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The objective of this study was to assess the beliefs of parents of youth soccer players about Chronic Traumatic Encephalopathy (CTE), concussion, and retirement from sport decisions and compare them to those of concussion-specialized clinicians. An electronic survey was completed by parents of youth club soccer players (n=247/1600, 15.4% response rate) and concussion-specialized clinicians (n=18/47, 38.3% response rate) located in a large U.S. urban center. Parents believed more strongly in the causal relationship between concussions and CTE, and between CTE and harm than did clinicians. Parents who themselves had participated in sport at a high level had more conservative beliefs than other parents about the number of concussions after which an athlete should retire from contact or collision sport. Results are discussed in the context of ethical risk communication between clinicians and parents. This includes the importance of communicating information about CTE to parents and youth athletes in an understandable way so that they can make informed choices about contact and collision sport participation. Further research is encouraged to evaluate approaches of communicating evidence about CTE to a diverse population of families of youth athletes.
Injured survivors of individual and mass trauma are at risk for developing post-traumatic stress disorder (PTSD). Few investigations have assessed PTSD after injury in large samples across diverse acute care hospital settings.
A total of 2931 injured trauma survivors aged 18–84 who were representative of 9983 in-patients were recruited from 69 hospitals across the USA. In-patient medical records were abstracted, and hospitalized patients were interviewed at 3 and 12 months after injury. Symptoms consistent with a DSM-IV diagnosis of PTSD were assessed with the PTSD Checklist (PCL) 12 months after injury.
Approximately 23% of injury survivors had symptoms consistent with a diagnosis of PTSD 12 months after their hospitalization. Greater levels of early post-injury emotional distress and physical pain were associated with an increased risk of symptoms consistent with a PTSD diagnosis. Pre-injury, intensive care unit (ICU) admission [relative risk (RR) 1·17, 95% confidence interval (CI) 1·02–1·34], pre-injury depression (RR 1·33, 95% CI 1·15–1·54), benzodiazepine prescription (RR 1·46, 95% CI 1·17–1·84) and intentional injury (RR 1·32, 95% CI 1·04–1·67) were independently associated with an increased risk of symptoms consistent with a PTSD diagnosis. White injury survivors without insurance demonstrated approximately twice the rate of symptoms consistent with a diagnosis of PTSD when compared to white individuals with private insurance. By contrast, for Hispanic injury survivors PTSD rates were approximately equal between uninsured and privately insured individuals.
Nationwide in the USA, more than 20% of injured trauma survivors have symptoms consistent with a diagnosis of PTSD 12 months after acute care in-patient hospitalization. Coordinated investigative and policy efforts could target mandates for high-quality PTSD screening and intervention in acute care medical settings.
This paper reports the process outcomes of a randomized trial of a one-session Motivational Interviewing (MI) intervention conducted with youth (12–20 years) in a hospital emergency department (ED) while undergoing medical care for an injury. The interventions targeted six behaviors placing youths at high risk for injury. Those youth whose counselors perceived their readiness to increase between the start and end of the MI session were 4.5 times more likely to have improved their use of seat belts 6 months later compared with youth who were not perceived to have increased in readiness during the session.
In the twentieth-century, evidence-based injury prevention and control strategies have contributed to a substantial decline in the number of deaths associated with injury. However, researchers in the field of injury prevention have often gathered their study methods from other disciplines; it can be difficult for injury investigators to locate all of the research tools that can be applied to problems related to injury. Injury Control: A Guide to Research and Program Evaluation addresses the growing need for a comprehensive source of knowledge on all research designs available for injury control and research. Included in this accessible guidebook is information about choices in study design, details about study execution and discussion of specific tools such as injury severity scales, programme evaluations and systematic reviews. Epidemiologists, health service investigators, trauma surgeons and emergency medicine physicians will find this a useful source for understanding, reviewing and conducting research related to injuries.
During the twentieth century, deaths from infectious diseases have declined dramatically around the world, particularly in industrialized countries. Injury prevention strategies have long existed; however, only relatively recently have these interventions been based on firm scientific evidence and rigorous evaluation. It is the evidence-based approach to advances in injury control that holds the most promise in further reducing the impact of injury on our society. One of the most important milestones in the development of injury research was the publication of Accident Research: Methods and Approaches by Haddon et al. in 1964. Research into violence-related injury has been predominantly conducted by criminologists, psychologists, and sociologists. Injury research must incorporate the scientific advances as it searches for etiologic mechanisms of injury, tests new interventions, especially those based on new technology and laboratory discoveries, and examines the impact of interventions on patient outcomes.
To document the existence and nature of variation in times to trauma care between urban and rural locations; to assess the impact of identified variations on outcome.
Retrospective case review
Washington state, 1986
Previously unreported definitions of urban and rural location and possibly preventable death were used to conduct a comparative analysis of urban and rural fatalities. Trauma care times in the prehospital and the emergency department (ED) phases of care were abstracted. Their relationships to corresponding crude death rates and possibly preventable death rates also were examined.
Prehospital times averaged two times longer in rural locations than in urban areas. First-physician contact in the ED averaged six times longer in rural locations than in urban settings. Concomitantly, the crude death rate in rural settings was three times that of the urban areas. The overall possibly preventable death rate was double the urban rates in rural incidents. When stratified by phase of care, rate of possibly preventable death showed no urban/rural variation for the prehospital phase, but was three times greater for the ED phase in rural areas than in urban ones.
Trauma care times and adverse outcome appear to be associated. Allocation of resources to decrease length of and geographic variation in time to definitive care, particularly in the ED phase, seems appropriate.
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