This study examined differences in post-injury psychological symptoms between collegiate athletes who sustained concussions and orthopaedic injuries.
Method
A cohort of athletes was recruited at the beginning of each sports season from 2007 to 2011. Study participants were collegiate athletes from 9 sports teams at two Big Ten Conference universities. Upon injury, injured athletes were followed prospectively at multiple intervals to measure psychological symptoms (e.g., 1 week, and 1, 3, 6, and 12 months) until the injured athlete's return to play. Differences in post-injury psychological symptoms, including symptoms of depression and anxiety, pain, fear of re-injury, and fear of return-to-play were compared between athletes with concussions and orthopaedic injuries, both at one week after injury and at return-to-play.
Results
Of a total of 597 injuries sustained, 71 (11.9%) were concussions and 526 (88.1%) were orthopaedic injuries. One-fourth of concussions (n = 18, 25.4%) were sustained by females. Football had the largest number of concussions (n = 42) and orthopaedic injuries (n = 196). No differences in post-injury symptoms of depression and anxiety were found between athletes with concussions and orthopaedic injuries. While 88.7% of concussed athletes returned to play one week following injury, only 59.1% of athletes with orthopaedic injuries did so. Furthermore, concussed athletes were less likely to report pain (p < 0.0001), fear of re-injury (p < 0.0001), and fear of return-to-play (p < 0.0001) at one week following injury, than athletes with orthopaedic injuries. These differences remained significant at return-to-play as well as after adjusting for covariates.
Conclusions
While post-injury psychological symptoms are often not evident for concussed athletes, these symptoms need to be addressed to ensure successful injury recovery.
Significance and contributions
Our findings provide empirical evidence on differences in psychological symptoms between athletes with concussions and orthopaedic injuries, and have practical implications for psychological recovery from injuries.
Long-term impacts of the COVID-19 pandemic on racial and ethnic disparities in motor vehicle crash (MVC) injuries and death are poorly understood. This study aimed to characterize trends and investigate the heterogeneity of MVC-related disparities in North Carolina across several data sources. Crash reports, emergency department visit records, and death certificates from 2018 to 2021 were used to calculate monthly population-rates of MVC-related public health outcomes. We estimated trendlines using joinpoint regression and compared outcomes across racial and ethnic classifications. MVC and MVC-related injury rates declined in conjunction with NC's stay-at-home order, while rates of severe outcomes remained unimpacted. By December 2021 rates of MVC-related outcomes met or exceeded pre-pandemic levels, with the highest rates observed among non-Hispanic Black individuals. Racial and ethnic disparities in MVC-related outcomes remained prevalent throughout the COVID-19 pandemic. These results highlight the importance of a holistic approach to traffic injury surveillance when assessing the impact of MVCs.
Objective: To investigate the relationships between indices of lifetime history of traumatic brain injury (TBI) exposure and measures of behavioral health status among Ohioans. Participants: A random sample ( n = 6996) of Ohioans contacted to complete the 2014 Ohio Behavioral Risk Factors Surveillance System (BRFSS). Design: A cross-sectional survey. Main measures: The Ohio State University TBI Identification Method adapted for BRFSS module and BRFSS behavioral indicators. Results: After demographic adjustment, lifetime history of TBI was found to be associated with increased odds of binge drinking, heavy drinking, smoking, a depressive disorder, or mental health not being good (≥2 days and ≥14 days in last 30 days). Mixed findings across behavioral indicators were observed in regard to number and severity of injury. Age at first injury showed no remarkable associations with the behavioral health indicators. Conclusions: Ohioans who have sustained at least one TBI with loss of consciousness in their lifetime are at increased risk for poor behavioral health, including alcohol misuse, smoking, and depression. The findings underscore the need for community-based mental health treatment programs to screen for TBI history in their intake evaluations, and to train clinicians on the provisions of accommodations for cognitive and behavioral deficits.
Pediatric overuse injuries present with a gradual mechanism of onset and an underlying pathogenesis of microtrauma. We evaluated the clinical presentation of pediatric sports injuries to determine if differences exist between age and sex. A retrospective chart review was performed over a 6-year period; 6593 overuse injuries were included with the mean age of 13.4 years. Males presented with a greater proportion of apophysis, physis, and articular cartilage injuries ( P < .01). Females presented with greater bone, tendon, and “other” injuries ( P < .01). Children <9 years of age demonstrated apophysis and physis injuries. Conversely, children older than 15 years of age presented with tendon, bone, bursa, and other ( P < .01) overuse injuries. A significant number of pediatric athletes in this cohort reported playing through pain prior to clinical evaluation. Injury prevention programs need to educate children, and a red flag should be raised when pediatric athletes are participating with pain.
We examined the effect of a noncontact, subsymptom exacerbation early exercise recommendation on recovery from sports-related concussion. Retrospective analysis of adolescents, 10-17 years old, with symptomatic concussion, within 30 days of injury was performed. Time to recovery was measured between the early exercise group and a comparison group. A total of 187 patients studied—112 in the exercise group and 75 in the comparison group; 55% were male (n = 103). The exercise group had a significantly longer duration of concussion symptoms (18.5 days vs 14, P = .002), although both groups recovered within the expected time to recovery for concussion. When analyzed separately, males experienced longer time to recovery from injury (19 days vs 14, P = .003), than females, respectively (18 days vs 14.5, P = .18). Recommendation of early exercise resulted in significantly longer recovery from concussion in male adolescents but had no significant effect in female adolescents; both groups recovered within the expected time frame.
Screening children for social determinants of health (SDOHs) has gained attention in recent years, but there is a deficit in understanding the present state of the science.To systematically review SDOH screening tools used with children, examine their psychometric properties, and evaluate how they detect early indicators of risk and inform care.Comprehensive electronic search of PubMed, Cumulative Index to Nursing and Allied Health Literature, Embase, Cochrane Central Register of Controlled Trials, and Web of Science Core Collection.Studies in which a tool that screened children for multiple SDOHs (defined according to Healthy People 2020) was developed, tested, and/or employed.Extraction domains included study characteristics, screening tool characteristics, SDOHs screened, and follow-up procedures.The search returned 6274 studies. We retained 17 studies encompassing 11 screeners. Study samples were diverse with respect to biological sex and race and/or ethnicity. Screening was primarily conducted in clinical settings with a parent or caregiver being the primary informant for all screeners. Psychometric properties were assessed for only 3 screeners. The most common SDOH domains screened included the family context and economic stability. Authors of the majority of studies described referrals and/or interventions that followed screening to address identified SDOHs.Following the Healthy People 2020 SDOH definition may have excluded articles that other definitions would have captured.The extent to which SDOH screening accurately assessed a child's SDOHs was largely unevaluated. Authors of future research should also evaluate if referrals and interventions after the screening effectively address SDOHs and improve child well-being.
Toll-based congestion pricing (CP) policies are increasingly implemented globally for alleviating road traffic congestion. Several interconnected factors affecting or induced by CP implementation include air quality/emissions, travel time, and road user safety. We sought to examine and characterize research output and patterns across several domains (e.g., health, policy acceptability) surrounding toll-based CP policies, in order to identify where research has focused and where gaps exist. We conducted a structured review and identified 2333 relevant publications, using semi-supervised and machine learning strategies combined with manual review. Annual publication counts peaked in 2015 (n = 122). Themes identified from title and abstract terms included policy implementation characteristics, advanced transportation modeling methods and approaches, and public perception and acceptability. Authorship networks indicated a lack of interdisciplinary research. Country analyses identified the US, China, and the UK as the most frequently represented countries, and underrepresentation from low-income countries. Findings indicate that research focused on specific road user types (e.g., pedestrians) and safety impacts, and equity considerations were relatively sparse compared to other topics (e.g., policy economics, public perception). Additional research on these critical topics is necessary to ensure that such policies are designed to promote positive and equitable effects on road user health and safety.
