a broad range of activity against Gram-positive, Gram-negative, and some atypical microbes. Unfortunately, these drugs are associated with significant adverse events including neuropathy, tendinopathy, cardiac rhythm abnormalities, and mental health side effects. The mechanism by which fluoroquinolones cause many of these toxicities is unknown. The antibacterial mechanism of action involves disruption of the catalytic mechanism of type-II topoisomerases in bacteria, namely topoisomerase IV and DNA gyrase. Fluoroquinolones inhibit the ability of the enzymes to ligate cleaved DNA and result in single- and double-stranded DNA breaks. Thus, there is an interest in investigating whether human topoisomerase II is involved in mediating the adverse events associated with quinolones. Previous studies demonstrate some response of human topoisomerase IIα and IIβ to high levels of ciprofloxacin. However, it is not clear whether the concentration of ciprofloxacin utilized in those studies corresponds to concentrations that would be routinely achievable in patients. Therefore, this study set out to examine three clinically relevant fluoroquinolones along with two older agents to determine whether these compounds display activity against topoisomerase IIα and IIβ at drug concentrations that more closely approximate typical patient plasma values. On the basis of our evidence, none of the quinolones studied were able to poison DNA cleavage by either human enzyme. Ciprofloxacin, desethylene-ciprofloxacin, and the recently removed from market gemifloxacin were able to inhibit topoisomerase II-mediated DNA relaxation at concentrations of 200-300 μM. On the basis of these data, we propose that human topoisomerase II is not likely to be the main cause of these adverse events and that additional targets need to be identified to clarify the mechanisms underlying quinolone toxicities.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1021/acsomega.8b03428DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6648947PMC
February 2019

Does It Matter if This Baby Is 22 or 23 Weeks?

Pediatrics 2019 09 8;144(3). Epub 2019 Aug 8.

Department of Pediatrics, Children's Mercy Hospital, Kansas City, Missouri

A 530-g girl born at 22 weeks and 6 days' gestation (determined by an ultrasound at 11 weeks) was admitted to the NICU. Her mother had received prenatal steroids. At 12 hours of age, she was stable on low ventilator settings. Her blood pressure was fine. Her urine output was good. After counseling, her parents voiced understanding of the risks and wanted all available life-supporting measures. Many nurses were distressed that doctors were trying to save a "22-weeker." In the past, 4 infants born at 22 weeks' gestation had been admitted to that NICU, and all had died. The attending physician on call had to deal with many sick infants and the nurses' moral distress.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1542/peds.2019-0113DOI Listing
September 2019

Effect of concomitant vancomycin and piperacillin-tazobactam on frequency of acute kidney injury in pediatric patients.

Am J Health Syst Pharm 2019 Aug;76(16):1204-1210

Celgene Corporation, Summit, NJ.

Purpose: Results of a study of rates of acute kidney injury (AKI) in pediatric patients treated with vancomycin plus piperacillin-tazobactam or vancomycin plus alternative antipseudomonal β-lactams (APBLs) are reported.

Methods: A retrospective, single-center cohort study was performed. Pediatric patients were included in the study cohort if they received combination therapy for at least 48 hours, had documented baseline and follow-up serum creatinine levels, and had a documented serum vancomycin trough concentration. The primary outcome was the frequency of AKI, defined as a 50% or greater increase in serum creatinine concentration from baseline or an increase of at least 0.5 mg/dL from baseline. The secondary outcome was time to AKI onset.

Results: A total of 474 patients were included. Among 100 patients who received vancomycin plus piperacillin-tazobactam, the rate of AKI was higher than the rate in the group treated with vancomycin plus alternative APBLs (27% versus 7%, p < 0.0001). The median time to AKI onset was shorter in the piperacillin-tazobactam group versus the alternative APBL group (3.8 versus 7.9 days, p = 0.0065). Patients who were administered piperacillin-tazobactam were almost 6 times as likely to develop AKI (odds ratio [OR], 5.955; 95% confidence interval [CI], 2.774-12.784), and patients who had a maximum vancomycin trough concentration greater than 20 mg/L were 7.5 times as likely to develop AKI (OR, 7.552; 95% CI, 3.625-15.734).

Conclusion: Pediatric patients treated with concomitant vancomycin and piperacillin-tazobactam had a higher rate of AKI, with faster AKI onset, than those who received vancomycin in combination with other APBLs.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1093/ajhp/zxz125DOI Listing
August 2019
-->