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Hannah TC, Li AY, Spiera Z, Kuohn L, Dai J, McAuley F, Ali M, Durbin JR, Dreher N, Marayati NF, Gometz A, Lovell M, Choudhri T. Sex-Related Differences in the Incidence, Severity, and Recovery of Concussion in Adolescent Student-Athletes Between 2009 and 2019. Am J Sports Med 2021; 49:1929-1937. [PMID: 33955795 DOI: 10.1177/03635465211008596] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND The sex of an athlete is thought to modulate concussion incidence; however, the effects of sex on concussion severity and recovery are less clear. PURPOSE To evaluate sex differences in concussion severity and recovery using a large, heterogeneous sample of young student-athletes with the goal of understanding how sex affects concussion outcomes in young athletes. STUDY DESIGN Cohort study; Level of evidence, 3. METHODS The Immediate Post-Concussion Assessment and Cognitive Testing results of 11,563 baseline and 5216 postinjury tests were used to calculate the incidence of concussion of adolescent male and female student-athletes ages 12 to 22 years (median, 15 years). The postinjury tests of 3465 male and 1751 female student-athletes evaluated for concussion or head trauma were used to assess differences in the Severity Index (SI) and recovery. Chi-square tests and t tests were used to compare differences in demographic characteristics, incidence, and SI between the 2 cohorts. Multivariable linear, logistic, and Cox proportional hazards regressions were used to control for differences between cohorts in analyses of incidence, SI, and recovery. RESULTS When we controlled for demographic differences, female participants had higher odds of concussion (odds ratio, 1.62; 95% CI, 1.40-1.86; P < .0001) and higher SI after concussion (β = 0.67; 95% CI, 0.02-1.32; P = .04). This discrepancy in SI was a result of differences in Symptom (2.40 vs 2.94; P < .0001) and Processing Speed (0.91 vs 1.06; P = .01) composite scores between male and female participants, respectively. We found no effect of sex on time to recovery when controlling for initial concussion SI (hazard ratio, 0.94; 95% CI, 0.78-1.12; P = .48). CONCLUSION Using large, multisport cohorts, this study provides evidence that female athletes are at higher risk for more concussions and these concussions are more severe, but male and female athletes have similar recovery times when the analysis controls for initial concussion SI.
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Affiliation(s)
- Theodore C Hannah
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA.,Investigation performed at Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Adam Y Li
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA.,Investigation performed at Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Zachary Spiera
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA.,Investigation performed at Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Lindsey Kuohn
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA.,Investigation performed at Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Jennifer Dai
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA.,Investigation performed at Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Fiona McAuley
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA.,Investigation performed at Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Muhammad Ali
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA.,Investigation performed at Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - John R Durbin
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA.,Investigation performed at Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Nickolas Dreher
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA.,Investigation performed at Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Naoum Fares Marayati
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA.,Investigation performed at Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Alex Gometz
- Physical Medicine and Rehabilitation, Concussion Management of New York, New York, New York, USA.,Investigation performed at Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Mark Lovell
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.,Investigation performed at Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Tanvir Choudhri
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA.,Investigation performed at Icahn School of Medicine at Mount Sinai, New York, New York, USA
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Patterson J, Toft K, McAuley F, King E, McLachlan K, Roe JWG, Wells M. Feasibility and outcomes of fibreoptic endoscopic evaluation of swallowing following prophylactic swallowing rehabilitation in head and neck cancer. Clin Otolaryngol 2019; 44:549-556. [PMID: 30892816 DOI: 10.1111/coa.13331] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2018] [Revised: 12/12/2018] [Accepted: 01/26/2019] [Indexed: 01/31/2023]
Abstract
OBJECTIVES Investigate the feasibility and outcomes of fibreoptic endoscopic evaluation of swallowing (FEES) following a programme of prophylactic swallowing exercises in head and neck cancer (HNC) patients treated with radiotherapy. DESIGN Prospective, single cohort, feasibility study. SETTING Three head and neck cancer centres in Scotland. PARTICIPANTS Pre-radiotherapy HNC patients who consented to participate in a prophylactic swallowing intervention. OUTCOME MEASURES Fibreoptic endoscopic evaluation of swallowing recruitment and retention rates, assessment acceptability and compliance, qualitative process evaluation. RESULTS Higher rates of recruitment and retention were achieved in centres where FEES equipment was available on-site. Travel and anticipated discomfort were barriers to recruitment. Data completion was high for all rating scales, with good reliability. Following radiotherapy, swallowing safety significantly deteriorated for liquid boluses (P = 0.005-0.03); pharyngeal residue increased for liquid and semi-solid boluses. Pharyngo-laryngeal oedema was present pre-treatment and significantly increased post-radiotherapy (P = 0.001). Patients generally reported positive experience of FEES for their own learning and establishing a baseline. CONCLUSIONS Fibreoptic endoscopic evaluation of swallowing is an acceptable method of assessing patients for a prophylactic swallowing intervention and offers some additional information missing from VF. Barriers have been identified and should be taken into account in order to maximise recruitment for future trials.
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Affiliation(s)
- Joanne Patterson
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK.,Speech and Language Therapy Department, Sunderland Royal Hospital, Sunderland, UK
| | - Kate Toft
- Speech and Language Therapy Department, NHS Lothian Western General Hospital, Edinburgh, UK
| | - Fiona McAuley
- Speech and Language Therapy Department, Ninewells Hospital, Dundee, UK
| | - Emma King
- Nursing, Midwifery, Allied Health Professional Research Unit, University of Stirling, Stirling, UK
| | - Kirsty McLachlan
- Speech and Language Therapy Department, NHS Lothian Western General Hospital, Edinburgh, UK
| | - Justin W G Roe
- Department of Otolaryngology, Head and Neck Surgery, Imperial College Healthcare NHS Trust, London, UK.,Division of Surgery, Department of Surgery and Cancer, Imperial College, London, UK.,Department of Speech and Language Therapy, Royal Marsden NHS Foundation Trust, London, UK
| | - Mary Wells
- Department of Nursing, Imperial College Healthcare NHS Trust, London, UK
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Abstract
This study aimed to compare the time to first failure of stainless steel orthodontic first permanent molar bands cemented with either a modified composite (Band-Lok, Reliance Orthodontic Products) or a conventional glass ionomer cement (AquaCem, De Trey Dentsply). The effect of patient sex, patient age at the start of treatment, the presenting malocclusion, treatment mechanics, and the operator proficiency on band survival was also assessed. Data for 219 bands cemented with Band-Lok in 108 patients and for 395 bands cemented with AquaCem in 183 patients were analyzed. For each case, a single molar band, either the band that was first to fail or the band that had the shortest follow-up time, was chosen for analysis. For each cement, whether headgear was used or not, there was no significant difference in time to first band failure (P = .398). Twenty-six percent of patients had at least one band failure with Band-Lok, and 30% of patients had at least one band failure with AquaCem, representing an 18% band failure rate for each cement. There was no significant difference in time to first band failure for either cement with respect to sex of the patient (P = .842), patient age at the start of treatment (P = .257), presenting malocclusion (P = .319), or operator proficiency (P = .062). The use of headgear, however, reduced significantly the time to first band failure irrespective of cement type (P = .0069). Headgear use was identified as a predictor of first permanent molar band survival. Clinical performance of bands cemented with either cement appears to be similar and was influenced significantly by the use of headgear.
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Affiliation(s)
- D T Millett
- Orthodontic Unit, Glasgow Dental Hospital and School, North Glasgow University Hospitals NHS Trust, UK.
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Millett DT, McCluskey LA, McAuley F, Creanor SL, Newell J, Love J. A comparative clinical trial of a compomer and a resin adhesive for orthodontic bonding. Angle Orthod 2000; 70:233-40. [PMID: 10926433 DOI: 10.1043/0003-3219(2000)070<0233:acctoa>2.0.co;2] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
The study aimed to compare the survival time and cariostatic potential of a compomer to that of a resin adhesive when used to bond stainless steel orthodontic brackets to labial segment teeth only. The effect of the patients' sex, age at the start of treatment and presenting malocclusion on bracket survival time was assessed also. Forty-five consecutive patients who attended for fixed appliance therapy were randomly selected. Four hundred twenty-six brackets were bonded (213 with compomer and 213 with resin adhesive) with a split mouth design; the right or left side allocation of compomer in either arch was alternated. Color transparencies of the maxillary incisors, mandibular incisors, or both, and transparencies of the canines, were taken before treatment. At the debond stage, the transparencies were projected (20x) and assessed by an experienced examiner, who used a caries index. The survival time distributions for brackets bonded with each bonding agent were not significantly different (P = .74, paired Prentice-Wilcoxon test; P = .75, Akritas test), with bracket failure rates of 17% and 20% recorded for compomer and resin adhesive, respectively. Neither the patients' sex (P = .85) nor malocclusion (P = .26) appear to affect significantly bracket survival, but patient age was identified as a useful prognostic indicator of bracket survival (P < .001). On average, there was more decalcification related to brackets bonded with resin adhesive than with compomer (P = .0075). Survival time distributions of brackets bonded with compomer or resin adhesive appear comparable, but decalcification was reduced significantly by bonding with compomer.
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Affiliation(s)
- D T Millett
- Orthodontic Unit, Glasgow Dental Hospital & School, UK.
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Abstract
A series of doses (0.5 to 2.0 mg/kg) of d-amphetamine was administered to rats whose lever pressing was maintained by fixed-interval 30-s, 60-s, or 120-s schedules of reinforcement by sucrose delivery. Under both saline and d-amphetamine conditions, molecular features of responding were reliably described in terms of the distribution of postreinforcement pauses and local response rate following the onset of responding. Postreinforcement pause always varied from interval to interval but, on average, shortened under the drug. Local response rate (response rate exclusive of pause time) tended to decrease under the drug, and where acceleration occurred within runs of responses, it was reduced by the drug. All of these effects were dose-related. These findings suggest that fixed-interval behavior can be analyzed effectively at a molecular level, and that the effects of d-amphetamine are best described as disruption of temporal discrimination.
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