Is there a gender difference in concussion incidence and outcomes?

OBJECTIVE: To determine if there is a gender difference in the incidence and outcomes of sport concussion. DESIGN: Critical literature review of sport concussion by gender. INTERVENTION: PubMed and major sports medicine journals were reviewed using the keywords concussion and gender. Articles included in this paper were English prospective surveillance that included concussion as an injury option conducted over the past 10 years, involved data collected by qualified medical personnel (athletic trainers/therapists or medical doctors) and used injury rates as opposed to raw counts. Only data from sports (soccer, basketball and ice hockey) where actions, equipment and most rules were similar between genders were reviewed. RESULTS: For the PubMed search, using "concussion" and "gender" as keywords, there were 51 articles. Ten studies (four in football (soccer), four in basketball and two in ice hockey, including high school, college and professional athletes) were included in the incidence portion of the paper. Nine of the studies showed higher absolute injury rates for female concussion compared to their male counterparts with four of them reaching statistical significance. Five of the studies (two football (soccer), two basketball and one ice hockey) examined concussion mechanism and in all cases, males had a higher absolute percent of player contact concussions while females had a higher absolute percentage of surface or ball contact concussion episodes. Two brain injury and four sport concussion outcome papers were reviewed. Traumatic brain injury outcome was shown to be worse in females than in males for a majority of measured variables; females also are shown to have different baseline and post-concussion outcomes on neuropsychological testing. CONCLUSIONS: After evaluating multiple years of concussion data in comparable sports, the evidence indicates that female athletes may be at greater risk for concussion than their male counterparts. There also is some evidence that gender differences exist in outcomes of traumatic brain injury and concussions. Because concussion is a clinical diagnosis often depending on self reporting and with no established biological marker or consistent symptoms/definitions, and because there is evidence that females are more honest in reporting general injuries than males, it is unclear whether the concussion incidence data, while generally consistent in showing a higher risk in females as compared to males in similar sports, is a true difference or is influenced by a reporting bias.

Noncontact anterior cruciate ligament injuries: risk factors and prevention strategies.

An estimated 80,000 anterior cruciate ligament (ACL) tears occur annually in the United States. The highest incidence is in individuals 15 to 25 years old who participate in pivoting sports. With an estimated cost for these injuries of almost a billion dollars per year, the ability to identify risk factors and develop prevention strategies has widespread health and fiscal importance. Seventy percent of ACL injuries occur in noncontact situations. The risk factors for non-contact ACL injuries fall into four distinct categories: environmental, anatomic, hormonal, and biomechanical. Early data on existing neuromuscular training programs suggest that enhancing body control may decrease ACL injuries in women. Further investigation is needed prior to instituting prevention programs related to the other risk factors.

Injuries in collegiate wrestling.

We evaluated the data of the National Collegiate Athletic Association Injury Surveillance System on collegiate wrestling with a focus on musculoskeletal injuries. Over 800,000 athlete-exposures during an 11-year period compose these data. Findings particular to wrestling and a comparison with other collegiate sports are included. Collegiate wrestling had a relatively high rate of injury at 9.6 injuries per 1000 athlete-exposures. It was second to spring football in total injury rate. Most injuries in this study were not serious, with 6.3% resulting in surgery and 37.6% resulting in a week or more off from wrestling. There was only one catastrophic, nonfatal injury. The knee, shoulder, and ankle were the most commonly injured regions, and injuries to them were often the more serious. Sprains, strains, and contusions were the most common injury types. Takedowns and sparring were the most common activities at the time of injury. Mechanism of injury was evaluated; rotation about a planted foot and contact with environmental objects were identified as areas needing further attention. Illegal action accounted for only 4.6% of injuries in competition. Competition had a significantly higher injury rate than practice, but the injury profiles of these two areas showed both to be equally important. The preseason and regular season had higher injury rates than the postseason, but, again, the injury profiles of these periods were similar. Injury percentages were similar among the 10 weight classes.

Predictive and concurrent validity of the Suicidal Ideation Questionnaire among American Indian adolescents.

Suicide is currently the second leading cause of death for ages 15-24 years; reports indicate that 6-8% of American teens have attempted suicide. Rates of suicide and suicide attempts are at least as high, if not higher, for American Indian adolescents and young adults. The Suicidal Ideation Questionnaire (Junior High School Version) (SIQ-JR) could be used to identify young people who may be at risk for attempting suicide, since this questionnaire focuses on suicidal ideation, a major risk factor for suicide attempt. However, little is known about the predictive validity of the SIQ-JR, particularly in American Indian adolescent populations. A suicide attempt cluster at an American Indian boarding school provided the unique opportunity to examine the performance of the SIQ-JR in a group of American Indian high school students who had taken the SIQ-JR approximately 2 months prior to the outbreak of attempts. The SIQ-JR proved to be an excellent predictor of future suicide attempts when compared to other measures of distress: anxiety, depression, and alcohol use. The SIQ-JR is an effective screener for suicide risk in this American Indian adolescent population.

Inquest on QUEST.

Describes how a group of nurse managers developed a tool for measuring the quality of care in mental hospital wards and how this was adapted for use within general elderly services. Examines the impact of the tool on service provision within a group of small local community hospitals and evaluates it using a matrix composed of Donabedian's structure/process/outcome model of quality and Maxwell's six dimensions of quality.

Influence of rapid weight gain after the weigh-in on success in collegiate wrestlers.

UNLABELLED: We investigated whether acute weight gain between the weigh-in and competition was associated with success in a collegiate wrestling tournament. Wrestlers at the NCAA championships were weighed at the official weigh-in and again just before the first round of the tournament (20 h later). Weight gain and the weight discrepancy between first-round opponents were calculated (N = 607 excluding heavyweights). Indices of success included season record (% wins in total matches), tournament seeding, the sum of the advancement and placement points scored during the tournament (team points), and final placement in the tournament. ANOVA showed no differences in weight variation between placewinners and non-placewinners, or across placewinners only. Correlation coefficients among weight variables and indices of success were also low (P > 0.05). Multiple logistic regression, used to determine whether weight gain or weight discrepancy between opponents contributed to success in the first round of the tournament, revealed that neither variables was predictive of first-round outcome even after attempting to account for differences in ability (e.g., forcing team points into the regression first). CONCLUSION: neither acute weight gain after the weight-in or the weight discrepancy between opponents in the first round influenced success in a collegiate wrestling tournament.

Acute weight gain in collegiate wrestlers following a tournament weigh-in.

UNLABELLED: The purpose of this study was to determine the magnitude of weight gained in collegiate wrestlers between the weigh-in and beginning of tournament competition. Body weight of the qualifiers for the NCAA Division I, II, and III wrestling finals (N = 668) was recorded at the official weigh-in and again approximately 20 h later, before the first round of competition in the tournament. The results showed that on average (+/- SD), wrestlers gained 4.9 +/- 2.4% (3.3 +/- 1.5 kg) of body weight before competing. An inverse relationship was found such that wrestlers in the lightest weight classes gained the most weight (kg) compared with heavier wrestlers (r = -0.45, P < 0.05). Despite the large mean weight gain, the mean discrepancy between first round opponents was 2.1 +/- 3.0 kg and even less when heavyweight wrestlers were excluded from the analyses (1.5 +/- 1.2 kg, N = 607). A significant correlation between weight gain and weight discrepancy of opponents was found (r = 0.65, P < 0.05). CONCLUSION: collegiate wrestlers, excluding heavyweights, gained significant amounts of weight (3.7 kg average) during the 20-h period prior to tournament competition. The magnitude of weight gain was positively correlated to the degree of weight discrepancy (size advantage) over the opponent; however, because weight gain of some magnitude after the weigh-in was common in most participants, the average discrepancy between opponents was only about 1.5 kg.

Survey of NCAA institutions concerning HIV/AIDS policies and universal precautions.

Attention has recently been focused on issues concerning HIV disease and competitive athletics. These issues have included HIV testing of athletes, participation by HIV-infected athletes, and the practice of "Universal Precautions" by members of the athletic health care team. A survey of all NCAA member institutions was conducted to further investigate these areas. Routine testing for the HIV virus is rare in NCAA member athletic departments. Policies of NCAA member institutions athletic departments concerning participation with HIV virus are few but nearly half restrict participation. Only 12 schools reported having HIV-positive athletes or AIDS-diagnosed athletes at their institutions. There is a need for increased awareness, knowledge, and practice of "Universal Precautions" in all athletic training rooms.

Alcohol use among male and female Native American adolescents: patterns and correlates of student drinking in a boarding school.

This study examined the patterns and correlates of alcohol use in a Native American boarding school. Specifically, stressful life events, social support and emotional distress were associated with quantity as well as frequency of alcohol use in this population. A sample of 188 students (52% female) in grades 9-12 attending a boarding school in the midwest were administered self-report measures of these above constructs as part of a larger battery. Family support, and to some degree stressful life events and emotional distress, correlated significantly with alcohol use. The implications of these findings for Native American adolescents in general, and in a boarding school population specifically, are discussed. The need for longitudinal research to explore further the temporal sequence of depression, stressful life events and social support in relation to alcohol use is addressed.

The epidemiology of intravenous vancomycin usage in a university hospital. A 10-year study.

OBJECTIVES: To examine the trends of intravenous vancomycin usage during a 10-year period, to classify the indications for which physicians prescribed the antibiotic, and to identify the independent predictors for empirical use of vancomycin. DESIGN: A descriptive epidemiological study, a cross-sectional study, and a case-control study were performed. SETTING: A 900-bed university-teaching hospital. MAIN OUTCOME MEASURES: The annual crude usage (grams) and incidence density (grams/1000 patient-days) of vancomycin were measured for 10 years (July 1981 to July 1991). In 109 randomly selected patient medical records, we evaluated the proportion of usage of vancomycin classified as prophylaxis, empirical therapy, or specifically directed therapy. Univariate and multivariate analyses were performed to identify determinants of empirical administration of vancomycin vs a penicillase-resistant penicillin to 64 case patients and 64 control patients. RESULTS: The rate of vancomycin usage increased 20-fold from 5.72 g/1000 patient-days in 1981 to 121.25 g/1000 patient-days in 1991. The use of vancomycin was significantly higher (P < .0001) in hematology-oncology areas compared with that in other hospital areas. The rates for each indication for vancomycin were 35.0% for prophylaxis 31.8% for empirical therapy, and 33.2% for therapy specifically directed by culture results. In a multivariate analysis, the presence of "plastic" medical devices was the best independent predictor for patients receiving vancomycin: intravenous lines (odds ratio [OR], 6.23; 95% confidence interval [CI], 2.28 to 17.06; P < .001), Hickman catheters (OR, 76.12; 95% CI, 15.06 to 384.73; P < .001), and other medical devices (OR, 10.50; 95% CI, 2.54 to 43.38; P = .001). CONCLUSIONS: Vancomycin use has increased linearly in the last decade primarily related to the presence of indwelling vascular devices in hematology-oncology patients. Use of vancomycin is equally divided among empirical therapy, prophylaxis, and specific therapy for a documented infection.

Forum.

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Properties of the Inventory to Diagnose Depression in American Indian adolescents.

The Inventory to Diagnose Depression (IDD) was administered to 177 American Indian adolescents attending a tribally administered boarding school. The psychometric properties in this population were studied and compared to those obtained when the Center for Epidemiologic Studies-Depression Scale (CES-D) was administered to a similar population. Analyses were performed on the scale items individually as well as on the continuous summary score and the dichotomous diagnosis. The internal consistency was very good (0.94 to 0.96). There were relatively few gender effects at the item level and none with respect to the diagnosis. IDD prevalence estimates of depression were much closer to the expected rates suggested by epidemiological studies than those generated by other self-report measures like the CES-D. These findings recommend the IDD for additional investigation in terms of its use with adolescent populations.

Risk factors for suicide among Indian adolescents at a boarding school.

Suicide rates among American Indians, especially adolescents, are higher than those for the general population. This paper summarizes the relevant literature on prevalence of, and risk factors for, suicide among American Indian groups, with a strong emphasis on adolescents. Data concerning risk of suicide for a sample of high school students attending an Indian boarding school are presented. Approximately 23 percent of these students had attempted suicide at some time in the past, and 33 percent reported suicidal ideation within the past month. Students at greatest risk for suicide include those who reported having either family or friends who had attempted suicide and those who reported on standardized psychological measures as having experienced greater depressive symptomatology, greater quantity and frequency of alcohol use, or little family support. In a 1988 survey of community-based programs for Indian adolescents, 194 were identified as carrying out significant suicide prevention activities. Forty-one of those programs were school-based; they emphasized early identification of students' mental health problems and reduction of specific risk factors such as substance abuse.

An explanation of the upward drift in oxygen uptake during prolonged sub-maximal downhill running.

The upward drift in oxygen uptake (UDO) that occurs during some prolonged sub-maximal exercises involving eccentric muscle action has received only scant attention in the literature. Those papers reporting UDO have generally used bicycling on an ergometer modified for eccentric exercise as the experimental activity. The purpose of this study was to quantify and propose an explanation for UDO during a different activity involving eccentric muscle action--downhill running. Oxygen consumption, quadriceps muscle electromyography, and stride length were collected from 10 experienced male runners (mean maximal oxygen consumption = 65.0 +/- 5.2 ml X kg X min-1) during two 40-min sub-maximal runs at 3.83 m X s-1. The first run was on a level grade and required 66% of the subjects' mean maximal oxygen consumption. The second run, completed 2 d later, was performed on a 10% downhill grade and elicited 44% of the mean maximal oxygen consumption. Results of the level run showed non-significant changes in oxygen consumption, rectified integrated electromyography, and stride length between minutes 10 and 40. Significant (P less than 0.05) increases in oxygen consumption (10%) and integrated electromyography (23%) were found across the same time period of the downhill run. No significant changes in downhill stride length were observed. Delayed-onset muscle soreness, a presumed indication of muscle damage, occurred only following the downhill run. It is hypothesized that UDO and increasing integrated electromyography during downhill running reflected increased motor unit recruitment within the eccentrically acting muscles caused by an ongoing combination of muscle damage, connective tissue damage, and local muscle fatigue.

Development of a multifunctional drug file for hospital pharmacy computer applications.

The development of a multifunctional master drug file (MDF) which satisfies initial pharmacy data base requirements and has the capability to support increasingly sophisticated computer applications is described. The computerized purchasing, inventory, drug use review and formulary systems in a 1,100-bed teaching hospital were evaluated to determine which existing data fields should be included in the MDF, Functional requirements for the MDF and 27 data fields, each with its own particular specifications for programming, were identified. A method of data input was designed to create and maintain the file using keypunched Hollerith cards. Data input forms were designed to serve as coding documents for drug file data. Verification of all data in the file can be performed by running a program which lists the contents of each drug recorded. Based on 1975 salary rates, the total cost of the MDF development was $4,010; total time required was 640 hours. Approximately one hour per week is needed to keep the file contents up to date. File design specifications and contents are discussed, with special emphasis on the functional aspects of the MDF. The MDF successfully fulfilled the initaial pharmacy computer system requirements and has the potential to accommodate increasingly sophisticated applications.